Association between muscle strength and the cardiopulmonary status of individuals living with HIV/AIDS

OBJECTIVE: The purpose of this study was to compare aerobic function [anaerobic threshold (%_VVO2-AT), respiratory compensation point (%_VVO2-RCP) and peak oxygen uptake (_VVO2peak)] between physically active patients with HIV/AIDS and matched controls and to examine associations between disease status, poor muscle strength, depression (as estimated by the profile of mood states questionnaire) and the aerobic performance of patients. METHODS: Progressive treadmill test data for %_VVO2-AT (V-slope method), RCP and (_VVO2peak) were compared between 39 male patients with HIV/AIDS (age 40.6¡1.4 years) and 28 male controls (age 44.4¡2.1 years) drawn from the same community and matched for habitual physical activity. Within-patient data were also examined in relation to CD4+ counts (nadir and current data) and peak isokinetic knee torque. RESULTS: AT, RCP and (_VVO2peak) values were generally similar for patients and controls.Within the patient sample, binary classification suggested that AT, RCP and (_VVO2peak) values were not associated with either the nadir or current CD4+ count, but treadmill test variables were positively associated with peak isokinetic knee torque. CONCLUSION: The aerobic performance of physically active patients with HIV/AIDS is generally well conserved. Nevertheless, poor muscle strength is observed in some HIV/AIDS patients, which is associated with lower anaerobic power and (_VVO2peak), suggesting the possibility of enhancing the aerobic performance of patients with weak muscles through appropriate muscle-strengthening activities.

The Gemini planet-finding campaign: the frequency of giant planets aroud debris disk stars

We have completed a high-contrast direct imaging survey for giant planets around 57 debris disk stars as part of the Gemini NICI Planet-Finding Campaign. We achieved median H-band contrasts of 12.4 mag at 0.''5 and 14.1 mag at 1'' separation. Follow-up observations of the 66 candidates with projected separation <500 AU show that all of them are background objects. To establish statistical constraints on the underlying giant planet population based on our imaging data, we have developed a new Bayesian formalism that incorporates (1) non-detections, (2) single-epoch candidates, (3) astrometric and (4) photometric information, and (5) the possibility of multiple planets per star to constrain the planet population. Our formalism allows us to include in our analysis the previously known β Pictoris and the HR 8799 planets. Our results show at 95% confidence that <13% of debris disk stars have a ≥5 M Jup planet beyond 80 AU, and <21% of debris disk stars have a ≥3 M Jup planet outside of 40 AU, based on hot-start evolutionary models. We model the population of directly imaged planets as d 2 N/dMdavpropm α a β, where m is planet mass and a is orbital semi-major axis (with a maximum value of a max). We find that β < –0.8 and/or α > 1.7. Likewise, we find that β < –0.8 and/or a max < 200 AU. For the case where the planet frequency rises sharply with mass (α > 1.7), this occurs because all the planets detected to date have masses above 5 M Jup, but planets of lower mass could easily have been detected by our search. If we ignore the β Pic and HR 8799 planets (should they belong to a rare and distinct group), we find that <20% of debris disk stars have a ≥3 M Jup planet beyond 10 AU, and β < –0.8 and/or α < –1.5. Likewise, β < –0.8 and/or a max < 125 AU. Our Bayesian constraints are not strong enough to reveal any dependence of the planet frequency on stellar host mass. Studies of transition disks have suggested that about 20% of stars are undergoing planet formation; our non-detections at large separations show that planets with orbital separation >40 AU and planet masses >3 M Jup do not carve the central holes in these disks.

The Gemini NICI planet-finding campaign: the frequency of giant planets around young B and A stars

We have carried out high contrast imaging of 70 young, nearby B and A stars to search for brown dwarf and planetary companions as part of the Gemini NICI Planet-Finding Campaign. Our survey represents the largest, deepest survey for planets around high-mass stars (≈1.5-2.5 M ☉) conducted to date and includes the planet hosts β Pic and Fomalhaut. We obtained follow-up astrometry of all candidate companions within 400 AU projected separation for stars in uncrowded fields and identified new low-mass companions to HD 1160 and HIP 79797. We have found that the previously known young brown dwarf companion to HIP 79797 is itself a tight (3 AU) binary, composed of brown dwarfs with masses 58$^{+21}_{-20}$ M Jup and 55$^{+20}_{-19}$ M Jup, making this system one of the rare substellar binaries in orbit around a star. Considering the contrast limits of our NICI data and the fact that we did not detect any planets, we use high-fidelity Monte Carlo simulations to show that fewer than 20% of 2 M ☉ stars can have giant planets greater than 4 M Jup between 59 and 460 AU at 95% confidence, and fewer than 10% of these stars can have a planet more massive than 10 M Jup between 38 and 650 AU. Overall, we find that large-separation giant planets are not common around B and A stars: fewer than 10% of B and A stars can have an analog to the HR 8799 b (7 M Jup, 68 AU) planet at 95% confidence. We also describe a new Bayesian technique for determining the ages of field B and A stars from photometry and theoretical isochrones. Our method produces more plausible ages for high-mass stars than previous age-dating techniques, which tend to underestimate stellar ages and their uncertainties.

