Case-control study of factors associated with virologic failure in HIV-infected children on HAART in Botswana, a developing African country

According to the United Nations Program on HIV/AIDS (UNAIDS, 2008), in 2007 about 67 per cent of all HIV-infected patients in the world were in Sub-Saharan Africa, with 35% of new infections and 38% of the AIDS deaths occurring in Southern Africa. Globally, the number of children younger than 15 years of age infected with HIV increased from 1.6 million in 2001 to 2.0 million in 2007 and almost 90% of these were in Sub-Saharan Africa. (UNAIDS, 2008).^ Both clinical and laboratory monitoring of children on Highly Active Anti-Retroviral Therapy (HAART) are important and necessary to optimize outcomes. Laboratory monitoring of HIV viral load and genotype resistance testing, which are important in patient follow-up to optimize treatment success, are both generally expensive and beyond the healthcare budgets of most developing countries. This is especially true for the impoverished Sub-Saharan African nations. It is therefore important to identify those factors that are associated with virologic failure in HIV-infected Sub-Saharan African children. This will inform practitioners in these countries so that they can predict which patients are more likely to develop virologic failure and therefore target the limited laboratory monitoring budgets towards these at-risk patients. The objective of this study was to examine those factors that are associated with virologic failure in HIV-infected children taking Highly Active Anti-retroviral Therapy in Botswana, a developing Sub-Saharan African country. We examined these factors in a Case-Control study using medical records of HIV-infected children and adolescents on HAART at the Botswana-Baylor Children's Clinical Center of Excellence (BBCCCOE) in Gaborone, Botswana. Univariate and Multivariate Regression Analyses were performed to identify predictors of virologic failure in these children.^ The study population comprised of 197 cases (those with virologic failure) and 544 controls (those with virologic success) with ages ranging from 3 months to 16 years at baseline. Poor adherence (pill count <95% on at least 3 consecutive occasions) was the strongest independent predictor of virologic failure (adjusted OR = 269.97, 95% CI = 104.13 to 699.92; P < 0.001). Other independent predictors of virologic failure identified were: First Line NNRTI with Nevirapine (OR = 2.99, 95% CI = 1.19 to7.54; P = 0.020), Baseline HIV-1 Viral Load >750,000/ml (OR = 257, 95% CI = 1.47 to 8.63; P = 0.005), Positive History of PMTCT (OR = 11.65, 95% CI = 3.04-44.57; P < 0.001), Multiple Care-givers (>=3) (OR = 2.56, 95% CI = 1.06 to 6.19; P = 0.036) and Residence in a Village (OR = 2.85, 95% CI = 1.36 to 5.97; P = 0.005).^ The results of this study may help to improve virologic outcomes and reduce the costs of caring for HIV-infected children in resource-limited settings. ^ Keywords: Virologic Failure, Highly Active Anti-Retroviral Therapy, Sub-Saharan Africa, Children, Adherence.^

Improving adherence in African American women with uncontrolled primary hypertension

Background and Objectives: African American (AA) women are disproportionately affected with hypertension (HTN). The aim of this randomized controlled trial was to evaluate the effectiveness of a 6-week culturally-tailored educational intervention for AA women with primary HTN who lived in rural Northeast Texas. ^ Methods: Sixty AA women, 29 to 86 years (M 57.98 ±12.37) with primary HTN were recruited from four rural locations and randomized to intervention (n =30) and wait-list control groups ( n =30) to determine the effectiveness of the intervention on knowledge, attitudes, beliefs, social support, adherence to a hypertension regimen, and blood pressure (BP) control. Survey and BP measurements were collected at baseline, 3 weeks, 6 weeks (post intervention) and 6 months post intervention. Culturally-tailored educational classes were provided for 90 minutes once a week for 6 weeks in two local churches and a community center. The wait-list control group received usual care and were offered education at the conclusion of the data collection six months post-intervention. Linear mixed models were used to test for differences between the groups. ^ Results: A significant overall main effect (Time) was found for systolic blood pressure, F(3, 174) =11.104, p=.000, and diastolic blood pressure. F(3, 174) =4.781, p=.003 for both groups. Age was a significant covariate for diastolic blood pressure. F(1, 56) =6.798 p=.012. Participants 57 years or older (n=30) had lower diastolic BPS than participants younger than 57 (n=30). No significant differences were found between groups on knowledge, adherence, or attitudes. Participants with lower incomes had significantly less knowledge about HBP Prevention (r=.036, p=.006). ^ Conclusion: AA women who participated in a 6 week intervention program demonstrated a significant decrease in BP over a 6 month period regardless of whether they were in the intervention or control group. These rural AA women had a relatively good knowledge of HTN and reported an average level of compliance, compared to other populations. Satisfaction with the program was high and there was no attrition, suggesting that AA women will participate in research studies that are culturally tailored to them, held in familiar community locations, and conducted by a trusted person with whom they can identify. Future studies using a different program with larger sample sizes are warranted to try to decrease the high level of HTN-related complications in AA women. ^

