Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality

OBJECTIVE: To determine the effect of nonadherence to antiretroviral therapy (ART) on virologic failure and mortality in naive individuals starting ART. DESIGN: Prospective observational cohort study. METHODS: Eligible individuals enrolled in the Swiss HIV Cohort Study, started ART between 2003 and 2012, and provided adherence data on at least one biannual clinical visit. Adherence was defined as missed doses (none, one, two, or more than two) and percentage adherence (>95, 90-95, and <90) in the previous 4 weeks. Inverse probability weighting of marginal structural models was used to estimate the effect of nonadherence on viral failure (HIV-1 viral load >500 copies/ml) and mortality. RESULTS: Of 3150 individuals followed for a median 4.7 years, 480 (15.2%) experienced viral failure and 104 (3.3%) died, 1155 (36.6%) reported missing one dose, 414 (13.1%) two doses and, 333 (10.6%) more than two doses of ART. The risk of viral failure increased with each missed dose (one dose: hazard ratio [HR] 1.15, 95% confidence interval 0.79-1.67; two doses: 2.15, 1.31-3.53; more than two doses: 5.21, 2.96-9.18). The risk of death increased with more than two missed doses (HR 4.87, 2.21-10.73). Missing one to two doses of ART increased the risk of viral failure in those starting once-daily (HR 1.67, 1.11-2.50) compared with those starting twice-daily regimens (HR 0.99, 0.64-1.54, interaction P = 0.09). Consistent results were found for percentage adherence. CONCLUSION: Self-report of two or more missed doses of ART is associated with an increased risk of both viral failure and death. A simple adherence question helps identify patients at risk for negative clinical outcomes and offers opportunities for intervention.

Transcending the self in immersive virtual reality

Cognitive neuroscientists have discovered various experimental setups that suggest that our body representation is surprisingly flexible, where the brain can easily be tricked into the illusion that a rubber hand is your hand or that a manikin body is your body. These multisensory illusions work well in immersive virtual reality (IVR). What is even more surprising is that such embodiment induces perceptual, attitudinal and behavioural changes that are concomitant with the displayed body type. Here we outline some recent findings in this field, and suggest that this offers a powerful tool for neuroscience, psychology and a new path for IVR.

Effect of long-range Coulomb interaction on shot-noise suppression in ballistic transport

We present a microscopic analysis of shot-noise suppression due to long-range Coulomb interaction in semiconductor devices under ballistic transport conditions. An ensemble Monte Carlo simulator self-consistently coupled with a Poisson solver is used for the calculations. A wide range of injection-rate densities leading to different degrees of suppression is investigated. A sharp tendency of noise suppression at increasing injection densities is found to scale with a dimensionless Debye length related to the importance of space-charge effects in the structure.

Non-thermal emission from microquasar/ISM interaction

Context. The interaction of microquasar jets with their environment can produce non-thermal radiation as in the case of extragalactic outflows impacting on their surroundings. Significant observational evidence of jet/medium interaction in galactic microquasars has been collected in the past few years, although little theoretical work has been done regarding the resulting non-thermal emission. Aims. In this work, we investigate the non-thermal emission produced in the interaction between microquasar jets and their environment, and the physical conditions for its production. Methods. We developed an analytical model based on those successfully applied to extragalactic sources. The jet is taken to be a supersonic and mildly relativistic hydrodynamical outflow. We focus on the jet/shocked medium structure in its adiabatic phase, and assume that it grows in a self-similar way. We calculate the fluxes and spectra of the radiation produced via synchrotron, inverse Compton, and relativistic bremsstrahlung processes by electrons accelerated in strong shocks. A hydrodynamical simulation is also performed to investigate further the jet interaction with the environment and check the physical parameters used in the analytical model. Results. For reasonable values of the magnetic field, and using typical values of the external matter density, the non-thermal particles could produce significant amounts of radiation at different wavelengths, although they do not cool primarily radiatively, but by adiabatic losses. The physical conditions of the analytical jet/medium interaction model are consistent with those found in the hydrodynamical simulation. Conclusions. Microquasar jet termination regions could be detectable at radio wavelengths for current instruments sensitive to ~arcminute scales. At X-ray energies, the expected luminosities are moderate, although the emitter is more compact than the radio one. The source may be detectable by XMM-Newton or Chandra, with 1-10 arcsec of angular resolution. The radiation at gamma-ray energies may be within the detection limits of the next generation of satellite and ground-based instruments.

