Effect of atazanavir versus other protease inhibitor-containing antiretroviral therapy on endothelial function in HIV-infected persons: randomised controlled trial

OBJECTIVE: Impaired endothelial function was demonstrated in HIV-infected persons on protease inhibitor (PI)-containing antiretroviral therapy, probably due to altered lipid metabolism. Atazanavir is a PI causing less atherogenic lipoprotein changes. This study determined whether endothelial function improves after switching from other PI to atazanavir. DESIGN: Randomised, observer-blind, treatment-controlled trial. SETTING: Three university-based outpatient clinics. PATIENTS: 39 HIV-infected persons with suppressed viral replication on PI-containing regimens and fasting low-density lipoprotein (LDL)-cholesterol greater than 3 mmol/l. INTERVENTION: Patients were randomly assigned to continue the current PI or change to unboosted atazanavir. MAIN OUTCOME MEASURES: Endpoints at week 24 were endothelial function assessed by flow-mediated dilation (FMD) of the brachial artery, lipid profiles and serum inflammation and oxidative stress parameters. RESULTS: Baseline characteristics and mean FMD values of the two treatment groups were comparable (3.9% (SD 1.8) on atazanavir versus 4.0% (SD 1.5) in controls). After 24 weeks' treatment, FMD decreased to 3.3% (SD 1.4) and 3.4% (SD 1.7), respectively (all p = ns). Total cholesterol improved in both groups (p<0.0001 and p = 0.01, respectively) but changes were more pronounced on atazanavir (p = 0.05, changes between groups). High-density lipoprotein and triglyceride levels improved on atazanavir (p = 0.03 and p = 0.003, respectively) but not in controls. Serum inflammatory and oxidative stress parameters did not change; oxidised LDL improved significantly in the atazanavir group. CONCLUSIONS: The switch from another PI to atazanavir in treatment-experienced patients did not result in improvement of endothelial function despite significantly improved serum lipids. Atherogenic lipid profiles and direct effects of antiretroviral drugs on the endothelium may affect vascular function. Trial registration number: NCT00447070.

Governance and the Capacity to Manage Resilience in Regional Social-Ecological Systems

The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: ( 1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; ( 2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and ( 3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?

Observational Research on NCDs in HIV-Positive Populations: Conceptual and Methodological Considerations

: Noncommunicable diseases (NCDs) account for a growing burden of morbidity and mortality among people living with HIV in low- and middle-income countries (LMICs). HIV infection and antiretroviral therapy interact with NCD risk factors in complex ways, and research into this "web of causation" has so far been largely based on data from high-income countries. However, improving the understanding, treatment, and prevention of NCDs in LMICs requires region-specific evidence. Priority research areas include: (1) defining the burden of NCDs among people living with HIV, (2) understanding the impact of modifiable risk factors, (3) evaluating effective and efficient care strategies at individual and health systems levels, and (4) evaluating cost-effective prevention strategies. Meeting these needs will require observational data, both to inform the design of randomized trials and to replace trials that would be unethical or infeasible. Focusing on Sub-Saharan Africa, we discuss data resources currently available to inform this effort and consider key limitations and methodological challenges. Existing data resources often lack population-based samples; HIV-negative, HIV-positive, and antiretroviral therapy-naive comparison groups; and measurements of key NCD risk factors and outcomes. Other challenges include loss to follow-up, competing risk of death, incomplete outcome ascertainment and measurement of factors affecting clinical decision making, and the need to control for (time-dependent) confounding. We review these challenges and discuss strategies for overcoming them through augmented data collection and appropriate analysis. We conclude with recommendations to improve the quality of data and analyses available to inform the response to HIV and NCD comorbidity in LMICs.

Ethnography of a Land-Deal. Local Perceptions and Vertical Perspectives of a Large Scale Land Acquisition Project in Northern Sierra Leone

In the aftermath of the devastating civil war, the Sierra Leonean government created favourable conditions for foreign investors willing to lease large areas of land to bring development to the country. A team of anthropologists and geographers did extensive fieldwork on the Addax Bioenergy Project in order to a) document the project affected people’s (PAP) perceptions and interests on a horizontal level and b) identify the different actors that are necessary for the implementation of such a project on the vertical level. Findings indicate that the project triggers a number of processes: Cultural and linguistic differences between PAP and company, their diverse understanding of development and the stance of local elites led to misunderstandings concerning each other’s responsibilities and created a lot of frustration on both sides. Further, the loss of natural resources that comes along with the land lease affects mostly women and other vulnerable groups.

