Antiretroviral Treatment Knowledge and Stigma--Implications for Programs and HIV Treatment Interventions in Rural Tanzanian Populations.

To analyse antiretroviral treatment (ART) knowledge and HIV- and ART-related stigma among the adult population in a rural Tanzanian community. Population-based cross-sectional survey of 694 adults (15-49 years of age). Latent class analysis (LCA) categorized respondents' levels of ART knowledge and of ART-related stigma. Multinomial logistic regression assessed the association between the levels of ART knowledge and HIV- and ART-related stigma, while controlling for the effects of age, gender, education, marital status and occupation. More than one-third of men and women in the study reported that they had never heard of ART. Among those who had heard of ART, 24% were east informed about ART, 8% moderately informed, and 68% highly informed. Regarding ART-related stigma, 28% were least stigmatizing, 41% moderately stigmatizing, and 31% highly stigmatizing toward persons taking ART. Respondents that had at least primary education were more likely to have high levels of knowledge about ART (OR 3.09, 95% CI 1.61-5.94). Participants highly informed about ART held less HIV- and ART-related stigma towards ART patients (OR 0.26, 95% CI 0.09-0.74). The lack of ART knowledge is broad, and there is a strong association between ART knowledge and individual education level. These are relevant findings for both HIV prevention and HIV treatment program interventions that address ART-related stigma across the entire spectrum of the community

Current epigenetic aspects the clinical kidney researcher should embrace

Chronic kidney disease (CKD), affecting 10-12% of the world's adult population, is associated with a considerably elevated risk of serious comorbidities, in particular, premature vascular disease and death. Although a wide spectrum of causative factors has been identified and/or suggested, there is still a large gap of knowledge regarding the underlying mechanisms and the complexity of the CKD phenotype. Epigenetic factors, which calibrate the genetic code, are emerging as important players in the CKD-associated pathophysiology. In this article, we review some of the current knowledge on epigenetic modifications and aspects on their role in the perturbed uraemic milieu, as well as the prospect of applying epigenotype-based diagnostics and preventive and therapeutic tools of clinical relevance to CKD patients. The practical realization of such a paradigm will require that researchers apply a holistic approach, including the full spectrum of the epigenetic landscape as well as the variability between and within tissues in the uraemic milieu

Får domstolens rättstillämpning komma som en blixt från klar himmel? - En utredning av principen om jura novit curias förhållande till kontradiktionsprincipen

