Australian Gay and Bisexual Men’s Attitudes to HIV Treatment as Prevention in Repeated,National Surveys, 2011-2013

Objective

Assess the acceptability of HIV treatment as prevention and early antiretroviral treatment among gay and bisexual men in Australia and any changes in attitudes over time.

Methods

National, online, cross-sectional surveys of gay and bisexual men were repeated in 2011 and 2013. Changes in attitudes to HIV treatment over time were assessed with multivariate analysis of variance. The characteristics of men who agreed that HIV treatment prevented transmission and thought that early treatment was necessary were identified with multivariate logistic regression.

Results

In total, 2599 HIV-negative, untested and HIV-positive men participated (n = 1283 in 2011 and n = 1316 in 2013). Attitudes changed little between 2011 and 2013; most participants remained sceptical about the preventative benefits of HIV treatment. In 2013, only 2.6% of men agreed that HIV treatment prevented transmission; agreement was associated with being HIV-positive, having an HIV-positive regular partner, and having received HIV post-exposure prophylaxis. In contrast, 71.8% agreed that early antiretroviral treatment is necessary; younger men were more likely and HIV-positive men and participants with HIV-positive partners were much less likely to agree with this.

Conclusions

Promoting the individual health benefits of HIV treatment rather than its preventative benefits remains more acceptable to Australian gay and bisexual men.     

Knowledge of HIV and Willingness to Conduct Oral Rapid HIV Testing among Dentists in Xi’an China

Introduction

China is considered a country of low HIV prevalence (780,000 people living with HIV), however, HIV infections among high-risk populations continue to grow at alarming rates. Voluntary Counseling and Testing services were first implemented in 2003, and oral rapid HIV testing (ORHT) began in 2012. Dentists, as oral health experts, would be well placed to conduct ORHT. We assessed willingness of dentists to undertake ORHT in their clinical practice.

Methods

A cross-sectional, paper-based survey of dentists from the Xi’an region of China was conducted from April to June 2013. Dentists were recruited from Shaanxi Stomatological Association using a stratified sampling methodology. A 40-item survey was used to measure knowledge of HIV, attitudes toward people living with HIV and willingness to conduct ORHT.

Results

477 dentists completed the survey with a mean HIV knowledge test score of 13.2/18 (SD 1.9). If made available in the dental setting, 276 (57.9%) preferred to use blood to diagnose HIV, only 190 (39.8%) preferred saliva or both. Four hundred and thirty-five (91.2%) thought that ORHT was needed in dental clinics. Female dentists felt more accepting of ORHT than males (93.8% vs. 87.8%; χ²=5.145; p<0.05). 42.6% of the participants who responded thought that lack of education on ORHT for dentists was the most urgent problem to solve for ORHT, 144 (31.3%) thought that lack of support for ORHT from patients was the most urgent problem. There was statistically significant difference among dental hospital, dentistry and department of dentistry (χ²=24.176; p<0.05).

Conclusions

The majority of Chinese dentists thought that ORHT was needed in the dental setting. Providing opportunities for dentists and dental students to learn about HIV testing guidelines and practices is needed as well as feasibility and implementation science research.     

When Parents Separate and One Parent ‘Comes Out’ as Lesbian,Gay or Bisexual: Sons and Daughters Engage with the Tension that Occurs When Their Family Unit Changes

The experiences of Irish sons and daughters born into heterosexually-organised parental partnerships/unions whose parents have separated and one has come out as Lesbian, Gay or Bisexual (LGB) were explored through a grounded theory approach. 15 adult children (over the age of 18 years), who varied in age when their parents separated and one disclosed as LGB, were interviewed. The primary concern that emerged centred on participants having to adjust to their parents’ being separated, as opposed to their parent being LGB. This involved engaging with the tension that arose from the loss of the parental union, which involved changes to the home environment and adapting to new parental partners and family units. Heightened reflection on sexual orientation and an increased sensitivity to societal LGB prejudice were specifically associated with a parent coming out as LGB. How parents negotiated disclosing the changes to others, the level of support available to parents, and how capable parents were at maintaining the parent-child relationship had an impact on the tension experienced by sons and daughters. Participants moved from initially avoiding and resisting the family changes that were occurring to gradual consonance with their altered family environments. Concluding directions for research and clinical considerations are suggested.     

