Progressive Group Research Articles

Cysteine 138 mutation in HIV-1 Nef from patients with delayed disease progression

The nef gene from HIV-1 has been shown to be an important pathogenic factor when considering development of AIDS. Detection of nef variants with an effect on immune modulation is important to understand HIV-1 pathogenesis and has possible impact on treatment strategies. The nef gene of HIV-1 isolates from patients in a long-term non-progressor (LTNP) cohort and a slow-progressor (SP) cohort (n = 11) was analysed and compared with isolates from a control patient group of progressors (n = 18). Most of the patients with delayed disease progression had extensive medical records, providing an insight into the LTNP disease profile and allowing for the stratification of patients based on their CD4 cell decline. In sequences from nine patients, most of the functional domains of HIV-1 Nef appeared intact, and no major deletions were observed to possibly account for an effect on the delayed disease status. However, the results demonstrate a high incidence of a single amino acid polymorphism (cysteine 138) in HIV-1 Nef. The allelic frequency of cysteine 138 between the delayed disease progression group and the progressor group was found to be statistically significant (P = 0.0139). The phylogeny of isolates was investigated and the variants harbouring the cysteine 138 mutation clustered independently. The present study describes a viral genetic polymorphism related to AIDS disease progression. The polymorphism (cysteine 138) has previously been reported to confer decreased viral replication (Premkumar DR, et al. AIDS Res Hum Retroviruses 1996; 12(4): 337-45). A sequence database search for comparative mutations revealed a high frequency of cysteine 138 in patients with reported SP AIDS.

Virus replication and disease progression inversely correlate with SIV tat evolution in morphine-dependent and SIV/SHIV-infected Indian rhesus macaques

We analyzed the association between evolution of the 5′ exon of tat and disease progression in an SIV/SHIV macaque model of opiate dependence and AIDS. Cloned tat sequences were obtained by RT-PCR amplification of 3 plasma viruses (recovered at different times) from 6 morphine-dependent and 2 control Indian rhesus macaques inoculated with SHIV KU-1B SHIV 89.6P and SIV/17E-Fr. Approximately ten clones were sequenced for each animal per time point for use in phylogenetic analyses. We found a strong, significant inverse correlation between disease progression and tat diversity in plasma by 20 weeks post-infection. The morphine-dependent macaques developed 2 distinct disease patterns – rapid progressor (Group A) and slow progressor (Group B) – whereas control animals developed into slow progressor only (Group C). The three animals in Group A exhibited ∼40% ( P = 0.01) and ∼50% ( P = 0.028) less diversity than Group B and C animals, respectively, over the 20 weeks. Furthermore, the Group A macaques showed a prominent reemergence of the wild-type SV17E tat sequence used in the inoculum that coincided with disease progression. This suggests that the virus from the original infection represented the most pathogenic form among all animals in these cohorts throughout the first 20 weeks of infection. We were unable to support or rule out a role for immune pressure on tat evolution based on the spectrum of sequence changes in the data set. Thus, in the short duration of this study, the Tat-specific immune pressure cannot explain the different disease outcomes of the six morphine animals nor of the two controls. Our results also suggest that in vivo morphine dependence can contribute to the pathogenesis of SIV/SHIV infection and that it may do so in conjunction with the evolution of viral proteins, such as Tat.

Developmental Stages in Public Health Partnerships: A Practical Perspective

Health education practitioners often form and provide support to partnerships directed toward public health goals. The authors viewed the start-up of a state health department/multiuniversity partnership for the evaluation of the state's tobacco settlement pilot project using the lens of the Tuckman four-stage model of group development. The four stages--forming, storming, norming, and performing--occurred in sequence but with pronounced overlap. Two types of performing--institutional and group performing--were observed. An awareness of group developmental stages can allow leaders and members to improve the ways their partnership works together. Applying Tuckman's model also can allow expectations about the group's progress and members' interactions to be managed so that tasks are aligned with the appropriate stage of development. Finally, for partnerships that have a long life span, understanding that the stages may occur several times throughout the group's existence can acclimate members to shifting responsibilities and relationships over time.

