Treatment outcomes of HIV patients with hepatitis B and C virus co-infections in Southwest China: an observational cohort study

Background Antiretroviral therapy (ART) has reduced mortality among people living with HIV (PLWH) in China, but co-infections of hepatitis B virus (HBV) and hepatitis C virus (HCV) may individually or jointly reduce the effect of ART. This study aimed to evaluate the impacts of HBV/HCV coinfections on treatment drop-out and mortality among PLWH on ART. Methods A retrospective cohort study analysis of 58 239 people living with HIV (PLWH) who initiated antiretroviral therapy (ART) during 2010–2018 was conducted in Guangxi Province, China. Data were from the observational database of the National Free Antiretroviral Treatment Program. Cox proportional hazard models were fitted to evaluate the effects of baseline infection of HBV or HCV or both on death and treatment attrition among PLWH. Results Our study showed high prevalence of HBV (11.5%), HCV (6.6%) and HBV-HCV (1.5%) co-infections. The overall mortality rate and treatment attrition rate was 2.95 [95% confidence interval (CI) 2.88–3.02] and 5.92 (95% CI 5.82–6.01) per 100 person-years, respectively. Compared with HIV-only patients, HBV-co-infected patients had 42% higher mortality [adjusted hazard ratio (aHR) = 1.42; 95% CI 1.32–1.54], HCV-co-infected patients had 65% higher mortality (aHR = 1.65; 95% CI 1.47–1.86), and patients with both HCV and HBV co-infections had 123% higher mortality (aHR = 2.23; 95% CI 1.87–2.66). Conclusions HBV and HCV coinfection may have an additive effect on increasing the risk of all-cause death among PLWH who are on ART. It is suggested that there is need for primary prevention and access to effective hepatitis treatment for PLWH. Graphical Abstract

Engagement and desertion in MOOCs: Systematic review

Massive and open online courses (MOOCs) satisfy learning needs from the particularities of their typologies (xMOOC, tMOOC, cMOOC, iMOOC, among others) even though their high dropout rate is still latent. Recent studies reaffirm engagement as an alternative to reduce dropout rates. The literature analyzed has not yet been able to systematize responses as to how to guarantee engagement in MOOCs and thus reduce their attrition rate. And, consistent with that question, are there still challenges for teachers in this area of educational technology? These answers motivated us to carry out this systematic review to determine how engagement has been studied to help reduce the attrition rate in MOOCs. Articles from journals indexed in Scopus or WoS were reviewed applying the PRISMA protocol. At the end of the protocol, it was defined to analyze 40 studies. The results reflect that the main variables are: the design of e-activities, intrinsic and extrinsic motivation, and communication between students. This paper confirms that the main challenges to guarantee engagement in MOOCs are individualized tutoring, interactivity, and feedback. Due to the scarcity of studies that analyze the variables in an integrated way, it is proposed as future work to determine what relationships exist between these variables that interfere with engagement and dropout in MOOCs. Los cursos en línea masivos y abiertos (MOOCs) permiten satisfacer necesidades de aprendizaje desde las particularidades de sus tipologías (xMOOC, tMOOC, cMOOC, iMOOC, entre otras), sin embargo, es aún latente su alta tasa de deserción. Estudios recientes reafirman el engagement como una alternativa para disminuir los índices de deserción. La literatura analizada aún no logra sistematizar respuestas a ¿cómo garantizar el engagement en los MOOCs y disminuir así su tasa de deserción? Y, en coherencia con esa pregunta, ¿existen aún retos del profesorado en este ámbito de la tecnología educativa? Ello motivó a realizar esta revisión sistemática para determinar cómo se ha trabajado el engagement para contribuir a disminuir la tasa de deserción en los MOOCs. Se revisaron artículos de revistas indexadas en Scopus o en WoS aplicando el protocolo PRISMA. Al finalizar el protocolo se definió analizar 40 estudios. Los resultados reflejan que las principales variables son: el diseño e-actividades; la motivación intrínseca y extrínseca y; la comunicación entre los estudiantes. Se ratifica que los principales retos para garantizar el engagement en los MOOCs son: la tutoría individualizada; la interactividad; y la retroalimentación. Debido a la escasez de estudios que analicen de forma integrada las variables antes mencionadas, se propone como trabajo futuro, determinar qué relaciones existen entre estas variables que intervienen en el engagement y la deserción en los MOOCs.

