Multiple facets of HIV-associated renal disease

HIV infection has a broad spectrum of renal manifestations. This study examined the clinical and histological manifestations of HIV-associated renal disease, and predictors of renal outcomes. Sixty-one (64% male, mean age 45 years) HIV patients were retrospectively evaluated. Clinical presentation and renal histopathology were assessed, as well as CD4 T-cell count and viral load. The predictive value of histological lesion, baseline CD4 cell count and viral load for end-stage renal disease (ESRD) or death were determined using the Cox regression model. The outcomes of chronic kidney disease (CKD) and ESRD or death were evaluated by baseline CD4 cell count. The percent distribution at initial clinical presentation was non-nephrotic proteinuria (54%), acute kidney injury (28%), nephrotic syndrome (23%), and chronic kidney disease (22%). Focal segmental glomerulosclerosis (28%), mainly the collapsing form (HIVAN), acute interstitial nephritis (AIN) (26%), and immune complex-mediated glomerulonephritis (ICGN) (25%) were the predominant renal histology. Baseline CD4 cell count ≥200 cells/mm3 was a protective factor against CKD (hazard ratio=0.997; 95%CI=0.994-0.999; P=0.012). At last follow-up, 64% of patients with baseline CD4 ≥200 cells/mm3 had eGFR >60 mL·min-1·(1.73 m2)-1 compared to the other 35% of patients who presented with CD4 <200 cells/mm3 (log rank=9.043, P=0.003). In conclusion, the main histological lesion of HIV-associated renal disease was HIVAN, followed by AIN and ICGN. These findings reinforce the need to biopsy HIV patients with kidney impairment and/or proteinuria. Baseline CD4 cell count ≥200 cells/mm3 was associated with better renal function after 2 years of follow-up.

Issues in the Transatlantic Trade and Investment Partnership: A critical discourse analysis

Negotiating trade agreements is an important part of government trade policies, economic planning and part of the globally operating trading system of today. European Union and the United States have been active in the formation of trade agreements in global comparison. Now these two economic giants are engaged in negotiations to form their own trade agreement, the so called Transnational Trade and Investment Partnership (TTIP). The purpose of this thesis is to understand the reasons for making a trade agreement between two economic areas and understanding the issues it may include in the case of the TTIP. The TTIP has received a great deal of attention in the media. The opinions towards the partnership have been extreme, and the debate has been heated. The purpose of this study is to introduce the nature of the public discussion regarding the TTIP from Spring 2013 until 2014. The research problem is to find out what are the main issues in the agreement and what are the values influencing them. The study was conducted applying methods of critical discourse analysis to the chosen data. This includes gathering the issues from the data based on the attention each has received in the discussion. The underlying motives for raising different issues were analysed by investigating the authors’ position in the political, economic and social circuits. The perceived economic impacts of the TTIP are also under analysis with the same criteria. Some of the most respected economic newspapers globally were included in the research material as well as papers or reports published by the EU and global organisations. The analysis indicates a clear dichotomy of the attitudes towards the TTIP. Key problems include lack of transparency in the negotiations, the misunderstood investor-state dispute settlement, the constantly expanding regulatory issues and the risk of protectionism. The theory and data does suggest that the removal of tariffs is an effective tool for reaching economic gains in the TTIP and even more effective would be the reducing of non-tariff barriers, such as protectionism. Critics are worried over the rising influence of corporations over governments. The discourse analysis reveals that the supporters of the TTIP have values related to increasing welfare through economic growth. Critics do not deny the economic benefits but raise the question of inequality as a consequence. Overall they represent softer values such as sustainable development and democracy as a counter-attack to the corporate values of efficiency and the maximising of profits.

