bluuebunny/crossref_metadata_2025 huggingface dataset:
Providing Crisis Counseling to New Yorkers after the Terrorist Attack on the World Trade Center
Authors: Jordan Karin
Published: May 2005

This article provides an overview of two crisis intervention techniques used by a marriage and family counselor who served as a crisis counselor in New York City after the September 11th terrorist attack. The intervention techniques described are Critical Incident Stress Debriefing and one-on-one crisis counseling. An overview of both techniques as well as the actual application are described.
The Mother-Adult Daughter Questionnaire (MAD): Developing a Culturally Sensitive Instrument
Authors: Rastogi Mudita
Published: May 2005

This article is an account of the development of the Mother-Adult Daughter Questionnaire (MAD) to measure adult daughters’ perceptions of their relationship with their mothers in a culturally sensitive manner. The MAD was administered to 91 women from three ethnic groups (Asian Indian American, Mexican American, and European American) to establish validity. The instrument contains 18 items and three subscales: Connectedness, Interdependence, and Trust in Hierarchy. Trust in Hierarchy is a newly developed culturally sensitive construct. Items for subscales were constructed using cross-cultural and mother-daughter literature and were refined after an initial pilot study. Subscale reliability (alpha) ranged from .86 to .92. Findings indicate that the MAD has promise as a reliable and valid measure of the mother-daughter relationship across cultures.
Multiple Family Group Therapy: An Interpersonal/Postmodern Approach
Authors: Thorngren Jill M. , Kleist David M.
Published: May 2005

Multiple Family Group Therapy has been identified as a viable treatment model for a variety of client populations. A combination of family systems theories and therapeutic group factors provide the opportunity to explore multiple levels of intrapersonal and interpersonal relationships between families. All group members are afforded the opportunity of both giving and receiving feedback about strengthening their own family ties. This article depicts a Multiple Family Group Therapy model based on interpersonal and postmodern theories of therapy. A theoretical base is provided in conjunction with descriptions of weekly activities.
Family Therapy in a Women’s Group: Integrating Marriage and Family Therapy and Group Therapy
Authors: Getz Hildy G.
Published: May 2005

This article describes how a family therapy perspective can be integrated into group as a treatment modality. This conceptual approach offers new possibilities for marriage and family therapists when women alone seek help. Concepts from family therapy are illustrated through a description of a specific women’s group and case study. Techniques from family therapy applied in group are derived from multigenerational, experiential/humanistic, and cognitive-behavioral approaches. Among them are the genogram, sculpting, role playing, reframing, and reconstructing the story. This integrative approach makes the process described available to therapists of many orientations. Similarly, the group therapy modality can have a great impact on family treatment.
Sexual Information and Internet Resources
Authors: Millner Vaughn S. , Kiser Jerry D.
Published: May 2005

Internet Web pages providing sexual information are prolific. Finding factual, relevant sexual information responsibly written can be an arduous task for the public and counselors. This article contains an annotated “webliography” containing Internet addresses and descriptions of pertinent Internet sexuality resources for the general public, adolescents, young adults, and older adults. Internet addresses for mental health professionals interested in working with sexual issues are provided as well as Web sites that contain Internet screening information.
Screening ADHD Problems in the Sports Behavior Checklist: Factor Structure, Convergent and Divergent Validity, and Group Differences
Authors: Clendenin Aaron A. , Businelle Michael S. , Kelley Mary Lou
Published: May 2005

The Sports Behavior Checklist (SBC) is subjected to a principal components analysis, and subscales are correlated with subscales of the Conners’ Revised Parent Form and the Social Skills Rating System. Both of these analyses are conducted to determine the construct validity of the instrument. A subsample of lower socioeconomic status individuals is used to compare ADHD and control group differences on the subscales of the SBC. The authors find that a six-factor solution, as proposed by the original authors, accounted for 71.5% of the variance. As hypothesized, subscales on the SBC are low to moderately related to subscales on the anchor measures. Significant group differences are found on the Aggression, Emotional Reactivity, and Injury subscales. Implications and limitations are discussed.
Training Raters to Assess Adult ADHD: Reliability of Ratings
Authors: Adler Lenard A. , Spencer Thomas , Faraone Stephen V. , Reimherr Fred W. , Kelsey Douglas , Michelson David , Biederman Joseph
Published: May 2005

The standardization of ADHD ratings in adults is important given their differing symptom presentation. The authors investigated the agreement and reliability of rater standardization in a large-scale trial of atomoxetine in adults with ADHD. Training of 91 raters for the investigator-administered ADHD Rating Scale (ADHDRS-IV-Inv) occurred prior to initiation of a large, 31-site atomoxetine trial. Agreement between raters on total scores was established in two ways: (a) by Kappa coefficient (rater agreement for each item with the percentage of raters that had identical item-by-item scores) and (b) intraclass correlation coefficients (reliability). For the ADHDRS-IV-Inv, rater agreement was moderate, and reliability, as measured by Cronbach’s alpha, was substantial. The data indicate that clinicians can be trained to reliably evaluate ADHD in adults using the ADHDRS-IV-Inv.
An Exploration Into the Creative Abilities of Children With ADHD
Authors: Healey Dione , Rucklidge Julia J.
Published: May 2005