Exploring Attrition and Completion in a Community Situated Family Violence Intervention Programme

<p>This thesis aims to explore the factors associated with attrition and completion for a New Zealand based community situated family violence intervention programme. It takes a mixed methods approach across two studies. Study one quantitatively investigated the attrition rate of the programme, and factors that predict this attrition. It used survival analysis techniques to analyse data files collected during the assessment phase of the programme. An attrition rate of 46% was identified, which is slightly higher than the average rate of attrition across family violence prevention programmes internationally. Ethnicity was the only variable found to predict attrition. Study two qualitatively explored the experiences of men who completed the intervention programme. Men were interviewed to provide insights into the facilitators and barriers to programme completion. Thematic analysis identified three themes of overcoming barriers to engagement and attendance; motivating factors for engagement; and the importance of active participation in facilitating healing. Aspects of the programme that could be strengthened to improve the engagement and attendance of future participants are discussed alongside the wider implications for family violence prevention practice and policy.</p>

Exploring Attrition and Completion in a Community Situated Family Violence Intervention Programme

<p>This thesis aims to explore the factors associated with attrition and completion for a New Zealand based community situated family violence intervention programme. It takes a mixed methods approach across two studies. Study one quantitatively investigated the attrition rate of the programme, and factors that predict this attrition. It used survival analysis techniques to analyse data files collected during the assessment phase of the programme. An attrition rate of 46% was identified, which is slightly higher than the average rate of attrition across family violence prevention programmes internationally. Ethnicity was the only variable found to predict attrition. Study two qualitatively explored the experiences of men who completed the intervention programme. Men were interviewed to provide insights into the facilitators and barriers to programme completion. Thematic analysis identified three themes of overcoming barriers to engagement and attendance; motivating factors for engagement; and the importance of active participation in facilitating healing. Aspects of the programme that could be strengthened to improve the engagement and attendance of future participants are discussed alongside the wider implications for family violence prevention practice and policy.</p>

Breaking down chipping and fragmentation in sediment transport: the control of material strength

As rocks are transported, they primarily undergo two breakdown mechanisms: fragmentation and chipping. Fragmentation is catastrophic breakup by fracture in the bulk – either by subcritical crack growth under repeated collisions, or from a single high-energy (supercritical) collision – and produces angular shards. Chipping is a distinct low-energy mechanism of impact attrition that involves shallow cracking; this process rounds river pebbles in a universal manner under bed-load transport. Despite its geophysical significance, the transition from chipping to fragmentation is not well studied. Here, we examine this transition experimentally by measuring the shape and mass evolution of concrete particles of varying strength, subject to repeated collisions in a rotating drum. For sufficiently strong particles, chipping occurred and was characterized by the following: attrition products were orders of magnitude smaller than the parent; attrition rate was insensitive to material strength; and particles experienced monotonic rounding toward a spherical shape. As strength decreased, we observed the onset of a subcritical cracking regime associated with fragmentation: mass of attrition products became larger and more varied; attrition rate was inversely proportional to material strength; and shape evolution fluctuated and became non-monotonic. Our results validate conceptual and numerical models for impact attrition: chipping follows “Sternberg's law” of exponential mass loss through time; for fragmentation, the lifetime of particles increases nonlinearly with material strength, consistent with “Basquin's law” of fatigue failure. We suggest that bedrock erosion models must be clarified to incorporate distinct attrition mechanisms, and that pebble or bedrock-channel shape may be utilized to deduce the operative mechanism in a given environment.

Kuakini HHP Center for Translational Research on Aging: Aims and Preliminary Findings

