HIV & HCV Co-infection

The development of the nursing profession has continued to develop over decades. Whether it's a LVN, LPN, PCT, RN, BSN... certification you have earned, the standards of each program increases with every graduating class. The curriculum has expanded (at my school specifically) by incorporating different aspects of nursing, such as research. For this assignment, we simply had to find an article discussing evidenced-based research, present it in a specific "PICO paper" format, and use APA 6th edition.

TREATMENT FOR PATIENTS CO-INFECTED WITH HIV AND HCV

P = Patient/Problem = Sixty individuals co-infected with Hepatitis C (HCV) and Human Immunodeficiency virus (HIV)

I = Intervention = Twelve weeks of standard therapy with pegylated interferon-alfa and ribavirin in combination with a direct-acting agent, telaprevir

C = Comparison = Standard therapy alone

O = Outcome = Increased virologic response rate of co-infected patients with dual treatment

PICO question:

What is the effectiveness of dual treatment for patients co-infected with HIV as compared to patients receiving standard treatment alone?

Article Reference

Sherman, K. (2011). Telaprevir combination with peginterferon alfa - 2a/ribavirin in hcv/hiv co-infected patients: 24-week treatment interim analysis. Hepatology 2011, Abstract LB-8.

What Intervention is Studied?

Pegylated interferon-alfa and ribavirin in combination with a direct-acting agent, telaprevir, was the intervention evaluated in Sherman’s et al. (2011) research study.

What Outcome is Measured?

One of the outcomes measured is the increased virologic response rate, defined as undetectable Hepatitis C, to dual treatment.

Who is Studied?

Sixty patients co-infected with HIV and HCV were randomly assigned to receive twelve weeks of standard therapy with pegylated interferon-alfa and ribavirin, or to receive their current treatment with the addition of telaprevir. The initial twelve weeks was to be followed by a further thirty-six weeks on pegylated interferon and ribavirin alone. Race, age, and sex were not reported. The study took place in San Francisco, California.

What is the Research Design?

The study had a randomized control trial research design.

What are the Results?

Treatment with the protease inhibitor telaprevir, combined with standard therapy, led to twenty-four week virologic response rates of seventy-one percent. In contrast, fifty-five percent of patients getting standard treatment alone had undetectable hepatitis C virus after twenty-four weeks.

What is the Final Analysis?

Evidence was elucidated by Sherman’s et al (2011) randomized control study’s findings of increased virologic response rate with dual treatment as compared to standard treatment alone.

What are the Study’s Limitations?

The patients, all with the difficult to treat genotype 1 hepatitis C virus, were also stratified by their anti-HIV regimen into three groups: no therapy, efavirenz-based triple therapy, and atazanavir-based triple therapy. Patients taking efavirenz-based triple therapy required an increased dose of telaprevir to compensate. In previous studies, these patients were unable to participate due to drug interactions. The results only reflect a short-term switch and virologic response rates may not be sustained after treatment is discontinued.

What is the Practical Application of the Study’s Findings?

Patients co-infected with HIV and HCV receiving standard treatment, pegylated interferon-alfa and ribavirin, in combination with a direct-acting agent, telaprevir, yielded increased virologic response rates compared to patients receiving standard treatment alone. While there has been concern about drug interactions, especially for patients taking efavirenz, most people providing HIV care may be preparing co-infected patients by switching their regimens in advance of hepatitis treatment (Sherman, et al., 2011). The results reported are very encouraging and at the twenty-four week mark, there appears to be no adverse effect on HIV control.

From the sociological mind of a nurse...(almost)

Embracing the Intersex

When filling out paperwork for a routine check-up at a health clinic and once asked to select the appropriate gender, does an individual truly consider what constitutes to being female or male? These two words, female and male, are used to describe gender, which can be loosely defined as attributes, behaviors, and personality characteristics expected to be associated with a particular sex in a culture. This denotes that gender and sexual identity are conceptually independent but are contrarily associated with each other. This occurs because our ideas regarding, but not limited to, gender and sexuality are socially constructed.