The purpose of this study is to explore whether ADHD is associated with high creative ability. Sixty-seven children, ages 10 to 12 (33 ADHD and 34 controls) completed the Torrance Tests of Creative Thinking (TTCT), Maier’s Two-String Problem, and the Block Design and Vocabulary subsets of the Wechsler Intelligence Scale for Children (WISC-III). The results show that there is no significant difference between the ADHD group’s and control group’s performance on either the TTCT, Maier’s Two-String Problem, or WISC-III, suggesting that children diagnosed with ADHD are no more creative than children without the diagnosis.
Social Rejection and ADHD in Young Adults: An Analogue Experiment
Authors: Paulson James F. , Buermeyer Curt , Nelson-Gray Rosemery O.
Published: May 2005

Poor outcomes in ADHD may be related to problematic social functioning and consequences of social rejection. This study examines how ADHD symptom expression affects mood and social rejection. Working from findings in depression that describe maintenance through negative interpersonal interactions, the authors seek to examine this theory’s applicability to poor outcomes in ADHD. In a completely randomized design, 130 participants are exposed to one of several videotape segments that include displays of ADHD, depression, and social anxiety. A normal control is also used. All abnormal videotapes are met with greater rejection than the control. Displays of ADHD elicit similar levels of rejection to those elicited by displays of depression. Additionally, ADHD elicits greater levels of hostile mood, whereas depression elicits high levels of depression and fatigue. Implications for an interpersonal theory of vulnerability in ADHD are discussed along with implications for future research, prevention, and intervention.
Reexamining the Familial Association Between Asthma and ADHD in Girls
Authors: Hammerness Paul , Monuteaux Michael C. , Faraone Stephen V. , Gallo Lauren , Murphy Heather , Biederman Joseph
Published: May 2005

The objective of this study is to further evaluate the association between asthma and ADHD, addressing issues of familiality in female probands. A case control study of referred ADHD proband girls, controls, and relatives are used. Participants include 140 ADHD proband girls and 122 non-ADHD comparisons, with 417 and 369 first-degree biological relatives, respectively. Relatives are stratified into four groups according to proband ADHD and asthma status. The authors compare rates of asthma and ADHD in relatives. ADHD does not increase the risk for asthma in probands. Patterns of familial aggregation are mostly consistent with independent transmission of ADHD and asthma in families of girl probands. The results extend to female probands’ previously reported findings that asthma and ADHD are independently transmitted in families. These findings further support the conclusion that ADHD symptoms should not be dismissed as part of asthma symptomatology or a consequence of its treatment.
Self-Regulation and Inhibition in Comorbid ADHD Children: An Evaluation of Executive Functions
Authors: Sarkis Stephanie Moulton , Sarkis Elias H. , Marshall David , Archer James
Published: May 2005

The relationship between executive function and comorbid diagnoses in ADHD children is examined. One hundred six children between 7 and 15 years of age are assessed using the Tower of London (TOL), a test of executive function, and the Kiddie Schedule of Affective Disorders and Schizophrenia, Present and Lifetime Version, a diagnostic interview. All children met the diagnostic criteria for ADHD. A majority of the children had comorbid anxiety disorders, mood disorders, or oppositional defiant disorder. Measures on the TOL are total move score, total initiation time, and total rule violations. Age is predictive in all three measures of executive function as assessed by the TOL. Gender is predictive of total initiation time and total rule violations. Comorbid disorders are found to not have significance on executive function as measured by the TOL. This study concludes that comorbid disorders may not affect executive function
Adjustment, Social Skills, and Self-Esteem in College Students With Symptoms of ADHD
Authors: Shaw-Zirt Barbara , Popali-Lehane Leelawatte , Chaplin William , Bergman Andrea
Published: May 2005

Many studies of ADHD have shown that the problems associated with the disorder continue into adolescence and beyond for 10% to 60% of patients. The present study assesses several aspects of college adjustment, social skills, and self-esteem in a nonreferred sample of college students meeting criteria for a Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of ADHD. Twenty-one undergraduate students with symptoms of ADHD are compared to 20 students without significant ADHD symptoms, who match the ADHD students on age, gender, and grade point average. Students with ADHD symptoms show decreased functioning in several areas of college adjustment as well as lower levels of self-reported social skills and self-esteem. The results also suggest that the relation between ADHD and college adjustment is partially mediated by self-reported levels of self-esteem.
The development of a destination through the image assessment of six geographic markets
Authors: Obenour William , Lengfelder Julie , Groves David
Published: May 2005

The purposes of this study are to assess the image of a newly developed nature-based tourist destination and investigate the influence of distance on the image of the destination. The image was assessed on a seven-point Likert scale and the sampling comprised six dominant market areas (DMAs) that were various distances from the nature-based destination. The internet survey resulted in 610 respondents and a 45 per cent response rate of the log-in panelists. The analysis used analysis of variance (ANOVA) to compare the information sources, positioning, and the 28 image attributes with the DMAs, and the image attributes were used in a discriminant analysis. The analysis indicated that not all nearby and long-distance geographic markets are uniform. On-site visitation apparently was a factor in creating complex perceptions of the image of the destination. A differentiated message that is cost-effective should be pursed with individual DMAs and clusters of DMAs.
Foot-and-mouth disease: A scenario of reoccurrence for Scotland’s tourism industry
Authors: Yeoman Ian , Lennon J. John , Black Lynn
Published: May 2005