Dyadic Relationship and Quality of Life Patients with Chronic Kidney Disease

AbstractIintroduction:Chronic Renal insufficiency (CRI) and dialysis treatment lead to a succession of situations for kidney chronic patient, which compromises his aspect, not only physically, and psychologically, with personal, family and social repercussions.Objective:(1) to verify the existence of differences of dyadic adjustment (DA) according to renal replacement treatment (RRT) and (2) verify the existence of differences quality of life (QOL) in accordance with the RRT.Methods:This is a cross-sectional study of a descriptive nature through surveys, exploratory and correlational. The sample consisted of 125 participants. Of these, 31 were to be made RRT by automated peritoneal dialysis (APD) and 94 hemodialysis (HD). Participants were selected from three renal centers: (1) Centro Renal da Prelada (Porto, Portugal), (2) Centrodial (S. João da Madeira, Portugal) and Centro Renal da Misericórdia de Paredes (Paredes, Portugal). The study was carried out for 6 months. The following instruments were applied: Socio-demographic and clinical questionnaire (SDCQ), Dyadic Adjustment Scale (DAS), World Health Organization Quality of Life (WHOQOL-Bref).Results:The results demonstrate the existence of statistically significant differences between the type of RRT and most areas of QOL, as well as the existence of statistically significant differences between the subscales of the DAS evaluated and the type of RRT.Conclusion:The present study demonstrates a greater commitment in terms of QOL of individuals undergoing treatment for HD when compared with those subjected to APD. It turns out, also, that DA is most strongly perceived by patients in APD than with HD.

Late-onset spinal motor neuronopathy- a new neuromuscular disease

The aim of this study was to clarify the clinical phenotype of late-onset spinal motor neuronopathy (LOSMoN), an adult-onset autosomal dominant lower motor neuron disorder identified first in two families in Eastern Finland, in order to clarify its genetic background. Motor neuron disorders (MNDs) are characterized by dysfunction and premature death of motor neurons in the brain and spinal cord. MNDs can manifest at any age of the human lifespan, ranging from pre- or neonatal forms such as spinal muscular atrophy type I (SMA I) to those preferentially affecting the older age groups exemplified by sporadic amyotrophic lateral sclerosis (ALS). With a combination of genetic linkage analysis and genome sequencing using DNA from a total of 55 affected members of 17 families and a whole genome scan, we were able to show that LOSMoN is caused by the c.197G>T p.G66V mutation in the gene CHCHD10. This study showed that LOSMoN has very characteristic features that help to differentiate it from other more malignant forms of motor neuron disease, such as ALS, which was erroneously diagnosed in many patients in our cohort. Lack of fibrillations in the first dorsal interosseus muscle on EMG and extensive grouping of non-atrophic type IIA/2A fibers on muscle biopsy were shown to be common findings in LOSMoN, but rare or absent in ALS patients. The results of this study will help clinicians recognize the characteristic phenotype of LOSMoN disease and thus improve their diagnostic accuracy, and will also allow physicians to provide adequate genetic counseling for patients.

