Implementing a Pre-Exposure Prophylaxis Intervention for Safer Conception among HIV Serodiscordant Couples: Recommendations for Health Care Providers

Couples in HIV serodiscordant relationships frequently desire children. Although partners who are virally suppressed pose almost no risk of transmitting HIV to their partners, partners who are inconsistently on therapy may transmit HIV to their partners when attempting to conceive. Pre-exposure prophylaxis (PrEP) is an available safer conception strategy for these couples but is not consistently offered. We sought to better understand barriers to PrEP implementation for couples seeking conception and patient perceptions on what providers could do to encourage use. We conducted in-depth, qualitative interviews with 11 participants representing six couples taking PrEP for safer conception in a safety-net hospital in New England. Semi-structured qualitative interviews assessed the following: Relationship nature and contextual factors; attitudes and perceptions regarding PrEP for safer conception; experience within health care systems related to HIV and PrEP; and facilitators, barriers, and other experiences using PrEP for safer conception. Four key themes have important implications for implementation of PrEP for safer conception: Knowledge and understanding gaps regarding HIV and PrEP among both members of the couple, role of insurance and financing in decision-making, learning to manage and adhere to a treatment plan, and the need for providers to enhance knowledge and offer further support. Addressing barriers to safer conception strategies at multiple levels is needed to prevent HIV transmission within serodiscordant couples who desire children. Providers can play an important role in lowering these barriers through the use of multiple strategies

Task force on immigration and higher education in Central Massachusetts

In August 2007, the Colleges of Worcester Consortium, Inc. created a task force to examine the issue of immigration and higher education in Central Massachusetts. It has become increasingly clear from recent demographic and economic studies and projections that the population in the northeast, and certainly in Central Massachusetts, is showing minimal growth. There is evidence that a decline in the “native-born” population is caused by significant out-migration due to a number of factors, including the high cost of living, limited career opportunities and a declining birth rate. The limited population growth that is evident is due primarily to the recent influx of immigrants to this area, with the most significant numbers in Worcester coming from Ghana, Brazil, the Dominican Republic, Kenya, El Salvador, Albania and Liberia. It is also clear that the area’s economy is becoming more knowledge-based with an increasing percentage of all new jobs requiring some form of postsecondary education. According to the 2007 Massachusetts Department of Workforce Development’s Job Vacancy Survey, 38 percent of current job vacancies in Massachusetts require an associate’s degree or higher. This represents an increase from 30 percent in 2003. Consequently, the level of education that the immigrant population attains is of vital importance to everyone—not only to immigrant students and their families but also to the economic well-being of the entire region. The Task Force was charged with researching the barriers to higher education faced by this new wave of immigrants and suggesting recommendations to address those barriers. The 36-member Task Force was made up of representatives from Consortium member institutions; federal, state and local governments; community and faithbased organizations; the Worcester Public Schools; the Massachusetts Board of Higher Education; and the Massachusetts Immigrant and Refugee Advocacy (MIRA) Coalition. Meetings were held over six months, during which the Task Force identified three main barriers faced by immigrant communities in accessing higher education, and sub-committees were created to work on each of these. Speakers were invited to present on topics of interest. Two public hearings were held, the first of which was conducted at Worcester State College in October. It attracted community representatives, as well as college and high school faculty and administrators. The second hearing, held at the downtown branch of Quinsigamond Community College (QCC) in December, was attended by immigrants (English for Speakers of Other Languages – ESOL and GED) students as well as QCC staff.Published versio

Methodologies for Housing Justice Resource Guide

This Resource Guide is the outcome of a Summer Institute on Methodologies for Housing Justice convened by the Institute on Inequality and Democracy at UCLA Luskin as part of the Housing Justice in Unequal Cities Network, which is supported by the National Science Foundation (BCS 1758774). Held in Los Angeles in August 2019, the Summer Institute brought together participants from cities around the world. As is the case with the overall scope and purpose of the Housing Justice in Unequal Cities Network, it created a shared terrain of scholarship for movement-based and university-based scholars. Dissatisfied with the canonical methods that are in use in housing studies and guided by housing justice movements that are active research communities, the Summer Institute was premised on the assertion that methodology is political. Methodology is rooted in arguments about the world and involves relations of power and knowledge. The method itself – be it countermapping or people’s diaries – does not ensure an ethics of solidarity and a purpose of justice. Such goals require methodologies for liberation. Thus, as is evident in this Resource Guide, our endeavor foregrounds innovative methods that are being used by researchers across academia and activism and explicitly situates such methods in an orientation towards housing justice

Metodologías para la justicia de la vivienda: Guia de recursos

Esta Guía de Recursos es el resultado de un Instituto de Verano sobre Metodologías para la Justicia en la Vivienda convocado por el Instituto sobre Desigualdad y Democracia de UCLA Luskin como parte de la Red de Justicia en la Vivienda en Ciudades Desiguales, que es apoyada por la Fundación Nacional de Ciencias (BCS 1758774). Celebrado en Los Ángeles en agosto de 2019, el Instituto de Verano reunió a participantes de ciudades de todo el mundo. Al igual que el alcance y el propósito general de la Red de Justicia en las Ciudades Desiguales, creó un terreno compartido de para estudiosos del movimiento y académicos de universidades. Con una insatisfacción a los métodos canónicos que se utilizan en los estudios sobre la vivienda y guiado por los movimientos de justicia de la vivienda que son comunidades de investigación activa, el Instituto de verano se basó en la afirmación de que la metodología es política. La metodología se basa en argumentos sobre el mundo e implica relaciones de poder y conocimiento. El método por sí mismo -ya sea el contra ataque al mapeo o los diarios de la genteno asegura una ética de solidaridad y un propósito de justicia. Tales objetivos requieren metodologías para la liberación. Por lo tanto, como es evidente en esta Guía de Recursos, nuestro esfuerzo pone en primer plano los métodos innovadores que están siendo utilizados por los investigadores en todo el mundo académico y el activismo y sitúa explícitamente tales métodos en una orientación hacia la vivienda la justicia

