Ethnic inequalities in mental health and socioeconomic status among older women living with HIV: results from the PRIME Study.

OBJECTIVES: Women living with HIV in the UK are an ethnically diverse group with significant psychosocial challenges. Increasing numbers are reaching older age. We describe psychological and socioeconomic factors among women with HIV in England aged 45-60 and explore associations with ethnicity. METHODS: Analysis of cross-sectional data on 724 women recruited to the PRIME Study. Psychological symptoms were measured using the Patient Health Questionnaire 4 and social isolation with a modified Duke-UNC Functional Social Support Scale. RESULTS: Black African (BA) women were more likely than Black Caribbean or White British (WB) women to have a university education (48.3%, 27.0%, 25.7%, respectively, p<0.001), but were not more likely to be employed (68.4%, 61.4%, 65.2%, p=0.56) and were less likely to have enough money to meet their basic needs (56.4%, 63.0%, 82.9%, p<0.001). BA women were less likely to report being diagnosed with depression than WB women (adjusted odds ratio (aOR) 0.40, p<0.001) but more likely to report current psychological distress (aOR 3.34, p<0.05). CONCLUSIONS: We report high levels of poverty, psychological distress and social isolation in this ethnically diverse group of midlife women with HIV, especially among those who were BA. Despite being more likely to experience psychological distress, BA women were less likely to have been diagnosed with depression suggesting a possible inequity in access to mental health services. Holistic HIV care requires awareness of the psychosocial needs of older women living with HIV, which may be more pronounced in racially minoritised communities, and prompt referral for support including psychology, peer support and advice about benefits

Risk-shifting Through Issuer Liability and Corporate Monitoring

This article explores how issuer liability re-allocates fraud risk and how risk allocation may reduce the incidence of fraud. In the US, the apparent absence of individual liability of officeholders and insufficient monitoring by insurers under-mine the potential deterrent effect of securities litigation. The underlying reasons why both mechanisms remain ineffective are collective action problems under the prevailing dispersed ownership structure, which eliminates the incentives to moni-tor set by issuer liability. This article suggests that issuer liability could potentially have a stronger deterrent effect when it shifts risk to individuals or entities holding a larger financial stake. Thus, it would enlist large shareholders in monitoring in much of Europe. The same risk-shifting effect also has implications for the debate about the relationship between securities litigation and creditor interests. Credi-tors’ claims should not be given precedence over claims of defrauded investors (e.g., because of the capital maintenance principle), since bearing some of the fraud risk will more strongly incentivise large creditors, such as banks, to monitor the firm in jurisdictions where corporate debt is relatively concentrated

On a discrete Davey-Stewartson system

We propose a differential difference equation in ${\mathcal R}^1\times {\mathcal Z}^2$ and study it by Hirota's bilinear method. This equation has a singular continuum limit into a system which admits the reduction to the Davey-Stewartson equation. The solutions of this discrete DS system are characterized by Casorati and Grammian determinants. Based on the bilinear form of this discrete DS system, we construct the bilinear B\"{a}cklund transformation which enables us to obtain its Lax pair.Comment: 12 pages, 2 figure

Thirty Years After Michael E. Porter: What Do We Know About Business Exit?

Although a business exit is an important corporate change initiative, the buyer’s side seems to be more appealing to management researchers than the seller’s because acquisitions imply growth, i.e., success. Yet from an optimistic viewpoint, business exit can effectively create value for the selling company. In this paper we attempt to bring the relevance of the seller’s side back into our consciousness by asking: What do we know about business exit? We start our exploration with Porter (1976), focusing on literature that investigates the antecedents of, barriers to, and outcomes of business exit. We also include studies from related fields such as finance and economics.1 Through this research we determine three clusters of findings: factors promoting business exit, exit barriers, and exit outcomes. Overall, it is the intention of this paper to highlight the importance of business exit for research and practice. Knowing what we know about business exits and their high financial value we should bear in mind that exit need not mean failure but a new beginning for a corporation

Studying complex interventions : reflections from the FEMHealth project on evaluating fee exemption policies in West Africa and Morocco

Peer reviewedPublisher PD

Attitudes to and Understanding of Risk of Acquisition of HIV Over Time: Design and Methods for an Internet-based Prospective Cohort Study Among UK Men Who Have Sex With Men (the AURAH2 Study)

