Adherence Required On Dolutegravir

Abstract Background Historical data from a study of non-boosted protease inhibitor-based antiretroviral therapy (ART) regimens have suggested that an average adherence threshold of 95% is the minimum necessary for viral suppression. However, dolutegravir-containing regimens, which are recommended as preferred first-line ART regimens worldwide, may be more forgiving due to their potency and high barrier to drug resistance. Methods We analyzed data from 483 ART-experienced adults in Uganda who were routinely switched from non-nucleoside reverse transcriptase inhibitor-based regimens to tenofovir-lamivudine-dolutegravir (TLD). We compared the proportion virally suppressed (\u3c 50 copies/mL) at 24- and 48-weeks post-enrollment across levels of self-reported adherence using the three-item Wilson adherence scale, with χ2 tests to determine significant differences. We also fit generalized estimating equations (GEE) with viral suppression as the outcome of interest and self-reported adherence as the predictor of interest. Results Median age was 47 (IQR 40-53), and 41% were female. Overall suppression rates were high (\u3e72%). However, we found that those reporting the lowest levels of adherence in ability and percentage had lower rates of virologic suppression than those in moderate or high adherence categories (Figure 1). When using low versus moderate to high adherence ability or percentage as a predictive measure of viral non-suppression, sensitivity and specificity were \u3c18% and \u3e93%, respectively. In regression models, lower self-reported adherence remained significantly associated with viral non-suppression after adjustment for age, sex, duration of ART, and previous ART regimen. Conclusions Individuals reporting high adherence to TLD have extremely high rates of viral suppression. However, individuals reporting poor adherence to TLD, specifically ability and percent, have significantly higher levels of viral non-suppression, which had a low sensitivity of \u3c18% due to high rates of viral suppression overall, and a specificity of \u3e93% for identifying virologic failure. Self-reported adherence questionnaires should be explored as a possible means of identifying individuals for targeted virologic monitoring and/or adherence support

Learning from failure in conservation: Individual, team, and organizational dynamics

Conservation aims to ensure the persistence of biodiversity despite myriad and mounting threats at the intersection of biological processes and socio-economic activity, and many efforts have struggled to achieve success. Failure is inevitable in the complex contexts in which conservation initiatives take place and yet is largely underexamined. Reasons for this shortcoming are multidimensional, encompassing behavioral and cognitive limitations at the individual, group, and organizational levels. Conservation is recognized as primarily about people and the choices they make, but there is a gap in what we know about how conservation professionals themselves as people operating within teams and organizations learn from and manage failure. My research investigates the current state of failure management in conservation, building upon existing literature in organizational learning and drawing insights from other disciplines to identify ways for conservation to more effectively learn from failure. To do this, I first conduct a literature review to investigate factors contributing to a lack of learning from failure and success in conservation. I find that failure reports are rare and largely unstandardized, and human factors such as stakeholder relationships were the most commonly cited cause of project failure. I then carry out a strategic review of organizational learning literature to provide an inter-disciplinary synthesis of thinking and practice of failure management. Armed with these broad insights, I delve into individual intentions to engage in learning from failure behaviors, finding that social norms, psychological safety, organizational support, and leader behavior play important roles in facilitating learning from failure. To place these individual motivations into a broader context, I then investigate barriers and enabling conditions for learning from failure through a multimethod qualitative study. Finally, I synthesize my findings and provide an operational model and actionable steps going forward. Providing the first empirical examination of failure in conservation, this thesis highlights both shortfalls in failure management in conservation and, more importantly, opportunities to create a learning transformation going forward.Open Acces

Voting and volunteering in Scotland : who participates?

On 5th September, the Conservative party elected a new prime minister of the United Kingdom. Scotland has not voted for a conservative government since 1955, and Liz Truss marks the twelfth prime minister in the last hundred years elected without majority support in Scotland. The last time Scotland's vote mirrored the majority was in 2005 – the last time that a general election resulted in a Labour majority. The Brexit vote in 2016 is another good example of how far Scotland's opinion differs from that of the UK majority – less than 40% of Scottish voters approved the referendum to leave the EU, compared to more than 50% from Wales and England. Scotland's status as a minority among the UK electorate isn't so surprising from a population standpoint – Scotland only accounts for about 9% of the total UK electorate. England, by contrast, claims 84% of all voters2. The vast difference between Scotland's opinion and UK electoral outcomes may result in worsened well-being for the Scottish population. People derive a sense of satisfaction from having the ability to participate in and impact politics and governmental structures. This satisfaction, termed "democratic well-being," is weakened by perceived or structural inequalities3. Participatory inequality stems from any situation in which a particular group is unlikely to or discouraged from some form of civic participation, which includes behaviours like voting, interacting with political campaigns, activism, or volunteering