Bringing Interdisciplinary and Multicultural Team Building to Health Care Education: The Downstate Team-Building Initiative

To evaluate the impact of the Downstate Team-Building Initiative (DTBI), a model multicultural and interdisciplinary health care team-building program for health professions students. A total of 65 students representing seven health disciplines participated in DTBI's first three years (one cohort per year since implementation). During the 18-session curriculum, students self-evaluated their group's progress through Tuckman's four team-development stages (FORMING, STORMING, NORMING, PERFORMING) on an 11-point scale. Students completed matched pre- and postintervention program evaluations assessing five variables: interdisciplinary understanding, interdisciplinary attitudes, teamwork skills, multicultural skills, and team atmosphere. After participation, students completed narrative follow-up questionnaires investigating impact one and two years after program completion. Each year's team development curve followed a similar logarithmic trajectory. Cohort 1 remained in team development stage 3 (NORMING) while Cohorts 2 and 3 advanced into the final stage-PERFORMING. A total of 34 matched pre- and postintervention evaluations showed significant change in all major variables: Team atmosphere and group teamwork skills improved most (48% and 44%, respectively). Interdisciplinary understanding improved 42%. Individual multicultural skills (defined by ability to address racism, homophobia, and sexism) started at the highest baseline and improved the least (13%). Group multicultural skills improved 36%. Of 23 responses to the follow-up surveys, 22 (96%) stated DTBI was a meaningful educational experience applicable to their current clinical surroundings. DTBI successfully united students across health discipline, ethnicity, socioeconomic class, gender, and sexual orientation into functioning teams. The model represents an effective approach to teaching health care team building and demonstrates benefits in both preclinical and clinical years of training.

A Structured Group for Gay Men Newly Diagnosed with HIV/AIDS

The author presents a structured group model designed to help gay men newly diagnosed with HIV/AIDS. A facilitator's manual is included to outline the group's progression through eight sessions and to address the psychosocial concerns often ignited by an HIV or AIDS diagnosis. Suggestions for future group work are also provided.

Differences in disease progression in a cohort of long-term non-progressors after more than 16 years of HIV-1 infection.

It is unclear whether resistance to immunologic damage in long-term non-progressors (LTNP) will last indefinitely or whether it merely represents the extreme of a Gaussian distribution, and therefore progression will occur eventually. A cohort of 19 LTNP was established in 1997. Plasma viraemia and CD4 cell counts were measured two to three times each year until 2003. Analyses of nef and vpr viral genes, CCR5 genotypes, co-receptor tropism, viral replication capacity, and immunological parameters were performed. Twelve subjects (non-progressors, NP) showed stable CD4 cell counts over the 6-year follow-up, while seven (slow progressors, SP) showed a trend towards progressive CD4 cell depletion; however, only three SP experienced significant CD4 cell count declines. All SP had detectable plasma HIV-RNA (median 1118 copies/ml). In contrast, five of 12 NP had always undetectable viraemia. Only one patient showed a deletion in nef. The vpr R77Q change was recognized in seven patients. All patients were infected with R5 viruses. The virus replicative capacity was reduced in all tested individuals (range 5-93%). None of the patients was homozygous for the delta-32 CCR5 genotype, which was found in heterozygosis in three. CD8 T-cell activation was low in all but three individuals, all of whom had detectable viraemia and showed progressive CD4 cell depletion. Cytotoxic T lymphocyte responses were similar to those found in a control group of HIV progressors. A substantial proportion of LTNP show low-level virus replication and progressive loss of CD4 T cells over time. Progressive immunologic damage seems to be directly associated with some degree of virus replication and T-cell activation.

Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes

To evaluate the change in osteoarthritic (OA) knee cartilage volume over a two-year period with the use of magnetic resonance imaging (MRI) and to correlate the MRI changes with radiologic changes. Thirty-two patients with symptomatic knee OA underwent MRI of the knee at baseline and at 6, 12, 18, and 24 months. Loss of cartilage volumes were computed and contrasted with changes in clinical variables for OA and with standardized semiflexed knee radiographs at baseline at 1 and 2 years. Progression of cartilage loss at all followup points was statistically significant (P < 0.0001), with a mean +/- SD of 3.8 +/- 5.1% for global cartilage loss and 4.3 +/- 6.5% for medial compartment cartilage loss at 6 months, 3.6 +/- 5.1% and 4.2 +/- 7.5% at 12 months, and 6.1 +/- 7.2% and 7.6 +/- 8.6% at 24 months. Discriminant function analysis identified 2 groups of patients, those who progressed slowly (<2% of global cartilage loss; n = 21) and those who progressed rapidly (>15% of global cartilage loss; n = 11) over the 2 years of study. At baseline, there was a greater proportion of women (P = 0.001), a lower range of motion (P = 0.01), a greater circumference and higher level of pain (P = 0.05) and stiffness in the study knee, and a higher body mass index in the fast progressor group compared with the slow progressor group. No statistical correlation between loss of cartilage volume and radiographic changes was seen. Quantitative MRI can measure the progression of knee OA precisely and can help to identify patients with rapidly progressing disease. These findings indicate that MRI could be helpful in assessing the effects of treatment with structure-modifying agents in OA.

