David William Cohen

Long-term survival and serious cardiovascular events in HIV-infected patients treated with highly active antiretroviral therapy

There is continuing interest in the longer term effects of highly active antiretroviral therapy (HAART) on the risk of cardiopulmonary events. We assessed this using updated administrative data from an open retrospective cohort of HIV-infected persons receiving care from the US Veterans Affairs (VA). Information on 41,213 HIV-infected patients receiving VA care between January 1993 and December 2003 was included. Patients were followed for an average of 4 years or 168,213 person-years of follow-up. The death rate fell from 20.9 deaths per 100 patient-years of observation in 1995 to 5.2 deaths per 100 patient-years in 2003. In patient-level analysis, adjusted hazard ratios for death dropped precipitously for all races to a low of 0.18 (95% confidence interval: 0.15 to 0.23) at 72 months of exposure to HAART. Hazards for serious cardiovascular events remained near 1.0 for exposure to HAART, and hazards for serious cardiovascular events, stroke, or death were only slightly higher than for death alone. No selection effects or secular trends were found. The benefits of HAART continued to increase in the 8 years after introduction and with 6 years of individual use. The risk of serious cardiovascular events should be factored into individual patient management but does not pose an important public health risk.PURPOSE A recent increase in Acanthamoeba keratitis (AK) cases has been associated with Complete MoisturePlus, although many cases used other solutions. Complete MoisturePlus contains taurine and hydroxypropyl methylcellulose, unlike other multipurpose solutions (MPSs). The purpose of this study is to (1) determine contact lens solution efficacy against recent clinical and tap water Acanthamoeba isolates and (2) determine whether taurine inclusion increases Acanthamoeba survival against contact lens solutions. METHODS Acanthamoeba T4 trophozoites from recent AK clinical and tap water isolates were placed on multiple concentrations of taurine-saline agar for 72 hours with Enterobacter aerogenes as prey. Amoebae were exposed for 6 and 24 hours to hydrogen peroxide solutions and MPSs (ReNu Multiplus, Complete MoisturePlus, AMO Trade Name, Opti-free Express, Clear Care, and UltraCare) and tested for survival. Plates were examined over the following week for growth. RESULTS Strain type and solution affected survival. MPSs were ineffective, with 100% survival of all strains at 6-hour exposure. Hydrogen peroxide systems were more effective, with survival of 3/5 strains (Clear Care) and 1/5 strains (UltraCare) at 6 hours. The Chicago-area tap water strain was most resistant. Among hydrogen peroxide systems, no statistically significant difference in Acanthamoeba survival existed with taurine inclusion. CONCLUSIONS Recent clinical and tap water Acanthamoeba strains, representing proven human pathogens and/or household strains, were highly virulent against contact lens solutions. The Chicago-area tap water strain was most resilient, a concern if tap water is contributing to the AK increase. Results further differentiated resistance among T4 strains, highlighting the importance of multiple strain testing.

Reliving the Past: The Worlds of Social History

Five historians uncover the ties between peoples daily routines and the all-encompassing framework of their lives. They trace the processes of social construction in Western Europe, the United States, Latin America, Africa, and China, discussing both the historical similarities and the ways in which individual history has shaped each areas development. They stress the need for a social history that connects individuals to major ideological, political, and economic transformations.

Agenda for African Economic History

It is frequently remarked that Africa is so diverse as to defy generalization. Perhaps one generalization that can legitimately be made is that today there exists in every sphere of government in every African country a “development consciousness,†preeminent within this consciousness a dependence on economic planning for growth. The historical lessons of Europe and America are proffered and the lessons are studied and more than occasionally applied in the African setting. The Euroamerican historical record is rich and ripe for study; the African record of economic history, on the other hand, nearly does not exist. The embarrassing lacunae of historical work on the economies of Africa is pronounced, whether one is speaking of the transitional economies which through increased trading links first bridged world and African communities in perhaps an irreversible way, or whether one is speaking of the colonial economies of increased dependence, or of the “development economies†of more recent years. And there is irony here, for when seen against the often thin character of the pre-colonial historical record, work on the economic features of pre-colonial Africa seems relatively more substantial than work on the colonial and post-colonial periods.

Improving healthcare value through clinical community and supply chain collaboration

BACKGROUND We hypothesized that integrating supply chain with clinical communities would allow for clinician-led supply cost reduction and improved value in an academic health system. METHODS Three clinical communities (spine, joint, blood management) and one clinical community-like physician led team of surgeon stakeholders partnered with the supply chain team on specific supply cost initiatives. The teams reviewed their specific utilization and cost data, and the physicians led consensus-building conversations over a series of team meetings to agree to standard supply utilization. RESULTS The spine and joint clinical communities each agreed upon a vendor capping model that led to cost savings of

The Cultural Topography of a ‘Bantu Borderland’: Busoga, 1500–1850

3 million dollars and

The history of Busoga

1.5 million dollars respectively. The blood management decreased blood product utilization and achieved

Siaya: The Historical Anthropology of an African Landscape.

1.2 million dollars savings.

Burying SM: The Politics of Knowledge and the Sociology of Power in Africa

5.6 million dollars in savings was achieved by a clinical community-like group of surgeon stakeholders through standardization of sutures and endomechanicals. CONCLUSIONS Physician led clinical teams empowered to lead change achieved substantial supply chain cost savings in an academic health system. The model of combining clinical communities with supply chain offers hope for an effective, practical, and scalable approach to improving value and engaging physicians in other academic health systems. IMPLICATIONS This clinician led model could benefit both private and academic health systems engaging in value optimization efforts. LEVEL OF EVIDENCE N/A.

African words, African voices : critical practices in oral history

The terrain of Busoga and adjacent areas of eastern Uganda constituted a portion of the boundary of the broad Bantu speech community of southern, central, west-central and eastern Africa. By examining closely the settings and circumstances of contact between Bantu and non-Bantu in this portion of the ‘Bantu line’ between approximately 1500 and 1850, it is possible to see the complexity of the ‘face of contact’ between speech communities in eastern Uganda. The study reviews several different efforts to comprehend and represent the evolving contacts between Bantu-speakers in the Busoga area and, in particular, Luo-speaking immigrants. Over the long run, many groups associated with Luo immigration took over Bantu speech while gaining dominant statuses and positions within the largely Bantu-speaking communities in the area. The study distinguishes five distinctive and non-homologous zones within this narrow stretch of the Bantu borderland, emphasizing through comparative analysis the very local, immediate, and contextual character of contacts across speech boundaries. It brings forward the economic and political significance of the circumstances of contact, and locates patterns of resistance, flux, and reflux within the era following the linguistic incorporation of the ‘stranger’ Luo within Bantu speech communities. Indeed, some of the important population flows in Busoga appear to have developed out of reactions to elaborated forms of domination building over a number of years, rather than as instant expressions of boundary and cultural formation by the participants in the experience.

Underserved Urban African American Men: Hypertension Trial Outcomes and Mortality During 5 Years

The original article can be retrieved from the JSTOR database at http://www.jstor.org/stable/217701