The beliefs of a society may appear to be natural, normal and obvious to those individuals who choose to accept it, but they are in fact an invention or artifact to that particular culture or society. To sustain these beliefs a ‘box system’ is used to categorize females and males. For example females are typically associated with the color pink, wear dresses, and even take on roles of maintaining a household; while males are associated with the color blue, wear pants, and financially support the family but are not perceived as caregivers. But what happens when an individual does not fit this ‘box system’? What if a young boy decides he wants to play with Barbie dolls versus G.I. Joe’s? He may be criticized by his peers and scolded by adults. In an extreme situation, what if a young child has innate characteristics that cannot be taken away or altered? For instance, what if a child is born with ambiguous or undersized genitalia? Such a child can be labeled as intersex; a person born with reproductive and/or copulatory organs which do not categorically define them as female or male. When this occurs, there is normally a hormonal imbalance and in some cases chromosomal differences. In these situations measures have been taken where doctors surgically shape the infants’ genitals soon after birth. In many cases, the ethics of this procedure are contested and questions have been raised regarding consent.

Since intersex varies in many ways, different procedures are administered. Surgical procedures are greatly critiqued because assigning a gender to an intersex child is precursory and immediately performed after birth because so much meaning and emphasis is placed on announcing ‘It’s a boy/girl!’ Additional surgeries may be needed, hormone therapy may be administered, and at times particular precautions must be assessed to ensure correct development of copulatory organs. This treatment may be traumatic for the child and later as the child matures, there may be an indirect correlation with how the individual identifies themselves and the gender they are assigned. It is particularly difficult at the onset of puberty because hormonal imbalances may hinder development and additional therapy may be necessary and could continue for the rest of a persons’ life. At times when discrepancies arise, individuals undergo a reversed surgery which correctly identifies them as the gender of their choice.

Within the past decade, there has been a positive progression in support of transgendered individuals. Beginning in 1993, the Intersex Society of North America was established with the mission to “Devote to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female”. This organization proposes proper psychological care and deferred surgery until the individual is in agreement. In 2003, the Female Genital Mutilation Act was passed and it states, “A person is guilty of an offence if he excises, infibulates or otherwise mutilates the whole or any part of a girl’s labia majora, labia minora or clitoris”. This act helped decipher whether a guardian has the right to issue consent to genital surgery of an infant. Although gray areas still exist, this act has helped prevent incorrect or unwanted gender assignment and has left the decision up to the individual.

Sleep Sweet

I've finally put forth the effort to make my dorm room to feel a bit more "homely". It's worked for the most part. But tonight, for some reason I crave to feel the warmth of someone sleeping beside me.

Status Update

"Transmissions From Camp Trans"
In this Rogerian style writing the claim opposes the exclusion of transsexual women from joining Michigan Womyn’s Music Festival.

"Dark Webs Goth Subcultures in Cyberspace"
This writing style is Toulmin and the claim states that indivduals of the Gothic subculture use cyberspace [the internet] to communicate with one another, to meet people similar to them, receive insight from others, and to share ideas and beliefs.

"The Truck Stop as Community and Culture"
In this classic style writing, the claim suggests that truckers can be compared to cowboys. [Suggests the nomadic lifestyle in which both subcultures share.]

"House for the Homeless"
In the Rogerian style piece the claim states that homeless individuals should not be entirely disreguarded like they are, they are not worthless, they are living beings.


Regarding my paper, I still feel like I have a bit to do. I want to visit my field site this weekend or within the next two weeks or so. I have arrangements to speak to two individuals, one who is currently a part of the 21st century Gothic subculture and the other who is a former Goth. I want to make a claim about religion [Atheism] but I'm not sure how much I could possibly write about that. I am looking into the Gothic fashion style and what colours represent [the stereotypical 'black' and dark colours]. I feel as if I am complete with my research, I just want to get some more insight from others. I haven't started my rough draft but will after I possibly visit my field site.

As for peer review, I would like to know how well my claim relates to the overall theme of my paper. Does it capture the reader's attention? Did I leave the reader with questions at the end?

At Town Center Mall

There are several places I was debating where I should begin my observations of the gothic culture. There is always the courtyard, specifically in front of GCB, various restaurants in Little Five Points along with music venues, and of course, the mall. I wanted to be in a place where I wouldn't feel like a total outcast but at the same time, I wanted to really be in a goth-like setting. I decided to visit Town Center mall in Kennesaw. I chose a mall that had a store called "Hot Topic". It's a store that carries merchandise, apparel, and music for those who are part of the gothic and punk culture. Hot Topic is just as its slogan states, "Everything about the music."

I headed down to Town Center around 4 or 5 p.m. and walked around in the food court for a while. I was excited when I found empty tables near a group of teenagers. There were six who were sitting at the table and a few others that kept getting up and walking around, leaving and returning. I assumed they were around the ages of fifteen and seventeen, I knew they were still in high school because of what some of the things they were discussing. For the most part, there was not much that was absolutely surprsing about this group of individuals other than their way of dress and maybe the way they were such extroverts. Overall, it was a helpful experience.

