The role of the Indonesian government's internal oversight apparatus (APIP) in guiding and supervising government institutions obliges them to maintain and improve its performance. This paper ...investigates the effect of management support, competence, objectivity, and integrity on the performance of the government's internal oversight apparatus. The tool used in this data processing is SPSS. The results show that support for management, objectivity and integrity have a significant effect on APIP performance, while competition has a non-significant effect on APIP performance. Governments should be involved in supporting APIP performance by creating policies that can improve the management of internal oversight officers.
Abstract
Background
Organ transplantation from donors with human immunodeficiency virus (HIV) to recipients with HIV (HIV D+/R+) presents risks of donor-derived infections. Understanding clinical, ...immunologic, and virologic characteristics of HIV-positive donors is critical for safety.
Methods
We performed a prospective study of donors with HIV-positive and HIV false-positive (FP) test results within the HIV Organ Policy Equity (HOPE) Act in Action studies of HIV D+/R+ transplantation (ClinicalTrials.gov NCT02602262, NCT03500315, and NCT03734393). We compared clinical characteristics in HIV-positive versus FP donors. We measured CD4 T cells, HIV viral load (VL), drug resistance mutations (DRMs), coreceptor tropism, and serum antiretroviral therapy (ART) detection, using mass spectrometry in HIV-positive donors.
Results
Between March 2016 and March 2020, 92 donors (58 HIV positive, 34 FP), representing 98.9% of all US HOPE donors during this period, donated 177 organs (131 kidneys and 46 livers). Each year the number of donors increased. The prevalence of hepatitis B (16% vs 0%), syphilis (16% vs 0%), and cytomegalovirus (CMV; 91% vs 58%) was higher in HIV-positive versus FP donors; the prevalences of hepatitis C viremia were similar (2% vs 6%). Most HIV-positive donors (71%) had a known HIV diagnosis, of whom 90% were prescribed ART and 68% had a VL <400 copies/mL. The median CD4 T-cell count (interquartile range) was 194/µL (77–331/µL), and the median CD4 T-cell percentage was 27.0% (16.8%–36.1%). Major HIV DRMs were detected in 42%, including nonnucleoside reverse-transcriptase inhibitors (33%), integrase strand transfer inhibitors (4%), and multiclass (13%). Serum ART was detected in 46% and matched ART by history.
Conclusion
The use of HIV-positive donor organs is increasing. HIV DRMs are common, yet resistance that would compromise integrase strand transfer inhibitor–based regimens is rare, which is reassuring regarding safety.
Under the HOPE Act, 92 donors (58 human immunodeficiency virus HIV positive, 34 false-positive) donated 177 organs to recipients with HIV. Many donors (64%) were taking antiretrovirals, and although HIV drug resistance was common (42%), multiclass (12%) and integrase strand transfer inhibitor resistance (4%) was rare.
This book offers a multifaceted approach to the world of young adults, everything from Ray Schrocks use of Walter Dean Myers sports stories to discuss race relations and cultural politics to Joyce ...Littons analysis of the highly popular Sisterhood of the Traveling Pants Quartet. The cover illustration is done by Joel Rudinger based on his experiences with the Inuit where he learned many of their legends and myths, resulting in his own excellent work on Sedna, the creation goddess, a story f.
The mapping and sequencing of the human genome promises rapid growth in understanding the genetically influenced mechanisms that underlie human disease. To realize this promise fully, it is necessary ...to relate genetic information to clinical phenotypes. Genetic tissue banking in clinical studies provides opportunities to analyze the genetic contribution to variation in response to treatments. The challenges to progress are likely to come from the complex organizational, social, political, and ethical issues that must be resolved in order to put clinical and DNA bank information together. Concerns about subjects' rights, informed consent, privacy, and ownership of genetic material require attention in the development of DNA banks. In this paper we describe one approach to the solution of these problems that was adopted by one clinical trials group, the Department of Veterans Affairs Cooperative Studies Program.
Accumulation of aminoglycoside antibiotics by bacteria requires energy, and it appears that this must be derived from electron transport occurring within the cytoplasmic membrane. Dependence of ...aminoglycoside accumulation on cellular menaquinone content was examined using a menaquinone auxotroph of bacillus subtilis. This dependence manifested itself only when the menaquinone concentration was decreased to less than 10% of normal. The restricted aminoglycoside accumulation observed under these conditions was closely correlated with susceptibility to growth inhibition by the antibiotics. Evidence of saturation of the accumulation system was observed at low menaquinone concentrations, an effect not seen when menaquinone deficiency was relieved by supplying adequate shikimic acid (a menaquinone precursor) to the auxotroph. Lipophilic quinones may play two roles in aminoglycoside accumulation by bacteria: (i) as a binding site or part of a carrier complex: and (ii) as a crucial component of the electron transport system in maintaining the proton electrochemical gradient.
A system of tort law reform is proposed to deal with the problems caused by the current system, which is a very expensive and unfair method of compensating victims. Under the plan, the first 6 months ...of earnings loss for short-term disabilities would be dealt with by a mandatory employer-provided sick leave and a statewide disability insurance plan. Only short-term injuries involving serious disfigurement or impairment would be actionable. Long-term disabilities still would be covered by tort and/or workers compensation systems. Tort law no longer would duplicate benefits provided by other sources, and punitive damages and awards for pain and suffering would be curtailed. Successful plaintiffs would be able to recover attorneys' fees from defendants and would not see their awards reduced because they were at fault. In addition, judges would be responsible for determining the propriety of punitive damages. The other authors comment, generally unfavorably, on the proposals.
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