Genetic Evaluation of Localized Prostate Cancer in a Cohort of Forty Patients: Gain Of Distal 8q Discriminates Between Progressors and Nonprogressors

Over-representation of sequences on chromosome 7 and 8 have been reported to be associated with aggressive behavior of prostate cancer. In this study we have performed a molecular cytogenetic survey by comparative genomic hybridization of a cohort of 40 prostate cancer patients, consisting of 20 progressors and 20 nonprogressors, after radical surgery for localized adenocarcinoma. Progression was defined as a biochemical relapse, ie, an elevation in prostate-specific antigen level in the serum. The mean follow-up after prostatectomy for the progressor group was 10.6 years, for the nonprogressor group, 9.1 years. Using comparative genomic hybridization, we found that progressors harbored on average more aberrations than nonprogressors. Gains were especially more prominent among progressors (p < 0.05), whereas a statistical trend was detected for losses (p = 0.10). As a consequence we examined all chromosome arms separately. The frequencies of loss for areas known to be frequently deleted in prostate cancer, such as 6q, 8p, or 13q, were not different between the two groups. A tendency was observed for more frequent gain on 3q in the progressor group (p = 0.09). However, gain of 8q (minimal overlapping region at 8q24-qter) was significantly more frequent in the progressor group (p = 0.04). This biomarker retained its significance when adjusted for the factors age, tumor grade, tumor stage, resection margin status, and preoperative prostate-specific antigen level. In conclusion we have created a map of genetic changes in progressive and nonprogressive prostatic carcinomas. Importantly, the presence of gain of distal 8q markedly reduced the progression-free survival, suggesting a clinical role for 8q gain in assessing the malignant potential of localized prostatic adenocarcinoma.

Facilitating Transformative Learning Groups: Reflections on Mexico and Highlander

Introduction In the mid 1990s, the authors participated in two trips to learn about facilitating group transformative learning in differing cultural contexts. The first trip was to Guanajuato, Mexico, in order to engage in the systematic process of learning about popular adult education there. Popular education in Mexico is well developed and our host, Felix Cadena, is considered to be one of the leading experts in this methodology in all of Latin America. Popular education in the Mexican context is influenced by Paulo Freire's work. After studying the implementation of transformational learning strategies all across SouthAmerica, Cadena (1991) developed, through dialogue with those who had been struggling with empowering the disenfranchised, a systematic approach to implementing transformational learning or praxis. His approach, which draws on the work of others, emphasizes community enhancement through self-sufficiency It integrates the respectful dialogue of individuals in the community working in cooperation to solve community problems. It is through the process of identifying and solving problems that people and communities are empowered. Rather than solutions being driven by a pre-conceived theory, solutions to practical problems are based on peoples' experience as they grapple to try to solve problems for themselves. However, it is Cadena's belief that unless praxis is implemented in a systematic way, the process can break down and agreed upon goals and objectives may not be reached. The second journey to the Highlander Center (Highlander) was held as an international conference with representatives from Canada, the United States, and Mexico. Highlander is one of the most well--known residential popular education organizations in the United States. In the decades since 1932, activists have gathered to reflect upon and prepare for activities designed to address historically well-known social, environmental, and economic problems facing the people of the South, including, but not limited to, the Southern labor movements of the 1930s, the Civil Rights Movement of the 1940s- 1960s, and the Appalachian people's movements of the 1970s-1980s. Highlander's work is dedicated to the eradication of human suffering through the facilitation of participatory social and educational strategies designed to help all people. The purpose of these educational experiences was to learn more about the methods as well as issues related to implementing transformative learning strategies from a cross-contextual perspective. We reflect upon our experience as well as the documentation collected by the group's memory committee on both trips in order to provide guidance to those wishing to implement these strategies, if they feel they are appropriate to their own context. The memory committee consisted of three members who were responsible for taking notes and organizing all materials collected on our journey Hopefully, our experience can provide general guidance for those who work with adult educators in many settings. In order to study transformative learning in Mexico, the Popular Adult Education Group (PAEG) of Rutgers University, New Brunswick, New Jersey, was formed. PAEG actually adopted the principles of popular education--systematization--to facilitate our learning about its principles when we journeyed to Mexico. Systemization is engaged in by purposefully organizing individuals into groups to regularly share personal reflections upon the day's activities in order to evaluate the group's progress toward the collective goal(s) and to facilitate communication among its members. At Highlander, the atmosphere was more collegial and participatory, with less rigorous emphasis on participatory pre-planning, reflection, group process, and experience. It is our contention that what we learned from our experience in Mexico was deeper and more profound because of the meticulous attention paid to facilitating group process through systematization (Cadena, 1991), which was thoroughly and successfully implemented. …

