Outcomes of patients on dual-boosted PI regimens: experience of the Swiss HIV cohort study

Dual-boosted protease inhibitors (DBPI) are an option for salvage therapy for HIV-1 resistant patients. Patients receiving a DBPI in the Swiss HIV Cohort Study between January1996 and March 2007 were studied. Outcomes of interest were viral suppression at 24 weeks. 295 patients (72.5%) were on DBPI for over 6 months. The median duration was 2.2 years. Of 287 patients who had HIV-RNA >400?copies/ml at the start of the regimen, 184 (64.1%) were ever suppressed while on DBPI and 156 (54.4%) were suppressed within 24 weeks. The median time to suppression was 101 days (95% confidence interval 90-125 days). The median number of past regimens was 6 (IQR, 3-8). The main reasons for discontinuing the regimen were patient's wish (48.3%), treatment failure (22.5%), and toxicity (15.8%). Acquisition of HIV through intravenous drug use and the use of lopinavir in combination with saquinavir or atazanavir were associated with an increased likelihood of suppression within 6 months. Patients on DBPI are heavily treatment experienced. Viral suppression within 6 months was achieved in more than half of the patients. There may be a place for DBPI regimens in settings where more expensive alternates are not available.

Mycobacterium microti infection in the cat: a case report, literature review and recent clinical experience

OVERVIEW: Mycobacterium microti infection is infrequently described in cats in the veterinary literature. It can be one of a large number of possible differential diagnoses in a feline patient with dermal nodules and non-healing draining ulcers, and can occasionally spread to involve the lungs and/or other areas of the body. CASE SUMMARY: This report describes the clinical signs, eventual diagnosis and variable response to treatment in a cat in Switzerland with recurrent cutaneous M microti infection. Only after several diagnostic and therapeutic attempts, over more than 2 years, was the species of Mycobacterium finally identified and targeted therapy given. PRACTICAL RELEVANCE: For any cat in which there is even a low suspicion of mycobacterial infection, the authors recommend that an aggressive diagnostic approach is taken. Tissue specimens should be collected and frozen early on, and, as soon as acid-fast bacilli are detected, samples should be sent to a mycobacterial reference laboratory for definitive identification. LITERATURE REVIEW: A review of the literature relating to the aetiopathogenesis, diagnosis and management of M microti infection in cats and dogs is included. This is supplemented with clinical and therapeutic experience gained from this case and other, unpublished cases managed over the past 15 years by one of the authors (DGM).

Why Death Matters: Understanding Gameworld Experience

This article presents a study of the staging and implementation of death and the death penalty in a number of popular MMOGs and relates it to players general experience of gameworlds. Game mechanics, writings and stories by designers and players, and the results of an online survey are analysed and discussed. The study shows that the death penalty is implemented much in the same way across worlds; that death can be both trivial and non-trivial, part of the grind of everyday life, or essential in the creation of heroes, depending on context. In whatever function death may serves, it is argued that death plays an important part in the shaping and emergence of the social culture of a world, and in the individual players experience of life within it.

Neoliberalism, the Third Way and Social Work: the UK experience

For most of the past two decades, the notion that there is no alternative to the market as a basis for organising society has constituted a kind of global 'common sense', accepted not only by the neo-liberal Right but also by social democratic thinkers and politicians, in the form of 'the Third Way'. This paper will critically assess the central claims of neoliberalism in the light of experience in the UK and internationally, evaluate the ways in which Third Way policies are shaping social work in the UK, and in the final section, begin to explore some of the ways in which the anti-capitalist movement which has emerged in recent years might contribute to the development of a new, engaged social work, based on social justice.