At this field site, the food court at Town Center, I observed a group of teenage goths. I was able to get a table close enough to hear what they were saying. They simply talked and ate. Two of these individuals were dating and somewhat separated themselves from the rest of the group. Three other teens, two boys and one girl, joined the group of six at a later time and continued to leave and come back to the group of six. I didn't find out what they were doing or where they were going but I assumed it was to visit other stores in the mall.

The members of this subculture interact no differently than I do with my own friends. Some of what they discussed may be different, a lot of what they discussed consisted of music and clothing. They talked about upcoming shows at the Masquerade, a music venue in Atlanta which I am familiar with and the girls talked about the new line of band shirts they had at Hot Topic. The three other teens that kept getting up and leaving the table did act a bit differently. They were a bit loud and attention seeking. The boys would purposely irritate the girl, messing with her hair or taking her bag, which would cause a scene. Other than that, there was nothing out of the ordinary.

There were some terms I wasn't familiar with or some that I had heard before but never bothered looking into. Some of these words were:

Nu Metal
Gothing Up
Poseur
Weekender

After listening to their conversation for a while, I had a few questions about the words listed above and about their music. I felt strange approaching them because I didn't want them to think I was entirely listening to their conversation, even though I was. But I got up and asked about a show at the Masquerade. I told them I didn't mean to intrude on their conversation but overheard them talking about a band that I thought I was familiar with. They seemed surprise when I mentioned the band [Brain Drill] and said that they were performing at the Masquerade in mid-April. I asked them how long they had been listening to the band and then I slowly began to ask how they got into being goth. I used the term 'babygoth' in hope that I wouldn't look stupid or completely unaware. Thankfully, I didn't and I didn't offened them either. They ended up cutting the conversation short because they had a movie to watch. I thanked them for the talk and they left the food court.

As my first outing at my field site, I feel that this is a success. I plan on visiting some workers of Hot Topic in the near future and maybe getting some more insight.

Act V

1) What makes a good field site?
The field site used gave great insight to the prisoners' thoughts and emotions. A variety of prisoners were also interviewed. Race varied along with crimes committed, length of imprisonment, and "prisoner social class". A good field site should contain all of these elements, a large, diverse population and a proper environment that will not affect the actions or emotions of the subject.

2)What observations are made by the author to give the audience a better understanding?
The author makes note of the different characteristics amongst all the prisoners interviewed. The background of each criminal is explored and stories about their childhood and families are shared. For some of the criminals, they shared the crimes committed and used the play of Hamlet to try to delve deep and find out the motive behind their actions.

3)What interview techniques does the author use to help us understand the subculture?
The author simply allows the prisoners to talk. He asks questions in which the prisoners can continuously discuss the answer. Sometimes surprising information is reveals but also helps us understand what is going through the minds of these individuals.

4)What are the norms and values of the subculture?
All men imprisoned have committed some crime. They all have limited education and can read up to the high school level. A man's social standing depends on his physical strength and how well he can protect himself.

Topic: Gothic culture

Sources:

Bibby, Michael; Goodlad, Lauren. Goth: Undead Subculture. Durham : Duke University Press, 2007.

Hodkinson, Paul. Goth: Identity, Style, and Subculture. Oxford ; New York : Berg, 2002.

Siegel, Carol. Goth's Dark Empire. Bloomington : Indiana University Press, c2005.

Spooner, Catherine, Ph. D. Fashioning Gothic Bodies. Manchester ; New York : Manchester University Press ; New York : Distributed in the USA by Palgrave, 2004.

Wolfram, Herwig. History of Goths. Berkeley : University of California Press, c1987.

Reflection:

Goth: Identity, Style, and Subculture was a great source to research. I was a bit nervous before beginning this assignment because I was afraid that the only books or articles that I could find would be about Gothic revival or Gothic architecture, topics that do not relate to the culture I had chosen. The author , Paul Hodkinson, is a sociologist who studied a great deal about the G0thic culture. Hodkinson discusses this culture and when it first emerged from Britain’s punk-rock scene in the late 1970s. When I read this, I had NO idea that the Goth scene had only been around for such a short time. I then began to think about how the Gothic culture has changed in the past four decades. I am now debating whether I should narrow my search or have my focal point on Gothic culture of a particular decade. I also may want to focus on the location of this Gothic culture. Should I research the culture in England, where it all began? Or Los Angeles, Austin, Leeds, Buffalo, New York City, and Sydney? Other things I really liked about this book are the personal accounts and experiences of individuals who are included in this culture. This is gives great credibility to the author.