MÖJLIGHETER OCH HINDER INOM PREVENTIVT HIV/AIDS-ARBETE : En intervjuundersökning, i Zambia, om rådgivares upplevelser

HIV/Aids är ett av de största globala problemen och utmaningar av idag. Södra Afrika är särskilt drabbat och detta påverkar många olika delar av mänskligt liv. Syftet med denna uppsats har varit att söka ökad förståelse för hur maktstrukturer, utifrån fem rådgivares upplevelser, påverkar det preventiva HIV/Aids arbetet. Vilka faktorer som utgör möjligheter och hinder samt ifall maktstrukturer bidrar till att inte förändring av beteende sker trots kunskap om dess risker, har getts stort fokus. Det geografiska området för studien var södra Zambia. Det finns inget givet svar på vår forskningsfråga, utan resultatet visar snarare på motsatser och komplexitet. Vår utgångspunkt har varit att det inte finns något självklart rätt eller fel och inte heller en enda sanning. Dock är vår slutsats att de möjligheter som finns kan basera sig i att ta hänsyn till lokala förhållanden och maktstrukturer.

Grandparents Left with AIDS-orphans; Challenges and Strategies Handling Poverty and Stigma

By 2010 it is estimated that one third of the African children will be orphans as an effect of HIV/AIDS. The crisis is already a fact and most orphans are absorbed by the extended family where the grandparents become the primary caretakers. This qualitative study was carried out in Kenya to explore the situation of these grandparents and to define their current resources and needs. Eight grandparents living in rural village or urban slum caring for their orphaned grandchildren were interviewed. The results showed that these families live under extremely poor conditions lacking food, other vital neccesities and a basic social network. Local churches and support groups emerged as the grandparents main sources to enhance strength and support. Key factors causing the acute poverty is HIV-related stigma and lack of access to land.

Sjuksköterskans kunskap och attityder vid omvårdnad av HIV/AIDS patient

Abstract Bakgrund: Totalt har nästan 30 miljoner avlidit sedan första AIDS- fallet diagnostiserades år 1981. Ovissheten och hotet om sjukdom och för tidig död innebär stora psykiska påfrestningar på individen. Sjuksköterskans attityder och sätt att vara spelar en viktig roll för etablering av en terapeutisk relation. Syfte: Syftet var att belysa sjuksköterskans attityder till patienter med HIV- infektion. Metod: Genom en litteraturstudie av tidigare forskning har 16 vetenskapliga artiklar granskats. Dessa fann vi på databaserna PubMed och Cinahl. Resultat: Sjuksköterskor upplevde rädsla vid omvårdnad av patienter med HIV/AIDS på grund av dess smittrisk. De ansåg att de behövde mer utbildning och support och professionell support mellan kollegor för att orka med sitt arbete. Från forskarnas observationer sågs ett fysiskt undvikande av patienter, som att vårdpersonalen inte svarade på patientens ringningar, de undvek att gå in till patienten. Sjuksköterskestuderande som hade en rädsla för HIV/AIDS har mer homofobier, de ansåg att det var ett straff för deras oordnade sexliv och att de förtjänade sitt öde. Slutsats: Vi anser att många av dessa attityder skulle kunna undvikas om personalen får mer kunskap om smitta, sexuallitet och droger, hur sjukdomsförloppet ser ut, och vilka funderingar en HIV/AIDS smittad kan ha. Detta skulle bidra till att sjuksköterskor/vårdpersonal vågar möta patienten och utveckla en god relation till denne.

Development of Clinical Decision Support Systems based on Mathematical Models of Physiological Systems