Kuakini Medical Center (Kuakini) is creating an interdisciplinary Hawai’i-based Center for translational research on aging. This Center will build upon Kuakini’s five-decades of NIH-funded research, its 420,000-specimen biorepository, and existing strengths in aging research, notably, the 56-year ongoing Kuakini Honolulu Heart Program cohort study (Kuakini HHP), Kuakini Honolulu-Asia Aging Study (Kuakini HAAS), and Kuakini HHP Offspring Study. The overall goal is to find practical means to enhance healthy human lifespan (healthspan). Four research project leaders (RPLs) have been selected from various disciplines for mentorship in translational aging research. The first RPL presentation will introduce a novel mouse model, enabling controlled expression of the pro-longevity gene FoxO3, and assess the impact on lifespan and healthspan phenotypes in mice. These phenotypes will be compared to similar phenotypes in humans with/without the FOXO3 longevity genotype. The second RPL presentation will assess the relation between leukocyte telomere attrition rates (from banked blood collected at three time points over 20-plus years) in older Kuakini HHP men with/without the FOXO3 longevity genotype. The third RPL presentation will assess whether FOXO3 genotype, peripheral leukocyte telomere dynamics (attrition rate, telomerase activity) and inflammatory cytokines mediate the human brain integrity and function with age. This project will utilize structural and functional MRI data from male and female Kuakini HHP Offspring Study participants. The fourth RPL presentation will assess whether APOE e2, e4, and FOXO3 longevity-associated alleles impact 34-year incidence of intracerebral hemorrhage. We will summarize the findings, address the healthspan implications and provide future directions. Supported by NIH 5P20GM125526.

Dental caries and its association with the oral microbiomes and HIV in young children—Nigeria (DOMHaIN): a cohort study

Background This study seeks to understand better the mechanisms underlying the increased risk of caries in HIV-infected school-aged Nigerian children by examining the relationship between the plaque microbiome and perinatal HIV infection and exposure. We also seek to investigate how perinatal HIV infection and exposure impact tooth-specific microbiomes' role on caries disease progression. Methods The participants in this study were children aged 4 to 11 years recruited from the University of Benin Teaching Hospital (UBTH), Nigeria, between May to November 2019. Overall, 568 children were enrolled in three groups: 189 HIV-infected (HI), 189 HIV-exposed but uninfected (HEU) and 190 HIV-unexposed and uninfected (HUU) as controls at visit 1 with a 2.99% and 4.90% attrition rate at visit 2 and visit 3 respectively. Data were obtained with standardized questionnaires. Blood samples were collected for HIV, HBV and HCV screening; CD4, CD8 and full blood count analysis; and plasma samples stored for future investigations; oral samples including saliva, buccal swabs, oropharyngeal swab, tongue swab, dental plaque were collected aseptically from participants at different study visits. Conclusions Results from the study will provide critical information on how HIV exposure, infection, and treatment, influence the oral microbiome and caries susceptibility in children. By determining the effect on community taxonomic structure and gene expression of dental microbiomes, we will elucidate mechanisms that potentially create a predisposition for developing dental caries. As future plans, the relationship between respiratory tract infections, immune and inflammatory markers with dental caries in perinatal HIV infection and exposure will be investigated.

Testing a newly developed activity pacing framework for chronic pain/fatigue: a feasibility study

ObjectivesTo test the feasibility of using a new activity pacing framework to standardise healthcare professionals’ instructions of pacing, and explore whether measures of activity pacing/symptoms detected changes following treatment.DesignSingle-arm, repeated measures study.SettingOne National Health Service (NHS) Pain Service in Northern England, UK.ParticipantsAdult patients with chronic pain/fatigue, including chronic low back pain, chronic widespread pain, fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis.InterventionsSix-week rehabilitation programme, standardised using the activity pacing framework.Outcome measuresFeasibility was explored via patients’ recruitment/attrition rates, adherence and satisfaction, and healthcare professionals’ fidelity. Questionnaire data were collected from patients at the start and end of the programme (T1 and T2, respectively) and 3 months’ follow-up (T3). Questionnaires included measures of activity pacing, current/usual pain, physical/mental fatigue, depression, anxiety, self-efficacy, avoidance, physical/mental function and quality of life. Mean changes in activity pacing and symptoms between T1-T2, T2-T3 and T1-T3 were estimated.ResultsOf the 139 eligible patients, 107 patients consented (recruitment rate=77%); 65 patients completed T2 (T1-T2 attrition rate=39%), and 52 patients completed T3 (T1-T3 attrition rate=51%). At T2, patients’ satisfaction ratings averaged 9/10, and 89% attended ≥5 rehabilitation programme sessions. Activity pacing and all symptoms improved between T1 and T2, with smaller improvements maintained at T3.ConclusionThe activity pacing framework was feasible to implement and patients’ ability to pace and manage their symptoms improved. Future work will employ a suitable comparison group and test the framework across wider settings to explore the effects of activity pacing in a randomised controlled trial.Trial registration numberNCT03497585.