Virologic and immunologic responses in treatment-naive patients to ritonavir-boosted atazanavir or efavirenz with a common backbone

Background: Atazanavir boosted with ritonavir (ATV/r) and efavirenz (EFV) are both recommended as first-line therapies for HIV-infected patients. We compared the 2 therapies for virologic efficacy and immune recovery. Methods: We included all treatment-naïve patients in the Swiss HIV Cohort Study starting therapy after May 2003 with either ATV/r or EFV and a backbone of tenofovir and either emtricitabine or lamivudine. We used Cox models to assess time to virologic failure and repeated measures models to assess the change in CD4 cell counts over time. All models were fit as marginal structural models using both point of treatment and censoring weights. Intent-to-treat and various as-treated analyses were carried out: In the latter, patients were censored at their last recorded measurement if they changed therapy or if they were no longer adherent to therapy. Results: Patients starting EFV (n = 1,097) and ATV/r (n = 384) were followed for a median of 35 and 37 months, respectively. During follow-up, 51% patients on EFV and 33% patients on ATV/r remained adherent and made no change to their first-line therapy. Although intent-to-treat analyses suggest virologic failure was more likely with ATV/r, there was no evidence for this disadvantage in patients who adhered to first-line therapy. Patients starting ATV/r had a greater increase in CD4 cell count during the first year of therapy, but this advantage disappeared after one year. Conclusions: In this observational study, there was no good evidence of any intrinsic advantage for one therapy over the other, consistent with earlier clinical trials. Differences between therapies may arise in a clinical setting because of differences in adherence to therapy.

A web-based non-intrusive ambient system to measure and classify activities of daily living.

BACKGROUND The number of older adults in the global population is increasing. This demographic shift leads to an increasing prevalence of age-associated disorders, such as Alzheimer's disease and other types of dementia. With the progression of the disease, the risk for institutional care increases, which contrasts with the desire of most patients to stay in their home environment. Despite doctors' and caregivers' awareness of the patient's cognitive status, they are often uncertain about its consequences on activities of daily living (ADL). To provide effective care, they need to know how patients cope with ADL, in particular, the estimation of risks associated with the cognitive decline. The occurrence, performance, and duration of different ADL are important indicators of functional ability. The patient's ability to cope with these activities is traditionally assessed with questionnaires, which has disadvantages (eg, lack of reliability and sensitivity). Several groups have proposed sensor-based systems to recognize and quantify these activities in the patient's home. Combined with Web technology, these systems can inform caregivers about their patients in real-time (e.g., via smartphone). OBJECTIVE We hypothesize that a non-intrusive system, which does not use body-mounted sensors, video-based imaging, and microphone recordings would be better suited for use in dementia patients. Since it does not require patient's attention and compliance, such a system might be well accepted by patients. We present a passive, Web-based, non-intrusive, assistive technology system that recognizes and classifies ADL. METHODS The components of this novel assistive technology system were wireless sensors distributed in every room of the participant's home and a central computer unit (CCU). The environmental data were acquired for 20 days (per participant) and then stored and processed on the CCU. In consultation with medical experts, eight ADL were classified. RESULTS In this study, 10 healthy participants (6 women, 4 men; mean age 48.8 years; SD 20.0 years; age range 28-79 years) were included. For explorative purposes, one female Alzheimer patient (Montreal Cognitive Assessment score=23, Timed Up and Go=19.8 seconds, Trail Making Test A=84.3 seconds, Trail Making Test B=146 seconds) was measured in parallel with the healthy subjects. In total, 1317 ADL were performed by the participants, 1211 ADL were classified correctly, and 106 ADL were missed. This led to an overall sensitivity of 91.27% and a specificity of 92.52%. Each subject performed an average of 134.8 ADL (SD 75). CONCLUSIONS The non-intrusive wireless sensor system can acquire environmental data essential for the classification of activities of daily living. By analyzing retrieved data, it is possible to distinguish and assign data patterns to subjects' specific activities and to identify eight different activities in daily living. The Web-based technology allows the system to improve care and provides valuable information about the patient in real-time.

Training primary care physicians to offer their patients faecal occult blood testing and colonoscopy for colorectal cancer screening on an equal basis: a pilot intervention with before-after and parallel group surveys.

