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“Ashamed of being seen in an HIV clinic”: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial
Full text linkBackground
There is high post-hospital discharge mortality among persons with HIV who are hospitalized, and post-hospital survival is strongly associated with early HIV clinic linkage, clinic attendance, and antiretroviral therapy adherence. The Daraja intervention, a context-tailored case management strategy implemented and tested through a randomized trial in Tanzania, was associated with improved HIV clinic linkage, retention, and ART initiation and adherence.
Methods
We conducted in-depth interviews (IDIs) in a sub-sample of 40 study participants (20 control and 20 intervention) 12 months after enrollment into the trial to gain an in-depth understanding of the barriers to HIV care engagement and the perceived mechanisms through which the Daraja intervention impacted these barriers. We also conducted IDIs with 20 health care providers. We used a thematic analysis approach to generate themes following the Gelberg-Andersen behavioral model for vulnerable population domains.
Results
Perceived stigma, coupled with the mistrust of healthcare providers, underemployment or lack of reliable income, unreliable transport, and a lack of social support, were identified as key barriers to HIV clinic attendance and ART adherence. Perceived stigma complicated not only linking to and attending an HIV clinic but also decision-making regarding the choice of the clinic’s location. The Daraja intervention was reported to help normalise HIV diagnosis, plug the social support gap, increase patients’ self-efficacy and their capacity of participants to navigate the HIV clinic during HIV clinic linkage.
Conclusion
These qualitative research results identified several important barriers to engaging in HIV care and provide insights into the mechanisms through which the Daraja intervention operated to affect the perceived stigma, social support, self-efficacy, and increased capacity of participants to navigate the HIV clinic during HIV clinic linkage.
Daraja trial registration ClinicalTrials.gov, NCT03858998. Registered on 01 March 2019
Disability and (In)dependence in the Rehabilitation Age: A History of the Functional Model of Disability, 1935-1970
No full textUsing archival and historical sources, this dissertation explores the development of a broad, inter-impairment disability movement and the functional model of disability within the post-World War II medical rehabilitation movement and the development of the welfare state in the United States.
This dissertation highlights how disabled people, federal administrators, non-governmental organizations, and rehabilitation physicians and researchers bolstered support for medical rehabilitation while the nascent specialty struggled for professional recognition. By examining the ideological interconnectedness of eugenics and rehabilitation, this study documents the limitations of the rehabilitation approach to disability while demonstrating how rehabilitation replaced eugenics as the primary site of disability research and statistics. Highlighting the work of Maya Rivière, a disabled feminist, Sociomedical Scientist, and rehabilitation expert, this study reveals how disabled people actively shaped rehabilitation and independent living ideology from the 1940s to the 1960s.
The second half of this study analyzes the Rehabilitation Codes project that developed the functional model of disability and became the basis of the World Health Organization’s experimental statistical classification, the International Classification of Impairment, Disability, and Handicap, published in 1980. By defining terms such as “impairment,” “disability,” and “handicap,” the functional model advanced by the Rehabilitation Codes attempted to combat the stigma of disability and bolster rehabilitation and employment opportunities available to disabled people by accounting for prejudice against disabled people and their physical and mental capabilities.
