HIV-related stigmatization remains a potent stressor for HIV-positive people. This study examined the relationships among stigma-related experiences and depression, medication adherence, serostatus ...disclosure, and sexual risk among 221 HIV-positive men and women. In bivariate analyses that controlled for background characteristics, stigma was associated with depressive symptoms, receiving recent psychiatric care, and greater HIV-related symptoms. Stigma was also associated with poorer adherence and more frequent serostatus disclosure to people other than sexual partners, but showed no association to sexual risk behavior. In a multivariate analysis that controlled for all correlates, depression, poor adherence, and serostatus disclosure remained as independent correlates of stigma-related experiences. Findings confirm that stigma is associated with psychological adjustment and adherence difficulties and is experienced more commonly among people who disclose their HIV status to a broad range of social contacts. Stigma should be addressed in stress management, health promotion, and medication adherence interventions for HIV-positive people.
Abstract Purpose To develop and validate a highly efficient motion compensated free‐breathing isotropic resolution 3D whole‐heart joint T 1 /T 2 mapping sequence with anatomical water/fat imaging at ...0.55 T. Methods The proposed sequence takes advantage of shorter T 1 at 0.55 T to acquire three interleaved water/fat volumes with inversion‐recovery preparation, no preparation, and T 2 preparation, respectively. Image navigators were used to facilitate nonrigid motion‐compensated image reconstruction. T 1 and T 2 maps were jointly calculated by a dictionary matching method. Validations were performed with simulation, phantom, and in vivo experiments on 10 healthy volunteers and 1 patient. The performance of the proposed sequence was compared with conventional 2D mapping sequences including modified Look‐Locker inversion recovery and T 2 ‐prepared balanced steady‐SSFP sequence. Results The proposed sequence has a good T 1 and T 2 encoding sensitivity in simulation, and excellent agreement with spin‐echo reference T 1 and T 2 values was observed in a standardized T 1 /T 2 phantom ( R 2 = 0.99). In vivo experiments provided good‐quality co‐registered 3D whole‐heart T 1 and T 2 maps with 2‐mm isotropic resolution in a short scan time of about 7 min. For healthy volunteers, left‐ventricle T 1 mean and SD measured by the proposed sequence were both comparable with those of modified Look‐Locker inversion recovery (640 ± 35 vs. 630 ± 25 ms p = 0.44 and 49.9 ± 9.3 vs. 54.4 ± 20.5 ms p = 0.42), whereas left‐ventricle T 2 mean and SD measured by the proposed sequence were both slightly lower than those of T 2 ‐prepared balanced SSFP (53.8 ± 5.5 vs. 58.6 ± 3.3 ms p < 0.01 and 5.2 ± 0.9 vs. 6.1 ± 0.8 ms p = 0.03). Myocardial T 1 and T 2 in the patient measured by the proposed sequence were in good agreement with conventional 2D sequences and late gadolinium enhancement. Conclusion The proposed sequence simultaneously acquires 3D whole‐heart T 1 and T 2 mapping with anatomical water/fat imaging at 0.55 T in a fast and efficient 7‐min scan. Further investigation in patients with cardiovascular disease is now warranted.
PurposeTo develop and validate a highly efficient motion compensated free‐breathing isotropic resolution 3D whole‐heart joint T1/T2 mapping sequence with anatomical water/fat imaging at 0.55 ...T.MethodsThe proposed sequence takes advantage of shorter T1 at 0.55 T to acquire three interleaved water/fat volumes with inversion‐recovery preparation, no preparation, and T2 preparation, respectively. Image navigators were used to facilitate nonrigid motion‐compensated image reconstruction. T1 and T2 maps were jointly calculated by a dictionary matching method. Validations were performed with simulation, phantom, and in vivo experiments on 10 healthy volunteers and 1 patient. The performance of the proposed sequence was compared with conventional 2D mapping sequences including modified Look‐Locker inversion recovery and T2‐prepared balanced steady‐SSFP sequence.ResultsThe proposed sequence has a good T1 and T2 encoding sensitivity in simulation, and excellent agreement with spin‐echo reference T1 and T2 values was observed in a standardized T1/T2 phantom (R2 = 0.99). In vivo experiments provided good‐quality co‐registered 3D whole‐heart T1 and T2 maps with 2‐mm isotropic resolution in a short scan time of about 7 min. For healthy volunteers, left‐ventricle T1 mean and SD measured by the proposed sequence were both comparable with those of modified Look‐Locker inversion recovery (640 ± 35 vs. 630 ± 25 ms p = 0.44 and 49.9 ± 9.3 vs. 54.4 ± 20.5 ms p = 0.42), whereas left‐ventricle T2 mean and SD measured by the proposed sequence were both slightly lower than those of T2‐prepared balanced SSFP (53.8 ± 5.5 vs. 58.6 ± 3.3 ms p < 0.01 and 5.2 ± 0.9 vs. 6.1 ± 0.8 ms p = 0.03). Myocardial T1 and T2 in the patient measured by the proposed sequence were in good agreement with conventional 2D sequences and late gadolinium enhancement.ConclusionThe proposed sequence simultaneously acquires 3D whole‐heart T1 and T2 mapping with anatomical water/fat imaging at 0.55 T in a fast and efficient 7‐min scan. Further investigation in patients with cardiovascular disease is now warranted.