This paper considers how a future outbreak of foot-and-mouth disease (FMD) would be treated and considers the potential reaction by government agencies with particular reference to communication and the management of crises within the tourism sectors. Lessons and experience are drawn from the outbreak of FMD in Scotland in 2001 and reoccurrences in other parts of the world. Two potential scenarios are considered, namely a ‘suspected case’ and a ‘confirmed case’, and the likely consequences of both for the tourism industry of Scotland and the UK are considered.
Update on Didanosine
Authors: Cooper David A.
Published: May 2005

Didanosine (ddI) has been a cornerstone of HIV management since it was made available in October 1991. Didanosine was originally introduced as an alternative to zidovudine (ZDV) for patients who were intolerant of ZDV or experienced disease progression during ZDV monotherapy. Didanosine is now used extensively as an integral component of multidrug combination regimens in both adults and children with HIV infection, and is now available for once-daily administration in the United States, Canada, and Europe. The recently approved Videx® EC is an enteric-coated didanosine capsule dosed as one capsule, once daily.

This paper provides an update of recently published studies on the use of ddI in combination anti-HIV therapy. In particular, these studies examine the rationale for the use of ddI as first-line anti-HIV therapy, and describe newer findings concerning its long-term efficacy, side effects, compliance, resistance, and once-daily use. The increased survival of HIV-infected patients is largely attributed to the introduction of the triple combination drug therapy but is probably also due to the long-term clinical efficacy of ddI.
Hospitalization in HIV in Chicago
Authors: Sherer Renslow , Pulvirenti Joseph , Stieglitz Kim , Narra Jyothi , Jasek John , Green Lynn , Moore Billie , Shott Susan , Cohen Mardge
Published: May 2005

Background: Reduction in HIV-related morbidity and mortality in the highly active antiretroviral therapy (HAART) era has been unevenly distributed in the United States, and its impact on hospitalizations in urban minority populations in the public sector has been poorly characterized.

Methods: We conducted a retrospective analysis of clinical and administrative data sets of an urban public hospital HIV clinic from 1997 and 1998 to identify the correlates of hospitalization early in the HAART era.

Results: 2,647 unduplicated HIV-infected patients were seen in 1997 and 1998 at the CORE Center. There were 31.7 percent women, 71 percent African-Americans and 12 percent Hispanics, and the mean age was 38 years. Men who had sex with men (MSM), injection drug users (IDU), and heterosexuals each made up one third of the population. A majority of the patients had no health insurance, and 27 percent had Medicaid. The median CD4 T cell count was 266 cells/μL, and the median viral load was 1,901 copies/ml. Hospitalizations declined significantly from 1997 (1,579) to 1998 (1,160). Admissions were confined to 25 percent of clinic patients, and 16 patients (range 8-15) had eight or more admissions. African-Americans and Hispanics had significantly more and longer hospitalizations than whites, but there was no difference by gender. IDUs had significantly more admissions than non-IDUs (28 percent vs. 21 percent respectively). On multivariate analysis, lower CD4 T cell count and higher viral load predicted risk of admission in all periods. Unexpectedly, hospitalization rates were high in patients in the highest baseline CD4 T cell stratum, >500 cells/ml (45 of 353, 13 percent), and lowest viral load stratum, <500 copies/ml (103 of 675, 15 percent), and rose from 1997 to 1998. HAART (ie, 1 or 2 drug regimens) predicted fewer hospitalizations compared to 1 or 2 drug regimens. In a subset of patients who filled prescriptions on site, HAART increased from 72 percent to 85 percent and 1-2 drug regimens fell from 28 percent to 15 percent from 1997 to 1998. Regular care was associated with more frequent hospitalization and more hospital days per admission than no regular care. Hospitalized patients had significantly higher mortality than patients not hospitalized (12 percent vs. 2 percent respectively).

Conclusion: HIV-related hospitalizations were frequent in the HAART era and decreased over time. Older age, lack of HAART, lower CD4 T cell count, higher viral load, and minority race predicted hospitalization, while gender did not. However, patients with extremely favorable CD4 T cell and viral load counts also had higher than expected hospitalization rates. Three quarters of patients had no hospitalizations, and clustering of hospitalizations in a small number of patients may enable targeted programs to reduce recidivism.
Justice and HIV Care in Africa—Antiretrovirals in Perspective
Authors: Houston Stan
Published: May 2005

The immense burden of HIV disease in sub-Saharan Africa has focused international interest on HIV care, especially on the lack of access to antiretroviral therapy (ART).

Difficulties in implementing ART in Africa include drug costs, adequate long-term funding sources, assurance of drug quality, and rapid development of the human resources and healthcare infrastructure needed to deliver ART.

Important questions requiring study are the minimum level of laboratory monitoring and clinical support consistent with good treatment outcomes, the impact of antiretroviral drug resistance on treated individuals and communities, and the effect of ART on transmission at a community level.

There are some concerns and risks. First, a focus on treatment could compromise the commitment of individuals to risk-reduction, and of governments to prevention. Second, health equity could be reduced, by diverting scarce public funds from basic care for the poorest, to costly disease-suppressive care for a small and probably elite group.