Cholesterol, cardiovascular disease and statin use in older persons

Older age increases the risk of developing a chronic atherosclerotic cardiovascular disease (CVD), such as coronary heart disease. Complications of CVDs, myocardial infarction or stroke often lead to loss of functional capacity or premature death. Dyslipidemia, high serum levels of total or low-density lipoprotein cholesterol (LDL-c) and low levels of high-density lipoprotein cholesterol (HDL-c), is among the most important modifiable risk factors for CVDs; it can be treated with lifestyle modifications, and with lipid-lowering drugs, primarily statins. In older persons, however, the association of cholesterol levels with cardiovascular and all-cause mortality has been inconsistent in previous studies. Furthermore, the beneficial effects of statins in older persons without previous CVD are still somewhat unclear, and older persons are more prone to adverse effects from statins. This thesis presents a prospective cohort study (TUVA), exploring associations of cholesterol levels with mortality and the changes in cholesterol levels of a 70-year-old population in long-term follow-up. Further, prevalence of CVDs, risk factors and preventive medication use in the TUVA cohort is compared with respective prevalences in another age-matched cohort (UTUVA) 20 years later in order to examine the changes in cardiovascular risk over time. Additionally, to evaluate statin use patterns among older persons, an observational register study was conducted covering the total Finnish population aged 70 and older during 2000-2008. Based on individual-level data retrieved from national health registries, the population was classified into low, moderate and high risk groups according to estimated CVD risk. The prevalence, incidence and persistence of statin use among the risk groups was then evaluated based upon yearly statin purchases tracked from the Prescription Register. The prospective cohort study demonstrated that low total cholesterol, LDL-c and HDL-c were associated with higher mortality in a cohort of home-dwelling 70-year-olds. However, after adjusting for traditional cardiovascular risk factors and cancer this association disappeared. Further, low total cholesterol seemed to be protective, whereas low HDL-c strongly predicted increased risk of CVD death. Cholesterol levels of those elderly who remained available for follow-up and were still home-dwelling at the age of 85 seemed to improve with advancing age. Compared to the TUVA cohort, the later born UTUVA cohort had less CVDs and their risk factors were better controlled, which was reflected in the higher use of preventive medications such as statins and antihypertensives. The register studies confirmed that statin use has increased significantly during 2000-2008 among older persons, especially among the oldest (80+) age groups and among those at high risk for cardiovascular events. Two-thirds of new statin users persisted with their use during the four years of follow-up; the most discontinuations were made during the first year of use. In conclusion, statins are commonly used among older age groups in Finland. Most of the older statin users had a high cardiovascular event risk, indicating that the treatment is well directed towards those who are likely to benefit from it the most. No age-limits should be put on the screening and treatment of dyslipidemia in older persons, but the benefits and adverse effects of statin treatment should be carefully weighed based on an individual assessment of the person’s general health status and functional capacity. Physicians should pay more attention to medication adherence, especially when prescribing preventive medications.

A minor theory of the transit of materiality into discourse, Via Campesina.

In this thesis I explore how the material properties of plant seed enter the political discourses of the international peasant coalition the Via Campesina and coalition member the National Fanners Union of Canada (NFU), querying how this process might be employed as a resource for a transformative eco-social politics. I employ several post-structural theoretical constructs, configuring them together as a "minor theory". This minor theory provides the basis for a "minor" reading of three sets of Via Campesina and NFU texts. The aim of these readings is to track the movement of seed from a local agricultural concern to a transitive political one, across both the material and discursive registers. In surfacing the presence of the seed's physical properties in the three texts, I highlight the distinctions between the constraining seed of corporate industrial agriculture, and the social and agroecological opportunities resulting from what I call a "Seed Event".

Understanding the polyvocality of autism discourse : a critical autoethnographic approach

Currently, much of the autism literature supports the notion that Pervasive Developmental Disorder (PDD) is a deviation from what is considered "normal" and, accordingly, that it is in need of early remediation. This thesis explored alternative constructions of autism and pathology by drawing on theorists from other disciplines, such as cultural studies (Deleuze & Guattari, 1987, 1965, 1972, 1975,1980, 2003), critical psychology (Parker, 1995, 2002, 2005, 2007), disability studies (Danforth,1997, 1999, 2000; Skrtic, 1995, 1996) and anti-psychiatry (Basaglia, 1987). In an attempt to show how our accounts of the world encompass constructions rooted in language and our own histories of thinking about topics that interest us, this research took an autoethnographic approach to understanding autism discourse. Instead of denying the researcher's existence and personal investment in the research, the author attempted to implicate "the self in the research by acknowledging her own assumptions, biases and ideologies about autism discourse and practice. Thus, tensions between the self and other, personal and political become woven into the fabric, creating a personal, subjective, and partial account of the phenomenon. This research was intended to explicate and interrogate some of the taken-for-granted Truths which guide our practices with people with autism. This alternative critical framework focused on understanding autism as a discourse and explored the way these dominant autism constructions function in society. Furthermore, positioning "the self in the research was meant to illustrate the fundamental need for self-reflective practice in the social sciences.

