Trends in Decline of Antiretroviral Resistance among ARV-Experienced Patients in the HIV Outpatient Study: 1999–2008

Background. Little is known about temporal trends in frequencies of clinically relevant ARV resistance mutations in HIV strains from U.S. patients undergoing genotypic testing (GT) in routine HIV care. Methods. We analyzed cumulative frequency of HIV resistance among patients in the HIV Outpatient Study (HOPS) who, during 1999–2008 and while prescribed antiretrovirals, underwent GT with plasma HIV RNA >1,000 copies/mL. Exposure ≥4 months to each of three major antiretroviral classes (NRTI, NNRTI and PI) was defined as triple-class exposure (TCE). Results. 906 patients contributed 1,570 GT results. The annual frequency of any major resistance mutations decreased during 1999–2008 (88% to 79%, P = 0.05). Resistance to PIs decreased among PI-exposed patients (71% to 46%, P = 0.010) as exposure to ritonavir-boosted PIs increased (6% to 81%, P < 0.001). Non-significant declines were observed in resistance to NRTIs among NRTI-exposed (82% to 67%), and triple-class-resistance among TCE patients (66% to 41%), but not to NNRTIs among NNRTI-exposed. Conclusions. HIV resistance was common but declined in HIV isolates from subgroups of ARV-experienced HOPS patients during 1999–2008. Resistance to PIs among PI-exposed patients decreased, possibly due to increased representation of patients whose only PI exposures were to boosted PIs

Discontinuation of Pneumocystis jirovecii Pneumonia Prophylaxis with CD4 Count <200 Cells/µL and Virologic Suppression: A Systematic Review

HIV viral load (VL) is currently not part of the criteria for Pneumocystis jirovecii pneumonia (PCP) prophylaxis discontinuation, but suppression of plasma viremia with antiretroviral therapy may allow for discontinuation of PCP prophylaxis even with CD4 count <200 cells/µL.A systematic review was performed to determine the incidence of PCP in HIV-infected individuals with CD4 count <200 cells/µL and fully suppressed VL on antiretroviral therapy but not receiving PCP prophylaxis.Four articles examined individuals who discontinued PCP prophylaxis with CD4 count <200 cells/µL in the context of fully suppressed VL on antiretroviral therapy. The overall incidence of PCP was 0.48 cases per 100 person-years (PY) (95% confidence interval (CI) (0.06-0.89). This was lower than the incidence of PCP in untreated HIV infection (5.30 cases/100 PY, 95% CI 4.1-6.8) and lower than the incidence in persons with CD4 count <200 cells/µL, before the availability of highly active antiretroviral therapy (HAART), who continued prophylaxis (4.85/100 PY, 95% CI 0.92-8.78). In one study in which individuals were stratified according to CD4 count <200 cells/µL, there was a greater risk of PCP with CD4 count ≤100 cells/µL compared to 101-200 cells/µL.Primary PCP prophylaxis may be safely discontinued in HIV-infected individuals with CD4 count between 101-200 cells/µL provided the VL is fully suppressed on antiretroviral therapy. However, there are inadequate data available to make this recommendation when the CD4 count is ≤100 cells/µL. A revision of guidelines on primary PCP prophylaxis to include consideration of the VL is merited

Creating Inner and Outer Sacred Space: An Adult Learner Program’s Wholistic Approach to Supporting Low-Income Women Who Have Been Impacted by Violence

At our Adult Learner Program, we have identified that women who have experienced violence need various supports in order to effectively learn upon their reentry to school. Using three broad definitions of violence, I have investigated the impact of violence on low-income women’s learning at our literacy program. We have found that if our program supports transformation of the inner and outer sacred space of a woman, then she can gain the qualities she needs to learn throughout her time at our program, but for lifelong learning. “Sacred” in the sense used here denotes something worthy of respect. This paper documents the curricula, activities, and transformation of the sacred space that our Adult Learner Program has given attention to, especially during the past five years. Our curricula include activities that acknowledge that the essence of a human being is comprised of four inseparable aspects: the mind, body, spirit, and emotions. Using the First Nations’ medicine wheel, we have developed lessons that “bring the whole person to learning (Horsman, 2000).” The curricula also focus on empowering learners through cultivating a greater sense of self (understanding the interconnectedness between the four aspects of the person) and developing a sense of place (establishing the self with a supportive community). We explored ways to construct a sacred learning environment for the women in the program. By catering to all the senses in the classroom, we wanted to create an environment, which we felt our learners were worthy to be in. We took on the challenge to transform a sacred space that reflected the value we knew our students possessed

Learning to Embrace Two Cultures: Child-Rearing Patterns Among Filipino American Families

Why is it even important to think about identity? As long as human beings search for a sense of belonging, identity can provide that security and unification. It is also important to note, however, U.S. society pressures individuals to "identify, "especially when they are visibly different from the majority. How often does a minority in America encounter the question, "what are you?" On how many questionnaires and forms is one's race or ethnicity asked? Identity is a multi-faceted notion that consists of many aspects like culture, ethnicity, race, religion, sexual preference, and gender. In today's multicultural society, cultural pluralism is often practiced; although people in America share a common allegiance, more people are expressing their individual cultures as an integral part of their personal identities. Even if people do not overtly declare their ethnic or cultural identities, it is likely that it affects their lives-their actions, the choices they make, and their ideals. Cultural identities present a new level of personality which we can explore. The author seeks to establish the effects of the Philippines' rich history on the ideals of Filipinos and Filipino Americans. The author perceives the family as the primary conveyor of these values.The basic methods that parents use to impart these values in their children are important in forming their overall personality and establishing a healthy well-being