Impact of cardiac transplantation on kidney function: a single- center experience

Long-term follow-up of cardiac transplant recipients reveals a progressive decline in kidney function in a significant number of patients. This complication is one of the most important prognostic parameters for the outcome of cardiac transplantation. The risk factors implicated in the pathogenesis of renal dysfunction following cardiac transplantation are numerous, with the immunosuppressive drug cyclosporine (CsA) playing a major role. This case–control study was designed to evaluate the role of different risk factors among patients who had been transplanted at the Northern General Hospital Cardiothoracic Centre (CTC) with the possibility of identifying modifiable risk factors that mitigate the nephrotoxicity of CsA. Over a 10-year period, heart transplantation was performed in 205 patients at the CTC. Seventeen patients who experienced chronic renal failure (CRF) and were treated at the outpatient clinic of the Sheffield Kidney Institute were randomly selected from those who had >2-year graft survival and follow-up after cardiac transplantation. As controls, 15 cardiac transplant patients were randomly selected from 32 with comparable survival and follow-up after transplantation and without evidence of significant renal dysfunction (serum creatinine ≤150 μmol/L). The putative risk factors for development of renal insufficiency were retrospectively studied as well as those affecting the rate of progression of CRF. Seventy-five percent of the progressors (cases) had ischemic cardiomyopathy compared with 10% of nonprogressors (controls) (P < .05). CsA trough levels during the follow-up period were higher among the nonprogressors compared with the progressors (P = .03). Follow-up systolic blood pressure revealed a statistically significant correlation with the slope of serum creatinine in the progressor group (r = −.515 and P < .05). At the time of transplantation, ischemic cardiomyopathy as an underlying diagnosis seems to be a detrimental factor, contributing to the pathogenesis of renal dysfunction after heart transplantation. CsA trough levels alone do not seem to discriminate between progressors and nonprogressors. A randomized controlled study may be required to evaluate the possibility of replacing or reducing CsA to the lowest possible dose in the early posttransplant period for the subset of patients with ischemic cardiomyopathy.

Cytokine gene polymorphisms: association with psoriatic arthritis susceptibility and severity.

To determine whether functional cytokine gene polymorphisms influence disease susceptibility and phenotype in patients with psoriatic arthritis (PsA). DNA was obtained from 147 PsA patients and 389 controls. Seven functional proinflammatory (interleukin-1beta [IL-1beta] +3953, IL-6 -174, tumor necrosis factor alpha [TNFalpha] -308, TNFbeta +252) and antiinflammatory (IL-10 -1082, IL-10 -592, IL-1 receptor antagonist [intron 2, 86 bp, variable-number tandem repeat]) gene polymorphisms were detected by polymerase chain reaction and restriction fragment length polymorphism assays. No significant difference in genotype frequencies was observed between the control and the PsA patient populations, and no association with Steinbrocker functional class, disease classification (polyarticular or oligoarticular), presence of spinal involvement, or age at PsA onset was observed. The presence of joint erosions was significantly associated with the TNFalpha -308 and TNFbeta +252 polymorphisms (P < 0.0001 and P = 0.0017, respectively). Frequencies of the TNFalpha -308 and TNFbeta +252 genotypes were also significantly different (P = 0.0078 and P = 0.0486, respectively) in a group of progressors (patients with early PsA in whom the number of joint erosions in the hands and feet increased over a median interval of 24 months) compared with a group of nonprogressors. Age at psoriasis onset was significantly associated with the TNFbeta +252 and TNFalpha -308 polymorphisms (P = 0.0003 and P = 0.0081, respectively). The TNFB2B2 and TNFalpha -308 AA genotypes were associated with the earliest mean ages at psoriasis onset. The TNFalpha -308 and TNFbeta +252 polymorphisms were significantly associated with age at psoriasis onset, presence of joint erosions in PsA, and progression of joint erosions in early PsA. TNF gene polymorphisms may be useful prognostic markers in PsA, and these results support the rationale for using anti-TNF treatment in patients with severe, progressive PsA.

