From scaling up to sustainability in HIV: potential lessons for moving forward

Background: In 30 years of experience in responding to the HIV epidemic, critical decisions and program characteristics for successful scale-up have been studied. Now leaders face a new challenge: sustaining large-scale HIV prevention programs. Implementers, funders, and the communities served need to assess what strategies and practices of scaling up are also relevant for sustaining delivery at scale. Methods: We reviewed white and gray literature to identify domains central to scaling-up programs and reviewed HIV case studies to identify how these domains might relate to sustaining delivery at scale. Results: We found 10 domains identified as important for successfully scaling up programs that have potential relevance for sustaining delivery at scale: fiscal support; political support; community involvement, integration, buy-in, and depth; partnerships; balancing flexibility/adaptability and standardization; supportive policy, regulatory, and legal environment; building and sustaining strong organizational capacity; transferring ownership; decentralization; and ongoing focus on sustainability. We identified one additional potential domain important for programs sustaining delivery at scale: emphasizing equity. Conclusions: Today, the public and private sector are examining their ability to generate value for populations. All stakeholders are aiming to stem the tide of the HIV epidemic. Implementers need a framework to guide the evolution of their strategies and management practices. Greater research is needed to refine the domains for policy and program implementers working to sustain HIV program delivery at scale

What is the Best Measure of Daytime Sleepiness in Adults With Heart Failure?

Purpose To identify the best screening measure of daytime sleepiness in adults with heart failure (HF). Data sources A total of 280 adults with HF completed the Epworth Sleepiness Scale, the Stanford Sleepiness Scale, and a single Likert item measuring daytime sleepiness. The sensitivity and specificity of these self-report measures were assessed in relation to a measure of daytime dysfunction from poor sleep quality. Conclusions Only 16% of the sample reported significant daytime dysfunction because of poor sleep quality. Those reporting daytime dysfunction were likely to be younger (p \u3c .001), to be unmarried (p = .002), to have New York Heart Association (NYHA) functional class IV HF (p = .015), and to report low income (p = .006) and fewer hours of sleep (p = .015). The measure of daytime sleepiness that was most sensitive to daytime dysfunction was a single Likert item measured on a 10-point (1–10) scale. Patients with a score ≥4 were 2.4 times more likely to have daytime dysfunction than those with a score \u3c4. Implications for practice Complaints of daytime dysfunction because of poor sleep are not common in adults with HF. Routine use of a single question about daytime sleepiness can help nurse practitioners to identify those HF patients with significant sleep issues that may require further screening

Characteristics of EGRET Blazars in the VLBA Imaging and Polarimetry Survey (VIPS)

We examine the radio properties of EGRET-detected blazars observed as part of the VLBA Imaging and Polarimetry Survey (VIPS). VIPS has a flux limit roughly an order of magnitude below the MOJAVE survey and most other samples that have been used to study the properties of EGRET blazars. At lower flux levels, radio flux density does not directly correlate with gamma-ray flux density. We do find that the EGRET-detected blazars tend to have higher brightness temperatures, greater core fractions, and possibly larger than average jet opening angles. A weak correlation is also found with jet length and with polarization. All of the well-established trends can be explained by systematically larger Doppler factors in the gamma-ray loud blazars, consistent with the measurements of higher apparent velocities found in monitoring programs carried out at radio frequencies above 10 GHz.Comment: 20 pages, 7 figures, accepted to Ap

Celebrity culture and public connection: bridge or chasm?

Media and cultural research has an important contribution to make to recent debates about declines in democratic engagement: is for example celebrity culture a route into democratic engagement for those otherwise disengaged? This article contributes to this debate by reviewing qualitative and quantitative findings from a UK project on 'public connection'. Using self-produced diaries (with in-depth multiple interviews) as well as a nationwide survey, the authors argue that while celebrity culture is an important point of social connection sustained by media use, it is not linked in citizens' own accounts to issues of public concern. Survey data suggest that those who particularly follow celebrity culture are the least engaged in politics and least likely to use their social networks to involve themselves in action or discussion about public-type issues. This does not mean 'celebrity culture' is 'bad', but it challenges suggestions of how popular culture might contribute to effective democracy

Deficiency in Nrf2 transcription factor decreases adipose tissue mass and hepatic lipid accumulation in leptin‐deficient mice