In conclusion, while prevention must be the first priority, care is also essential. The vast prevailing economic inequity between the world’s rich and poor is the fundamental determinant of inequities in health and healthcare, including care for HIV. The global community of health-care workers must focus its substantial influence on changing political and economic policies that foster injustice and AIDS.
A Clinical Review of Micronutrients in HIV Infection
Authors: Singhal Neera , Austin James
Published: May 2005

This article reviews current literature on the role of micronutrients in human immunodeficiency virus (HIV) infection. Deficiencies of micronutrients are common in HIV-infected persons. They occur due to malabsorption, altered metabolism, gut infection, and altered gut barrier function. There is a compelling association of deficiencies of micronutrients in HIV-infection with immune deficiency, rapid disease progression, and mortality. Also, there is increased risk of vertical HIV transmission from mother to child with deficiency of vitamin A, and of neurological impairment with vitamin B12. The last five years have been exciting in micronutrient research, and there is promise that some micronutrients may be key factors in maintaining health in HIV immunodeficiency, and in reducing mortality. Selenium appears important in reducing virulence of HIV and slowing disease progression. Vitamin A supplementation in pregnant women with HIV may reduce maternal mortality and improve birth outcomes. Supplementation in children with HIV may accelerate growth. Carotenoid supplementation is being evaluated. Vitamin B12 may slow HIV immune deficiency disease progression, and reverse neurological compromise. Clinical benefit of supplementation with some micronutrients may be measurable in the presence of pre-existing deficiency. Apart from improved general nutrition, the impact of micronutrient supplements on health and their optimal use in HIV infection is controversial because there are so few controlled clinical trials. Further research is needed to elucidate the role of micronutrient deficiencies on the course of HIV infection, and the preventive and therapeutic role of supplementation in its clinical management. Nevertheless, current knowledge supports the use of routine multivitamin and trace element supplementation as adjuvant to conventional antiretroviral drug treatment as a relatively low-cost intervention.
Clinical Correlates to Muscle Biopsy Findings in HIV Patients Experiencing Fatigue: A case series
Authors: Zell Steven C. , Nielsen Surl
Published: May 2005

Muscular fatigue may result from HIV infection, and may be associated with antiretroviral drug treatment. Clinical features linked to muscle biopsy findings may assist in determining etiology, and guide treatment decisions.

This case series examined HIV patients in an ambulatory HIV clinic who received antiretroviral therapy, and complained of unexplained muscular fatigue. Clinical features with measurement of acid-base status, levels of lactate, aminotransferases, triglycerides and creatine kinase were correlated to light and electron microscopic results of muscle biopsy.

Three patients with acquired mitochondrial changes on biopsy shared common features of lactatemia, elevated aminotransferases and triglycerides, and ultrasonographic hepatic steatosis. A fourth patient with normal mitochondria had myositis with fibrosis, but no systemic symptoms. Biochemical parameters were unremarkable, except for a high creatine kinase.

Acquired mitochondrial disease may manifest as systemic illness and muscular fatigue. Unique metabolic changes and other organ dysfunction may precede overt physical signs of HIV myopathy.
Can Structured Treatment Interruptions (STIs) Be Used as a Strategy to Decrease Total Drug Requirements and Toxicity in HIV Infection?
Authors: Walmsley Sharon , Loutfy Mona
Published: May 2005

Structured treatment interruptions (STIs) are a new strategy under investigation in clinical trials involving a number of different HIV-infected populations. These populations include patients with prolonged HIV RNA suppression who were treated in either seroconversion or later in disease, and patients with virologic failure despite HAART, prior to the initiation of a salvage regimen. The goals of STI vary in each of these groups. Until the results of clinical trials are available, the use of STIs must be considered experimental. There are a number of potential risks, including the loss of a significant number of CD4 cells with the development of opportunistic infections, rebound of HIV RNA, emergence of drug resistance, and reseeding of viral reservoirs. However, STIs also hold the promise for decreasing antiretroviral drug burden and toxicity, and improving quality of life. Given that much of the world’s population infected with HIV does not have access to continuous HAART, the development of strategies that could decrease overall drug burden and cost is important.

This paper provides an update of the recently published and presented studies on the use of STIs in various populations of HIV-infected patients. In particular, it discusses what is known and unknown about the relative risks and benefits of this approach, and what studies are ongoing. Lastly, it identifies how the use of STIs could decrease drug burden and toxicity in patients receiving therapy.
CNS Cryptococcoma in an HIV-Positive Patient
Authors: Troncoso Alcides , Fumagalli Julio , Shinzato Ruben , Gulotta Héctor , Toller Marcela , Bava Javier
Published: May 2005

This is the first case of brain cryptococcoma in an AIDS patient reported in Argentina. The patient was a 28-year-old white heterosexual man with AIDS who presented with altered mental status, seizures, visual hallucinations, headache, and fever without significant focal neurological deficit. He had a lumbar puncture, and was treated for cryptococcal meningitis. Subsequent brain CT scanning and MRI disclosed a mass lesion in the occipital lobe. Histopathological examination of biopsy was compatible with cryptococcoma, and tissue culture revealed Cryptococcus neoformans. Resolution of the mass and edema resulted after treatment with intravenous amphotericin B for six weeks, which was followed with maintenance oral fluconazole.

