The Self-Reported Sexual Behaviors of Single Older African Americans

Abstract African Americans are disproportionally affected by HIV/AIDS, but little is known about the risky sexual behaviors of older African Americans. This cross-sectional, comparative study, investigated the self-reported sexual behaviors of sexually active older African Americans. The nonrandom sample (N = 78) included single African American men (59%) and women (41%), 50-74 years of age. Participants were recruited from various community sites, and data were collected with a standard sexual history questionnaire. Participants reported practicing risky behaviors such having unprotected oral, anal, and vaginal sex (96.5%), and having multiple sex partners (37.2%). There were several significant gender differences such as males using condoms more for vaginal sexual activity, and they discussed using a condom more than females. Faced with an aging population and a growing incidence of HIV/AIDS, older adults need to know the types of sexual behaviors that put them at risk and skills to reduce risky behaviors. Age/gender-appropriate interventions for HIV prevention are needed for older African Americans

The caregiving perspective in heart failure: a population based study

Background: Heart failure (HF) is a frequent condition in the elderly and mortality is high. This study sought to describe the profile of those providing care in the community and their needs. Methods: The South Australian Health Omnibus is an annual, random, face-to-face, cross sectional survey conducted within the state. Having standardized data to the whole population, the study describes the subset of the population who identify that they actively cared for someone at the end of life with HF in the five years before survey administration

Adding Soft-Skills to the Hard Target of Adequacy: The Case for Rearticulation Based on a Multifocal Analysis

The purpose of this study is to expand the definition of adequacy by adding soft skills as a measure of school productivity. The singular focus on academic standards inherent in education policy has prevented scholars from seeing the concept of adequacy through myriad perspectives and has contributed to a resegregation of schools. Education policy includes legal, historical, and political perspectives; research inquiries must accommodate these multiple foci. This study made use of multifocal analysis to investigate the development of the concept of adequacy in South Carolina. Conclusions suggest an expanded definition of adequacy has potential for addressing school financing policy, but also for making historical, political and legal contributions to educational and economic policies aimed at repurposing schools

Enhancing food security in an era of global climate change

The goal of the workshop was to build a more strategic and integrated perspective on the threats and opportunities latent in the food / climate issue, and to discuss the hard challenges of moving forward toward common goals in a private, off-the-record setting. An executive session convened by the John F. Kennedy School of Government at Harvard University and the Venice International University on June 6-9, 2010 attracted more than 25 of the world’s leading experts from the fields of policy, science, and business to San Servolo Island for an intensive three day session (see text for a list of the participants). The discussions were off-the-record, with each participant present in his or her own capacity, rather than representing an organization. The session was one in a series on Grand Challenges of the Sustainability Transition organized by the Sustainability Science Program at Harvard University with the generous support of the Italy’s Ministry for Environment, Land and Sea. This particular session was held in cooperation with the new Mega Program on Climate Change, Agriculture and Food Security being developed by the Consultative Group on International Agricultural Research (CGIAR) and the Earth System Science Partnership. This summary report of the session is our synthesis of the main points and arguments that emerged from the discussions. It does not represent a consensus document, since no effort was made at the Session to arrive at a single consensus view. Rather, we report here on what we heard to be the major themes discussed at the session. Any errors or misrepresentations remain solely our responsibility

A predominance of R5-like HIV genotypes in vaginal secretions is associated with elevated plasma HIV-1 RNA levels and the absence of anti-retroviral therapy

HIV expressed in genital secretions provides the inoculum from which transmitting variants are selected, both in sexual transmission and mother-to-infant transmission during partuition. Characterization of HIV levels and genotypes found in vaginal secretions and the impact of anti-retroviral therapy (ART) on this virus can provide valuable insight for the prevention of HIV transmission. Vaginal HIV was evaluated in a cohort of 43 women attending a New Orleans HIV outpatient clinic. Predominant vaginal genotypes were characterized as R5- or X4-like by heteroduplex tracking analyses of the envelope V3 region. Most women (67.4%) shed R5-like genotypes in vaginal secretions which was associated with elevated plasma HIV levels (≥ 10,000 copies HIV-RNA/mL) and absence of ART. Because R5-like genotypes are more frequently associated with transmission, these observations suggest that the majority of women shedding HIV in genital secretions present a transmission risk. The levels of vaginal virus were similar between both groups, but shedding of X4-like genotypes was associated with lower plasma viral loads and the use of ART, suggesting that ART use may impact the genotypes of virus found in the female genital compartment

