1,326 research outputs found
Initiation of Antiretroviral Therapy in Early Asymptomatic HIV Infection
No full textPresentes no The INSIGHT START Study Group: Beatriz Grinsztejn; Valdiléa Veloso; Sandra Wagner Cardoso (Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil)Data from randomized trials are lacking on the benefits and risks of initiating antiretroviral therapy in patients with asymptomatic human immunodeficiency virus (HIV) infection who have a CD4+ count of more than 350 cells per cubic millimeter
Why START? Reflections that led to the conduct of this large long-term strategic HIV trial
No full textPresentes no INSIGHT Strategic Timing of AntiRetroviral Treatment Study Group: Beatriz Grinsztejn; Sandra Wagner Cardoso (Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil)
Editorial: March 2019 (Vol. 5, Issue 1)
No full textOver the past year, we’ve had a change of hands from our founder, Matt Barr, to our new editor-in-chief, Mahli-Ann Butt. We’ve taken some extra time to put together this issue with great pride and care.
Through a friendly double-open peer-reviewing process, for this open-call issue we’ve published 7 excellent game studies student articles:
Dennis Jansen’s ‘The Environment at Play: Confronting Nature in The Elder Scrolls V: Skyrim and the “Frostfall” Mod,’ argues that the natural environment in the base game of The Elder Scrolls V: Skyrim (2011) is devoid of agency and power in the face of the player’s colonialist endeavours to explore, conquer and master that environment. Jansen thus discusses how the “Frostfall” counteracts the destructive and oppositional relationship between the player and nature in Skyrim.
Brianna Dym’s ‘The Burden of Queer Love,’ explores attempts by game development studio Bioware to create video games that are inclusive of gay, lesbian, and bisexual players by writing in queer romantic narrative subplots into their games. While Bioware’s attempts are certainly not malicious, they fail time and time again, game after game, to break free of the hypermasculine and heterocentric culture dominant in the gaming industry. Instead, Bioware appropriates queer experiences and construes them as a burden to the player so as not to displace the fantasies of male, heterosexual gamers.
Chris Alton’s ‘Aya of the Beholder: An Examination of the Construction of Real-World Locations in Parasite Eve,’ uses the foundational example of Square’s Parasite Eve (1997) to examine the ways in which real-world locations and approximations of such are represented within video game worlds. Alton examines the methods through which videogames can create spaces which evoke the conceptual idea of a given place, both through audio/visual and interactive means, without constructing a one-to-one simulacrum of the location. Thus, the player actively contributes in the transformation of an actionable virtual space into an actualized lived place.
Anna Maria Kalinowski’s ‘Silent Halls: P.T., Freud, and Psychological Horror,’ draws from Sigmund Freud’s concept of the uncanny to address how the psychological concepts surface within the never-ending hallway of P.T. (2014) and create a deeply psychologically horrifying experience.
Sean Pellegrini’s ‘And How Does That Make You Feel?: A Psychological Approach to a Classic Game Studies Debate – Violent Video Games and Aggression,’ investigates the claim that violent video games can cause aggression. The findings of this study suggest that people highly correlated with the Dark Triad of personality are a high-risk group for aggression, but that this aggression is unrelated to video games.
Daniel Odin Shaw’s ‘Ideology in BioShock: A Critical Analysis,’ analyses the Bioshock series, with a particular focus on the treatment of ideology. By examining the games, with a particular reference the use of procedural rhetoric, this paper argues that this series presents a critique of extreme ideology itself.
Hayley McCullough’s ‘“Hey! Listen!”: Video Game Dialogue, Integrative Complexity and the Perception of Quality,’ explores potential complexity differences between winning and losing video games at the Spike Video Game Awards. It compared the integrative complexity of a sample of video game dialogue for three categories (Best Shooter, Best RPG and Best Action/Adventure). Across all analyses a consistent mean pattern emerged: The winning games averaged lower complexity scores than the losing games. These findings suggest a general association between simplistic dialogue and high-quality video games, providing keen insight into the underlying psychology of video games, and establishes a strong foundation for future research.
As this issue demonstrates, Press Start is always delighted to be publishing the best new work by early career researchers from a wide variety of disciplinary fields.
