Non-clinical outcomes of antiretroviral therapy for HIV/AIDS in developing countries: a systematic literature review

The impacts of antiretroviral therapy on quality of life, mental health, labor productivity, and economic wellbeing for people living with HIV/AIDS in developing countries are only beginning to be measured. We conducted a systematic literature review to analyze the effect of antiretroviral therapy (ART) on these non-clinical indicators in developing countries and assess the state of research on these topics. Both qualitative and quantitative studies were included, as were peer-reviewed articles, gray literature, and conference abstracts and presentations. Findings are reported from 12 full-length articles, 7 abstracts, and 1 presentation (representing 16 studies). Compared to HIV-positive patients not yet on treatment, patients on ART reported significant improvements in physical, emotional and mental health and daily function. Work performance improved and absenteeism decreased, with the most dramatic changes occurring in the first three months of treatment and then leveling off. Little research has been done on the impact of ART on household wellbeing, with modest changes in child and family wellbeing within households where adults are receiving ART reported so far. Studies from developing countries have not yet assessed non-clinical outcomes of therapy beyond the first year; therefore, longitudinal outcomes are still unknown. As ART roll out extends throughout high HIV prevalence, low-resource countries and is sustained over years and decades, both positive and adverse non-clinical outcomes need to be empirically measured and qualitatively explored in order to support patient adherence and maximize treatment benefits.

The Least of These: American Evangelical Parachurch Missions to the Poor, 1947-2005

This dissertation narrates the historical development of American evangelical missions to the poor from 1947-2005 and analyzes the discourse of its main parachurch proponents, especially World Vision, Compassion International, Food for the Hungry, Samaritan's urse, Sojourners, Evangelicals for Social Action, and the Christian Community Development Association. Although recent scholarship on evangelicalism has been prolific, much of the historical work has focused on earlier periods. Sociological and political scientific scholarship on the postwar period has been attracted mostly to controversies surrounding the Religious Right, leaving evangelicalism's resurgent concern for the poor relatively understudied. This dissertation addresses these lacunae. The study consists of three chronological parts, each marked by a distinctive model of mission to the poor. First, the 1950s were characterized by compassionate charity for individual emergencies, a model that cohered neatly with evangelicalism's individualism and emotionalism. This model should be regarded as the quintessential, bedrock evangelical theory of mission to the poor. It remained strong throughout the entire postwar period. Second, in the 1970s, a strong countercurrent emerged that advocated for penitent protest against structural injustice and underdevelopment. In contrast to the first model, it was distinguished by going against the grain of many aspects of evangelical culture, especially its reflexive patriotism and individualism. Third, in the 1990s, an important movement towards developing potential through hopeful holism gained prominence. Its advocates were confident that their integration of biblical principles with insights from contemporary economic development praxis would contribute to drastic, widespread reductions in poverty. This model signaled a new optimism in evangelicalism's engagement with the broader world. The increasing prominence of missions to the poor within American evangelicalism led to dramatic changes within the movement's worldview: by 2005, evangelicals were mostly unified in their expressed concern for the physical and social needs of the poor, a position that radically reversed their immediate postwar worldview of near-exclusive focus on the spiritual needs of individuals. Nevertheless, missions to the poor also paralleled, reinforced, and hastened the increasing fragmentation of evangelicalism's identity, as each missional model advocated for highly variant approaches to poverty amelioration that were undergirded by diverse sociological, political, and theological assumptions.