Worldview Assimilation Method (WAM): Effects on Student Behavior and Conceptual Understanding in Science Institute for Teaching and Learning Worldview Assimilation Method (WAM): Effects on Student Behavior and Conceptual Understanding in Science

Abstract Worldview Assimilation Method is a researcher designed teaching approach that investigates the effect of students&apos; acquired knowledge, experiences, and personal beliefs on their behavior and conceptual understanding. Two sections of Grade 6 in Jubilee Christian Academy were randomly assigned as to WAM or conventional group and were exposed to the respective teaching approaches. Student behavior for both groups was observed using the same checklist. Both groups were also administered with the same pre and post test for conceptual understanding test. Two-samples-test Kolmogorov-Smirnov Test revealed that the students under WAM have a higher behavioral mean score than the students under the conventional method. The t-test for the conventional group and the WAM group showed that there is a significant difference between the pretest and the posttest scores

A preliminary study on the effects of anaerobes on wastewater treatment using the granulated activated carbon upflow column

This study is about the comparison of the efficiency of Granulated Activated Carbon (GAC) upflow columns with and without anaerobes. The efficiency was evaluated by determining the COD and BOD reduction of the treated wastewater samples, using the GAC columns. Two retention times, 2 hours and 2 days, were also used to determine its effect in the reduction of BOD and COD levels.Overall, the result of the study showed that the anaerobes will lower the efficiency of the GAC upflow column. It also showed that the 2 days retention time without microorganisms will result in a clearer effluent and higher BOD and COD reduction

Students' conceptual understanding and science process skills in an inquiry-based flipped classroom environment

Purpose: The purpose of this study is to determine the impact of an Inquiry-based Flipped classroom model on the conceptual understanding and science process skills of junior high school students in the Philippines. Method: A two-group pretest/post-test design was conducted on 55 Grade 9 students for the study. One group received instruction using the flipped classroom format while the other group serving as control was taught in the conventional format. A Conceptual Understanding Test (CUT) and a Science Process Skills Test (SPST) were used to measure the impact of instruction on the two groups. Independent samples t-test was used to determine if there was a significant difference between the groups while paired samples t-test was conducted on both groups to determine if the groups improved significantly after a 7-week intervention. Linear regression was performed to determine if science process skills was a positive predictor of conceptual understanding. Findings: Inquiry-based flipped classroom did not make students perform better than the non-flipped inquiry-based learning environment in the Conceptual Understanding Test (CUT) and Science Process Skills Test (SPST) except on one biology topic (non-Mendelian Genetics) where the Flipped Inquiry Group scored significantly higher than the control in the CUT. Students' science process skills positively predicted their conceptual understanding in biology. Significance: Inquiry based flipped classroom can be as effective as the non-flipped inquiry-based instruction in improving students conceptual understanding and science process skills but can be made even more effective depending on the content, the manner the content is uploaded and the choice of LMS for uploading the online content. The study also showed the importance of science process skills in enhancing students conceptual understanding in biology

Evaluation of Commercially Available Anthelminthics in Laboratory Models of Human Intestinal Nematode Infections

Drug repurposing from veterinary to human medicine has been the main strategy to develop the four recommended human anthelminthics, albendazole, mebendazole, levamisole, and pyrantel pamoate, for the treatment of soil-transmitted helminthiasis. A systematic, head-to-head comparison of the anthelminthic activity profile of derivatives of these drugs and other anthelminthics developed in succession has not been conducted to date. We studied eight benzimidazoles, five macrocyclic lactones, tribendimidine, levamisole, and pyrantel pamoate in laboratory models of human intestinal nematode infections. In vitro studies were performed on Trichuris muris L1 larval stage and adults, as well as Ancylostoma ceylanicum, Necator americanus, Heligmosomoides polygyrus, and Strongyloides ratti L3 larvae and adults. The benzimidazoles showed pronounced differences against larval and adult stages, with low activity against larvae and the highest activity observed against adult N. americanus (IC50 of flubendazole 1.1 muM). The macrocyclic lactones, on the other hand, revealed a higher activity on the larval stages, with the lowest IC50 values observed against N. americanus L3 (IC50 values of 0.03-3 muM). In vivo studies were performed in the T. muris and H. polygyrus mice models, with moxidectin and milbemycin oxime showing the highest activity against H. polygyrus (ED50 values of 0.009 and 0.006 mg/kg, respectively) and moxidectin and abamectin being the most effective drugs against T. muris (ED50 values of 0.2 and 0.5 mg/kg, respectively). Laboratory models for soil-transmitted helminthiasis can assist characterizing potential drug candidates. Drugs should be evaluated against different species, and both the adult and larval stages as activities could differ considerably