The influence of neurocognitive impairment, alcohol and other drug (AOD) use, and psychosocial factors on antiretroviral treatment adherence, service utilization and viral load among HIV-seropositive adults

Among people living with HIV (PLWH), adherence to antiretroviral therapy (ART) can be affected by problems of neurocognitive (NC) impairment, stress, alcohol and other drug (AOD) abuse, and other barriers. The aims of this research were to: (1) examine factors associated with NC impairment, (2) explore relationships between psychosocial variables with ART adherence and viral load (VL), and (3) evaluate the efficacy of an evidence-based intervention in improving ART adherence, increasing service utilization, and decreasing VL. The first study (n=370) was cross sectional and used structural equation modeling to test whether AOD use, years living with HIV, and time from HIV diagnosis to seeking care were associated with poorer NC functioning. The second study (n=246) used similar methods to test the hypothesis that stress, barriers to adherence, NC impairment, poor social support, and AOD use were related to lower VL mediated by ART adherence. The third study (n=243) evaluated an evidence-based, eight-session program to improve ART adherence, reduce VL, and increase service utilization in a randomized controlled trial. Study participants were PLWH living in South Florida, 18 to 60 years old, with a history of alcohol abuse enrolled from January 2009 through November 2012. Secondary analysis of available data showed: (1) scores on interference with executive functioning increased by 0.32 for each day of marijuana use and 1.18 for each year living with HIV, but no association was found between alcohol use and NC functioning; (2) each barrier to adherence was associated with a 10% decrease in adherence to ART and a 0.42 unit increase in VL (log10) and the relationship between barriers and VL was partially mediated by ART adherence; (3) participants in the evidence-based program were more likely than the comparison group to report an undetectable VL (OR=2.25, p<0.01) at 6 months, but not 3 months, post-intervention. Psychosocial factors affect VL, but ART adherence is essential in achieving an undetectable VL in PLWH.

Evaluation of the use and management of fish resources in the pachitea river basin, Peruvian Amazon

The purpose of this study was to analyze the interrelations between the needs of local people and their usage and management of natural fisheries. Between June and August 2001, 177 households in the basin were interviewed regarding their fishing customs. The results were analyzed with parametric and nonparametric statistics considering a cultural and a geographic comparison. Results confirm that indigenous households rely more on fisheries as a resource than colonists. Fishing takes place throughout the year but is more common in the dry season. Fishing is commonly practiced using hooks and cast nets. More destructive techniques such as dynamite and "barbasco" (poisonous plant) were also used. Indigenous people use a greater array of techniques and they fish at a greater diversity of sites. Respondents also reported that fishing yields have decreased recently. Some of the most common fish genera captured are Pimelodus and Leporinus.

Substance Use and Sexual Risk Behaviors among Adolescent Detainees

During the past two decades there has been much research conducted on the relationship between the risky sexual behavior practices and substance use among U.S. adolescents. This body of research has documented the fact that substance use and not using condoms are the most important indicators associated with the risk of becoming infected with sexually transmitted diseases (STD) both among adolescents and adults (Florida Department of Public Health, 2004; Malow, Devieux, Jennings, & Lucenko, 2001; McCoy & Inciardi, 1995). Data from those reports and studies indicate that adolescents and adults who use a condom regularly and appropriately are 20 times less likely to contract an STD than those who do not (Pinkerton & Abramson, 1997). However, less empirical evidence exists about the factors that influence adolescent use of condoms, particularly among adolescents who are detained due to their criminal lifestyle. Researchers have found both a high prevalence of STD in addition to early onset of sexual activity without protection among some adolescent groups such as the detainees (D'angelo & DiClemente, 1996) and that adolescents tend to underestimate their risks of acquiring the human immunodeficiency virus (HIV) (Magura, Shapiro, & Kang, 1994). Many adolescents will experiment with alcohol and other drugs. This behavior may compromise their judgment and increase their chances of engaging in risky sex (Rotheram-Borus, 2000). Hence the need for research that investigates the influence that substance use, risky sexual attitudes, knowledge about the transmission of HIV, and both peer and parental approval of condom use have on the use of condoms among both female and male adolescent detainees. Lastly, it is important for additional research to be conducted because adolescent detainees have been identified as being at high risk of becoming infected with an STD (Malow, Rosemberg, & Devieux, 2006). The purpose of this study was to examine the relationship among adolescent substance use, gender, sexual risk attitude, attitude about personal use of condoms, knowledge associated with the transmission of HIV, peer and family approval of condom use, history of sexually transmitted diseases (STD) and the level of condom use in a sample of adolescents housed in a correctional institution. Further details of the explanatory variables, the control variables and their expected relationships can be found in the review of the Literature in Chapter 2. Also, more information about the separate analysis of the research questions is detailed in the Methods section in Chapter 3. Based on the literature detailed in Chapter 2 (e.g., Malow et al., 2006), the current study’s researcher anticipated that adolescents’ higher levels of illicit drug use would be related to higher levels of sexual risk behaviors, as measured by lower levels of condom use, than their counterparts who used no drugs. Similarly, it was hypothesized that positive attitudes toward condom use and higher levels of HIV risk knowledge would be associated with a lower level of risky sexual behaviors along with a higher level of condom use skill. It was further hypothesized that the level of approval perceived from parents and peers regarding condom use was going to be related to adolescents’ safe sex behavior (i.e., condom use). Therefore, it was expected that participants’ perception of a high level of approval to use condoms from peers and parents would be a statistically significant variable in helping explain the condom use within this sample of adolescent detainees.

