Previous studies concerning disparities in Human Immunodeficiency Virus (HIV) services use among vulnerable groups did not control for specific clinical need for care such as symptom events. Using ...the Andersen Behavioral Model of Health Services Use, the authors determined whether minorities, women, and the less educated (vulnerable groups) were less likely to receive care for HIV symptoms. Persons enrolled in the HIV Cost and Services Utilization Study were asked whether they received care for their most bothersome symptom. Surprisingly, minorities and women were no more likely to go without care than other groups. Those with Medicaid, Medicare, private health maintenance organization (HMO) insurance, or no insurance were less likely to receive care for symptoms than those with private-non-HMO insurance. Vulnerable groups were no less likely to use services for HIV-related symptoms when need for care was considered. However, disparities may exist for symptom-specific care among HIV infected persons covered by public or HMO insurance.
The objective of this study was to identify and describe ways that a spiritually based intervention of silently repeating a mantram-sacred word or phrase-was used as a coping strategy for managing ...human immunodeficiency virus (HIV) disease.
The design was a qualitative research method, the critical incident technique.
The study was conducted at an academically affiliated Veterans Affairs Hospital in southern California.
The subjects were outpatient adults living with HIV (n=32) who were receiving care through HIV clinics, community agencies, and HIV providers.
Subjects who participated in the intervention arm of a randomized controlled trial that tested the efficacy of a 5-weekly group mantram intervention were interviewed 2 months postintervention. Follow-up telephone interviews were specifically aimed at identifying instances of mantram use, and also participant perceptions of intervention usefulness or nonusefulness.
The outcome measures comprised categorization and comparison of the types and frequency of incidents reported, describing ways that the intervention was "helpful" or "not helpful" in managing stressors of HIV disease.
Participants reported a total of 185 incidents. Analysis and classification of the incidents resulted in eight mutually exclusive categories, including Increasing calm and/or peace, Mastering the technique, Changing my viewpoint, Increasing personal awareness, Adjusting behaviors, Managing physical symptoms, Increasing spirituality, and Enhancing relationships.
This study shows support for the benefits of the mantram intervention for adults with HIV. Additionally, the spiritually based mantram repetition intervention was found to be more helpful in providing a convenient, portable tool for managing a wide range of situations related to living with HIV disease.
The Veterans Health Administration (VHA) sees ≈17,000 human immunodeficiency virus (HIV)-infected patients each year, which makes it the largest provider of HIV care in the United States. HIV causes ...chronic progressive disease that leads to early death. Newer combination antiretroviral treatments are effective but expensive and difficult to use. The HIV Quality Enhancement Research Initiative (HIV-QUERI) uses the QUERI process to identify high-risk and high-volume populations (step 1), which includes those already under VHA care for HIV, those who do not know of their infection, and those at risk for HIV. In identifying best practices (step 2), the HIV-QUERI will benefit greatly from existing guidelines for the care of established HIV infection, but gaps in knowledge regarding adherence to medication regimens and cost-effective screening are large. To identify existing practice patterns (step 3), the HIV-QUERI will develop a clean analytic data set based on Immunology Case Registry files and expand it through a survey of veterans. Interventions to improve care (step 4) will include national, regional, and site-specific feedback on performance relative to quality standards, as well as patient-level and provider-level interventions to improve adherence and support medical decision-making. To document that best practices improve outcomes and quality of life (steps 5 and 6), HIV-QUERI will track indicators on an ongoing basis by use of the Immunology Case Registry database and possible future waves of the survey. In addition, we will require that these issues be addressed in evaluations of HIV-QUERI interventions. In the present article, we present these steps within a framework and plan.
We randomly selected a cohort of human immunodeficiency virus (HIV)-positive patients from a large university-based general medicine practice to determine how often recommended disease prevention ...services are received. We used a standardized medical record review protocol to gather data from the records of 159 randomly selected HIV-positive adults followed in a university general medicine practice. We set 80% as the minimum acceptable rate of receipt of each recommended preventive service. Within three months of initiating HIV care, 88% of patients had CD4+ cell counts. Within six months, 75% had serology for syphilis, 64% had purified protein derivative tuberculin skin tests, 64% had hepatitis B serology, and 49% had pneumococcal vaccinations. Within one year, 33% had influenza vaccinations. Of 50 subjects eligible for Pneumocystis carinii prophylaxis (CD4+ cells < 200/mm3), 88% had started prophylaxis within six months. Of 56 subjects eligible for antiretroviral therapy (CD4+ cells < 500/mm3), 77% had started an antiretroviral within six months. Within one year, 22% of 23 subjects with documented nonimmunity to hepatitis B began hepatitis vaccination; only one subject completed the series of three vaccinations. Many HIV-positive patients did not receive appropriate screening tests for tuberculosis and syphilis or vaccinations for pneumococcal pneumonia, influenza, and hepatitis B. Patients did receive CD4+ cell counts, Pneumocystis carinii prophylaxis, and antiretroviral therapy at acceptable rates.
Optimizing health-related quality of life (HRQOL) is an increasingly important goal in the treatment of HIV/AIDS. Interpretation of HRQOL scores in clinical trials is enhanced by comparative data.
To ...estimate AIDS Clinical Trials Group (ACTG) QOL 601-602 questionnaire scale scores for a nationally representative sample of persons in care for HIV.