A crisis of social democracy : organized labour and the NDP in an era of neoliberalism

The NDP was founded out of the ashes of the Co-Operative Commonwealth Federation to cooperate with the Canadian Labour Congress to become the 'political arm of organized labour' in Canada. The NDP has long claimed they are the party which represents the policy goals of organized labour in Canada: that the NDP alone will fight for trade union rights, and will fight for Canadian workers. Divergent Paths is an examination of the links between the labour movement and the ND P in an era ofneo-liberalism. Provincial NDP governments have become increasingly neoliberal in their ideological orientation, and have often proved to be no friend to the labour movement when they hold office. The Federal party has never held power, nor have they ever formed the Official Opposition. This thesis charts the progress of the federal NDP as they become more neoliberal from 1988 to 2006, and shows how this trend effects the links between the NDP and labour. Divergent Paths studies each federal election from 1988 to 2006, looking at the interactions between Labour and the NDP during these elections. Elections provide critical junctions to study discourse - party platforms, speeches, and other official documents can be used to examine discourse. Extensive newspaper searches were used to follow campaign events and policy speeches. Studying the party's discourse can be used to determine the ideological orientation of the party itself: the fact that the party's discourse has become neoliberal is a sure sign that the party itself is neoliberal. The NDP continues to drive towards the centre of the political spectrum in an attempt to gain multi-class support. The NDP seems more interested in gaining seats at any cost, rather then promoting the agenda of Labour. As the party attempts to open up to more multi-class support, Labour becomes increasingly marginalised in the party. A rift which arguably started well before the 1988 election was exacerbated during that election; labour encouraged the NDP to campaign solely on the issue of Free Trade, and the NDP did not. The 1993 election saw the rift between the two grow even further as the Federal NDP suffered major blowbacks from the actions of the Ontario NDP. The 1997 and 2000 elections saw the NDP make a deliberate move to the centre of the political spectrum which increasingly marginalised labour. In the 2004 election, Jack Layton made no attempt to move the party back to the left; and in 2006 the link between labour and the NDP was perhaps irreparably damaged when the CAW endorsed the Liberal party in a strategic voting strategy, and the CLC did not endorse the NDP. The NDP is no longer a reliable ally of organized labour. The Canadian labour movement must decide wether the NDP can be 'salvaged' or if the labour movement should end their alliance with the NDP and engage in a new political project.

Medicalization and women : O, the Oprah Magazine diagnosed through critical discourse analysis

This thesis uses critical discourse analysis (COAl to explore and examine direct-toconsumer (OTC) pharmaceutical drug advertisements appearing in four issues of 0, The Oprah Magazine in 2006. The theoretical underpinnings of this thesis emerge from social scientists and feminists analyses regarding the medicalization of everyday life. The findings of this study highlight three types of discourses used by pharmaceutical companies. First, I explore the use of historical and contemporary gender norms to seJi pharmacological products; second, J examine discourses which normalize the use of chemical solutions as the first line of defense to address a wide range of everyday problems; and finally, I assess how phannaceutical advertisements provide an illusion of autonomy by responsibilizing individuals as patients, at the same time as they suggest that real independence can only be achieved with medication. My discussion of these themes also includes an analysis of why 0 Magazine, which explicitly promotes women's empowerment through holistic approaches to health and personal growthmight support such advertising. Thus I explore: how does OTC advertising benefit both pharmaceutical companies and 0 Magazine itself? I conclude through a brief discussion of the larger implications of OTC advertising for women's health.

Impact of social constructs on administrator understanding of social justice

Educational administrators are expected to relate social justice considerations to their actions and to the theoretical foundations of their practice. At the same time, social constructs-including those related to administrative practice, social justice, and societal norms-are important in helping administrators understand, frame, and describe administrative issues. Furthermore, as part of socially constructed language, these constructs represent discursive practices and accepted ways of knowing, valuing, and experiencing the world. Drawing on the multidimensional methods of critical discourse analysis as articulated in the writings of Michel Foucault, Norman Fairclough, and Allan Luke, and using deconstruction as a strategic device for reading and interpreting texts, this exploratory qualitative study examined how administrator knowledge, values, and experiences impact their understanding of social justice within the context of delivering social justice for students who experience bullying. Study findings reveal that school administrators interpreted social justice as equitable distribution, action, and results; fairness; and equity. Constructs embedded in these interpretations assumed common things such as universal acceptance of norms of social relations and conveyed administrator intent to secure the kind of social relations that enabled individuals to enjoy greater equality within existing social arrangements.