Assessment of ‘top-down’ and ‘bottom-up’ forces as determinants of rotifer distribution among lakes in Ontario,Canada

Predation and food supply are generally perceived as important determinants of spatial and temporal variations of populations. The population dynamics of freshwater rotifers have been well researched in this aspect. However, their spatial variations have attracted less attention and have not been studied by simultaneously considering both predation and food supply. We studied spatial variations of rotifer abundance among 34 Canadian boreal lakes. A large part of the variance of rotifer abundance was associated with variables related to trophic status including chlorophyll a and total phosphorus. However, abundances of mesozooplankton such as potential predators and competitors did not correlate with rotifer abundance and did not explain the residual of the regression between rotifer abundance and chlorophyll a. The results of the present study indicated that variation in rotifer abundance among lakes was caused by bottom-up forces related to food supply and not by top-down predatory interactions. This provides a contrast to previous empiric and experimental studies that reported that temporal variations of rotifer abundance were mainly regulated by top-down interactions. This discrepancy suggests that overall differences in rotifer abundance among lakes are mainly determined by bottom-up forces while temporal changes in single lakes are shaped by top-down forces. Meanwhile, the composition of rotifer species was correlated with mesozooplankton abundance as well as trophic status. Rotifer species with long spines or rigid loricae were found in the lakes where mesozooplankton were abundant, which suggests that defensive morphology could have affected the rotifer species distribution among the study lakes.     

Shock Treatment: Using Immersive Digital Realism to Restage and Re-examine Milgram’s ‘Obedience to Authority’ Research

Attempts to revisit Milgram’s ‘Obedience to Authority’ (OtA) paradigm present serious ethical challenges. In recent years new paradigms have been developed to circumvent these challenges but none involve using Milgram’s own procedures and asking naïve participants to deliver the maximum level of shock. This was achieved in the present research by using Immersive Digital Realism (IDR) to revisit the OtA paradigm. IDR is a dramatic method that involves a director collaborating with professional actors to develop characters, the strategic withholding of contextual information, and immersion in a real-world environment. 14 actors took part in an IDR study in which they were assigned to conditions that restaged Milgrams’s New Baseline (‘Coronary’) condition and four other variants. Post-experimental interviews also assessed participants’ identification with Experimenter and Learner. Participants’ behaviour closely resembled that observed in Milgram’s original research. In particular, this was evidenced by (a) all being willing to administer shocks greater than 150 volts, (b) near-universal refusal to continue after being told by the Experimenter that “you have no other choice, you must continue” (Milgram’s fourth prod and the one most resembling an order), and (c) a strong correlation between the maximum level of shock that participants administered and the mean maximum shock delivered in the corresponding variant in Milgram’s own research. Consistent with an engaged follower account, relative identification with the Experimenter (vs. the Learner) was also a good predictor of the maximum shock that participants administered.     

‘Act on Oncology’ as a New Comprehensive Approach to Assess Prostate Cancer Centres – Method Description and Results of a Pilot Study

Background

Multidisciplinary care of prostate cancer is increasingly offered in specialised cancer centres. It requires the optimisation of medical and operational processes and the integration of the different medical and non-medical stakeholders.

Objective

To develop a standardised operational process assessment tool basing on the capability maturity model integration (CMMI) able to implement multidisciplinary care and improve process quality and efficiency.

Design, Setting, and Participants

Information for model development was derived from medical experts, clinical guidelines, best practice elements of renowned cancer centres, and scientific literature. Data were organised in a hierarchically structured model, consisting of 5 categories, 30 key process areas, 172 requirements, and more than 1500 criteria. Compliance with requirements was assessed through structured on-site surveys covering all relevant clinical and management processes. Comparison with best practice standards allowed to recommend improvements. ‘Act On Oncology’(AoO) was applied in a pilot study on a prostate cancer unit in Europe.

Results and Limitations

Several best practice elements such as multidisciplinary clinics or advanced organisational measures for patient scheduling were observed. Substantial opportunities were found in other areas such as centre management and infrastructure. As first improvements the evaluated centre administration described and formalised the organisation of the prostate cancer unit with defined personnel assignments and clinical activities and a formal agreement is being worked on to have structured access to First-Aid Posts.

