Understanding the acceptability and utility of early antiretroviral therapy to reduce transmission of HIV amongst men who have sex with men in the UK

High viraemia in early HIV infection (EHI) may contribute disproportionately to onward transmission in men who have sex with men (MSM) but early antiretroviral therapy (ART) could minimise risk of transmission. The effectiveness of this strategy depends on viral load (VL) at presentation, sexual behaviour and ART acceptability, which are unknown. This thesis combines quantitative and qualitative methods to understand the acceptability and utility of early ART to reduce HIV transmission in UK MSM. Using UK Register of HIV Seroconverters data I examined temporal trends in ART initiation and VL at presentation, using Kaplan-Meier and logistic regression. An in-depth interview and cross-sectional survey explored and quantified men’s attitudes, beliefs and acceptability of early ART and sexual behaviour. Using logistic regression I examined factors associated with early ART initiation and high-risk sex post diagnosis. VL peaked in men presenting ~30 days post-seroconversion, plateauing ~day 100. Median(95% CI) time from seroconversion to ART initiation decreased, from 3.7(3.2,4.9) years pre-2000 to 1.4(1.3,1.7) in 2010-11. Early ART was acceptable; 67%(76/114) would have accepted it at diagnosis and 47%(55/116) had initiated it. ART initiation was more likely if men believed it had health benefits or their clinician recommended it. It was perceived to reduce transmission anxiety and provide holistic health benefits, but fear of toxicities and stigma were potential barriers to initiation. Transmission risk was low postdiagnosis; 32%(37/117) abstained from sex and 21%(24/117) exclusively used condoms. However, 35%(41/117) reported high-risk sex, associated with treatment optimism, ChemSex and higher partner numbers pre-diagnosis. Early ART was acceptable to MSM to prevent transmission, and for perceived holistic health benefits. It is unlikely, however, to be effective in reducing transmission risk during peak viraemia given the low proportion presenting at that stage. Expansion of HIV testing is required to identify MSM during that stage

From socioeconomic disadvantage to obesity: the mediating role of psychological distress and emotional eating

Objective: Lower socioeconomic status is robustly associated with obesity; however, the underpinning psychological mechanisms remain unclear. The current study sought to determine whether the relationship between lower socioeconomic status and obesity is explained by psychological distress and subsequent emotional eating as a coping strategy. It also examined whether psychological resilience plays a protective role in this pathway. Methods: Participants (N = 150) from a range of socioeconomic backgrounds completed questionnaire measures of psychological distress, emotional eating, and resilience. They reported their income and education level as an indicator of socioeconomic status and their height and weight in order to calculate BMI. Results: There was a significant indirect effect of socioeconomic status on BMI via psychological distress and emotional eating; specifically, lower socioeconomic status was associated with higher distress, higher distress was associated with higher emotional eating, and higher emotional eating was associated with higher BMI (b [SE] = −0.02 [0.01]; 95% CI: −0.04 to −0.01). However, resilience was not a significant moderator of this association. Conclusions: Psychological distress and subsequent emotional eating represent a serial pathway that links lower socioeconomic status with obesity. Targeting these maladaptive coping behaviors may be one strategy to reduce obesity in low-income populations. © 2019 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS

Values - reviewing the construct and drawing implications for values work in organisation and leadership. Kap. 2

I: H.Askeland, G. Espedal, B. Jelstad Løvaas & S. Sirris (Eds.), Understanding values work : Institutional perspectives in organizations and leadershipThis chapter outlines the trajectory of values, particularly within streams of organisational institutionalism, in order to analyse its application to values work in organisation and leadership. Conveying a frame for discussing values work, it aims at clarifying how to conceptualise the term values. Discussing classic and recent contributions, the chapter proposes seeing values as individual and collective conceptions of desirable trans-situational behaviours, objectives and ideals, serving to guide or valuate practice. Despite being an essential part of defining organisational institutionalism, and its sub-streams, values are seldom explicated. Utilising values in organisational and leadership research requires attention to their situatedness in contexts, and this chapter argues they are salient to organisations operating in pluralistic institutional environment. Studying values work, attention should be given to who and how such work is performed.publishedVersio