The study cohort was from the HIV Cost and Services Utilization Study (HCSUS), a multistage national probability sample. We derived HCSUS HRQOL scale scores from the items shared between the ACTG QOL 601-602 and HCSUS HRQOL questionnaires using regression equations. Cronbach's alpha coefficient was used to estimate the reliability of the multi-item scales in the ACTG QOL 601-602 and HCSUS HRQOL instruments. Correlation Coefficients and R2s of regression models were calculated to determine the concordance of the models. Multiple regression was used to determine if patient characteristics accounted for differences (residuals) between scores observed from the full HCSUS HRQOL instruments and scores predicted using the subset of shared items in ACTG QOL 601-2.
Internal consistency reliability estimates were acceptable (>0.70) for all scales in the ACTG QOL 601-602 and HCSUS HRQOL instruments. Correlations between corresponding ACTG QOL 601-602 and HCSUS HRQOL scale scores were high (>0.9). The R2s for predicting HCSUS HRQOL scores from the ACTG QOL 601-602 scales were also high (>0.8). For physical functioning, emotional well-being, and general health perceptions, the predictors of differences (residuals) in observed and predicted HCSUS HRQOL scores were gender and CDC stage of HIV infection (P < .05).
This study provides normative data from the US HIV/AIDS population for comparison to the ACTG QOL 601-602 questionnaire. Accuracy of estimation is enhanced if done separately by gender and HIV disease stage.
NASA Architecture for Solar System Time Distribution Miller, J.J.; Gifford, A.; Brodsky, B. ...
2007 IEEE International Frequency Control Symposium Joint with the 21st European Frequency and Time Forum
Conference Proceeding
The National Aeronautics and Space Administration (NASA) is developing an architecture for communication, navigation, and time distribution to support the future human exploration of space. ...Foreseeable applications span a wide range of demands for time services, including event logging by robotic and human explorers, networking of cooperative elements on a planetary surface, time transfer for navigation, and time synchronization and correlation for communication and science. This paper describes the key attributes of a flexible approach designed to meet those demands.
DNA-binding transcriptional regulators interpret the genome's regulatory code by binding to specific sequences to induce or repress gene expression. Comparative genomics has recently been used to ...identify potential cis-regulatory sequences within the yeast genome on the basis of phylogenetic conservation, but this information alone does not reveal if or when transcriptional regulators occupy these binding sites. We have constructed an initial map of yeast's transcriptional regulatory code by identifying the sequence elements that are bound by regulators under various conditions and that are conserved among Saccharomyces species. The organization of regulatory elements in promoters and the environment-dependent use of these elements by regulators are discussed. We find that environment-specific use of regulatory elements predicts mechanistic models for the function of a large population of yeast's transcriptional regulators.
The Chesterian (Mississippian) Hartselle Sandstone is a tar sand exposed in the Black Warrior Basin and southern Appalachian fold belt in northern Mississippi and Alabama. Previous studies disagree ...about the delivery direction and relative contributions of sediment from the cratonic interior, the Appalachians, and the Ouachitas. The goal of this research is to investigate lateral trends in sedimentary and geochemical properties to provide new details about the provenance of the Hartselle. Samples were collected along a west-to-east transect and analyzed using petrography, X-ray fluorescence (XRF) geochemistry, and U-Pb detrital zircon (DZ) geochronology. Point counting indicated a major cratonic interior source with a minor recycled orogen signal. Sillimanite in the easternmost sample narrows down the potential Appalachian sources to areas of high-grade metamorphism. Petrographic observations suggest both western and eastern sources. The XRF results showed high concentrations of Ti and Mo in the westernmost sample, suggestive of a nearby terrigenous source. All of the samples had similar U-Pb DZ age distributions except for the easternmost sample, which had statistically higher proportions of Paleozoic- and Archean-aged grains (Kolmogorov-Smirnov test: p < .02). For the first time, Eoarchean and Paleoarchean grains were found in the Hartselle, indicating a likely sediment source from the Minnesota River Valley gneisses of the Superior Craton prior to Grenvillian overprinting. Based on integration of all data, we conclude that a large fluvial system draining the continental interior provided a substantial volume of sediment from the northwest. At the same time, a more dispersed drainage basin associated with the Appalachian front contributed recycled orogenic material from the northeast.
In this study, we discuss the colonial project as an eliminatory structure of indigenous ways of knowing and doing that is built into Canadian social and health institutions. We elaborate on the role ...nursing plays in maintaining systemic racism, marginalization and discrimination of Indigenous Peoples. Based on historical practices and present‐day circumstances, we argue that changing language in research and school curriculums turns decolonization into what Tuck and Yang call a ‘metaphor’. Rather, we propose decolonization as a political project where nurses acknowledge their involvement in colonial harms and disrupt the assumptions that continue to shape how nurses interact with Indigenous people, including knowledge systems that perpetuate colonial interests and privilege. Decolonization requires nurses to understand the colonial practices that led to dispossession of land, erasure of knowledge, culture and identity, while upholding indigenous ways of knowing and doing in health, healing and living. As a political manifesto that liberates indigenous life from oppressive structures of colonialism and capitalism, The Red Deal is presented as a visionary platform for decolonization. The aim of this study is to articulate three dimensions of caretaking within The Red Deal as a framework to decolonize nursing knowledge development and practice. Based on the philosophical dimension embedded in The Red Deal that revoke norms and knowledge assumptions of capitalism that destroy indigenous ways of knowing and doing, we underscore an approach toward decolonizing nursing. Our approach rejects the apolitical nature of nursing as well as the unilateral western scientific knowledge approach to knowledge development and recognition. A critical emancipatory approach that addresses the socio‐political and historical context of health care, recognizes dispossession of land and adopts a ‘multilogical’ vision of knowledge that gives space for representation and voice is needed for true decolonization of nursing.
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