The effect of Tenofovir on vitamin D metabolism in HIV-infected adults is dependent on sex and ethnicity

Background: Tenofovir has been associated with renal phosphate wasting, reduced bone mineral density, and higher parathyroid hormone levels. The aim of this study was to carry out a detailed comparison of the effects of tenofovir versus non-tenofovir use on calcium, phosphate and, vitamin D, parathyroid hormone (PTH), and bone mineral density. Methods: A cohort study of 56 HIV-1 infected adults at a single centre in the UK on stable antiretroviral regimes comparing biochemical and bone mineral density parameters between patients receiving either tenofovir or another nucleoside reverse transcriptase inhibitor. Principal Findings: In the unadjusted analysis, there was no significant difference between the two groups in PTH levels (tenofovir mean 5.9 pmol/L, 95% confidence intervals 5.0 to 6.8, versus non-tenofovir; 5.9, 4.9 to 6.9; p = 0.98). Patients on tenofovir had significantly reduced urinary calcium excretion (median 3.01 mmol/24 hours) compared to non-tenofovir users (4.56; p,0.0001). Stratification of the analysis by age and ethnicity revealed that non-white men but not women, on tenofovir had higher PTH levels than non-white men not on tenofovir (mean difference 3.1 pmol/L, 95% CI 5.3 to 0.9; p = 0.007). Those patients with optimal 25-hydroxyvitamin D (.75 nmol/L) on tenofovir had higher 1,25-dihydroxyvitamin D [1,25(OH)2D] (median 48 pg/mL versus 31; p = 0.012), fractional excretion of phosphate (median 26.1%, versus 14.6;p = 0.025) and lower serum phosphate (median 0.79 mmol/L versus 1.02; p = 0.040) than those not taking tenofovir. Conclusions: The effects of tenofovir on PTH levels were modified by sex and ethnicity in this cohort. Vitamin D status also modified the effects of tenofovir on serum concentrations of 1,25(OH)2D and phosphate.

Inequities, alternatives and future directions : inside perspectives of Indigenous sentencing in Queensland

In Australia, sentencing researchers have generally focussed on whether there is statistical equality/inequality in outcomes by reference to Indigenous status. However, contextualising the sentencing process requires us to move away from a reliance on statistical analyses alone, as this approach cannot tell us whether sentencing is an equitable process for Indigenous people. Consultation with those working at the sentencing ‘coal face’ provides valuable insight into the nexus between Indigenous status and sentencing. This article reports the main themes from surveys of the judiciary and prosecutors, and focus groups of Community Justice Groups undertaken in Queensland. The aim is to understand better the sentencing process for Indigenous Queenslanders. Results suggest that while there have been some positive developments in sentencing (e.g. the Murri Court, Community Justice Groups) Indigenous offenders still face a number of inequities.

Feminist criminologies’ contribution to understandings of sex, gender, and crime

This chapter provides an overview of the contribution of feminist criminologies to understandings of the complex intersections between sex, gender and crime. Dozens of scholars and activists have participated in these debates over the past four decades. For our contribution to this handbook, we interviewed ten distinguished scholars whose contributions are recognized internationally. Through the commentary provided by these scholars, this chapter examines some of the distinctive contributions of feminism to our knowledge about sex, gender, and crime, as well as some of the challenges it continues to face in the field of criminology. We conclude that feminist work within criminology continues to face a number of lingering challenges, most notably in relation to the struggle to maintain relevance in a world where concerns about gender inequality are marginalized and considered as historical relics not contemporary issues; where there are on-going tensions around the best strategies for change, as well as difficulties in challenging distorted representations of female crime and violence; and where a backlash, anti-feminist politics seeks to discredit explanations that draw a link between sex, gender, and crime. This chapter critically reviews these lingering challenges—locating feminist approaches (of which there are many) at the centre and not the periphery of advancing knowledge about gender, sex, and crime.

Private health insurance status and utilisation of dental services in Australia

This article focuses on the relationship between private insurance status and dental service utilisation in Australia using data between 1995 and 2001. This article employs joint maximum likelihood to estimate models of time since last dental visit treating private ancillary health insurance (PAHI) as endogenous. The sensitivity of results to the choice between two different but related types of instrumental variables is examined. We find robust evidence in both 1995 and 2001 that individuals with a PAHI policy make significantly more frequent dental consultations relative to those without such coverage. A comparison of the 1995 and 2001 results, however, suggests that there has been an increasing role of PAHI in terms of the frequency of dental consultations over time. This seems intuitive given the trends in the price of unsubsidised private dental consultations. In terms of policy, our results suggest that while government measures to increase private health insurance coverage in Australia has been successful to a significant degree, it may have come at some cost in terms of socio-economic inequality as the privately insured are provided much better access to care and financial protection.