Local Perceptions and Vertical Perspectives of a Large Scale Land Acquisition Project in Northern Sierra Leone

Despite increased scientific interest in the phenomenon of large-scale land acquisitions (LSLA), accurate data on implementation processes remain sparse. This paper aims at filling this gap by providing empirical in-depth knowledge on the case of the Swiss-based Addax Bioenergy Ltd. in Sierra Leone. Extensive fieldwork allowed the interdisciplinary research team 1) the identification of different actors that are necessary for the implementation on a vertical level and 2) the documentation of the heterogeneous group of project affected people’s perceptions and strategies on a horizontal level. Findings reveal that even a project labeled as best-practice example by UN agencies triggers a number of problematic processes for affected communities. The loss of natural resources that comes along with the land lease and the lack of employment possibilities mostly affects already vulnerable groups. On the other hand, strategies and resistance of local people also affect the project implementation. This shows that the horizontal and vertical levels are not separate entities. They are linked by social networks, social interactions, and means of communication and both levels take part in shaping the project’s impacts.

Governance and the Capacity to Manage Resilience in Regional Social-Ecological Systems

The sustainability of regional development can be usefully explored through several different lenses. In situations in which uncertainties and change are key features of the ecological landscape and social organization, critical factors for sustainability are resilience, the capacity to cope and adapt, and the conservation of sources of innovation and renewal. However, interventions in social-ecological systems with the aim of altering resilience immediately confront issues of governance. Who decides what should be made resilient to what? For whom is resilience to be managed, and for what purpose? In this paper we draw on the insights from a diverse set of case studies from around the world in which members of the Resilience Alliance have observed or engaged with sustainability problems at regional scales. Our central question is: How do certain attributes of governance function in society to enhance the capacity to manage resilience? Three specific propositions were explored: ( 1) participation builds trust, and deliberation leads to the shared understanding needed to mobilize and self-organize; ( 2) polycentric and multilayered institutions improve the fit between knowledge, action, and social-ecological contexts in ways that allow societies to respond more adaptively at appropriate levels; and ( 3) accountable authorities that also pursue just distributions of benefits and involuntary risks enhance the adaptive capacity of vulnerable groups and society as a whole. Some support was found for parts of all three propositions. In exploring the sustainability of regional social-ecological systems, we are usually faced with a set of ecosystem goods and services that interact with a collection of users with different technologies, interests, and levels of power. In this situation in our roles as analysts, facilitators, change agents, or stakeholders, we not only need to ask: The resilience of what, to what? We must also ask: For whom?

Reflexiones en torno al proceso de implementación de un programa social en el campo de la actividad física en poblaciones vulnerables : Aportes para la formación del profesorado de Educación Física y la mejora de las políticas públicas

En este artículo se propone describir y analizar el proceso de implementación de un Programa social de intervención en poblaciones vulnerables a través del deporte, la actividad física y el juego recreativo que se desarrolla desde 2011 en tres espacios socio-residenciales de villa o asentamiento urbano informal del Partido de la Matanza. El programa social es analizado en diferentes aspectos claves de su proceso de implementación. Estos aspectos fueron abordados a través de una investigación cualitativa con objetivos amplios y un enfoque integral, en esta oportunidad se reflexiona sobre un avance de investigación que privilegia las percepciones y representaciones de los docentes técnicos que ejercieron el rol docente en el marco del Programa y se realizan algunos aportes para pensar la mejora en las futuras acciones y en la formación del profesorado.Se realizaron 6 grupos focales y se estima que los insumos generados serán útiles para la mejor planificación de las prácticas docentes y formación específica de los futuros profesores. Asimismo, se espera poder aportar elementos de análisis y de juicio para la gestión de políticas públicas en el campo del deporte y la actividad física como estrategia de integración social

Reflexiones en torno al proceso de implementación de un programa social en el campo de la actividad física en poblaciones vulnerables : Aportes para la formación del profesorado de Educación Física y la mejora de las políticas públicas