The Press Start Journal team also welcomed many new members to our editorial board. During this transition period, we’ve begun a mentoring program for our senior members to share their knowledge of the editorial process. This spirit of mentorship, guidance, and support is something we hope to continue into our journal’s future as it reflects our larger goal of encouraging game studies students to share their work and take part in a lively, academic community.
Once again, we’re seeking new members to replace our outgoing board, who are graduating and moving on to other things. Board members of Press Start serve as key stakeholders and decision-makers for developing the journal and actively work to support student scholarship in game studies. Current students and graduates within one year of their graduation date are eligible to apply. Our deadline to apply to be on the editorial board this year has just past, but if you are interested in working with Press Start in the future, you can find more information on the responsibilities of an editor here.
In 2018, we saw some of our editors present on a panel at DiGRA in Turin, Italy. This was an exciting opportunity for our new members to sit down with established members and discuss our hopes, expectations, and advice regarding the publishing process in general, and with Press Start in particular. While everyone has a wide range of backgrounds and experiences, some commonalities emerged. Fostering an open, supportive, caring – in other words, overtly feminist – atmosphere for editors, reviewers, and contributors has been our most important goal. Reaching out to, and encouraging, junior scholars, new graduate students, upper year undergraduate students, and scholars whose first language is not English are also central goals for Press Start. Given the often intimidating, daunting, and confusing process of academic publishing, we hope to make Press Start an appealing home for exciting, innovative, unusual, and social justice-oriented games research.
As students and emerging academics, we believe Press Start should embody the kinds of practices that we want to see become standards for academia. Thus, in order to see a greater diversity in game studies scholarship, we have introduced an initiative to translate our calls for papers into as many languages as we can find volunteers: http://tinyurl.com/yblfxkk4. Press Startencourages submissions from ESL writers, especially if they are not yet fully confident of their ability to write academically in English but want to learn and improve.
Press Start Journal is a labour of love and we thank you for your continued support of our journal.
Best wishes from the Press Start editorial board,
Mahli-Ann Butt, Landon Kyle Berry, Sarah Stang, Alicia Copeland, Leandro Augusto Borges Lima, Erin MacLean, Reece Thomson, and Dennis Wilson
Why START? Reflections that led to the conduct of this large long-term strategic HIV trial
No full textThe effect of interrupted/deferred antiretroviral therapy on disease risk: a SMART & START combined analysis
No full textBackground: Pooled data from SMART and START were used to compare deferred/intermittent versus immediate/continuous antiretroviral therapy (ART) on disease risk. Methods: Endpoints assessed were AIDS, serious non-AIDS (SNA), cardiovascular disease (CVD), cancer, and death. Pooled (stratified by study) hazard ratios (HRs) from Cox models were obtained for deferred/intermittent ART vs immediate/continuous ART; analyses were conducted to assess consistency of HRs across baseline-defined subgroups. Results: Among 10156 participants, there were 124 AIDS, 247 SNA, 117 cancers, 103 CVD and 120 deaths. Interventions in each trial led to similar differences in CD4 count and viral suppression Pooled HRs (95% CI) of deferred/intermittent ART vs immediate/continuous ART were for AIDS 3.63 (2.37, 5.56); SNA 1.62 (1.25-2.09); CVD 1.59 (1.07-2.37); cancer 1.93 (1.32-2.83); and death 1.80 (1.24-2.61). Underlying risk was greater in SMART than START. Given the similar HRs for each study, absolute risk differences between treatment groups were greater in SMART than START. Pooled HRs were similar across subgroups. Conclusions: Treatment group differences in CD4 count and viral suppression were similar in SMART and START. Likely as a consequence, relative differences in risk of AIDS and SNA between immediate/continuous ART and deferred/intermittent ART were similar
Systemic Inflammation, Coagulation, and Clinical Risk in the START Trial