Speaking truth to power : sexism, outrage and the public consciousness

Alan Jones's now infamous comment that women are destroying the joint' sparked a flurry of observations and interpretations in the national and international media and in the blogosphere about the motivations and meanings of such a statement. The overriding tone of this commentary was outrage - how dare an influential figure like Jones state with such blatant and provocative hostility that women are at best unsuitable for leadership and at worst, damaging our public and private institutions? The answers, as we have seen, are likely to be complex, but an alternative question could also be posed. Why the outrage? Public male figures have, throughout history, made derogatory, demeaning and sexist remarks about women, and the material effects of gender inequality continue to be felt- consider the gender pay gap and glass ceiling phenomenon for starters. So why did this particular comment ignite such widespread indignation and anger?

(Neo)Liberal doses of inequality : advance Australia where?

The relationship between social background and achievement has preoccupied educational researchers since the mid-20th century with major studies in the area reaching prominence in the late 60s. Despite five decades of research and innovation since, recent studies using OECD data have shown that the relationship is strengthening rather than weakening. In this paper, the systematic destabilisation of public education in Australia is examined as a philosophical problem stemming from a fundamental shift in political orientation, where “choice” and “aspiration” work to promote and disguise survivalism. The problem for education however extends far deeper than the inequity in Federal government funding. Whilst this is a major problem, critical scrutiny must also focus on what states can do to turn back aspects of their own education policy that work to exacerbate and entrench social disadvantage.

Costly technology adoption, redistribution and growth

We study a political economy model which aims to understand the diversity in the growth and technology-adoption experiences in different economies. In this model the cost of technology adoption is endogenous and varies across heterogeneous agents. Agents in the model vote on the proportion of revenues allocated towards such expenditures. In the early stages of development, the political-economy outcome of the model ensures that a sub-optimal proportion of government revenue is used to finance adoption-cost reducing expenditures. This sub-optimality is due to the presence of inequality; agents at the lower end of the distribution favor a larger amount of revenue allocated towards redistribution in the form of lump-sum transfers. Eventually all individuals make the switch to the better technology and their incomes converge. The outcomes of the model therefore explain why public choice is more likely to be conservative in nature; it represents the majority choice given conflicting preferences among agents. Consequently, the transition path towards growth and technology adoption varies across countries depending on initial levels of inequality.

Communication and the casualisation of nursing : a critical ethnography

The contemporary working environment is being rapidly reshaped by technological, industrial and political forces. Increased global competitiveness and an emphasis on productivity have led to the appearance of alternative methods of employment, such as part-time, casual and itinerant work, allowing greater flexibility. This allows for the development of a core permanent staff and the simultaneous utilisation of casual staff according to business needs. Flexible workers across industries are generally referred to as the non-standard workforce and full-time permanent workers as the standard workforce. Even though labour flexibility favours the employer, increased opportunity for flexible work has been embraced by women for many reasons, including the gender struggle for greater economic independence and social equality. Consequently, the largely female nursing industry, both nationally and internationally, has been caught up in this wave of change. This ageing workforce has been at the forefront of the push for flexibility with recent figures showing almost half the nursing workforce is employed in non-standard capacity. In part, this has allowed women to fulfil caring roles outside their work, to ease off nearing retirement and to supplement the family income. More significantly, however, flexibility has developed as an economic management initiative, as a strategy for cost constraint. The result has been the development of a dual workforce and as suggested by Pocock, Buchanan and Campbell (2004), associated deep-seated resentment and the marginalisation of part-time and casual workers by their full-time colleagues and managers. Additionally, as nursing currently faces serious recruitment and retention problems there is urgent need to understand the factors which are underlying present discontent in the nursing profession. There is an identified gap in nursing knowledge surrounding the issues relating to recruitment and retention. Communication involves speaking, listening, reading and writing and is an interactive process which is central to the lives of humans. Workplace communication refers to human interaction, information technology, and multimedia and print. It is the means to relationship building between workers, management, and their external environment and is critical to organisational effectiveness. Communication and language are integral to nursing performance (Hall, 2005), in twenty-four hour service however increasing fragmentation due to part-time and casual work in the nursing industry means that effective communication management has become increasingly difficult. More broadly it is known that disruption to communication systems impacts negatively on consumer outcomes. Because of this gap in understanding how nurses view their contemporary nursing world, an interpretative ethnographic study which progressed to a critical ethnographic study, based on the conceptual framework of constructionism and interpretativism was used. The study site was a division within an acute health care facility, and the relationship between increasing casualisation of the nursing workforce and the experiences of communication of standard and non-standard nurses was explored. For this study, full-time standard nurses were those employed to work in a specific unit for forty hours per week. Non-standard nurses were those employed part-time in specific units or those nurses employed to work as relief pool nurses for shift short falls where needed. Nurses employed by external agencies, but required to fill in for shifts at the facility were excluded from this research. This study involved an analysis of observational, interview and focus group data of standard and non-standard nurses within this facility. Three analytical findings - the organisation of nursing work; constructing the casual nurse as other; and the function of space, situate communication within a broader discussion about non-standard work and organisational culture. The study results suggest that a significant culture of marginalisation exists for nurses who work in a non-standard capacity and that this affects communication for nurses and has implications for the quality of patient care. The discussion draws on the seven elements of marginalisation described by Hall, Stephen and Melius (1994). The arguments propose that these elements underpin a culture which supports remnants of the historically gendered stereotype "the good nurse" and these cultural values contribute to practices and behaviour which marginalise all nurses, particularly those who work less than full-time. Gender inequality is argued to be at the heart of marginalising practices because of long standing subordination of nurses by the powerful medical profession, paralleling historical subordination of women in society. This has denied nurses adequate representation and voice in decision making. The new knowledge emanating from this study extends current knowledge of factors surrounding recruitment and retention and as such contributes to an understanding of the current and complex nursing environment.

