Delayed initiation of antiretroviral therapy among HIV-discordant couples in Kenya.

Timely initiation of antiretroviral therapy (ART) is particularly important for HIV-discordant couples because viral suppression greatly reduces the risk of transmission to the uninfected partner. To identify issues and concerns related to ART initiation among HIV-discordant couples, we recruited a subset of discordant couples participating in a longitudinal study in Nairobi to participate in in-depth interviews and focus group discussions about ART. Our results suggest that partners in HIV-discordant relationships discuss starting ART, yet most are not aware that ART can decrease the risk of HIV transmission. In addition, their concerns about ART initiation include side effects, sustaining an appropriate level of drug treatment, HIV/AIDS-related stigma, medical/biological issues, psychological barriers, misconceptions about the medications, the inconvenience of being on therapy, and lack of social support. Understanding and addressing these barriers to ART initiation among discordant couples is critical to advancing the HIV "treatment as prevention" agenda.

A population-based study of the risk of repeat clinical chorioamnionitis in Washington State, 1989-2008.

OBJECTIVE: Chorioamnionitis can cause severe complications for the infant; therefore, characterization of the risk of recurrence and identification of the factors that modify it are clinically relevant to pregnant women and their providers. STUDY DESIGN: The risk of recurrence was examined in a retrospective population-based cohort study with the use of birth certificate and delivery hospitalization discharge data from Washington State for the years 1989-2008. RESULTS: Women who had chorioamnionitis in their first deliveries were 3.43 times as likely to have chorioamnionitis in their second deliveries as were women who did not have chorioamnionitis in their first deliveries (95% confidence interval [CI], 2.67-4.42; P < .001). Smoking status modified this association (smokers: odds ratio, 1.38 [95% CI, 0.62-3.08]; nonsmokers: odds ratio, 3.80 [95% CI, 2.88-5.00]). CONCLUSION: These data provide strong evidence for the occurrence of repeat chorioamnionitis; the association is strongest in women who do not smoke during pregnancy.

An FTIR investigation of flanking sequence effects on the structure and flexibility of DNA binding sites.

Fourier transform infrared (FTIR) spectroscopy and a library of FTIR marker bands have been used to examine the structure and relative flexibilities conferred by different flanking sequences on the EcoRI binding site. This approach allowed us to examine unique peaks and subtle changes in the spectra of d(AAAGAATTCTTT)(2), d(TTCGAATTCGAA)(2), and d(CGCGAATTCGCG)(2) and thereby identify local changes in base pairing, base stacking, backbone conformation, glycosidic bond rotation, and sugar puckering in the studied sequences. The changes in flanking sequences induce differences in the sugar puckers, glycosidic bond rotation, and backbone conformations. Varying levels of local flexibility are observed within the sequences in agreement with previous biological activity assays. The results also provide supporting evidence for the presence of a splay in the G(4)-C(9) base pair of the EcoRI binding site and a potential pocket of flexibility at the G(4) cleavage site that have been proposed in the literature. In sum, we have demonstrated that FTIR is a powerful methodology for studying the effect of flanking sequences on DNA structure and flexibility, for it can provide information about the local structure of the nucleic acid and the overall relative flexibilities conferred by different flanking sequences.

Retention of J-1 visa waiver program physicians in Washington State's health professional shortage areas.

PURPOSE: To determine whether the Conrad Program, which allows states to recruit 30 foreign-trained physicians per year to work in underserved settings, is meeting its goal of increasing the number of physicians in Washington State's underserved areas. Participating physicians have completed their residency training in, and want to continue residing in, the United States. METHOD: The authors identified all J-1 visa waiver physicians assigned to employers in Washington between 1995 and 2003, tracked them (whenever possible) through public databases to their current locations, and surveyed them about their experiences in, and subsequent to, the program. RESULTS: The authors tracked 141 of 155 physicians (91%). Of those 141, 77 (55%) responded to the survey. These respondents reported that they remained with their J-1 waiver employers a median of 23 (range: 0-120) months longer than their required commitment periods and that they remained in practices serving primarily underserved populations for, on average, 34 (0-120) consecutive months after fulfilling their commitments. After leaving J-1 waiver employers, 35 of 47 physicians (74%) who served in rural areas moved toward more urban areas, and 57% (80/141) still live in the state. Whereas most expressed satisfaction with the program, 29/77 (38%) felt employers should have shown them more respect. CONCLUSIONS: In Washington State, the Conrad Program has increased the number of physicians in underserved areas who frequently stay beyond their obligations. The significant movement away from rural areas for postobligation employment, however, highlights the long-term need to continue state efforts to recruit physicians to these areas.