Två grundläggande rättsgrundsatser inom civilprocessrätten är principen om jura novit curia och kontradiktionsprincipen. Jura novit curia innebär att domstolen känner lagen och att domstolen ska tillämpa den adekvata rättsregeln på tvisten, oavsett om parterna baserat sin talan på denna eller ej. Kontradiktionsprincipen, som både finns i intern svensk rätt och i EKMR, stadgar att ingen får dömas ohörd. Dessa två principer existerar parallellt. Det som är omdiskuterat är huruvida kontradiktionsprincipen skapar en rätt för parterna att bemöta den rättsregel som domstolen kommer grunda domen på och uppsatsen syftar till att undersöka detta och huruvida en sådan rätt i vart fall borde finnas. Inom doktrin finns blandade uppfattningar om detta, men det torde stå klart att de flesta anser att domstolen i vart fall bör underrätta parterna innan domslutet grundas på icke-åberopade rättsregler. Med utgångspunkt i principernas tillämpningsområden aktualiseras även frågan om domstolens materiella processledning avseende rättsregler. Processledningen är först och främst inriktad på att berika och begränsa processmaterialet för att reda ut oklarheter i parternas talan. I RB stadgas inget uttryckligt om materiell processledning avseende rättsfrågor, men där uppställs heller inget hinder för detta. HD har i sin praxis berört frågan flertalet gånger. I bl.a. NJA 1989 s. 614 konstateras jura novit curias starka ställning i svensk rätt. I resningsärendet till NJA 2016 s. 107 uttalade HD att parterna borde getts möjlighet att yttra sig i tvistemålet. Torgny Håstad har i samband med detta påstått att HD har skapat en plikt för domstolar att inhämta parternas synpunkter. Även NJA 1999 s. 629 ger uttryck för att parterna bör bli upplysta i de fall domstolen överväger att tillämpa en rättsregel som inte diskuterats under rättegången. Europadomstolen har ännu inte prövat frågan om jura novit curia i förhållande till kontradiktionsprincipen i dispositiva tvistemål och tills ett sådant avgörande kommer torde det vara oklart hur långt kontradiktionsprincipen sträcker sig. Som rättsläget ser ut idag är det alltså tillåtet för domstolen att grunda sin dom på andra rättsregler än de som åberopats av parterna, utan att parterna förvarnas om detta. Dock bör kommunicering med parterna ske och det går därmed att utläsa att överraskande rättstillämpning inte är önskvärt.Two fundamental principles in the Swedish procedural code are the principle iura novit curia and the principle of an adversarial procedure. Iura novit curia means that the court knows the law and that the judge is responsible for the application of the relevant legal rules, whether the parties have based their pleadings on these or not. The principle of an adversarial procedure, which exists both in Swedish internal law and in the ECHR, states that the parties have the right not to be judged unheard. These two principles exist side by side. It is discussed whether the principle of an adversarial procedure creates a right for the parties to respond to the legal rule that the court will base its decision on. This thesis aims to examine this question and whether such a right should exist. Within the doctrine there are some different opinions, but it is quite clear that the prevailing view is that the court should notify the parties before it bases its decision on other rules than those the parties raised during the process. The issue concerning the material proceedings regarding the application of law is actualized by the application of these two principles. The material proceedings are first of all aiming to clarify uncertainties in the parties’ pleadings. The rules in RB do not express any explicit support for the notion that direction of proceedings encompasses the application of law, neither does it put up any bars for this notion. The Swedish Supreme Court (HD) has touched the question a couple of time. I NJA 1989 s. 614 HD stated that iura novit curia has a strong position within swedish law. In the new trial case to NJA 2016 s. 107, HD expressed that the parties should have been given the opportunity to express themselves in the dispute. Torgny Håstad has in this context alleged that HD has created an obligation for the court to obtain the view of the parties. Also, NJA 1999 s. 629 expresses that the parties should be enlightened when the court is considering to applying another legal rule to the dispute other than those the parties have referred to. The European Court of Human Rights has not yet tried the issue about iura novit curia in relation to the principle of an adversarial procedure when it comes to civil disputes. Until such a judgement is created, it will probably be uncertain how far the principle of an adversarial procedure stretches. The legal situation today allows the court to base its judgement on other legal rules than does quoted by the parties, without giving the parties such notice. However, communication ought to occur as surprising law enforcement is not desirable

Testing together challenges the relationship': Consequences of HIV Testing as a couple in a High HIV prevalence setting in Rural South Africa

OBJECTIVE: We conducted qualitative individual and combined interviews with couples to explore their experiences since the time of taking an HIV test and receiving the test result together, as part of a home-based HIV counselling and testing intervention. METHODS: This study was conducted in October 2011 in rural KwaZulu-Natal, South Africa, about 2 years after couples tested and received results together. Fourteen couples were purposively sampled: discordant, concordant negative and concordant positive couples. FINDINGS: Learning about each other’s status together challenged relationships of the couples in different ways depending on HIV status and gender. The mutual information confirmed suspected infidelity that had not been discussed before. Negative women in discordant partnerships remained with their positive partner due to social pressure and struggled to maintain their HIV negative status. Most of the couple relationships were characterized by silence and mistrust. Knowledge of sero-status also led to loss of sexual intimacy in some couples especially the discordant. For most men in concordant negative couples, knowledge of status was an awakening of the importance of fidelity and an opportunity for behaviour change, while for concordant positive and discordant couples, it was seen as proof of infidelity. Although positive HIV status was perceived as confirmation of infidelity, couples continued their relationship and offered some support for each other, living and managing life together. Sexual life in these couples was characterized by conflict and sometimes violence. In the concordant negative couples, trust was enhanced and behaviour change was promised. CONCLUSIONS: Findings suggest that testing together as couples challenged relationships in both negative and positive ways. Further, knowledge of HIV status indicated potential to influence behaviour change especially among concordant negatives. In the discordant and concordant positive couples, traditional gender roles exposed women’s vulnerability and their lack of decision-making power.Department of HE and Training approved lis

