scholarly journals Frame me if you must: PrEP framing and the impact on adherence to HIV Pre-exposure Prophylaxis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S439-S439
Author(s):  
Eric Ellorin ◽  
Jill Blumenthal ◽  
Sonia Jain ◽  
Xiaoying Sun ◽  
Katya Corado ◽  
...  
Keyword(s):  
A Priori ◽  
Social Groups ◽  
Continuous Measure ◽  
Gay Community ◽  
Randomized Controlled ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Actual Prevalence ◽  
Tenofovir Diphosphate

Abstract Background “PrEP whore” has been used both as a pejorative by PrEP opponents in the gay community and, reactively, by PrEP advocates as a method to reclaim the label from stigmatization and “slut-shaming.” The actual prevalence and impact of such PrEP-directed stigma on adherence have been insufficiently studied. Methods CCTG 595 was a randomized controlled PrEP demonstration project in 398 HIV-uninfected MSM and transwomen. Intracellular tenofovir-diphosphate (TFV-DP) levels at weeks 12 and 48 were used as a continuous measure of adherence. At study visits, participants were asked to describe how they perceived others’ reactions to them being on PrEP. These perceptions were categorized a priori as either “positively framed,” “negatively framed,” or both. We used Wilcoxon rank-sum to determine the association between positive and negative framing and TFV-DP levels at weeks 12 and 48. Results By week 4, 29% of participants reported perceiving positive reactions from members of their social groups, 5% negative, and 6% both. Reporting decreased over 48 weeks, but positive reactions were consistently reported more than negative. At week 12, no differences in mean TFV-DP levels were observed in participants with positively-framed reactions compared with those reporting no outcome or only negatively-framed (1338 [IQR, 1036-1609] vs. 1281 [946-1489] fmol/punch, P = 0.17). Additionally, no differences were observed in those with negative reactions vs. those without (1209 [977–1427] vs. 1303 [964–1545], P = 0.58). At week 48, mean TFV-DP levels trended toward being higher among those that report any reaction, regardless if positive (1335 [909–1665] vs. 1179 [841–1455], P = 0.09) or negative (1377 [1054–1603] vs. 1192 [838–1486], P = 0.10) than those reporting no reaction. At week 48, 46% of participants reported experiencing some form of PrEP-directed judgment, 23% reported being called “PrEP whore,” and 21% avoiding disclosing PrEP use. Conclusion Over 48 weeks, nearly half of participants reported some form of judgment or stigmatization as a consequence of PrEP use. However, individuals more frequently perceived positively framed reactions to being on PrEP than negative. Importantly, long-term PrEP adherence does not appear to suffer as a result of negative PrEP framing. Disclosures All authors: No reported disclosures.

Wages of neoliberalism:

2020 ◽  
Vol 2 ◽  
pp. e020014
Author(s):  
Praveen Jha ◽  
Archana Prasad
Keyword(s):  
Social Groups ◽  
Adverse Outcomes ◽  
Emerging Trends ◽  
The World ◽  
Hours Of Work ◽  
Different Dimensions ◽  
Structural Failures ◽  
The Impact ◽  
Conditions Of Work

This essay highlights the impact of neoliberalism on the world of work with particular reference to India. It provides a brief overview of the structural transformations and their impact on the growing vulnerability of workers, with particular focus on the deepening and reconfiguration of informality within the current labour scenario. The first section provides a brief profile of labour in India with a focus on the last decade. It shows how the emerging trends are marked by regional and social unevenness, with particularly adverse outcomes for women and vulnerable social groups. The second section explores different dimensions of growing insecurity of work, particularly with respect to hours of work and wages. The third section examines some of the major reasons for deteriorating conditions of work by locating in an overview of the long-term structural failures and the ascendency of neoliberal policies in the recent years. In the fourth section we follow this up by a discussion of the recent State-led labour reforms and their role in accelerating flexibilisation in the world of work and the essay closes with a very brief concluding remark regarding the contemporary labour scenario in section five.

