Lipodystrophy in HIV patients: its challenges and management approaches

HIV-associated lipodystrophy is a term used to describe a constellation of body composition (lipoatrophy and lipohypertrophy) and metabolic (dyslipidemia and insulin resistance) alterations that accompany highly active antiretroviral therapy. These changes, which resemble metabolic syndrome, have been associated with a variety of adverse outcomes including accelerated cardiovascular disease. The body composition and metabolic changes appear to cluster in HIV infection, although they are distinct alterations and do not necessarily coexist. Epidemiological studies have demonstrated multiple pathogenic influences associated with host, disease, and treatment-related factors. The adverse treatment effects were more prominent in early regimens; continued drug development has led to the application of metabolically safer regimens with equal or greater potency than the regimens being replaced. Disease-related factors include HIV infection as well as inflammation, immune activation, and immune depletion. The body composition changes promote anxiety and depression in patients and may affect treatment adherence. Treatment of dyslipidemia and alterations in glucose metabolism is the same as in non-HIV-infected individuals. Lipoatrophy is managed by strategic choice of antivirals or by antiviral switching, and in some cases by plastic/reconstructive surgery. Lipohypertrophy has been managed mainly by lifestyle modification, ie, a hypocaloric diet and increased exercise. A growth hormone releasing factor, which reduces central fat, has recently become available for clinical use

Positioning the Destination Product-Can Regional Tourist Boards Learn from Private Sector Practice?

This article examines the role of positioning in the marketing of a tourism destination. The study focuses on the current positioning strategies pursued by the Regional Tourist Boards (RTBs) in England. A recent nationwide consumer research study into short holiday destination choice in the UK revealed that consumers were confused by the regional product message. The evidence suggests that current RTB positioning strategies are failing to keep pace with the constantly evolving needs of the consumer. This article explores the reasons for clearly positioning the destination product and suggests that, although RTBs could learn from marketing strategies employed in other sectors of the tourism industry, there are likely to be organisational and cultural barriers inhibiting this learning curve

Fear and loathing on the landscape: What can foraging theory tell us about vigilance and fear?

We discuss fear and vigilance from the perspective of foraging theory. Rather than focusing on proximate indicators of fear, we suggest that fear is an adaptation for assigning a cost to activities that incur a risk of injury or death. We use theory to provide definitions for fear and vigilance and then use that theory to compare them. We agree that there are limits to the reliability of vigilance as an indicator of fear, but we arrive at this conclusion differently

MANTLE-CRUST INTERACTION AT THE LATE STAGE OF EVOLUTION OF HERCYNIAN ALTAI COLLISION SYSTEM, WESTERN PART OF CAOB

Altai collision system of Hercynides was formed in Late Paleozoic as a result of oblique collision of Siberian continent and Kazakhstan composed terrane [Vladimirov et al., 2003; 2008; Xiao et al., 2010]. At the late stages of its evolution (time interval from 310–300 to 280–270 Ma) the huge different mafic and felsic magmatism occurred at the territory (Fig. 1) [Vladimirov et al., 2008; Khromykh et al., 2011, 2013, 2014, 2016; Kotler et al., 2015; Sokolova et al., 2016]. It is evident about increased thermal gradient in lithosphere and about significant role of mantle and active manifestation of mantle-crust interactions. Some magmatic complexes may be considered as indicators of mantle-crust interaction processes.Altai collision system of Hercynides was formed in Late Paleozoic as a result of oblique collision of Siberian continent and Kazakhstan composed terrane [Vladimirov et al., 2003; 2008; Xiao et al., 2010]. At the late stages of its evolution (time interval from 310–300 to 280–270 Ma) the huge different mafic and felsic magmatism occurred at the territory (Fig. 1) [Vladimirov et al., 2008; Khromykh et al., 2011, 2013, 2014, 2016; Kotler et al., 2015; Sokolova et al., 2016]. It is evident about increased thermal gradient in lithosphere and about significant role of mantle and active manifestation of mantle-crust interactions. Some magmatic complexes may be considered as indicators of mantle-crust interaction processes

Selective demarketing: When customers destroy value.