Beyond child's play : wealth, status, and the death of children in the MH-LH I periods of the Argolid, Greece

This study explores the mortuary remains of children from the MH-LH I periods of the Argolid, Greece. This examination concentrates on how the child in death acted as a tool for wealth and status display. Here, children are understood to have perpetuated, maintained, and reinforced status distinctions between families in their community. The analysis of one hundred child burials that date to these periods illustrates how the burials of children were important opportunities used by the families of children to display wealth and status. Thus, children can be viewed as important factors in the reorganization of social structure in the transition from the Middle to Late Helladic.

John W. Fisher Fonds, 1937-1961, 1964-1989, 1993, n.d.

Norah and Fred Fisher welcomed John Fisher into the world on November 29, 1912, not knowing what an influential role he would play in shaping Canada's history. John Fisher grew up as the middle child of five brothers and sisters in Frosty Hollow, New Brunswick, close to today’s town of Sackville. Sackville’s main industry was the Enterprise Foundry which the Fisher family owned and operated; however, Fisher had no plans of going into the family business. He was more inspired by his maternal grandfather, Dr. Cecil Wiggins, who lived with the family after retiring from the Anglican ministry. Wiggins encouraged all his grandchildren to be well read and to take part in discussions on current events. There were often visitors in the Fisher household taking part in discussions about politics, religion, and daily life. Fisher forced himself to take part in these conversations to help overcome his shyness in social settings. These conversations did help with his shyness and also in forming many opinions and observations about Canada. It put Fisher on the road to becoming Mr. Canada and delivering the many eloquent speeches for which he was known. Fisher did not venture far from home to complete his first degree. In 1934 he graduated from Mount Allison University in Sackville, NB with an Arts degree. The same year Fisher enrolled in Dalhousie’s law school. During his time at Dalhousie, Fisher discovered radio through Hugh Mills. Mills or “Uncle Mel” was on CHNS, Halifax’s only radio station at the time. Fisher began by making appearences on the radio drama show. By 1941 he had begun writing and broadcasting his own works and joined the staff as an announcer and continuity writer. In 1936 the Canadian Broadcasting Corporation was formed, the first National radio station. Fisher joined the CBC shortly after it’s beginning and remained with them, as well as the Halifax Herald newspaper, even after his law school graduation in 1937. By 1943 Fisher’s talks became a part of the CBC’s programming for a group of maritime radio stations. Fisher once described his talks as follows “my talks weren’t meant to be objective. . . they were meant to be favourable. They were ‘pride builders’” He began his famed John Fisher Reports at CBC Toronto when he transfered there shortly after the war. This program brought emmence pride to the fellow Canadians he spoke about leading to approximately 3500 requests per year to speak at banquets and meeting throughout Canada and the United States. Fisher was a well travelled indivdual who would draw on personal experiences to connect with his audience. His stories were told in simple, straight forward language for anyone to enjoy. He became a smooth, dynamic and passionate speaker who sold Canada to Canadians. He became a renowned journalist, folk historian, writer and broadcaster. Fisher was able to reach a vast array of people through his radio work and build Canadian pride, but he did not stop there. Other ways Fisher has contributed to Canada and the Canadian people include: Honoured by five Canadian Universities. 1956, became the Director of the Canadian Tourist Association. 1961, was appointed Special Assistant to the Prime Minister of Canada. 1963, Commissioner of the Centennial Commission (the Federal Agency Responsible for Canada’s 100th birthday) 1968, received the Service Medal , a coveted Order of Canada. President of John Fisher Enterprises Ltd., private consultant work, specializing in Centennial planning, broadcasts, lectures and promotion. John Fisher continued recording radio broadcasts even after his diagnosis with cancer. He would record 3 or 4 at a time so he was free to travel across Canada, the U.S., Europe and Mexico in search of treatments. Fisher passed away from the disease on February 15, 1981 and he is buried at Mount Pleasant Cemetery in Toronto.