A Comparative Study of Data and Physically Based Gas Turbine Modeling for Long-Term Monitoring Scenarios: Part II — Emission Prediction Utilizing Different Levels of Design Information

2018 ◽  
Author(s):  
Moritz Lipperheide ◽  
Thomas Bexten ◽  
Manfred Wirsum ◽  
Martin Gassner ◽  
Stefano Bernero
Keyword(s):  
Gas Turbine ◽  
A Priori ◽  
Model Development ◽  
Fine Tuning ◽  
Plant Operator ◽  
Engine Model ◽  
Physically Based ◽  
Design Type ◽  
The Impact

Reliable engine and emission models allow for an online monitoring of commercial gas turbine operation and help the plant operator and the original equipment manufacturer (OEM) to ensure emission compliance of the aging engine. However, model development and validation require fine-tuning on the particular engines, which may differ in a fleet of a single design type by production, assembly and aging status. For this purpose, Artificial Neural Networks (ANN) offer a good and fast alternative to traditional physically-based engine modeling, because the model creation and adaption is merely an automatized process in commercially available software environments. However, ANN performance depends strongly on the availability of suitable data and a-priori data processing. The present work investigates the impact of specific engine information from the OEM’s design tools on ANN performance. As an alternative to a strictly data-based benchmark approach, engine characteristics were incorporated into ANNs by a pre-processing of the raw measurements with a simplified engine model. The resulting ‘virtual’ measurements, i.e. hot gas temperatures, then served as inputs to ANN training and application during long-term gas turbine operation. When processed input parameters were used for ANNs, overall long-term NOx prediction improved by 55%, and CO prediction by 16% in terms of RMSE, yielding comparable overall RMSE values to the physically-based model.

scholarly journals Medical students’ mood adversely affected by COVID-19 pandemic: An interim analysis from the SPICE-19 prospective cohort study of 2075 medical students and interim foundation doctors

2020 ◽  
Author(s):  
Soham Bandyopadhyay ◽  
Ioannis Georgiou ◽  
Bibire Baykeens ◽  
Conor S Gillespie ◽  
Marta de Andres Crespo ◽  
...  
Keyword(s):  
Medical Students ◽  
A Priori ◽  
Workforce Planning ◽  
Short Term ◽  
The United Kingdom ◽  
Exam Preparation ◽  
Course Material ◽  
The Impact ◽  
Exam Preparation Course

Abstract Background:Currently, we can only speculate on what the effects of the COVID-19 pandemic have been on medical students and interim foundation year doctors. In order to support them appropriately both now and, in the future, it is imperative that we understand the impact it has had upon them. This study assessed the effects of the COVID-19 pandemic on medical students and interim foundation year doctors across the United Kingdom (UK), and the support that they received and sought. Methods:A prospective, observational, multicentre study was conducted. All medical students and interim foundation year doctors were eligible to participate. The data analysis was carried out as detailed a priori in the protocol. Findings:A total of 2075 individuals participated in the SPICE-19 survey from 33 medical schools. There was a significant (p < 0.0001) decrease in participants’ mood when comparing their mood before the pandemic to during the pandemic. Social distancing and more time at home/with family were the factors that negatively and positively respectively impacted the mood of the greatest number of participants. All areas of life included in the survey were found to have been significantly more negatively impacted than positively impacted (p < 0.0001). 931 participants wanted more support from their university. Participants were mainly seeking support with exam preparation, course material, and financial guidance. Discussion:Medical and foundation schools need to prepare adequate and effective support. If no action is taken, there may be a knock-on effect on workforce planning and the health of our future workforce. When medical students return to their universities, there is likely to be need for enhanced wellbeing support, adaptations in the short-term and long-term strategies for medical education, and provision of financial guidance.

scholarly journals Is Culture Expansion Necessary in Autologous Mesenchymal Stromal Cell Therapy to Obtain Superior Results in the Management of Knee Osteoarthritis?—Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 (12) ◽  
pp. 220
Author(s):  
Sathish Muthu ◽  
Randhi Rama Kartheek ◽  
Naveen Jeyaraman ◽  
Ramya Lakshmi Rajendran ◽  
Manish Khanna ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Group Analysis ◽  
Cochrane Library ◽  
Osteoarthritis Of The Knee ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
The Impact