Disease progression markers during asymptomatic phase of HIV-1 infected children with unimpaired CD4+ cell values: evaluation of repeat CD4+ cell evaluation vs. other immunological parameters.

The availability of a marker that could predict the course of disease progression in HIV-infected individuals would be of considerable relevance during the asymptomatic stage in order to undertake timely prophylactic measures. A prospective study was undertaken in a group of 42 children suffering from thalassemia major with HIV-1 infection to assess the status of immune parameters, such as peripheral CD4+ T lymphocyte (CD4+ cell) percentage, delayed type of hypersensitivity (DTH) response to recall antigens, detection rate and levels of p24 antigen, and levels of beta-2 microglobulin and cytokines in serum. All were assessed at an interval of 2 years during the asymptomatic period, (baseline and follow-up assessments) in relation to the development of AIDS defining illness within a follow-up period of 3 years. No difference could be observed in the mean CD4+ cell percentage at baseline between those who progressed subsequently to develop AIDS within the follow-up period (progressors) and those who did not (non-progressors). However, at the point of follow-up assessment the progressor group showed significantly lower CD4+ cell percentage compared to the non-progressor group (33 +/- 4.9 vs. 22 +/- 5.6; p < 0.05), although in the progressor group there was no correlation of the baseline and follow-up CD4+ cell percentage with the duration of the AIDS-free interval. However, in the progressor group there was a strong negative correlation between the rate of decline in CD4+ cell percentage and subsequent duration of the AIDS-free interval (r = -0.859). Analysis of additional immune parameters at baseline revealed that the progressor group, despite having CD4+ cell values comparable to non-progressors, showed impaired DTH response (number and total induration of positive responses being 2.0 +/- 1.23 and 6.2 +/- 1.4 in the former group vs. 3.2 +/- 0.76 and 12.6 +/- 3.80 in the later group; p < 0.05 for both the parameters), and elevated levels (mg/l) of serum beta-2 microglobulin (2.92 +/- 0.89 vs. 1.38 +/- 0.43; p < 0.05). The serum cytokine profile at baseline in the progressor group showed a T helper type-2 (Th2) dominant pattern, i.e. elevation of interleukin-4 (IL-4) and interleukin-10 (IL-10) levels with decreased levels of interleukin-2 (IL-2) and gamma interferon (gamma-IFN) compared to the non-progressor group that showed a T helper type-1 (Th1) dominant profile, i.e., elevation of IL-1 and gamma-IFN level with decreased levels of IL-4 and IL-10 (p < 0.05 for all four cytokines). The present study points out that rate of decline rather than single point of assessment of CD4+ cell values is a more reliable predictor for disease progression in HIV-1 infected children. In addition, parameters such as DTH response, serum levels of beta-2 microglobulin and serum cytokine profile, may provide valuable predictors of subsequent fall in CD4+ cell value.

Phosphites Add Across Double Bonds

From the ACS meeting Chemists in Japan have developed a technique for the catalytic addition of hydrogen-phosphorus bonds (hydrophosphorylation) to olefins and conjugated dienes. Their achievement makes possible the convenient production of alkanephosphonic acid derivatives for potential use as synthetic intermediates, flame retardants, herbicides, chiral ligands (for asymmetric synthetic catalysts), and extraction media (to treat actinide nuclear waste). Hydrophosphorylation thus joins hydroboration and hydrosilylation as a means of forming bonds from carbon to other elements. The work was carried out by postdoctoral fellow Farzad Mirzaei, organic chemistry department chairman Masato Tanaka, senior research chemist Li-Biao Han, and postdoctoral fellow Chang-Qiu Zhao at the National Institute of Materials & Chemical Research, Tsukuba, Japan. Mirzaei reported the group's progress in a presentation to the Division of Organic Chemistry. The researchers find that success depends on the use of the cyclic ester...

