Lack Of Positive Association Research Articles

Links between unit costs for HIV services, perceived service quality and client satisfaction in Ukraine

Ukraine’s HIV prevention and management efforts focus on continuous and sustained scale-up of services. To reach UNAIDS 90–90-90 targets by 2020, Ukraine should increase investments in diagnosing, enrolling and retaining people living with HIV in treatment and care. We evaluated the relationship between expenditure on HIV services and client perception of service quality, as client satisfaction has been linked to retention in the HIV care continuum. We interviewed 617 clients who received HIV services at 43 healthcare facilities. Perceived service quality was measured across five domains: comprehensiveness of services, accessibility, user-friendliness, confidentiality and privacy, and overall satisfaction. Annual unit costs were estimated for HIV counseling and testing (HCT), antiretroviral treatment (ART), opioid substitution therapy (OST) and the needle and syringe program (NSP). Linkages between perceived service quality scores that were dichotomized at median and unit costs were measured using logistic regressions among subsets of clients who received respective HIV services. Median annual unit costs for HIV services varied from $7.94 to $661.84. Odds of HCT comprehensiveness increased linearly with the unit cost for HCT services (OR = 3.54, 95% CI 1.43–10.27). ART comprehensiveness was not linked to ART costs (OR = 0.46, 95% CI: 0.04–4.53). There was a negative relationship between confidentiality and privacy and OST costs (OR = 0.61, 95% CI: 0.38–0.96). Overall satisfaction was positively linked only to HCT costs (OR = 2.54, 95% CI 1.12–6.29), and no association was found for NSP costs (OR = 2.28, 95% CI 0.47–12.56). Unit costs for HCT services were associated with better perception of service quality and overall satisfaction, whereas other unit costs were negatively linked (OST) or were not associated (ART, NSP). Mixed results suggest that higher unit costs for some HIV services do not necessarily translate into better quality and consequently into improved retention in care. The lack of positive associations between unit costs and perceived quality of some services highlights the need to explore how HIV resource allocations can be improved in Ukraine to achieve better outcomes.

Abstract 291: Cardiopulmonary Resuscitation Prior to Arrival of Emergency Medical Services in Arizona Extended Care Facilities

Background: Extended care facilities (ECFs) house unique patient populations with increased risk of out of hospital cardiac arrest (OHCA) and with unique, generally medically trained first responders initiating care prior to arrival of emergency medical services (EMS). However, little is known about bystander cardiopulmonary resuscitation (CPR) and resuscitation outcomes in this population. Our aim is to assess rate of CPR delivery prior to EMS arrival in cases of OHCA among residents ECFs across the state of Arizona. Methods: Cases of OHCA between 2016-2018, cared for by participating Arizona EMS agencies, were included if OHCA occurred at an ECF, age 18+, and was of presumed cardiac etiology. Association between survival status at discharge and bystander CPR was examined first by Chi-squared test then by logistic regression, which adjusted for important risk factors and potential confounders including: age, gender, witnessed arrest, shockable initial rhythm, and return of spontaneous circulation (ROSC) in EMS care. Results: There were 1,046 cases included in this study after excluding 32 cases with DNR and 11 with unknown bystander CPR status. Median patient age was 74 (interquartile range 64, 83). The overall rate of CPR prior to EMS arrival was 78.4% (95% CI, 75.8%, 80.9%). Survival to hospital discharge and survival with favorable neurologic outcome were not different between nursing home patients who received CPR prior to EMS arrival and those who did not [6.2% vs. 4.4% (p = 0.34) and 3.1% vs. 1.8% (p = 0.29)]. There was no statistically significant difference in the adjusted analysis. Conclusions: In this study population CPR was commonly delivered prior to EMS arrival. However, delivery of CPR prior to EMS arrival was not associated with survival to hospital discharge or favorable neurologic outcome. The lack of positive association between CPR prior to arrival and survival to hospital discharge may be related to comorbid factors present in ECF patients or differences in the time between collapse and initiation of CPR. Further study is needed to identify factors that might improve survival in this unique population.

