New Exoplanet Surveys in the Canadian High Arctic at 80 Degrees North

Observations from near the Eureka station on Ellesmere Island, in the Canadian High Arctic at 80 degrees North, benefit from 24-hour darkness combined with dark skies and long cloud-free periods during the winter. Our first astronomical surveys conducted at the site are aimed at transiting exoplanets; compared to mid-latitude sites, the continuous darkness during the Arctic winter greatly improves the survey's detection efficiency for longer-period transiting planets. We detail the design, construction, and testing of the first two instruments: a robotic telescope, and a set of very wide-field imaging cameras. The 0.5m Dunlap Institute Arctic Telescope has a 0.8-square-degree field of view and is designed to search for potentially habitable exoplanets around low-mass stars. The very wide field cameras have several-hundred-square-degree fields of view pointed at Polaris, are designed to search for transiting planets around bright stars, and were tested at the site in February 2012. Finally, we present a conceptual design for the Compound Arctic Telescope Survey (CATS), a multiplexed transient and transit search system which can produce a 10,000-square-degree snapshot image every few minutes throughout the Arctic winter.Comment: 11 pages, 6 figures, SPIE vol 8444, 201

Causes of Death in HIV Patients and the Evolution of an AIDS Hospice: 1988–2008

This paper reports on the transformation that has occurred in the care of people living with HIV/AIDS in a Toronto Hospice. Casey House opened in the pre-HAART era to care exclusively for people with HIV/AIDS, an incurable disease. At the time, all patients were admitted for palliative care and all deaths were due to AIDS-defining conditions. AIDS-defining malignancies accounted for 22 percent of deaths, mainly, Kaposi sarcoma and lymphoma. In the post-HAART era, AIDS-defining malignancies dropped dramatically and non-AIDS-defining malignancies became a significant cause of death, including liver cancer, lung cancer and gastric cancers. In the post-HAART era, people living with HIV/AIDS served at Casey House have changed considerably, with increasing numbers of patients facing homelessness and mental health issues, including substance use. Casey House offers a picture of the evolving epidemic and provides insight into changes and improvements made in the care of these patients

Factors in AIDS Dementia Complex Trial Design: Results and Lessons from the Abacavir Trial

OBJECTIVES: To determine the efficacy of adding abacavir (Ziagen, ABC) to optimal stable background antiretroviral therapy (SBG) to AIDS dementia complex (ADC) patients and address trial design. DESIGN: Phase III randomized, double-blind placebo-controlled trial. SETTING: Tertiary outpatient clinics. PARTICIPANTS: ADC patients on SBG for ≥8 wk. INTERVENTIONS: Participants were randomized to ABC or matched placebo for 12 wk. OUTCOME MEASURES: The primary outcome measure was the change in the summary neuropsychological Z score (NPZ). Secondary measures were HIV RNA and the immune activation markers β-2 microglobulin, soluble tumor necrosis factor (TNF) receptor 2, and quinolinic acid. RESULTS: 105 participants were enrolled. The median change in NPZ at week 12 was +0.76 for the ABC + SBG and +0.63 for the SBG groups (p = 0.735). The lack of efficacy was unlikely related to possible limited antiviral efficacy of ABC: at week 12 more ABC than placebo participants had plasma HIV RNA ≤400 copies/mL (p = 0.002). There were, however, other factors. Two thirds of patients were subsequently found to have had baseline resistance to ABC. Second, there was an unanticipated beneficial effect of SBG that extended beyond 8 wk to 5 mo, thereby rendering some of the patients at baseline unstable. Third, there was an unexpectedly large variability in neuropsychological performance that underpowered the study. Fourth, there was a relative lack of activity of ADC: 56% of all patients had baseline cerebrospinal fluid (CSF) HIV-1 RNA <100 copies/mL and 83% had CSF β-2 microglobulin <3 nmol/L at baseline. CONCLUSIONS: The addition of ABC to SBG for ADC patients was not efficacious, possibly because of the inefficacy of ABC per se, baseline drug resistance, prolonged benefit from existing therapy, difficulties with sample size calculations, and lack of disease activity. Assessment of these trial design factors is critical in the design of future ADC trials

Factors in AIDS Dementia Complex Trial Design: Results and Lessons from the Abacavir Trial

To determine the efficacy of adding abacavir (Ziagen, ABC) to optimal stable background antiretroviral therapy (SBG) to AIDS dementia complex (ADC) patients and address trial design

Management of Depression and Related Neuropsychiatric Symptoms Associated with HIV/AIDS and Antiretroviral Therapy