In the last years of research, I focused my studies on different physiological problems. Together with my supervisors, I developed/improved different mathematical models in order to create valid tools useful for a better understanding of important clinical issues. The aim of all this work is to develop tools for learning and understanding cardiac and cerebrovascular physiology as well as pathology, generating research questions and developing clinical decision support systems useful for intensive care unit patients. I. ICP-model Designed for Medical Education We developed a comprehensive cerebral blood flow and intracranial pressure model to simulate and study the complex interactions in cerebrovascular dynamics caused by multiple simultaneous alterations, including normal and abnormal functional states of auto-regulation of the brain. Individual published equations (derived from prior animal and human studies) were implemented into a comprehensive simulation program. Included in the normal physiological modelling was: intracranial pressure, cerebral blood flow, blood pressure, and carbon dioxide (CO2) partial pressure. We also added external and pathological perturbations, such as head up position and intracranial haemorrhage. The model performed clinically realistically given inputs of published traumatized patients, and cases encountered by clinicians. The pulsatile nature of the output graphics was easy for clinicians to interpret. The manoeuvres simulated include changes of basic physiological inputs (e.g. blood pressure, central venous pressure, CO2 tension, head up position, and respiratory effects on vascular pressures) as well as pathological inputs (e.g. acute intracranial bleeding, and obstruction of cerebrospinal outflow). Based on the results, we believe the model would be useful to teach complex relationships of brain haemodynamics and study clinical research questions such as the optimal head-up position, the effects of intracranial haemorrhage on cerebral haemodynamics, as well as the best CO2 concentration to reach the optimal compromise between intracranial pressure and perfusion. We believe this model would be useful for both beginners and advanced learners. It could be used by practicing clinicians to model individual patients (entering the effects of needed clinical manipulations, and then running the model to test for optimal combinations of therapeutic manoeuvres). II. A Heterogeneous Cerebrovascular Mathematical Model Cerebrovascular pathologies are extremely complex, due to the multitude of factors acting simultaneously on cerebral haemodynamics. In this work, the mathematical model of cerebral haemodynamics and intracranial pressure dynamics, described in the point I, is extended to account for heterogeneity in cerebral blood flow. The model includes the Circle of Willis, six regional districts independently regulated by autoregulation and CO2 reactivity, distal cortical anastomoses, venous circulation, the cerebrospinal fluid circulation, and the intracranial pressure-volume relationship. Results agree with data in the literature and highlight the existence of a monotonic relationship between transient hyperemic response and the autoregulation gain. During unilateral internal carotid artery stenosis, local blood flow regulation is progressively lost in the ipsilateral territory with the presence of a steal phenomenon, while the anterior communicating artery plays the major role to redistribute the available blood flow. Conversely, distal collateral circulation plays a major role during unilateral occlusion of the middle cerebral artery. In conclusion, the model is able to reproduce several different pathological conditions characterized by heterogeneity in cerebrovascular haemodynamics and can not only explain generalized results in terms of physiological mechanisms involved, but also, by individualizing parameters, may represent a valuable tool to help with difficult clinical decisions. III. Effect of Cushing Response on Systemic Arterial Pressure. During cerebral hypoxic conditions, the sympathetic system causes an increase in arterial pressure (Cushing response), creating a link between the cerebral and the systemic circulation. This work investigates the complex relationships among cerebrovascular dynamics, intracranial pressure, Cushing response, and short-term systemic regulation, during plateau waves, by means of an original mathematical model. The model incorporates the pulsating heart, the pulmonary circulation and the systemic circulation, with an accurate description of the cerebral circulation and the intracranial pressure dynamics (same model as in the first paragraph). Various regulatory mechanisms are included: cerebral autoregulation, local blood flow control by oxygen (O2) and/or CO2 changes, sympathetic and vagal regulation of cardiovascular parameters by several reflex mechanisms (chemoreceptors, lung-stretch receptors, baroreceptors). The Cushing response has been described assuming a dramatic increase in sympathetic activity to vessels during a fall in brain O2 delivery. With this assumption, the model is able to simulate the cardiovascular effects experimentally observed when intracranial pressure is artificially elevated and maintained at constant level (arterial pressure increase and bradicardia). According to the model, these effects arise from the interaction between the Cushing response and the baroreflex response (secondary to arterial pressure increase). Then, patients with severe head injury have been simulated by reducing intracranial compliance and cerebrospinal fluid reabsorption. With these changes, oscillations with plateau waves developed. In these conditions, model results indicate that the Cushing response may have both positive effects, reducing the duration of the plateau phase via an increase in cerebral perfusion pressure, and negative effects, increasing the intracranial pressure plateau level, with a risk of greater compression of the cerebral vessels. This model may be of value to assist clinicians in finding the balance between clinical benefits of the Cushing response and its shortcomings. IV. Comprehensive Cardiopulmonary Simulation Model for the Analysis of Hypercapnic Respiratory Failure We developed a new comprehensive cardiopulmonary model that takes into account the mutual interactions between the cardiovascular and the respiratory systems along with their short-term regulatory mechanisms. The model includes the heart, systemic and pulmonary circulations, lung mechanics, gas exchange and transport equations, and cardio-ventilatory control. Results show good agreement with published patient data in case of normoxic and hyperoxic hypercapnia simulations. In particular, simulations predict a moderate increase in mean systemic arterial pressure and heart rate, with almost no change in cardiac output, paralleled by a relevant increase in minute ventilation, tidal volume and respiratory rate. The model can represent a valid tool for clinical practice and medical research, providing an alternative way to experience-based clinical decisions. In conclusion, models are not only capable of summarizing current knowledge, but also identifying missing knowledge. In the former case they can serve as training aids for teaching the operation of complex systems, especially if the model can be used to demonstrate the outcome of experiments. In the latter case they generate experiments to be performed to gather the missing data.