No full textBackground. The Strategic Timing of AntiRetroviral Treatment (START) trial demonstrated that immediate (at CD4+ > 500 cells/mu L) vs deferred (to CD4+ Methods. Biomarkers were measured from stored plasma prior to randomization and at month 8. Associations of baseline biomarkers with event risk were estimated with Cox regression, pooled across groups, adjusted for age, gender, and treatment group, and stratified by region. Mean changes over 8 months were estimated and compared between the immediate and deferred ART arms using analysis of covariance models, adjusted for levels at entry. Results. Baseline biomarker levels were available for 4299 START participants (92%). Mean follow-up was 3.2 years. Higher levels of IL-6 and D-dimer were the only biomarkers associated with risk for AIDS, SNA or death, as well as the individual components of SNA and AIDS events (HRs ranged 1.37-1.41 per 2-fold higher level), even after adjustment for baseline CD4+ count, HIV RNA level, and other biomarkers. At month 8, biomarker levels were lower in the immediate arm by 12%-21%. Conclusions. These data, combined with evidence from prior biomarker studies, demonstrate that IL-6 and D-dimer consistently predict clinical risk across a broad spectrum of CD4 counts for those both ART-naive and treated. Research is needed to identify disease-modifying treatments that target inflammation beyond the effects of ART.Peer reviewe
Covid-19 Safety in Large Events
No full textSince April 2021, VKEMS (Virtual Forum for Knowledge Exchange in the Mathematical Sciences) has delivered a series of Virtual Study Groups considering minimising risk / impact of COVID-19 in a range of scenarios (including train travel, opening up higher education and the impact on cardiovascular waiting lists).We have now been tasked by RAMP Continuity Network (a UKRI funded project) to undertake a series of Virtual Study Groups on their behalf.The first Virtual Study Group has the theme - COVID Safety in Large Events. This was a three day event, starting on Tuesday 13th July. This three day event was an intensive session bringing mathematical scientists and other disciplines together to solve end user defined challenges. Study Groups work best when a real-world problem / scenario is posed at the start of the three days. This enables the assembled scientists to develop the generic thinking required but also provide some pertinent insight for the particular case considered. We worked with a number of stakeholders to identify appropriate problems/scenarios for this study group. We provided details of outline problem during the event.The study group covered the spectrum of large events from indoor to outdoor, ticketed to un-ticketed, dynamic to static. Some areas which were looked at:How to partition attendees? What effect do bubbles have on probable transmission rates? How does partitioning by age affect the transmission? Are there other partitions which could be used? How can we avoiding risky queuing? What physical interventions could be made? What is the role of ventilation? Can staircases and other shared spaces be managed to reduce the probability of infection? What about cleaning strategies? Where and how often? What is the role and impact of testing? Can we model 100 % testing with 20-minute result time and its impact on arena filling? What about longer test times and what is the optimal number of tests to do? Can we envisage how "immunity passports" might help?What about support workers? How do we effectively protect those working in these spaces with shift patterns and rotas?Following the event, a working paper was developed, which outlined some potential modelling solutions
Concurrent sexual partnerships and HIV prevalence in five urban communities of sub-Saharan Africa.
No full textOBJECTIVE: To estimate parameters of concurrent sexual partnerships in five urban populations in sub-Saharan Africa and to assess their association with levels of HIV infection and other sexually transmitted infections (STI). METHODS: Data were obtained from a multicentre study of factors which determine the differences in rate of spread of HIV in five African cities. Consenting participants were interviewed on sexual behaviour and at four of the five sites also provided a blood and a urine sample for testing for HIV and other STI. Data on sexual behaviour included the number of partnerships in the 12 months preceding the interview as well as the dates of the start and end of each partnership. Summary indices of concurrent sexual partnerships -- some of which were taken from the literature, while others were newly developed -- were computed for each city and compared to HIV and STI prevalence rates. RESULTS: A total of 1819 adults aged 15--49 years were interviewed in Dakar (Senegal), 2116 in Cotonou (Benin), 2089 in Yaoundé (Cameroon), 1889 in Kisumu (Kenya) and 1730 in Ndola (Zambia). Prevalence rates of HIV infection were 3.4% for Cotonou, 5.9% for Yaoundé, 25.9% for Kisumu and 28.4% for Ndola, and around 1% for Dakar. The estimated fraction of sexual partnerships that were concurrent at the time of interview (index k) was relatively high in Yaoundé (0.98), intermediate in Kisumu (0.44) and Cotonou (0.33) and low in Ndola (0.26) and in Dakar (0.18). An individual indicator of concurrency (iic) was developed which depends neither on the number of partners nor on the length of the partnerships and estimates the individual propensity to keep (positive values) or to dissolve (negative values) on-going partnership before engaging in another one. This measure iic did not discriminate between cities with high HIV infection levels and cities with low HIV infection levels. In addition, iic did not differ significantly between HIV-infected and uninfected people in the four cities where data on HIV status were collected. CONCLUSION: We could not find evidence that concurrent sexual partnerships were a major determinant of the rate of spread of HIV in five cities in sub-Saharan Africa. HIV epidemics are the result of many factors, behavioural as well as biological, of which concurrent sexual partnerships are only one
