Factors associated with adherence to antiretroviral therapy in HIV/AIDS patients: a cross-sectional study in Southern Brazil

A cross-sectional study was conducted on HIV-infected adults being treated with antiretroviral drugs at a reference service in Southern Brazil. Participants answered a sociodemographic questionnaire and were tested by scales assessing sociocognitive variables. Adherence to treatment was assessed by a self-report inventory developed for the study. Clinical information was obtained from the patients' records. Significance tests were conducted using univariate logistic regressions followed by multivariate logistic regression analysis. A total of 195 patients participated in the study and 56.9% of them reported > or = 95% adherence on the previous two days. In univariate analysis, the odds of adherence increased with self-efficacy (a person's conviction that he/she can successfully execute the behavior required to produce a certain desired outcome) in taking medications as prescribed (OR = 3.50, 95% CI 1.90-6.55), and decreased with perception of negative affect and physical concerns (OR = 0.71, 95% CI 0.53-0.95). The odds were lower for taking antiretroviral medications >4 times a day (OR = 0.44, 95% CI 0.20-0.94) and higher for patients with 8 years of schooling (OR = 2.28, 95% CI 1.12-4.66). In the multivariate analysis, self-efficacy (OR = 3.33, 95% CI 1.69-6.56) and taking medication >4 times a day (OR = 0.34, 95% CI 0.14-0.80) were independently associated with adherence. Self-efficacy was the most important predictor of adherence, followed by number of times antiretroviral medication was taken per day. Among sociodemographic and clinical variables, only the number of years of schooling was associated with adherence. Motivational interventions based on self-efficacy may be useful for increasing treatment adherence.

IS1245 restriction fragment length polymorphism typing of Mycobacterium avium from patients admitted to a reference hospital in Campinas, Brazil

Mycobacterium avium is an important pathogen among immunodeficient patients, especially patients with AIDS. The natural history of this disease is unclear. Several environmental sources have been implicated as the origin of this infection. Polyclonal infection with this species is observed, challenging the understanding of its pathogenesis and treatment. In the present study 45 M. avium strains were recovered from 39 patients admitted to a reference hospital between 1996 and 1998. Species identification was performed using a species-specific nucleic acid hybridization test (AccuProbe®) from Gen-Probe®. Strains were genotyped using IS1245 restriction fragment length polymorphism typing. Blood was the main source of the organism. In one patient with disseminated disease, M. avium could be recovered more than once from potentially sterile sites. Strains isolated from this patient had different genotypes, indicating that the infection was polyclonal. Four patient clones were characterized in this population, the largest clone being detected in eight patients. This finding points to a common-source transmission of the organism.

Evaluation of genotype resistance testing for salvage antiretroviral therapy at AIDS care centers from Ribeirão Preto, São Paulo, Brazil

The availability of HIV-1 genotype resistance testing (GRT) to clinicians has been insufficiently studied outside randomized clinical trials. The present study evaluated the outcome of salvage antiretroviral therapy (ART) recommended by an expert physician based on GRT in a non-clinical trial setting in Ribeirão Preto, Brazil. A prospective, open, nonrandomized study evaluating easy access to GRT at six Brazilian AIDS Clinics was carried out. This cooperative study analyzed the efficacy of treatment recommended to patients whose salvage ART was guided by GRT with that of treatment with ART based only on previous ART history. A total of 112 patients with ART failure were included in the study, and 77 of them were submitted to GRT. The median CD4 cell count and viral load for these 77 patients at baseline were (mean ± SD) 252.1 ± 157.4 cells/µL and 4.60 ± 0.5 log10 HIV RNA copies/mL, respectively. The access time, i.e., the time elapsed between ordering the GRT and receiving the result was, on average, 71.9 ± 37.3 days. The study results demonstrated that access to GRT followed by expert recommendations did not improve the time to persistent treatment failure when compared to conventional salvage ART. Access to GRT in this Brazilian community health care setting did not improve the long-term virologic outcomes of HIV-infected patients experiencing treatment failure. This result is probably related to the long time required to implement ART guided by GRT.

Hypomagnesemia is a risk factor for nonrecovery of renal function and mortality in AIDS patients with acute kidney injury