Gene Expression Profiling of Peri-Implant Healing of PLGA-Li+ Implants Suggests an Activated Wnt Signaling Pathway In Vivo

Bone development and regeneration is associated with the Wnt signaling pathway that, according to literature, can be modulated by lithium ions (Li+). The aim of this study was to evaluate the gene expression profile during peri-implant healing of poly(lactic-co-glycolic acid) (PLGA) implants with incorporated Li+, while PLGA without Li+ was used as control, and a special attention was then paid to the Wnt signaling pathway. The implants were inserted in rat tibia for 7 or 28 days and the gene expression profile was investigated using a genome-wide microarray analysis. The results were verified by qPCR and immunohistochemistry. Histomorphometry was used to evaluate the possible effect of Li+ on bone regeneration. The microarray analysis revealed a large number of significantly differentially regulated genes over time within the two implant groups. The Wnt signaling pathway was significantly affected by Li+, with approximately 34% of all Wnt-related markers regulated over time, compared to 22% for non-Li+ containing (control; Ctrl) implants. Functional cluster analysis indicated skeletal system morphogenesis, cartilage development and condensation as related to Li+. The downstream Wnt target gene, FOSL1, and the extracellular protein-encoding gene, ASPN, were significantly upregulated by Li+ compared with Ctrl. The presence of beta-catenin, FOSL1 and ASPN positive cells was confirmed around implants of both groups. Interestingly, a significantly reduced bone area was observed over time around both implant groups. The presence of periostin and calcitonin receptor-positive cells was observed at both time points. This study is to the best of the authors' knowledge the first report evaluating the effect of a local release of Li+ from PLGA at the fracture site. The present study shows that during the current time frame and with the present dose of Li+ in PLGA implants, Li+ is not an enhancer of early bone growth, although it affects the Wnt signaling pathway

Sexual risk taking among patients on antiretroviral therapy in an urban informal settlement in Kenya: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Our intention was to analyze demographic and contextual factors associated with sexual risk taking among HIV-infected patients on antiretroviral treatment (ART) in Africa's largest informal urban settlement, Kibera in Nairobi, Kenya.</p> <p>Methods</p> <p>We used a cross-sectional survey in a resource-poor, urban informal settlement in Nairobi; 515 consecutive adult patients on ART attending the African Medical and Research Foundation clinic in Kibera in Nairobi were included in the study. Interviewers used structured questionnaires covering socio-demographic characteristics, time on ART, number of sexual partners during the previous six months and consistency of condom use.</p> <p>Results</p> <p>Twenty-eight percent of patients reported inconsistent condom use. Female patients were significantly more likely than men to report inconsistent condom use (aOR 3.03; 95% CI 1.60-5.72). Shorter time on ART was significantly associated with inconsistent condom use. Multiple sexual partners were more common among married men than among married women (adjusted OR 4.38; 95% CI 1.82-10.51).</p> <p>Conclusions</p> <p>Inconsistent condom use was especially common among women and patients who had recently started ART, i.e., when the risk of HIV transmission is higher. Having multiple partners was quite common, especially among married men, with the potential of creating sexual networks and an increased risk of HIV transmission. ART needs to be accompanied by other preventive interventions to reduce the risk of new HIV infections among sero-discordant couples and to increase overall community effectiveness.</p