Self-assembly of supermolecular species directed by hydrogen bonding and aromatic π-π stacking interactions

A new Cu(II) trimers, [Cu3(dcp)2(H2O)8]. 4DMF, with the ligand 3,5-pyrazoledicarboxylic acid monohydrate (H3dcp) has been prepared by solvent method. Its solid-state structure has been characterized by elemental analysis, thermal analysis (TGA and DSC), and single crystal X-ray diffraction. X-ray crystallographic studies reveal that this complex has extended 1-D,2-D and 3-D supramolecular architectures directed by weak interactions (hydrogen bond and aromatic π-π stacking interaction) leading to a sandwich solid-state structure.

Intercultural bridges in teenagers' theatrical events : performing self and constructing cultural identity through a creative drama process

The overriding aim of this drama educational case study is to deepen the understanding of meaning making in a creative intercultural youth theatre process and to examine it in the context of the 10th European Children's TheatreEncounter. The research task is to give a theoretical description of some key features of a creative drama process as the basis for theory about meaning makingin physical theatre. The first task is to illuminate the culture-historical connections of the multilayered practice of the EDERED-association. The second taskis to analyse and interpret theatrical meaning making. The ethnographical research site is regarded as a theatrical event. The analysis of the theatrical eventis divided into four segments: cultural contexts, contextual theatricality, theatrical playing and playing culture. These segments are connected with four research questions: What are the cultural contexts of a creative drama process? How can the organisation of the Encounter, genres, aesthetic codes and perception ofcodes be seen to influence the lived experiences of the participants? What are some of the key phases and characteristics in a creative practice? What kind of cultural learning can be interpreted from the performance texts? The interpretative question concerns identity and community (re)construction. How are the categories, `community´ and `child´ constructed in the Encounter culture? In this drama educational case study the research material (transcribed interviews, coded questionnaire answers, participant drawings, videotaped process text and performance texts) are examined in a multi-method analysis in the meta-theoretical framework of Dewey's naturalistic pragmatism. A three-dimensional research interest through a combination of lived experiences, social contexts and cultural-aesthetical practices compared with drama-educational practices required the methodological project of cultural studies. Furthermore, the critical interpretation of cultural texts is divided into three levels of analyses which are called description, structural analysis and theoretical interpretation. Dialogic validity (truthfulness, self-reflexivity and polyvocality) is combined with contextual validity (sensitivity to social context and awareness of historicity) and with deconstructive validity (awareness of the social discourses). My research suggests that itis possible, by means of physical theatre, to construct symbolic worlds where questions about intercultural identity and multilingual community are examined and where provisional answers are constructed in social interaction.

Plant-Herbivore Interaction in a Fragmented Landscape: Local Adaptation and Inbreeding