This dissertation argues that the functional model facilitated a more humane disability evaluation process, expanded the field of disability research, and provided the theoretical foundation for a broad, inter-disability rights movement, but it also institutionalized long-standing intra-disability hierarchies. Ultimately, this dissertation demonstrates that the functional model of disability, like the concept of disability itself, is context-specific and has evolved across time and space and in response to historical circumstances and socio-cultural norms
Enhancer RNAs: a Source of Novel, Rapidly-Evolving Proteins
No full textEnhancer RNAs (eRNAs) are a family of long noncoding RNAs (lncRNAs) transcribed from enhancer sites by RNA polymerase II (RNAPII) as part of the process of enhancer activation. Normally, eRNAs are typically processed by the Integrator complex and incorporated into the enhancer looping machinery formed by the Mediator and Cohesin complexes. However, some eRNAs escape this processing step and are instead transcribed to produce longer, polyadenylated RNAs. Poly(A)+ eRNAs are usually targeted for exosomal degradation by the Mtr4-containing PAXT complex, but under some conditions can be exported to the cytoplasm. I
n this latter option, as shown in Chapter 2 of this thesis, eRNAs that contain ORFs, of which there are a surprising number, are capable of being translated to produce functional proteins. eRNAs can gain ORFs through the process of de-novo gene birth, resulting in novel genes at sites capable of fulfilling the roles of both canonical coding genes and enhancers.This dissertation is divided into three main sections, and an additional fourth section outlining future research directions. In the first section, I review the current research on eRNAs and other lncRNAs including their origins, processing, and functions. I also review current research on proteins encoded by canonically noncoding RNAs, and the process and implications of de-novo gene birth as it relates to the aforementioned topics.
In the second section, we aimed to identify translating eRNAs in the human genome using ribosome profiling compared to a database of transcribed enhancers. Using these results, we selected ten large eRNA ORFs to investigate the functions of the proteins they encode, including their subcellular localization and protein interactomes. Finally, we investigated the homologs of these eRNA ORF sequences in other species to determine their level of evolutionary conservation compared to that observed in canonical protein-coding genes. Our findings in the second section provide evidence for novel, highly-basic, arginine-rich proteins encoded by eRNAs and capable of interacting with DNA and RNA, either directly or through interactions with other associated proteins. We also present evidence that the ORFs encoding these proteins appeared relatively recently in human evolution, with most being primate-specific and exhibiting mutation rates associated with purifying selection of coding sequences across their homologs in great apes.
In the third section, we present additional results from analysis of published proteomics and RNA-seq results that provide evidence for expression of ORF-containing eRNAs in differentiating stem cells. These results were also confirmed using qRT-PCR of whole-cell RNA samples isolated from these differentiating cells. These results show expression of several eRNAs identified in the second section during the early stages of human embryonic stem cell differentiation into the three germ layers and subsequent mature cell types. These results are also supported by a decrease in Mtr4 protein levels also detected in proteomics results from the same differentiations. These results indicate that expression of ORF-containing eRNAs and the Mtr4-depleted conditions leading to it are present in stem cells during differentiation, and stem cell differentiation is a promising subject of future research on the roles of eRNA-encoded proteins in normal cellular function
“A Place of Beginning Along the Land”: Migration and Community in the Dutch Atlantic World, 1609-1715
No full textThis dissertation examines how people in two seventeenth-century cities – Amsterdam and New Amsterdam, which later became New York – navigated the challenges of migration, belonging, and community construction. Drawing on notarial records, court documents, epistolary sources, and administrative papers, I trace a path of migration from the streets of Amsterdam to the fields of New Netherland.
I argue that transatlantic migration was a key component of community-building. I introduce the idea of strategic mobility as a means by which free Black Africans in Amsterdam coped with the difficulty of life on the margins of society in Europe. By putting maritime migration at the center of my analysis, I reveal how the structure of seafaring life shaped communities on land. Using the rich notarial records of the Amsterdam City Archives to excavate and reconstruct the experiences of maritime migrants, I show how they used urban spaces to transform land-based lives into ones ready for seafaring.
Re-conceptualizing the transatlantic journey as one that began at home or in a notary’s office, I reveal how migrants transferred, translated, and transcribed their private lives into the public record. I argue that migrants instrumentalized their relationships, debts, and obligations as they confronted the risk of death or loss at sea. Moving ashore in America, I investigate the racialized social economies of Anglo-Dutch colonies, revealing how enslaved people – particularly enslaved women – countered and circumvented their systematic exploitation
Design and Evaluation of a Theory-based Nutrition Education Intervention Among Pregnant and Pre-pregnant Women in Beijing, China
Full text linkPregnancy constitutes a critical period during which maternal nutrition plays a pivotal role in both fetal and maternal well-being. However, many pregnant women in China fail to achieve a balanced dietary pattern as recommended by the Chinese dietary guidelines for pregnancy, consequently placing them at a higher risk of adverse maternal and fetal outcomes. Interventions beginning as early as the "pre-pregnant" period ("备孕期")—when women prepare for pregnancy—are essential to promote healthy eating habits and improve nutritional status. Despite the potential of theory-based nutrition education, few interventions in China have targeted pregnant women, and none have included pre-pregnant women.