The bitter and the sweet: the irony of assessment-driven social studies professional development in one US school

This article is focused on the Michigan Educational Assessment Program (hereafter referred to as the MEAP), and its immediate and evolving influence on social studies professional development at Reed Elementary School located in a Southwest Michigan Public School District in the United States. This particular elementary school has a 7-year-old schooluniversity partnership that involves university coordinators and a concentrated number of intern teachers (from 9-20 per semester). The school/university partners (two university coordinators and 10 mentor teachers) meet each week for 2 hours to focus on professional development. This study examines the evolution of the mentor teachers as they requested to become involved in a professional development focus on social studies. Their progress toward increased social studies developed slowly, but there is substantive evidence which documents the group's progress in three areas, i.e. their understanding regarding the intersection of and defined differences between social studies and socialisation, an increased understanding of the scope of social studies and its interdisciplinary nature, and greater clarity regarding the nature of the MEAP and the school-wide, cross-grade planning that must be developed to assist children in their social studies learning.

PCR-Based assay to quantify human immunodeficiency virus type 1 DNA in peripheral blood mononuclear cells.

An assay that quantifies the amount of human immunodeficiency virus type 1 (HIV-1) DNA in peripheral blood mononuclear cells has been developed. PCR amplification of the HIV-1 DNA is performed in the presence of an internal quantitation standard, and colorimetric detection of the amplified product is performed with microwell plates. The copies of HIV-1 DNA are normalized to total genomic DNA input. The assay has an analytical sensitivity of 10 input copies per amplification reaction and a three-log detection range. In an analysis of sequential samples from patients on combination therapy, HIV-1 DNA was quantifiable for all individuals tested, including those with undetectable plasma HIV-1 RNA. In a separate study, a comparison of HIV-1 DNA levels was made with a group of long-term survivors and progressors. The mean HIV-1 DNA levels were lower in the long-term survivors than in the progressors (P, 0.04). The mean HIV-1 RNA levels were also lower, but the difference was not statistically significant (P, 0.164). A quantitative DNA assay will provide an additional tool to gain insight into the natural history of infection and the continued efficacy of potent antiretroviral therapies.

Grouping in the Dark

What College Students Learn from Group Projects More and more college and university faculty are assigning students to work in groups to solve real-world or simulated problems (Gamson, 1994). The trend toward classroom teamwork has been stimulated by students, prospective employers of college graduates, accrediting agencies, and educators who advocate learning. Many students, particularly the growing population of returning adults, appreciate interactive experiences (Watkins, 1990). As companies rely more on to improve productivity (Schilder, 1992), they also emphasize the need for college graduates to be skilled in teamwork and effective communication (Coleman, 1996). Accrediting agencies also stress the importance of group experiences for students. New criteria established by the Accreditation Board for Engineering and Technology (ABET), for example, require engineering programs to demonstrate that graduates have an ability to function on multi-disciplinary teams and an ability to communicate effectively (ABET, 1997). Seve ral educators who have investigated the benefits of peer group experiences for elementary and secondary school students also advocate that college students collaborate as they learn (Bosworth & Hamilton, 1994; Johnson, Johnson, & Smith, 1991, 1998). The umbrella term collaborative learning refers to a variety of instructional practices that encourage students to work together as they apply course material to answer questions, solve problems, or create a product (Smith & MacGregor, 1992). Research conducted with college students indicates that participation in group projects promotes students' academic achievement, persistence in college, and positive attitudes about (Springer, Stanne, & Donovan, 1997). Students are more likely to attain positive outcomes from group experiences when instructors provide students with information and guidance about how to work together (Bosworth & Hamilton, 1994). The types of guidance instructors should provide are specified clearly by proponents of cooperative learning such as Johnson and Johnson (1994) and Slavin (1983) who maintain that group work will enhance more than individual work only if instructors structure assignments to meet specific conditions. These conditions include providing instruction about interpersonal skills, encouraging positive interdependence among students, making individual goal achievement dependent upon attainment of group goals, and encouraging students to reflect on the group process (Johnson & Johnson, 1994; Slavin, 1983). With proper guidance, students will hold all members accountable for group performance, support each others' learning, share leadership, and monitor their efforts to improve the group's performance. When instructors fail to provide such guidance, Johnson and Johnson (1994) argue that students will not hold other group members accountable, have little commitment to other group members' learning, work alone as much as possible, only recognize a team leader appointed by the instructor, and fail to assess the quality of the group's progress. The conditions for group in higher education settings rarely meet the standards advocated by scholars. Few faculty have either extensive experience working in groups themselves or formal training about how to manage groups. As a result, many well-intentioned faculty assign group projects without providing students the information and guidance prescribed by advocates. A survey conducted with participants in group projects at a single university found that many students had negative reactions to group experiences. Students were particularly frustrated when they believed that the instructor had poor group skills or shirked responsibility for helping the groups (Fiechtner & Davis, 1984-85). The survey also revealed that many students, nevertheless, perceived that some of their group experiences were positive. …