Intracranial mass is an uncommon complication in AIDS patients with cryptococcosis, and cryptococcoma should be considered as differential diagnosis of brain mass lesion in these patients. The etiologic diagnosis is necessary because central nervous system (CNS) toxoplasmosis, lymphoma, and tuberculoma can produce similar clinical syndromes and MRI or CT findings to cryptococcoma. Also, these pathologies may coexist with meningeal cryptococcosis.
The Significance of HIV Viral Load Assay Precision: A Review of the Package Insert Specifications of Two Commercial Kits
Authors: Chernoff David N.
Published: May 2005

Quantification of HIV-1 RNA levels is a vital tool in the medical management of individuals infected with HIV. The commercially available US Federal Drug Administration (FDA)-approved assays vary in their ability to accurately measure and detect significant changes in plasma viral load. A more precise assay can accurately distinguish true clinically significant biologic changes in viral plasma load from background noise, or systematic variation. These differences in precision between assays are profound at low, near-cutoff levels, but also occur throughout the dynamic range of the assays. This review examines the precision specifications, expressed as fold changes in test and retesting, across the dynamic ranges of the Bayer Versant bDNA assay, and the two available versions of the Roche Amplicor Monitor PCR assays. Highly validated data from their respective package inserts are analyzed to confirm each assay’s performance throughout its dynamic range. The precision of a viral load assay is critical to patient management, and gives the clinician a clearer picture of the patient’s true virologic status that is attributable to infection or treatment as opposed to systematic variation in assays.
Once-daily antiretroviral therapies for HIV infection: Consensus statement of an Advisory Committee of the International Association of Physicians in AIDS Care
Authors: Cohen Calvin , Elion Richard A. , Frank Ian , Kloser Patricia , Sherer Renslow , Squires Kathleen E. , Steinhart Corklin , Tebas Pablo
Published: May 2005

Objective: Adherence is essential to successful virologic outcome of highly active antiretroviral therapy (HAART). Documented factors contributing to poor adherence include toxicity, food requirements, and pill burden. Once-daily antiretroviral therapies for HIV infection offer potential benefit by decreasing pill burden and dosing frequency, which may subsequently improve treatment adherence. This Consensus Statement is intended to offer guidance to physicians actively involved in HIV/AIDS care.

Participants: Eight physicians with expertise in HIV medicine were invited by the International Association of Physicians in AIDS Care (IAPAC) to serve on an ad hoc Advisory Committee.

Consensus process: IAPAC convened the Advisory Committee in June 2002 to develop a draft Consensus Statement. Scientific and clinical research, and other data in published literature and abstracts from scientific conferences were considered by strength of evidence. A Subcommittee updated the Consensus Statement in October 2002 to reflect relevant data presented at the XIV International AIDS Conference and the 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy. This document represents consensus agreement of the Advisory Committee.

Conflict of interest disclosure: The International Association of Physicians in AIDS Care sponsored and coordinated the development of this Consensus Statement with an unrestricted educational grant from Bristol-Myers Squibb. The opinions expressed in this Consensus Statement represent only those of the Advisory Committee.
Early Factors in Successful Anti-HIV Treatment
Authors: Piliero Peter J.
Published: May 2005

Rapid suppression of plasma HIV RNA and sustained increase in CD4 cell count following highly active antiretroviral therapy (HAART) regimens can be prognostic indicators of long-term virologic treatment success. Routine measurement of plasma HIV RNA levels (viral load or VL) at four and eight or 12 weeks is recommended after initiating treatment because favorable changes are predictive of durable success at six months and longer. Early favorable response of VL, as soon as six days after HAART initiation, can signify that the patient is initially adherent to treatment, which is necessary in the long term for a successful regimen. Early favorable response is also an indicator of adequate pharmacokinetic profile and potent antiviral activity of the drug regimen. It also can indicate that the predominant HIV strain infecting the patient is sensitive to the treatment regimen. These factors of adherence, drug levels, potency, and susceptibility favor a long-term durable response. Evaluation of early treatment responses may create the opportunity to promptly change the HAART regimen in the event of an anticipated long-term failure, delaying or preventing the evolution of drug resistance, and improving the effectiveness of treatment overall.
Ethics and the AIDS Pandemic in the Developing World
Authors: Ahn Mark J. , Grimwood Ashraf , Schwarzwald Heidi , Herman Allen
Published: May 2005

Traditional ethics provide insight, but often fall short of guiding the complex biomedical ethical concerns of research conducted in developing countries. The need to create research within a framework that is appropriate to the social, medical, and political context of developing countries is examined through the current AIDS pandemic in sub-Saharan Africa. A specific case study focuses on this issue.
Pre-Exposure Chemoprophylaxis (PREP) as an HIV Prevention Strategy
Authors: Youle Mike , Wainberg Mark A.
Published: May 2005