The main purpose of this study was to understand the nutritional needs of women in China and understand if nutrition interventions can be effective. The study had three parts and was conducted with different groups of participants. Part 1 was a cross-sectional study to serve as a need assessment to evaluate the nutritional status of pre-pregnant and pregnant women in Beijing, China, enrolling 32 women (Group 1). Part 2 was a pre-post study investigating whether the newly developed online six-session intervention impacted pre-pregnant and pregnant women’s psychosocial determinants, eating behaviors, healthy weight status, and satisfaction with the program, with 71 participants initially enrolled and 40 completing both pre- and post-tests (Group 2). Part 3 was a descriptive study using discussion-based interviews to understand pregnant women’s knowledge about nutrition and their perceptions and expectations regarding nutrition support; 21 women participated (Group 3).
The need assessment for Group 1 showed that our target population had an unbalanced dietary pattern that failed to meet many recommendations from the Chinese dietary guidelines. The intervention for Group 2 significantly improved most psychosocial determinants, including attitudes (p=0.018), perceived norms (p=0.002), perceived behavioral control (p=0.008), self-depictions (p=0.028), behavioral intention (p=0.035), and skills and abilities (p=0.027). The environment was the only psychosocial determinant that showed no change (p=0.532). It also demonstrated effectiveness in promoting healthy eating behaviors, such as increased soy and soy products consumption (p=0.008), milk and dairy products consumption (p=0.003), and fish and other seafood consumption (p=0.010). However, no significant positive change was found in the consumption of vegetables, fruits, nuts, lean meat, and fatty meat (p>0.05). Participants reported reading nutrition labels more frequently (p=0.007) and paying greater attention to fat content when shopping (p=0.021). However, the intervention was less effective in reducing unhealthy cooking methods, dining out, and the intake of ultra-processed foods (p>0.05). It also did not succeed in helping pregnant women with excessive weight gain achieve a healthy weight gain (p>0.05).
Nevertheless, the intervention achieved acceptable attendance and engagement and high satisfaction rates among those who retained. Participants also provided positive feedback concerning the course content, format, and teaching and offered constructive suggestions for future courses.
The discussion-based interview for Group 3 also enriched our understanding of the target population and offered valuable insights for future interventions. While most pregnant women expressed concerns or worries about nutrition during pregnancy, many had limited knowledge or held misconceptions about it. Despite these concerns, a significant number of participants did not feel the need for or desire nutritional support. This reluctance was often due to a lack of awareness about the potential risks of their current behaviors or low self-efficacy in making dietary changes.
The study's findings suggested the efficacy of a TPB-based online nutrition education intervention in improving participants’ psychosocial determinants related to healthy eating and some dietary behaviors. This could inform future studies, which should adopt a more rigorous study design, implement longer and more intense interventions, and follow up for more long-term effects
Search for Higgs boson decays into a pair of pseudoscalar particles in the _had_had final state using collisions at √= 13 TeV with the ATLAS detector
No full textA search for exotic decays of the 125 GeV Higgs boson into a pair of new spin-0 particles, H → aa, where one decays into a photon pair and the other into a -lepton pair, is presented. Hadronic decays of the τ-leptons are considered and reconstructed using a dedicated tagger for collimated -lepton pairs. The search uses 140 fb⁻¹ of proton-proton collision data at a centre-of-mass energy of √ = 13 TeV recorded between 2015 and 2018 by the ATLAS experiment at the Large Hadron Collider.
