Newcomers in a hazardous environment; a qualitative inquiry of sex worker vulnerability to HIV in Bali, Indonesia

Background Women new to sex work and those with a greater degree of mobility have higher risk of HIV infection. Using social capital as a theoretical framework, we argue that better understanding of the interactions of micro-level structural factors can be valuable in reshaping and restructuring health promotion programmes in Bali to be more responsive to the concerns and needs of newcomer and mobile female sex workers (FSWs). Methods We conducted interviews with 11 newcomer FSWs (worked  six months). The interviews explored women’s experience of sex work including how and why they came to sex work, relationships with other FSWs and their HIV prevention practices. Results A thematic framework analysis revealed newcomer FSWs faced multiple levels of vulnerability that contributed to increased HIV risk. First, a lack of knowledge and self-efficacy about HIV prevention practices was related to their younger age and low exposure to sexual education. Second, on entering sex work, they experienced intensely competitive working environments fuelled by economic competition. This competition reduced opportunities for positive social networks and social learning about HIV prevention. Finally, the lack of social networks and social capital between FSWs undermined peer trust and solidarity, both of which are essential to promote consistent condom use. For example, newcomer FSWs did not trust that if they refused to have sex without a condom, their peers would also refuse; this increased their likelihood of accepting unprotected sex, thereby increasing HIV risk. Conclusions Public health and social welfare interventions and programmes need to build social networks, social support and solidarity within FSW communities, and provide health education and HIV prevention resources much earlier in women’s sex work careers.School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australi

Murine Dendritic Cells Transcriptional Modulation upon Paracoccidioides brasiliensis Infection

Limited information is available regarding the modulation of genes involved in the innate host response to Paracoccidioides brasiliensis, the etiologic agent of paracoccidioidomycosis. Therefore, we sought to characterize, for the first time, the transcriptional profile of murine bone marrow-derived dendritic cells (DCs) at an early stage following their initial interaction with P. brasiliensis. DCs connect innate and adaptive immunity by recognizing invading pathogens and determining the type of effector T-cell that mediates an immune response. Gene expression profiles were analyzed using microarray and validated using real-time RT-PCR and protein secretion studies. A total of 299 genes were differentially expressed, many of which are involved in immunity, signal transduction, transcription and apoptosis. Genes encoding the cytokines IL-12 and TNF-α, along with the chemokines CCL22, CCL27 and CXCL10, were up-regulated, suggesting that P. brasiliensis induces a potent proinflammatory response in DCs. In contrast, pattern recognition receptor (PRR)-encoding genes, particularly those related to Toll-like receptors, were down-regulated or unchanged. This result prompted us to evaluate the expression profiles of dectin-1 and mannose receptor, two other important fungal PRRs that were not included in the microarray target cDNA sequences. Unlike the mannose receptor, the dectin-1 receptor gene was significantly induced, suggesting that this β-glucan receptor participates in the recognition of P. brasiliensis. We also used a receptor inhibition assay to evaluate the roles of these receptors in coordinating the expression of several immune-related genes in DCs upon fungal exposure. Altogether, our results provide an initial characterization of early host responses to P. brasiliensis and a basis for better understanding the infectious process of this important neglected pathogen

Impact of recent legislative bills regarding clinical research on Italian ethics committee activity.

Abstract: Aims and background: The present work assessed the impact of two decrees on ethics committees in Italy, aimed at bringing the national laws on the conduct of clinical trials into line with the rest of the EC, and regulating and facilitating not-for-profit research. Material and methods: Prospectively collected data from an Italian multicentre study were examined with respect to the ethics review process. Administrative and time elements of the review process were audited. Main outcome measures were time between the application submission and the ethics committee definitive opinion, type and number of application submission forms, number of ethics committees that refused fee exemption, and time between the ethics committee approval and the administrative authorisation. Results: A total of 134 local research ethics committees (LRECs) were approached. Application submission procedures and application forms varied greatly; paper submission was mandatory. The median time from submission to approval was 72 days. Only two LRECs refused the fee exemption. The median time from LREC approval to administrative agreement was 50 days and only 9.6% of local authorities came to a verbal agreement with the sponsor. Conclusions: Italian LRECs are still not sufficiently efficient in complying with the Directive 2001/20/EC requirement (60 days). Better coordination of LRECs work is needed although the optimal level of coordination between them is still not known. In the meantime, national guidelines are needed concerning the application of Directive 2001/20/EC. The behaviour of Italian LRECs towards not-for-profit research was excellent although only the fee exemptio

