ING116070: a study of the pharmacokinetics and antiviral activity of dolutegravir in cerebrospinal fluid in HIV-1-infected, antiretroviral therapy-naive subjects.

BackgroundDolutegravir (DTG), a once-daily, human immunodeficiency virus type 1 (HIV-1) integrase inhibitor, was evaluated for distribution and antiviral activity in cerebrospinal fluid (CSF).MethodsING116070 is an ongoing, single-arm, open-label, multicenter study in antiretroviral therapy-naive, HIV-1-infected adults. Subjects received DTG (50 mg) plus abacavir/lamivudine (600/300 mg) once daily. The CSF and plasma (total and unbound) DTG concentrations were measured at weeks 2 and 16. The HIV-1 RNA levels were measured in CSF at baseline and weeks 2 and 16 and in plasma at baseline and weeks 2, 4, 8, 12, and 16.ResultsThirteen white men enrolled in the study; 2 withdrew prematurely, 1 because of a non-drug-related serious adverse event (pharyngitis) and 1 because of lack of treatment efficacy. The median DTG concentrations in CSF were 18 ng/mL (range, 4-23 ng/mL) at week 2 and 13 ng/mL (4-18 ng/mL) at week 16. Ratios of DTG CSF to total plasma concentration were similar to the unbound fraction of DTG in plasma. Median changes from baseline in CSF (n = 11) and plasma (n = 12) HIV-1 RNA were -3.42 and -3.04 log10 copies/mL, respectively. Nine of 11 subjects (82%) had plasma and CSF HIV-1 RNA levels <50 copies/mL and 10 of 11 (91%) had CSF HIV-1 RNA levels <2 copies/mL at week 16.ConclusionsThe DTG concentrations in CSF were similar to unbound plasma concentrations and exceeded the in vitro 50% inhibitory concentration for wild-type HIV (0.2 ng/mL), suggesting that DTG achieves therapeutic concentrations in the central nervous system. The HIV-1 RNA reductions were similar in CSF and plasma. Clinical Trials Registration. NCT01499199

A Racial/Ethnic Performance Disparity on the Facial Recognition Test

The Facial Recognition Test is a widely used psychometric instrument for assessing visuoperceptual functioning. Only two prior studies have examined the effects of race/ethnicity on this test. Given that the United States has become more culturally diverse since the creation of the test, it is important to re-visit the effects of this demographic variable on performance. Participants were 75 males and 75 females between the ages of 18 and 43 years (M = 21.91, SD = 5.33). Racial/ethnic categories utilized by the U.S. Census Bureau were equally represented. No gender differences were observed. The race/ethnicity main effect was significant. The gender x race/ethnicity interaction was not significant. The data revealed a clear racial/ethnic performance disparity on the Facial Recognition Test

Effects of triclosan in breast milk on the infant fecal microbiome

Triclosan is frequently used for its antimicrobial properties and has been detected in human serum, urine, and breast milk. Animal and molecular studies have shown that triclosan exerts a wide range of adverse health effects at both high (ppm) and low (ppb) concentrations. Since triclosan is of growing concern to human and environmental health, there is a need to improve extraction procedures and to study additional effects from triclosan exposure. In this study, we have improved triclosan extraction from breast milk by using salt (MgSO4) to reduce emulsion formation and increase water polarity and water (~80%) to enhance the overall extraction efficiency (~3.5 fold). This extraction method was applied to breast milk samples collected from donors who i) recorded their use of triclosan-containing personal care products and ii) provided matching infant stool samples. Of the participants who had detectable amounts of triclosan in their breast milk, nine (75%) of them reported daily use of triclosan-containing personal care products. Levels of triclosan in breast milk were compared to the donor\u27s infant\u27s fecal microbiome. We found that the bacterial diversity in the fecal microbiome of the infants exposed to breast milk with detectable triclosan levels differed compared to their peers exposed to milk containing non-detectable amounts. This finding implies that exogenous chemicals are impacting microbiome diversity

