Media Exposure to and Knowledge of the BCG Economic Development Policy Model of the Thai People

This study investigated the media exposure and knowledge of the BCG economic development policy model among the Thai people. An online questionnaire was used to collect data from 496 Thai respondents. The frequency distribution, percentage, mean and standard deviation were used to analyze the data. It was found that among thirteen channels, the majority of the respondents were exposed to the BCG model information through websites (47.72%), followed by Facebook (45.23%), and the least, to clubhouse and radio (3.73% for both). As for the frequency of exposure, the majority of the respondents were exposed to media for information about the  BCG policy model from time to time depending on the occasion, followed by 4-5 times a month, and the least exposed at all times. Regarding the quality of information dissemination, data analysis revealed that the respondents indicated the quality at a moderate level in all aspects. Analysis of the responses of eight questions about the BCG model revealed that the majority of the respondents had a low level of knowledge of the BCG policy model, followed by a moderate level, and a high level of only 2.1%

THE SYNDEMIC OF HEPATITIS CO-INFECTION AND SUBSTANCE USE AMONG PEOPLE LIVING WITH HIV: INSIGHTS FROM BALTIMORE AND BANGKOK

The research presented in this dissertation explores the impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on the health of those living with HIV, and emphasizes the role substance use plays in the care of those with HIV/HCV. The first paper explores barriers to HCV care in the interferon era and compares those who initiated treatment for HCV to those who did not in the Johns Hopkins HIV Clinical Cohort. Non-black and those with advanced fibrosis were more likely to have initiated HCV treatment, while those who reported active drug use or missed a higher proportion of clinic visits were less likely to have initiated treatment. The second paper explores the relationship between HBV and/or HCV co-infection on mortality of those with HIV in early (1996-2001) and later (2002-2013) antiretroviral treatment (ART) eras. We conducted a survival analysis comparing HIV, HIV/HBV, HIV/HCV, and HIV/HBV/HCV patients. In this analysis, later ART substantially reduced mortality among HIV mono-infected individuals but not among all groups of coinfected patients, even after adjustment for age, CD4 count, and levels of HIV RNA suppression. Tenofovir and pegylated interferon did not significantly impact all-cause or liver-related mortality for coinfected patients. The third paper documents increasing incidence of HCV among a Bangkok-based cohort of men who have sex with men (MSM) who were diagnosed with acute HIV. Previously, MSM were not considered to be at high risk for HCV infection in Thailand, and no incident HCV infections were identified between 2009-2014. However, since that time, HCV incidence has increased to 44.8 per 1000 PY in 2018. Methamphetamine use, group sex, and syphilis were associated with incident HCV. Taken together, these papers highlight the impact of substance use on the likelihood that people living with HIV 1) acquire viral hepatitis and 2) receive treatment for co-infection. Additionally, it draws attention to persistently increased mortality rates among individuals co-infected with HIV and viral hepatitis despite the availability of treatment for HIV, HBV, and HCV. Interventions are needed to address factors underlying these disparities, and should focus on mitigating the effect of substance use disorder on engagement in clinical care

Circulating CD4‐positive lymphocyte levels as predictor of response to induction chemotherapy in patients with advanced laryngeal cancer

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102107/1/hed23263.pd

Infiltrating lymphocytes and human papillomavirus‐16–associated oropharyngeal cancer

Objectives/Hypothesis: Human papillomavirus‐16 (HPV‐16)–associated carcinoma of the oropharynx has a favorable prognosis. Such patients have elevated CD8+ T‐lymphocyte levels that correlate with response to chemotherapy and survival. Tumor‐infiltrating lymphocyte (TIL) subpopulations were assessed in pretreatment biopsies from a prospective patient cohort to determine if TIL subsets differed by HPV status, clinical factors, or patient outcome or correlated with peripheral blood T‐cell levels. Study Design: Retrospective immunological correlative study of patients entered in a prospective Phase 2 clinical trial. Methods: Measured were CD8, CD4, CD68, and Treg (FoxP3) lymphocytes by immunohistochemistry in a tissue microarray created from patients (n = 46) with advanced oropharyngeal cancer. Correlations with peripheral blood levels, HPV status, expression of epidermal growth factor receptor (EGFR), clinical tumor, and patient characteristics and outcome were determined. Median follow‐up was 6.6 years. Results: HPV‐16–positive patients had improved survival ( P = .016). Degree of T‐cell infiltration did not differ by HPV status but was significantly related to disease‐specific survival (DSS) and overall survival (OS). Even after adjusting for HPV status, we found that CD8, FoxP3, and total T cells were significantly associated with DSS ( P = .0236, P = .0040, and P = .0197, respectively) and OS ( P = .0137, P = .0158, and P = .0115, respectively). Less T‐cell infiltration ( P = .0130) and CD4 cells in particular ( P = .0792) were associated with higher EGFR expression. Conclusions: Improved outcomes are associated with increased TILs independent of HPV status and suggest the local immune response may be more related to factors such as tumor size, EGFR expression, or performance status than HPV status. Further study of larger numbers of patients and infiltrates combined with functional analysis of individual subsets may be necessary to detect significant differences in local immunity in HPV‐16–related cancers.Laryngoscope, 122:121–127, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89454/1/22133_ftp.pd