Selective demarketing is a strategic option for firms to manage customers who are or are likely to be a poor fit with its offering. Research has investigated related areas such as customer profitability and relationship dissolution but, as yet, studies have not offered a robust conceptualisation of selective demarketing. Based on research into value co-destruction, this study argues that these customers effectively destroy value by misusing or misunderstanding how to integrate their operant resources with those of the firm. As firms exist within a wider service system, this failure to integrate resonates throughout the system. To demarket selectively, firms use higher order operant resources to disengage and discourage these customers. This study offers a novel conceptualisation of selective demarketing and extends research on value destruction through adopting a firm and systems perspective

Nation branding: what is being branded?

Nation branding and nation brand are two different concepts. A nation has a brand image with or without nation branding. This paper examines the concept of nation branding, focusing on the central question of what is being branded. It differentiates nation branding from product branding, and draws comparisons between nation branding and product-country image. Paradoxical issues around the concept and the wider context in which nation branding can be applied are also discussed. More research is needed to find out if and how nation branding could help the economic development in a country. As many other non-marketing factors also affect a nation’s image the role played by nation branding may turn out to be only a modest one

Rail Marketing, Jobs and Public Engagement

The chapter briefly explains the marketing mix in a rail context and then discusses marketing strategies to promote rail from two perspectives. Firstly, rail is perceived as a transport service offered to potential users and various marketing tools are used to maximise rail companies’ profit. Secondly rail is seen as a career path and variety of marketing, skills training and public engagement actions are targeting potential talents, already within the industry as well as those beyond the railway sector. The pool of talented individuals includes students, graduates, academics and professionals who are exposed to recruitment and retention activities of the railway sector. Various activities and projects run by the rail industry, targeting audience at school, university, professional and general public’s levels, are presented with their success stories as well as challenges some of the initiatives faced. Also, results of a survey focusing on skills and jobs for rail (and transport sector) of the future are presented and commented on

Soft power: Power of attraction or confusion?

Despite its popularity soft power remains power of confusion. The paper examines the concept, with a special focus on the nature and sources of soft power. Nye’s notion of soft power is largely ethnocentric and based on the assumption that there is a link between attractiveness and the ability to influence others in international relations. This poses two problems: Firstly, a country has many different actors. Some of them like the attraction and others don’t. Whether the attraction will lead to the ability to influence the policy of the target country depends on which groups in that country find it attractive and how much control they have on policymaking. Secondly, policymaking at the state level is far more complicated than at the personal level; and has different dynamics that emphasise the rational considerations. This leaves little room for emotional elements thus significantly reducing the effect of soft power. Given the nature of soft power being uncontrollable and unpredictable, it would be impossible to wield soft power in any organised and coordinated fashion as Nye suggested. Furthermore, the relationship between two countries is shaped by many complex factors. It is ultimately decided by the geopolitics and strategic interests of nations, in which soft power may play only a limited role. The paper also discusses the link between soft power and nation branding as both concepts are concerned with a nation’s influence on the world stage. Public diplomacy is a subset of nation branding that focuses on the political brand of a nation; whereas nation branding is about how a nation as whole to reshape the international opinions. A successful nation branding campaign will help create a more favourable and lasting image among the international audience thus further enhancing a country’s soft power

Look before you leap: is risk of injury a foraging cost?

Theory states that an optimal forager should exploit a patch so long as its harvest rate of resources from the patch exceeds its energetic, predation, and missed opportunity costs for foraging. However, for many foragers, predation is not the only source of danger they face while foraging. Foragers also face the risk of injuring themselves. To test whether risk of injury gives rise to a foraging cost, we offered red foxes pairs of depletable resource patches in which they experienced diminishing returns. The resource patches were identical in all respects, save for the risk of injury. In response, the foxes exploited the safe patches more intensively. They foraged for a longer time and also removed more food (i.e., had lower giving up densities) in the safe patches compared to the risky patches. Although they never sustained injury, video footage revealed that the foxes used greater care while foraging from the risky patches and removed food at a slower rate. Furthermore, an increase in their hunger state led foxes to allocate more time to foraging from the risky patches, thereby exposing themselves to higher risks. Our results suggest that foxes treat risk of injury as a foraging cost and use time allocation and daring—the willingness to risk injury—as tools for managing their risk of injury while foraging. This is the first study, to our knowledge, which explicitly tests and shows that risk of injury is indeed a foraging cost. While nearly all foragers may face an injury cost of foraging, we suggest that this cost will be largest and most important for predators