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Search Results: 1 - 10 of 305644 matches for " Frank J. Palella "
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CD4 Cell Counts at HIV Diagnosis among HIV Outpatient Study Participants, 2000–2009
Kate Buchacz,Carl Armon,Frank J. Palella,Rose K. Baker,Ellen Tedaldi,Marcus D. Durham,John T. Brooks
AIDS Research and Treatment , 2012, DOI: 10.1155/2012/869841
Abstract: Background. It is unclear if CD4 cell counts at HIV diagnosis have improved over a 10-year period of expanded HIV testing in the USA. Methods. We studied HOPS participants diagnosed with HIV infection ≤6 months prior to entry into care during 2000–2009. We assessed the correlates of CD4 count <200 cells/mm3 at HIV diagnosis (late HIV diagnosis) by logistic regression. Results. Of 1,203 eligible patients, 936 (78%) had a CD4 count within 3 months after HIV diagnosis. Median CD4 count at HIV diagnosis was 299 cells/mm3 and did not significantly improve over time ( ). Comparing periods 2000-2001 versus 2008-2009, respectively, 39% and 35% of patients had a late HIV diagnosis ( ). Independent correlates of late HIV diagnosis were having an HIV risk other than being MSM, age ≥35 years at diagnosis, and being of nonwhite race/ethnicity. Conclusions. There is need for routine universal HIV testing to reduce the frequency of late HIV diagnosis and increase opportunity for patient- and potentially population-level benefits associated with early antiretroviral treatment. 1. Introduction Recent HIV surveillance data suggest that approximately 33% of HIV-infected persons in the United States present for HIV testing late and have AIDS (CD4+ cell count <200?cells/mL or an AIDS-defining illness) within one year after HIV diagnosis [1, 2]. Patients are less likely to experience the full benefits of highly active combination antiretroviral (cART) therapy if they enter HIV care and initiate treatment at a CD4 count <350?cells/mm3 [3, 4]; the clinical cost is even more profound when the CD4 count is <200?cells/mm3 or the patient has already developed clinical AIDS [5–8]. In addition, persons who remain unaware of their HIV-positive status (estimated 21% to 25% of infected persons in the USA in recent years) [9, 10] may not only miss the benefits of earlier cART treatment, but are also more likely to remain chronically viremic and are thereby more likely to transmit HIV to their sexual and needle-sharing partners [9]. The CDC has been promoting strategies to encourage more widespread HIV screening to diagnose infected persons earlier in the course of their illness, including by releasing in 2006 the guidelines for implementing routine universal opt-out testing in healthcare settings [11]. Yet, the latest HIV surveillance data [1, 2] and epidemiologic studies in multiple US populations indicate that the proportion of persons who are diagnosed late in the course of HIV infection [2, 12, 13] or present late for HIV care [14, 15] remains unacceptably high. Stable or worsening
Trends in Decline of Antiretroviral Resistance among ARV-Experienced Patients in the HIV Outpatient Study: 1999–2008
Kate Buchacz,Rose Baker,Douglas J. Ward,Frank J. Palella,Joan S. Chmiel,Benjamin Young,Bienvenido G. Yangco,Richard M. Novak,John T. Brooks
AIDS Research and Treatment , 2012, DOI: 10.1155/2012/230290
Abstract: Background. Little is known about temporal trends in frequencies of clinically relevant ARV resistance mutations in HIV strains from U.S. patients undergoing genotypic testing (GT) in routine HIV care. Methods. We analyzed cumulative frequency of HIV resistance among patients in the HIV Outpatient Study (HOPS) who, during 1999–2008 and while prescribed antiretrovirals, underwent GT with plasma HIV RNA >1,000 copies/mL. Exposure ≥4 months to each of three major antiretroviral classes (NRTI, NNRTI and PI) was defined as triple-class exposure (TCE). Results. 