Impact of gender, sexual orientation and socio-economic factors on HIV treatment outcomes in the UK

The effectiveness of antiretroviral therapy (ART) has led to greatly improved prognosis for people living with HIV, such that they now have a similar life expectancy to the general population. However, these improvements over time have not necessarily been seen equally among all demographic groups. The aim of this thesis was to investigate the differences in virological response to ART, treatment adherence, and late HIV diagnosis by gender and sexual orientation among people with HIV in the UK, and assess whether any differences have narrowed in more recent years. Additional analyses explored whether socio-economic factors could explain the observed differences in outcome across gender/sexual orientation groups. The analyses were based on data from two observational UK studies: the Royal Free HIV Cohort Study and the Antiretrovirals Sexual Transmission Risk and Attitudes (ASTRA) questionnaire study. Results showed that, among individuals on ART, women and men who have sex with women (MSW) had a higher prevalence of detectable viral load and lower CD4 counts than men who have sex with men (MSM). Similarly, for initial response to first-line ART, virological outcomes were less favourable for women and MSW, compared to MSM even in the most recent years, and there was no evidence that these differences in outcome were narrowing over time. Socio-economic disadvantage (financial hardship; non-employment; renting; unstable housing status; non-university education) was strongly associated with higher prevalence of ART non-adherence and poorer virological outcomes. Socio-economic status explained much of the disparities in treatment outcomes between MSM and women, but less between MSW and MSM. A considerably higher prevalence of late diagnosis was seen among women and MSW compared to MSM. In conclusion, this thesis identified ongoing disparities in HIV outcomes between gender/sexual orientation groups. Clinical management strategies should focus on demographic and socio-economic groups at risk of poorer treatment outcomes

Kidney function in the very elderly with hypertension: data from the hypertension in the very elderly (HYVET) trial.

BACKGROUND: numerous reports have linked impaired kidney function to a higher risk of cardiovascular events and mortality. There are relatively few data relating to kidney function in the very elderly. METHODS: the Hypertension in the Very Elderly Trial (HYVET) was a randomised placebo-controlled trial of indapamide slow release 1.5mg ± perindopril 2-4 mg in those aged ≥80 years with sitting systolic blood pressures of ≥160 mmHg and diastolic pressures of <110 mmHg. Kidney function was a secondary outcome. RESULTS: HYVET recruited 3,845 participants. The mean baseline estimated glomerular filtration rate (eGFR) was 61.7 ml/min/1.73 m(2). When categories of the eGFR were examined, there was a possible U-shaped relationship between eGFR, total mortality, cardiovascular mortality and events. The nadir of the U was the eGFR category ≥60 and <75 ml/min/1.73 m(2). Using this as a comparator, the U shape was clearest for cardiovascular mortality with the eGFR <45 ml/min/1.73 m(2) and ≥75 ml/min/1.73 m(2) showing hazard ratios of 1.88 (95% CI: 1.2-2.96) and 1.36 (0.94-1.98) by comparison. Proteinuria at baseline was also associated with an increased risk of later heart failure events and mortality. CONCLUSIONS: although these results should be interpreted with caution, it may be that in very elderly individuals with hypertension both low and high eGFR indicate increased risk

Constraint Treatment for Chronic Aphasia: Do Treatment Gains Generalize to Story Retelling?

The current investigation included 8 participants with aphasia of greater than 3 years duration in Constraint-Induced Language Therapy (CILT). We sought to determine if CILT treatment gains generalized to Narrative Story Card (Helm-Estabrooks & Nicholas, 2003) retelling. We examined two outcome measures, number words produced and content information units, to determine whether quantity of language, quality of language, or both increased with CILT. Although CILT was beneficial to people with chronic aphasia, gains made in treatment generalized only modestly to Narrative Story Card retelling for most participants. Performance across individuals was quite variable and was not well-characterized by group performance

Koinonia

Themed HousingTheme Houses: Getting to the Foundations of Community, Jim McCormick A Year in the Little Yellow House, Lisa Burch Conference SpotlightBuilding Cross Cultural Community, Stuart C. Lord ArticlesStandards of Excellence in Short-Term Mission, Jenny Collins Follow Me : Intimacy with God Through Spiritual Direction, Tracy Balzer Faith, Wisdom and Grace: Walt Campbell Interviews, Steve Austin FeaturesThe President\u27s Corner Editor\u27s Disk Thinking Theologically: Learning Communities, Todd Reamhttps://pillars.taylor.edu/acsd_koinonia/1010/thumbnail.jp

Competition and the origins of novelty: experimental evolution of niche-width expansion in a virus