Conclusions

In the pilot study, the AoO approach was feasible to identify opportunities for process improvements. Measures were derived that might increase the operational process quality and efficiency.     

The Increased Effectiveness of HIV Preventive Intervention among Men Who Have Sex with Men and of Follow-Up Care for People Living with HIV after ‘Task-Shifting’ to Community-Based Organizations: A ‘Cash on Service Delivery’ Model in China

Background

A large number of men who have sex with men (MSM) and people living with HIV/AIDS (PLHA) are underserved despite increased service availability from government facilities while many community based organizations (CBOs) are not involved. We aimed to assess the feasibility and effectiveness of the task shifting from government facilities to CBOs in China.

Methods

HIV preventive intervention for MSM and follow-up care for PLHA were shifted from government facilities to CBOs. Based on ‘cash on service delivery’ model, 10 USD per MSM tested for HIV with results notified, 82 USD per newly HIV cases diagnosed, and 50 USD per PLHA received a defined package of follow-up care services, were paid to the CBOs. Cash payments were made biannually based on the verified results in the national web-based HIV/AIDS information system.

Findings

After task shifting, CBOs gradually assumed preventive intervention for MSM and follow-up care for PLHA from 2008 to 2012. HIV testing coverage among MSM increased from 4.1% in 2008 to 22.7% in 2012. The baseline median CD4 counts of newly diagnosed HIV positive MSM increased from 309 to 397 cells/µL. HIV tests among MSM by CBOs accounted for less than 1% of the total HIV tests in Nanjing but the share of HIV cases detected by CBOs was 12.4% in 2008 and 43.6% in 2012. Unit cost per HIV case detected by CBOs was 47 times lower than that by government facilities. The coverage of CD4 tests and antiretroviral therapy increased from 71.1% and 78.6% in 2008 to 86.0% and 90.1% in 2012, respectively.

Conclusion

It is feasible to shift essential HIV services from government facilities to CBOs, and to verify independently service results to adopt ‘cash on service delivery’ model. Services provided by CBOs are cost-effective, as compared with that by government facilities.     

‘Cry-for-help’ in contaminated soil: a dialogue among plants and soil microbiome to survive in hostile conditions

An open question in environmental ecology regards the mechanisms triggered by root chemistry to drive the assembly and functionality of a beneficial microbiome to rapidly adapt to stress conditions. This phenomenon, originally described in plant defence against pathogens and predators, is encompassed in the ‘cry-for-help’ hypothesis. Evidence suggests that this mechanism may be part of the adaptation strategy to ensure the holobiont fitness in polluted environments. Polychlorinated biphenyls (PCBs) were considered as model pollutants due to their toxicity, recalcitrance and poor phyto-extraction potential, which lead to a plethora of phytotoxic effects and rise environmental safety concerns. Plants have inefficient detoxification processes to catabolize PCBs, even leading to by-products with a higher toxicity. We propose that the ‘cry-for-help’ mechanism could drive the exudation-mediated recruitment and sustainment of the microbial services for PCBs removal, exerted by an array of anaerobic and aerobic microbial degrading populations working in a complex metabolic network. Through this synergistic interaction, the holobiont copes with the soil contamination, releasing the plant from the pollutant stress by the ecological services provided by the boosted metabolism of PCBs microbial degraders. Improving knowledge of root chemistry under PCBs stress is, therefore, advocated to design rhizoremediation strategies based on plant microbiome engineering.     

‘Rings’ of F-actin form around the nucleus in cultured human MCF7 adenocarcinoma cells upon exposure to both taxol and taxotere