An assessment of vulnerability to HIV infection of boatmen in Teknaf, Bangladesh

<p>Abstract</p> <p>Background</p> <p>Mobile population groups are at high risk for contracting HIV infection. Many factors contribute to this risk including high prevalence of risky behavior and increased risk of violence due to conflict and war. The Naf River serves as the primary border crossing point between Teknaf, Bangladesh and Mynamar [Burma] for both official and unofficial travel of people and goods. Little is known about the risk behavior of boatmen who travel back and forth between Teknaf and Myanmar. However, we hypothesize that boatmen may act as a bridging population for HIV/AIDS between the high-prevalence country of Myanmar and the low-prevalence country of Bangladesh.</p> <p>Methods</p> <p>Methods included initial rapport building with community members, mapping of boatmen communities, and in-depth qualitative interviews with key informants and members from other vulnerable groups such as spouses of boatmen, commercial female sex workers, and injecting drug users. Information from the first three stages was used to create a cross-sectional survey that was administered to 433 boatmen.</p> <p>Results</p> <p>Over 40% of the boatmen had visited Myanmar during the course of their work. 17% of these boatmen had sex with CSW while abroad. There was a significant correlation found between the number of nights spent in Myanmar and sex with commercial sex workers.</p> <p>In the past year, 19% of all boatmen surveyed had sex with another man. 14% of boatmen had participated in group sex, with groups ranging in size from three to fourteen people. Condom use was rare {0 to 4.7% during the last month}, irrespective of types of sex partners. Regression analysis showed that boatmen who were 25 years and older were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the boatmen aged less than 25 years. Similarly deep-sea fishing boatmen and non-fishing boatmen were statistically less likely to have sexual intercourse with non- marital female partners in the last year compared to the day long fishing boatmen adjusting for all other variables. Boatmen's knowledge regarding HIV transmission and personal risk perception for contracting HIV was low.</p> <p>Conclusion</p> <p>Boatmen in Teknaf are an integral part of a high-risk sexual behaviour network between Myanmar and Bangladesh. They are at risk of obtaining HIV infection due to cross border mobility and unsafe sexual practices. There is an urgent need for designing interventions targeting boatmen in Teknaf to combat an impending epidemic of HIV among this group. They could be included in the serological surveillance as a vulnerable group. Interventions need to address issues on both sides of the border, other vulnerable groups, and refugees. Strong political will and cross border collaboration is mandatory for such interventions.</p

The use of electrical impedance spectroscopy for monitoring the hydration products of Portland cement mortars with high percentage of pozzolans

In this paper, mortars and pastes containing large replacement of pozzolan were studied by mechanical strength, thermogravimetric analysis (TGA), scanning electronic microscopy (SEM), mercury intrusion porosimetry (MIP) and electrical impedance spectroscopy (EIS). The effect of metakaolin (35%) and fly ash (60%) was evaluated and compared with an inert mineral addition (andalusite). The portlandite content was measured, finding that the pozzolanic reaction produced cementing systems with all portlandite fixed. The EIS measurements were analyzed by the equivalent electrical circuit (EEC) method. An EEC with three branches in parallel was applied. The dc resistance was related to the degree of hydration and allowed us to characterize plain and blended mortars. A constant phase element (CPE) quantified the electrical properties of the hydration products located in the solid¿solution interface and was useful to distinguish the role of inert and pozzolanic admixtures present in the cement matrix.The authors thank the Universitat Politecnica de Valencia (UPV, Vicerrectorado de Investigacion) for its support (project PAID-05-09 ref 4302) and Debra Westall (UPV) for revising the manuscript.Cruz González, JM.; Fita Fernández, IC.; Soriano Martinez, L.; Paya Bernabeu, JJ.; Borrachero Rosado, MV. (2013). The use of electrical impedance spectroscopy for monitoring the hydration products of Portland cement mortars with high percentage of pozzolans. Cement and Concrete Research. 50:51-61. doi:10.1016/j.cemconres.2013.03.019S51615

Tumour-infiltrating lymphocytes predict for outcome in HPV-positive oropharyngeal cancer

Background: Human papillomavirus (HPV)-positive oropharyngeal cancer (OPSCC) is associated with improved survival compared with HPV-negative disease. However, a minority of HPV-positive patients have poor prognosis. Currently, there is no generally accepted strategy for identifying these patients.Methods: We retrospectively analysed 270 consecutively treated OPSCC patients from three centres for effects of clinical, pathological, immunological, and molecular features on disease mortality. We used Cox regression to examine associations between factors and OPSCC death, and developed a prognostic model for 3-year mortality using logistic regression analysis.Results: Patients with HPV-positive tumours showed improved survival (hazard ratio (HR), 0.33 (0.21–0.53)). High levels of tumour-infiltrating lymphocytes (TILs) stratified HPV-positive patients into high-risk and low-risk groups (3-year survival; HPV-positive/TILhigh=96%, HPV-positive/TILlow=59%). Survival of HPV-positive/TILlow patients did not differ from HPV-negative patients (HR, 1.01; P=0.98). We developed a prognostic model for HPV-positive tumours using a ‘training’ cohort from one centre; the combination of TIL levels, heavy smoking, and T-stage were significant (AUROC=0·87). This model was validated on patients from the other centres (detection rate 67%; false-positive rate 5.6%; AUROC=0·82).Interpretation: Our data suggest that an immune response, reflected by TIL levels in the primary tumour, has an important role in the improved survival seen in most HPV-positive patients, and is relevant for the clinical evaluation of HPV-positive OPSCC