OBJECTIVES Primary care physicians (PCPs) should prescribe faecal immunochemical testing (FIT) or colonoscopy for colorectal cancer screening based on their patient's values and preferences. However, there are wide variations between PCPs in the screening method prescribed. The objective was to assess the impact of an educational intervention on PCPs' intent to offer FIT or colonoscopy on an equal basis. DESIGN Survey before and after training seminars, with a parallel comparison through a mailed survey to PCPs not attending the training seminars. SETTING All PCPs in the canton of Vaud, Switzerland. PARTICIPANTS Of 592 eligible PCPs, 133 (22%) attended a seminar and 106 (80%) filled both surveys. 109 (24%) PCPs who did not attend the seminars returned the mailed survey. INTERVENTION A 2 h-long interactive seminar targeting PCP knowledge, skills and attitudes regarding offering a choice of colorectal cancer (CRC) screening options. OUTCOME MEASURES The primary outcome was PCP intention of having their patients screened with FIT and colonoscopy in equal proportions (between 40% and 60% each). Secondary outcomes were the perceived role of PCPs in screening decisions (from paternalistic to informed decision-making) and correct answer to a clinical vignette. RESULTS Before the seminars, 8% of PCPs reported that they had equal proportions of their patients screened for CRC by FIT and colonoscopy; after the seminar, 33% foresaw having their patients screened in equal proportions (p<0.001). Among those not attending, there was no change (13% vs 14%, p=0.8). Of those attending, there was no change in their perceived role in screening decisions, while the proportion responding correctly to a clinical vignette increased (88-99%, p<0.001). CONCLUSIONS An interactive training seminar increased the proportion of physicians with the intention to prescribe FIT and colonoscopy in equal proportions.

Understanding and Characterizing Shared Decision-Making and Behavioral Intent in Medical Uncertainty

Applying Theoretical Constructs to Address Medical Uncertainty Situations involving medical reasoning usually include some level of medical uncertainty. Despite the identification of shared decision-making (SDM) as an effective technique, it has been observed that the likelihood of physicians and patients engaging in shared decision making is lower in those situations where it is most needed; specifically in circumstances of medical uncertainty. Having identified shared decision making as an effective, yet often a neglected approach to resolving a lack of information exchange in situations involving medical uncertainty, the next step is to determine the way(s) in which SDM can be integrated and the supplemental processes that may facilitate its integration. SDM involves unique types of communication and relationships between patients and physicians. Therefore, it is necessary to further understand and incorporate human behavioral elements - in particular, behavioral intent - in order to successfully identify and realize the potential benefits of SDM. This paper discusses the background and potential interaction between the theories of shared decision-making, medical uncertainty, and behavioral intent. Identifying Shared Decision-Making Elements in Medical Encounters Dealing with Uncertainty A recent summary of the state of medical knowledge in the U.S. reported that nearly half (47%) of all treatments were of unknown effectiveness, and an additional 7% involved an uncertain tradeoff between benefits and harms. Shared decision-making (SDM) was identified as an effective technique for managing uncertainty when two or more parties were involved. In order to understand which of the elements of SDM are used most frequently and effectively, it is necessary to identify these key elements, and understand how these elements related to each other and the SDM process. The elements identified through the course of the present research were selected from basic principles of the SDM model and the “Data, Information, Knowledge, Wisdom” (DIKW) Hierarchy. The goal of this ethnographic research was to identify which common elements of shared decision-making patients are most often observed applying in the medical encounter. The results of the present study facilitated the understanding of which elements patients were more likely to exhibit during a primary care medical encounter, as well as determining variables of interest leading to more successful shared decision-making practices between patients and their physicians. Understanding Behavioral Intent to Participate in Shared Decision-Making in Medically Uncertain Situations Objective: This article describes the process undertaken to identify and validate behavioral and normative beliefs and behavioral intent of men between the ages of 45-70 with regard to participating in shared decision-making in medically uncertain situations. This article also discusses the preliminary results of the aforementioned processes and explores potential future uses of this information which may facilitate greater understanding, efficiency and effectiveness of doctor-patient consultations.Design: Qualitative Study using deductive content analysisSetting: Individual semi-structure patient interviews were conducted until data saturation was reached. Researchers read the transcripts and developed a list of codes.Subjects: 25 subjects drawn from the Philadelphia community.Measurements: Qualitative indicators were developed to measure respondents’ experiences and beliefs related to behavioral intent to participate in shared decision-making during medical uncertainty. Subjects were also asked to complete the Krantz Health Opinion Survey as a method of triangulation.Results: Several factors were repeatedly described by respondents as being essential to participate in shared decision-making in medical uncertainty. These factors included past experience with medical uncertainty, an individual’s personality, and the relationship between the patient and his physician.Conclusions: The findings of this study led to the development of a category framework that helped understand an individual’s needs and motivational factors in their intent to participate in shared decision-making. The three main categories include 1) an individual’s representation of medically uncertainty, 2) how the individual copes with medical uncertainty, and 3) the individual’s behavioral intent to seek information and participate in shared decision-making during times of medically uncertain situations.