Evidence of Genetic Instability in Tumors and Normal Nearby Tissues

We have analyzed the sequence heterogeneity of the transcripts of the human HPRT and G6PD single copy genes that are not considered tumor markers. Analyses have been performed on different colon cancers and on the nearby histologically normal tissues of two male patients. Several copies of each cDNA, which were produced by cloning the RT-PCR-amplified fragments of the specific mRNA, have been sequenced. Similar analyses have been performed on blood samples of two ostensibly healthy males as reference controls. The sequence heterogeneity of the HPRT and G6PD genes was also determined on DNA from tumor tissues. The employed analytical approach revealed the presence of low-frequency mutations not detectable by other procedures. The results show that genetic heterogeneity is detectable in HPRT and G6PD transcripts in both tumors and nearby healthy tissues of the two studied colon tumors. Similar frequencies of mutations are observed in patient genomic DNA, indicating that mutations have a somatic origin. HPRT transcripts show genetic heterogeneity also in healthy individuals, in agreement with previous results on human T-cells, while G6PD transcript heterogeneity is a characteristic of the patient tissues. Interestingly, data on TP53 show little, if any, heterogeneity in the same tissues. CONCLUSIONS/SIGNIFICANCE: These findings show that genetic heterogeneity is a peculiarity not only of cancer cells but also of the normal tissue where a tumor arises

The impact of clinical placements on the emotional intelligence of occupational therapy, physiotherapy, speech pathology, and business students: a longitudinal study

Background: Emotional intelligence (EI) is a critical skill for healthcare practitioners. Minimal longitudinal research has tracked the changes in EI of therapy students over their final full-time clinical placements. Methods: The Emotional Quotient Inventory (EQ-i2.0) measured the EI of 283 therapy students and 93 business students (control group who do no clinical placements) at three time points over a 16-month period, the same period that the therapy students participated in clinical placements. Results: Analysis of the therapy students showed significant increases over the 16 months of the study in Total EI score, as well as nine other EI skills. However, large percentages of students reported declining scores in emotional expression, assertiveness, self-expression, and stress tolerance, with some students reporting low EI scores before commencing full-time extended clinical placements. Conclusions: The study contributes to new knowledge about the changing EI skills of therapy students as they complete their full-time, extended placements. Emotional intelligence in student therapists should be actively fostered during coursework, clinical placements and when first entering the workforce. University educators are encouraged to include EI content through the therapy curricula. Employers are encouraged to provide peer coaching, mentoring and workshops focused on EI skills to recent graduates

Molecular and cellular mechanisms underlying the evolution of form and function in the amniote jaw.

The amniote jaw complex is a remarkable amalgamation of derivatives from distinct embryonic cell lineages. During development, the cells in these lineages experience concerted movements, migrations, and signaling interactions that take them from their initial origins to their final destinations and imbue their derivatives with aspects of form including their axial orientation, anatomical identity, size, and shape. Perturbations along the way can produce defects and disease, but also generate the variation necessary for jaw evolution and adaptation. We focus on molecular and cellular mechanisms that regulate form in the amniote jaw complex, and that enable structural and functional integration. Special emphasis is placed on the role of cranial neural crest mesenchyme (NCM) during the species-specific patterning of bone, cartilage, tendon, muscle, and other jaw tissues. We also address the effects of biomechanical forces during jaw development and discuss ways in which certain molecular and cellular responses add adaptive and evolutionary plasticity to jaw morphology. Overall, we highlight how variation in molecular and cellular programs can promote the phenomenal diversity and functional morphology achieved during amniote jaw evolution or lead to the range of jaw defects and disease that affect the human condition

Exploring the Mode of Action of Bioactive Compounds by Microfluidic Transcriptional Profiling in Mycobacteria

10.1371/journal.pone.0069191PLoS ONE87-POLN

Analysis of Cancer Mutation Signatures in Blood by a Novel Ultra-Sensitive Assay: Monitoring of Therapy or Recurrence in Non-Metastatic Breast Cancer