Educator Evaluation of Academic and Social Competence in Students with Acquired Brain Injury (ABI) Relative to Assessed Performance and Sense of Belonging

Acquired brain injury (ABI) is the leading cause of death and disability amongst children and adolescents andpresents itself with challenges associated in cognitive, social, emotional, and behavioural domains. These changes may interfere with academic performance and social inclusion, influencing self-esteem and personal success. The current study examined a subset of data to capture the sense of academic and social belonging for students with ABI as a function of the classroom teachers’ subjective perception of ability, their ABI knowledge, and student identification. Overall, a discrepancy was found between educators’ subjective ratings of student performance and students’ neurocognitive capacity. Educator knowledge and identification of ABI influenced student success in academic and social domains independent of teaching approach. This research has implications for the identification of ABI in the classroom and related challenges students experience. Educators are underprepared for the reintegration of students returning to school and lack appropriate knowledge and strategies to accommodate individual needs.

Utilizing a Phenomenological Approach to Examine the Experience of Sexuality for Women Concerned about Urinary Incontinence following Spinal Cord Injury

Sexuality after spinal cord injury (SCI) is a complex issue that is influenced by a number of social, psychological and physiological factors, one of which is urinary incontinence (UI). Using a phenomenological approach, seven mixed methods interviews combining both the interview guide and standardized open-ended approaches were conducted to examine the experience of sexuality for women who are concerned about UI following SCI. Sexual function was one of the top priorities for the women after SCI, and UI was one of the main concerns the women had regarding sexuality. The findings of this study demonstrate that various dimensions of intimacy and the sexual experience as a whole were affected by UI, and the women discussed both physical and psychological concerns. The main issues regarding sexuality included concerns related to relationships, frustrations with limited sexual activities and the difficulty of being sexually satisfied, the number of unanswered questions and concerns, and a fear of being hurt or injured while participating in sexual activities. The main concerns regarding UI were embarrassment, the work and inconvenience involved with the clean-up of UI, bladder infections, the lack of accessible washrooms, and the negative effects of UI medications. When examining sexuality and UI together, the major issues were the constant comparison to the way things were before SCI, as well as the new concerns that the women did not have to worry about previously, worrying about how their partner would react if UI were to occur during sexual activity, and the impact of their own feelings toward UI on sexuality, a connection between pleasurable sexual sensations and UI as well as difficulty differentiating between the sensation of UI with the sensation of UI, dealing with infected urine during sexual activity, having to discuss UI with a new potential sexual partner, and a fear of rejection. Other identified issues included those related to body image, a lack of resources, Doctors who were inadequately educated regarding SCI, and issues related to both having and raising children. There is a significant shortage of information available for women with SCI to use as a resource regarding sexual function in general, and sexual function as it relates to UI. It is necessary that future work focus on creating resources to assist in this area, and that the dissemination of those resources becomes both appropriate and effective. Addressing sexual function and UI which are among the top concerns for this population has the opportunity to greatly improve quality of life (QOL) for these individuals.

Exploring perspectives about sexuality among Ghanaian youth living in Canada: Understanding the impact of cultural contact.

Research on sexuality in Ghana has been scanty due to the nature of the Ghanaian society where sensitive issues like sexuality are not openly discussed and researched. This qualitative study examined how social contact with Canadian society has impacted the views of Ghanaian students living in Canada about sexuality. The data for this research study were gathered through in-depth interviews with 15 Ghanaian students between ages18 to 30 who had been living in Canada for more than one year. This study’s findings revealed that religion plays a central role in shaping views about sexuality among young Ghanaians living in Canada. The findings also highlighted the impact of cultural contact in shaping several aspects of sexuality including contraception and same-sex relations. The theoretical implications of this study’s results are discussed in terms of how they can help to clarify culturally informed models focusing on the role played by society, religion, family and peers in the development of adolescent perspectives about sexuality. The practical and educational implications of this study’s results are also discussed.