Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals.

BackgroundHIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.Methods and resultsWe studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).ConclusionIn HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death

Investigating mechanisms of social support effectiveness: The case of locomotion motivation

Although social support can entail costs, individuals with a higher locomotion orientation, who are motivated to move and take action, benefit from support. In two dyadic studies, we tested whether perceived movement towards important goals would mediate the effect of recipients’ locomotion motivation on positive outcomes in support contexts. In Study 1, couples completed a 10-day diary and then recalled support interactions with their partner after the diary period. In Study 2, couples engaged in laboratory support interactions for important goals. Perceived goal movement mediated the effect of higher (vs. lower) locomotion on self-reported ratings and coder ratings of support outcomes. Higher locomotion recipients may benefit in support contexts because they perceive they can move smoothly towards their goals

Carotid Intima-Media Thickness Progression in HIV-Infected Adults Occurs Preferentially at the Carotid Bifurcation and Is Predicted by Inflammation.

BackgroundShear stress gradients and inflammation have been causally associated with atherosclerosis development in carotid bifurcation regions. The mechanism underlying higher levels of carotid intima-media thickness observed among HIV-infected individuals remains unknown.Methods and resultsWe measured carotid intima-media thickness progression and development of plaque in the common carotid, bifurcation region, and internal carotid artery in 300 HIV-infected persons and 47 controls. The median duration of follow-up was 2.4 years. When all segments were included, the rate of intima-media thickness progression was greater in HIV-infected subjects compared with controls after adjustment for traditional risk factors (0.055 vs. 0.024 mm/year, P=0.016). Rate of progression was also greater in the bifurcation region (0.067 vs. 0.025 mm/year, P=0.042) whereas differences were smaller in the common and internal regions. HIV-infected individuals had a greater incidence of plaque compared with controls in the internal (23% vs. 6.4%, P=0.0037) and bifurcation regions (34% vs. 17%, P=0.014). Among HIV-infected individuals, the rate of progression in the bifurcation region was more rapid compared with the common carotid, internal, or mean intima-media thickness; in contrast, progression rates among controls were similar at all sites. Baseline hsCRP was elevated in HIV-infected persons and was a predictor of progression in the bifurcation region.ConclusionsAtherosclerosis progresses preferentially in the carotid bifurcation region in HIV-infected individuals. hsCRP, a marker of inflammation, is elevated in HIV and is associated with progression in the bifurcation region. These data are consistent with a model in which the interplay between hemodynamic shear stresses and HIV-associated inflammation contribute to accelerated atherosclerosis. (J Am Heart Assoc. 2012;1:jah3-e000422 doi: 10.1161/JAHA.111.000422.)Clinical trial registrationURL: http://clinicaltrials.gov. Unique identifier: NCT01519141

Understanding how institutions may support the development of transdisciplinary approaches to sustainability research

This article analyses the approaches of academics seeking to engage with private, public and community-based stakeholders through transdisciplinary research about pressing sustainability challenges and, in particular, climate change; it outlines aspects of the institutional factors which influence transdisciplinary research. A qualitative approach was employed in conducting 10 semi-structured interviews to analyse the challenges and motivations of academic researchers when working with a range of other stakeholders through transdisciplinary practice. Two key contributions are made through this work. First, this article adds to the existing literature on motivations and challenges for undertaking research with private, public and community stakeholders in a cross-disciplinary manner. Second, the current institutional circumstances influencing such research practices are outlined, alongside potential ways forward. The research presented here has been undertaken in light of the experiences of the two lead co-authors as early career researchers coming from the disciplines of sociology and energy engineering, engaging in transdisciplinary research within a local community context in relation to a regional energy transition project

Delphi with feedback of rationales: how large can a Delphi group be such that participants are not overloaded, de-motivated, or disengaged?

In this paper, we investigate the effect of Delphi group size and opinion diversity on group members’ information load as well as on their overall experience of the Delphi process - in terms of task involvement (enjoyment and interest) and in terms of group sway (the influence and helpfulness of others’ rationales). For Delphi applications involving the exchange of rationales between participants, we found no evidence that group sizes of up to 19 participants cause information overload or de-motivation and disengagement of participants

Voting power measurement: a story of misreinvention

In this account of the history of voting-power measurement, we confine ourselves to the concept of a priori voting power. We show how the concept was re-invented several times and how the circumstances in which it was reinvented led to conceptual confusion as to the true meaning of what is being measured. In particular, power-as-influence was conflated with value in the sense of transferable utility cooperative game theory (power as share in constant total payoff). Influence was treated, improperly, as though it were transferable utility, and hence an additive and distributive quantity. We provide examples of the resulting misunderstanding and mis-directed criticism

Tracking momentary experience in the evaluation of arts-on-prescription services: Using mood changes during art workshops to predict global wellbeing change

Aims: To measure the immediate impact of participating in arts-on-prescription workshops on multiple dimensions of mood and to evaluate whether improvement in mood is a mechanism for change, predicting improvements in global wellbeing before and after participation in arts-on-prescription programmes. Methods: The evaluation drew upon the experience sampling method, asking participants to complete a six-item mood questionnaire at the beginning and end of each workshop in a 12-week-long arts-on-prescription programme. Participants also completed a measure of global wellbeing at the beginning and end of the programme. Results: Multilevel modelling was used to test hypotheses since the data were hierarchical (with 1491 mood reports nested within 66 participants). There was a significant improvement in global wellbeing across participation in the arts-on-prescription programme. After each art workshop there was a significant increase on all dimensions of mood: hedonic tone (contentment); tense arousal (calmness); and energetic arousal (alertness). There was also a significant improvement in these dimensions of mood, over time, upon arrival at the art workshops each week. Furthermore, reduction in tense arousal after art workshops significantly predicted changes in global wellbeing. Conclusion: The findings suggest that a reduction in tense arousal (feeling less nervous, anxious and stressed) is a crucial component of arts-on-prescription services and make a direct link between experiences during art workshops and changes in global wellbeing for the first time. This strengthens the evidence base for arts-on-prescription and suggests that tracking experience across interventions is a useful evaluation tool, with much potential

Meeting Highlights of the 11th Annual Scientific Sessions of the Society for Cardiovascular Magnetic Resonance, Los Angeles, February 1–3, 2008

This paper features the most interesting presentations and discussions of the 2008 Annual Sessions of the Society for Cardiovascular Magnetic Resonance, which were held in Los Angeles from February 1 to 3, 2008