Language Outcomes of the Play and Language for Autistic Youngsters (PLAY) Project Home Consultation model—An Extended Analysis

The current study is a post-hoc analysis of data from the original randomized control trial of the Play and Language for Autistic Youngsters (PLAY) Home Consultation program, a parent-mediated, DIR/Floortime based early intervention program for children with ASD (Solomon, Van Egeren, Mahone, Huber, & Zimmerman, 2014). We examined 22 children from the original RCT who received the PLAY program. Children were split into two groups (high and lower functioning) based on the ADOS module administered prior to intervention. Fifteen-minute parent-child video sessions were coded through the use of CHILDES transcription software. Child and maternal language, communicative behaviors, and communicative functions were assessed in the natural language samples both pre- and post-intervention. Results demonstrated significant improvements in both child and maternal behaviors following intervention. There was a significant increase in child verbal and non-verbal initiations and verbal responses in whole group analysis. Total number of utterances, word production, and grammatical complexity all significantly improved when viewed across the whole group of participants; however, lexical growth did not reach significance. Changes in child communicative function were especially noteworthy, and demonstrated a significant increase in social interaction and a significant decrease in non-interactive behaviors. Further, mothers demonstrated an increase in responsiveness to the child’s conversational bids, increased ability to follow the child’s lead, and a decrease in directiveness. When separated for analyses within groups, trends emerged for child and maternal variables, suggesting greater gains in use of communicative function in both high and low groups over changes in linguistic structure. Additional analysis also revealed a significant inverse relationship between maternal responsiveness and child non-interactive behaviors; as mothers became more responsive, children’s non-engagement was decreased. Such changes further suggest that changes in learned skills following PLAY parent training may result in improvements in child social interaction and language abilities

Data Insight : Characteristics of Exporting Firms in Northern Ireland

This project uses novel datasets and input-output (IO) modelling to investigate the differences between exporting and non-exporting firms in Northern Ireland, and to understand the scale of employment supported by exporting in Northern Ireland. In particular, we sought to answer two questions: - What is the scale of employment supported by exporting in Northern Ireland, and what is the nature of this employment, particularly with regards to gender? - What is the nature of exporting versus non-exporting firms in Northern Ireland, at a detailed sectoral level

Health Inequalities in Scotland : Trends in the Socio-economic Determinants of Health in Scotland

Socioeconomic factors play a critical role in influencing health and health inequalities. These socioeconomic factors include the pay, security and nature of the jobs that people do. They include households’ financial security, which influences the extent to which people are exposed to stress and anxiety, the time and resources people have to adopt healthy behaviours, and their ability to secure a decent standard of living generally. They also include the physical environment in which people live, both in terms of housing – poor quality or overcrowded housing can affect health in various ways – and neighbourhoods more generally (which influence opportunities for work, play and exercise, and exposure to pollution). The aim of this report is to examine trends in key socioeconomic determinants of health in Scotland since 1999, the year of the establishment of the Scottish parliament. The report is based on six thematic chapters which examine trends in: the labour market; household income and financial security; education and social mobility; housing; public services; and neighbourhoods. A seventh chapter examines trends in socioeconomic determinants of health during the Covid-19 pandemic and the emerging cost-of-living crisis

Testing Multi-Theory Model (MTM) in Predicting Initiation and Sustenance of Physical Activity Behavior Among College Students

Background: Most college students do not adequately participate in enough physical activity (PA) to attain health benefits. A theory-based approach is critical in developing effective interventions to promote PA. The purpose of this study was to examine the utility of the newly proposed multi-theory model (MTM) of health behavior change in predicting initiation and sustenance of PA among college students. Methods: Using a cross-sectional design, a valid and reliable survey was administered in October 2015 electronically to students enrolled at a large Southern US University. The internal consistency Cronbach alphas of the subscales were acceptable (0.65-0.92). Only those who did not engage in more than 150 minutes of moderate to vigorous intensity aerobic PA during the past week were included in this study. Results: Of the 495 respondents, 190 met the inclusion criteria of which 141 completed the survey. The majority of participants were females (72.3%) and Caucasians (70.9%). Findings of the confirmatory factor analysis (CFA) confirmed construct validity of sub-scales (initiation model: χ2 = 253.92 [df = 143], P \u3c 0.001, CFI = 0.91, RMSEA = 0.07, SRMR = 0.07; sustenance model: χ2= 19.40 [df = 22], P \u3c 0.001, CFI = 1.00, RMSEA = 0.00, SRMR = 0.03). Multivariate regression analysis showed that 26% of the variance in the PA initiation was explained by advantages outweighing disadvantages, behavioral confidence, work status, and changes in physical environment. Additionally, 29.7% of the variance in PA sustenance was explained by emotional transformation, practice for change, and changes in social environment. Conclusion: Based on this study\u27s findings, MTM appears to be a robust theoretical framework for predicting PA behavior change. Future research directions and development of suitable intervention strategies are discussed