Combined Genotypes of CCR5, CCR2, SDF1, and HLA Genes Can Predict the Long-Term Nonprogressor Status in Human Immunodeficiency Virus-1–Infected Individuals

AbstractHuman immunodeficiency virus (HIV)-1–infected long-term nonprogressors (LT-NP) represent less than 5% of HIV-1–infected patients. In this work, we tried to understand whether combined genotypes of CCR5-▵32, CCR2-64I, SDF1-3′A and HLA alleles can predict the LT-NP status. Among the chemokine receptor genotypes, only the frequency of the CCR5-▵32 allele was significantly higher in LT-NP compared with the group of standard progressors. The predominant HLA alleles in LT-NP were HLA-A3, HLA-B14, HLA-B17, HLA-B27, HLA-DR6, and HLA-DR7. A combination of both HLA and chemokine receptor genotypes integrated in a multivariate logistic regression model showed that if a subject is heterozygous for CCR5-▵32 and homozygous for SDF1 wild type, his odds of being LT-NP are increased by 16-fold, by 47-fold when a HLA-B27 allele is present with HLA-DR6 absent, and by 47-fold also if at least three of the following alleles are present: HLA-A3, HLA-B14, HLA-B17, HLA-DR7. This model allowed a correct classification of 70% of LT-NPs and 81% of progressors, suggesting that the host's genetic background plays an important role in the evolution of HIV-1. The chemokine receptor and chemokine genes along with the HLA genotype can serve as predictors of HIV-1 outcome for classification of HIV-1–infected subjects as LT-NPs or progressors.

Combined Genotypes of CCR5, CCR2, SDF1, and HLA Genes Can Predict the Long-Term Nonprogressor Status in Human Immunodeficiency Virus-1–Infected Individuals

Human immunodeficiency virus (HIV)-1–infected long-term nonprogressors (LT-NP) represent less than 5% of HIV-1–infected patients. In this work, we tried to understand whether combined genotypes of CCR5-▵32, CCR2-64I, SDF1-3′A and HLA alleles can predict the LT-NP status. Among the chemokine receptor genotypes, only the frequency of the CCR5-▵32 allele was significantly higher in LT-NP compared with the group of standard progressors. The predominant HLA alleles in LT-NP were HLA-A3, HLA-B14, HLA-B17, HLA-B27, HLA-DR6, and HLA-DR7. A combination of both HLA and chemokine receptor genotypes integrated in a multivariate logistic regression model showed that if a subject is heterozygous for CCR5-▵32 and homozygous for SDF1 wild type, his odds of being LT-NP are increased by 16-fold, by 47-fold when a HLA-B27 allele is present with HLA-DR6 absent, and by 47-fold also if at least three of the following alleles are present: HLA-A3, HLA-B14, HLA-B17, HLA-DR7. This model allowed a correct classification of 70% of LT-NPs and 81% of progressors, suggesting that the host’s genetic background plays an important role in the evolution of HIV-1. The chemokine receptor and chemokine genes along with the HLA genotype can serve as predictors of HIV-1 outcome for classification of HIV-1–infected subjects as LT-NPs or progressors.