Las elecciones en la provincia de Buenos Aires (1910-1918) y la reforma de la ley electoral de 1913

El 1º de febrero de 1912 fue promulgada la Ley Sáenz Peña que establecía, como una novedad para el sistema electoral nacional, el voto obligatorio y secreto. La provincia de Buenos Aires no adoptó tal cual dicha ley, luego de un largo debate, promulgó su propia ley electoral, que sirvió de instrumento al partido Conservador para mantenerse en el poder, hasta 1917 cuando el presidente Yrigoyen decretó la intervención federal. El objetivo del presente trabajo es ver cómo la ley bonaerense sirvió a los propósitos conservadores, y cómo, con la intervención, los radicales lograron imponerse en la provincia de Buenos Aires.

Las elecciones en la provincia de Buenos Aires (1910-1918) y la reforma de la ley electoral de 1913

El 1º de febrero de 1912 fue promulgada la Ley Sáenz Peña que establecía, como una novedad para el sistema electoral nacional, el voto obligatorio y secreto. La provincia de Buenos Aires no adoptó tal cual dicha ley, luego de un largo debate, promulgó su propia ley electoral, que sirvió de instrumento al partido Conservador para mantenerse en el poder, hasta 1917 cuando el presidente Yrigoyen decretó la intervención federal. El objetivo del presente trabajo es ver cómo la ley bonaerense sirvió a los propósitos conservadores, y cómo, con la intervención, los radicales lograron imponerse en la provincia de Buenos Aires.

Las elecciones en la provincia de Buenos Aires (1910-1918) y la reforma de la ley electoral de 1913

El 1º de febrero de 1912 fue promulgada la Ley Sáenz Peña que establecía, como una novedad para el sistema electoral nacional, el voto obligatorio y secreto. La provincia de Buenos Aires no adoptó tal cual dicha ley, luego de un largo debate, promulgó su propia ley electoral, que sirvió de instrumento al partido Conservador para mantenerse en el poder, hasta 1917 cuando el presidente Yrigoyen decretó la intervención federal. El objetivo del presente trabajo es ver cómo la ley bonaerense sirvió a los propósitos conservadores, y cómo, con la intervención, los radicales lograron imponerse en la provincia de Buenos Aires.

From authoritarianism to upheaval : the political economy of the Syrian uprising and regime persistence

The ensuing bloodshed and deteriorating humanitarian crisis in Syria, the failure of the United Nations Security Council to reach a consensus on what action to take, and the involvement of contending external actors partially reflect the complexity of the current impasse. Despite the importance of regional and international factors, however, this papers attempts to argue that the domestic dynamics of the Syrian crisis have been vitally important in determining the course of the popular uprising and the regime’s response. In this, Syria’s crisis belongs with the Arab Spring the trajectories and prospects of which have been shaped by dynamics within regimes. It will be seen that the formal and informal institutional structure of the Ba‘thist regime in Syria has been critical to its resilience and ability to stay united so far while attempting to crush a peaceful popular uprising that turned into insurgency in the face of the regime’s violent crackdown.

Examining the University of Denver's Family Friendly Benefits Plans: A look at Creating More Family Friendly Benefits to Drive Employee Retention

In the latter half of the twentieth century the workforce dynamic changed when the number of women entering the workforce increased by record amounts. In direct opposition to this change was the inability of organizations to meet the needs of employees with childcare concerns. Organizations and employees alike are best served when policies, procedures, and benefits are implemented to achieve a positive work/life balance. Companies that institute benefits that are supportive to families observe decreases in turnover and increased employee retention. Employees who are offered family friendly resources have been known to stay with companies even when offered a higher salary elsewhere. Demonstrating that retention of valued employees is linked to an organizations ability to offer support for family needs.