Health-related quality of life and strain in caregivers of Australians with Parkinson’s disease : An observational study

Background: The relationship between health-related quality of life (HRQoL) in people with Parkinson’s disease and their caregivers is little understood and any effects on caregiver strain remain unclear. This paper examines these relationships in an Australian sample. Methods: Using the generic EuroQol (EQ-5D) and disease-specific Parkinson’s Disease Questionnaire-39 Item (PDQ- 39), HRQoL was evaluated in a sample of 97 people with PD and their caregivers. Caregiver strain was assessed using the Modified Caregiver Strain Index. Associations were evaluated between: (i) caregiver and care-recipient HRQoL; (ii) caregiver HRQoL and caregiver strain, and; (iii) between caregiver strain and care-recipient HRQoL. Results: No statistically significant relationships were found between caregiver and care-recipient HRQoL, or between caregiver HRQoL and caregiver strain. Although this Australian sample of caregivers experienced relatively good HRQoL and moderately low strain, a significant correlation was found between HRQoL of people with PD and caregiver strain (rho 0.43, p<.001). Conclusion: Poor HRQoL in people with PD is associated with higher strain in caregivers. Therapy interventions may target problems reported as most troublesome by people with PD, with potential to reduce strain on the caregive

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe

Scalable, efficient, and fault-tolerant data center networking

The advent of cloud computing and the expectation of anytime availability of user data and services have brought data center design to the forefront of computer science research. Modern data centers can be massive in size, consisting of hundreds of thousands of servers and millions of virtualized end hosts. At this scale and complexity, the underlying network becomes central to data center scalability, efficiency, availability and fault tolerance. Given the scale of today's data center networks, operators typically turn to symmetric, highly structured network topologies, sacrificing flexibility for relative simplicity. These topologies tend to have an "all or nothing'' tradeoff between fault tolerance and scalability. Over these topologies, data center operators often run protocols borrowed from the Internet, an environment that is drastically different from that of the data center. Because these protocols have not been built for the data center, they can operate and interact in unexpected and undesirable ways. Moreover, they are generally vetted by virtue of having survived in the Internet, rather than by formal reasoning. This makes the management burden associated with configuration, maintenance and error diagnosis for these protocols substantial, leading to compromised efficiency and availability. The first contribution of this dissertation is the introduction of a new class of network topologies called Aspen trees. Aspen trees provide the high throughput and path multiplicity of current data center network topologies while also allowing a network operator to select a particular point on the scalability versus fault tolerance spectrum. This addresses the challenge of supporting simultaneous scalability and fault tolerance in data center networks. Next, the challenge of providing scalable and efficient communication is addressed with the design of ALIAS, a protocol for scalable, automatic and decentralized addressing and communication in the data center. Finally, this dissertation presents a formalization and proof of correctness of the fundamental building block of ALIAS, thus enabling feasible configuration and maintenance of ALIAS in the data center. This combination of tunable topology structure and tailored communication protocols enables scalable, efficient and fault-tolerant data center communicatio

Scalable, efficient, and fault-tolerant data center networking

The advent of cloud computing and the expectation of anytime availability of user data and services have brought data center design to the forefront of computer science research. Modern data centers can be massive in size, consisting of hundreds of thousands of servers and millions of virtualized end hosts. At this scale and complexity, the underlying network becomes central to data center scalability, efficiency, availability and fault tolerance. Given the scale of today's data center networks, operators typically turn to symmetric, highly structured network topologies, sacrificing flexibility for relative simplicity. These topologies tend to have an "all or nothing'' tradeoff between fault tolerance and scalability. Over these topologies, data center operators often run protocols borrowed from the Internet, an environment that is drastically different from that of the data center. Because these protocols have not been built for the data center, they can operate and interact in unexpected and undesirable ways. Moreover, they are generally vetted by virtue of having survived in the Internet, rather than by formal reasoning. This makes the management burden associated with configuration, maintenance and error diagnosis for these protocols substantial, leading to compromised efficiency and availability. The first contribution of this dissertation is the introduction of a new class of network topologies called Aspen trees. Aspen trees provide the high throughput and path multiplicity of current data center network topologies while also allowing a network operator to select a particular point on the scalability versus fault tolerance spectrum. This addresses the challenge of supporting simultaneous scalability and fault tolerance in data center networks. Next, the challenge of providing scalable and efficient communication is addressed with the design of ALIAS, a protocol for scalable, automatic and decentralized addressing and communication in the data center. Finally, this dissertation presents a formalization and proof of correctness of the fundamental building block of ALIAS, thus enabling feasible configuration and maintenance of ALIAS in the data center. This combination of tunable topology structure and tailored communication protocols enables scalable, efficient and fault-tolerant data center communicatio