The Continuum of Care: Housing and Services at James Lenox House

At the cusp of the 21st century the dynamic changes affecting family constellations, demographics, and life expectancy influence the much debated health care delivery system. Less often discussed is housing development, housing stock, and the services brought into the homes where people reside. Although this lack of attention to the latter holds true for the entire population, it is of acute concern to the elderly. Nowadays older adults may select from a large variety and bewildering array of residential settings to live out the remainder of their lives. Along with the more familiar apartments, cooperatives and condominiums, a large number of residential complexes and living arrangements are available from which to choose (Table 1). The lengthy list does not include Board and Care Homes, also called Domiciliary Care; sheltered housing or residential care facilities; Congregate Housing (a collective term for various forms of residential care or adult homes); nor facilities/services such as Respite, Adult Day and Hospice Care (Skolnick & Warrick, 1985). In addition, Nursing Homes have been transformed into minimedical facilities, often with added specialty units for Alzheimer's, hospice, and rehabilitation patients, and with subacute care units. The proliferation of residential and custodial care facilities for the older population highlights this group's progression from independence to dependence and from wellness to chronicity which frequently necessitates episodic care for temporary ailments and end-of-life care. The purpose of these relatively new living accommodations (Table 1), with their varied and frequently bewildering nomenclature, is aimed at extending and supporting independence in settings resembling as nearly as possible normal living arrangements. Designed for the specific purpose of delaying or preventing a move to a more protective environment, they are less institutional in mission and structure and are therefore less regulated. The state of the art in assisted living has given rise to many subtle distinctions in the service delivery packages and living arrangements available to the elderly. Public officials worry that market forces in and of themselves may be insufficient to regulate the burgeoning private development of the assisted living industry (Klein, 1998). NEW YORK CITY'S UNIQUENESS Large urban environments such as New York City have for decades attracted individualists. The percentage of those in nontraditional living arrangements and of those who have never married is particularly high, even among present day New York City elders. Some have never kept house, taking advantage instead of the many apartment hotels and single room occupancies (SROs). Many were employed in positions in which room and board were included as part of their remuneration, such as nannies, baby nurses, housekeepers, building superintendents, and support staff in institutional settings. Independent individualists, who are particularly unaccustomed to accepting assistance from anyone, and who become disturbed if increasing frailty prevents them from giving rather than receiving, predominate. Some are survivors of more traditional households whose other members have died, who have left to follow career opportunities elsewhere, or who have sought less costly or perhaps safer neighborhoods in which to raise their families. These, then, are the persons who, when they near the end of life, must be sheltered, protected, and assisted toward a dignified death (United States Bureau of the Census, 1990; Weisel & Joshi, 1994). The purpose of this paper is to describe a not-for-profit organization's successful, commonsense approach to the development of an independent living facility in an urban environment and its subsequent growth. JAMES LENOX HOUSE James Lenox House (JLH), although designed and intended as an independent senior residence, has followed, from its inception, the tradition of a caring community. …

Incidence and determinants of microalbuminuria in Koreans with type 2 diabetes.

The incidence of diabetic nephropathy in type 2 diabetes differs widely by race. Although clinical proteinuria is reportedly more common in East Asian type 2 diabetic patients than in their Caucasian counterparts, data on the incidence of microalbuminuria are not available. This study was undertaken to investigate the incidence and the determinants of microalbuminuria in Korean type 2 diabetic patients. A cohort of 188 Korean type 2 diabetic patients with initial normoalbuminuria were followed prospectively for 5.5 +/- 0.9 years in an outpatient clinic of a university hospital. The incidence of elevated urinary albumin excretion (UAE) (> 20 micrograms/min) and its relationship with baseline characteristics and follow-up data were determined. Of the 146 patients who finished the study, 37 showed persistently elevated UAE during follow-up, giving an incidence of 52/1,000 person-years. Age, duration of diabetes, and baseline UAE were significantly higher in the progressors than in the nonprogressors. More patients in the progressor group had retinopathy at baseline and at the end of follow-up. The mean values of fasting plasma glucose, HbA1, and systolic and diastolic blood pressure during the follow-up period were significantly higher in the progressors than in the nonprogressors. Cox proportional hazards analysis revealed that presence of retinopathy, duration of diabetes, mean fasting plasma glucose, and mean systolic blood pressure during follow-up are independent variables that have a statistically significant influence on the development of microalbuminuria. The incidence of microalbuminuria in Korean type 2 diabetic patients is lower than that reported in Pima Indians with type 2 diabetes but is as high as that in Caucasians with type 1 diabetes. Presence of diabetic retinopathy, poor glycemic control, and high blood pressure are risk factors for development of microalbuminuria in Koreans with type 2 diabetes.