The anti-cancer taxoids, Taxol® (paclitaxel) and Taxotere® (docetaxel), are the most promising anti-mitotic agents developed for cancer treatment in the past decade. The effectiveness of this new class of compounds lies in their unique mechanism of action on the cytoskeleton. Both taxol and taxotere bind to microtubules and shift the normal equilibrium between monomeric and polymerized tubulin to favor the polymerized form by strongly promoting tubulin assembly and inhibiting microtubule depolymerization. Although very similar in structure, these two compounds have recently demonstrated different in vitro, in vivo, and clinical activities; however, no study to date has effectively compared specific cytoskeletal alterations induced by taxol and taxotere in cultured cells. Using specific staining techniques for both F-actin and α-tubulin, this study provides the first detailed immunohistochemical comparison of the effects of equimolar concentrations of taxol and taxotere on both the microfilament and microtubule networks in a cultured cell line. Using human MCF7 breast adenocarcinoma cells, new observations of taxotere/taxol alterations of the cytoskeleton include: an increased abundance of parallel microtubule ‘bundles’ in taxotere treated cells and a definitive reorganization of the microfilament network which results in novel ring-like formations of F-actin condensed exclusively in the perinuclear zone. Reorganization of the actin cytoskeleton induced by a taxoid disruption of the microtubule equilibrium is indicative of the interdependence between microtubules and microfilaments in this transformed cell line and suggests that the indirect role of the taxoids on the microfilament network may have been overlooked in their mechanism of action as chemotherapeutic agents.     

‘We eat meat every day’: ecology and economy of dietary change among Oaxacan migrants from Mexico to New Jersey

Abstract

In the late twentieth and early twenty-first centuries, the USA has experienced large-scale and continuing immigration from around the world, especially Latin America and, within Latin America, from Mexico. One dimension of these transnational processes is dietary change. In this paper, we qualitatively assess the effects of migration from Oaxaca, Mexico to central New Jersey on the ecology and economy of dietary patterns. We explore multiple factors at the micro and macro levels. Data come from focus groups held among Mexican migrants in New Jersey, and in Oaxaca among people from their sending communities. Economic constraints and lack of culturally appropriate foods are larger barriers to healthy eating than lack of knowledge about appropriate diets. We end with recommendations for nutrition education and interventions.     

Site-Activated Chelators Derived from Anti-Parkinson Drug Rasagiline as a Potential Safer and More Effective Approach to the Treatment of Alzheimer’s Disease

chelators can modulate β-amyloid accumulation, protect against tau hyperphosphorylation, and block metal-related oxidative stress, and thereby hold considerable promise as effective anti-AD drugs. At present, a growing interest is focusing on increasing the efficacy and targeting of chelators through drug design. To this end, we have developed a new class of multifunctional prochelators from three FDA- approved drugs rasagiline, rivastigmine, and donepezil or tacrine. HLA20 A was designed by merging the important pharmacophores of rasagiline, rivastigmine, and donepezil into our newly developed multifunctional chelator HLA20. M30D was constructed using the key pharmacophoric moieties from rasagiline, rivastigmine, and tacrine. Experiments showed that both compounds possess potent anti-acetylcholinesterase (AChE) activity in vitro with weak inhibition of butyrylcholinesterase (BuChE), and without significant metal-binding activity. M30D was found also to be a highly potent MAO A inhibitor with moderate inhibition of MAO B in vitro. Both HLA20 and M30D can be activated by inhibition of AChE to release active chelators HLA20 and M30, respectively. HLA20 and M30 have been shown to be able to modulate amyloid precursor protein regulation and beta-amyloid reduction, suppress oxidative stress, and passivate excess metal ions (Fe, Cu, and Zn). Compared with the activated chelator HLA20 or M30, both HLA20A and M30D exhibited lower cytotoxicity in SH-SY5Y neuroblastoma cells, substantiating the prochelator strategy for minimizing toxicity associated with poor targeted chelators.     

The Pattern of Complaints about Australian Wind Farms Does Not Match the Establishment and Distribution of Turbines: Support for the Psychogenic, ‘Communicated Disease’ Hypothesis

Background and Objectives

With often florid allegations about health problems arising from wind turbine exposure now widespread, nocebo effects potentially confound any future investigation of turbine health impact. Historical audits of health complaints are therefore important. We test 4 hypotheses relevant to psychogenic explanations of the variable timing and distribution of health and noise complaints about wind farms in Australia.

Setting

All Australian wind farms (51 with 1634 turbines) operating 1993–2012.

Methods

Records of complaints about noise or health from residents living near 51 Australian wind farms were obtained from all wind farm companies, and corroborated with complaints in submissions to 3 government public enquiries and news media records and court affidavits. These are expressed as proportions of estimated populations residing within 5 km of wind farms.

