Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study

Background Increased mortality among men on antiretroviral therapy (ART) has been documented but remains poorly understood. We examined the magnitude of and risk factors for gender differences in mortality on ART. Methods and Findings Analyses included 46,201 ART-naïve adults starting ART between January 2002 and December 2009 in eight ART programmes across South Africa (SA). Patients were followed from initiation of ART to outcome or analysis closure. The primary outcome was mortality; secondary outcomes were loss to follow-up (LTF), virologic suppression, and CD4+ cell count responses. Survival analyses were used to examine the hazard of death on ART by gender. Sensitivity analyses were limited to patients who were virologically suppressed and patients whose CD4+ cell count reached >200 cells/µl. We compared gender differences in mortality among HIV+ patients on ART with mortality in an age-standardised HIV-negative population. Among 46,201 adults (65% female, median age 35 years), during 77,578 person-years of follow-up, men had lower median CD4+ cell counts than women (85 versus 110 cells/µl, p<0.001), were more likely to be classified WHO stage III/IV (86 versus 77%, p<0.001), and had higher mortality in crude (8.5 versus 5.7 deaths/100 person-years, p<0.001) and adjusted analyses (adjusted hazard ratio [AHR] 1.31, 95% CI 1.22–1.41). After 36 months on ART, men were more likely than women to be truly LTF (AHR 1.20, 95% CI 1.12–1.28) but not to die after LTF (AHR 1.04, 95% CI 0.86–1.25). Findings were consistent across all eight programmes. Virologic suppression was similar by gender; women had slightly better immunologic responses than men. Notably, the observed gender differences in mortality on ART were smaller than gender differences in age-standardised death rates in the HIV-negative South African population. Over time, non-HIV mortality appeared to account for an increasing proportion of observed mortality. The analysis was limited by missing data on baseline HIV disease characteristics, and we did not observe directly mortality in HIV-negative populations where the participating cohorts were located. Conclusions HIV-infected men have higher mortality on ART than women in South African programmes, but these differences are only partly explained by more advanced HIV disease at the time of ART initiation, differential LTF and subsequent mortality, and differences in responses to treatment. The observed differences in mortality on ART may be best explained by background differences in mortality between men and women in the South African population unrelated to the HIV/AIDS epidemic.

Poems /

Mode of access: Internet.

To John Greenleaf Whittier on the anniversary of his 87th [i.e. 78th] birthday /

Extracted from Golden Era, Vol.XXXIV, no. 8, December, 1885; [San Francisco].

Endura : or, three generations : a New England romance / by B. P. Moore.

Mode of access: Internet.

Vedânta philosophy; three lectures on philosophy of work. Delivered under the auspices of the Vedânta Society, in Carnegie lyceum, New York.

Philosophy of work.--Secret of work.--Duty or motive in work.

Focus on the San Bernardino-Riverside-Ontario metropolitan area : an economic study /

Supplement to table 2, page 3 inserted.

Twenty-four letters from labourers in America to their friends in England.

Prepared by the personnel of the Works Progress Administration, Project no. 665-08-3-236, A. Yedidia, supervisor.

Transactions of the Commonwealth Club of California.

One number of each year called Annual progress report for previous year.

Official report of the California State Agricultural Society's fourth annual fair, cattle show and industrial exhibition, held at Stockton, Sept. 29th, 30th, Oct. 1st and 2d, 1857 /

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Mode of access: Internet.

