Sub-Optimal Vitamin B-12 Levels among ART-Naïve HIV-Positive Individuals in an Urban Cohort in Uganda

Malnutrition is common among HIV-infected individuals and is often accompanied by low serum levels of micronutrients. Vitamin B-12 deficiency has been associated with various factors including faster HIV disease progression and CD4 depletion in resource-rich settings. To describe prevalence and factors associated with sub-optimal vitamin B-12 levels among HIV-infected antiretroviral therapy (ART) naïve adults in a resource-poor setting, we performed a cross-sectional study with a retrospective chart review among individuals attending either the Mulago-Mbarara teaching hospitals’ Joint AIDS Program (MJAP) or the Infectious Diseases Institute (IDI) clinics, in Kampala, Uganda. Logistic regression was used to determine factors associated with sub-optimal vitamin B-12. The mean vitamin B-12 level was 384 pg/ml, normal range (200–900). Sub-optimal vitamin B-12 levels (<300 pg/ml) were found in 75/204 (36.8%). Twenty-one of 204 (10.3%) had vitamin B-12 deficiency (<200 pg/ml) while 54/204 (26.5%) had marginal depletion (200–300 pg/ml). Irritable mood was observed more among individuals with sub-optimal vitamin B-12 levels (OR 2.5, 95% CI; 1.1–5.6, P = 0.03). Increasing MCV was associated with decreasing serum B-12 category; 86.9 fl (±5.1) vs. 83 fl (±8.4) vs. 82 fl (±8.4) for B-12 deficiency, marginal and normal B-12 categories respectively (test for trend, P = 0.017). Compared to normal B-12, individuals with vitamin B-12 deficiency had a longer known duration of HIV infection: 42.2 months (±27.1) vs. 29.4 months (±23.8; P = 0.02). Participants eligible for ART (CD4<350 cells/µl) with sub-optimal B-12 had a higher mean rate of CD4 decline compared to counterparts with normal B-12; 118 (±145) vs. 22 (±115) cells/µl/year, P = 0.01 respectively. The prevalence of a sub-optimal vitamin B-12 was high in this HIV-infected, ART-naïve adult clinic population in urban Uganda. We recommend prospective studies to further clarify the causal relationships of sub-optimal vitamin B-12, and explore the role of vitamin B-12 supplementation in immune recovery

Integrating narratives into decision making for complex systems engineering design issues

Engineering decision making and design requires collaboration between groups from different disciplines, each with different tools, vocabulary, and concerns. Traditional engineering decision-making tools are generally based on understanding the decision makers’ values, modeling uncertainty with probability, and selecting the alternative that maximizes utility. This rational approach to decision making may not be well understood or used by many stakeholders involved in the engineering design process. Constructing narratives, a basic means of human communication, may aid in engineering communication and comprehension and help with decision making. Narratives represent events by means of a story and usually include characters or agents who cause events and to whom events happen. This paper recommends three methods for how the use of narrative can be applied to the area of engineering decision making. These methods include connecting the decision maker to the analysis, creating narrative simulations for training decision makers, and fostering consensus in problems with multiple stakeholders. An illustrative example of designing a better cookstove for the developing world demonstrates the role that understanding narratives of various stakeholders can play for accomplishing complex systems engineering

Mapping the Relationship Among Political Ideology, CSR Mindset, and CSR Strategy: A Contingency Perspective Applied to Chinese Managers

The literature on antecedents of corporate social responsibility (CSR) strategies of firms has been predominately content driven. Informed by the managerial sense-making process perspective, we develop a contingency theoretical framework explaining how political ideology of managers affects the choice of CSR strategy for their firms through their CSR mindset. We also explain to what extent the outcome of this process is shaped by the firm’s internal institutional arrangements and external factors impacting on the firm. We develop and test several hypotheses using data collected from 129 Chinese managers. The results show that managers with a stronger socialist ideology are likely to develop a mindset favouring CSR, which induces the adoption of a proactive CSR strategy. The CSR mindset mediates the link between socialist ideology and CSR strategy. The strength of the relationship between the CSR mindset and the choice of CSR strategy is moderated by customer response to CSR, industry competition, the role of government, and CSR-related managerial incentives

Vocationalism varies (a lot): a 12-country multivariate analysis of participation in formal adult learning

To encourage adult participation in education and training, contemporary policy makers typically encourage education and training provision to have a strongly vocational (employment-related) character, while also stressing individuals’ responsibility for developing their own learning. Adults’ motivation to learn is not, however, purely vocational—it varies substantially, not only between individuals but between populations. This article uses regression analysis to explain motivation among 12,000 learners in formal education and training in 12 European countries. Although vocational motivation is influenced by individual-level characteristics (such as age, gender, education, occupation), it turns out that the country in which the participation takes place is a far stronger explanatory variable. For example, although men’s vocational motivation to participate is higher than women’s in all countries, Eastern European women have significantly higher levels of vocational motivation than men in Western Europe. This supports other research which suggests that, despite globalization, national institutional structures (social, economic) have continuing policy significance