En este artículo se propone describir y analizar el proceso de implementación de un Programa social de intervención en poblaciones vulnerables a través del deporte, la actividad física y el juego recreativo que se desarrolla desde 2011 en tres espacios socio-residenciales de villa o asentamiento urbano informal del Partido de la Matanza. El programa social es analizado en diferentes aspectos claves de su proceso de implementación. Estos aspectos fueron abordados a través de una investigación cualitativa con objetivos amplios y un enfoque integral, en esta oportunidad se reflexiona sobre un avance de investigación que privilegia las percepciones y representaciones de los docentes técnicos que ejercieron el rol docente en el marco del Programa y se realizan algunos aportes para pensar la mejora en las futuras acciones y en la formación del profesorado.Se realizaron 6 grupos focales y se estima que los insumos generados serán útiles para la mejor planificación de las prácticas docentes y formación específica de los futuros profesores. Asimismo, se espera poder aportar elementos de análisis y de juicio para la gestión de políticas públicas en el campo del deporte y la actividad física como estrategia de integración social

Reflexiones en torno al proceso de implementación de un programa social en el campo de la actividad física en poblaciones vulnerables : Aportes para la formación del profesorado de Educación Física y la mejora de las políticas públicas

En este artículo se propone describir y analizar el proceso de implementación de un Programa social de intervención en poblaciones vulnerables a través del deporte, la actividad física y el juego recreativo que se desarrolla desde 2011 en tres espacios socio-residenciales de villa o asentamiento urbano informal del Partido de la Matanza. El programa social es analizado en diferentes aspectos claves de su proceso de implementación. Estos aspectos fueron abordados a través de una investigación cualitativa con objetivos amplios y un enfoque integral, en esta oportunidad se reflexiona sobre un avance de investigación que privilegia las percepciones y representaciones de los docentes técnicos que ejercieron el rol docente en el marco del Programa y se realizan algunos aportes para pensar la mejora en las futuras acciones y en la formación del profesorado.Se realizaron 6 grupos focales y se estima que los insumos generados serán útiles para la mejor planificación de las prácticas docentes y formación específica de los futuros profesores. Asimismo, se espera poder aportar elementos de análisis y de juicio para la gestión de políticas públicas en el campo del deporte y la actividad física como estrategia de integración social

Habilidades funcionais de autocuidado, mobilidade e função social em crianças com fissura labiopalatina e Espectro Óculo-Aurículo-Vertebral (EOAV)

As anomalias craniofaciais ocasionam comprometimentos estéticos e funcionais com grande impacto na saúde e na integração social da criança, com interferência no desenvolvimento global e social. Das anomalias craniofaciais este estudo abordou as Fissuras Labiopalatinas (FLP) e o Espectro Óculo Aurículo Vertebral (EOAV). As FLP constituem malformações resultantes de falta do fechamento completo dos tecidos que compõe o lábio e o palato. O EOAV, também conhecido como Síndrome de Goldenhar, é uma anomalia congênita de etiologia desconhecida, com manifestação genética variável e de causa bastante heterogênea. Conhecer as habilidades funcionais e o impacto destas no desenvolvimento global de crianças com EOAV e FLP pode otimizar o desenvolvimento de programas de prevenção e intervenção para promover a saúde e a integração social destes indivíduos. Este estudo foi delineado com objetivo de verificar e comparar o desempenho em habilidades funcionais quanto ao desempenho nas áreas de autocuidado, mobilidade, função social e nível de independência entre crianças com EOAV, crianças com FLP e um grupo comparativo, de crianças sem anomalias. O modelo de pesquisa foi observacional descritivo transversal com uma casuística de 39 pais/responsáveis de crianças na faixa etária entre três anos e sete anos e seis meses, de ambos os gêneros. Foram convidados para participar pais/responsáveis de crianças em tratamento no Hospital de Reabilitação de Anomalias Craniofaciais da Universidade e São Paulo (HRAC-USP) os quais foram divididos em três grupos: dois experimentais e um grupo comparativo. O instrumento para coleta dos dados das habilidades funcionais foi o Pediatric Evaluation of Disability Inventory (PEDI), em sua versão adaptada para o português. A avaliação é realizada por meio de entrevista com o cuidador, o qual deve saber informar sobre o desempenho da criança em atividades e tarefas típicas da rotina diária. Os dados foram apresentados por análise descritiva com medidas de tendência central (média aritmética), dispersão (desvio-padrão) e distribuição de frequência, nas variáveis: idades, gênero e nível socioeconômico da família e caracterização da casuística. Para as análises das pontuações bruta e normativa do questionário PEDI no que se refere às habilidades funcionais e a assistência do cuidador nas três áreas de função autocuidado, mobilidade e função social, foi utilizado o teste de variância One Way, e para o teste de normalidade foi utilizado Shapiro Wilk para variável dependente. A análise comparativa foi realizada pelo teste de Kruskal-Wallis, adotando-se o valor de significância de p< 0,05. Os resultados deste estudo na análise comparativa nas habilidades funcionais na mobilidade, houve diferença estatisticamente significante na comparação entre os grupos GC vs GEEOAV, no escore bruto, e entre os grupos GC vs GEEOAV e GC vs GEFLP, no escore normativo.Na assistência do cuidador no autocuidado, houve diferença estatisticamente significante na comparação entre os grupos GC vs GEEOAV, no escore normativo. Na assistência do cuidador na mobilidade, houve diferença estatisticamente significante na comparação entre os grupos GC vs GEEOAV nos escores bruto e normativo.Na assistência do cuidador na função social houve diferença estatisticamente significante na comparação entre os grupos GC vs GEFLP.