Integrating clinical and biological prognostic biomarkers in patients with advanced NSCLC treated with immunotherapy: the DEMo score system

Background: Several biomarkers have been separately described to select patients for immunotherapy (IO), but few studies integrate these markers. Di Maio, EPSILoN and the plasma microRNA signature classifier (MSC), are three different clinico, biochemical and molecular markers able to independently predict prognosis in non-small cell lung cancer (NSCLC).Methods: Complete data such as sex, histology, ECOG-PS, stage, smoking status, presence of liver metastasis, LDH and neutrophils-to-lymphocyte ratio were collected to generate Di Maio and EPSILoN. The MSC risk level was prospectively assessed in plasma samples collected at baseline IO. The 3 markers were integrated into the DEMo score system prospectively tested in a cohort of 200 advanced NSCLC patients treated with IO. Endpoints were overall survival (OS), progression-free survival (PFS) and overall response rate (ORR).Results: DEMo separated patients in 7-risk groups whose median OS had a trend ranging from 29.7 to 1.5 months (P<0.0001). When comparing patients with the lowest (n=29) and the highest (n=35) DEMo scores ORR was 45% and 3%, respectively (P<0.0001). Considering the 53 PD-L1 >= 50% patients, DEMo identified a group of 13 (25%) patients who benefit less from IO in terms of both OS (HR: 8.81; 95% CI: 2.87-20.01) and PFS (HR: 6.82; 95% CI: 2.57-18.10). Twelve out of 111 (11%) patients who most benefit from IO according to OS (HR: 0.21; 95% CI: 0.07-0.62) and PFS (HR: 0.28; 95% CI: 0.12-0.65) were identified by DEMo in the PD-L1 <50% group.Conclusions: The DEMo prognostic score system stratified NSCLC patients treated with IO better than each single marker. The proper use of DEMo according to PD-L1 could improve selection in IO regimens

Integrated conservation and development: evaluating a community-based marine protected area project for equality of socioeconomic impacts

Despite the prevalence of protected areas, evidence of their impacts on people is weak and remains hotly contested in conservation policy. A key question in this debate is whether socioeconomic impacts vary according to social subgroup. Given that social inequity can create conflict and impede poverty reduction, understanding how protected areas differentially affect people is critical to designing them to achieve social and biological goals. Understanding heterogeneous responses to protected areas can improve targeting of management activities and help elucidate the pathways through which impacts of protected areas occur. Here, we assessed whether the socioeconomic impacts of marine protected areas (MPAs)—designed to achieve goals for both conservation and poverty alleviation—differed according to age, gender or religion in associated villages in North Sulawesi, Indonesia. Using data from pre-, mid- and post-implementation of the MPAs for control and project villages, we found little empirical evidence that impacts on five key socioeconomic indicators related to poverty differed according to social subgroup. We found suggestive empirical evidence that the effect of the MPAs on environmental knowledge differed by age and religion; over the medium and long terms, younger people and Muslims showed greater improvements compared with older people and Christians, respectively

Morphology and discrimination features of pollen from Italian olive cultivars (Olea europaea L.)

Pollen morphology of 14 cultivars of Olea europaea subsp. europaea var. europaea was analysed in order to discriminate main pollen types. The cultivars were selected from the most spread and early flowering crops grown in Italy. Morphometric parameters were observed on acetolysed pollen by means of light microscopy and scanning electron microscopy. Polar axis (P), equatorial diameter (E), P/E ratio, maximum distance between colpi in mesocolpium, distance between the apices of two colpi, exine thickness, maximum length of lumina in mesocolpium and in apocolpium, and exine reticulum thickness in mesocolpium have been measured. According to P and E, the 14 olive cultivars of this study can be divided into the three groups of small (P: 21.75 µm, E: 22.55 µm; ‘Manna’ and ‘Tonda di Cagliari’), large (P: 25.1 µm, E: 26.1 µm; ‘Pescarese’ and ‘Rotondella di Sanza’) and medium size (P: 23.49 µm, E: 24.54 µm, ‘Carolea’, ‘Grossa di Cassano’, ‘Giarraffa’, ‘Nocellara messinese’, ‘Nocellara del Belice’, ‘Santagatese’, ‘Intosso’, ‘Maiatica di Ferrandina’, ‘Nostrale di Fiano Romano’, ‘Santa Caterina’). Maximum length of lumina and exine thickness are useful parameters for further distinction of olive pollen groups, since these parameters are able to provide a specific pollen profile for each cultivar