906 patients contributed 1,570 GT results. The annual frequency of any major resistance mutations decreased during 1999–2008 (88% to 79%, ). Resistance to PIs decreased among PI-exposed patients (71% to 46%, ) as exposure to ritonavir-boosted PIs increased (6% to 81%, ). Non-significant declines were observed in resistance to NRTIs among NRTI-exposed (82% to 67%), and triple-class-resistance among TCE patients (66% to 41%), but not to NNRTIs among NNRTI-exposed. Conclusions. HIV resistance was common but declined in HIV isolates from subgroups of ARV-experienced HOPS patients during 1999–2008. Resistance to PIs among PI-exposed patients decreased, possibly due to increased representation of patients whose only PI exposures were to boosted PIs. 1. Introduction Highly active combination antiretroviral therapy (cART) has significantly improved survival and reduced the rates of AIDS-related complications among HIV-infected persons [1–3]. Emergence of HIV variants with reduced susceptibility to antiretroviral (ARV) medications can significantly limit the effectiveness and durability of treatment [3–8]. Use of ARV resistance testing to optimize cART selection has been associated with better virologic and clinical outcomes [9–11] and improved survival [12], and resistance testing is now generally recommended in the clinical management of HIV infection [13–15]. We have previously shown that use of genotypic and phenotypic testing increased in the HIV Outpatient Study (HOPS) during 1999–2006 and that the likelihood of testing varied by HIV disease severity and demographic characteristics [16]. Recent European and Canadian studies have suggested that both the prevalence [17, 18] and incidence [19, 20] of ARV resistance among HIV-infected persons have declined, due predominately to a decrease in the proportion of patients with pre-cART mono- or dual-ARV experience, and the increasing use and effectiveness of more tolerable and potent cART regimens that appear less likely to result in resistance mutations [18–22].
Factors Affecting Glomerular Filtration Rate, as Measured by Iohexol Disappearance, in Men with or at Risk for HIV Infection
Joseph B. Margolick, Lisa P. Jacobson, George J. Schwartz, Alison G. Abraham, Annie T. Darilay, Lawrence A. Kingsley, Mallory D. Witt, Frank J. Palella
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086311
Abstract: Objective Formulae used to estimate glomerular filtration rate (GFR) underestimate higher GFRs and have not been well-studied in HIV-infected (HIV(+)) people; we evaluated the relationships of HIV infection and known or potential risk factors for kidney disease with directly measured GFR and the presence of chronic kidney disease (CKD). Design Cross-sectional measurement of iohexol-based GFR (iGFR) in HIV(+) men (n = 455) receiving antiretroviral therapy, and HIV-uninfected (HIV(?)) men (n = 258) in the Multicenter AIDS Cohort Study. Methods iGFR was calculated from disappearance of infused iohexol from plasma. Determinants of GFR and the presence of CKD were compared using iGFR and GFR estimated by the CKD-Epi equation (eGFR). Results Median iGFR was higher among HIV(+) than HIV(?) men (109 vs. 106 ml/min/1.73 m2, respectively, p = .046), and was 7 ml/min higher than median eGFR. Mean iGFR was lower in men who were older, had chronic hepatitis C virus (HCV) infection, or had a history of AIDS. Low iGFR (≤90 ml/min/1.73 m2) was associated with these factors and with black race. Other than age, factors associated with low iGFR were not observed with low eGFR. CKD was more common in HIV(+) than HIV(?) men; predictors of CKD were similar using iGFR and eGFR. Conclusions iGFR was higher than eGFR in this population of HIV-infected and -uninfected men who have sex with men. Presence of CKD was predicted equally well by iGFR and eGFR, but associations of chronic HCV infection and history of clinically-defined AIDS with mildly decreased GFR were seen only with iGFR.