Reciprocal selection between interacting species is a major driver of biodiversity at both the genetic and the species level. This reciprocal selection, or coevolution, has led to the diversification of two highly diverse and abundant groups of organisms, flowering plants and their insect herbivores. In heterogeneous environments, the outcome of coevolved species interactions is influenced by the surrounding community and/or the abiotic environment. The process of adaptation allows species to adapt to their local conditions and to local populations of interacting species. However, adaptation can be disrupted or slowed down by an absence of genetic variation or by increased inbreeding, together with the following inbreeding depression, both of which are common in small and isolated populations that occur in fragmented environments. I studied the interaction between a long-lived plant Vincetoxicum hirundinaria and its specialist herbivore Abrostola asclepiadis in the southwestern archipelago of Finland. I focused on mutual local adaptation of plants and herbivores, which is a demonstration of reciprocal selection between species, a prerequisite for coevolution. I then proceeded to investigate the processes that could potentially hamper local adaptation, or species interaction in general, when the population size is small. I did this by examining how inbreeding of both plants and herbivores affects traits that are important for interaction, as well as among-population variation in the effects of inbreeding. In addition to bi-parental inbreeding, in plants inbreeding can arise from self-fertilization which has important implications for mating system evolution. I found that local adaptation of the plant to its herbivores varied among populations. Local adaptation of the herbivore varied among populations and years, being weaker in populations that were most connected. Inbreeding caused inbreeding depression in both plants and herbivores. In some populations inbreeding depression in herbivore biomass was stronger in herbivores feeding on inbred plants than in those feeding on outbred ones. For plants it was the other way around: inbreeding depression in anti-herbivore resistance decreased when the herbivores were inbred. Underlying some of the among-population variation in the effects of inbreeding is variation in plant phenolic compounds. However, variation in the modification of phenolic compounds in the digestive tract of the herbivore did not explain the inbreeding depression in herbivore biomass. Finally, adult herbivores had a preference for outbred host plants for egg deposition, and herbivore inbreeding had a positive effect on egg survival when the eggs were exposed to predators and parasitoids. These results suggest that plants and herbivores indeed exert reciprocal selection, as demonstrated by the significant local adaptation of V. hirundinaria and A. asclepiadis to one another. The most significant cause of disruption of the local adaptation of herbivore populations was population connectivity, and thus probably gene flow. In plants local adaptation tended to increase with increasing genetic variation. Whether or not inbreeding depression occurred varied according to the life-history stage of the herbivore and/or the plant trait in question. In addition, the effects of inbreeding strongly depended on the population. Taken together, inbreeding modified plant-herbivore interactions at several different levels, and can thus affect the strength of reciprocal selection between species. Thus inbreeding has the potential to affect the outcome of coevolution.

Estrogen receptor 1 gene polymorphisms in premenopausal women: interaction between genotype and smoking on lipid levels

Estrogen has multiple effects on lipid and lipoprotein metabolism. We investigated the association between the four common single nucleotide polymorphisms in the estrogen receptor 1 (ESR1) gene locus, -1989T>G, +261G>C, IVS1-397T>C and IVS1-351A>G, and lipid and lipoprotein levels in southern Brazilians. The sample consisted in 150 men and 187 premenopausal women. The women were considered premenopausal if they had regular menstrual bleeding within the previous 3 months and were 18-50 years of age. Exclusion criteria were pregnancy, secondary hyperlipidemia due to renal, hepatic or thyroid disease, and diabetes. Smoking status was self-reported; subjects were classified as never smoked and current smokers. DNA was amplified by PCR and was subsequently digested with the appropriate restriction enzymes. Statistical analysis was carried out for men and women separately. In the study population, major allele frequencies were _1989*T (0.83), +261*G (0.96), IVS1-397*T (0.58), and IVS1-351*A (0.65). Multiple linear regression analyses indicated that an interaction between +261G>C polymorphism and smoking was a significant factor affecting high-density lipoprotein cholesterol (HDL-C) levels (P = 0.028) in women. Nonsmoking women with genotype G/C of +261G>C polymorphism had mean HDL-C levels higher than those with G/G genotype (1.40 ± 0.33 vs 1.22 ± 0.26 mmol/L; P = 0.033). No significant associations with lipid and lipoprotein levels in women and men were detected for other polymorphisms. In conclusion, the +261G>C polymorphism might influence lipoprotein and lipid levels in premenopausal women, but these effects seem to be modulated by smoking, whereas in men ESR1 polymorphisms were not associated with high lipoprotein levels.

Designing new learning experiences? : exploring corporate E-learners’ self-regulated learning