Geographic variation in the incidence of marginal zone lymphoma (MZL) subtypes and infectious risk factors.

e13094 Background: Helicobacter pylori is a known etiologic factor for gastric MZL, but data for infectious etiology in other MZL subtypes are controversial. Proposed hypothetical factors include Borrelia burgdorferi for cutaneous MZL (cMZL), Campylobacter (Cmp) for intestinal MZL (iMZL), and hepatitis C (HCV) for splenic (SMZL) or nodal MZL (NMZL). We explored geographic variation in the incidence rate (IR) of MZL and reportable infections in the United States (US) to examine these hypotheses. Methods: Using the National Program of Cancer Registries, we calculated age-adjusted IR (per 100 000 person-years) of MZL subtypes for each US state in 2001-2015. We linked them to the 2010 US census data, data on IR (per 10 000) of Lyme disease (2001-2015) and Cmp infections (2016) from the Center for Disease Control, and to published estimates of HCV prevalence (2013-2016). We examined the hypotheses in multivariable Poisson models adjusting for median age, proportion of men, Black or Asian individuals in each state, reporting adjusted IR ratios (IRR) with 95% confidence intervals (CI). Results: The study included 5,085 cases of cMZL, 3,948 of iMZL, 26,648 of NMZL, and 12,184 of SMZL. Across the US, IR varied between 0.02 and 0.22 for cMZL, 0.04-0.12 for iMZL, 0.33-0.91 for NMZL, and 0.12-0.47 for SMZL. For all subtypes, IR was highest in the Northeast, and lowest in the South ( P<.0001), consistent with general lymphoma epidemiology. However, the IRR for South relative to Northeast was significantly lower for cMZL (0.42; CI, 0.38-0.45) than iMZL (0.65), NMZL (0.65), SMZL (0.67), or aggregate MZL (0.65; CI, 0.64-0.66). In adjusted models, IR of Lyme disease was significantly associated with increased IR of cMZL (IRR=1.11; CI, 1.07-1.16), and Cmp infection was associated with iMZL (IRR=1.19; CI, 1.02-1.38). In contrast, HCV, prevalent in the South, was inversely associated with all MZL subtypes. Conclusions: These results support the putative association between cMZL and Lyme disease, and between iMZL and Cmp infection. Conversely, lack of positive association between any MZL subtype and HCV suggests that it is not a major pathogenic factor in the US. These ecological results do not rule out associations at the individual level, which will require further research.

Obstructive Sleep Apnea and Sleep Architecture in Adolescents With Severe Obesity: Effects of a 9-Month Lifestyle Modification Program Based on Regular Exercise and a Balanced Diet.

Physical exercise and lifestyle modification are recognized as adjunct therapy for obstructive sleep apnea (OSA) in overweight adults. The objectives of this study were to investigate the effects of long-term physical exercise combined with a balanced diet on sleep architecture, sleep duration, and OSA in adolescents with severe obesity. This interventional study was conducted in a nursing institution. Participants were aged 14.6 ± 1.2 years with obesity (body mass index (BMI) = 40.2 ± 6.5 kg/m2). At admission and at 9 months, participants underwent ambulatory polysomnography and incremental maximal exercise testing to determine cardiorespiratory fitness. Twenty-four subjects completed the study. Analyses were performed on the whole population and on a subgroup of subjects with OSA (OSA-subgroup). OSA, defined as obstructive apnea-hypopnea index (OAHI) ≥ 2 events/h, was diagnosed in 58.3% of the population. OAHI was only associated with fat mass in males (r = .75, P < .05). At 9 months postintervention, weight loss (-11.1 kg, P < .0001) and improved cardiorespiratory fitness (VO2peak: +4.9 mL/min/kg, P < .001) were found in the whole population. Sleep duration was increased (+34 minutes, P < .05) and sleep architecture was changed with an increase of rapid eye movement sleep (+2.5%, P < .05) and a decrease of stage N3 sleep (-3.1%, P < .001). Similar results were found in the OSA subgroup. However, OAHI remained unchanged (P = .18). A combination of supervised aerobic exercise and a balanced diet led to weight loss, improved aerobic capacity, and modified sleep architecture without changes in OSA. A commentary on this article appears in this issue on page 907. Registry: ClinicalTrials.gov, Title: Exercise and Venous Compression on Upper Airway Resistance in Obese Teenagers With OSA (OBESOMAC), URL: https://clinicaltrials.gov/ct2/show/NCT02588469, Identifier: NCT02588469.