PARAMETERS AFFECTING THE IMAGING AND DETECTION OF MICROBUBBLES IN BLOOD

Stabilized micron-sized bubbles, known as contrast agents, are often injected into the body to enhance ultrasound imaging of blood flow. The ability to detect such bubbles in blood depends on the relative magnitude of the acoustic power backscattered from the microbubbles (‘signal’) to the power backscattered from the red blood cells (‘noise’). Erythrocytes are acoustically small (Rayleigh regime), weak scatterers, and therefore the backscatter coefficient (BSC) of blood increases as the fourth power of frequency throughout the diagnostic frequency range. Microbubbles, on the other hand, are either resonant or super-resonant in the range 5-30 MHz. Above resonance, their total scattering cross-section remains constant with increasing frequency. In the present thesis, a theoretical model of the BSC of a suspension of red blood cells is presented and compared to the BSC of Optison® contrast agent microbubbles. It is predicted that, as the frequency increases, the BSC of red blood cell suspensions eventually exceeds the BSC of the strong scattering microbubbles, leading to a dramatic reduction in signal-to-noise ratio (SNR). This decrease in SNR with increasing frequency was also confirmed experimentally by use of an active cavitation detector for different concentrations of Optison® microbubbles in erythrocyte suspensions of different hematocrits. The magnitude of the observed decrease in SNR correlated well with theoretical predictions in most cases, except for very dense suspensions of red blood cells, where it is hypothesized that the close proximity of erythrocytes inhibits the acoustic response of the microbubbles.

EXPERIMENTAL INVESTIGATION OF LINEAR BUBBLE DYNAMICS IN A VISCOELASTIC XANTHAN GEL

Oceanic bubble plumes caused by ship wakes or breaking waves disrupt sonar communi- cation because of the dramatic change in sound speed and attenuation in the bubbly fluid. Experiments in bubbly fluids have suffered from the inability to quantitatively characterize the fluid because of continuous air bubble motion. Conversely, single bubble experiments, where the bubble is trapped by a pressure field or stabilizing object, are limited in usable frequency range, apparatus complexity, or the invasive nature of the stabilizing object (wire, plate, etc.). Suspension of a bubble in a viscoelastic Xanthan gel allows acoustically forced oscilla- tions with negligible translation over a broad frequency band. Assuming only linear, radial motion, laser scattering from a bubble oscillating below, through, and above its resonance is measured. As the bubble dissolves in the gel, different bubble sizes are measured in the range 240 – 470 μm radius, corresponding to the frequency range 6 – 14 kHz. Equalization of the cell response in the raw data isolates the frequency response of the bubble. Compari- son to theory for a bubble in water shows good agreement between the predicted resonance frequency and damping, such that the bubble behaves as if it were oscillating in water.

Large Decrease of Fluctuations for Supercooled Water in Hydrophobic Nanoconfinement

Using Monte Carlo simulations we study a coarse­grained model of a water layer confined in a fixed disordered matrix of hydrophobic nanoparticles at different particle concentrations c. For c = 0 we find a 1st order liquid­liquid phase transition (LLPT) ending in one critical point at low pressure P. For c > 0 our simulations are consistent with a LLPT line ending in two critical points at low and high pressure. For c = 25% at high P and low temperature T we find a dramatic decrease of compressibility, thermal expansion coefficient, and specific heat. Surprisingly, the effect is present also for c as low as 2.4%. We conclude that even a small presence of nanoscopic hydrophobes can drastically suppress thermodynamic fluctuations, making the detection of the LLPT more difficult.

On the Performance of Polynomial-time CLIQUE Approximation Algorithms on Very Large Graphs

The performance of a randomized version of the subgraph-exclusion algorithm (called Ramsey) for CLIQUE by Boppana and Halldorsson is studied on very large graphs. We compare the performance of this algorithm with the performance of two common heuristic algorithms, the greedy heuristic and a version of simulated annealing. These algorithms are tested on graphs with up to 10,000 vertices on a workstation and graphs as large as 70,000 vertices on a Connection Machine. Our implementations establish the ability to run clique approximation algorithms on very large graphs. We test our implementations on a variety of different graphs. Our conclusions indicate that on randomly generated graphs minor changes to the distribution can cause dramatic changes in the performance of the heuristic algorithms. The Ramsey algorithm, while not as good as the others for the most common distributions, seems more robust and provides a more even overall performance. In general, and especially on deterministically generated graphs, a combination of simulated annealing with either the Ramsey algorithm or the greedy heuristic seems to perform best. This combined algorithm works particularly well on large Keller and Hamming graphs and has a competitive overall performance on the DIMACS benchmark graphs.