Stimulating demand for AIDS prevention : lessons from the RESPECT trial

HIV-prevention strategies have yielded only limited success so far in slowing down the AIDS epidemic. This paper examines novel intervention strategies that use incentives to discourage risky sexual behaviors. Widely-adopted conditional cash transfer programs that offer payments conditioning on easily monitored behaviors, such as well-child health care visits, have shown positive impact on health outcomes. Similarly, contingency management approaches have successfully used outcome-based rewards to encourage behaviors that are not easily monitored, such as stopping drug abuse. These strategies have not been used in the sexual domain, so this paper assesses how incentives can be used to reduce risky sexual behavior. After discussing theoretical pathways, it discusses the use of sexual-behavior incentives in the Tanzanian RESPECT trial. There, participants who tested negative for sexually transmitted infections are eligible for outcome-based cash rewards. The trial was well-received in the communities, with high enrollment rates and more than 90 percent of participants viewing the incentives favorably. After one year, 57 percent of enrollees in the"low-value"reward arm stated that the cash rewards"very much"motivated sexual behavioral change, rising to 79 percent in the"high-value"reward arm. Despite its controversial nature, the authors argue for further testing of such incentive-based approaches to encouraging reductions in risky sexual behavior.Health Monitoring&Evaluation,Population Policies,Disease Control&Prevention,HIV AIDS,Adolescent Health

Tanzanian Couples' Perspectives on Gender Equity, Relationship Power, and Intimate Partner Violence: Findings from the RESPECT Study.

Intimate partner violence (IPV) is widely prevalent in Tanzania. Inequitable gender norms manifest in men's and women's attitudes about power and decision making in intimate relationships and are likely to play an important role in determining the prevalence of IPV. We used data from the RESPECT study, a randomized controlled trial that evaluated an intervention to prevent sexually transmitted infections in a cohort of young Tanzanian men and women, to examine the relationship between couples' attitudes about IPV, relationship power, and sexual decision making, concordance on these issues, and women's reports of IPV over 12 months. Women expressed less equitable attitudes than men at baseline. Over time, participants' attitudes tended to become more equitable and women's reports of IPV declined substantially. Multivariable logistic regression analyses suggested that inequitable attitudes and couple discordance were associated with higher risk of IPV. Our findings point to the need for a better understanding of the role that perceived or actual imbalances in relationship power have in heightening IPV risk. The decline in women's reports of IPV and the trend towards gender-equitable attitudes indicate that concerted efforts to reduce IPV and promote gender equity have the potential to make a positive difference in the relatively short term

Evolving Strategies, Opportunistic Implementation: HIV Risk Reduction in Tanzania in the Context of an Incentive-Based HIV Prevention Intervention.

\ud Behavior change communication (BCC) interventions, while still a necessary component of HIV prevention, have not on their own been shown to be sufficient to stem the tide of the epidemic. The shortcomings of BCC interventions are partly due to barriers arising from structural or economic constraints. Arguments are being made for combination prevention packages that include behavior change, biomedical, and structural interventions to address the complex set of risk factors that may lead to HIV infection. In 2009/2010 we conducted 216 in-depth interviews with a subset of study participants enrolled in the RESPECT study - an HIV prevention trial in Tanzania that used cash awards to incentivize safer sexual behaviors. We analyzed community diaries to understand how the study was perceived in the community. We drew on these data to enhance our understanding of how the intervention influenced strategies for risk reduction. We found that certain situations provide increased leverage for sexual negotiation, and these situations facilitated opportunistic implementation of risk reduction strategies. Opportunities enabled by the RESPECT intervention included leveraging conditional cash awards, but participants also emphasized the importance of exploiting new health status knowledge from regular STI testing. Risk reduction strategies included condom use within partnerships and/or with other partners, and an unexpected emphasis on temporary abstinence. Our results highlight the importance of increasing opportunities for implementing risk reduction strategies. We found that an incentive-based intervention could be effective in part by creating such opportunities, particularly among groups such as women with limited sexual agency. The results provide new evidence that expanding regular testing of STIs is another important mechanism for providing opportunities for negotiating behavior change, beyond the direct benefits of testing. Exploiting the latent demand for STI testing should receive renewed attention as part of innovative new combination interventions for HIV prevention.\u

Separate roles of PKA and EPAC in renal function unraveled by the optogenetic control of cAMP levels in vivo

Cyclic AMP (cAMP) is a ubiquitous second messenger that regulates a variety of essential processes in diverse cell types, functioning via cAMP-dependent effectors such as protein kinase A (PKA) and/or exchange proteins directly activated by cAMP (EPAC). In an intact tissue it is difficult to separate the contribution of each cAMP effector in a particular cell type using genetic or pharmacological approaches alone. We, therefore, utilized optogenetics to overcome the difficulties associated with examining a multicellular tissue. The transgenic photoactive adenylyl cyclase bPAC can be activated to rapidly and reversibly generate cAMP pulses in a cell-type-specific manner. This optogenetic approach to cAMP manipulation was validated in vivo using GAL4-driven UAS–bPAC in a simple epithelium, the Drosophila renal (Malpighian) tubules. As bPAC was expressed under the control of cell-type-specific promoters, each cAMP signal could be directed to either the stellate or principal cells, the two major cell types of the Drosophila renal tubule. By combining the bPAC transgene with genetic and pharmacological manipulation of either PKA or EPAC it was possible to investigate the functional impact of PKA and EPAC independently of each other. The results of this investigation suggest that both PKA and EPAC are involved in cAMP sensing, but are engaged in very different downstream physiological functions in each cell type: PKA is necessary for basal secretion in principal cells only, and for stimulated fluid secretion in stellate cells only. By contrast, EPAC is important in stimulated fluid secretion in both cell types. We propose that such optogenetic control of cellular cAMP levels can be applied to other systems, for example the heart or the central nervous system, to investigate the physiological impact of cAMP-dependent signaling pathways with unprecedented precision