Visualization of expressing culinary experience in social network, memetic approach

Objectives: The scientific aim of the study was the implementation of the assumptions of tourist experience formation model according to Quan and Wang (2004) in the context of meme theory (i.e. carriers of cultural information, Dawkins, 1976) for evaluation and visualization of the expression of regional cuisine culinary experience by social network users. The quality of culinary service influencing consumer's experience is equal to memetic transmission forming and broadcasting. Such type of transmission is acquired and decoded by consumers for further expression, i.a. through social networks. According to meme theory, the formation and expression of culinary experience is the building of memetic maps described by the frequency of the appearance of certain memes. Data and methods: Research included ten catering facilities, serving dishes of the regional cuisine (Polish, Belarussian, Ukrainian, Lithuanian and Tartar), located in the Podlaskie Voivodeship and having an active profile in Facebook social network. 370 comments were considered from the period between May and September 2016, referring to the contents connected only with the culinary offer of the facilities taken into account. The quantitative and qualitative content analysis was performed. The classification of emotion according to Xu et. al (2015) was used in the semantic decomposition of posted comments. Positive (enjoyment, confidence, safety, positive associations) and negative (dissatisfaction, distrust, anxiety, lack of positive associations) content of posted comments referred to the decor of the inside (mechanic factor), the quality of service (humanic factor) and served dishes (functional factor) were distinguished and analysed (Wall and Berry, 2007).Results: The analysis of the obtained meme maps suggests the presence of positive relationship between presence of memes of holistic enjoyment and enjoyment associated with regional dishes (rS=0.67; p<0,05). Similar relationship was observed between sense of enjoyment as well as the formation of positive associations with regional cuisine (rS=0.67; p<0,05). Expression of anxiety is also highly connected with the negative perception of food quality (rS=0.65; p<0,05). Conclusions: Meme theory is an effective and useful framework for social media content analysis. The study had utilitarian character. Results can be used for the establishment of a system of the recommendation towards improving the quality of regional cuisine culinary services.

A cross-sectional study to examine the association between self-reported sleep and the frequency, duration and intensity of exercise.

Insufficient sleep is associated with increased risk of several health concerns. Although physical activity is generally considered to improve sleep, the influence of different levels of exercise frequency, duration and intensity respectively, has not been sufficiently examined to allow specific recommendations to the general population. Therefore, our aim was to evaluate the association between different levels of the three cardinal characteristics of exercise and sleep disturbance. Data were collected through a Norwegian comprehensive self-report survey. A total of 3763 respondents (46% males, 54% females) with an average age of 47.9 years (range 15-93) completed the questionnaire, whereof 13.7% were categorized as poor sleepers. The exercise characteristics and sleep disturbance were measured on a 6 to 8 and a 4-item Likert scale, respectively. Respondents reporting intermediate levels of exercise frequency, duration and intensity, respectively, had a significantly lower occurrence of sleep disturbance compared to respondents with a sedentary lifestyle. No statistical difference in sleep disturbance was observed between respondents performing exercise corresponding to the lowest and highest levels of the three exercise characteristics and those who were sedentary. The lack of positive association between the lowest and highest levels of the cardinal exercise characteristic and reduction in sleep disturbance revealed in the present study support a recommendation of intermediate levels of exercise frequency, duration and intensity for preventing sleep disturbance in the general population.

Large-scale comparative metagenomics of Blastocystis, a common member of the human gut microbiome

The influence of unicellular eukaryotic microorganisms on human gut health and disease is still largely unexplored. Blastocystis spp. commonly colonize the gut, but its clinical significance and ecological role are currently unsettled. We have developed a high-sensitivity bioinformatic pipeline to detect Blastocystis subtypes (STs) from shotgun metagenomics, and applied it to 12 large data sets, comprising 1689 subjects of different geographic origin, disease status and lifestyle. We confirmed and extended previous observations on the high prevalence the microrganism in the population (14.9%), its non-random and ST-specific distribution, and its ability to cause persistent (asymptomatic) colonization. These findings, along with the higher prevalence observed in non-westernized individuals, the lack of positive association with any of the disease considered, and decreased presence in individuals with dysbiosis associated with colorectal cancer and Crohn’s disease, strongly suggest that Blastocystis is a component of the healthy gut microbiome. Further, we found an inverse association between body mass index and Blastocystis, and strong co-occurrence with archaeal organisms (Methanobrevibacter smithii) and several bacterial species. The association of specific microbial community structures with Blastocystis was confirmed by the high predictability (up to 0.91 area under the curve) of the microorganism colonization based on the species-level composition of the microbiome. Finally, we reconstructed and functionally profiled 43 new draft Blastocystis genomes and discovered a higher intra subtype variability of ST1 and ST2 compared with ST3 and ST4. Altogether, we provide an in-depth epidemiologic, ecological, and genomic analysis of Blastocystis, and show how metagenomics can be crucial to advance population genomics of human parasites.