Study Design: Meta-analysis. Objectives: We aimed to analyze the impact of cultured expansion of autologous mesenchymal stromal cells (MSCs) in the management of osteoarthritis of the knee from randomized controlled trials (RCTs) available in the literature. Materials and Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science, and Cochrane Library until August 2021 for RCTs analyzing the efficacy and safety of culture-expanded compared to non-cultured autologous MSCs in the management of knee osteoarthritis. The Visual Analog Score (VAS) for pain, Western Ontario McMaster University’s Osteoarthritis Index (WOMAC), Lysholm score, Knee Osteoarthritis Outcome Score (KOOS), and adverse events were the analyzed outcomes. Analysis was performed in R-platform using OpenMeta [Analyst] software. Results: Overall, 17 studies involving 767 patients were included for analysis. None of the studies made a direct comparison of the culture expanded and non-cultured MSCs, hence we pooled the results of all the included studies of non-cultured and cultured types of MSC sources and made a comparative analysis of the outcomes. At six months, culture expanded MSCs showed significantly better improvement (p < 0.001) in VAS outcome. Uncultured MSCs, on the other hand, demonstrated significant VAS improvement in the long term (12 months) in VAS (p < 0.001), WOMAC (p = 0.025), KOOS score (p = 0.016) where cultured-expanded MSCs failed to demonstrate a significant change. Culturing of MSCs did not significantly increase the complications noted (p = 0.485). On sub-group analysis, adipose-derived uncultured MSCs outperformed culture-expanded MSCs at both short term (six months) and long term (12 months) in functional outcome parameters such as WOMAC (p < 0.001, p = 0.025), Lysholm (p < 0.006), and KOOS (p < 0.003) scores, respectively, compared to their controls. Conclusions: We identified a void in literature evaluating the impact of culture expansion of MSCs for use in knee osteoarthritis. Our indirect analysis of literature showed that culture expansion of autologous MSCs is not a necessary factor to obtain superior results in the management of knee osteoarthritis. Moreover, while using uncultured autologous MSCs, we recommend MSCs of adipose origin to obtain superior functional outcomes. However, we urge future trials of sufficient quality to validate our findings to arrive at a consensus on the need for culture expansion of MSCs for use in cellular therapy of knee osteoarthritis.

scholarly journals Caring Near and Far by Connecting Community-Based Clients and Family Member/Friend Caregivers Using Passive Remote Monitoring: Protocol for a Pragmatic Randomized Controlled Trial

10.2196/15027 ◽  
2020 ◽  
Vol 9 (1) ◽  
pp. e15027
Author(s):  
Lorie Donelle ◽  
Sandra Regan ◽  
Michael Kerr ◽  
Merrick Zwarenstein ◽  
Michael Bauer ◽  
...  
Keyword(s):  
Older Adults ◽  
Home Care ◽  
Family Member ◽  
Controlled Trial ◽  
Term Care ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
The Family ◽  
The Impact

Background Significant chronic disease challenges exist among older adults. However, most older adults want to remain at home even if their health conditions challenge their ability to live independently. Yet publicly funded home care resources are scarce, private home care is expensive, and family/friend caregivers have limited capacity. Many older adults with chronic illness would require institutional care without the support from family member/friend caregivers. This role raises the risk of physical health problems, stress, burnout, and depression. Passive remote monitoring (RM), the use of sensors that do not require any action by the individual for the system to work, may increase the older adult’s ability to live independently while also providing support and peace of mind to both the client and the family member/friend caregiver. Objective This paper presents the protocol of a study conducted in two provinces in Canada to investigate the impact of RM along with usual home care (the intervention) versus usual home care alone (control) on older adults with complex care. The primary outcome for this study is the occurrence of and time to events such as trips to emergency, short-term admission to the hospital, terminal admission to the hospital awaiting admission to long-term care, and direct admission to long-term care. The secondary outcomes for this study are (1) health care costs, (2) client functional status and quality of life in the home, (3) family/friend caregiver stress, and (4) family/friend caregiver functional health status. Methods The design for this study is an unblinded pragmatic randomized controlled trial (PRCT) with two parallel arms in two geographic strata (Ontario and Nova Scotia). Quantitative and qualitative methodologies will be used to address the study objectives. This PRCT is conceptually informed by the principles of client-centered care and viewing the family as the client and aims at providing supported self-management. Results This study is supported by the Canadian Institutes for Health Research. A primary completion date is anticipated in fall 2022. Conclusions Findings from this real-world rigorous randomized trial will support Canadian decision-makers, providers, and clients and their caregivers in assessing the health, well-being, and economic benefits and the social and technological challenges of integrating RM technologies to support older adults to stay in their home, including evaluating the impact on the burden of care experienced by family/friend caregivers. With an aging population, this technology may reduce institutionalization and promote safe and independent living for the elderly as long as possible. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN) 79884651; http://www.isrctn.com/ISRCTN79884651 International Registered Report Identifier (IRRID) DERR1-10.2196/15027