BACKGROUND: Tumor DNA has been shown to be present both in circulating tumor cells in blood and as fragments in the plasma of metastatic cancer patients. The identification of ultra-rare tumor-specific mutations in blood would be the ultimate marker to measure efficacy of cancer therapy and/or early recurrence. Herein we present a method for detecting microinsertions/deletions/indels (MIDIs) at ultra-high analytical selectivity. MIDIs comprise about 15% of mutations. METHODS AND FINDINGS: We describe MIDI-Activated Pyrophosphorolysis (MAP), a method of ultra-high analytical selectivity for detecting MIDIs. The high analytical selectivity of MAP is putatively due to serial coupling of two rare events: heteroduplex slippage and mis-pyrophosphorolysis. MAP generally has an analytical selectivity of one mutant molecule per >1 billion wild type molecules and an analytical sensitivity of one mutant molecule per reaction. The analytical selectivity of MAP is about 100,000-fold better than that of our previously described method of Pyrophosphorolysis Activated Polymerization-Allele specific amplification (PAP-A) for detecting MIDIs. The utility of this method is illustrated in two ways. 1) We demonstrate that two EGFR deletions commonly found in lung cancers are not present in tissue from four normal human lungs (10(7) copies of gDNA each) or in blood samples from 10 healthy individuals (10(7) copies of gDNA each). This is inconsistent, at least at an analytical sensitivity of 10(-7), with the hypotheses of (a) hypermutation or (b) strong selection of these growth factor-mutated cells during normal lung development leads to accumulation of pre-neoplastic cells with these EGFR mutations, which sometimes can lead to lung cancer in late adulthood. Moreover, MAP was used for large scale, high throughput "gene pool" analysis. No germline or early embryonic somatic mosaic mutation was detected (at a frequency of >0.3%) for the 15/18 bp EGFR deletion mutations in 6,400 individuals, suggesting that early embryonic EGFR somatic mutation is very rare, inconsistent with hypermutation or strong selection of these deletions in the embryo. 2) The second illustration of MAP utility is in personalized monitoring of therapy and early recurrence in cancer. Tumor-specific p53 mutations identified at diagnosis in the plasma of six patients with stage II and III breast cancer were undetectable after therapy in four women, consistent with clinical remission, and continued to be detected after treatment in two others, reflecting tumor progression. CONCLUSIONS: MAP has an analytical selectivity of one part per billion for detection of MIDIs and an analytical sensitivity of one molecule. MAP provides a general tool for monitoring ultra-rare mutations in tissues and blood. As an example, we show that the personalized cancer signature in six out of six patients with non-metastatic breast cancer can be detected and that levels over time are correlated with the clinical course of disease

GABAA Receptor-Mediated Acceleration of Aging-Associated Memory Decline in APP/PS1 Mice and Its Pharmacological Treatment by Picrotoxin

Advanced age and mutations in the genes encoding amyloid precursor protein (APP) and presenilin (PS1) are two serious risk factors for Alzheimer's disease (AD). Finding common pathogenic changes originating from these risks may lead to a new therapeutic strategy. We observed a decline in memory performance and reduction in hippocampal long-term potentiation (LTP) in both mature adult (9–15 months) transgenic APP/PS1 mice and old (19–25 months) non-transgenic (nonTg) mice. By contrast, in the presence of bicuculline, a GABAA receptor antagonist, LTP in adult APP/PS1 mice and old nonTg mice was larger than that in adult nonTg mice. The increased LTP levels in bicuculline-treated slices suggested that GABAA receptor-mediated inhibition in adult APP/PS1 and old nonTg mice was upregulated. Assuming that enhanced inhibition of LTP mediates memory decline in APP/PS1 mice, we rescued memory deficits in adult APP/PS1 mice by treating them with another GABAA receptor antagonist, picrotoxin (PTX), at a non-epileptic dose for 10 days. Among the saline vehicle-treated groups, substantially higher levels of synaptic proteins such as GABAA receptor α1 subunit, PSD95, and NR2B were observed in APP/PS1 mice than in nonTg control mice. This difference was insignificant among PTX-treated groups, suggesting that memory decline in APP/PS1 mice may result from changes in synaptic protein levels through homeostatic mechanisms. Several independent studies reported previously in aged rodents both an increased level of GABAA receptor α1 subunit and improvement of cognitive functions by long term GABAA receptor antagonist treatment. Therefore, reduced LTP linked to enhanced GABAA receptor-mediated inhibition may be triggered by aging and may be accelerated by familial AD-linked gene products like Aβ and mutant PS1, leading to cognitive decline that is pharmacologically treatable at least at this stage of disease progression in mice