Lack of Positive Association Between Falls and Bacteriuria Plus Pyuria in Older Nursing Home Residents

Lack of Positive Association Between Falls and Bacteriuria Plus Pyuria in Older Nursing Home Residents

Private Schools in a Global World

Globalization is a popular term that, to economists, describes the effects of diminished costs to trade around the world. The technological revolution of the past two decades lowered barriers to trade in the financial sector as well as in the goods and services sectors. As a result, we routinely consume products from China, India, or Latin America, and these and other countries likewise consume goods and services from us. Many argue that a by-product of the technological revolution is the loss of country and regional cultural identity. We find McDonald's and Starbucks in Seattle, Washington, Beijing, China, and small towns around the globe. Others argue that this simply implies wider choice of goods and of cultural identities.As economists think about globalization, we attribute these changes to efficiency in the marketplace. The technological advances have enabled countries to export those goods and services for which they have a comparative advantage, and the gains from trade have resulted in increased economic growth worldwide. While we see the benefits from the enhanced flow of goods and services across markets, economists have paid less attention to the nonmarket aspects of globalization. The increased flow of information and people across national boundaries implies increased competition across all sectors of the economy. Similar to the market for goods and services, the political institutions that survive the competitive race in the long run presumably will be those that enhance efficiency. This is not to intimate that political systems will replicate the efficiency of the marketplace but to suggest that competitive forces tend to lead to more efficient structures and, ultimately, toward more efficient outcomes. As these public administrative institutions become more competitive, politics should play a diminished role and economic efficiency should play an even greater role in future structures.If globalization ultimately leads to more efficient institutions, the value of examining current international differences in institutional structures is immense. Through understanding past and current differences, we gain insight into our future. Today I want to examine one specific institution within this context--private provision of elementary and secondary schooling. I want to examine private schooling by exploring the institutions that govern the provision of private schooling, the role of politics and economics in the evolution of these institutions, and, finally, the efficiency implications of the various institutional arrangements. At each step in this examination, I shall be assessing the role that globalization has played, and is expected to play, in the delivery of schooling around the world.1. Private Provision around the WorldEconomists have studied education since the days of Adam Smith. We have estimated the demand for schooling, provided normative assessments of the role of the state in education, examined the effects of public expenditures for education on housing markets, estimated the returns to schooling, and estimated the relationship between public schooling and economic development. But most of all, economists have estimated education production functions that relate public sector inputs such as per pupil expenditures, pupil-teacher ratios, or teacher salaries to educational achievement. And, as last year's Southern Economic Association Distinguished Guest Lecturer so eloquently demonstrated, economists, policymakers, and the public have been sorely perplexed by the lack of positive association between these inputs and the achievement of public school students (Hoxby 2004).The private side of schooling has received increasing attention from economists as data have become more available (James 1993). Private schooling occupies a significantly smaller sector of the economy in the United States than does public schooling. According to UNESCO (2000) data, approximately 12% of students enrolled in primary schools in this country attend private schools. …

Spatial distribution patterns of the dominant canopy dipterocarp species in a seasonal dry evergreen forest in western Thailand

