High acceptability and viral suppression rate for first-Line patients on a dolutegravir-based regimen: An early adopter study in Nigeria.

Nigeria adopted dolutegravir (DTG) as part of first line (1L) antiretroviral therapy (ART) in 2017. However, there is limited documented experience using DTG in sub-Saharan Africa. Our study assessed DTG acceptability from the patient's perspective as well as treatment outcomes at 3 high-volume facilities in Nigeria. This is a mixed method prospective cohort study with 12 months of follow-up between July 2017 and January 2019. Patients who had intolerance or contraindications to non-nucleoside reverse-transcriptase inhibitors were included. Patient acceptability was assessed through one-on-one interviews at 2, 6, and 12 months following DTG initiation. ART-experienced participants were asked about side effects and regimen preference compared to their previous regimen. Viral load (VL) and CD4+ cell count tests were assessed according to the national schedule. Data were analysed in MS Excel and SAS 9.4. A total of 271 participants were enrolled on the study, the median age of participants was 45 years, 62% were female. 229 (206 ART-experienced, 23 ART-naive) of enrolled participants were interviewed at 12 months. 99.5% of ART-experienced study participants preferred DTG to their previous regimen. 32% of particpants reported at least one side effect. "Increase in appetite" was most frequently reported (15%), followed by insomnia (10%) and bad dreams (10%). Average adherence as measured by drug pick-up was 99% and 3% reported a missed dose in the 3 days preceding their interview. Among participants with VL results (n = 199), 99% were virally suppressed (<1000 copies/ml), and 94% had VL <50 copies/ml at 12 months. This study is among the first to document self-reported patient experiences with DTG in sub-Saharan Africa and demonstrated high acceptability of DTG-based regimens among patients. The viral suppression rate was higher than the national average of 82%. Our findings support the recommendation of DTG-based regimen as the preferred 1L ART.

Morphological and Spectral Features of Ionospheric Structures at E- and F-Region Altitudes over Poker Flat Analyzed Using Modeling and Observations.

Electron density irregularities in the ionosphere modify the phase and amplitude of trans-ionospheric radio signals. We aim to characterize the spectral and morphological features of E- and F-region ionospheric irregularities likely to produce these fluctuations or "scintillations". To characterize them, we use a three-dimensional radio wave propagation model-"Satellite-beacon Ionospheric scintillation Global Model of upper Atmosphere" (SIGMA), along with the scintillation measurements observed by a cluster of six Global Positioning System (GPS) receivers called Scintillation Auroral GPS Array (SAGA) at Poker Flat, AK. An inverse method is used to derive the parameters that describe the irregularities by estimating the best fit of model outputs to GPS observations. We analyze in detail one E-region and two F-region events during geomagnetically active times and determine the E- and F-region irregularity characteristics using two different spectral models as input to SIGMA. Our results from the spectral analysis show that the E-region irregularities are more elongated along the magnetic field lines with rod-shaped structures, while the F-region irregularities have wing-like structures with irregularities extending both along and across the magnetic field lines. We also found that the spectral index of the E-region event is less than the spectral index of the F-region events. Additionally, the spectral slope on the ground at higher frequencies is less than the spectral slope at irregularity height. This study describes distinctive morphological and spectral features of irregularities at E- and F-regions for a handful of cases performed using a full 3D propagation model coupled with GPS observations and inversion.

High acceptability and viral suppression of patients on Dolutegravir-based first-line regimens in pilot sites in Uganda: A mixed-methods prospective cohort study.

Uganda adopted the integrase inhibitor dolutegravir (DTG) as part its preferred first-line HIV treatment regimen in 2018. Prior to the national rollout, the Uganda Ministry of Health and Clinton Health Access Initiative (CHAI) launched a pilot study in July 2017 aimed at better understanding patients' and prescribers' experience and acceptability of DTG. Patients were enrolled in the study if they were newly initiating treatment or switched from an NNRTI regimen due to intolerance. Patients were followed up for 6 months after initiation onto DTG and acceptability and experiences were assessed through questionnaires at one-month and six-month follow-up visits. In addition to acceptability side effects of patients on DTG regimens were assessed. Analysis was conducted using MS Excel and SAS 9.4 and confidence intervals were adjusted for facility level clustering. A total of 365 patients from 6 study sites were enrolled in the study, of whom 50% were treatment-experienced and 50% treatment naïve. 325 patients completed the 6 months of follow-up. Survey results showed a high level of acceptability (more than 90%) of DTG-containing regimens for both categories of patients during the from one-month and six-months interviews. The rate of self-reported side effects amongst patients was 33% overall and higher for experienced (37%) than naïve (29%) patients at 6 months. Although frequencies declined between month-1 and month-6, the changes were not statistically significant. Almost all patients (94%) were virally suppressed at 6 months. Overall, the study findings showed a very high level of acceptability of Dolutegravir-based regimens across both experienced and naïve patients. The overall viral suppression rate in this cohort was 94% at six months of taking DTG-based regimen.