Background: The annual number of new HIV infections among men who have sex with men (MSM) has risen in the UK and, of those HIV positive, the proportion undiagnosed is high. The prospective AURAH2 study aims to assess factors associated with HIV acquisition among MSM in the UK, and to investigate changes over time within individuals in sexual behaviour and HIV-testing practices. / Methods/Design: AURAH2 is a prospective study among MSM without diagnosed HIV, aiming to recruit up to 1000 sexually active MSM attending sexual health clinics in London and Brighton. Participants complete an initial paper-based questionnaire, followed by four monthly online follow-up questionnaires collecting socio-demographic, health and behavioural data, including sexual behaviour, recreational and other drug use, HIV testing practices and Pre-Exposure Prophylaxis use, over a planned three year period. / Discussion: The results from AURAH2 study will provide an important insight into established and emerging risk behaviours that may be associated with acquisition of HIV in MSM, in the UK, changes over time within individuals in sexual behaviour, and inform on HIV testing practices. This data will be crucial to inform future HIV prevention strategies

Differences in antiretroviral scale up in three South African provinces: the role of implementation management

BACKGROUND: South Africa's antiretroviral programme is governed by defined national plans, establishing treatment targets and providing funding through ring-fenced conditional grants. However, in terms of the country's quasi-federal constitution, provincial governments bear the main responsibility for provision of health care, and have a certain amount of autonomy and therefore choice in the way their HIV/AIDS programmes are implemented. METHODS: The paper is a comparative case study of the early management of ART scale up in three South African provincial governments--Western Cape, Gauteng and Free State--focusing on both operational and strategic dimensions. Drawing on surveys of models of ART care and analyses of the policy process conducted in the three provinces between 2005 and 2007, as well as a considerable body of grey and indexed literature on ART scale up in South Africa, it draws links between implementation processes and variations in provincial ART coverage (low, medium and high) achieved in the three provinces. RESULTS: While they adopted similar chronic disease care approaches, the provinces differed with respect to political and managerial leadership of the programme, programme design, the balance between central standardisation and local flexibility, the effectiveness of monitoring and evaluation systems, and the nature and extent of external support and programme partnerships. CONCLUSIONS: This case study points to the importance of sub-national programme processes and the influence of factors other than financing or human resource capacity, in understanding intervention scale up

Detectability of Strange Matter in Heavy Ion Experiments

We discuss the properties of two distinct forms of hypothetical strange matter, small lumps of strange quark matter (strangelets) and of hyperon matter (metastable exotic multihypernuclear objects: MEMOs), with special emphasis on their relevance for present and future heavy ion experiments. The masses of small strangelets up to A = 40 are calculated using the MIT bag model with shell mode filling for various bag parameters. The strangelets are checked for possible strong and weak hadronic decays, also taking into account multiple hadron decays. It is found that strangelets which are stable against strong decay are most likely highly negative charged, contrary to previous findings. Strangelets can be stable against weak hadronic decay but their masses and charges are still rather high. This has serious impact on the present high sensitivity searches in heavy ion experiments at the AGS and CERN facilities. On the other hand, highly charged MEMOs are predicted on the basis of an extended relativistic mean-field model. Those objects could be detected in future experiments searching for short-lived, rare composites. It is demonstrated that future experiments can be sensitive to a much wider variety of strangelets.Comment: 26 pages, 5 figures, uses RevTeX and epsf.st

Dibaryons with Strangeness: their Weak Nonleptonic Decay using SU(3) Symmetry and how to find them in Relativistic Heavy-Ion Collisions

Weak SU(3) symmetry is successfully applied to the weak hadronic decay amplitudes of octet hyperons. Weak nonmesonic and mesonic decays of various dibaryons with strangeness, their dominant decay modes, and lifetimes are calculated. Production estimates for BNL's Relativistic Heavy-Ion Collider are presented employing wave function coalescence. Signals for detecting strange dibaryon states in heavy-ion collisions and revealing information about the unknown hyperon-hyperon interactions are outlined.Comment: 4 pages, 2 figures, uses RevTeX, discussion about the model of the weak decay and experimental signals extended, references update

Explicit Flow Equations and Recursion Operator of the ncKP hierarchy

The explicit expression of the flow equations of the noncommutative Kadomtsev-Petviashvili(ncKP) hierarchy is derived. Compared with the flow equations of the KP hierarchy, our result shows that the additional terms in the flow equations of the ncKP hierarchy indeed consist of commutators of dynamical coordinates \{$u_i$\}. The recursion operator for the flow equations under $n$-reduction is presented. Further, under 2-reduction, we calculate a nonlocal recursion operator $\Phi(2)$ of the noncommutative Korteweg-de Vries(ncKdV) hierarchy, which generates a hierarchy of local, higher-order flows. Thus we solve the open problem proposed by P.J. Olver and V.V. Sokolov(Commun.Math.Phys. 193 (1998), 245-268).Comment: 20pages,no figure, accepted by Nonlinearity(Aug., 2011