The objective of the present study was to determine the prevalence of electrolyte disturbances in AIDS patients developing acute kidney injury in the hospital setting, as well as to determine whether such disturbances constitute a risk factor for nephrotoxic and ischemic injury. A prospective, observational cohort study was carried out. Hospitalized AIDS patients were evaluated for age; gender; coinfection with hepatitis; diabetes mellitus; hypertension; time since HIV seroconversion; CD4 count; HIV viral load; proteinuria; serum levels of creatinine, urea, sodium, potassium and magnesium; antiretroviral use; nephrotoxic drug use; sepsis; intensive care unit (ICU) admission, and the need for dialysis. Each of these characteristics was correlated with the development of acute kidney injury, with recovery of renal function and with survival. Fifty-four patients developed acute kidney injury: 72% were males, 59% had been HIV-infected for >5 years, 72% had CD4 counts <200 cells/mm³, 87% developed electrolyte disturbances, 33% recovered renal function, and 56% survived. ICU admission, dialysis, sepsis and hypomagnesemia were all significantly associated with nonrecovery of renal function and with mortality. Nonrecovery of renal function was significantly associated with hypomagnesemia, as was mortality in the multivariate analysis. The risks for nonrecovery of renal function and for death were 6.94 and 6.92 times greater, respectively, for patients with hypomagnesemia. In hospitalized AIDS patients, hypomagnesemia is a risk factor for nonrecovery of renal function and for in-hospital mortality. To determine whether hypomagnesemia is a determinant or simply a marker of critical illness, further studies involving magnesium supplementation in AIDS patients are warranted.

Acute kidney injury in AIDS: frequency, RIFLE classification and outcome

The objective of the present study was to evaluate the characteristics of acute kidney injury (AKI) in AIDS patients and the value of RIFLE classification for predicting outcome. The study was conducted on AIDS patients admitted to an infectious diseases hospital inBrazil. The patients with AKI were classified according to the RIFLE classification: R (risk), I (injury), F (failure), L (loss), and E (end-stage renal disease). Univariate and multivariate analyses were used to evaluate the factors associated with AKI. A total of 532 patients with a mean age of 35 ± 8.5 years were included in this study. AKI was observed in 37% of the cases. Patients were classified as "R" (18%), "I" (7.7%) and "F" (11%). Independent risk factors for AKI were thrombocytopenia (OR = 2.9, 95%CI = 1.5-5.6, P < 0.001) and elevation of aspartate aminotransferase (AST) (OR = 3.5, 95%CI = 1.8-6.6, P < 0.001). General mortality was 25.7% and was higher among patients with AKI (40.2 vs17%, P < 0.001). AKI was associated with death and mortality increased according to RIFLE classification - "R" (OR 2.4), "I" (OR 3.0) and "F" (OR 5.1), P < 0.001. AKI is a frequent complication in AIDS patients, which is associated with increased mortality. RIFLE classification is an important indicator of poor outcome for AIDS patients.

'TINA', Aids, and the underdevelopment problem in Africa

The assumption that 'There Is No Alternative' (TINA) to capitalism as practiced in the United States of America and Western Europe has been the bane of aids effectiveness in assisting to solve the underdevelopment problem in Africa. This paper attempts to show that except there is a fundamental reorientation in the conceptualization of capitalism-free market and democracy-the underdevelopment problem would only be further complicated with aids.

Finding Methods for Recognizing and Classifying Spare Part Criticality – Case Full Deposit Stripping Machines

The aim of this Master’s thesis is to find a method for classifying spare part criticality in the case company. Several approaches exist for criticality classification of spare parts. The practical problem in this thesis is the lack of a generic analysis method for classifying spare parts of proprietary equipment of the case company. In order to find a classification method, a literature review of various analysis methods is required. The requirements of the case company also have to be recognized. This is achieved by consulting professionals in the company. The literature review states that the analytic hierarchy process (AHP) combined with decision tree models is a common method for classifying spare parts in academic literature. Most of the literature discusses spare part criticality in stock holding perspective. This is relevant perspective also for a customer orientated original equipment manufacturer (OEM), as the case company. A decision tree model is developed for classifying spare parts. The decision tree classifies spare parts into five criticality classes according to five criteria. The criteria are: safety risk, availability risk, functional criticality, predictability of failure and probability of failure. The criticality classes describe the level of criticality from non-critical to highly critical. The method is verified for classifying spare parts of a full deposit stripping machine. The classification can be utilized as a generic model for recognizing critical spare parts of other similar equipment, according to which spare part recommendations can be created. Purchase price of an item and equipment criticality were found to have no effect on spare part criticality in this context. Decision tree is recognized as the most suitable method for classifying spare part criticality in the company.

Will the "fight" ever end? : a critical reading of the metaphors and discourses that construct HIV/AIDS in an African context

In this thesis, I critically examine the discourses that inform how we conceptualise HIV/AIDS in Sub-Saharan Africa as they are produced in a sample of Canadian news articles, two nonfiction texts - Stephanie Nolen's 28 Stories of AIDS in Africa and Jonathan Morgan and the Bambanani Women's Group's Long Life ... Positive HIV Stories - as well as two literary texts - John Le Carre's popular fiction novel The Constant Gardener and an anthology of stories and poems from Southern Africa titled Nobody Ever Said AIDS, compiled and edited by Nobantu Rasebotsa, Meg Samuelson and Kylie Thomas. Paying particular attention to the role of metaphor in discursive formation, I have found that military metaphors, usually used in conjunction with biomedical discourses, continue to dominate what is said about HIV/AIDS. However, the use of military metaphors to conceptualise HIV/AIDS contributes to stigma and limits the effectiveness of responses to the pandemic. I argue that accessing alternative metaphors and discourses, such as biopsychosocial discourse, can lead to a more layered - and more beneficial - conceptualisation of HIV/AIDS, encouraging a more active response to the pandemic.

