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Prevention, Aging, and Multimorbidity: A Modeling Study of Challenges Facing the Global HIV Response
No full textBackground: The global burden of HIV is substantial, with 1.5 million new infections and 38 million people living with HIV (PLWH) in 2021. These PLWH are also aging and becoming increasingly at risk for non-communicable diseases (NCDs). Local policymakers need efficient approaches to better prevent new HIV infections and care for an aging HIV population.
Methods: Using a suite of modeling tools, we project the impact of efforts to prevent new HIV infections and care for an aging HIV population. In the United States, we adapted a model of HIV epidemics in 18 cities to quantify the benefits of improved pre-exposure prophylaxis (PrEP) coverage, linkage, retention, and suppression among key risk groups. In Kenya, we first developed a model of HIV transmission to project the effect of demographic shifts and HIV-targeted interventions on the age distribution of PLWH, then developed a microsimulation of NCDs to examine the impact of approaches to integrated HIV/NCD care.
Results: In the US, improving city-wide PrEP coverage to 25% reduced ten-year HIV incidence by a projected 49% and improving retention in care to 95% reduced incidence by 39%. Focusing on key risk groups had varied impact across locations. In Kenya, demographic changes and HIV-targeted interventions shifted the age structure of PLWH towards older age groups: the median age of PLWH was projected to increase from 39 in 2025 to 43 in 2040 absent intervention or to 46 with scale-up of HIV-specific interventions. Integrating NCD services within HIV clinics provided a 0.3% and 0.5% reduction in cardiovascular disease events and deaths, respectively; focusing similar efforts in the community provided greater population-level impact (with a 2.9% and 4.3% reduction in events and deaths, respectively). Per person treated, NCD screening and treatment was more efficient within HIV clinics than in the general community.
Conclusions: Local decision-makers in the US can utilize the results from this modeling analysis to identify the combinations of interventions and risk groups that will maximize impact with limited resources. In Kenya, new HIV policy must consider the needs of an aging HIV population as a whole—including how best to treat age-associated comorbidities
Shear Response of Fastened Assemblies of Cementitious Panel to Steel Deck for FastFloor Residential Project
Get PDFTechnical report on small-scale push-out testingThe goal of the FastFloor Residential project is to create a new steel floor system that is lightweight, fast to construct, and nonproprietary. FastFloor Residential strives to achieve this by exploring prototypes such as the one shown in Figure 1, employing 18 gauge 3 in. deep steel deck fastened back-to-back to create a cellular deck, then topped with ¾ in thick cementitious (structural) panel screwed to the steel deck. This report summarizes a series of push-out tests that were conducted in the Thin-Walled Structures Lab at Johns Hopkins University. The push-out tests provide the shear response of the fasteners used to attach the cementitious panel to the steel deck. Repeatability of response, fastener spacing, and installation conditions (overdriven screws) are all explored in the testing.American Institute of Steel Construction (AISC), Steel Deck Institute (SDI
ASSESSING CLIMATE VULNERABILITIES FOR FEDERAL FACILITY GROUNDWATER REMEDIES IN THE SOUTHEASTERN UNITED STATES
No full textThe long term management of legacy contamination at federally-owned Superfund sites does not yet have a defined process for incorporating the impacts of a changing climate into site remedies. The impacts at privately-owned Superfund sites have been considered by the Government Accountability Office. This research applies the methods which GAO used in their report to determine site vulnerabilities to federally-owned Superfund sites in the southeast. Using sea level rise and storm surge data from the National Oceanic and Atmospheric Administration and flood data from the Federal Emergency Management Agency, this process determined that 16 out of 18 federally-owned Superfund sites in the southeast may experience impacts from these datasets within 1 mile of their primary geographic coordinat
Oral History of Vann Michael Millhouse
No full textThis oral history about transgender experience in Baltimore was recorded as part of Vintage T, a public humanities project led by Monica Stevens, Jamie Grace Alexander, and Rahne Alexander and sponsored by Sistas of the “T” and the Winston Tabb Special Collections Research Center. Vintage T was launched in 2023 to document and archive the perspectives, strategies, and personal histories of trans individuals in Baltimore, thereby preserving valuable traditions within trans communities
Heritage under Threat: Documentation Methods for Preserving at-risk Cultural Identity and Prosecuting Cultural Heritage War Crimes during the Russo-Ukrainian War