An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities.

BACKGROUND AND PURPOSE: The Health Risk Screening Tool (HRST) is a 22-item instrument specifically designed to assess the health risk of persons with developmental disabilities. The predictive validity of the HRST was investigated by examining its ability to predict mortality. METHODS: The sample consisted of 12,582 people with an intellectual or developmental disability residing in Georgia (U.S.). Data were analyzed using survival analysis (Kaplan-Meier estimate and Cox regression) and a binary logistic regression. RESULTS: All models supported the prognostic value of the six-level health risk classification. The Kaplan-Meier procedure showed clear separation among functions. The Cox proportional hazard regression revealed that hazard is inversely related to the health risk level, even after controlling for potential confounding by gender, ethnicity, and race. CONCLUSIONS: The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.

An Examination of the Validity of the Health Risk Screening Tool: Predicting Mortality in People With Intellectual Disabilities.

BACKGROUND AND PURPOSE: The Health Risk Screening Tool (HRST) is a 22-item instrument specifically designed to assess the health risk of persons with developmental disabilities. The predictive validity of the HRST was investigated by examining its ability to predict mortality. METHODS: The sample consisted of 12,582 people with an intellectual or developmental disability residing in Georgia (U.S.). Data were analyzed using survival analysis (Kaplan-Meier estimate and Cox regression) and a binary logistic regression. RESULTS: All models supported the prognostic value of the six-level health risk classification. The Kaplan-Meier procedure showed clear separation among functions. The Cox proportional hazard regression revealed that hazard is inversely related to the health risk level, even after controlling for potential confounding by gender, ethnicity, and race. CONCLUSIONS: The HRST can predict mortality. Therefore, it can serve as a basis for establishing healthcare needs and determining nursing care acuity.

The state, parenting, and the populist energies of anxiety.

In this essay James Conroy raises the question of how far the state should engage in the rearing of children, looking in particular at homeschooling as a site for contestation. He considers this question by looking specifically at recent developments in the United Kingdom around the elision of child safeguarding issues with concern about the control of home education. In the first part of the essay, Conroy explores some general questions about the relation between politics and populism, and the consequences for the prerogatives of parents. In the second part of the essay, he interrogates constructivist accounts of the family and offers something of a historical corrective to the widely held view (emanating from Philippe Ariès) that the very conceit of the family is a "modern" invention. This analysis leads Conroy to conclude that, while states do have a proper locus in the upbringing of children, they must make certain presumptions in favor of the parent if governmental responses to home education are to be considered political rather than populist and "controlling."

A cost-benefit analysis of community and institutional placements for persons with mental retardation in Oklahoma.

Matched samples of 174 pairs of persons with mental retardation who live in either community settings or congregate care settings were compared on both cost and outcome dimensions. It was learned that costs were significantly lower in community programs. Greater levels of service and integration were evident in the community programs, but institutional programs offered vocational opportunities for more individuals. Although we were able to predict with accuracy who lived in community and institutional settings, we were unable to predict costs.

Statewide longitudinal survey of psychotropic medication use for persons with mental retardation: 1994 to 2000.

The use of psychotropic medication with persons who have mental retardation was surveyed. Data were collected on a large sample of Oklahomans in both 1994 and 2000. Analysis revealed that the use of antidepressant medication increased dramatically over the course of the study, apparently as a function of increased use of SSRI medications. Antipsychotic medication did not change dramatically, but a shift to the newer atypical antipsychotic medications was noted. In a separate analysis of persons who moved from an institutional setting to a community-based setting, evidence suggested an increased use of psychotropic medication.

The Hissom closure outcomes study: a report on six years of movement to supported living.

Changes in quality of life observed in 254 people with developmental disabilities who moved from a large state institution to supported living settings as a result of a court ordered closure of Hissom Memorial Center in Oklahoma were reported. Using pre-post measures on a multitude of qualities of life, we measured significant improvements between 1990 and 1995 in class members' adaptive and challenging behaviors, participation in employment, number of hours of developmentally oriented services, opportunities for integration, frequency of contact with relatives, and use of antipsychotic medications. We noted concern regarding health care, where there was a need for easier access to health professionals in community settings.

The impact of deinstitutionalization on family contact.