Chemoprophylaxis may be a prevention strategy for the sexual transmission of human immunodeficiency virus (HIV). Evidence suggests that condom use has waned with the availability of antiretroviral medication, at least in some resource-rich settings. Barrier methods of HIV prevention have inherent problems, and the potential for failure. Microbicide research has focused primarily on male-to-female transmission. Analogous to post-exposure prophylaxis, HIV prevention may be achieved by pre-exposure prophylaxis in some settings. Research in this potential strategy may be rewarding.
Tuberculosis and HIV: A Partnership Against the Most Vulnerable
Authors: Cahn Pedro , Perez Hector , Ben Graciela , Ochoa Claudia
Published: May 2005

Tuberculosis (TB) is a major cause of morbidity and mortality worldwide. Each year, there are eight million new Mycobacterium tuberculosis complex (MTB) infections and three million TB-related deaths. The catastrophic effects of TB are borne disproportionately among the most vulnerable. The HIV pandemic has further increased the burden so that the risk of TB reactivation from latency is 5 to 15 percent in HIV/TB coinfection. Tuberculosis reactivation fuels further primary infections, creating a vicious cycle of increasing infection, disease, and deaths. In addition, drug-resistant TB exacerbates this increasingly common problem.

The clinical presentations of TB in relation to HIV and HIV-associated immune deficiency are discussed from the perspective of clinical diagnosis and treatment in patient care. Tuberculosis prophylaxis, concurrent drug treatment of TB and HIV, drug interactions, and overlapping toxicities are detailed for the practitioner. Immune reconstitution inflammatory reactions are now a common phenomenon in HIV treatment, where similar reactions have been less commonly described in TB treatment in the past.

Global distributive injustices in wealth, the burden of disease, and the provision of healthcare are obvious in TB, and clearly show us that the needs of the most vulnerable populations must be met in order to address the problems.
Jewish Religious Ethics Mandate Access to Antiretroviral Drugs in Developing Countries
Authors: Spira Shalom C. , Wainberg Mark A.
Published: May 2005

The plight of millions of HIV-infected individuals without access to antiretroviral (ARV) medications constitutes an enormous problem. Religious values can influence policymakers in public and personal health issues. This article posits that Jewish religious law mandates the broadest possible access to ARV medications for HIV-infected individuals, and argues that wealthy countries must assist poorer ones to facilitate access.
Actual Medication Pill Burden and Dosing Frequency in HIV-infected Patients with Undetectable Viral Loads
Authors: Clay Patrick G.
Published: May 2005

Studies have shown equivalent or improved outcomes with once-daily antiretroviral (ARV) regimens, but have failed to quantify the true daily dosing frequency and pill burden of HIV-infected patients, by not considering concomitant medications. This study was conducted to describe the total daily number (pill burden) and dosing frequency for all oral medicines, and not just ARV medications in HIV-infected patients with undetectable viral loads.
Successful Public/Private Donation Programs: A Review of the Diflucan Partnership Program in South Africa
Authors: Wertheimer Albert I. , Santella Thomas M. , Lauver Heather J.
Published: May 2005

A review of the partnership between Pfizer Inc. and the South African Ministry of Health to distribute free Diflucan (fluconazole) in the Diflucan Partnership Program (DPP) demonstrates that product donations may be a useful response to AIDS if they are coupled with efforts to build means of drug distribution and enhance professional healthcare capacity to treat patients. Equally important is the creation of a new set of productive working relationships between stakeholders who came to the project with different backgrounds and perspectives, as well as a frankly disparate set of objectives. A decision tree illustrates how these relationships were built into the DPP.
Atazanavir—A Once-daily HIV Protease Inhibitor That Does Not Cause Dyslipidemia in Newly Treated Patients: Results from Two Randomized Clinical Trials
Authors: Cahn Pedro E. , Gatell José M. , Squires Kathleen , Percival Lisa D. , Piliero Peter J. , Sanne Ian A. , Shelton Sarah , Lazzarin Adriano , Odeshoo Linda , Kelleher Thomas D. , Thiry Alexandra , Giordano Michael D. , Schnittman Stephen M.
Published: May 2005

Protease inhibitor (PI) treatment can result in dyslipidemia in a significant proportion of patients. Atazanavir (ATV) is a once-daily PI that has not been associated with clinically relevant increases in total cholesterol (TC), fasting low-density lipoprotein cholesterol (LDL-C), or fasting triglyceride (TG) concentrations. The objectives of this paper were to evaluate lipid profiles in untreated patients, and investigate the frequency and severity of dyslipidemia in the same individuals after treatment with ATV or nelfinavir (NFV) for 48 weeks. Two multinational, randomized, active-controlled, blinded trials compared the safety and efficacy of ATV and NFV in combination with two nucleoside reverse transcriptase inhibitors (NRTIs) in antiretroviral (ARV)-naive patients. Serum lipid concentrations were analyzed in patients who had available measurements both at baseline and at week 48. Patients who had missing data at either time point were not included.

Lipid levels remained within baseline ranges at week 48 with ATV treatment, whereas clinically relevant elevations in TC, fasting LDL-C, and fasting TG concentrations occurred with NFV treatment. Mean changes from pre-treatment baseline in fasting LDL-C ranged from -6 percent to +6 percent in the ATV-treatment groups, and from +27 percent to +31 percent in the NFV-treatment groups. After 48 weeks, there was a substantive increase in the proportion of NFV-treated patients who would be recommended for lipid-lowering treatment by National Cholesterol Education Program (NCEP) guidelines, whereas a lesser proportion of ATV-treated patients would be recommended for lipid-lowering treatment.