Verständlichkeitsstudie Generalkonsent : Aufklärung und Einwilligung zur Weiterverwendung von biologischem Material und gesundheitsbezogenen Personendaten für die Forschung

Das Ziel des Berichtes ist, das Generalkonsent-Template 1/2017 empirisch auf Verständlichkeit hin zu untersuchen und Optimierungsmöglichkeiten aufzuzeigen. Im Usability-Testing wurde der GK1/2017_ORIG und eine für Testzwecke konstruierte Textalternative GK_ALTERN untersucht. Die Ergebnisse des vergleichenden Verfahrens zeigen text- und kontextgebundene Verständlichkeitsprobleme auf

Prevalence of ultrasound-determined cystic endometrial hyperplasia and the relationship with age in dogs

To investigate the potential relationship between age and diagnosis of cystic endometrial hyperplasia (CEH) in the bitches, 348 ultrasound examinations from 240 bitches (Labradors, Golden Retrievers, German Shepherds, Flat Coated Retrievers, or crosses of those breeds aged between 1.6 and 7.2 years at examination) were examined. A subpopulation of 32 bitches that had completed their breeding careers at 6 years or more of age was also identified. Of all, 18.3% of the bitches were diagnosed with CEH; these cases were newly diagnosed when bitches were between 2.5 years and 7.3 years of age. The proportion of ultrasound examinations in which CEH was identified increased from 6.8% of examinations on 2-year-old breeding bitches to 60.0% of examinations on 6-year-old bitches. Logistic regression identified a positive correlation between mean age at the examination and presence of CEH (χ2 = 30.74, degrees of freedom = 1, P < 0.001). For 32 bitches that had completed their breeding career, the prevalence of CEH was 56.3%, age at the diagnosis ranged from 3.8 to 7.3 years, and the proportion of bitches affected with CEH increased from 6.3% at 3 years of age to 56.3% at 7 years of age. These data support the contention that the prevalence of CEH increases with age

Artificial Intelligence as a Means to Moral Enhancement

This paper critically assesses the possibility of moral enhancement with ambient intelligence technologies and artificial intelligence presented in Savulescu and Maslen (2015). The main problem with their proposal is that it is not robust enough to play a normative role in users’ behavior. A more promising approach, and the one presented in the paper, relies on an artifi-cial moral reasoning engine, which is designed to present its users with moral arguments grounded in first-order normative theories, such as Kantianism or utilitarianism, that reason-responsive people can be persuaded by. This proposal can play a normative role and it is also a more promising avenue towards moral enhancement. It is more promising because such a system can be designed to take advantage of the sometimes undue trust that people put in automated technologies. We could therefore expect a well-designed moral reasoner system to be able to persuade people that may not be persuaded by similar arguments from other people. So, all things considered, there is hope in artificial intelli-gence for moral enhancement, but not in artificial intelligence that relies solely on ambient intelligence technologies

Circulating fibroblast‐like cells in men with metastatic prostate cancer

BACKGROUND Metastatic prostate cancer is an incurable disease. During the development of this disease, prostate cancer cells enter the bloodstream as single cells or clusters of cells. Prostate fibroblasts, a cancer‐promoting cell type in the prostate cancer microenvironment, could in theory incorporate into these migrating cell clusters or follow cancer cells into the bloodstream through holes in the tumor vasculature. Based on this idea, we hypothesized that fibroblast‐like cells, defined here as cytokeratin 8/18/19 − /DAPI + /CD45 − /vimentin + cells, are present in the blood of men with metastatic prostate cancer. METHODS Veridex's CellSearch® system was used to immunomagnetically capture EpCAM + cells and clusters of cells heterogeneous for EpCAM expression from the blood of men with metastatic prostate cancer, localized cancer, and no known cancer, and immunostain them for the presence of cytokeratins 8/18/19, a nucleus, CD45, and vimentin. Fibroblast‐like cells were then quantified. RESULTS Fibroblast‐like cells were present in 58.3% of men with metastatic prostate cancer but not in any men with localized prostate cancer or no known cancer. The presence of these cells correlated with certain known indicators of poor prognosis: ≥5 circulating tumor cells, defined here as cytokeratin 8/18/19 + /DAPI + /CD45 − cells, per 7.5 ml of blood, and a relatively high serum prostate‐specific antigen level of ≥20 ng/ml. CONCLUSIONS The presence of fibroblast‐like cells in the blood may provide prognostic information as well as information about the biology of metastatic prostate cancer. Prostate 73: 176–181, 2013. © 2012 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95517/1/22553_ftp.pd