Turbulent mixing and sediment processes in peri-urban estuariesin South-East Queensland (Australia)

An estuary is formed at the mouth of a river where the tides meet a freshwater flow and it may be classified as a function of the salinity distribution and density stratification. An overview of the broad characteristics of the estuaries of South-East Queensland(Australia) is presented herein, where the small peri-urban estuaries may provide an useful indicator of potential changes which might occur in larger systems with growing urbanisation. Small peri-urban estuaries exhibits many key hydrological features and associated with ecosystem types of larger estuaries, albeit at smaller scales, often with a greater extent of urban development as a proportion of catchment area. We explore the potential for some smaller peri-urban estuaries to be used as natural laboratories to gain some much needed information on the estuarine processes, although any dynamics similarity is presently limited by critical absence of in-depth physical investigation in larger estuarine systems. The absence of the detailed turbulence and sedimentary data hampers the understanding and modelling of the estuarine zones. The interactions between the various stake holders are likely to define the vision for the future of South-East Queensland's peri-urban estuaries. This will require a solid understanding of the bio-physical function and capacity of the peri-urban estuaries. Based upon the knowledge gap, it is recommended that an adaptive trial and error approach be adopted for the future of investigation and management strategies.

Gay men, social media and self-presentation : managing identities in Gaydar, Facebook and beyond

This study analyses young gay men's identity management in social networking sites Gaydar and Facebook. It examines the expanded opportunities for identity management made available through the convergence of these spaces, as well as new privacy and safety concerns. Findings from this study are discussed in terms of their significance for gay men's digital culture, the approach to gay men's mental health taken by GLBT organisations and support groups, and within broader concerns around social networking sites and digital inequality.

Essays on technology adoption under uncertainty, globalization and economic growth

This thesis examines how the initial institutional and technological aspects of the economy and the reforms that alter these aspects influence long run growth and development. These issues are addressed in the framework of stochastic endogenous growth models and an empirical framework. The thesis is able to explain why developing nations exhibit diverse growth and inequality patterns. Consequently, the thesis raises a number of policy implications regarding how these nations can improve their economic outcomes.

Convergence in the gender wage gap in Australia over the 1980s : identifying the role of counteracting forces via the Juhn, Murphy and Pierce decomposition

The paper utilises the Juhn Murphy and Pierce (1991) decomposition to shed light on the pattern of slow male-female wage convergance in Australia over the 1980s. The analysis allows one to distinguish between the role of wage structure and genderspecific effects. The central question addressed is whether rising wage inequality counteracted the forces of increased female investment in labour market skills, i.e. education and experience. The conclusion is that in contrast to the US and the UK, Australian women do not appear to have been swimming against a tide of adverse wage structure changes.