The Democratic Biopolitics of PrEP

PrEP (Pre-Exposure Prophylaxis) is a relatively new drug-based HIV prevention technique and an important means to lower the HIV risk of gay men who are especially vulnerable to HIV. From the perspective of biopolitics, PrEP inscribes itself in a larger trend of medicalization and the rise of pharmapower. This article reconstructs and evaluates contemporary literature on biopolitical theory as it applies to PrEP, by bringing it in a dialogue with a mapping of the political debate on PrEP. As PrEP changes sexual norms and subjectification, for example condom use and its meaning for gay subjectivity, it is highly contested. The article shows that the debate on PrEP can be best described with the concepts ‘sexual-somatic ethics’ and ‘democratic biopolitics’, which I develop based on the biopolitical approach of Nikolas Rose and Paul Rabinow. In contrast, interpretations of PrEP which are following governmentality studies or Italian Theory amount to either farfetched or trivial positions on PrEP, when seen in light of the political debate. Furthermore, the article is a contribution to the scholarship on gay subjectivity, highlighting how homophobia and homonormativity haunts gay sex even in liberal environments, and how PrEP can serve as an entry point for the destigmatization of gay sexuality and transformation of gay subjectivity. ‘Biopolitical democratization’ entails making explicit how medical technology and health care relates to sexual subjectification and ethics, to strengthen the voice of (potential) PrEP users in health politics, and to renegotiate the profit and power of Big Pharma

‘Remembering as Forgetting’: Organizational commemoration as a politics of recognition

This paper considers the politics of how organizations remember their past through commemorative settings and artefacts. Although these may be seen as ‘merely’ a backdrop to organizational activity, they form part of the lived experience of organizational spaces that its members enact on a daily basis as part of their routes and routines. The main concern of the paper is with how commemoration is bound up in the reflection and reproduction of hierarchies of organizational recognition. Illustrated with reference to two commemorative settings, the paper explores how organizations perpetuate a narrow set of symbolic ideals attributing value to particular forms of organizational membership while appearing to devalue others. In doing so, they communicate values that undermine attempts to achieve equality and inclusion. Developing a recognition-based critique of this process, the discussion emphasizes how commemorative settings and practices work to reproduce established patterns of exclusion and marginalization. To this end, traditional forms of commemorative portraiture that tend to close off difference are contrasted with a memorial garden, in order to explore the potential for an alternative, recognition-based ethics of organizational commemoration that is more open to the Other

Surface Dimming by the 2013 Rim Fire Simulated by a Sectional Aerosol Model

The Rim Fire of 2013, the third largest area burned by fire recorded in California history, is simulated by a climate model coupled with a size-resolved aerosol model. Modeled aerosol mass, number and particle size distribution are within variability of data obtained from multiple airborne in-situ measurements. Simulations suggest Rim Fire smoke may block 4-6 of sunlight energy reaching the surface, with a dimming efficiency around 120-150 W m(exp -2) per unit aerosol optical depth in the mid-visible at 13:00-15:00 local time. Underestimation of simulated smoke single scattering albedo at mid-visible by 0.04 suggests the model overestimates either the particle size or the absorption due to black carbon. This study shows that exceptional events like the 2013 Rim Fire can be simulated by a climate model with one-degree resolution with overall good skill, though that resolution is still not sufficient to resolve the smoke peak near the source region

Improving a Mother to Child HIV Transmission Programme through Health System Redesign: Quality Improvement, Protocol Adjustment and Resource Addition

Health systems that deliver prevention of mother to child transmission (PMTCT) services in low and middle income countries continue to underperform, resulting in thousands of unnecessary HIV infections of newborns each year. We used a combination of approaches to health systems strengthening to reduce transmission of HIV from mother to infant in a multi-facility public health system in South Africa.All primary care sites and specialized birthing centers in a resource constrained sub-district of Cape Metro District, South Africa, were enrolled in a quality improvement (QI) programme. All pregnant women receiving antenatal, intrapartum and postnatal infant care in the sub-district between January 2006 and March 2009 were included in the intervention that had a prototype-innovation phase and a rapid spread phase. System changes were introduced to help frontline healthcare workers to identify and improve performance gaps at each step of the PMTCT pathway. Improvement was facilitated and spread through the use of a Breakthrough Series Collaborative that accelerated learning and the spread of successful changes. Protocol changes and additional resources were introduced by provincial and municipal government. The proportion of HIV-exposed infants testing positive declined from 7.6% to 5%. Key intermediate PMTCT processes improved (antenatal AZT increased from 74% to 86%, PMTCT clients on HAART at the time of labour increased from 10% to 25%, intrapartum AZT increased from 43% to 84%, and postnatal HIV testing from 79% to 95%) compared to baseline.System improvement methods, protocol changes and addition/reallocation of resources contributed to improved PMTCT processes and outcomes in a resource constrained setting. The intervention requires a clear design, leadership buy-in, building local capacity to use systems improvement methods, and a reliable data system. A systems improvement approach offers a much needed approach to rapidly improve under-performing PMTCT implementation programmes at scale in sub-Saharan Africa