Norovirus Epidemiology and Duration of Shedding in Michigan, 2007-2008

Background: In the United States, an estimated 23 million cases of norovirus (NoV) are reported each year, and although mortality is low, the morbidity and economic impact are substantial. Methods: RT-PCR and sequencing were used for identification of NoV genotypes obtained from outbreak and sporadic cases. RT Quant PCR was used to determine the viral load in fecal specimens. In order to rule out bacterial infection as the cause for acute gastroenteritis (AGE), bacterial culture for Salmonella, E.coli O157, Shigella, Campylobacter and Clostridium difficile was performed by standard laboratory procedures. The duration of NV shedding was investigated with longitudinal sampling in the sporadic cases and an evaluation of the association between viral load and days since clinical onset in the outbreak-associated cases. Results: We describe the epidemiology and strain identification for NoV circulating in Michigan during 2007-8 in concurrent sporadic and outbreak-associated cases. In 2007- 8, 138 norovirus outbreaks (3,437 cases) were reported to the MDCH. Among the 47 outbreak specimens sequenced, GI was identified in 14 (29.8%) and GII in 33 (70.2%). The predominant type was GII.4, found in 23 of the 33 (69.6%) GII specimens. The statistical analysis of outbreak-associated cases showed that neither NoV type nor number of days post-onset were associated with NoV log concentration. Among the sporadic cases, the repeated measures analysis of variance showed that NoV type (I or II) was not associated with log titer (P = 0.90), but that the number of weeks post-onset was statistically associated with declining log titer at p = 0.0005. Conclusion: We found no predominant strain difference between concurrent sporadic and outbreak-associated cases. Prevalent strains of NoV were shed in high concentration for at least two weeks past disease onset, suggesting that current public health recommendations for 2-3 days home isolation following clinical recovery may need to be lengthened

Medical Concerns

Panel Chair, Greg Cox Papers Presented: Ebene: Psychedelic Snuff of the Yanomami by Kelly Partin Mycobacterium Tuberculosis: A Survey by Mary Cronin Kinematic Analysis of Universal Joint using Catia V5 by Jibin Jacob Effects of Preterm Birth by Patricia J. Campos Proposal for ETT Research using Picutre-Induced Neural Signatures by Katy N. Lee Severe Mental Illness in the Homeless by Batoul C. Zalkout Asthma Disease of the Respiratory System by Janelle Clar

Results of ASERTAA, a randomized prospective crossover pharmacogenetic study of immediate-release versus extended-release tacrolimus in African American kidney transplant recipients

BACKGROUND: Differences in tacrolimus dosing across ancestries is partly attributable to polymorphisms in CYP3A5 genes that encode tacrolimus-metabolizing cytochrome P450 3A5 enzymes. The CYP3A5*1 allele, preponderant in African Americans, is associated with rapid metabolism, subtherapeutic concentrations, and higher dose requirements for tacrolimus, all contributing to worse outcomes. Little is known about the relationship between CYP3A5 genotype and the tacrolimus pharmacokinetic area under the curve (AUC) profile in African Americans or whether pharmacogenetic differences exist between conventional twice-daily, rapidly absorbed, immediate-release tacrolimus (IR-Tac) and once-daily extended-release tacrolimus (LifeCycle Pharma Tac [LCPT]) with a delayed absorption profile. STUDY DESIGN: Randomized prospective crossover study. SETTING & PARTICIPANTS: 50 African American maintenance kidney recipients on stable IR-Tac dosing. INTERVENTION: Recipients were randomly assigned to continue IR-Tac on days 1 to 7 and then switch to LCPT on day 8 or receive LCPT on days 1 to 7 and then switch to IR-Tac on day 8. The LCPT dose was 85% of the IR-Tac total daily dose. OUTCOMES: Tacrolimus 24-hour AUC (AUC MEASUREMENTS: CYP3A5 genotype, 24-hour tacrolimus pharmacokinetic profiles. RESULTS: ∼80% of participants carried the CYP3A5*1 allele (CYP3A5 expressers). There were no significant differences in AUC LIMITATIONS: This was primarily a pharmacogenetic study rather than an efficacy study; the follow-up period was too short to capture clinical outcomes. CONCLUSIONS: Achieving therapeutic tacrolimus trough concentrations with IR-Tac in most African Americans results in significantly higher peak concentrations, potentially magnifying the risk for toxicity and adverse outcomes. This pharmacogenetic effect is attenuated by delayed tacrolimus absorption with LCPT. TRIAL REGISTRATION: Registered at ClinicalTrials.gov, with study number NCT01962922