Fasting blood glucose and 8-year mortality in the hypertension detection follow-up program population

This study analyzed the relationship between fasting blood glucose (FBG) and 8-year mortality in the Hypertension Detection Follow-up Program (HDFP) population. Fasting blood glucose (FBG) was examined both as a continuous variable and by specified FBG strata: Normal (FBG 60–100 mg/dL), Impaired (FBG ≥100 and ≤125 mg/dL), and Diabetic (FBG>125 mg/dL or pre-existing diabetes) subgroups. The relationship between type 2 diabetes was examined with all-cause mortality. This thesis described and compared the characteristics of fasting blood glucose strata by recognized glucose cut-points; described the mortality rates in the various fasting blood glucose strata using Kaplan-Meier mortality curves, and compared the mortality risk of various strata using Cox Regression analysis. Overall, mortality was significantly greater among Referred Care (RC) participants compared to Stepped Care (SC) {HR = 1.17; 95% CI (1.052,1.309); p-value = 0.004}, as reported by the HDFP investigators in 1979. Compared with SC participants, the RC mortality rate was significantly higher for the Normal FBG group {HR = 1.18; 95% CI (1.029,1.363); p-value = 0.019} and the Impaired FBG group, {HR = 1.34; 95% CI (1.036,1.734); p-value = 0.026,}. However, for the diabetic group, 8-year mortality did not differ significantly between the RC and SC groups after adjusting for race, gender, age, smoking status among Diabetic individuals {HR = 1.03; 95% CI (0.816,1.303); p-value = 0.798}. This latter finding is possibly due to a lack of a treatment difference of hypertension among Diabetic participants in both RC and SC groups. The largest difference in mortality between RC and SC was in the Impaired subgroup, suggesting that hypertensive patients with FBG between 100 and 125 mg/dL would benefit from aggressive antihypertensive therapy.^

Fas ligand and soluble Fas -opposing molecules in melanoma lung metastasis

Deregulation of apoptotic cell death can result in aberrant accumulation of cells and increased tumor incidence. Fas (CD95) and Fas ligand (FasL) are a receptor-ligand pair whose activation induces apoptosis in many cell types. Previously, we demonstrated that low metastatic, Fas+ K1735-P murine melanoma cells spontaneously metastasize to the lung following orthotopic injection into FasL-deficient (gld) mice compared to wild-type (wt) controls. We further demonstrated that the expression of the Fas antagonist soluble Fas (sFas) directly correlates with disease stage in patients with melanoma, breast, and colon cancer. These findings document a role for host-derived FasL, in the control of metastatic disease and suggest a role for tumor-associated sFas in acquiring metastatic potential. To directly test whether FasL expressed on lymphocytes or on lung stromal cells restricts metastasis, bone marrow chimeras were generated between C3H wt and C3H gld mice. Chimeric animals were injected subcutaneously with 5 × 105 K1735-P and the incidence and number of spontaneous lung metastases scored. The data show that wt mice receiving gld marrow had a greater number of lung metastases (median 9.5, range 2–31) than gld mice reconstituted with wt marrow (median 1, range 0–31; p < 0.016). Interestingly, both groups had fewer metastases compared to gld controls (median 18.5, range 0–46) but more than wt controls (median 2, range 0–7). These observations provide the first evidence that both hematopoietic- and nonhematopoietic-host derived FasL, are important in the control of melanoma metastasis to the lung. To directly test whether tumor-associated sFas expression can enhance metastasis, K1735-P cells were transfected with three isoforms of sFas (Exo4Del, Exo6Del, and Exo3, 4, 6Del). RT-PCR and ELISA analysis confirmed the expression of sFas RNA and protein respectively. Following intravenous injection of 5 × 104 cells, sFas transfected cells formed significantly more experimental lung metastases [Exo6Del clone 3 (median 22, range 0–36), Exo6Del clone 7 (median 31, range 4–50), Exo3, 4, 6Del (median 22.5, range 13–48)] compared to vector control cells (median 6.5, range 3–29). Together, these data provide the first evidence that sFas is sufficient to enhance the metastatic potential of Fas+ melanoma cells. ^