Australian spiny mountain crayfish (Euastacus, Parastacidae) and their ecotosymbiotic temnocephalan flatworms (Temnocephalida, Platyhelminthes) may have co-occurred and interacted through deep time, ...during a period of major environmental change. Therefore, reconstructing the history of their association is of evolutionary, ecological, and conservation significance. Here, time-calibrated Bayesian phylogenies of Euastacus species and their temnocephalans (Temnohaswellia and Temnosewellia) indicate near-synchronous diversifications from the Cretaceous. Statistically significant cophylogeny correlations between associated clades suggest linked evolutionary histories. However, there is a stronger signal of codivergence and greater host specificity in Temnosewellia, which co-occurs with Euastacus across its range. Phylogeography and analyses of evolutionary distinctiveness (ED) suggest that regional differences in the impact of climate warming and drying had major effects both on crayfish and associated temnocephalans. In particular, Euastacus and Temnosewellia show strong latitudinal gradients in ED and, conversely, in geographical range size, with the most distinctive, northern lineages facing the greatest risk of extinction. Therefore, environmental change has, in some cases, strengthened ecological and evolutionary associations, leaving host-specific temnocephalans vulnerable to coextinction with endangered hosts. Consequently, the extinction of all Euastacus species currently endangered (75%) predicts coextinction of approximately 60% of the studied temnocephalans, with greatest loss of the most evolutionarily distinctive lineages.
Study question How effective is supported computerised cognitive behaviour therapy (cCBT) as an adjunct to usual primary care for adults with depression?Methods This was a pragmatic, multicentre, ...three arm, parallel randomised controlled trial with simple randomisation. Treatment allocation was not blinded. Participants were adults with symptoms of depression (score ≥10 on nine item patient health questionnaire, PHQ-9) who were randomised to receive a commercially produced cCBT programme (“Beating the Blues”) or a free to use cCBT programme (MoodGYM) in addition to usual GP care. Participants were supported and encouraged to complete the programme via weekly telephone calls. Control participants were offered usual GP care, with no constraints on the range of treatments that could be accessed. The primary outcome was severity of depression assessed with the PHQ-9 at four months. Secondary outcomes included health related quality of life (measured by SF-36) and psychological wellbeing (measured by CORE-OM) at four, 12, and 24 months and depression at 12 and 24 months.Study answer and limitations Participants offered commercial or free to use cCBT experienced no additional improvement in depression compared with usual GP care at four months (odds ratio 1.19 (95% confidence interval 0.75 to 1.88) for Beating the Blues v usual GP care; 0.98 (0.62 to 1.56) for MoodGYM v usual GP care). There was no evidence of an overall difference between either programme compared with usual GP care (0.99 (0.57 to 1.70) and 0.68 (0.42 to 1.10), respectively) at any time point. Commercially provided cCBT conferred no additional benefit over free to use cCBT or usual GP care at any follow-up point. Uptake and use of cCBT was low, despite regular telephone support. Nearly a quarter of participants (24%) had dropped out by four months. The study did not have enough power to detect small differences so these cannot be ruled out. Findings cannot be generalised to cCBT offered with a much higher level of guidance and support. What this study adds Supported cCBT does not substantially improve depression outcomes compared with usual GP care alone. In this study, neither a commercially available nor free to use computerised CBT intervention was superior to usual GP care.Funding, competing interests, data sharing Commissioned and funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project No 06/43/05). The authors have no competing interests. Requests for patient level data will be considered by the REEACT trial management groupTrial registration Current Controlled Trials ISRCTN91947481.
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