Microbicide Research and Development—Where To?

Abstract

Purpose: Against the backdrop of increasing numbers of HIV infections in women and the limitations of current safer sex messages, several calls have been made for the development of women-initiated methods of prevention as an essential component of the armamentarium to reduce women’s vulnerability of acquiring infection with HIV. An effective microbicide is a critical survival tool in instances and situations where existing proven prevention strategies have failed to be adopted. Method: The results of published N-9 clinical trials in terms of anti-HIV activity, safety data, and anti-sexually transmitted infection (STI) activity are discussed. Results: There is no evidence of efficacy against HIV in three clinical trials, there is scanty evidence for protection against STIs, and there is considerable evidence of dose-related adverse effects. Conclusion: During this time, a vast array of potential microbicides with differing modes of action have been discovered, and some have undergone preclinical and early clinical testing. Effort, time, and resources might be better spent on advancing preclinical and clinical testing of these other candidate microbicides.     

What is the point: will screening mammography save my life?

Background  

We analyzed the claim "mammography saves lives" by calculating the life-saving absolute benefit of screening mammography in reducing breast cancer mortality in women ages 40 to 65.     

Where to prick the apple for skin testing?

Mal d 1 is not equally distributed over the apple. We aimed to examine the influence of the location of pricking in the apple on prick‐to‐prick skin prick test (PTP) results. PTPs were performed in autumn 2007 and spring 2008, before the birch pollen season, in 32 Dutch adults with symptoms of oral allergy to fresh apple, using apples harvested in autumn 2007. PTPs with fresh intact and unpeeled Pink Lady, Golden Delicious, Elise, Santana and Modi apples were performed using material obtained from approximately 2 cm near the stalk (top), and the middle region. All PTP responses were greater when performed with apple material near the stalk than from the middle region. In 2007, these differences were statistically significant for Pink Lady, Golden Delicious and Elise, and in 2008, for Pink Lady and Modi. When performing PTPs, the apple should be pricked near the stalk rather than in the middle.     

Depression: immunological resignation of the will to live?

Evolution is assumed to promote the survival of the fittest by the greater success of the reproductive potential of those with the characteristics most suited to their environment. Little thought is given to how those least adapted fail to survive to reproduce. If the species, rather than the individual, has a drive to adaptation and survival, there should be a specific mechanism for those least adapted to withdraw from life. The immunological changes accompanying depression may facilitate heart disease, infection, parasitic infestation or other ill health, so that depression is a mechanism for those least resilient, or faced with most adversity, to succumb to illness. If depression is a state facilitating withdrawal from competition for reproductive success, major depressive illness may be the inappropriate and spontaneous occurrence of a mental state which has advantages for the species in allowing those ‘least fit’ to fail to survive. This hypothesis gives an empirically testable challenge to the view that the species has no evolutionary drive to survival and increased adaptedness to the environment, as well as explaining the more and more frequent occurence of a specific mental state and its associated changes in the immune system.     

Are the force characteristics of synchronous handcycling affected by speed and the method to impose power?

ObjectiveTo investigate the influence of exercise conditions (speed and method to impose power) on the applied force, force effectiveness and distribution of work during handcycling.MethodTen able-bodied men performed handcycling on a treadmill. To test the effect of speed, subjects propelled at different velocities (1.38 m/s, 1.66 m/s, 1.94 m/s) with a constant power output (35 W). To test the effect of method to impose power, subjects cycled at a constant speed (1.66 m/s) and different power outputs imposed by incline (1%, 2.5%, 4%) versus pulley system (simulated resistance of incline conditions). From the applied forces, fraction of effective force and work production over the propulsion cycle were calculated.ResultsWhile total force (24.2 to 18.2 N) and tangential force (20.0 to 13.5 N) decreased significantly with higher speed, no change in lateral force was observed (3.5 to 2.8 N). This resulted in a significant decrease of effectiveness (82.6 to 72.9%) and in a change of relative work distribution over the propulsion cycle (44 to 29.8 J). While cycling with the highest velocity, compared to the lower velocities, more work was achieved during pulling and pressing and less work was produced while lifting the crank. No significant differences between the two methods to impose power were found in any parameter (p < 0.05).ConclusionsWhen propelling at equal power output, speed influences the force characteristics of handcycling and should be considered when analyzing force application. Since there is no difference in the force characteristics between propelling at an incline versus ground-level, results of studies examining handbike propulsion with either of these methods are largely comparable.     

Commentary on 'What is the point: will screening mammography save my life?' by Keen and Keen

Commentary on Keen and Keen 'What is the point: will screening mammography save my life?' BMC Medical Informatics and Decision Making, 2009     

From COVID-19 to cancer,watching social determinants decide life: When will we stop spectating?

The COVID-19 pandemic reminds us that African American, Latinx, Indigenous, and poor communities face significant healthcare disparities. Members of these communities have increased exposure to the virus due to higher rates of crowded living conditions and employment in essential occupations. Furthermore, news reports and public health data show that residents of these communities have more comorbidities, utilize hospitals with fewer resources, and experience greater treatment delays, all resulting in higher mortality related to COVID-19. The same social determinants contributing to the inequities seen in COVID-19 drive similar disparities in oncology. Oncologic inequities have long predated the inequities associated with COVID-19 and have led to considerably more deaths. These stark realities demand that we stop merely reporting the impact of adverse social determinants on the health of communities. We must instead target these causes of healthcare disparities. Here, we discuss proposed action items from the 2019 National Cancer Policy Forum workshop entitled “Applying Big Data to Address the Social Determinants of Health in Oncology.” These actions are critical first steps to address adverse social determinants and thereby decrease unnecessary deaths in underserved communities.