Revised depth scale, splice tie points and chron boundaries of ODP Hole 151-907A and Site 162-907

The magnetic polarity stratigraphy at Site 907 obtained from the shipboard pass-through magnetometer and from discrete samples is readily interpretable back to the onset of the Gilbert Chron (5.89 Ma). From this level to the base of the section at ~14 Ma, the interpretation is corroborated by silicoflagellate datums with predictable correlation to polarity chrons. The resulting magnetostratigraphic interpretation differs from those proposed in the Leg 151 (Hole 907A) and 162 (Holes 907B and 907C) Initial Reports volumes. An important hiatus in the 7-10 Ma interval at Site 907 caused sedimentation to slow or cease for ~2.7 m.y. We have revised the shipboard correlation among the three holes at Site 907, resulting in a new composite section splice and recalculation of composite depths. For Site 985, magnetostratigraphic interpretation is possible down to ~150 meters below seafloor (mbsf) (C3An/C3Ar) at ~6 Ma. There are no useful biostratigraphic datums from Site 985 to support this interpretation; however, the interpretation is supported by the correlation of Sites 985 and 907 using natural gamma data from the shipboard multisensor track. Below ~150 mbsf at Site 985, drilling-related deformation at the onset of extended core barrel drilling precluded magnetostratigraphic interpretation.

(Table 1) Dissolved organic carbon, water temperature and conductivity in three subarctic ponds near Kilpisjärvi, North Finland

Daphnia was collected from five subarctic ponds which differed greatly in their DOC contents and, consequently, their underwater light (UV) climates. Irrespective of which Daphnia species was present, and contrary to expectations, the ponds with the lowest DOC concentrations (highest UV radiation levels) contained Daphnia with the highest eicosapentaenoic acid (EPA) concentrations. In addition, EPA concentrations in these Daphnia generally decreased in concert with seasonally increasing DOC concentrations. Daphnia from three of the ponds was also tested for its tolerance to solar ultraviolet radiation (UVR) with respect to survival. Daphnia pulex from the clear water pond showed, by far, the best UV-tolerance, followed by D. longispina from the moderately humic and D. longispina from the very humic pond. In addition, we measured sublethal parameters related to UV-damage such as the degree to which the gut of Daphnia appeared green (as a measure of their ability to digest algae), and whether their guts appeared damaged. We developed a simple, noninvasive scoring system to quantify the proportion of the gut in which digestive processes were presumably active. This method allowed repeated measurement of the same animals over the course of the experiment. We demonstrated, for the first time, that sublethal damage of the gut precedes mortality caused by exposure to UVR. In a parallel set of experiments we fed UV-exposed and non-exposed algae to UV-exposed and non-exposed daphnids. UVR pretreatment of algae enhanced the negative effects of exposure to natural solar UV-irradiation in Daphnia. These UV-related effects were generally not specific to the species of Daphnia.

Reforma Educativa en Misiones: organización curricular y prácticas de enseñanza en el campo de las Ciencias Económicas en el Trayecto Profesional de E. 16H375

Este proyecto de investigación se cuestiona sobre la estructura organizativa de la Educación Técnica Profesional en escuelas de la ciudad de Misiones y las características didácticas y pedagógicas que asumen los procesos de enseñanza y aprendizaje en esta modalidad educativa, para el campo de las Ciencias Económicas. La reestructuración del Sistema Educativo supone el establecimiento de acuerdos y redefiniciones al interior de las escuelas, en relación con la norma que propicia la vinculación de la educación, el trabajo y la producción, y la realización de prácticas educativas que permitan a los estudiantes el manejo de tecnologías o brinden la experiencia adecuada a su formación y orientación vocacional. Por ello realizaremos una revisión crítica de las documentaciones, marcos legales y orientaciones curriculares, así como de su impacto en las prácticas educativas desde la perspectiva de los actores, teniendo presente las peculiaridades de esta modalidad formativa.

Diagnóstico de la Oferta Turística del sur de la provincia de Misiones. 16H336

Actividades desarrolladas durante el período: Búsqueda y recopilación de documentos y materiales bibliográficos existentes en los archivos de los proyectos de investigación finalizados con anterioridad y que estén vinculados directa e indirectamente con el objeto de este trabajo; Elaboración de fichas para el relevamiento de la oferta turística; Recopilación fotográfica existente y registro fotográfico de la situación actual; Búsqueda y recopilación de nuevos documentos y materiales bibliográficos en la Ciudad de Apóstoles, San José, Garupá y Posadas; Análisis y procesamiento de la información recolectada hasta el momento; Generación del Informe Parcial sobre la situación de avance del proyecto correspondiente a esta etapa.