Validation of the S5P Formaldehyde L2 product using MAX-DOAS network observations

2020 ◽  
Author(s):  
Isabelle De Smedt ◽  
Gaia Pinardi ◽  
Corinne Vigouroux ◽  
Steven Compernolle ◽  
Kai Uwe Eichman ◽  
...  
Keyword(s):  
A Priori ◽  
Retrieval Algorithm ◽  
Comparison Results ◽  
Seasonal And Diurnal Variations ◽  
Wide Range ◽  
Polluted Sites ◽  
German Aerospace ◽  
The Impact

&lt;p&gt;The Sentinel-5 Precursor (S5P) was launched on the 13th of October 2017, with on board the TROPOspheric Monitoring Instrument (TROPOMI). The formaldehyde (HCHO) L2 product is operational since the end of 2018. The prototype of the tropospheric HCHO retrieval algorithm is developed at BIRA-IASB and implemented at the German Aerospace Center (DLR) in the S5P operational processor (De Smedt et al., 2018).&lt;/p&gt;&lt;p&gt;In this work, we investigate the quality of the HCHO tropospheric column product and its validation within the MPC framework (Mission Performance Center) and the S5PVT NIDFORVAL project (S5P NItrogen Dioxide and FORmaldehyde VALidation). Within NIDFORVAL, the S5P HCHO product has been validated using the full FTIR and MAXDOAS dataset. Validation results have been assessed against reported product uncertainties taking into account the full comparison error budget, showing that the product quality reaches its requirements.&lt;/p&gt;&lt;p&gt;Here, we focus on satellite-satellite comparison based on the OMI QA4ECV HCHO product and on ground-based validation using MAX-DOAS and Pandora network observations. About 15 HCHO measuring stations are involved, providing data corresponding to a wide range of observation conditions at mid and low latitudes, and covering remote, sub-urban, and urban polluted sites. Comparison results show usually negative biases for large HCHO columns, while a positive offset is observed for the lowest columns. For the MAX-DOAS stations providing vertical profile retrievals, the impact of a priori profiles on the comparison is assessed. The dataset allows to discuss validation results as a function of emission source. Seasonal and diurnal variations are compared. Long term variation are also monitored using the OMI and MAX-DOAS QA4ECV dataset.&lt;/p&gt;

scholarly journals Introducing pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Sweden: insights from a mathematical pair formation model

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033852 ◽  
Author(s):  
Disa Hansson ◽  
Susanne Strömdahl ◽  
Ka Yin Leung ◽  
Tom Britton
Keyword(s):  
High Risk ◽  
Sexual Behaviour ◽  
Casual Sex ◽  
Pair Formation ◽  
Hiv Prevalence ◽  
Formation Model ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact

ObjectivesSince 2017, the Public Health Agency of Sweden recommends that pre-exposure prophylaxis (PrEP) for HIV should be offered to high-risk individuals, in particular to men who have sex with men (MSM). The objective of this study is to develop a mathematical model investigating the effect of introducing PrEP to MSM in Sweden.DesignA pair formation model, including steady and casual sex partners, is developed to study the impact of introducing PrEP. Two groups are included in the model: sexually high active MSM and sexually low active MSM. Three mixing assumptions between the groups are considered.SettingA gay-friendly MSM HIV/sexually transmitted infection testing clinic in Stockholm, Sweden. This clinic started offering PrEP to MSM in October 2018.ParticipantsThe model is calibrated according to detailed sexual behaviour data gathered in 2015 among 403 MSM.ResultsBy targeting sexually high active MSM, a PrEP coverage of 3.5% of the MSM population (10% of all high actives) would result in the long-term HIV prevalence to drop considerably (close to 0%). While targeting only low actives would require a PrEP coverage of 35% for a similar reduction. The main effect of PrEP is the reduced susceptibility, whereas the increased HIV testing rate (every third month) among PrEP users plays a lesser role.ConclusionsTo create a multifaceted picture of the effects of interventions against HIV, we need models that include the different stages of HIV infection and real-world data on detailed sexual behaviour to calibrate the mathematical models. Our findings conclude that targeting HIV high-risk individuals, within HIV risk populations such as MSM, with PrEP programmes could greatly decrease the long-term HIV prevalence in Sweden. Therefore, risk stratification of individuals is of importance in PrEP implementation programmes, to ensure optimising the effect and cost-effectiveness of such programmes.

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