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Forming Groups and Choosing a Topic

• Science and Engineering are cooperative pursuits and you will probably often take part in teams throughout your career. Therefore, this course includes an in class team presentation designed to be in a journal club style. • 1) Form a group with five students total. Each group should elect a communication representative or leader. Please have the group members to be emailed to me at [email protected] by February 12th by the group leader.

You and your group will present a Power Point presentation on a topic related to the course material centred on one original research publication in a topic NOT related to your thesis work. This could include a publication on an application to the Anatomy or Physiology of a specific therapeutic situation in humans or could include an original basic research paper on a topic in the course. For instance you can choose a publication that shows an application using stem cells. 2) Topic; for this purpose the group will need to choose a topic and find a recent publication to match the topic.

This topic and publication is to be chosen by February 26th.You can change afterwards if the group agrees. 3) Once the paper is chosen, please show it to me to ensure that it is acceptable. 4) The presentation should be divided as follows: A) Current state of knowledge in the area B) Introduction to the topic including the condition to be treated and the background to the technology to be used. 

A description of the publication including methods and procedures D) A summary of data obtained E) Conclusions You might also discuss shortcomings and future directions • 4) Duration of presentations are a maximum 25 minutes total for the group (5 minutes each). Questions should be reserved until after the presentation taking up to 30 minutes total for each group. Each group member must contribute to the presentation verbally. • 5) The Power Point presentation will be submitted to the Discussion board on the day of the first talk which is April 2nd and the second presentation day is April 13th. • 6) The posted presentation should include • A) Full references to the work cited including all authors, names of papers, all journal editions and pages as well as acknowledgements for images or videos used. • B) All of the presenting student’s names. • 7)

A signed acknowledgement on separate paper will be submitted as well stating that all four group members contributed equally to the presentation • 8) Each presentation will be reviewed by every other group using a rubric. The reviewing student will come from each group so that groups will sit together and sign the final graded rubric Group members (presenters)_______________________________________________ _______________________________________________________________________ Topic___________________________________________________________________ • Level weak could be improved very good excellent • Introduction to topic weak, general field not covered field covered but more could be done good coverage of field Excellent coverage of field • Introduction to publication weak - not too sure about the point of the work adequate intro to the topic of the paper good intro to the topic of the paper Excellent intro to the topic of the paper •

Materials and Methods weak – did not really explain methods adequate explanation of methods good - explained methods well excellentexplanation of methods • Results weak description of results adequate description of results gooddescription of results excellentdescription of results • Discussion weak discussion of results adequate discussion of results good discussion of results excellent discussion of results Ability to answer questions Poor adequate good Excellent Total marks Marks/24 Deductions for disorganization Deductions for reading from slides and lack of class engagement Deductions for not fully referencing topic Comments on presentation.

Forming Groups and Choosing a Topic

To the Editor: To recommend antiretroviral therapy (ART) as a policy to prevent transmission of the human immunodeficiency virus type 1 (HIV-1), it is critical to understand the risk of transmission through sex without condom use when the plasma viral load in patients receiving ART is fully suppressed.

In addition to data reported by Cohen et al. (Aug. 11 issue),1 a 2009 meta-analysis2 showed no transmissions in 291 person-years, and the Partners in Prevention Study (ClinicalTrials.gov number, NCT00194519)3 showed one transmission in 273 person-years, but some couples used condoms. Accounting for the proportions of couples having sex without the use of condoms (approximately 4%,1 75%,2 and 4%3 in these three studies, respectively), only approximately 292 person-years of sex without the use of condoms with viral-load suppression have been observed over all studies combined.

Even with no transmissions, these findings are associated with an upper 95% confidence limit for the transmission rate of 1.3 per 100 personyears. We think this is too high a rate on which to base a public health prevention policy. Further, there remain no data on men who have sex with men, among whom transmission rates for anal sex are likely to be different than rates for vaginal sex. Alison Rodger, M.D. Andrew Phillips, Ph.D. University College London London, United Kingdom [email protected] Jens Lundgren, Ph.D. University of Copenhagen Copenhagen, Denmark No potential conflict of interest relevant to this letter was reported. 1. Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy.

N Engl J Med 2011; 365:493-505. 2. Attia S, Egger M, Müller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: systematic review and meta-analysis. AIDS 2009;23:1397-404. 3. Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet 2010;375:2092-8. To the Editor: Cohen et al. compared the effects of early and delayed therapy for HIV-1– infected subjects among serodiscordant couples and found that the first regimen more significantly reduced the rates of sexual transmission and the incidence of clinical events of HIV-1.