Constructing a user experience user experience-based mobile learning environment

Mobile learning, in the past defined as learning with mobile devices, now refers to any type of learning-on-the-go or learning that takes advantage of mobile technologies. This new definition shifted its focus from the mobility of technology to the mobility of the learner (O'Malley and Stanton 2002; Sharples, Arnedillo-Sanchez et al. 2009). Placing emphasis on the mobile learner’s perspective requires studying “how the mobility of learners augmented by personal and public technology can contribute to the process of gaining new knowledge, skills, and experience” (Sharples, Arnedillo-Sanchez et al. 2009). The demands of an increasingly knowledge based society and the advances in mobile phone technology are combining to spur the growth of mobile learning. Around the world, mobile learning is predicted to be the future of online learning, and is slowly entering the mainstream education. However, for mobile learning to attain its full potential, it is essential to develop more advanced technologies that are tailored to the needs of this new learning environment. A research field that allows putting the development of such technologies onto a solid basis is user experience design, which addresses how to improve usability and therefore user acceptance of a system. Although there is no consensus definition of user experience, simply stated it focuses on how a person feels about using a product, system or service. It is generally agreed that user experience adds subjective attributes and social aspects to a space that has previously concerned itself mainly with ease-of-use. In addition, it can include users’ perceptions of usability and system efficiency. Recent advances in mobile and ubiquitous computing technologies further underline the importance of human-computer interaction and user experience (feelings, motivations, and values) with a system. Today, there are plenty of reports on the limitations of mobile technologies for learning (e.g., small screen size, slow connection), but there is a lack of research on user experience with mobile technologies. This dissertation will fill in this gap by a new approach in building a user experience-based mobile learning environment. The optimized user experience we suggest integrates three priorities, namely a) content, by improving the quality of delivered learning materials, b) the teaching and learning process, by enabling live and synchronous learning, and c) the learners themselves, by enabling a timely detection of their emotional state during mobile learning. In detail, the contributions of this thesis are as follows: • A video codec optimized for screencast videos which achieves an unprecedented compression rate while maintaining a very high video quality, and a novel UI layout for video lectures, which together enable truly mobile access to live lectures. • A new approach in HTTP-based multimedia delivery that exploits the characteristics of live lectures in a mobile context and enables a significantly improved user experience for mobile live lectures. • A non-invasive affective learning model based on multi-modal emotion detection with very high recognition rates, which enables real-time emotion detection and subsequent adaption of the learning environment on mobile devices. The technology resulting from the research presented in this thesis is in daily use at the School of Continuing Education of Shanghai Jiaotong University (SOCE), a blended-learning institution with 35.000 students.

Family Preservation and Support: Past, Present, and Future

As the family preservation and support movement evolves rapidly, this article overviews the past, present and future of this approach to policy and services. Building upon several decades of practice experience and research, and now federally funded, program designers are searching for ways to implement system wide change with an array of services all from a family focus, and strengths perspective. Critical issues facing the movement are discussed and a set of benchmarks to judge our future success is presented.

An Unscathed Past in the Face of Death: Mortality Salience Reduces Individuals’ Regrets

Folk wisdom and popular literature hold that, in the face of death, individuals tend to regret things in their lives that they have done or failed to do. Terror Management Theory (TMT), in contrast, allows for the prediction that individuals who are confronted with death try to minimize the experience of regret in order to retain a positive self-esteem. Three experiments put these competing perspectives to test. Drawing on TMT, we hypothesized and found that participants primed with their own death regret fewer things than control-group participants. This pattern of results cannot be attributed to differing types of regrets (Study 1). Furthermore, we provide evidence suggesting that the effect is not purely a product of cognitive mechanisms such as differing levels of construal (Study 2), cognitive contrast, or deficits (Study 3). Rather, the reported results are best explained in terms of a motivational coping mechanism: When death is salient, individuals strive to bolster as well as protect their self-esteem and accordingly try to minimize the experience of regret. The results add to our conceptual understanding of regret and TMT, and suggest that a multitude of lifestyle guidebooks need updating.

Fetal megacystis: experience of a single tertiary center in Switzerland over 20 years

OBJECTIVES Megacystis (MC) is rare and often associated with other structural and chromosomal anomalies. In euploid cases with early oligohydramnios, prognosis is poor mainly due to pulmonary hypoplasia and renal damage. We report our experience of the past 20 years. METHODS A retrospective review of cases with prenatally diagnosed MC was performed. Complete prenatal as well as postnatal medical records from 1989 to 2009 were reviewed focusing on diagnostic precision, fetal interventions [vesicocentesis (VC), vesicoamniotic shunt (VAS)], short- and long-term outcome, and potential prognostic factors. RESULTS 68 cases were included. Follow-up was available in 54 cases (9 girls and 45 boys including 3 cases with aneuploidy). We found 39 isolated MC at sonography (5 girls and 34 boys). 24 fetuses with isolated MC underwent VC and VAS at 19.6 ± 6.3 and 20 ± 4.9 weeks of gestation, respectively. Survival rate was higher in male than in female fetuses (51 vs. 33%). Renal problems occurred in 4/14 prenatally treated fetuses and in 1/10 when cases with prune belly syndrome (PBS) were excluded from the analysis. CONCLUSIONS Our study shows that a careful selection of cases with MC excluding fetuses with PBS and early treatment has still the potential to improve outcome.