Frauen und AIDS in Tansania /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 60

Mehr als die Hälfte aller HIV-positiven Tansanier sind Frauen. Ihre schwächere gesellschaftliche Stellung ist einer der Faktoren, der dazu beiträgt, dass sie einem erhöhten Infektionsrisiko ausgesetzt sind. Aufgrund geringerer Bildungschancen und einer anhaltenden gesellschaftlichen Idealvorstellung von der Frau als Mutter sind Frauen auch auf dem Arbeitsmarkt benachteiligt. Im Kontext von HIV/AIDS werden afrikanische Frauen häufig als passive Opfer der Epidemie dargestellt und es wird zu selten aufgezeigt, wie sie als Akteure eigene Strategien im Kampf gegen die Krankheit entwickeln. In letzter Zeit gewinnen Frauenorganisationen an Bedeutung, denn viele Frauen wollen ausdrücklich eigenverantwortlich und ohne Männer arbeiten. Eine solche Organisation ist die in meiner Arbeit vorgestellte NGO KIWAMWAKU („Kikundi cha Wanawake Mwanga kupambana na Ukimwi“ – Vereinigung von Frauen aus Mwanga zum Kampf gegen AIDS). Meine Forschung hat gezeigt, dass Frauen ihre gesellschaftliche Stellung durch das Engagement in einer NGO verbessern können. Sie können ein eigenes Einkommen erwirtschaften und nützliche Kenntnisse etwa in der Führung einer Organisation erlangen. Allerdings profitieren nicht alle Beteiligten gleichermaßen. Die drei Leiterinnen der erforschten NGO verfügten über die meisten Vorteile; sie profitierten finanziell, aber auch ideell, denn sie genossen durch ihre Arbeit hohes Ansehen im gesamten Mwanga-Distrikt. Dagegen konnten einige der Klientinnen nur in sehr geringem Maße von Interventionen profitieren. Letztlich bin ich jedoch überzeugt davon, dass durch solche Frauenorganisationen ein wichtiger Prozess angestoßen worden ist, durch den Frauen mittel- oder langfristig eine stärkere Stellung innerhalb der tansanischen Gesellschaft erlangen können, was sich wiederum positiv auf die immer noch steigenden HIV/AIDS-Infektionsraten auswirken kann.

Health risk appraisal for older people 4: case finding for hypertension, hyperlipidaemia and diabetes mellitus in older people in English general practice before the introduction of the Quality and Outcomes Framework

Early intervention can help to reduce the burden of disability in the older population, but many do not access preventive care. There is uncertainty over what factors influence case finding in older patients in general practice.

Examining the Role of Vocational Rehabilitation on Access to Care and Public Health Outcomes for People Living with HIV/AIDS

The purpose of this study is to examine the role of vocational rehabilitation services in contributing to the goals of the National HIV/AIDS strategy. Three key research questions are addressed: (a) What is the relationship among factors associated with the use of vocational rehabilitation services for people living with HIV/AIDS? (b) Are the factors associated with use of vocational rehabilitation also associated with access to health care, supplemental employment services and reduced risk of HIV transmission? And (c) What unique role does use of vocational rehabilitation services play in access to health care and HIV prevention? Survey research methods were used to collect data from a broad sample of volunteer respondents who represented diverse racial (37% Black, 37% White, 18% Latino, 7% other), gender (65% male, 34% female, 1% transgender) and sexual orientation (48% heterosexual, 44% gay, 8% bisexual) backgrounds. The fit of the final structural equation model was good (root mean square error of approximation = .055, Comparative Fit Index=.953, Tucker Lewis Index=.945). Standardized effects with bootstrap confidence intervals are reported. Overall, the findings support the hypothesis that vocational rehabilitation services can play an important role in health and prevention strategies outlined in the National HIV/AIDS strategy.

A comparison of initial antiretroviral therapy in the Swiss HIV Cohort Study and the recommendations of the International AIDS Society-USA

In order to facilitate and improve the use of antiretroviral therapy (ART), international recommendations are released and updated regularly. We aimed to study if adherence to the recommendations is associated with better treatment outcomes in the Swiss HIV Cohort Study (SHCS).