Get PDFThe war in Ukraine highlights a key issue we as an international community have not resolved: the need to document cultural heritage proactively during times of conflict. In most recent conflicts we see issues of destruction of cultural sites with little to no clear pathway for prosecution and by default, little in the way of effective reparations. Little still is offered for preemptive measures to protect our cultural heritage in times of conflict. By relying on a blended effort of open-source intelligence, crowdsourced documentation, and the leaning in of specialized practices offering guidance and help in setting documentation and proper prosecution of these crimes allow us to make effective chance at proper reparations after a conflict is over, but also how best we can improve tracking items lost, stolen and damaged using technology. This paper examines the efficacy of these methods as it relates to Ukrainian museums, determines needs for improvement in the face of this conflict, and provides insight to how the western world can better support Ukraine protecting its cultural identity as the war rages on
Oral History of Mickey Dehn
No full textThis oral history about transgender experience in Baltimore was recorded as part of Vintage T, a public humanities project led by Monica Stevens, Jamie Grace Alexander, and Rahne Alexander and sponsored by Sistas of the “T” and the Winston Tabb Special Collections Research Center. Vintage T was launched in 2023 to document and archive the perspectives, strategies, and personal histories of trans individuals in Baltimore, thereby preserving valuable traditions within trans communities
Homelessness During Early Childhood: A Primer on Definitions, Trends, and Best Practices Research
Get PDFThis document seeks to provide a broad overview of the contemporary trends and
existing research related to young children experiencing homelessness in the United
States. Conducted by Johns Hopkins University’s Center for Research and Reform in
Education in conjunction with the Johns Hopkins IDEALS Institute, this research was
conducted for purposes of providing early education practitioners with key information
concerning the definitions, demographic trends, and contemporary issues that inform the
broader societal discussion concerning childhood homelessness. As importantly, this
document also provides an overview of the existing research on both the impacts of
homelessness on educational outcomes for young children, as well as the key strategies
and programs that appear most promising for mitigating these impacts.
This research was conducted as part of technical assistance under the Maryland
Rebuilds Workforce Grant and is part of a broader project led by JHU IDEALS supporting
the advancement of early childcare and education professionals. As such, the research
presented throughout this document places special emphasis on that germane to children
five years and younger, as well as programs and demographic trends with homelessness
specific to the state of Maryland.
For organizational purposes, this document is framed as a series of questions and
answers as it relates to common topics concerning childhood homelessness and aims to
serve as an informational reference for early childhood educators and resource providers.
These orienting questions include the following, which are presented and addressed
throughout the subsequent sections of this document:
How is childhood homelessness defined?
How prevalent is childhood homelessness?
How can experiencing homelessness impact the learning and development of
young children?
What programs are employed on a national and/or state level that are aimed at
serving children experiencing homelessness?
What are “best practices” that should be considered in serving young children
experiencing homelessness
EVALUATION OF 6-THIO-2’-DEOXYGUANOSINE (6-Thio-dG), A POTENTIAL TELOMERASE-TARGETED ANTI-CANCER AGENT, IN TELOMERASE-POSITIVE AND TELOMERASE-NEGATIVE CELLS
No full textTelomeres are repetitive DNA sequences (TTAGGG) at the end of linear chromosomes. Telomeres are capped by protein complexes that protect them from DNA damage and from being recognized as double-stranded breaks. As cells continuously divide, telomere length shortens due to the end replication problem. Very short or uncapped telomeres are recognized as DNA damage causing the cells to undergo replicative senescence or apoptosis. Cancer cells evade replicative senescence and acquire genetic mutations that maintain telomeres’ length either by activating telomerase or via a homologous recombination-based mechanism termed, Alternative Lengthening of Telomeres (ALT). Telomerase is reactivated in ~90% of cancers and thus represents an attractive target for anti-cancer therapy. Recent studies have shown that 6-thio-2’-deoxyguanosine (6-thio-dG) is preferentially incorporated into telomeres by telomerase, leading to telomere uncapping and selectively triggering cell death in telomerase-positive cancer cells. However, more insight is needed into the mechanism of action of 6-thio-dG and its relative efficacy in a broader spectrum of cancers, including the ~10% of cancers that maintain telomeres via ALT. In the present study, we utilized cancerous and non-cancerous isogenic cell lines predominately of human prostate origin, that differ in their telomere maintenance mechanism (TMM); being either telomerase-positive or telomerase-negative,. Based on the proposed mechanism of 6-thio-dG, we hypothesized that telomerase-negative cells would be more resistant to 6-thio-dG treatment compared to telomerase-positive cells, especially within the same isogenic background. Cytotoxicity, cell growth, clonogenicity, and telomere-length analyses in our panel of telomerase-positive and telomerase-negative cells, however, did not show a significant dependence of 6-thio-dG on