Supporting Comparative Regional Analysis Across the UK : Evaluating the Availability, Comparability and Dissemination of Northern Ireland's Socioeconomic Data

The need for high quality regional and country economic indicators has repeatedly received attention in independent reviews of UK economic statistics (see Allsopp, 2004 and Bean, 2016). Such indicators play a key role in supporting policymaking at the UK level as well as across the devolved nations of Northern Ireland, Scotland and Wales. Further devolution, the UK’s departure from the European Union (EU) and the UK government’s ‘levelling up’ agenda have again renewed interest in subnational data with a particular emphasis on subnational data gaps and the coherence and comparability of data across the UK. In previous work, we analysed the opportunities, challenges and trade-offs when building a suite of subnational socioeconomic indicators for the UK (see Davidson et al., 2022). In doing so, we sought to respond to elements of the Government Statistical Service’s (GSS’) Subnational Data Strategy (Government Analysis Function, 2021) as well as the Levelling Up White Paper’s Technical Annex on Missions and Metrics (HM Government, 2022b). In this project, we shift our focus to Northern Ireland. The report’s overarching aim is to evaluate gaps in Northern Ireland’s economic data provision with the goal of supporting greater comparability and alignment with data available for the rest of the UK. The report therefore has three contributions. First, we consider key categories of indicator (for example, headline economic indicators, business and labour market indicators, health indicators etc.) and assess the extent to which Northern Ireland has data gaps relative to the rest of the UK

Economic Commentary [February 2023]

As we settle into 2023 it is clear the effects of the economic challenges that defined 2022 will very much continue to be felt this year. While inflation is largely believed to have peaked, it remains close to multi-decade highs and the Bank of England will need more convincing evidence that inflation is beaten before calling time on further rate hikes. The UK economy is likely to enter recession this year, or at best stagnate, as elevated inflation squeezes demand and the impact of higher interest rates further weighs on activity. However, the economy showed unexpected resilience in the closing months of 2022 and by the standards of past recessions this is likely to be a shallow one, with growth expected to resume towards the end of the yea

Economic Commentary [October 2023]

Growth in the economy has been faltering and pretty muted over 2023, with a high interest rate environment and wider economic uncertainty leading to many businesses choosing to delay or cancel investments. Whilst not in the recession that many economists were predicting at the end of 2022, monthly economic figures have been very mixed, which means growth overall for 2023 is likely to be pretty poor. The most recent data on inflation, which held steady at 6.7% in September, shows that the high inflationary and interest rate environment is likely to persist for longer than previously thought – therefore it is likely that there are more risks to the downside for our forecasts numbers than in the previous quarter. We are now forecasting growth of 0.2% in 2023, 0.7% in 2024 and 1.2% in 2025. For 2023, this is a revision down from our previous set of forecasts in June, as data for 2023 to date has been much weaker than expected. The forecasts for 2024 and 2025 have not changed since June. Analysis in the Commentary this quarter includes a detailed look at the hospitality sector in Scotland. This sector, one of the hardest hit over the period of the pandemic, is a large employer in Scotland and the institute has been carrying out research with employers and employees into how pay and conditions in the sector can be improved. The Commentary also looks ahead to the Autumn Statement, which will be presented by the UK Chancellor on 22nd November. This will be important to set the scene – and indeed broadly the spending envelope - for the Scottish Budget on 19th December. The outlook for the public finances continues to be challenging, with slow growth translating into weak tax revenue forecasts. Despite recent positive revisions to UK growth, this is unlikely to translate into more fiscal headroom for the Chancellor. This will mean that the spending envelope remains tight, which will put further pressure on the Scottish Government’s finances in the run-up to the Scottish Budget. There have been a number of spending commitments made by the Scottish Government in recent weeks that are likely to make the situation more challenging