The search is performed in the mass range of the a boson between 10 GeV and 60 GeV. No significant excess of events is observed above the Standard Model background expectation. Model-independent upper limits at 95% confidence level are set on the branching ratio of the Higgs boson to the final state, ( → → ), ranging from 0.2% to 2%, depending on the -boson mass hypothesis
Antonina Khanzhonkova
Full text linkAntonina Khanzhonkova, the first wife of the legendary Russian film producer Aleksandr Khanzhonkov, is known as the true uncrowned “tsarina” of Russian imperial cinema. In his brilliant memoir, film director Viacheslav Viskovskii wrote that “Khanzhonkov’s studio set the tone of everything. Madame Khanzhonkova was in charge of the entire business (both production and distribution), and Khanzhonkov, without violating the truth, could identify himself as Menelaus did: ‘I am the Tsarina’s husband’” (Viskovskii 3). Viskovskii even clarified that “I will refer to Khanzhonkov, who was the official head of the studio. Still, I will mean the actual chief and dictator, Madame Khanzhonkova.” Indeed, according to various evidence, she acted as a producer, film director, casting director, and screenwriter while contributing to all stages of film production from set design to editing. The first attempt to give an overview of Antonina Khanzhonkova’s career was made by Michele Leigh in 2015. This profile builds off of that important article, which was based mostly on secondary sources, by revisiting Khanzhonkova’s legacy mainly through primary materials
Retrospective analysis of estimated serial interval and reproductive number of SARS-CoV-2 Omicron variant in Korea
Full text linkThe novel Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2) threatens the global economy and public health, and therefore it is significant to research the intervention measures of this virus. In this study, we estimated the serial interval and reproductive number of the SARS-CoV-2 Omicron B1.1.529 variation, which can serve as indicators of the transmission potential of the Omicron variant in Korea from November 25 to December 30, 2021.
By examining 427 local omicron cases and constructing 65 transmission pairs, we estimated a mean continuous interval of 2.23 days and a mean number of regenerations of 1.30 for one of the kindergarten transmission chains using maximum likelihood estimation. Our research indicates that Omicron has a shorter serial interval, faster transmission, and greater immune evasion capacity than earlier variants. To effectively control community transmission of Omicron, it is necessary to rapidly track recent contacts, isolate asymptomatic individuals, adhere rigorously to public health policies, and enhance immunization efforts among teenagers. The retrospective analysis of the indexes may give us new guidance for the new infectious diseases in the future
Search for boosted low-mass resonances decaying into hadrons produced in association with a photon in collisions at √ = 13 TeV with the ATLAS detector
Full text linkMany extensions of the Standard Model, including those with dark matter particles, propose new mediator particles that decay into hadrons. This paper presents a search for such low mass narrow resonances decaying into hadrons using 140 fb⁻¹ of proton-proton collision data recorded with the ATLAS detector at a centre-of-mass energy of 13 TeV. The resonances are searched for in the invariant mass spectrum of large-radius jets with two-pronged substructure that are recoiling against an energetic photon from initial state radiation, which is used as a trigger to circumvent limitations on the maximum data recording rate.
This technique enables the search for boosted hadronically decaying resonances in the mass range 20–100 GeV hitherto unprobed by the ATLAS Collaboration. The observed data are found to agree with Standard Model predictions and 95% confidence level upper limits are set on the coupling of a hypothetical new spin-1 ′ resonance with Standard Model quarks as a function of the assumed ′-boson mass in the range between 20 and 200 GeV
Software and computing for Run 3 of the ATLAS experiment at the LHC
Full text linkAbstract The ATLAS experiment has developed extensive software and distributed computing systems for Run 3 of the LHC. These systems are described in detail, including software infrastructure and workflows, distributed data and workload management, database infrastructure, and validation. The use of these systems to prepare the data for physics analysis and assess its quality are described, along with the software tools used for data analysis itself. An outlook for the development of these projects towards Run 4 is also provided