Targeting Acetylcholinesterase: Identification of Chemical Leads by High Throughput Screening, Structure Determination and Molecular Modeling

Acetylcholinesterase (AChE) is an essential enzyme that terminates cholinergic transmission by rapid hydrolysis of the neurotransmitter acetylcholine. Compounds inhibiting this enzyme can be used (inter alia) to treat cholinergic deficiencies (e.g. in Alzheimer's disease), but may also act as dangerous toxins (e.g. nerve agents such as sarin). Treatment of nerve agent poisoning involves use of antidotes, small molecules capable of reactivating AChE. We have screened a collection of organic molecules to assess their ability to inhibit the enzymatic activity of AChE, aiming to find lead compounds for further optimization leading to drugs with increased efficacy and/or decreased side effects. 124 inhibitors were discovered, with considerable chemical diversity regarding size, polarity, flexibility and charge distribution. An extensive structure determination campaign resulted in a set of crystal structures of protein-ligand complexes. Overall, the ligands have substantial interactions with the peripheral anionic site of AChE, and the majority form additional interactions with the catalytic site (CAS). Reproduction of the bioactive conformation of six of the ligands using molecular docking simulations required modification of the default parameter settings of the docking software. The results show that docking-assisted structure-based design of AChE inhibitors is challenging and requires crystallographic support to obtain reliable results, at least with currently available software. The complex formed between C5685 and Mus musculus AChE (C5685•mAChE) is a representative structure for the general binding mode of the determined structures. The CAS binding part of C5685 could not be structurally determined due to a disordered electron density map and the developed docking protocol was used to predict the binding modes of this part of the molecule. We believe that chemical modifications of our discovered inhibitors, biochemical and biophysical characterization, crystallography and computational chemistry provide a route to novel AChE inhibitors and reactivators

Revisionens betydelse vid kreditgivning - en studie av skillnader mellan småstad och storstad

Syftet med vår uppsats är att återge ett antal banktjänstemäns föreställningar huruvida ett avskaffande av revisionsplikten kommer att påverka kreditbedömningen och kreditgivningen. Samt diskutera ett antal tänkbara effekter av ovanstående förändringar och om det finns några skillnader mellan banktjänstemän i småstad och storstad Uppsatsen är en kvalitativ undersökning. Sju semistrukturerade intervjuer har genomförts med banktjänstemän, tre i Malmö och fyra i småstäder i Skåne. T$eorier kring revision, avskaffandet av revisionsplikten, kredithanteringsprocessen samt en sociologisk teori, som berör skillnader mellan livet i en storstad och en småstad, har använts. Det empiriska materialet bygger på sju intervjuer med banktjänstemän i södra Skåne. Kredithanteringsprocessen skiljer sig åt beroende på vilken kontext bankerna är verksamma i, till exempel den sociala kontakten, mellan kund och banktjänsteman, har en större betydelse i småstadsbanker. En del av dessa skillnader kommer att förstärkas när revisionsplikten avskaffas

Arrival-angle anomalies across the USArray Transportable Array

We construct composite maps of surface-wave arrival-angle anomalies using clustered earthquakes and an array method for measuring wave-front geometry. This results in observations of arrival angles covering the entire footprint of the USArray Transportable Array during 2006–2010. Bands of arrival-angle deviations in the propagation direction indicate the presence of heterogeneous velocity structure both inside and outside of the array. We compare the observed patterns to arrival angles predicted using two global tomographic models, the mantle model S362ANI and the surface-wave-dispersion model GDM52. We use both ray-theory-based prediction methods and measurements on synthetic data calculated using a spectral-element method. Both models and all prediction methods produce similar mean arrival angles and long-wavelength patterns of anomalies which are similar to the observations. Predicted short-wavelength features generally do not agree with the observations. The spectral-element method produces some complexity that is not obtained using the ray-theory-based methods; this predicted complexity is similar in character to the observed patterns, but does not match them