CD4+ tumor infiltrating lymphocytes are prognostic and independent of R-IPI in patients with DLBCL receiving R-CHOP chemo-immunotherapy

Despite the Revised International Prognostic Index's (R-IPI) undoubted utility in diffuse large B-cell lymphoma (DLBCL), significant clinical heterogeneity within R-IPI categories persists. Emerging evidence indicates that circulating host immunity is a robust and R-IPI independent prognosticator, most likely reflecting the immune status of the intratumoral microenvironment. We hypothesized that direct quantification of immunity within lymphomatous tissue would better permit stratification within R-IPI categories. We analyzed 122 newly diagnosed consecutive DLBCL patients treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemo-immunotherapy. Median follow-up was 4 years. As expected, the R-IPI was a significant predictor of outcome with 5-year overall survival (OS) 87% for very good, 87% for good, and 51% for poor-risk R-IPI scores (P < 0.001). Consistent with previous reports, systemic immunity also predicted outcome (86% OS for high lymphocyte to monocyte ratio [LMR], versus 63% with low LMR, P = 0.01). Multivariate analysis confirmed LMR as independently prognostic. Flow cytometry on fresh diagnostic lymphoma tissue, identified CD4+ T-cell infiltration as the most significant predictor of outcome with ≥23% infiltration dividing the cohort into high and low risk groups with regard to event-free survival (EFS, P = 0.007) and OS (P = 0.003). EFS and OS were independent of the R-IPI and LMR. Importantly, within very good/good R-IPI patients, CD4+ T-cells still distinguished patients with different 5 year OS (high 96% versus low 63%, P = 0.02). These results illustrate the importance of circulating and local intratumoral immunity in DLBCL treated with R-CHOP.

Novel NOD2 haplotype strengthens the association between TLR4 Asp299gly and Crohnʼs disease in an Australian population

Background:: The first major Crohn's disease (CD) susceptibility gene, NOD2, implicates the innate intestinal immune system and other pattern recognition receptors in the pathogenesis of this chronic, debilitating disorder. These include the Toll‐like receptors, specifically TLR4 and TLR5. A variant in the TLR4 gene (A299G) has demonstrated variable association with CD. We aimed to investigate the relationship between TLR4 A299G and TLR5 N392ST, and an Australian inflammatory bowel disease cohort, and to explore the strength of association between TLR4 A299G and CD using global meta‐analysis. Methods:: Cases (CD = 619, ulcerative colitis = 300) and controls (n = 360) were genotyped for TLR4 A299G, TLR5 N392ST, and the 4 major NOD2 mutations. Data were interrogated for case‐control analysis prior to and after stratification by NOD2 genotype. Genotype–phenotype relationships were also sought. Meta‐analysis was conducted via RevMan. Results:: The TLR4 A299G variant allele showed a significant association with CD compared to controls (P = 0.04) and a novel NOD2 haplotype was identified which strengthened this (P = 0.003). Furthermore, we identified that TLR4 A299G was associated with CD limited to the colon (P = 0.02). In the presence of the novel NOD2 haplotype, TLR4 A299G was more strongly associated with colonic disease (P < 0.001) and nonstricturing disease (P = 0.009). A meta‐analysis of 11 CD cohorts identified a 1.5‐fold increase in risk for the variant TLR4 A299G allele (P < 0.00001). Conclusions:: TLR 4 A299G appears to be a significant risk factor for CD, in particular colonic, nonstricturing disease. Furthermore, we identified a novel NOD2 haplotype that strengthens the relationship between TLR4 A299G and these phenotypes.

Prognostic factors for malignant mesothelioma in 142 patients : validation of CALGB and EORTC prognostic scoring systems

Background The incidence of malignant mesothelioma is increasing. There is the perception that survival is worse in the UK than in other countries. However, it is important to compare survival in different series based on accurate prognostic data. The European Organisation for Research and Treatment of Cancer (EORTC) and the Cancer and Leukaemia Group B (CALGB) have recently published prognostic scoring systems. We have assessed the prognostic variables, validated the EORTC and CALGB prognostic groups, and evaluated survival in a series of 142 patients. Methods Case notes of 142 consecutive patients presenting in Leicester since 1988 were reviewed. Univariate analysis of prognostic variables was performed using a Cox proportional hazards regression model. Statistically significant variables were analysed further in a forward, stepwise multivariate model. EORTC and CALGB prognostic groups were derived, Kaplan-Meier survival curves plotted, and survival rates were calculated from life tables. Results Significant poor prognostic factors in univariate analysis included male sex, older age, weight loss, chest pain, poor performance status, low haemoglobin, leukocytosis, thrombocytosis, and non-epithelial cell type (p<0.05). The prognostic significance of cell type, haemoglobin, white cell count, performance status, and sex were retained in the multivariate model. Overall median survival was 5.9 (range 0-34.3) months. One and two year survival rates were 21.3% (95% CI 13.9 to 28.7) and 3.5% (0 to 8.5), respectively. Median, one, and two year survival data within prognostic groups in Leicester were equivalent to the EORTC and CALGB series. Survival curves were successfully stratified by the prognostic groups. Conclusions This study validates the EORTC and CALGB prognostic scoring systems which should be used both in the assessment of survival data of series in different countries and in the stratification of patients into randomised clinical studies.