Atazanavir does not lead to dyslipidemia in ARV-naive patients, and may limit the need for lipid-lowering strategies to reduce the risk of cardiovascular disease.
Microeconomic Loans and Health Education to Families in Impoverished Communities: Implications for the HIV Pandemic
Authors: Sherer Renslow D. , Bronson John D. , Teter Caroline J. , Wykoff Randolph F.
Published: May 2005

Poverty is among the root causes of death and poor health worldwide. Project HOPE’s Village Health Bank (VHB) program is a public health intervention that combines integrated microcredit lending and health education. Groups of 18 to 25 women receive small loans, and biweekly, one-hour health education sessions. Since 1993, about 50,000 women in 949 VHBs have participated in seven countries in the Americas, Africa, and Southeast Asia, receiving more than US$25 million in loans and 8,445 hours of health education. Members of VHBs are charged modest interest rates that enable them to become self-sufficient (eg, able to cover all operating charges, including the costs of the health education staff, and the necessary loan capital to continue without infusion of outside resources). The VHB program produces substantial economic improvements for individuals and groups, and benefits in health knowledge and behaviors, including increased utilization of healthcare services. Data from Guatemala, Malawi, and Thailand demonstrate that VHBs in countries with high HIV prevalence have been comparably successful in spite of the enormous added burdens of chronic illness, deaths, and orphans in need of support. For example, in 2004, 48 percent of 266 VHB members in Malawi experienced at least one death in their household in the preceding year, and 67 percent housed one or more orphans with an average of two orphans per household. Because of the unique combination of increased household economic stability and improved health knowledge, the VHB program is now being adapted to families of people affected by HIV/AIDS, including orphans.
Probiotics, Soluble Fiber, and L-Glutamine (GLN) Reduce Nelfinavir (NFV)or Lopinavir/Ritonavir (LPV/r)-related Diarrhea
Authors: Heiser Carla R. , Ernst Judith A. , Barrett James Tom , French Neel , Schutz Malte , Dube Michael P.
Published: May 2005

Purpose: Highly active antiretroviral therapy (HAART) can be associated with diarrhea and other gastrointestinal (GI) side effects. Reducing these side effects may improve treatment durability and quality of life (QOL). This study assessed the impact of nutritional co-therapies known to reduce diarrhea in HIV-positive men treated with nelfinavir (NFV)- or lopinavir/ritonavir (LPV/r)-containing regimens. Methods: Thirty-five HIV-positive men treated with NFV (n = 27) or LPV/r (n = 8) with diarrhea (± two liquid stools/day [d]) participated in a 12-week prospective study. Twenty-eight subjects were randomly assigned supplements (S), seven received standard of care (C). Group S received probiotics (1.2g/d) and soluble fiber (11g/d). If diarrhea persisted at week 4, 30g/d L-Glutamine (GLN) was added. Diarrhea incidence, as well as supplement and antidiarrheal use, was assessed monthly. Results: Weight, CD4 count, and HIV RNA were unchanged in both groups. Diarrhea completely resolved in 10 of 28 (36 percent) S subjects. The mean (± SD) number of stools/d declined [3.40 ± 1.25 to 2.54 ± 1.34 (p < 0.01)]. Diarrhea (loose, watery stools/d) lessened in S from 2.84 ± 1.42 to 0.74 ± 1.03 (p < 0.0001). Fifteen S subjects did not obtain full relief with probiotics and fiber, but stools/d decreased from 4.08 ± 1.35 to 3.06 ± 1.68 (p < 0.05) after starting GLN. In C, stools/d, 4.14 ± 4.86 to 3.44 ± 1.68(p = 0.678) and incidence of diarrhea/d, 3.00 ± 4.82 to 1.36 ± 1.29 (p= 0.361) was unchanged. In S, loperamide use decreased from 1.69 ± 2.34 to 0.31 ± 0.69 mg/d (p < 0.01); 18 versus eight subjects used loperamide at 0 and 12 weeks, respectively. Conclusion: Probiotics, soluble fiber, and GLN significantly reduced diarrhea for subjects receiving NFV or LPV/r. Nutritional co-therapies show clinical benefit in HIV-positive men with diarrhea.
Antiretroviral Therapy in Advanced HIV-1 Infection
Authors: Post Frank A. , Easterbrook Philippa J.
Published: May 2005

Current recommendations state that antiretroviral therapy (ART) should be commenced before the onset of severe HIV-associated immune deficiency and the development of AIDS-defining infections or malignancies. However, many patients only present and are diagnosed with HIV infection when they already have advanced disease. The optimal treatment for patients with advanced HIV disease remains to be defined. Key management questions include whether the virological and immunological responses to ART are comparable to those seen in patients with less advanced disease; whether the efficacy of different antiretroviral (ARV) regimens differs in patients with advanced disease; and whether there is an increased risk of drug toxicity and the immune reconstitution inflammatory syndrome.
Telling Stories: Rhetoric and Leadership, a Case Study
Authors: Cuno James
Published: May 2005