Exploring expressions of abandonment and rejection that emerged from group therapy with fibromyalgia patients
No full textBibliography: leaves 195-200.Fibromyalgia is a complex syndrome of diffuse pain associated with non-restorative sleep, fatigue, numerous tender points, depression and other conditions that often does not respond well to treatment posing a dilemma to health professionals. The aim of this study was to explore expressions of abandonment and rejection that emerged from group therapy with eleven fibromyalgia patients at the former Princess Alice Orthopaedic Hospital, Cape Town. It focused on abandonment/rejection by caregivers during childhood, death as a form of abandonment, abandonment/rejection in adulthood by family, spouse and family-in-law, by friends, colleagues and employers, by government and society, the hospital and doctors, and by fellow group members and the facilitator. The study is exploratory, interpretative and explanatory in nature with a purposive non-probability sample. The qualitative research method was used to gain insight into the subjective experiences of the lives and illness of the participants. The method of data collection was mainly the tape recorded and transcribed words of the participants over thirty-three group therapy sessions in eleven months and observations by the researcher as full participant observer. The data was sorted and analysed into emerging themes, patterns and categories. All participants had had repetitive experiences of abandonment/rejection, which they had denied, suppressed and avoided, as it was too painful. Due to a lack of inner and external resources, or any intervention, feelings of abandonment, fear and anger were internalized as an unresolved reservoir of emotional pain. This seemed to have escalated into an eventual expression of physical pain (somatisation). From the findings of this study, there appears to be a relationship between adverse psychosocial factors and stress, particularly experiences of abandonment/rejection and fibromyalgia. However, due to the qualitative nature and small sample, the findings cannot be extrapolated and generalized to the broader population of fibromyalgia patients, and quantitative studies are needed for verification
Incomplete ART adherence is associated with higher inflammation in individuals who achieved virologic suppression in the START study
No full textINTRODUCTION: Suboptimal ART adherence, despite HIV viral suppression, has been associated with chronic residual inflammation. Whether this association extends to individuals who initiate ART during early HIV infection remains unknown, which was the objective of this study. METHODS: Plasma levels of interleukin‐6 (IL‐6), high‐sensitivity C‐reactive protein, serum amyloid A protein (SAA), IL‐27, soluble intercellular adhesion molecule‐1, soluble vascular adhesion molecule‐1, D‐dimer and the CD4+/CD8+ T‐cell ratio, were analysed at baseline and eight months after ART initiation in treatment‐naïve participants with HIV and CD4+ T‐cells >500 cells/mm^{3} enrolled in the immediate arm of START. Adherence was assessed by seven‐day self‐report. Multivariable linear regression was utilized to analyse the association between ART adherence and each biomarker at the eight‐month visit in participants who achieved virologic suppression (<50 copies/mL). RESULTS: We evaluated 1627 participants (422 female) who achieved virologic suppression at the eight‐month visit in the period between 2009 and 2013. Median (IQR) CD4+ T‐cell count before ART was 651 (585, 769) cells/mm^{3}. Incomplete adherence was reported in 109 (7%) participants at the eight month visit. After adjusting for covariates, plasma IL‐6 was 1.12 (95% CI, 1.00 to 1.26; p = 0.047) fold higher in participants reporting incomplete versus 100% adherence. A similar association for SAA was observed in an exploratory analysis (1.29 (95% CI 1.04 to 1.60); p = 0.02). No significant differences in other biomarkers were observed. CONCLUSIONS: Incomplete ART adherence was associated with higher IL‐6 levels in individuals who achieved virologic suppression early after ART initiation in START. A potential similar association for SAA requires confirmation. These findings suggest a role for identifying strategies to maximize ART adherence even during virologic suppression. ClinicalTrials.gov number: NCT00867048
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