Resources use and conservation attitudes of local people in the Western Terai landscape, Nepal

Two protected areas: Royal Bardia National Park (RBNP) and Royal Suklaphanta Wildlife Reserve (RSWR) in the Western Terai, Nepal, are under threats due to present political turmoil, uncontrolled immigration, inefficient land reform policies and unsustainable resource use. I did a stratified random questionnaire survey of 234 households to determine how resource use patterns and problems influence conservation attitudes. Chi-square, Student's t, Mann-Whitney and Kruskal-Wallis tests, and multiple regression were used. There was spatio-temporal variability in resource use patterns and dependency. People were collecting eight and seven types of resources in RBNP and RSWR, respectively. However, people in RBNP were more dependent on resources than RSWR. In both areas, the problem of firewood is serious. The mean attitude score of RBNP (8.4 ± 1.44) was significantly higher than the score of RSWR (7.7 ± 1.66; t = 3.24, p = 0.0007). Conservation attitude was determined by variables such as participation in trainings, wildlife damage, and satisfaction towards user groups.

Modeling the Effect of Land Use and Climate Change Scenarios on the Water Flux of the Upper Mara River Flow, Kenya

Increasingly erratic flow in the upper reaches of the Mara River, has directed attention to land use change as the major cause of this problem. The semi-distributed hydrological model SWAT and Landsat imagery were utilized in order to 1) map existing land use practices, 2) determine the impacts of land use change on water flux; and 3) determine the impacts of climate change scenarios on the water flux of the upper Mara River. This study found that land use change scenarios resulted in more erratic discharge while climate change scenarios had a more predictable impact on the discharge and water balance components. The model results showed the flow was more sensitive to the rainfall changes than land use changes but land use changes reduce dry season flows which is a major problem in the basin. Deforestation increased the peak flows which translated to increased sediment loading in the Mara River.

A Modeling Approach to Determine the Impacts of Land Use and Climate Change Scenarios on the Water Flux of the Upper Mara River

With the flow of the Mara River becoming increasingly erratic especially in the upper reaches, attention has been directed to land use change as the major cause of this problem. The semi-distributed hydrological model Soil and Water Assessment Tool 5 (SWAT) and Landsat imagery were utilized in the upper Mara River Basin in order to 1) map existing field scale land use practices in order to determine their impact 2) determine the impacts of land use change on water flux; and 3) determine the impacts of rainfall (0%, ±10% and ±20%) and air temperature variations (0% and +5%) based on the Intergovernmental Panel on Climate Change projections on the water flux of the 10 upper Mara River. This study found that the different scenarios impacted on the water balance components differently. Land use changes resulted in a slightly more erratic discharge while rainfall and air temperature changes had a more predictable impact on the discharge and water balance components. These findings demonstrate that the model results 15 show the flow was more sensitive to the rainfall changes than land use changes. It was also shown that land use changes can reduce dry season flow which is the most important problem in the basin. The model shows also deforestation in the Mau Forest increased the peak flows which can also lead to high sediment loading in the Mara River. The effect of the land use and climate change scenarios on the sediment and 20 water quality of the river needs a thorough understanding of the sediment transport processes in addition to observed sediment and water quality data for validation of modeling results.

Land Use and Climate Change Impacts on the Hydrology of the Upper Mara River Basin, Kenya: Results of a Modeling Study to Support Better Resource Management

Some of the most valued natural and cultural landscapes on Earth lie in river basins that are poorly gauged and have incomplete historical climate and runoff records. The Mara River Basin of East Africa is such a basin. It hosts the internationally renowned Mara-Serengeti landscape as well as a rich mixture of indigenous cultures. The Mara River is the sole source of surface water to the landscape during the dry season and periods of drought. During recent years, the flow of the Mara River has become increasingly erratic, especially in the upper reaches, and resource managers are hampered by a lack of understanding of the relative influence of different sources of flow alteration. Uncertainties about the impacts of future climate change compound the challenges. We applied the Soil Water Assessment Tool (SWAT) to investigate the response of the headwater hydrology of the Mara River to scenarios of continued land use change and projected climate change. Under the data-scarce conditions of the basin, model performance was improved using satellite-based estimated rainfall data, which may also improve the usefulness of runoff models in other parts of East Africa. The results of the analysis indicate that any further conversion of forests to agriculture and grassland in the basin headwaters is likely to reduce dry season flows and increase peak flows, leading to greater water scarcity at critical times of the year and exacerbating erosion on hillslopes. Most climate change projections for the region call for modest and seasonally variable increases in precipitation (5–10 %) accompanied by increases in temperature (2.5–3.5 °C). Simulated runoff responses to climate change scenarios were non-linear and suggest the basin is highly vulnerable under low (−3 %) and high (+25 %) extremes of projected precipitation changes, but under median projections (+7 %) there is little impact on annual water yields or mean discharge. Modest increases in precipitation are partitioned largely to increased evapotranspiration. Overall, model results support the existing efforts of Mara water resource managers to protect headwater forests and indicate that additional emphasis should be placed on improving land management practices that enhance infiltration and aquifer recharge as part of a wider program of climate change adaptation.