Results

There are large historical and geographical variations in wind farm complaints. 33/51 (64.7%) of Australian wind farms including 18/34 (52.9%) with turbine size >1 MW have never been subject to noise or health complaints. These 33 farms have an estimated 21,633 residents within 5 km and have operated complaint-free for a cumulative 267 years. Western Australia and Tasmania have seen no complaints. 129 individuals across Australia (1 in 254 residents) appear to have ever complained, with 94 (73%) being residents near 6 wind farms targeted by anti wind farm groups. The large majority 116/129(90%) of complainants made their first complaint after 2009 when anti wind farm groups began to add health concerns to their wider opposition. In the preceding years, health or noise complaints were rare despite large and small-turbine wind farms having operated for many years.

Conclusions

The reported historical and geographical variations in complaints are consistent with psychogenic hypotheses that expressed health problems are “communicated diseases” with nocebo effects likely to play an important role in the aetiology of complaints.     

Improved Survival and Initiation of Differentiation of Human Induced Pluripotent Stem Cells to Hepatocyte-Like Cells upon Culture in William’s E Medium followed by Hepatocyte Differentiation Inducer Treatment

BackgroundHepatocyte differentiation inducer (HDI) lacks both glucose and arginine, but is supplemented with galactose and ornithine, and is added together with other reagents such as apoptosis inhibitor and oncostatin M. Although human induced pluripotent stem (iPS) cells initiate hepatocyte differentiation, most die within 7 days. In this study, we investigated both HDI and conventional media for their potential to improve cell survival.ResultsExpression levels of α-feto protein (AFP) were higher in cells cultured in WE and in Dulbecco’s Modified Eagle’s Medium/Nutrient F-12 Ham (DF12). 201B7 cells expressed the highest AFP and albumin (ALB) when cultured in HDI for 2 days following 7-day culture in WE. After three cycles of 5-day culture in WE followed by 2 days in HDI, 201B7 cells expressed AFP and ALB 54 ± 2.3 (average ± standard deviation) and 73 ± 15.1 times higher, respectively, than those cultured in ReproFF (feeder-free condition).Conclusion201B7 cells survived culture in WE for 7 days followed HDI for 2 days. After three cycles of culture under these conditions, hepatocyte differentiation was enhanced, as evidenced by increased AFP and ALB expression.     

Free metal activity and total metal concentrations as indices of micronutrient availability to barley [Hordeum vulgare (L.) ‘Klages’]

The form in which a micronutrient is found in the rhizosphere affects its availability to plants. We compared the availability to barley of the free hydrated cation form of Fe³⁺, Cu²⁺, Zn²⁺, and Mn²⁺ versus their total metal concentrations (free ion plus complexes) in chelator-buffered solutions. Free metal ion activities were estimated using the chemical equilibrium program GEOCHEM-PC with the corrected database. In experiment 1, barley was grown in nutrient solutions with different Fe³⁺ activities using chelators to control Fe levels. Chlorosis occurred at Fe³⁺ activities of 10^–18 and 10^–19 M for barley grown in HEDTA and EDTA solutions, respectively. In experiment 2, barley was grown in nutrient solutions with the same calculated Fe³⁺ activity and the same chelator, but different total Fe concentrations. Leaf, root and shoot Fe concentrations were higher from CDTA buffered solutions which had the higher total Fe concentration indicating the importance of the total Fe concentration on Fe uptake. Results from treatments using EDTA or HEDTA, with one exception, were similar to the results from the CDTA treatment. This suggests differences in critical Fe³⁺ activities found in experiment 1 were due to differences in the total Fe concentration and not errors in chelate formation constants used to estimate the critical activities. Results for Cu, Zn, and Mn were similar to Fe; despite solutions with equal free Cu²⁺, Zn²⁺ and Mn²⁺ activities, plant concentrations of these metals were generally greater when grown in the solutions with the greater total amount of Cu, Zn, or Mn. When the free Zn²⁺ activity was kept constant while the total amount of Zn was increased from 4.4 to 49 M, leaf Zn concentration increased from 77 to 146 g g^-1. In order to predict metal availability to barley and other species in chelator-buffered nutrient solutions, both free and total metal concentrations in solution must be considered. The critical Fe³⁺ activities required by barley in this study are much higher than those from tomato and soybean, 10^-28 M, which strongly supports the Strategy 2 model of Fe uptake for Poaceae. This is related to the importance of the Fe³⁺ (barley) and the Fe²⁺ (tomato and soybean) ions in Fe uptake. Fe-stressed barley is known to release phytosiderophores which compete for Fe³⁺ in the nutrient solution, while tomato and soybean reduce Fe³⁺ to Fe²⁺ at the epidermal cell membranes to allow uptake of Fe²⁺ from Fe³⁺ chelates in solution.Abbreviations CDTA trans-1,2-diaminocyclohexane-N,N,N,N-tetracetic acid - DTPA diethylenetriaminepentacetic acid - EDTA ethylenediaminetetracetic acid - EDDHA ethylenediamine-di(o-hydroxyphenylacetic acid) - HBED-N,N di(2-hydroxybenzoyl)-ethylenediamine-N,N-diacetic acid - HEDTA-N hydroxyethylenediaminetriacetic acid - MES-2 (N-morpholino)ethanesulfonic acid - NTA nitrilotriacetic acid     

