Objective. Despite modern antiretroviral therapy, HIV-associated neuropathy is one of the most prevalent, disabling and treatment-resistant complications of HIV disease. The presence and intensity of distal neuropathic pain is not fully explained by the degree of peripheral nerve damage. A better understanding of brain structure in HIV distal neuropathic pain may help explain why some patients with HIV neuropathy report pain while the majority does not. Previously, we reported that more intense distal neuropathic pain was associated with smaller total cerebral cortical gray matter volumes. The objective of this study was to determine which parts of the cortex are smaller.Methods. HIV positive individuals with and without distal neuropathic pain enrolled in the multisite (N 5 233) CNS HIV Antiretroviral Treatment Effects (CHARTER) study underwent structural brain magnetic resonance imaging. Voxel-based morphometry was used to investigate regional brain volumes in these structural brain images.Results. Left ventral posterior cingulate cortex was smaller for HIV positive individuals with versus without distal neuropathic pain (peak P 5 0.017; peak t 5 5.15; MNI coordinates x 5 26, y 5 254, z 5 20). Regional brain volumes within cortical gray matter structures typically associated with pain processing were also smaller for HIV positive individuals having higher intensity ratings of distal neuropathic pain.Conclusions. The posterior cingulate is thought to be involved in inhibiting the perception of painful stimuli. Mechanistically a smaller posterior cingulate cortex structure may be related to reduced anti-nociception contributing to increased distal neuropathic pain.
The overall objective of this article is to improve the understanding of the adaptation process to climate change and variability at the farm and the farming community levels through a mostly bottom-up process, while using the approach of co-construction in the Regional County Municipality (RCM) of Haut-Richelieu. To achieve this, the grounded theory approach is used. The results show that all participants recognized the fact that climate change is happening. According to the farmers, climate change is the main determinant of adaptive capacity, followed by institutional support. Most farmers recognized that extremes (or variability) are associated with climate change. To a lesser extent, some farmers concluded that one should not separate climatic factors from non-climatic factors. The results also show that while some farmers recognized the positive and the negative side of climate change and variability (CCV), the others are very optimistic about it as if they only see the positive side; there is nonetheless a need to see both sides of CCV. Moreover, there is still some uncertainty related to CCV, which comes from disinformation and desensitization of the farmers mainly in relation to the causes of CCV along with the nature of climatic events. Despite the latter, the results show that agriculture in the RCM of Haut-Richelieu is well adapted to cope with climate change and variability. Farmers have already adopted measures to cope with CCV; however, they adapt spontaneously. Furthermore, nearly all farmers need help mainly from the agricultural public and private institutions to better adapt to CCV.
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