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The SPARTAC study (Short Pulse Anti-Retroviral Therapy at HIV Conversion) was a randomised clinical trial of short (12 weeks) or long (48 weeks) pulsed antiretroviral therapy (ART) at primary or recent HIV infection, compared to deferred therapy (standard of care). The trial has shown a significant effect of 48 weeks ART, compared to deferred therapy; 12 weeks ART had no effect. This definitive result from the SPARTAC trial has informed HIV treatment guidelines nationally and internationally; patients identified with primary or recent HIV infection are now recommended to commence ART, based in whole or part on the evidence arising out of SPARTAC. As a consequence of the SPARTAC trial, it is no longer ethical to undertake research amongst individuals with recent HIV infection without offering immediate ART.
HIV-infected infants are at high risk of disease progression and death. Until 2008 guidelines recommended waiting until the infant displayed symptoms, or had a weakened immune system before starting treatment. The CHER trial found that starting infected infants on antiretroviral therapy as early as possible substantially reduced mortality compared with waiting until they developed symptoms or their immune system weakened. These results led quickly to changes in guidelines for treating HIV-infected infants issued by the US, World Health Organisation (WHO), Paediatric European Network for Treatment of AIDS (PENTA) and South Africa. These revised guidelines, if fully implemented along with early infant diagnosis, would reduce the number of infant deaths because of HIV by 76%, saving the lives of approximately 46,800 infants globally each year.
Our work with the World Health Organisation (WHO) had a major impact on global HIV treatment priorities at a critical time in the roll-out of anti-retroviral treatment (ART) worldwide. Concern had been expressed that if ART was provided without simultaneous monitoring of HIV viral load to determine switch in treatment, this would lead to an epidemic of drug resistant HIV. It was argued that viral load monitoring should be introduced as a priority, despite the fact that this was expensive and would inevitably divert resources from ART provision. We used a simulation model to predict the impact of lack of viral load monitoring and showed that while development of viral load assays was important, ART should be prioritised. As a result, the roll out of ART continued despite continued lack of viral load monitoring, and there are now over 9 million people on ART.
HIV associated plasmablastic multicentric Castleman's disease (MCD) has emerged as an uncommon disease over the last decade that is a significant cause of mortality in people living with HIV infection. Advances in our understanding of the epidemiology, virology and immunology of this disease led Professor Bower to recognise the potential for using targeted monoclonal antibody therapy. This has dramatically improved the survival of patients with MCD and is now advocated in the national treatment guidelines and is widely adopted in clinical practice globally. Moreover, the use of plasma Kaposi's sarcoma herpesvirus virus levels as a tumour marker for MCD has been developed.
Derek Matravers' research in aesthetics has contributed to the public discourse on art by offering a plausible postmodern definition of `art'. Matravers' definition offers a way of understanding art that places the emphasis on reasons, and thus moves beyond the obscurantism associated with contemporary art. His podcast on the subject, as part of the PhilosophyBites series, has taken the topic into public discourse. His work has also influenced the art world. Matravers participated in a conceptual art piece, where his ideas on the definition of art were incorporated into the art piece, effectively blurring the borders between the philosophy and the object of study.
This case study focuses on three areas in relation to the social impact of art, across the categories of `cultural life' and `public discourse'.
1) Artistic collaborations with non-artistic specialists in order to generate new interdisciplinary pathways
2) Artistic collaborations with non-artists within a given community or non-artistic institutional setting in order to create new forms of artist-audience participation
3) The sharing of knowledge/skills between either non-artistic specialists or a non-specialist audience and artists in the production of a shared task or project.
4) Performance-based practice inside and outside of the gallery
The outward facing nature of this research, then, addresses the way such work tests the prevailing competences, boundaries and identities of artist and audience alike. This means researchers are involved with both artistic and non-artistic funding-bodies and agencies as the basis for work on a range of critical issues affecting the borders between the art institution and non-artistic settings and contexts.
Researchers from St Georges have evaluated and optimised anti-fungal therapy for cryptococcal meningitis, the commonest cause of adult meningitis in sub-Saharan Africa. They have developed a "screen-and-treat" strategy to prevent the development of clinical disease in HIV-positive patients, and with collaborators developed and tested a novel point-of-care diagnostic test. These advances have led to changes in and development of a series of international guidelines and application of these new strategies in parts of Africa. A case for reduced costs of amphotericin was advanced by the group who were instrumental in reducing these costs in South Africa, allowing wider drug provision.
The impact of Professor Taylor's work in interpreting modern and contemporary art has taken place on two complementary levels: on the one hand the lucid and accessible exposition, for a wide international reading public, of some of the most difficult, intractable, or provocative works of recent and contemporary art; and on the other, more specialist readings, again for an international reading public, of key tendencies in the broader range of modern art, from Cubism to the present day. Wide readership across Asia, Europe, and the United States has secured increased public understanding of art, and has influenced both policy and art practice.
York's British Art Research School, judged `world-leading' in RAE 2008, aims to change the way key cultural institutions represent British art. To advance this aim we have fostered partnerships with museums and galleries at local, national, and international levels. The partnerships have influenced curatorial practices through:
These initiatives have helped partners to display and promote a significantly wider range of British art and to generate new kinds of interpretation for larger and more diverse publics.
Matthew Kieran's research focuses on the role that individual motivations, skills and settled dispositions (i.e. someone's character) actively play in artistic appreciation and creation. In particular, it shows the significant role that character should play in guiding artistic creativity and evaluation. He has worked extensively outside higher education—using small group sessions with the public, contributions to creators' conferences, high-profile media work, policy inputs, a prime-time TV documentary and widely disseminated web materials— to enrich the public understanding of artistic values based on this approach and to help skill people up in developing their artistic creativity and art appreciation.