HIV dynamics and natural history studies: Joint modeling with doubly interval-censored event time and infrequent longitudinal data

Hepatitis C virus (HCV) coinfection has become one of the most challenging clinical situations to manage in HIV-infected patients. Recently the effect of HCV coinfection on HIV dynamics following initiation of highly active antiretroviral therapy (HAART) has drawn considerable attention. Post-HAART HIV dynamics are commonly studied in short-term clinical trials with frequent data collection design. For example, the elimination process of plasma virus during treatment is closely monitored with daily assessments in viral dynamics studies of AIDS clinical trials. In this article instead we use infrequent cohort data from long-term natural history studies and develop a model for characterizing post-HAART HIV dynamics and their associations with HCV coinfection. Specifically, we propose a joint model for doubly interval-censored data for the time between HAART initiation and viral suppression, and the longitudinal CD4 count measurements relative to the viral suppression. Inference is accomplished using a fully Bayesian approach. Doubly interval-censored data are modeled semiparametrically by Dirichlet process priors and Bayesian penalized splines are used for modeling population-level and individual-level mean CD4 count profiles. We use the proposed methods and data from the HIV Epidemiology Research Study (HERS) to investigate the effect of HCV coinfection on the response to HAART.Comment: Published in at http://dx.doi.org/10.1214/10-AOAS391 the Annals of Applied Statistics (http://www.imstat.org/aoas/) by the Institute of Mathematical Statistics (http://www.imstat.org

Academic Integrity: A Study of Attitudes and Behaviors focused on Technology & Narcissism

This thesis focuses primarily on the misuses of technology in regards to academic integrity violations and examines some of the psychological traits that are more likely to lead these violations. It begins by defining Narcissism, and then analyzes its effect on cheating frequencies and attitudes. The next portion focuses on the relationship between the misuse of technology and narcissism. Finally, technological cheating methods are examined; survey results are compared with UA academic integrity case records to find areas in which violations most often occur

Health insurance for HIV prevention & treatment: predictors of health insurance enrollment among HIV+ women in Kenya

Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count ) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24-4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42-28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53-4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10-0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings.Othe

Autotransformer betters motor phase conversion : circuit of new static unit provides 3-phase currents to 3-phase induction motor from a single-phase line and also has a low starting kva requirement

"Jan. 22, 1956.""Reprinted from ELECTRICAL WORLD, vol. 144, page 120, October 17, 1955.

Chromosomes in the Clinic: The Visual Localization and Analysis of Genetic Disease in the Human Genome

This dissertation examines the visual cultures of postwar biomedicine, with a particular focus on how various techniques, conventions, and professional norms have shaped the `look\u27, classification, diagnosis, and understanding of genetic diseases. Many scholars have previously highlighted the `informational\u27 approaches of postwar genetics, which treat the human genome as an expansive data set comprised of three billion DNA nucleotides. Since the 1950s however, clinicians and genetics researchers have largely interacted with the human genome at the microscopically visible level of chromosomes. Mindful of this, my dissertation examines the `observational\u27 approaches of postwar genetics. This is accomplished through a series of case studies, which examine the visual delineation, diagnosis, and genomic localization of a number of disorders. My case studies explore various exemplary attempts to associate particular clinical disorders with specific genetic mutations. This dissertation uses archival resources, oral histories, and the published biomedical literature to examine the many successes of postwar biomedicine, and to highlight the contributions made by a wide rage of biomedical professionals. I find that the visible, tangible human genome, as conceived and depicted at the level of chromosomes, has become an important work object among a diverse array of practitioners. Chromosomal ideograms, I argue, provide an important basis for communication and common practices among this community. While genetic data is becoming increasingly significant to our understanding of human disease, distinguishing the normal from the pathological remains a task that relies on input from the laboratory and the clinic. Thus, the success of postwar genetic medicine must be seen in light of the contributions of biomedical actors from many disciplines, who have agreed to see and communicate about the human genome - their object of study - in standardized ways

Contested Identities and Language Education: Inculcating Nationalist Ideologies In the Basque Region

Nationalist sentiment has a long history in the Basque regions of northern Spain. Culturally separate from the dominant Castilian society, separatists have for many years advocated for an independent Basque state. Following democratic reforms under the Constitution of 1978, regional cultures and languages were explicitly recognized and protected in Spain. This allowed for the current set of language laws in the Autonomous Community of País Vasco in which Castilian Spanish and the Basque language of Euskara are held in equal status and recognition. Furthermore, Euskara has been recognized as a defining characteristic of Basque identity. The regional government has instituted a three-track education system in which students choose to be taught in varying ratios of Euskara and Castillian. This work explores ideas about language education and usage as it relates to the development of national identity in young people in the city of Bilbao. It shows that the everyday choices made about language in the region are complicated and not merely reflections of nationalist ideology. There are often pragmatic choices made reflecting economic realities or simple daily convenience. These basic trends though are further complicated by normal adolescent social negotiations. The language of Euskara is still an important identifier for individuals in the region, but there are now many perceived reasons for achieving fluency in it other than to make a political or cultural statement. These results illustrate a complicated picture of nationalism in the region and raise questions about its shifting focus and importance in future generations