Competition for resources has long been viewed as a key agent of divergent selection. Theory holds that populations facing severe intraspecific competition will tend to use a wider range of resources, possibly even using entirely novel resources that are less in demand. Yet, there have been few experimental tests of these ideas. Using the bacterial virus (bacteriophage) ϕ6 as a model system, we examined whether competition for host resources promotes the evolution of novel resource use. In the laboratory, ϕ6 exhibits a narrow host range but readily produces mutants capable of infecting novel bacterial hosts. Here, we show that when ϕ6 populations were subjected to intense intraspecific competition for their standard laboratory host, they rapidly evolved new generalist morphs that infect novel hosts. Our results therefore suggest that competition for host resources may drive the evolution of host range expansion in viruses. More generally, our findings demonstrate that intraspecific resource competition can indeed promote the evolution of novel resource-use phenotypes

Evolutionary rescue and the coexistence of generalist and specialist competitors: an experimental test

Competition for resources is thought to play a critical role in both the origins and maintenance of biodiversity. Although numerous laboratory evolution experiments have confirmed that competition can be a key driver of adaptive diversification, few have demonstrated its role in the maintenance of the resulting diversity. We investigate the conditions that favour the origin and maintenance of alternative generalist and specialist resource-use phenotypes within the same population. Previously, we confirmed that competition for hosts among φ6 bacteriophage in a mixed novel (non-permissive) and ancestral (permissive) host microcosm triggered the evolution of a generalist phenotype capable of infecting both hosts. However, because the newly evolved generalists tended to competitively exclude the ancestral specialists, coexistence between the two phenotypes was rare. Here, we show that reducing the relative abundance of the novel host slowed the increase in frequency of the generalist phenotype, allowing sufficient time for the specialist to further adapt to the ancestral host. This adaptation resulted in ‘evolutionary rescue’ of the specialists, preventing their competitive exclusion by the generalists. Thus, our results suggest that competition promotes both the origin and maintenance of biodiversity when it is strong enough to favour a novel resource-use phenotype, but weak enough to allow adaptation of both the novel and ancestral phenotypes to their respective niches

Haemoglobin, anaemia, dementia and cognitive decline in the elderly, a systematic review

<p>Abstract</p> <p>Background</p> <p>Anaemia may increase risk of dementia or cognitive decline. There is also evidence that high haemoglobin levels increase risk of stroke, and consequently possible cognitive impairment. The elderly are more at risk of developing dementia and are also more likely to suffer from anaemia, although there is relatively little longitudinal literature addressing this association.</p> <p>Methods</p> <p>To evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and anaemia or haemoglobin level, we conducted a systematic review and meta-analyses of peer reviewed publications. Medline, Embase and PsychInfo were searched for English language publications between 1996 and 2006. Criteria for inclusion were longitudinal studies of subjects aged ≥65, with primary outcomes of incident dementia or cognitive decline. Other designs were excluded.</p> <p>Results</p> <p>Three papers were identified and only two were able to be combined into a meta-analysis. The pooled hazard ratio for these two studies was 1.94 (95 percent confidence intervals of 1.32–2.87) showing a significantly increased risk of incident dementia with anaemia. It was not possible to investigate the effect of higher levels of haemoglobin.</p> <p>Conclusion</p> <p>Anaemia is one factor to bear in mind when evaluating risk of incident dementia. However, there are few data available and the studies were methodologically varied so a cautionary note needs to be sounded and our primary recommendation is that further robust research be carried out.</p

Analysis of part of the chicken Rfp-Y region reveals two novel lectin genes, the first complete genomic sequence of a class I α-chain gene, a truncated class II β-chain gene, and a large CR1 repeat

The Rfp-Y region lies on the same microchromosome as the B-F/B-L region of the B complex, yet in contrast to the latter it is poorly characterised. To date it has been shown to contain at least two class I alpha-chain ( Y-F) genes, a class II B-chain gene and a C-type lectin-like gene. We describe the sequencing and analysis of some 20 kb of the Rfp-Y region, and identify several new genes. These include two novel C-type lectin-like genes ( Y-Lec1 and Y-Lec2) that differ strongly from the previously described C-type lectin-like gene found in the Rfp-Y region. We describe a complete genomic sequence of a class I alpha-chain ( Y-F) gene and its promoter from the Rfp-Y region. The predicted cDNA from this gene has high homology to the previously reported Y-F cDNAs. The promoter contains an altered enhancer A element. This portion of the Rfp-Y region also contains a truncated class II B-chain ( Y-LB) gene, as well as a large chicken repeat 1 (CR1) element

Introductory programming: a systematic literature review

As computing becomes a mainstream discipline embedded in the school curriculum and acts as an enabler for an increasing range of academic disciplines in higher education, the literature on introductory programming is growing. Although there have been several reviews that focus on specific aspects of introductory programming, there has been no broad overview of the literature exploring recent trends across the breadth of introductory programming. This paper is the report of an ITiCSE working group that conducted a systematic review in order to gain an overview of the introductory programming literature. Partitioning the literature into papers addressing the student, teaching, the curriculum, and assessment, we explore trends, highlight advances in knowledge over the past 15 years, and indicate possible directions for future research