Letter from Samuel Willard, Cambridge, Massachusetts, to Abigail Willard, Petersham, Massachusetts, September 29, 1806

Willard discusses family issues then explains that he was preaching in Lexington for three weeks and turned down an offer to stay longer. He says that instead, he will “make Cambridge my headquarters.” Willard asks his sister to pick up his clothes for him.

Letter from Samuel Willard, Deerfield, Massachusetts, to Catherine Willard, Petersham, Massachusetts, April 16, 1807

Willard explains that the town of Deerfield has asked him to stay and preach for an extra six weeks, but he consented to stay four. He also asks his sister if she can send him some of his sermons.

Letters from Daniel Bates to William Jenks, May 1795-September 1798

Daniel Bates wrote these five letters to his friend and classmate, William Jenks, between May 1795 and September 1798. In a letter written May 12, 1795, Bates informs Jenks, who was then employed as an usher at Mr. Webb's school, of his studies of Euclid, the meeting of several undergraduate societies, and various sightings of birds, gardens and trees. In a letter written in November 1795 from Princeton, where he was apparently on vacation with the family of classmate Leonard Jarvis, he describes playing the game "break the Pope's neck" and tells Jenks what he was reading (Nicholson, Paley?, and Thompson) and what his friend's father was reading (Mirabeau and Neckar).

Flashlight Europe N°4–May 2015. Listen carefully to the British

Other than many have predicted the general election in the United Kingdom have not led to a hung parliament but the opposite: An absolute majority for David Cameron and his Tory party. Thus, the way is paved for the EU referendum. Cameron has promised to let his fellow citizens decide whether they would like to stay on in the EU or rather leave. Charles Grant, director of the Centre for European Reform, tells us what this means for the UK and its relation to Germany and the European Union.

What is happening to the Schengen borders? CEPS Liberty and Security in Europe No. 86, December 2015

What is happening to the Schengen borders? Is Schengen in ‘crisis’? This paper examines the state of play in the Schengen system in light of the developments during 2015. It critically examines the assertion that Schengen is ‘in crisis’ and seeks to set the record straight on what has been happening to the intra-Schengen border-free and common external borders system. The paper argues that Schengen is here to stay and that reports about the reintroduction of internal border checks are exaggerated as they are in full compliance with the EU rule of law model laid down in the Schengen Borders Code and subject to scrutiny by the European Commission. It also examines the legal challenges inherent to police checks within the internal border areas as having an equivalent effect to border checks as well as the newly adopted proposal for a European Border and Coast Guard system. The analysis shows that the most far-reaching challenge to the current and future configurations of EU border policies relates to ensuring that they are in full compliance with fundamental human rights obligations to refugees, effective accountability and independent monitoring of the implementation of EU legal standards. This should be accompanied by a transparent and informed discussion on which ‘Schengen’ and which 'common European Border and Coast Guard Agency' we exactly want within current democratic rule of law and fundamental rights remits.

The EU deal to avoid Brexit: Take it or leave. CEPS Special Report No. 131/February 2016

Beyond the drama of the European Council summit of 18-19 February 2016, what became clear was the fundamental desire on the part of the leaders of all 28 EU member states to agree a deal on the British government’s demands for a renegotiated settlement on the UK’s relationship within the European Union. The deal has provided David Cameron with the political capital he needed to call a date for the in/out referendum and to lead a campaign for the UK to stay in the EU. Yet, for all the technical reforms packed into it, the deal is neither a crowd pleaser nor a vote winner. It does, however, mark a watershed acknowledgement that EU integration is not a one-directional process of ‘ever closer union’. In this CEPS Special Report, Stefani Weiss and Steven Blockmans analyse the substance of the “Decision of the Heads of State or Government, meeting within the European Council, concerning a New Settlement for the United Kingdom within the European Union” and shed light on its legal character. They contextualise this EU deal to avoid Brexit, and draw on the conclusions reached in a simulation of European Council negotiations between representatives of think tanks in the European Policy Institutes Network (EPIN), conducted by CEPS and the Bertelsmann Stiftung in October 2015.