The context of this study is corporate e-learning, with an explicit focus on how digital learning design can facilitate self-regulated learning (SRL). The field of e-learning is growing rapidly. An increasing number of corporations use digital technology and elearning for training their work force and customers. E-learning may offer economic benefits, as well as opportunities for interaction and communication that traditional teaching cannot provide. However, the evolving variety of digital learning contexts makes new demands on learners, requiring them to develop strategies to adapt and cope with novel learning tools. This study derives from the need to learn more about learning experiences in digital contexts in order to be able to design these properly for learning. The research question targets how the design of an e-learning course influences participants’ self-regulated learning actions and intentions. SRL involves learners’ ability to exercise agency in their learning. Micro-level SRL processes were targeted by exploring behaviour, cognition, and affect/motivation in relation to the design of the digital context. Two iterations of an e-learning course were tested on two groups of participants (N=17). However, the exploration of SRL extends beyond the educational design research perspective of comparing the effects of the changes to the course designs. The study was conducted in a laboratory with each participant individually. Multiple types of data were collected. However, the results presented in this thesis are based on screen observations (including eye tracking) and video-stimulated recall interviews. These data were integrated in order to achieve a broad perspective on SRL. The most essential change evident in the second course iteration was the addition of feedback during practice and the final test. Without feedback on actions there was an observable difference between those who were instruction-directed and those who were self-directed in manipulating the context and, thus, persisted whenever faced with problems. In the second course iteration, including the feedback, this kind of difference was not found. Feedback provided the tipping point for participants to regulate their learning by identifying their knowledge gaps and to explore the learning context in a targeted manner. Furthermore, the course content was consistently seen from a pragmatic perspective, which influenced the participants’ choice of actions, showing that real life relevance is an important need of corporate learners. This also relates to assessment and the consideration of its purpose in relation to participants’ work situation. The rigidity of the multiple choice questions, focusing on the memorisation of details, influenced the participants to adapt to an approach for surface learning. It also caused frustration in cases where the participants’ epistemic beliefs were incompatible with this kind of assessment style. Triggers of positive and negative emotions could be categorized into four levels: personal factors, instructional design of content, interface design of context, and technical solution. In summary, the key design choices for creating a positive learning experience involve feedback, flexibility, functionality, fun, and freedom. The design of the context impacts regulation of behaviour, cognition, as well as affect and motivation. The learners’ awareness of these areas of regulation in relation to learning in a specific context is their ability for design-based epistemic metareflection. I describe this metareflection as knowing how to manipulate the context behaviourally for maximum learning, being metacognitively aware of one’s learning process, and being aware of how emotions can be regulated to maintain volitional control of the learning situation. Attention needs to be paid to how the design of a digital learning context supports learners’ metareflective development as digital learners. Every digital context has its own affordances and constraints, which influence the possibilities for micro-level SRL processes. Empowering learners in developing their ability for design-based epistemic metareflection is, therefore, essential for building their digital literacy in relation to these affordances and constraints. It was evident that the implementation of e-learning in the workplace is not unproblematic and needs new ways of thinking about learning and how we create learning spaces. Digital contexts bring a new culture of learning that demands attitude change in how we value knowledge, measure it, define who owns it, and who creates it. Based on the results, I argue that digital solutions for corporate learning ought to be built as an integrated system that facilitates socio-cultural connectivism within the corporation. The focus needs to shift from designing static e-learning material to managing networks of social meaning negotiation as part of a holistic corporate learning ecology.

Psychopathy and self-monitoring : additive and interactive effects on self-presentation tactics /

The purpose of this study was to determine the relative contributions of psychopathy and self-monitoring to the prediction of self-presentation tactics (behaviours that individuals use to manipulate their self-image). Psychopathy is composed of two main factors: Factor 1, which includes manipulativeness and shallow affect, and Factor 2, which includes irresponsibility and anti-social behaviours. Self-monitoring is a personality trait that distinguishes between those who adapt their behaviour to fit different social situations (high self-monitors) and those who behave as they feel regardless of social expectations (low selfmonitors). It was hypothesized that self-monitoring would moderate the relationship between psychopathy and self-presentation tactics. One hundred and forty-nine university students completed the Self-Monitoring Scale (Snyder, 1974), the Self-Report Psychopathy Scale - Version III (Paulhus et aI., in press), the Self-Presentation Tactics scale (Lee, S., et aI., 1999), the HEXACO-PI (a measure ofthe six major factors of personality; Lee, K., & Ashton, 2004), and six scenarios that were created as a supplementary measure of the selfpresentation tactics. Results of the hierarchical multiple regression analyses showed that self-monitoring did moderate the relationship between psychopathy and three of the selfpresentation tactics: apologies, disclaimers, and exemplification. Further, significant interactions were observed between Factor 1 and self-monitoring on apologies and the defensive tactics subscale, between Factor 2 and self-monitoring on self-handicapping, and between Factor 1 and Factor 2 on exemplification. Contrary to expectations, the main effect of self-monitoring was significant for the prediction of nine tactics, while psychopathy was significant for the prediction of seven tactics. This indicates that the role of these two personality traits in the explanation of self-presentation tactics tends to be additive in nature rather than interactive. In addition. Factor 2 alone did not account for a significant amount of variance in any of the tactics, while Factor 1 significantly predicted nine tactics. Results are discussed with regard to implications and possible directions for future research.