Use of Complementary and Alternative Medicine (CAM) as Part of the Oncological Treatment: Survey about Patients’ Attitude towards CAM in a University-Based Oncology Center in Germany

IntroductionTo understand if and which patients would be open-minded to Complementary and Alternative Medicine (CAM) use parallel to their oncological treatment. Moreover, we sought to determine which methods are most accepted and which are the primary motivators to use CAM.MethodsWe developed and anonymously conducted a questionnaire for patients in the oncology center (TU Munich). Questions focus on different CAM methods, previous experiences, and willingness to apply or use CAM when offered in a university-based setting.ResultsA total of 171 of 376 patients (37.4% women, 62.0% men, 0.6% unknown) participated. This corresponds to a return rate of 45%. Median age was 64 years (17–87 years). Of all participants, 15.2% used CAM during their oncological therapy; 32.7% have used it in the past. The majority (81.9%) was not using CAM during therapy; 55.5% have not used CAM in the past respectively. The analysis revealed a significant correlation between education and CAM use during therapy (r = 0.18; p = 0.02), and CAM use in the past (r = 0.17; p = 0.04). Of all patients using CAM during therapy, favored methods were food supplements (42.3%), vitamins/minerals (42.3%), massage (34.6%). Motivations are especially the reduction of side effect and stress, the positive effect of certain CAM-treatments on the immune system and tumor therapy. Results showed no difference between women and men. Most patients not having had any experience with CAM complain about the deficiency of information by their treating oncologist (31.4%) as well as missing treatment possibilities (54.3%).ConclusionSince many patients believe in study results demonstrating the efficacy of CAM, it stresses our task to develop innovative study protocols to investigate the outcomes of certain CAM on symptom reduction or other endpoints. Thus, prospective trials and innovative evidence-based treatment concepts to include CAM into high-end oncology is what patients demand and what a modern oncology center should offer.     

Subtle ‘boom and bust’ response of <Emphasis Type="Italic">Macquaria ambigua</Emphasis> to flooding in an Australian dryland river

The ecology of dryland rivers is driven by their highly variable hydrology, particularly flooding regimes, whereby intermittent floods typically generate ‘booms’ of primary and secondary productivity, including massive fish production. We tested these concepts in the Moonie River, Australia, using the percichthyid, Macquaria ambigua, a dryland river species known to display pronounced ‘boom and bust’ abundance patterns in response to floodplain inundation followed by extended periods of low to no channel flow. We expected that body condition (as measured by whole body lipid content) and biomass of M. ambigua would be related to prey biomass, and that these factors would all ‘spike’ following widespread flooding. Instead we found more subtle responses. There were ‘booms’ in biomass of Macrobrachium and zooplankton, two important food items, whereas M. ambigua maintained relatively low but sustained lipid and biomass levels following flooding. It appears that instead of a ‘boom’ in fish biomass, abundant invertebrate food resources and sustained lipid levels contributed to high survivorship of this species during the ‘bust’ period over cool dry months.