Fat distribution and longitudinal anthropometric changes in HIV-infected men with and without clinical evidence of lipodystrophy and HIV-uninfected controls: A substudy of the Multicenter AIDS Cohort Study
Todd T Brown, Xiaoqiang Xu, Majnu John, Jaya Singh, Lawrence A Kingsley, Frank J Palella, Mallory D Witt, Joseph B Margolick, Adrian S Dobs
AIDS Research and Therapy , 2009, DOI: 10.1186/1742-6405-6-8
Abstract: Between 1999 and 2002, 33 men with clinical evidence of lipodystrophy (LIPO+), 23 HIV-infected men without clinical evidence of lipodytrophy (LIPO-), and 33 HIV-uninfected men were recruited from the four sites of the Multicenter AIDS Cohort Study (MACS). Participants underwent dual-energy x-ray absorptiometry, quantitative computerized tomography of the abdomen and thigh, and circumference measurements of the waist, hip and thigh. Circumference measurements at each semi-annual MACS visit between recruitment and 2008 were used to compare average annual anthropometric changes in the 3 groups.Body mass index (BMI) was lower in LIPO+ men than in the LIPO- men and the HIV- uninfected controls (BMI: 23.6 ± 0.4 vs 26.8 ± 1.5 vs 28.7 ± 0.9 kg/m2, respectively, p < 0.001). The average amount of visceral adipose tissue (VAT) was similar in all three groups (p = 0.26), but after adjustment for BMI, VAT was higher in the LIPO+ group (169 ± 10 cm2) compared to the LIPO- men (129 ± 12 cm2, p = 0.03) and the HIV-uninfected group (133 ± 11 cm2, p = 0.07). Subcutaneous adipose tissue (thigh, abdomen) and total extremity fat were less in the HIV-infected men (LIPO+ and LIPO-) than in the HIV-uninfected men. Over an average of 6 years of follow-up, waist circumference increased at a faster rate in LIPO+ group, compared to the LIPO- men (0.51 cm/year vs 0.08 cm/year, p = 0.02) and HIV-uninfected control men (0.21 cm/year, p = 0.06). The annual changes in hip and thigh circumferences were similar in all three groupsSubcutaneous lipoatrophy was observed in HIV-infected patients, even those without clinical evidence of lipodystrophy, compared to age-matched HIV-uninfected men. Despite markedly lower BMI, HIV-infected men with lipodystrophy had a similar amount of VAT as HIV-uninfected men and tended to have more rapid increases in waist circumference over 6 years of follow-up. These longitudinal increases in waist circumference may contribute to the development of cardiovascular risk in
Early Onset of Tenofovir-Induced Renal Failure: Case Report and Review of the Literature
Shilpa M. Patel,Teresa R. Zembower,Frank Palella,Yashpal S. Kanwar
The Scientific World Journal , 2007, DOI: 10.1100/tsw.2007.164
Cammaroto,; Martins,Feliberto; Palella,Santa;
Investigación y Postgrado , 2003,
Abstract: the research is conceived in the education-university-society concept. its basic purpose was to analyze the instructional strategies used by the mathematics professors at simón bolívar university ?s coast campus. to that end, a diagnosis was made of the teaching techniques, activities and learning tools used in the mathematics classes. as regards the learning process, the study was grounded in the principles of the constructivism (kilpatrick (1995), cognitive psychology and instructional strategies (szczurek (1989). the methodology used was that of descriptive field research, with a non-experimental design. the sample consisted of the 13 mathematics professors and 90 students taking courses in that discipline. a questionnaire-based survey was applied, one aimed at the students and another at the professors. both were validated by expert judgment and the reliability of both instruments was determined through a pilot test using cronbach?s alpha statistic. given results obtained and the contrast of information, it became clear that the instructional strategy used by most professors it is the exposition (lecture class); in response, the students follow the patterns of traditional education; they observe and listen the professor and go no further than to take notes; and the instructional materials used in class are the blackboard and theoretical-practical study booklets.