telomerase expression. Both telomerase-positive and -negative cells were almost equally sensitive (cell death) to treatment with 6-thio-dG. We also demonstrate that neither apoptosis nor the cGAS/STING pathway were activated upon treatment with 6-thio-dG regardless of telomerase expression status. Furthermore, DNA damage was upregulated only in mouse embryonic fibroblasts (MEFs) in response to 6-thio-dG, but this was independent of telomerase expression. In conclusion, based on our present study, 6-thio-dG treatment results in non-selective cell death independent of telomerase status. As this is the first study to investigate the effects of 6-thio-dG in benign and malignant prostate cells, such telomerase-independent cytotoxicity by 6-thio-dG could be specific to prostate cells; thus, warranting further study in other tumor types
Patchwork Empire: Citizenship and Expansion in the 20th Century
No full textPatchwork Empire: Citizenship and American Expansion in the 20th Century explores citizenship polices in the U.S. territories and argues that granting (and at times withholding) citizenship to territorial populations has been central to empire building and the development of racial hierarchy in the U.S. Contrary to popular narratives of imperial power, I attribute territorial expansion and governance not only to military might, but also to legal and administrative innovation. Using archival materials, including congressional documents and records from the Bureau of Insular Affairs, I demonstrate that the U.S. strategically granted collective citizenship in order to strengthen its colonial rule. In Guam and Puerto Rico, the U.S. granted citizenship when two conditions converged: when Congress determined that the islands were strategically valuable to the U.S.; and when grassroots political movements weakened colonial control, for example, in the form of an independence movement. When these populations pulled away, Congress enveloped them in a bear hug that granted citizenship to weaken their movement. In contrast, the absence of a determination of strategic value and independence movement in American Samoa sheds light on why the territory has never been granted U.S. citizenship. While citizenship was an attractive solution to many of the problems that colonial officials faced, there were strong objections within the U.S. to granting citizenship to populations considered to be non-white. As a result, Congress created a workaround, by disentangling citizenship from the rights and privileges that typically accompany it and from statehood. This form of citizenship became a durable institution and a reshaped legal category. Though citizenship is often associated with democracy and equality, American officials turned citizenship into a mechanism of control for the empire they were building. This work uncovers strategies of American expansion and colonial governance and confronts deeply held notions of American citizenship and political community
ANOPHELINE BIONOMICS AND PLASMODIUM FALCIPARUM INFECTION RATES OVER A 9-MONTH PERIOD IN MALARIA HOLOENDEMIC NCHELENGE, NORTHERN ZAMBIA (FEBRUARY 2021- OCTOBER 2021)
No full textAccording to the World Health Organization (WHO) there were an estimated 247 million malaria cases in 2021, an increase from 245 million cases in 2020. Since 2015, malaria has been the fourth leading cause of disability-adjusted life years (DALYs) in Zambia for all ages and sexes. Nchelenge is a densely populated lakeside district on Lake Mweru, which has a system of rivers and streams that extend inland creating a swampy habitat. Even though there have been significant efforts to control malaria, Nchelenge has remained a holoendemic malaria transmission zone. Methods of prevention focus on the Plasmodium parasite’s definitive host, the anopheline mosquito. Long-lasting insecticide-treated nets (LLINs) and IRS are the most used methods for vector control in malaria-endemic areas, because they target the endophagic and the endophilic nature of the most numerous malaria vectors, An. funestus and An. gambiae. There is the ability for the vector to adapt and gain resistance to the method, as has been observed with pyrethroids, which is an insecticide used in both LLINs and IRS. Mosquitoes were collected indoors and outside of homes using CDC light traps over a 9-month period from February 2021- October 2021, from households in Nchelenge District, Zambia. This study uses a subset of 15% of each month's collections evaluating anopheline species through morphology and molecular identification confirmations and their abundant presence in the environment, the prevalence of the Plasmodium parasite, and ecological variables maintained in these communities.
The results show that An. funestus is the primary vector across seasons, with An. gambiae being the secondary vector, there were also other lesser-studied vectors present. There were significantly more anophelines collected at homes located inland than those located lakeside, suggesting the role of other temporary breeding sites in abundance in Nchelenge. Identifying the means of resistance is key so that the appropriate insecticide can be used and lead to IRS furthering the efforts toward malaria elimination. The inadequacy of net use highlights the importance of education surrounding prevention methods. To address malaria transmission in Nchelenge, there needs to be an improved plan for malaria prevention, testing, and effective treatment