Indices of family contact were reviewed across four cohorts of persons with mental retardation who were transferred from a large public institution to small supported living arrangements. In this longitudinal study, it was found that family contact increased subsequent to community placement, and that these increased levels of contact were maintained for as long as 4 years.

Contact Dermatitis in Dogs and Cats: Pathogenesis, Histopathology, Experimental Induction and Case Reports.

Résumé- Une revue de la physiopathologie et de Thistopathologie des dermites de contact par allergie et irritation est présentée. Le rôle des lymphocytes, des cellules de Langerhans, des basophiles et des éosinophiles est discuté. Des résultates précédents non-publiés de dermites de contact expérimentales chez le chien sont présentées. Les résumés des cas cliniques de dermites de contact spontannées chez le chien et le chat présentées lors du 9e congrès de l'AAVD sont inclus. Les cas cliniques sont comparés aux cas expérimentaux et aux aspects histopathologiques décrits chez 1'homme. Des lésions avec un infiltrat riche en éosinophiles ont été retrouvées dans trois cas; une discussion sur la possibilité d'existence d'IgE à la surface des cellules de Langerhans entrainant à la fois une réponse de type I et de type IV chez ces patients est développée. [Walder, E. J., Conroy, J. D. Contact dermatitis in dogs and cats: pathogenesis, histopathology, experimental induction and case reports (Dermite de contact chez le chien et le chat: pathogénie, histopathologie, induction expérimentale et cas cliniques). Resumen- Se revisa la fisiopatología e histopatología de la dermatitis por contacto alérgica y por irritación en la especie humana y en los animales. Se discute el papel de los linfocitos, las células de Langerhans, los basófilos y los eosinófilos. Se presentan datos sobre la dermatitis por contacto alérgica y por irritación en el perro no descritos hasta la fecha. Se incluyen los resumenes de los casos clinicos presentados en las das jornadas de la Academia Americana de Dermatología Veterinaria. Se comparan los casos clinicos con los hallazgos expérimentales en el perro y con las caracteristícas histopatológicas recientemente descritas en la especie humana. En tres casos se descubrieron vesiculo-pústulas con abundantes eosinófilos; se especula con la posibilidad de que células de Langerhens cargadas con IgE induzcan reacciones mixtas de hipersensibilidad de tipo I y IV ("atopia por contacto"). [Walder, E. J., Conroy, J. D. Contact dermatitis in dogs and cats: pathogenesis, histopathology, experimental induction and case reports (Dermatitis por contacto en el perro y en el gato: patogénesis, histopatología, reproducción experimental y casos clínicos). Zusammenfassung- Es erfolgt eine übersicht über Pathophysiologie und Histopothologie der irritativen und allergischen Kontakdermatitis das Mensch und Tier. Es werden die Rollen der Lymphozyton, Langerhans Zellen, basne und eosinophilen Granulozyten diskutiert. Es werden unveröffentlichte Daten über experimentelle irritative und allergische Kontaktdermatitis bei Hunden vorgestellt. Die Zusammenfassungen von Fallstudien spontaner Kontaktdermatitis bei Hund und Katze, veröffentlicht beim 9. Jahrestreffen der American Academy of Veterinary Dermatology werden miteingeschlossen. Die Fallstudien werden mit den experimentellen Ergebnissen beim Hund und mit den klassischen und kürzlich beschriebenen histopatholo-gischen Bildern beim Menschen verglichen. In drei Fällen wurden vesikulopustulöse Veränderungen, reich an ensinophilen Granulozyten, festgestellt; es werden Mutmaßungen über die Möglichkeit von IgE-tregenden Langerhans-Zellen angstellt, die überlappende Typ I- und Typ IV-Reaktionen ("Kontaktatopie") bei diesen Patienten induzieren. [Contact dermatitis in dogs and cats: pathognesis, histopathology, experimental induction, and case reports (Kontaktdermatitis bei Hund und Katze: Pathogenese, Histopathologie, experimentelle Induktion und Fallstudien). Abstract- The pathophysiology and histopathology of irritant and allergic contact dermatitis in man and animals are reviewed. The roles of lymphocytes, Langerhans cells, basophils and eosinophils are discussed. Previously unreported data on experimental irritant and allergic contact dermatitis in dogs are presented. The abstracts of case reports of spontaneous contact dermatitis in dogs and cats presented at the Ninth Annual American Academy of Veterinary Dermatology Meeting are included. The case reports are compared to the experimental findings in dogs and to classical and recently-described histopathologic features in humans. Eosinophil-rich, vesiculopustular lesions were found in three cases; speculation is made regarding the possibility of lgE-bearing Langerhans cells inducing overlap Type I and Type IV hypersensitivity reactions ("contact atopy") in these patients.