Representaciones y prácticas, entre demandantes y gestores, en torno a los programas de transferencia de ingresos. 16H333

Esta investigación persigue por objetivo identificar las representaciones sociales en torno a los programas de transferencia de ingresos entre los demandantes y los gestores de este tipo de programas y analizar la forma en que estas representaciones intervienen a la hora de solicitar o dar curso a este tipo de demanda. Se trata de un estudio de tipo exploratorio y descriptivo, de carácter cualitativo. La unidad de estudio se circunscribe a los ámbitos de gestión de los programas de transferencia de ingresos en la ciudad de Posadas. Fundamentalmente se prevé el trabajo con fuentes secundarias y primarias, entre las fuentes secundarias se considera utilizar los informes socio ambientales realizados por los trabajadores sociales ante la solicitud de los demandantes; en tanto los datos primarios serán relevados mediante la realización de entrevistas no dirigidas a profesionales del trabajo social que intervienen en la gestión de recurso, y de entrevistas semi estructuradas a los demandantes del recurso. Para la delimitación de la muestra se recurrirá al muestreo teórico.

Proceso de poblamiento y migraciones en la Provincia deMisiones, Argentina (1881-1970). En: Avá, nº 16

El objetivo es exponer los resultados iniciales sobre un estudio que tiene como alcance la elaboración de una cartografía etnográfica de la población deMisiones, Argentina, desde la etapa de Territorio Nacional 1881 hasta el año 1970. A través del “dibujo” de los mapas se describe el trayecto –histórico– de los diferentes tipos de colonización y poblamiento enmarcado en un proceso temporal y espacial de ocupación territorial, que permitirán en otra instancia observar la conformación de la sociedad misiónense caracterizada como plural, diferenciada y fragmentada según políticas socioeconómicas y culturales.

Las Cooperativas yerbateras entre proyectos estatales en mutación. Misiones (Argentina), 1950-1976. En: LaRivada, V. 3, nº 4

La actual provincia de Misiones desarrolló una economía relacionada a cultivos industriales, particularmente yerba mate y tabaco. El sistema productivo se enlazó a ellos, los cuales además modelaron las explotaciones agrícolas y al sujeto social agrario. El objetivo de este trabajo es analizar las acciones colectivas desplegadas por el cooperativismo yerbatero misionero y la representación de intereses del sector, tomando como referente a la Federación de Cooperativas Agrícolas de Misiones (Fedecoop); las mismas serán puestas en relación con los cambios en las políticas estatales a partir de la década de 1950 hasta 1976. Se sostiene la hipótesis de que las cooperativas promueven una organización económica y social válida para los sujetos rurales del agro misionero. Para este análisis histórico, interesa considerar la construcción de hegemonía, entrelazados con el vínculo existente entre los proyectos productivos y sociales que sostenía el sujeto cooperativo y aquél que el Estado intentó reformular al finalizar el gobierno peronista en 1955. El propósito es ponderar cuáles fueron las consecuencias de los cambios ocurridos a partir del paso de un Estado interventor a uno burocrático autoritario sobre el movimiento cooperativo.

Compilation of scientific results of the OASIS project

Seamounts are of great interest to science, industry and conservation because of their potential role as 'stirring rods' of the oceans, their enhanced productivity, their high local biodiversity, and the growing exploitation of their natural resources. This is accompanied by rising concern about the threats to seamount ecosystems, e.g. through over-fishing and the impact of trawling. OASIS described the functioning characteristics of seamount ecosystems. OASIS' integrated hydrographic, biogeochemical and biological information. Based on two case studies. The scientific results, condensed in conceptual and mass balanced ecosystem models, were applied to outline a model management plan as well as site-specific management plans for the seamounts investigated. OASIS addressed five main objectives: Objective 1: To identify and describe the physical forcing mechanisms effecting seamount systems Objective 2: To assess the origin, quality and dynamics of particulate organic material within the water column and surface sediment at seamounts. Objective 3: To describe aspects of the biodiversity and the ecology of seamount biota, to assess their dynamics and the maintenance of their production. Objective 4: Modelling the trophic ecology of seamount ecosystems. Objective 5: Application of scientific knowledge to practical conservation.