Cultural Politics of Resilience in Kingston, Jamaica

Recently, resilience has become a catchall solution for some of the world’s most pressing ecological, economic and social problems. This dissertation analyzes the cultural politics of resilience in Kingston, Jamaica by examining them through their purported universal principles of adaptation and flexibility. On the one hand, mainstream development regimes conceptualize resilience as a necessary and positive attribute of economies, societies and cultures if we are to survive any number of disasters or disturbances. Therefore, in Jamaican cultural and development policy resilience is championed as both a means and an end of development. On the other hand, critics of resilience see the new rollout of resilience projects as deepening neoliberalism, capitalism and new forms of governmentality because resilience projects provide the terrain for new forms of securitization and surveillance practices. These scholars argue that resilience often forecloses the possibilities to resist that which threatens us. However, rather than dismissing resilience as solely a sign of domination and governmentality, this dissertation argues that resilience must be understood as much more ambiguous and complex, rather than within binaries such as subversion vs. neoliberal and resistance vs. resilience. Overly simplistic dualities of this nature have been the dominant approach in the scholarship thus far. This dissertation provides a close analysis of resilience in both multilateral and Jamaican government policy documents, while exploring the historical and contemporary production of resilience in the lives of marginalized populations. Through three sites within Kingston, Jamaica—namely dancehall and street dances, WMW-Jamaica and the activist platform SO((U))L HQ—this dissertation demonstrates that “resilience” is best understood as an ambiguous site of power negotiations, social reproduction and survival in Jamaica today. It is often precisely this ambiguous power of ordinary resilience that is capitalized on and exploited to the detriment of vulnerable groups. At once demonstrating creative negotiation and reproduction of colonial capitalist social relations within the realms of NGO, activist work and cultural production, this dissertation demonstrates the complexity of resilience. Ultimately, this dissertation draws attention to the importance of studying spaces of cultural production in order to understand the power and limits of contemporary policy discourses and political economy. 

The social identity perspective - Intergroup relations, self-conception, and small groups

The historical development, metatheoretical background, and current state of the social identity perspective in social psychology are described. Although originally, an analysis mainly of intergroup relations between large-scale social categories, and more recently an analysis with a strong social cognitive emphasis, this article shows that the social identity perspective is intended to be a general analysis of group membership and group processes. It focuses on the generative relationship between collective self-conception and group phenomena. To demonstrate the relevance of the social identity perspective to small groups, the article describes social identity research in a number of areas: differentiation within groups; leadership; deviance; group decision making; organizations; computer mediated communication; mobilization, collective action, and social loafing; and group culture. These art the areas in which most work has been done and which arc therefore best placed for further developments in the near future.

Elevated amygdala activity to sad facial expressions:a state marker of bipolar but not unipolar depression

Background - Difficulties in emotion processing and poor social function are common to bipolar disorder (BD) and major depressive disorder (MDD) depression, resulting in many BD depressed individuals being misdiagnosed with MDD. The amygdala is a key region implicated in processing emotionally salient stimuli, including emotional facial expressions. It is unclear, however, whether abnormal amygdala activity during positive and negative emotion processing represents a persistent marker of BD regardless of illness phase or a state marker of depression common or specific to BD and MDD depression. Methods - Sixty adults were recruited: 15 depressed with BD type 1 (BDd), 15 depressed with recurrent MDD, 15 with BD in remission (BDr), diagnosed with DSM-IV and Structured Clinical Interview for DSM-IV Research Version criteria; and 15 healthy control subjects (HC). Groups were age- and gender ratio-matched; patient groups were matched for age of illness onset and illness duration; depressed groups were matched for depression severity. The BDd were taking more psychotropic medication than other patient groups. All individuals participated in three separate 3T neuroimaging event-related experiments, where they viewed mild and intense emotional and neutral faces of fear, happiness, or sadness from a standardized series. Results - The BDd—relative to HC, BDr, and MDD—showed elevated left amygdala activity to mild and neutral facial expressions in the sad (p < .009) but not other emotion experiments that was not associated with medication. There were no other significant between-group differences in amygdala activity. Conclusions - Abnormally elevated left amygdala activity to mild sad and neutral faces might be a depression-specific marker in BD but not MDD, suggesting different pathophysiologic processes for BD versus MDD depression.