Silent, invisible and under-supported? : An autoethnographic journey through the valley of the shadow and youth mental health in Australia

This autoethnographic account of personal loss and consequent meaning-making aims to contribute to a unique understanding of young Australians facing both times of uncertainty and mental illness. As a qualitative study, it explores the lived experience of the researcher whose working life was spent in youth studies. This tacit knowledge seemed to fail as she tried to get help for her mentally ill son who died unexpectedly of a drug overdose. Using critical autoethnography and a highly reflexive approach, the researcher deploys three reflexive selves – mother-self, youth studies self, and autoethnographer/researcher-self – in order to answer the research question, How might a mother’s autoethnographic account of her son “falling through the cracks” help us to better understand and support Australian youth experiencing mental illness? The study contributes insights from a community perspective about the disjunction between policy promises and service delivery for young people with mental illness in Australia. The gap this thesis fills is methodological by nature, since the autoethnographic voice of a parent is rare in the multidisciplinary contexts of this research. Using youth studies as its theoretical framework, the literature review explores broad themes in youth studies as well as mental health, along with specific themes addressed throughout the thesis such as the experience of exclusion from decision-making, the issues of youth agency and mental illness, shame and stigma, suicidality and psychiatric treatment for mentally ill youth. The autoethnography itself is presented as two distinct chapters, the first tracing a narrative arc through migration, schooling, bullying, giftedness, existential angst, suicidality and mental illness, and the second continuing beyond the death of the researcher’s son, exploring the “broken dialogue” in mental health policy and service settings, laying bare a disjunction between the lay and professional views of mental illness. This thesis will be of interest and relevance for professionals who work with gifted youth as well as parents, teachers, policy-makers and others concerned with the mental health of Australian youth

Associations Between Eight Earth Observation-Derived Climate Variables and Enteropathogen Infection : An Independent Participant Data Meta-Analysis of Surveillance Studies With Broad Spectrum Nucleic Acid Diagnostics

Diarrheal disease, still a major cause of childhood illness, is caused by numerous, diverse infectious microorganisms, which are differentially sensitive to environmental conditions. Enteropathogen-specific impacts of climate remain underexplored. Results from 15 studies that diagnosed enteropathogens in 64,788 stool samples from 20,760 children in 19 countries were combined. Infection status for 10 common enteropathogens-adenovirus, astrovirus, norovirus, rotavirus, sapovirus, Campylobacter, ETEC, Shigella, Cryptosporidium and Giardia-was matched by date with hydrometeorological variables from a global Earth observation dataset-precipitation and runoff volume, humidity, soil moisture, solar radiation, air pressure, temperature, and wind speed. Models were fitted for each pathogen, accounting for lags, nonlinearity, confounders, and threshold effects. Different variables showed complex, non-linear associations with infection risk varying in magnitude and direction depending on pathogen species. Rotavirus infection decreased markedly following increasing 7-day average temperatures-a relative risk of 0.76 (95% confidence interval: 0.69-0.85) above 28 degrees C-while ETEC risk increased by almost half, 1.43 (1.36-1.50), in the 20-35 degrees C range. Risk for all pathogens was highest following soil moistures in the upper range. Humidity was associated with increases in bacterial infections and decreases in most viral infections. Several virus species' risk increased following lower-than-average rainfall, while rotavirus and ETEC increased with heavier runoff. Temperature, soil moisture, and humidity are particularly influential parameters across all enteropathogens, likely impacting pathogen survival outside the host. Precipitation and runoff have divergent associations with different enteric viruses. These effects may engender shifts in the relative burden of diarrhea-causing agents as the global climate changes. Plain Language Summary Diarrheal disease is a big health problem for children. It can be caused by different bugs, which can be caught more easily in certain weather conditions, though not much is understood about this because the climate varies so much from one place to the next. This study combined data from many different countries where diarrhea-causing bugs were diagnosed in children's stool. Satellites recorded what the weather was like on the day each sample was collected. Rotavirus is easiest to catch in cold weather and when water washes over the ground after rain. Dry weather also makes it and other viruses easy to catch. Bacteria spread best when the air is warm and humid, and the soil moist, though one type of E. coli can also be spread in rainwater. Climate change will make dry places drier, wet places wetter and everywhere warmer. This might lead to more diarrhea caused by bacteria and less by viruses in some places, though places with moist soil might see more of every kind of bug.Peer reviewe

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin