A comparative analysis of perceived stigma among HIV-positive Ghanaian and African American males

The purpose of this paper was to address two questions: (i) Do Ghanaian and African American males with HIV/AIDS experience different types and degrees of stigma? and (ii) Is the impact of stigma associated with HIV/AIDS on the self different for Ghanaian and African American males? A quantitative method was used, and the four dimensions of stigma (social rejection, financial insecurity, internalised shame, and social interaction) were identified and measured using combination Likert-type questionnaires. Data regarding positive feelings of selfworth and self-deprecation, stress related to body image, and personal control were also collected in Ghana and the southeastern USA.The sample consisted of 55 men from Ghana and 55 men from the southeastern USA. Results indicate that values for the scales measuring stigma and self-perception were significantly higher for the Ghanaian sample than for the African American sample.Thus we conclude that the Ghanaian sample living with HIV/AIDS experienced a greater amount of negative self-perception and stigma-related strife than the African American sample.Keywords: stigma, HIV/AIDS, social rejection, financial insecurity, internalised shame, cultureRésuméLe but de cette communication est d'aborder deux questions, à savoir: (i) Est-ce que les hommes Ghanéens et Afro-Américains vivant avec le VIH/SIDA éprouvent de types et de degrés différents de stigmatisation? et (ii) Estce que l'impact de stigmatisation liée au VIH/SIDA sur le moi est différent chez les Ghanéens en comparaison aux Afro-Américains? Une méthode quantitative a été employée et les quatre dimensions de stigmatisation (le rejet social, l'insécurité financière, la honte intériorisée et l'interaction sociale) ont été identifiés et mesurés grâce à une combinaison des questionnaires Likert-type. Des données concernant des sentiments positifs de la valeur personnelle et d'auto-dénigrement, le stresse lié à l'image corporel et le contrôle de soi-même ont été recueilles au Ghana et au sud-est des États Unis. L'échantillon consistait de 55 hommes du Ghana et 55 hommes du sud-est des États Unis. Les chiffres des barèmes utilisées pour mesurer la stigmatisation et la perception de soi-même étaient sensiblement élevés pour l'échantillon ghanéen par rapport à l'échantillon afro-américain. L'échantillon ghanéen vivant avec le VIH/SIDA a davantage de perception négative de soi-même ainsi que la lutte liée à la stigmatisation par rapport à l'échantillon afro-américain.Mots clés: stigmatisation,VIH, SIDA, rejet social, insécurité financière, honte intériorisée, culture SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) Vol. 2(3) 2005: 344-35

Epistatic Interactions in Genetic Regulation of t-PA and PAI-1 Levels in a Ghanaian Population

The proteins, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1), act in concert to balance thrombus formation and degradation, thereby modulating the development of arterial thrombosis and excessive bleeding. PAI-1 is upregulated by the renin-angiotensin system (RAS), specifically by angiotensin II, the product of angiotensin converting enzyme (ACE) cleavage of angiotensin I, which is produced by the cleavage of angiotensinogen (AGT) by renin (REN). ACE indirectly stimulates the release of t-PA which, in turn, activates the corresponding fibrinolytic system. Single polymorphisms in these pathways have been shown to significantly impact plasma levels of t-PA and PAI-1 differently in Ghanaian males and females. Here we explore the involvement of epistatic interactions between the same polymorphisms in central genes of the RAS and fibrinolytic systems on plasma t-PA and PAI-1 levels within the same population (n = 992). Statistical modeling of pairwise interactions was done using two-way ANOVA between polymorphisms in the ETNK2, RENIN, ACE, PAI-1, t-PA, and AGT genes. The most significant interactions that associated with t-PA levels were between the ETNK2 A6135G and the REN T9435C polymorphisms in females (p = 0.006) and the REN T9435C and the TPA I/D polymorphisms (p = 0.005) in males. The most significant interactions for PAI-1 levels were with REN T9435C and the TPA I/D polymorphisms (p = 0.001) in females, and the association of REN G6567T with the TPA I/D polymorphisms (p = 0.032) in males. Our results provide evidence for multiple genetic effects that may not be detected using single SNP analysis. Because t-PA and PAI-1 have been implicated in cardiovascular disease these results support the idea that the genetic architecture of cardiovascular disease is complex. Therefore, it is necessary to consider the relationship between interacting polymorphisms of pathway specific genes that predict t-PA and PAI-1 levels

Out of the Orient: Post-Tethyan transoceanic and trans-Arabian routes fostered the spread of Baorini skippers in the Afrotropics

The origin of taxa presenting a disjunct distribution between Africa and Asia has puzzled biogeographers for more than a century. This biogeographic pattern has been hypothesized to be the result of transoceanic long-distance dispersal, Oligocene dispersal through forested corridors, Miocene dispersal through the Arabian Peninsula or passive dispersal on the rifting Indian plate. However, it has often been difficult to pinpoint the mechanisms at play. We investigate biotic exchange between the Afrotropics and the Oriental region during the Cenozoic, a period in which geological changes altered landmass connectivity. We use Baorini skippers (Lepidoptera, Hesperiidae) as a model, a widespread clade of butterflies in the Old World tropics with a disjunct distribution between the Afrotropics and the Oriental region. We use anchored phylogenomics to infer a robust evolutionary tree for Baorini skippers and estimate divergence times and ancestral ranges to test biogeographic hypotheses. Our phylogenomic tree recovers strongly supported relationships for Baorini skippers and clarifies the systematics of the tribe. Dating analyses suggest that these butterflies originated in the Oriental region, Greater Sunda Islands, and the Philippines in the early Miocene c. 23 Ma. Baorini skippers dispersed from the Oriental region towards Africa at least five times in the past 20 Ma. These butterflies colonized the Afrotropics primarily through trans-Arabian geodispersal after the closure of the Tethyan seaway in the mid-Miocene. Range expansion from the Oriental region towards the African continent probably occurred via the Gomphotherium land bridge through the Arabian Peninsula. Alternative scenarios invoking long-distance dispersal and vicariance are not supported. The Miocene climate change and biome shift from forested areas to grasslands possibly facilitated geodispersal in this clade of butterflies.Directorate for Biological Sciences. Grant Numbers: DEB‐1541500, DEB‐1541560.Peer reviewe

Assessing prognosis and prediction of treatment response in early rheumatoid arthritis: systematic reviews

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, debilitating disease associated with reduced quality of life and substantial costs. It is unclear which tests and assessment tools allow the best assessment of prognosis in people with early RA and whether or not variables predict the response of patients to different drug treatments. OBJECTIVE: To systematically review evidence on the use of selected tests and assessment tools in patients with early RA (1) in the evaluation of a prognosis (review 1) and (2) as predictive markers of treatment response (review 2). DATA SOURCES: Electronic databases (e.g. MEDLINE, EMBASE, The Cochrane Library, Web of Science Conference Proceedings; searched to September 2016), registers, key websites, hand-searching of reference lists of included studies and key systematic reviews and contact with experts. STUDY SELECTION: Review 1 - primary studies on the development, external validation and impact of clinical prediction models for selected outcomes in adult early RA patients. Review 2 - primary studies on the interaction between selected baseline covariates and treatment (conventional and biological disease-modifying antirheumatic drugs) on salient outcomes in adult early RA patients. RESULTS: Review 1 - 22 model development studies and one combined model development/external validation study reporting 39 clinical prediction models were included. Five external validation studies evaluating eight clinical prediction models for radiographic joint damage were also included. c-statistics from internal validation ranged from 0.63 to 0.87 for radiographic progression (different definitions, six studies) and 0.78 to 0.82 for the Health Assessment Questionnaire (HAQ). Predictive performance in external validations varied considerably. Three models [(1) Active controlled Study of Patients receiving Infliximab for the treatment of Rheumatoid arthritis of Early onset (ASPIRE) C-reactive protein (ASPIRE CRP), (2) ASPIRE erythrocyte sedimentation rate (ASPIRE ESR) and (3) Behandelings Strategie (BeSt)] were externally validated using the same outcome definition in more than one population. Results of the random-effects meta-analysis suggested substantial uncertainty in the expected predictive performance of models in a new sample of patients. Review 2 - 12 studies were identified. Covariates examined included anti-citrullinated protein/peptide anti-body (ACPA) status, smoking status, erosions, rheumatoid factor status, C-reactive protein level, erythrocyte sedimentation rate, swollen joint count (SJC), body mass index and vascularity of synovium on power Doppler ultrasound (PDUS). Outcomes examined included erosions/radiographic progression, disease activity, physical function and Disease Activity Score-28 remission. There was statistical evidence to suggest that ACPA status, SJC and PDUS status at baseline may be treatment effect modifiers, but not necessarily that they are prognostic of response for all treatments. Most of the results were subject to considerable uncertainty and were not statistically significant. LIMITATIONS: The meta-analysis in review 1 was limited by the availability of only a small number of external validation studies. Studies rarely investigated the interaction between predictors and treatment. SUGGESTED RESEARCH PRIORITIES: Collaborative research (including the use of individual participant data) is needed to further develop and externally validate the clinical prediction models. The clinical prediction models should be validated with respect to individual treatments. Future assessments of treatment by covariate interactions should follow good statistical practice. CONCLUSIONS: Review 1 - uncertainty remains over the optimal prediction model(s) for use in clinical practice. Review 2 - in general, there was insufficient evidence that the effect of treatment depended on baseline characteristics. STUDY REGISTRATION: This study is registered as PROSPERO CRD42016042402. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Host-switching by a vertically transmitted rhabdovirus in Drosophila

A diverse range of endosymbionts are found within the cells of animals. As these endosymbionts are normally vertically transmitted, we might expect their evolutionary history to be dominated by host-fidelity and cospeciation with the host. However, studies of bacterial endosymbionts have shown that while this is true for some mutualists, parasites often move horizontally between host lineages over evolutionary timescales. For the first time, to our knowledge, we have investigated whether this is also the case for vertically transmitted viruses. Here, we describe four new sigma viruses, a group of vertically transmitted rhabdoviruses previously known in Drosophila. Using sequence data from these new viruses, and the previously described sigma viruses, we show that they have switched between hosts during their evolutionary history. Our results suggest that sigma virus infections may be short-lived in a given host lineage, so that their long-term persistence relies on rare horizontal transmission events between hosts

An Open Label, Randomised Trial of Artesunate+Amodiaquine, Artesunate+Chlorproguanil-Dapsone and Artemether-Lumefantrine for the Treatment of Uncomplicated Malaria

BACKGROUND: Artesunate+amodiaquine (AS+AQ) and artemether-lumefantrine (AL) are now the most frequently recommended first line treatments for uncomplicated malaria in Africa. Artesunate+chlorproguanil-dapsone (AS+CD) was a potential alternative for treatment of uncomplicated malaria. A comparison of the efficacy and safety of these three drug combinations was necessary to make evidence based drug treatment policies. METHODS: Five hundred and thirty-four, glucose-6-phosphate dehydrogenase (G6PD) normal children were randomised in blocks of 15 to the AS+AQ, AL or AS+CD groups. Administration of study drugs was supervised by project staff and the children were followed up at r home on days 1,2,3,7,14 and 28 post treatment. Parasitological and clinical failures and adverse events were compared between the study groups. MAIN FINDINGS: In a per-protocol analysis, the parasitological and clinical failure rate at day 28 post treatment (PCF28) was lower in the AS+AQ group compared to the AL or AS+CD groups (corrected for re-infections: 6.6% vs 13.8% and 13.8% respectively, p = 0.08; uncorrected: 14.6% vs 27.6% and 28.1% respectively, p = 0.005). In the intention to treat analysis, the rate of early treatment failure was high in all three groups (AS+AQ 13.3%; AL 15.2%; and AS+CD 9.3%, p = 0.2) primarily due to vomiting. However, the PCF28 corrected for re-infection was lower, though not significantly, in the AS+AQ group compared to the AL or the AS+CD groups (AS+AQ 18.3%; AL 24.2%; AS+CD 20.8%, p = 0.4) The incidence of adverse events was comparable between the groups. CONCLUSIONS: AS+AQ is an appropriate first line treatment for uncomplicated malaria in Ghana and possibly in the neighbouring countries in West Africa. The effectiveness of AL in routine programme conditions needs to be studied further in West Africa. TRIAL REGISTRATION: ClinicalTrials.gov NCT00119145

Understanding the experience and impact of living with a vascular condition from the patients perspective: a qualitative evidence synthesis protocol

Background: Patient reported outcome measures (PROMs) provide a way of measuring outcomes elicited directly from the patient. It is important that PROMs cover the domains that are important to patients. This can be achieved by conducting qualitative research studies looking at patient experiences. Objectives: The aim of this qualitative evidence synthesis will be to examine the symptoms and quality of life domains that are important from the perspective of the patient with peripheral arterial disease (PAD), abdominal aortic aneurysm (AAA), carotid artery disease (CAD), varicose veins (VV) and venous leg ulcers (VLU). Methods: Searches will be conducted in CINAHL via EBSCO, MEDLINE and MEDLINE in Process via Ovid, EMBASE via Ovid, PsycINFO via Ovid, Social Science Citation Index/Science Citation Index via Web of Science (Thomson Reuters) and Proquest dissertations and theses to identify primary qualitative studies reporting on patients’ health or QoL for the 5 vascular conditions. The methods of each study will be assessed for quality using the CASP criteria, 10 questions to help you make sense of qualitative research. Data will be extracted and synthesised using a framework analysis in Nvivo. Discussion: This qualitative evidence synthesis will identify studies that are qualitatively exploring health and QoL life outcomes for people with one of the 5 conditions to inform the selection of patient reported outcome measures and identify targets for future research. This review forms part of a larger project concerned with selecting PROMs for use in vascular services