Finding the Open Spaces in Closed Systems: An Exploration of Critical Pedagogy with a Social Justice Directive in an Ontario Secondary School Classroom

This study examines the first experience of students, teachers, and an administrator in implementing a teacher-designed Leadership in Social Justice Program at a large urban Ontario secondary school. The program aimed to infuse a Freirean concept of critical pedagogical praxis (Freire, 1970/1993) in a grade 12 integrated educational experience with a social justice directive. Data were collected through two questionnaires and eight in-depth interviews. The data identified three areas of awareness that described ways in which student participants were impacted most profoundly (a) developing self-awareness, (b) understanding a new educational paradigm, and (c) finding a place in the world. The study found that the program was successful in highlighting the possibility for more meaningful education and engaged many students deeply; however, its success was limited by the lead teacher’s failure to fully grasp and implement tenets of Freirean critical pedagogy that involved the role of the teacher in pedagogical processes.

Square Root Finding In Graphs

Abstract: Root and root finding are concepts familiar to most branches of mathematics. In graph theory, H is a square root of G and G is the square of H if two vertices x,y have an edge in G if and only if x,y are of distance at most two in H. Graph square is a basic operation with a number of results about its properties in the literature. We study the characterization and recognition problems of graph powers. There are algorithmic and computational approaches to answer the decision problem of whether a given graph is a certain power of any graph. There are polynomial time algorithms to solve this problem for square of graphs with girth at least six while the NP-completeness is proven for square of graphs with girth at most four. The girth-parameterized problem of root fining has been open in the case of square of graphs with girth five. We settle the conjecture that recognition of square of graphs with girth 5 is NP-complete. This result is providing the complete dichotomy theorem for square root finding problem.

Finding and Implementing Relevant Resources in Adapted Physical Activity (APA): It's easier said than done...

The purpose of this research was to explore challenges to operationalizing and implementing relevant resources for Adapted Physical Activity (APA) and to develop a framework on how resources should be developed and implemented to foster appropriate APA. An unobtrusive methodology was used to examine existing resources and training/learning opportunities for practitioners teaching APA. Data were collected via unobtrusive methods: documents, records, literature and feedback forms. After the findings were summarized, expert consultations were completed using a modified Delphi- technique to confirm the findings. A constructivist approach and phenomenological orientation was used to analyze the data and develop the “ideal” resource. Results indicate there are limited APA resources and teaching/learning opportunities for practitioners and there is a need for practitioner facilitation through professional development on finding and implementing resources. Future research should develop and evaluate the “ideal” resource and strive to improve the connection and consistency of resources in APA.

GA approach for finding Rough Set decision rules based on bireducts

Feature selection plays an important role in knowledge discovery and data mining nowadays. In traditional rough set theory, feature selection using reduct - the minimal discerning set of attributes - is an important area. Nevertheless, the original definition of a reduct is restrictive, so in one of the previous research it was proposed to take into account not only the horizontal reduction of information by feature selection, but also a vertical reduction considering suitable subsets of the original set of objects. Following the work mentioned above, a new approach to generate bireducts using a multi--objective genetic algorithm was proposed. Although the genetic algorithms were used to calculate reduct in some previous works, we did not find any work where genetic algorithms were adopted to calculate bireducts. Compared to the works done before in this area, the proposed method has less randomness in generating bireducts. The genetic algorithm system estimated a quality of each bireduct by values of two objective functions as evolution progresses, so consequently a set of bireducts with optimized values of these objectives was obtained. Different fitness evaluation methods and genetic operators, such as crossover and mutation, were applied and the prediction accuracies were compared. Five datasets were used to test the proposed method and two datasets were used to perform a comparison study. Statistical analysis using the one-way ANOVA test was performed to determine the significant difference between the results. The experiment showed that the proposed method was able to reduce the number of bireducts necessary in order to receive a good prediction accuracy. Also, the influence of different genetic operators and fitness evaluation strategies on the prediction accuracy was analyzed. It was shown that the prediction accuracies of the proposed method are comparable with the best results in machine learning literature, and some of them outperformed it.

Aids to english composition, prepared for students of all grandes; embracing specimens and examples of school and college exercises and most of the Higher departaments of english composition, both in prose and verse

UANL

The Law-Finding Function of the American Jury

Article reprinted by permission of the Wisconsin Law Review. HARRINGTON Matthew P., "The Law-Finding Function of the American Jury", Copyright (1999) by The Board of Regents of the University of Wisconsin System.