Objective: To evaluate whether Nrf2 deficiency impacts insulin resistance and lipid accumulation in liver and white adipose tissue. Methods: Lepob/ob mice (OB) with targeted Nrf2 deletion (OB‐Nrf2KO) were generated. Pathogenesis of obesity and type 2 diabetes was measured in C57BL/6J, Nrf2KO, OB, and OB‐Nrf2KO mice. Hepatic lipid content, lipid clearance, and very low‐density lipoprotein (VLDL) secretion were determined between OB and OB‐Nrf2KO mice. Results: OB‐Nrf2KO mice exhibited decreased white adipose tissue mass and decreased adipogenic and lipogenic gene expression compared with OB mice. Nrf2 deficiency prolonged hyperglycemia in response to glucose challenge, which was paralleled by reduced insulin‐stimulated Akt phosphorylation. In OB mice, Nrf2 deficiency decreased hepatic lipid accumulation, decreased peroxisome proliferator‐activated receptor γ expression and nicotinamide adenine dinucleotide phosphate (NADPH) content, and enhanced VLDL secretion. However, this observation was opposite in lean mice. Additionally, OB‐Nrf2KO mice exhibited increased plasma triglyceride content, decreased HDL‐cholesterol content, and enhanced apolipoprotein B expression, suggesting Nrf2 deficiency caused dyslipidemia in these mice. Conclusions: Nrf2 deficiency in Lepob/ob mice reduced white adipose tissue mass and prevented hepatic lipid accumulation but induced insulin resistance and dyslipidemia. This study indicates a dual role of Nrf2 during metabolic dysregulation—increasing lipid accumulation in liver and white adipose tissue but preventing lipid accumulation in obese mice

Double jeopardy: the influence of excessive daytime sleepiness and impaired cognition on health‐related quality of life in adults with heart failure

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106066/1/ejhfhfs054.pd

The Robinson Gravitational Wave Background Telescope (BICEP): a bolometric large angular scale CMB polarimeter

The Robinson Telescope (BICEP) is a ground-based millimeter-wave bolometric array designed to study the polarization of the cosmic microwave background radiation (CMB) and galactic foreground emission. Such measurements probe the energy scale of the inflationary epoch, tighten constraints on cosmological parameters, and verify our current understanding of CMB physics. Robinson consists of a 250-mm aperture refractive telescope that provides an instantaneous field-of-view of 17 degrees with angular resolution of 55 and 37 arcminutes at 100 GHz and 150 GHz, respectively. Forty-nine pair of polarization-sensitive bolometers are cooled to 250 mK using a 4He/3He/3He sorption fridge system, and coupled to incoming radiation via corrugated feed horns. The all-refractive optics is cooled to 4 K to minimize polarization systematics and instrument loading. The fully steerable 3-axis mount is capable of continuous boresight rotation or azimuth scanning at speeds up to 5 deg/s. Robinson has begun its first season of observation at the South Pole. Given the measured performance of the instrument along with the excellent observing environment, Robinson will measure the E-mode polarization with high sensitivity, and probe for the B-modes to unprecedented depths. In this paper we discuss aspects of the instrument design and their scientific motivations, scanning and operational strategies, and the results of initial testing and observations.Comment: 18 pages, 11 figures. To appear in Millimeter and Submillimeter Detectors and Instrumentation for Astronomy III, Proceedings of SPIE, 6275, 200

Predictors of Objectively Measured Medication Nonadherence in Adults With Heart Failure

Background—Medication nonadherence rates are high. The factors predicting nonadherence in heart failure remain unclear. Methods and Results—A sample of 202 adults with heart failure was enrolled from the northeastern United States and followed for 6 months. Specific aims were to describe the types of objectively measured medication adherence (eg, taking, timing, dosing, drug holidays) and to identify contributors to nonadherence 6 months after enrollment. Latent growth mixture modeling was used to identify distinct trajectories of adherence. Indicators of the 5 World Health Organization dimensions of adherence (socioeconomic, condition, therapy, patient, and healthcare system) were tested to identify contributors to nonadherence. Two distinct trajectories were identified and labeled persistent adherence (77.8%) and steep decline (22.3%). Three contributors to the steep decline in adherence were identified. Participants with lapses in attention (adjusted OR, 2.65; P=0.023), those with excessive daytime sleepiness (OR, 2.51; P=0.037), and those with ≥2 medication dosings per day (OR, 2.59; P=0.016) were more likely to have a steep decline in adherence over time than to have persistent adherence. Conclusions—Two distinct patterns of adherence were identified. Three potentially modifiable contributors to nonadherence have been identified