Population structure and spatial patterns were examined for four species of canopy dipterocarps ( Anisoptera costata, Dipterocarpus alatus, Hopea odorata, Vatica cinerea) in a 50 ha plot in seasonal dry evergreen forest at the Huai Kha Khaeng Wildlife Sanctuary in western Thailand. Spatial dispersion was assessed with Morisita’s index for quadrat sizes ranging from 61 m 2 to 25 ha; spatial attraction and repulsion between species and size classes were measured with Iwao’s index. Only Vatica had a negative exponential diameter distribution suggesting continuous recruitment. The other species had either normal ( Hopea) or irregular diameter distributions with peaks in the large size classes ( Anisoptera, Dipterocarpus). All four species were significantly clumped at most quadrat sizes. At the local scale, saplings and poles of Hopea and Anisoptera were negatively associated with adults at quadrat sizes <1000–5000 m 2, while the distributions of Dipterocarpus and Vatica saplings and poles were independent of adult trees. In general, saplings and poles were always positively associated with each other. Spatial segregation among species may imply habitat specialization. A torus-translation analysis of habitat association for each of the dipterocarp species revealed both positive and negative species-specific associations. At HKK, most of the dipterocarps’ spatial distributions were independent of each other and there was no evidence of strong spatial segregation among species. The irregular diameter distributions, clumping at large spatial scales, and lack of positive association between juvenile and adult stems suggest that many of the dipterocarps at the 50 ha plot may have established after a large-scale catastrophic disturbance. In the absence of catastrophic disturbance, we hypothesize that the Hopea and Anisoptera populations will eventually disappear from the plot because of a lack of suitable recruitment conditions.

Cigarette Smoking and Drinking of Alcohol are not Associated with Rapid Progression to Acquired Immunodeficiency Syndrome among Homosexual Men in Norway

In order to study the influence of cigarette smoking and drinking of alcohol on the progression to acquired immunodeficiency syndrome (AIDS), eighty HIV infected homosexual men were included in a prospective study from the date of diagnosed HIV seropositivity. Two men were lost to follow-up. The mean follow-up time was 62 months. By the end of the follow-up period 26 out of 78 subjects (33%) were diagnosed with AIDS. When controlling for age, year of HIV diagnosis, number of male lifetime partners and frequency of receptive anal intercourse, the adjusted relative risk of being diagnosed with AIDS for the group smoking 1-20 cigarettes daily was 0.4 (0.2-1.2, 95% confidence interval) and 1.1 (0.4-2.7, 95% confidence interval) for the group smoking more than 20 cigarettes daily, as opposed to the non-smoking group. The adjusted relative risk of progression to AIDS for daily alcohol drinkers as opposed to less frequent drinkers was 0.8 (0.3-2.2, 95% confidence interval). The adjusted relative risks of receptive anal intercourse often or usually and more than 500 lifetime male partners were 2.2 and 2.0, respectively. These estimates, however, were not significantly above 1.0. The lack of positive association between cigarette smoking, drinking of alcohol and progression to AIDS found in this study as well as in other studies, may have implication for the understanding of the pathogenesis of the HIV disease and for counselling HIV infected subjects.

HIV Infection Rate, Use of Prostitutes Are Both High Among Young Military Recruits in Northern Thailand

Serological and sex behavior data collected in May and November 1991 on 2417 male military recruits aged 19-23 from six provinces in northern Thailand were analyzed. 12% tested positive for HIV 11% in May and 13% in November while 4% tested positive for syphilis. Having had four years or less of formal education; having been employed; cigarette marijuana and alcohol use; having sex with relatively less expensive prostitutes; ever using a condom with a prostitute; and an history of STD were all positively associated with being HIV-positive. All but two of the HIV- positive men reported having sex with a woman making them 13.7 times more likely to be infected with HIV than those who were not similarly experienced. Men reporting twenty or more lifetime sex partners were ten times more likely to be infected with HIV than were men with four or fewer lifetime partners. 97% of HIV-positive men reported having had sexual contact with a female prostitute and they were 7.4 times as likely as those who had not to be infected with HIV. 79% of men who were not HIV-positive however also reported contact with a female prostitute. Sex with female prostitutes is thus the norm among these men. The more contacts a recruit had with a female prostitute in the past year the greater his likelihood of being HIV-positive. Having had sex with a wife or girlfriend was not associated with HIV infection. Sex with a man was reported by 3% of the sample but was not associated with HIV infection. Homosexual orientation and drug use are not grounds for automatic exclusion from the Thai military. The same lack of positive association held for the use of injection drugs and having a tattoo reported by 1% and 8% respectively. A 1991 study of 1034 never married men in Chiang Mai also found that many young unmarried males visit prostitutes and have unprotected intercourse with both prostitutes and other female partners. Sex with female prostitutes is the main risk factor for HIV infection among these men. The level of condom use must be increased and the use of female prostitutes decreased if the AIDS epidemic is to be checked.