However, a comprehensive survey should be performed to assess the changes in sexual behavior among the subjects in response to ART. During the study, although interviews regarding sexual behavior were conducted at each visit, the changes in sexual behavior before and after ART were not compared. Reynolds et al.1 found that HIV-1 transmission was reduced among HIV-1–discorthis week’s letters 1934 Prevention of HIV-1 Infection with Antiretroviral Therapy 1936 Tissue Plasminogen Activator and DNase in Empyema 1937 Chimeric Antigen Receptor–Modified T Cells in CLL 1939 Malpractice Risk According to Physician Specialty 1940 HRAS Mutation Mosaicism Causing Urothelial Cancer and Epidermal Nevus 1942 Nitric Oxide during Altitude Acclimatization.

Presentation Format and Duration

The New England Journal of Medicine Downloaded from nejm.org at Danske Regioner on July 2, 2014. For personal use only. No other uses without permission. Copyright © 2011 Massachusetts Medical Society. All rights reserved. correspondence n engl j med 365;20 nejm.org november 17, 2011 1935 dant couples after initiation of ART because of the reduced HIV-1 viral load and the increased consistency of condom use. Nonetheless, the data indicate that ART increases risk-taking sexual behavior.2 Furthermore,

the high prevalence of HIV-1 drug resistance in persons who did not receive ART in other studies3,4 suggests that drug-resistance testing is necessary for the selection of the initial ART regimen and helpful in discussing the possible reasons for HIV-1 transmission among serodiscordant couples. Xiaohua Tao, M.D. Dan Shao, Ph.D. Wei Xue, M.D. Dermatology Hospital of Jiangxi Province Nanchang, China [email protected] No potential conflict of interest relevant to this letter was reported.

1. Reynolds SJ, Makumbi F, Nakigozi G, et al. HIV-1 transmission among HIV-1 discordant couples before and after the introduction of antiretroviral therapy. AIDS 2011;25:473-7. 2. Shafer LA, Nsubuga RN, White R, et al. Antiretroviral therapy and sexual behavior in Uganda: a cohort study. AIDS 2011; 25:671-8. 3. Hamers RL, Siwale M, Wallis CL, et al. HIV-1 drug resistance mutations are present in six percent of persons initiating antiretroviral therapy in Lusaka, Zambia. J Acquir Immune Defic Syndr 2010;55:95-101. 4. Ross L, Lim ML, Liao Q, et al.

Prevalence of antiretroviral drug resistance and resistance-associated mutations in antiretroviral therapy-naïve HIV-infected individuals from 40 United States cities. HIV Clin Trials 2007;8:1-8. The Authors Reply: Rodger and colleagues rightly note that we do not know the benefits of ART in persons who have unprotected sex (sex without the use of condoms). We recommended condoms to all couples at every visit in the HIV Prevention Trials Network (HPTN) 052 clinical trial (NCT00074581), and subjects in the earlytherapy and delayed-therapy groups of the trial reported similar condom usage, both at baseline and during follow-up.

Subjects who reported 100% condom use were less likely to have an HIV-1 transmission event. However, the acquisition of sexually transmitted diseases and the frequent occurrence of pregnancy during the study indicate that self-reported condom use was misleading, or that condoms performed imperfectly. To fully understand the efficacy of ART for HIV-1 prevention in persons who have unprotected sex requires a clinical trial that excludes the use of condoms, but such a trial would be unethical. Our article did not offer a public health recommendation; rather, we noted the considerable public health potential of ART under the conditions we used.

Finally, the degree to which the results we observed in heterosexual couples can be extrapolated to men who have sex with men is simply unknown. Tao and colleagues comment on the potential for increased risk-taking sexual behavior after the initiation of ART, citing self-reported behavior; this has been a source of intense study for many years, with variable results.1 An increase in risky sexual behavior is unlikely to substantially alter the prevention benefit of ART.2 However,

the unlinked transmission of HIV-1 in partners of treated subjects in our study and other studies3 warrants special attention. Transmitted drug resistance has been recognized worldwide4 and can compromise treatment of HIV-1. In our study, all subjects were treated with effective ART regimens, and these regimens were switched in participants with virologic failure. ART can reduce HIV-1 transmission only with durable suppression of HIV-1. The durability of HIV-1 suppression and longer-term transmission risks will be studied during continuation of the HPTN 052 trial.

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