Multimodal and monomodal discourses of marketization in higher education : power, ideology, and the absence of the image

The ubiquity of multimodality in hypermedia environments is undeniable. Bezemer and Kress (2008) have argued that writing has been displaced by image as the central mode for representation. Given the current technical affordances of digital technology and user-friendly interfaces that enable the ease of multimodal design, the conspicuous absence of images in certain domains of cyberspace is deserving of critical analysis. In this presentation, I examine the politics of discourses implicit within hypertextual spaces, drawing textual examples from a higher education website. I critically examine the role of writing and other modes of production used in what Fairclough (1993) refers to as discourses of marketisation in higher education, tracing four pervasive discourses of teaching and learning in the current economy: i) materialization, ii) personalization, iii) technologisation, and iv) commodification (Fairclough, 1999). Each of these arguments is supported by the critical analysis of multimodal texts. The first is a podcast highlighting the new architectonic features of a university learning space. The second is a podcast and transcript of a university Open Day interview with prospective students. The third is a time-lapse video showing the construction of a new science and engineering precinct. These three multimodal texts contrast a final web-based text that exhibits a predominance of writing and the powerful absence or silencing of the image. I connect the weightiness of words and the function of monomodality in the commodification of discourses, and its resistance to the multimodal affordances of web-based technologies, and how this is used to establish particular sets of subject positions and ideologies through which readers are constrained to occupy. Applying principles of critical language study by theorists that include Fairclough, Kress, Lemke, and others whose semiotic analysis of texts focuses on the connections between language, power, and ideology, I demonstrate how the denial of image and the privileging of written words in the multimodality of cyberspace is an ideological effect to accentuate the dominance of the institution.

Recruiting career-change professionals as teachers: the challenge of socialization into teaching

In many countries there is a shortage of quality teachers in areas of science, technology, engineering and mathematics (STEM). One solution has been to encourage mid-career professionals in the area of STEM to become school teachers. The transition of mid-career professionals to science and mathematics teaching in schools is thus becoming a common phenomenon. The assumption exists that their experiences and enthusiasm for their subject matter will inspire more students to achieve greater outcomes in school and to pursue careers in the sciences. Although the experiences of beginning teachers have been extensively studied for over half a century, there has been little research on career-change teachers and the particular challenges that they face in becoming school teachers. These career-changers have constructed professional identities and are accustomed to working within a culture of collaboration and inquiry. In contrast school cultures are quite different and often teaching is a lonely solitary affair with little opportunity for collegial relationships aimed at knowledge building in the context of teaching. This research was a longitudinal study that followed 17 teachers from the commencement of teaching. Most of these teachers left professional careers to become teachers. Seven remained in teaching after three years.

Reflections from early career graduates of the exceptional teachers for disadvantaged schools project

This paper aims to explore the experiences of newly qualified teachers and their supervising principals who work in schools situated in various high-poverty areas of Queensland, Australia. It is informed by data collected in the context of an Australian teacher education program, Exceptional Teachers for Disadvantaged Schools (ETDS). Now in its third year, this program was designed to prepare highly skilled pre-service teachers to work in schools that have large numbers of students from disadvantaged or low socio-economic status (SES) backgrounds. Addressing the oft-stated need to prepare high-quality teachers for low SES schools, high-achieving undergraduate education students were invited to participate in two years of specialised curriculum to prepare them for the schools that need them the most, which are also the schools that are often difficult to staff. Pre-service teachers in this program do all their teaching practicum placements in challenging or complex schools. In 2011, some of this cohort did their practicum teaching in schools with large numbers of Indigenous students and several went on to teach in remote communities after graduation. These graduates and the leaders of the schools they work in are the primary informants for this paper.

Taboo Texts and Troubling Silences: How Textual Choices Coconstruct a Positive School Climate for Same-Sex- Attracted Students

This paper offers insights into the relationship between curriculum decision making, positive school climate, and academic achievement for same-sex attracted (SSA) students. The authors use critical discourse analysis to present a ‘conversation’ between six same-sex attracted young people, aged 14-19, and three pop-culture texts currently popular with both teachers and school-aged peers: The Hunger Games, Tomorrow When the War Began, and Neighbours. Analysis starts from the perspective that schools are empowered agents in the production of students’ sexualised identities and seeks to understand how textual choices function as active discourse in that production. Through this analysis, an argument is made for expanding notions of what it means to ‘attend to’ gender and sexuality through textual choice and critical pedagogy.