Is family medicine meeting the HIV/AIDS challenge? A national survey of family physicians' beliefs, clinical competence, and experience regarding HIV disease

A national sample of family physicians was surveyed to (1) assess family physicians' beliefs about the human immunodeficiency virus (HIV) and individuals at risk for infection, their clinical competence regarding HIV-related issues, and their experiences with HIV disease; (2) present conclusions to the American Academy of Family Physicians (AAFP) to effect the development of an early clinical care protocol and a continuing medical education curriculum; and (3) collect base-line data for use in the evaluation of an early clinical care protocol and a continuing medical education curriculum, in the case that such programs are developed and disseminated. After considering retired or deceased respondents, of the 2,660 physicians surveyed, 1,678 (63.7%) responded. The resulting sample was representative of the active members of the AAFP. About 77% of the respondents were unable to accurately identify the universal precautions for blood and body fluids to prevent occupational transmission of HIV or hepatitis B virus (HBV). Residency trained and board certified physicians expressed fewer "external constraints," such as fear of losing patients, obviating them from providing treatment to individuals with HIV disease (p =.004 and p $<$.001, respectively). These physicians also manifested fewer "internal constraints" to the provision of HIV treatment, such as fear of becoming infected (p $<$.001 and p =.012, respectively). Residency trained physicians also expressed a greater comfort with discussing sexually-related topics with their patients than did non-residency trained physicians (p $<$.001). There were 67.1% of the physicians surveyed who reported never providing treatment to an individual with HIV disease. Residency trained and board certified physicians expressed a greater likelihood to provide treatment to HIV-infected patients (p $<$.001) than non-residency trained and non-board certified physicians.^ Among the various primary care specialties, family medicine is especially vulnerable to the current challenges of HIV/AIDS. These challenges are augmented by the epidemiologic pattern that characterizes AIDS. For the past several years, we have seen AIDS in this country assume a similar pattern to that seen in most other countries; HIV is becoming increasingly prevalent in the heterosexual population as well as in locations removed from metropolitan centers. This current phase of the epidemic generates greater pressures upon primary care physicians, particularly family physicians, to become better acquainted with the means to provide early care to HIV/AIDS patients and to prevent HIV/AIDS among their patients. Family medicine is especially appropriate for providing care to HIV patients because family medicine involves treatment to all age groups and conditions; other primary care specialties focus on limited patient populations or specific conditions. Family physicians should be armed with the expertise to confront HIV/AIDS. However, family physicians' clinical competence and experience with HIV is not known. The data collected in this survey describes their competencies, attitudes, and experiences. ^

How Blended Learning Reduce Underachievement in Higher Education: An Experience in Teaching Computer Sciences.

This paper presents a blended learning approach and a study evaluating instruction in a software engineering-related course unit as part of an undergraduate engineering degree program in computing. In the past, the course unit had a lecture-based format. In view of student underachievement and the high course unit dropout rate, a distance-learning system was deployed, where students were allowed to choose between a distance-learning approach driven by a moderate constructivist instructional model or a blended-learning approach. The results of this experience are presented, with the aim of showing the effectiveness of the teaching/learning system deployed compared to the lecture-based system previously in place. The grades earned by students under the new system, following the distance-learning and blended-learning courses, are compared statistically to the grades attained in earlier years in the traditional face-to-face classroom (lecture-based) learning.

Spaces of the Past, Histories of the Present: An Interview with Stuart Elden and Derek Gregory

The ontologies of space and territory, our experience of them and the techniques we use to govern them, the very conception of the socio-spatial formations that we inhabit, are all historically specific: they depend on a genealogy of practices, knowledges, discourses, regulations, performances and representations articulated in a way that is extremely complex yet nevertheless legible over time. In this interview we look at the logic and the patterns that intertwine space and time — both as objects and tools of inquiry — though a cross-disciplinary dialogue. The discussion with Stuart Elden and Derek Gregory covers the place of history in socio-spatial theory and in their own work, old and new ways of thinking about the intersection between history and territory, space and time, the implications of geography and history for thinking about contemporary politics, and the challenges now faced by critical thought and academic work in the current neo-liberal attack on public universities and the welfare state

Theory for normal and impaired experience-dependent plasticity in neocortex of adult rats