Persons with HIV/AIDS may experience a wide range of neuropsychiatric symptoms, including depressed mood, anxiety, irritability, suicidal ideation, agitation and insomnia. These symptoms may be related to psychosocial stressors, biological diathesis to psychiatric syndromes, HIV-related medical illness and/or the medications used in the treatment of HIV/AIDS. Depressed mood is the most common neuropsychiatric complaint in persons with HIV/AIDS seeking psychiatric evaluation. Prevalence rates of major depression in persons with HIV/AIDS have been reported to range between 22% and 45%. Despite the high prevalence, major depression remains underdiagnosed in patients with HIV/AIDS. Depression has a significant impact on quality of life, has a negative impact on antiretroviral adherence and is a significant risk factor for suicide. With the advent of highly active antiretroviral therapy, HIV/AIDS has evolved into a chronic, manageable illness. The management of mental health concerns and neuropsychiatric symptoms has, therefore, become an integral part of comprehensive HIV/AIDS care. Clinical experience to date suggests that psychiatric syndromes in persons with HIV/AIDS and treatment-emergent neuropsychiatric side effects related to antiretroviral medications can be successfully managed using standard psychiatric interventions. The present article focuses on the treatment and management of major depression, including the choice of antidepressants and potential drug interaction considerations. Management of related symptoms of agitation and sleep disturbances are also reviewed

Management of Depression Associated with HIV/AIDS and Antiretrovial Therapy

Depressed mood is a common psychiatric complaint in persons withHIV/AIDS, with a meta-analysis indicating that the rates of depressionwithin this group may be as high as double that of the generalpopulation. Depression may result from a biological diathesis to mooddisorders, a physiological reaction to a medical illness or its treatment,and/or a psychological reaction to challenging life circumstances.Associated symptoms include sleep, energy and appetite disturbances;social withdrawal; diminished capacity to experience pleasure; diminishedconcentration; feelings of worthlessness, shame and guilt; andrecurrent thoughts of death, including suicidal ideation. The emotionallyand physically painful state of major depression is associatedwith decreased antiretroviral adherence and poorer HIV/AIDS diseaseoutcomes.Neuropsychiatric symptoms have been reported with several of themedications taken by patients with HIV/AIDS, including lamivudine,zidovudine, interferon and, most notably, efavirenz. However, datafrom several sources demonstrate that neuropsychiatric symptomsassociated with efavirenz use are generally transient, with onset earlyafter treatment initiation, peaking after one week and decreasing overthe first one to four months of treatment. Recent comparative studieshave not found elevated incident rates of major depression in patientstreated with efavirenz, but they have confirmed the typical neuropsychiatricsymptoms reported in earlier open-label studies and casereports. Becoming skilled in the management of depression and psychiatricsymptoms is integral to the provision of comprehensive carefor patients with HIV/AIDS.Peer Reviewe

Management of Depression and Related Neuropsychiatric Symptoms Associated with HIV/AIDS and Antiretroviral Therapy

Persons with HIV/AIDS may experience a wide range of neuropsychiatric symptoms, including depressed mood, anxiety,irritability, suicidal ideation, agitation and insomnia. These symptoms may be related to psychosocial stressors,biological diathesis to psychiatric syndromes, HIV-related medical illness and/or the medications used in the treatmentof HIV/AIDS. Depressed mood is the most common neuropsychiatric complaint in persons with HIV/AIDS seekingpsychiatric evaluation. Prevalence rates of major depression in persons with HIV/AIDS have been reported torange between 22% and 45%. Despite the high prevalence, major depression remains underdiagnosed in patients withHIV/AIDS. Depression has a significant impact on quality of life, has a negative impact on antiretroviral adherenceand is a significant risk factor for suicide.With the advent of highly active antiretroviral therapy, HIV/AIDS has evolved into a chronic, manageable illness.The management of mental health concerns and neuropsychiatric symptoms has, therefore, become an integral partof comprehensive HIV/AIDS care. Clinical experience to date suggests that psychiatric syndromes in persons withHIV/AIDS and treatment-emergent neuropsychiatric side effects related to antiretroviral medications can be successfullymanaged using standard psychiatric interventions. The present article focuses on the treatment and managementof major depression, including the choice of antidepressants and potential drug interaction considerations.Management of related symptoms of agitation and sleep disturbances are also reviewed.Peer Reviewe

Management of Depression Associated with HIV/AIDS and Antiretrovial Therapy

Depressed mood is a common psychiatric complaint in persons with HIV/AIDS, with a meta-analysis indicating that the rates of depression within this group may be as high as double that of the general population. Depression may result from a biological diathesis to mood disorders, a physiological reaction to a medical illness or its treatment, and/or a psychological reaction to challenging life circumstances. Associated symptoms include sleep, energy and appetite disturbances; social withdrawal; diminished capacity to experience pleasure; diminished concentration; feelings of worthlessness, shame and guilt; and recurrent thoughts of death, including suicidal ideation. The emotionally and physically painful state of major depression is associated with decreased antiretroviral adherence and poorer HIV/AIDS disease outcomes. Neuropsychiatric symptoms have been reported with several of the medications taken by patients with HIV/AIDS, including lamivudine, zidovudine, interferon and, most notably, efavirenz. However, data from several sources demonstrate that neuropsychiatric symptoms associated with efavirenz use are generally transient, with onset early after treatment initiation, peaking after one week and decreasing over the first one to four months of treatment. Recent comparative studies have not found elevated incident rates of major depression in patients treated with efavirenz, but they have confirmed the typical neuropsychiatric symptoms reported in earlier open-label studies and case reports. Becoming skilled in the management of depression and psychiatric symptoms is integral to the provision of comprehensive care for patients with HIV/AIDS