Tuberculosis and HIV Co-Infection

Tuberculosis (TB) and HIV co-infections place an immense burden on health care systems and pose particular diagnostic and therapeutic challenges. Infection with HIV is the most powerful known risk factor predisposing for Mycobacterium tuberculosis infection and progression to active disease, which increases the risk of latent TB reactivation 20-fold. TB is also the most common cause of AIDS-related death. Thus, M. tuberculosis and HIV act in synergy, accelerating the decline of immunological functions and leading to subsequent death if untreated. The mechanisms behind the breakdown of the immune defense of the co-infected individual are not well known. The aim of this review is to highlight immunological events that may accelerate the development of one of the two diseases in the presence of the co-infecting organism. We also review possible animal models for studies of the interaction of the two pathogens, and describe gaps in knowledge and needs for future studies to develop preventive measures against the two diseases

Changing Ireland : cultural heritage and migration

This paper reports on the Cultural Heritage and Migration project which was conducted as part of the UCD Irish Virtual Research Library and Archive (IVRLA) series of demonstrator research projects. The project, undertaken from September to December 2009, has two separate strands: Schools’ Folklore Scheme 2009/10 and Migration to Ireland 2009/10. Both strands take as their starting point key surveys by the Irish Folklore Commission (in 1937-38 and 1955 respectively) and seek to gather comparative information in today’s very different Ireland, focusing on a society that is more urban, multicultural, and rapidly changing. The methodology and focus necessarily differ substantially from the earlier surveys, being influenced by debates and issues in the ethics of information collection as well as the need to reflect a more heterogeneous society. The project's online collection gives the background for both strands (including sample scanned material from the 1937-38 Schools’ Survey) and provides documentation in relation to the planning, design, and training phase. Due to time constraints, it was not possible to digitise the actual survey responses but this pilot project is being continued by the UCD John Hume Institute for Global Irish Studies and further research outputs, including digitised text for the schools’ strand and digitised audio for the migration strand, will be made available on their website. This paper gives an overview of the context for both strands, outlines the survey design phase, details the work done in collecting material, and discusses the complex ethical issues which arose in relation to the migration strand (where respondents were particularly vulnerable). The paper concludes by describing how the two surveys undertaken by this project will be made available online and discussing the possibilities for future research.Higher Education Authorityti, de OR 05/10/1

Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome

Objectives One-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of TKA need, readiness/willingness and expectations for a good TKA outcome.Methods In patients with knee osteoarthritis (OA) undergoing primary TKA, we preoperatively assessed TKA need (Western Ontario-McMaster Universities OA Index (WOMAC) Pain Score and Knee injury and Osteoarthritis Outcome Score (KOOS) function, arthritis coping), health status, readiness (Patient Acceptable Symptom State, depressive symptoms), willingness (definitely yes—yes/no) and expectations (outcomes deemed ‘very important’). A good outcome was defined as symptom improvement (met Outcome Measures in Rheumatology and Osteoarthritis Research Society International (OMERACT–OARSI) responder criteria) and satisfaction with results 1 year post TKA. Using logistic regression, we assessed independent outcome predictors, model discrimination (area under the receiver operating characteristic curve, AUC) and the predicted probability of a good outcome for different need, readiness/willingness and expectations scenarios.Results Of 1,053 TKA recipients (mean age 66.9 years (SD 8.8); 58.6% women), 78.1% achieved a good outcome. With TKA need alone (WOMAC pain subscale, KOOS physical function short-form), model discrimination was good (AUC 0.67, 95% CI 0.63 to 0.71). Inclusion of readiness/willingness, depressive symptoms and expectations regarding kneeling, stair climbing, well-being and performing recreational activities improved discrimination (p=0.01; optimism corrected AUC 0.70, 0.66–0.74). The predicted probability of a good outcome ranged from 44.4% (33.9–55.5) to 92.4% (88.4–95.1) depending on level of TKA need, readiness/willingness, depressive symptoms and surgical expectations.Conclusions Although external validation is required, our findings suggest that incorporation of patients’ TKA readiness, willingness and expectations in TKA decision-making may improve the proportion of recipients that experience a good outcome