The effectiveness of a health versus appearance message on pregnant women's intentions to exercise postpartum : the moderating role of self-monitoring

Despite the confimied health benefits of exercise during the postpartum period, many new mothers are not sufficiently active. The present research aimed to examine the effectiveness of 2 types of messages on intention to exercise after giving birth on 2 groups of pregnant women (low and high self-monitors) using the Theory of Planned Behavior as a theoretical basis. Participants were 2 1 8 pregnant women 1 8 years of age and older (Mean age = 27.9 years, SD = 5.47), and in their second or third trimester. Women completed a demographics questionnaire, a self-monitoring (SM) scale and the Godin Leisure Time Exercise Questionnaire for current and pre-pregnancy exercise levels. They then read one of two brochures, describing either the health or appearance benefits of exercise for postpartum women. Women's attitudes, social norms, perceived behavioral control, and intentions to exercise postpartum were then assessed to determine whether one type of message (health or appearance) was more effective for each group. A MANOVA found no significant effect (p>0.05) for message type, SM, or their interaction. Possible reasons include the fact that the two messages may have been too similar, reading any message about exercise may result in intentions to exercise, or lack of attention given to the brochure. Given the lack of research in this area, more studies are necessary to confirm the present results. Two additional exploratory analyses were conducted. Pearson correlations found higher levels of pre-pregnancy exercise and current exercise to be associated with more positive attitudes, more positive subjective norms, higher perceived behavioral control, and higher intention to exercise postpartum. A hierarchical regression was conducted to determine the predictive utility of attitudes, subjective norms, and perceived behavioral control on intention for each self-monitoring group. Results of the analysis demonstrated the three independent variables significantly predicted intention (p < .001) in both groups, accounting for 58-62% of the variance in intention. For low self-monitors, attitude was the strongest predictor of intention, followed by perceived behavioral control and subjective norm. For high self-monitors, perceived behavioral control was the strongest predictors, followed by attitudes and subjective norm. The present study has practical and real world implications by contributing to our understanding of what types of messages, in a brochure format, are most effective in changing pregnant women's attitudes, subjective norm, perceived behavioral control and intention to exercise postpartum and provides ftirther support for the use of the Theory of Planned Behavior with this population.

Aerobic exercise in adolescence : self-efficacy and stage of change

The purpose of this cross-sectional exploratory study was to examine the relationships among self-efficacy, stage of change, and exercise behaviour in a sample of younger (Grade 9) and older (Grade 12) adolescents. A secondary objective of this study was to apply the transtheoretical model of Stage of Change, as a measure of intention to change, in order to discover the applicability of the model to an adolescent cohort in relation to exercise behaviour. This five-stage model is a self-report measure of an individual's readiness to adopt a new behaviour (e.g., regular exercise). The transtheoretical model incorporates Bandura's self-efficacy factor, which is purported to be a predictive measure of exercise behaviour and a covariant of stage. Exercise behaviour was measured with the Physical Activity Scale, and the University of Rhode Island Change Assessment Scale (URleA) was used to measure the stage of change and self-efficacy variables. The results of this study indicated significant differences between younger and older adolescents, and between males and females in their exercise behaviour. No significant differences were found for grade and gender on stage of change as measured by either a single-item question or a continuous measure of stage. Although grade and gender subgroups were not significantly different in their self-efficacy, significant interaction was found in the grade*gender variable.