Global Change Pressures on Soils from Land Use and Management

This work contributed to The input of PS and PCW contributes to the Belmont Forum/FACCE-JPI funded DEVIL project (NE/M021327/1) and for PS also contributes to the EU FP7 SmartSoil project (Project number: 289694)

Global Change Pressures on Soils from Land Use and Management

This work contributed to The input of PS and PCW contributes to the Belmont Forum/FACCE-JPI funded DEVIL project (NE/M021327/1) and for PS also contributes to the EU FP7 SmartSoil project (Project number: 289694)

Asthma in Asia : Physician perspectives on control, inhaler use and patient communications

Peer reviewed

"I Use Weed for My ADHD": A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for problematic cannabis use. However, clinical and anecdotal evidence suggest an increasingly popular perception that cannabis is therapeutic for ADHD, including via online resources. Given that the Internet is increasingly utilized as a source of healthcare information and may influence perceptions, we conducted a qualitative analysis of online forum discussions, also referred to as threads, on the effects of cannabis on ADHD to systematically characterize the content patients and caregivers may encounter about ADHD and cannabis. METHODS: A total of 268 separate forum threads were identified. Twenty percent (20%) were randomly selected, which yielded 55 separate forum threads (mean number of individual posts per forum thread = 17.53) scored by three raters (Cohen's kappa = 0.74). A final sample of 401 posts in these forum threads received at least one endorsement on predetermined topics following qualitative coding procedures. RESULTS: Twenty-five (25%) percent of individual posts indicated that cannabis is therapeutic for ADHD, as opposed to 8% that it is harmful, 5% that it is both therapeutic and harmful, and 2% that it has no effect on ADHD. This pattern was generally consistent when the year of each post was considered. The greater endorsement of therapeutic versus harmful effects of cannabis did not generalize to mood, other (non-ADHD) psychiatric conditions, or overall domains of daily life. Additional themes emerged (e.g., cannabis being considered sanctioned by healthcare providers). CONCLUSIONS: Despite that there are no clinical recommendations or systematic research supporting the beneficial effects of cannabis use for ADHD, online discussions indicate that cannabis is considered therapeutic for ADHD-this is the first study to identify such a trend. This type of online information could shape ADHD patient and caregiver perceptions, and influence cannabis use and clinical care.

A Longitudinal Investigation of Infant Gesture Use and Parent Speech: Unique and Dynamic Influences on Infant Vocabulary Acquisition

How do infants learn word meanings? Research has established the impact of both parent and child behaviors on vocabulary development, however the processes and mechanisms underlying these relationships are still not fully understood. Much existing literature focuses on direct paths to word learning, demonstrating that parent speech and child gesture use are powerful predictors of later vocabulary. However, an additional body of research indicates that these relationships don’t always replicate, particularly when assessed in different populations, contexts, or developmental periods.

The current study examines the relationships between infant gesture, parent speech, and infant vocabulary over the course of the second year (10-22 months of age). Through the use of detailed coding of dyadic mother-child play interactions and a combination of quantitative and qualitative data analytic methods, the process of communicative development was explored. Findings reveal non-linear patterns of growth in both parent speech content and child gesture use. Analyses of contingency in dyadic interactions reveal that children are active contributors to communicative engagement through their use of gestures, shaping the type of input they receive from parents, which in turn influences child vocabulary acquisition. Recommendations for future studies and the use of nuanced methodologies to assess changes in the dynamic system of dyadic communication are discussed.

Land Use and Water Quality Correlations in Miami-Dade, Florida

South Florida continues to become increasingly developed and urbanized. My exploratory study examines connections between land use and water quality. The main objectives of the project were to develop an understanding of how land use has affected water quality in Miami-Dade canals, and an economic optimization model to estimate the costs of best management practices necessary to improve water quality. Results indicate Miami-Dade County land use and water quality are correlated. Through statistical factor and cluster analysis, it is apparent that agricultural areas are associated with higher concentrations of nitrogen, while urban areas commonly have higher levels of phosphorous than agricultural areas. The economic optimization model shows that urban areas can improve water quality by lowering fertilizer inputs. Agricultural areas can also implement methods to improve water quality although it may be more expensive than urban areas. It is important to keep solutions in mind when looking towards future water quality improvements in South Florida.