Bipolar Spectrum Disorders and Self-Concept among Males and Females with Parenting Roles  [PDF]
Frank J. Prerost, Sharon Song
Psychology (PSYCH) , 2012, DOI: 10.4236/psych.2012.34051
Abstract: Bipolar spectrum disorders have been found to produce significant psychosocial costs for individuals and society. Although a number of studies have examined various psychosocial and psychological aspects associated with the bipolar spectrum disorders, the research literature has been extremely limited when focused on the parenting role. This current study examined the self-concept among parents who have been diagnosed with a bipolar spectrum disorder. A group of male and female parents with a diagnosis of a bipolar spectrum disorder were assessed using the Tennessee Self-Concept Scales-2. Another group of males and females without a diagnosis of a bipolar spectrum disorder were also assessed for comparison using the same assessment tool. Compared to the non-bipolar parent group, results showed that participants with a diagnosis of a bipolar spectrum disorder showed a significantly lower self-concept marked with doubts, concerns about academic/work performance, and perceptions of being physically diminished, inadequate, alienated, and unworthy of the family role. Findings from this study showed that parents with a bipolar spectrum disorder expressed negative perceptions related to inadequacy as a person across a number of self-concept dimensions. The results expanded upon current descriptions of the psychological dimensions found among individuals diagnosed with a bipolar spectrum disorder.
Effect of Ap4A, UTP and Salbutamol on Mucociliary Clearance in a Mouse Model of Cystic Fibrosis (in Situ)  [PDF]
Frank Begrow, Eugen J. Verspohl
Pharmacology & Pharmacy (PP) , 2013, DOI: 10.4236/pp.2013.42025
Abstract: Cystic fibrosis is a life-threatening, wide spread genetic disease diagnosed in 1 to 3000 livebirths of the Caucasian population. Here a mouse model for this disease is described and optimized using the CFTR-channel selective inhibitor CFTR(inh 172). The target parameter was mucociliary clearance measured using microdialysis of the transported fluorescent dye rhodamine in the mouse trachea in situ. The impact of Ap4A (diadenosine tetraphosphate) as a potential drug was investigated. Its inhalation was effective at low concentrations; established compounds such as Salbutamol and UTP increased mucociliary clearance as well. Our data show a functioning model of cystic fibrosis and the effectiveness of the newly tested Ap4A.
Taxonomy and palaeoecology of Cretaceous nautilids Angulithes galea (Fritsch in Fritsch & Schl nbach, 1872) and Angulithes westphalicus (Schlüter, 1872)
Frank J
Bulletin of Geosciences , 2010, DOI: 10.3140/bull.geosci.1194
Abstract: Angulithes galea (Fritsch in Fritsch & Schl nbach, 1872) and Angulithes westphalicus (Schlüter, 1872) are representatives of Angulithes Montfort, 1808, occurring in the Late Cretaceous of Europe, from the Late Turonian to the Late Campanian. Following examination of the majority of specimens representing these species and their specific morphology, a detailed revision was made. Both species undergo significant morphological changes during their ontogeny, changing the shape of the ventral side and whorl cross-section attended by onset and loss of ventral keel and changing of the shell surface (by A. galea). Comparing these changes with the ontogeny of recent Nautilus suggests they are expressions of the approach and attainment of maturity. Due to this comparison, comparable changes in other taxa can be similarly interpreted, e.g. representatives of the genus Deltocymatoceras. The changes undergone by A. galea are at maturity accompanied by additional features such as strong radial ribbing, which is comparable with the ribbing in Deltocymatoceras. The affinity (ventral keel, suture, ontogeny and stratigraphy) of this genus with Angulithes is a topic for discussion.
Arch Reconstruction in Hypoplastic Left Heart Syndrome: Handling the Diminutive Aorta  [PDF]
Francisco J. Boye, Frank A. Pigula
World Journal of Cardiovascular Surgery (WJCS) , 2013, DOI: 10.4236/wjcs.2013.36039
Abstract: The diminutive aorta presents technical challenges in the palliation of hypoplastic left heart syndrome. Furthermore, aortic arch caliber changes and variable great vessel relationships can add complexity to an already difficult arch repair. We describe a technical approach that simplifies the aortic reconstruction and makes the procedure more generalizable and reproducible.
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