A speculative systems model of the dynamic interaction among students, faculty and administration in the community college, with particular reference to intrinsic motivation and the teacher-administrator interface

The challenge the community college faces in helping meet the needs of the living open system of society is examined in this study. It is postulated that internalization student outcomes are required by society to reduce entropy and remain self-renewing. Such behavior is characterized as having an intrinsically motivated energy source and displays the seeking and conquering of challenge, the development of reflective knowledge and skill, full use of all capabilities, internal control, growth orientation, high self-esteem, relativistic thinking and competence. The development of a conceptual systems model that suggests how transactions among students, faculty and administration might occur to best meet the needs of internalization outcomes in students, and intrinsic motivation in faculty is a major purpose of this study. It is a speculative model that is based on a synthesis of a wide variety of variables. Empirical evidence, theoretical considerations, and speculative ideas are gathered together from researchers and theoretici.ans who are working on separate answers to questions of intrinsic motivation, internal control and environments that encourage their development. The model considers the effect administrators·have on faculty anq the corresponding effect faculty may have on students. The major concentration is on the administrator--teacher interface.For administrators the model may serve as a guide in planning effective transactions, and establishing system goals. The teacher is offered a means to coordinate actions toward a specific overall objective, and the administrator, teacher and researcher are invited to use the model to experiment, innovate, verify the assumptions on which the model is based, and raise additional hypotheses. Goals and history of the community colleges in Ontario are examined against current problems, previous progress and open system thinking. The nature of the person as a five part system is explored with emphasis on intrinsic motivation. The nature, operation, conceptualization, and value of this internal energy source is reviewed in detail. The current state of society, education and management theory are considered and the value of intrinsically motivating teaching tasks together with "system four" leadership style are featured. Evidence is reviewed that suggests intrinsically motivated faculty are needed, and "system four" leadership style is the kind of interaction-influence system needed to nurture intrinsic motivation in faculty.

Self concept, acculturation, and fashion orientation

The research begins with a discussion of the worldwide and the Canadian market. The research profiles the examination of the relationship between a person's self concept (as defined by Malhotra) and fashion orientation (as defined by Gutman and Mills), and to understand how these factors are influenced by acculturation, focusing in-depth on their managerial implications. To study these relationships; a random sample of 196 ChineseCanadian female university students living in Canada was given a survey based on Malhotra's self-concept scale, and the SLASIA acculturation scale. Based on multiple regression analysis, findings suggest that the adoption of language and social interaction dimensions of acculturation constructs have significant effects on the relationship between self concept and fashion orientation. This research contributes significantly to both marketing theory and practice. Theoretically, this research develops new insights on the dimensionality of fashion orientation, identifies various moderating effects of acculturation on the relationship of self concept and fashion orientation dimensions, and provides a framework to examine these effects, where results can be generalized across different culture. Practically, marketers can use available findings to improve their understanding of the fashion needs of Chinese-Canadian consumers, and target them based on these findings. The findings provide valuable implications for companies to formulate their fashion marketing strategies for enhance fashion orientation in terms of different dimensions, based on different levels of acculturation.

Self-directed learning, lifelong learning and transformative learning in the Society for Creative Anachronism

This study examines the connection between leisure group participation and learning activities undertaken by participants in the Society for Creative Anachronism (SCA), a medieval recreationist group. The thesis of this connection was developed through the researcher's observations during SCA participation. The intent of this study is to understand adult learning from the self-directed learning, lifelong learning, and -transformative learning components derived from participant's SCA experiences. This qualitative study was conducted by interviewing eight active SCA participants, two in each participation theme of historical research, artistic representation, performance, and martial skills. Informants' responses demonstrated an integration of their leisure activity with learning. The contextualization of learning a s both a primary activity and a necessary support to participation, places learning a t the heart of participants' SCA related activities. The positive descriptions of learning activities, descriptive terms of ownership, and situating learning as an enjoyable activity engaged for the pleasure of the experience, provides adult educators with a fascinating glimpse of willing and engaged adult learners pursuing lifelong learning outside of the traditional educational structure. Two themes emerged during the interviews. First, bonding with others provided the motivation to continue their activities. Secondly, a feeling of commitment and helonging defined their enjoyment and satisfaction with SCA participation. The clear implications are that adult educators can create effective learning communities by developing educational structures that engage adult learners wi th meaningful social interaction.