Vulnerable identities: Maya Yucatec identities in a postmodern world

In numerous anthropological works there have been preoccupations about the relationships between Indigenous and non-Indigenous peoples. Whatever social researchers have concluded, one thing is consistent: the tendency to interpret ethnographic “data” in terms of binary oppositions. This dissertation reviews the works which have been centered upon binary oppositions, as for instance, in the case of Yucatan, between the Maya and the Dzul—the Yucatec Maya term for white males—and highlights the fact that such works have failed to recognize that within and between each “pole,” or social group there are individuals that have multiple identities, and that do not recognize themselves as belonging to a homogenized “pole.” Instead, these individuals, recognize themselves as belonging to different groups and, therefore, being aware that they have not a single identity but multiple ones. ^ Analogical anthropology is highly criticized because of its emphasis on binary oppositions, its authoritarianism, and the notion of the “Other.” In contrast, dialogical anthropology places great importance on the relationship between the individuals and the anthropologist. A relation in which both, the anthropologist and the subject, are immersed in a dialogue, because of the identification between the writer and the story that is being written. ^ However, anthropologists seem to be more interested in “dialoguing” among themselves rather than with the people that they write about. Indigenous people are relegated, they are voiceless, and, therefore, we keep treating them as “objects,” and not as individuals. This is ironic, precisely because it undermines the aim of the dialogical discourse. ^ In this context, awareness of self-identity or self-identities and the various ways in which Francisco, a good friend and the main character of this dissertation, assumes them, and the way I assume them, within multicultural contexts, leads us along the road to establish and reestablish communication. The methodology is based on four considerations: positioning, fieldwork conversations, self reflexivity and vulnerability. Hence, this dissertation constitutes an attempt to break with authoritarian models of ethnography, it is a dialogue between Francisco and me, a conversation among ourselves. A dialogue that expresses the desire of hearing our voices being echoed by each other. ^

Cultural Politics of Resilience in Kingston, Jamaica

Recently, resilience has become a catchall solution for some of the world’s most pressing ecological, economic and social problems. This dissertation analyzes the cultural politics of resilience in Kingston, Jamaica by examining them through their purported universal principles of adaptation and flexibility. On the one hand, mainstream development regimes conceptualize resilience as a necessary and positive attribute of economies, societies and cultures if we are to survive any number of disasters or disturbances. Therefore, in Jamaican cultural and development policy resilience is championed as both a means and an end of development. On the other hand, critics of resilience see the new rollout of resilience projects as deepening neoliberalism, capitalism and new forms of governmentality because resilience projects provide the terrain for new forms of securitization and surveillance practices. These scholars argue that resilience often forecloses the possibilities to resist that which threatens us. However, rather than dismissing resilience as solely a sign of domination and governmentality, this dissertation argues that resilience must be understood as much more ambiguous and complex, rather than within binaries such as subversion vs. neoliberal and resistance vs. resilience. Overly simplistic dualities of this nature have been the dominant approach in the scholarship thus far. This dissertation provides a close analysis of resilience in both multilateral and Jamaican government policy documents, while exploring the historical and contemporary production of resilience in the lives of marginalized populations. Through three sites within Kingston, Jamaica—namely dancehall and street dances, WMW-Jamaica and the activist platform SO((U))L HQ—this dissertation demonstrates that “resilience” is best understood as an ambiguous site of power negotiations, social reproduction and survival in Jamaica today. It is often precisely this ambiguous power of ordinary resilience that is capitalized on and exploited to the detriment of vulnerable groups. At once demonstrating creative negotiation and reproduction of colonial capitalist social relations within the realms of NGO, activist work and cultural production, this dissertation demonstrates the complexity of resilience. Ultimately, this dissertation draws attention to the importance of studying spaces of cultural production in order to understand the power and limits of contemporary policy discourses and political economy.