Often one hears that leaders lead through action, by example. But more often, and often more effectively, leaders lead through their words, by acts of speech, as it were. They are frequently called upon to speak and write, formally and informally, to convey their vision for their organization to their staff and constituents. In doing so, they are not only announcing that vision, but are engaging in a rhetorical negotiation with their audience, trying out words, phrases, and literary constructions to better and more convincingly communicate their vision of their organization and the direction in which they wish to take it. If their rhetoric fails, or is not wholly successful, they strive to change or modify it. Through such verbal exchanges, leaders communicate the style and substance of their leadership and give form and imaginative life to their vision for the organization. Howard Gardner (1995), the Harvard psychologist, has written that ‘[L]eaders achieve their effectiveness chiefly through the stories they relate’. He calls these stories ‘stories of identity’, narratives ‘that help individuals think about and feel who they are, where they come from, and where they are headed’ and that such stories ‘constitute the single most powerful weapon in the leader’s literary arsenal’. This essay recounts, as a case study, the role of such stories in the turnaround of an organization, the Harvard University Art Museums, and reflects generally on the role of rhetoric in leadership.
The Essence of Leadership? Existentialism and Leadership
Authors: Lawler John
Published: May 2005

The article outlines dominant themes in existential thinking and considers what this perspective might offer in developing our understanding of leadership. It explores existential concepts primarily using the writings of Sartre. The existential focus on the concepts of essence and existence is outlined and the current concerns with essentialism discussed in relation to this philosophical approach. The article notes that much research into leadership takes an objectivist approach which, while providing important insights into dimensions of leadership, fails to capture the subjective experience of the leadership relationship. The discussion then details existential themes such as freedom, responsibility and meaninglessness and discusses what questions these provoke for the further study of leadership.
Balanced expression of CXCR5 and CCR7 on follicular T helper cells determines their transient positioning to lymph node follicles and is essential for efficient B-cell help
Authors: Hardtke Svenja , Ohl Lars , Förster Reinhold
Published: May 2005

The production of high-affinity antibodies to T-dependent antigens requires the interaction of B cells and T helper cells expressing receptors specific for the same antigen. Although several mechanisms have been elucidated that regulate B-cell trafficking within lymphoid organs, less is known about molecular cues that guide the small subpopulation of CD4+ follicular T helper cells to B-cell follicles. Using adoptive transfer of transgenic T cells in mice, we demonstrate that antigen-induced activation leads to a finely tuned positioning of T cells either to the T-cell area or the B-cell follicle. We show that expression of CXCR5 is indispensable for T cells to enter B-cell follicles, whereas expression of CCR7 provides a counteracting signal to retain activated T cells in the T-cell area. Although only few T cells transiently migrate from the T-cell area to the B-cell follicle of peripheral lymph nodes following antigenic challenge, this step is essential to provide the help B cells require to produce antibodies efficiently. Thus, we demonstrate that the balanced expression of CCR7 and CXCR5 determines the positioning and proper function of follicular T helper cells.
Involvement of CD147 in overexpression of MMP-2 and MMP-9 and enhancement of invasive potential of PMA-differentiated THP-1
Authors: Zhou Jun , Zhu Ping , Jiang Jian Li , Zhang Qing , Wu Zhen Biao , Yao Xi Ying , Tang Hao , Lu Ning , Yang Yong , Chen Zhi Nan
Published: May 2005

Background

During infection and inflammation, circulating blood monocytes migrate from the intravascular compartments to the extravascular compartments, where they mature into tissue macrophages. The maturation process prepares the cells to actively participate in the inflammatory and immune responses, and many factors have been reported to be involved in the process. We found in our study that CD147 played a very important role in this process.

Results

By using PMA-differentiated human monocyte cells line THP-1, we found that CD147 mediated matrix metalloproteinases (MMPs) expression of the leukemic THP-1 cells and thus enhanced the invasiveness of THP-1 cells. After 24 hours of PMA-induced monocyte differentiation, the mean fluorescence intensity of CD147 in differentiated THP-1 cells (289.61 ± 31.63) was higher than that of the undifferentiated THP-1 cells (205.1 ± 19.25). There was a significant increase of the levels of proMMP-2, proMMP-9 and their activated forms in the differentiated THP-1 cells. Invasion assays using reconstituted basement membrane showed a good correlation between the invasiveness of THP-1 cells and the production of MMP-2 and MMP-9. The difference in the MMPs expression and the invasive ability was significantly blocked by HAb18G/CD147 antagonistic peptide AP-9. The inhibitory rate of the secretion of proMMP-9 in the undifferentiated THP-1 cells was 45.07%. The inhibitory rate of the secretion of proMMP-9, the activated MMP-9 and proMMP-2 in the differentiated THP-1 cells was 52.90%, 53.79% and 47.80%, respectively. The inhibitory rate of invasive potential in the undifferentiated cells and the differentiated THP-1 cells was 41.82 % and 25.15%, respectively.

Conclusion

The results suggest that the expression of CD147 is upregulated during the differentiation of monocyte THP-1 cells to macrophage cells, and CD147 induces the secretion and activation of MMP-2 and MMP-9 and enhances the invasive ability of THP-1 cells. The matured monocytes / macrophages, via their high expression of CD147, may play an important role in promoting the tissue repair or tissue damage during their inflammatory response.