We model experience-dependent plasticity in the cortical representation of whiskers (the barrel cortex) in normal adult rats, and in adult rats that were prenatally exposed to alcohol. Prenatal exposure to alcohol (PAE) caused marked deficits in experience-dependent plasticity in a cortical barrel-column. Cortical plasticity was induced by trimming all whiskers on one side of the face except two. This manipulation produces high activity from the intact whiskers that contrasts with low activity from the cut whiskers while avoiding any nerve damage. By a computational model, we show that the evolution of neuronal responses in a single barrel-column after this sensory bias is consistent with the synaptic modifications that follow the rules of the Bienenstock, Cooper, and Munro (BCM) theory. The BCM theory postulates that a neuron possesses a moving synaptic modification threshold, θM, that dictates whether the neuron's activity at any given instant will lead to strengthening or weakening of its input synapses. The current value of θM changes proportionally to the square of the neuron's activity averaged over some recent past. In the model of alcohol impaired cortex, the effective θM has been set to a level unattainable by the depressed levels of cortical activity leading to “impaired” synaptic plasticity that is consistent with experimental findings. Based on experimental and computational results, we discuss how elevated θM may be related to (i) reduced levels of neurotransmitters modulating plasticity, (ii) abnormally low expression of N-methyl-d-aspartate receptors (NMDARs), and (iii) the membrane translocation of Ca2+/calmodulin-dependent protein kinase II (CaMKII) in adult rat cortex subjected to prenatal alcohol exposure.

The Jewish Law Firm: Past and Present

The rise and growth of large Jewish law firms in New York City during the second half of the twentieth century was nothing short of an astounding success story. As late as 1950, there was not a single large Jewish law firm in town. By the mid-1960s, six of the largest twenty law firms were Jewish, and by 1980, four of the largest ten prestigious law firms were Jewish firms. Moreover, the accomplishment of the Jewish firms is especially striking because, while the traditional large White Anglo-Saxon Protestant law firms grew at a fast rate during this period, the Jewish firms grew twice as fast, and they did so in spite of experiencing explicit discrimination. What happened? This book chapter is a revised, updated study of the rise and growth of large New York City Jewish law firms. It is based on the public record, with respect to both the law firms themselves and trends in the legal profession generally, and on over twenty in-depth interviews with lawyers who either founded and practiced at these successful Jewish firms, attempted and failed to establish such firms, or were in a position to join these firms but decided instead to join WASP firms. According to the informants interviewed in this chapter, while Jewish law firms benefited from general decline in anti-Semitism and increased demand for corporate legal services, a unique combination of factors explains the incredible rise of the Jewish firms. First, white-shoe ethos caused large WASP firms to stay out of undignified practice areas and effectively created pockets of Jewish practice areas, where the Jewish firms encountered little competition for their services. Second, hiring and promotion discriminatory practices by the large WASP firms helped create a large pool of talented Jewish lawyers from which the Jewish firms could easily recruit. Finally, the Jewish firms benefited from a flip side of bias phenomenon, that is, they benefited from the positive consequences of stereotyping. Paradoxically, the very success of the Jewish firms is reflected in their demise by the early twenty-first century: because systematic large law firm ethno-religious discrimination against Jewish lawyers has become a thing of the past, the very reason for the existence of Jewish law firms has been nullified. As other minority groups, however, continue to struggle for equality within the senior ranks of Big Law, can the experience of the Jewish firms serve as a “separate-but-equal” blueprint for overcoming contemporary forms of discrimination for women, racial, and other minority attorneys? Perhaps not. As this chapter establishes, the success of large Jewish law firms was the result of unique conditions and circumstances between 1945 and 1980, which are unlikely to be replicated. For example, large law firms have become hyper-competitive and are not likely to allow any newcomers the benefit of protected pockets of practice. While smaller “separate-but-equal” specialized firms, for instance, ones exclusively hiring lawyer-mothers occasionally appear, the rise of large “separate-but-equal” firms is improbable.

Janet Sobel : expressions of experience

Historians have yet to realize the depth of artist Janet Sobel’s artistic aptitude and ingenuity. This paper focuses on understanding how unique Sobel and her art were due to her distinctive world experiences and her ability to express her feelings about these experiences through her art. It also demonstrates the importance of her Jewish and Ukrainian heritage, showing how this influenced her artistic development. Sobel immigrated to the United States at a young age and struggled with her identity. Her art was a way for her to define and accept her personal identity as an immigrant Eastern European Jew in America. In addition to this heritage, Sobel experienced many traumatic events in her early life. Her art therefore served as a way for Sobel to work through this past trauma and come to terms with it.