Leaving no-one behind? Social inequalities and contrasting development impacts in rural Rwanda

Two polar viewpoints have emerged regarding Rwanda’s post-genocide development: (1) that economic development has improved the wellbeing of Rwandans and (2) that repressive policies have negatively impacted many. Assessing the impacts and inclusiveness of policies through trends among different social groups is timely in the context of the Sustainable Development Goals’ pledge to ‘leave no-one behind’. This study examines rural Rwandans’ perspectives on the changes affecting them. A multidimensional wellbeing approach was applied through mixed-method research involving 115 rural households in two locations in western Rwanda, in 2011–12. Findings reveal that the household-level impact was heavily influenced by socio-economic power and socio-ethnic grouping. Negative impacts, including restricted freedom and loss of material and cultural resources are disproportionately felt by the poorest. The indigenous Batwa suffer particularly detrimental impacts. The findings suggest that strategies deemed successful in making progress towards the Millennium Development Goals in Rwanda need, as a minimal measure, to be supported by social protection programs that specifically target the landless, vulnerable and cultural minorities. However, to align Rwanda’s development policies with the ambitions of the Sustainable Development Goals (SDGs), a dramatic strategic shift is required to ‘leave no-one behind’ and avoid the reproduction of poverty and exacerbation of inequality

Development, psychometric testing, and revision of the atlanta heart failure knowledge test

BACKGROUND AND RESEARCH OBJECTIVE: Several heart failure (HF) knowledge tools have been developed and tested over the past decade; however, they vary in content, format, psychometric properties, and availability. This article details the development, psychometric testing, and revision of the Atlanta Heart Failure Knowledge Test (A-HFKT) as a standardized instrument for both the research and clinical settings. PARTICIPANTS AND METHODS: Development and psychometric testing of the A-HFKT were undertaken with 116 New York Heart Association (NYHA) class II and III community-dwelling HF patients and their family members (FMs) participating in a family intervention study. Internal consistency, reliability, and content validity were examined. Construct validity was assessed by correlating education level, literacy, dietary sodium ingestion, medication adherence, and healthcare utilization with knowledge. RESULTS: Content validity ratings on relevance and clarity ranged from 0.55 to 1.0, with 81% of the items rated from 0.88 to 1.0. Cronbach α values were .84 for patients, .75 for FMs, and .73 for combined results. Construct validity testing revealed a small but significant correlation between higher patient and FM knowledge on sodium restriction questions and lower ingested sodium, r = −0.17, P = .05 and r = −0.19, P = .04, respectively, and between patient knowledge and number of days that medications were taken correctly (diuretics: r = 0.173, P < .05, and angiotensin-converting enzyme: r = 0.223, P = .01). Finally, patients seeking emergency care or requiring hospitalization in the 4 months before study entry were found to have significantly lower FM knowledge using both t test and logistic regression modeling. CONCLUSIONS: The A-HFKT was revised using the content and construct validity data and is available for use with HF patients and FMs. The construct validity testing indicates that patient knowledge has a significant relationship to aspects of self-care. Furthermore, family knowledge may influence patient adherence with sodium restriction and healthcare utilization behavior