Growth response to antiretroviral treatment in HIV-infected children: a cohort study from Lilongwe, Malawi

Objective  Malnutrition is common in HIV-infected children in Africa and an indication for antiretroviral treatment (ART). We examined anthropometric status and response to ART in children treated at a large public-sector clinic in Malawi. Methods  All children aged <15 years who started ART between January 2001 and December 2006 were included and followed until March 2008. Weight and height were measured at regular intervals from 1 year before to 2 years after the start of ART. Sex- and age-standardized z-scores were calculated for weight-for-age (WAZ) and height-for-age (HAZ). Predictors of growth were identified in multivariable mixed-effect models. Results  A total of 497 children started ART and were followed for 972 person-years. Median age (interquartile range; IQR) was 8 years (4–11 years). Most children were underweight (52% of children), stunted (69%), in advanced clinical stages (94% in WHO stages 3 or 4) and had severe immunodeficiency (77%). After starting ART, median (IQR) WAZ and HAZ increased from −2.1 (−2.7 to −1.3) and −2.6 (−3.6 to −1.8) to −1.4 (−2.1 to −0.8) and −1.8 (−2.4 to −1.1) at 24 months, respectively (P < 0.001). In multivariable models, baseline WAZ and HAZ scores were the most important determinants of growth trajectories on ART. Conclusions  Despite a sustained growth response to ART among children remaining on therapy, normal values were not reached. Interventions leading to earlier HIV diagnosis and initiation of treatment could improve growth response.

Intraoperative fabrication of patient-specific moulded implants for skull reconstruction: single-centre experience of 28 cases

BACKGROUND Intraoperatively fabricated polymethylmethacrylate (PMMA) implants based on computer-designed moulds were used to improve cosmetic results after hard tissue replacement. To assess the implant's cosmetic and functional results we performed both subjective and objective assessments. METHODS This retrospective analysis was performed using a cohort of 28 patients who received PMMA implants between February 2009 and March 2012. The cosmetic and functional results were assessed using a patient questionnaire. Furthermore an objective volumetric subtraction score (0-100) was applied and implant thickness, as well as gaps and tiers, were measured. RESULTS Patients mainly judged their cosmetic result as "good". Two of the 28 patients found their cosmetic result unfavourable. The functional result and stability was mainly judged to be good. Measurements of implant thickness showed a very high correlation with the thickness of the contralateral bone. Volumetric subtraction led to a median quality of 80 on a scale from 0 to 100. Median gaps around the margins of the implant were 1.5 mm parietally, 1.7 mm frontally and 3.5 mm fronto-orbitally, and median tiers were 1.2 mm, 0 mm and 0 mm respectively. The overall rate of surgical revisions was 10.7 % (three patients). Two patients suffered from wound healing disturbances (7.1 %). The overall complication rate was comparable to other reports in the literature. CONCLUSIONS Implantation of intraoperatively fabricated patient-specific moulded implants is a cost-effective and safe technique leading to good clinical results with a low complication rate.

Loyal to the Game? Strategic Policy Representation in Mixed Electoral Systems

In Germany's compensatory mixed electoral system, alternative electoral routes lead into parliament. We study the relationship between candidates' electoral situations across both tiers and policy representation, fully accounting for candidate, party and district preferences in a multi-actor constellation and the exact electoral incentives for candidates to represent either the party or the district. The results (2009 Bundestag election data) yield evidence of an interactive effect of closeness of the district race and list safety on candidates' positioning between their party and constituency.

Evolution de l’industrie biotech et medtech suisse et influence de l’industrie pharmaceutique sur le système d’innovation

Cet article traite de l’influence d’un secteur ou d’une industrie dans l’économie nationale et de la manière dont il/elle peut influencer des secteurs et des technologies connexes. L’exemple choisi est constitué par l’industrie pharmaceutique suisse. L’article suggère que cette industrie a façonné le développement et la distribution spatiale des secteurs qui lui étaient liés, tels que les biotechnologies (biotech) et les technologies médicales (medtech). Il est supposé que cette influence diffère significativement selon l’extension géographique. Elle est manifeste à l’échelon national, dans la mesure où les biotech et les medtech ont bénéficié d’institutions nationales façonnées par l’industrie pharmaceutique. Les effets de cette industrie devraient également se faire sentir au niveau régional, notamment à Bâle où l’industrie pharmaceutique est concentrée, par le biais des créations d’entreprises et des liens d’affaires avec l’industrie pharmaceutique. Ces aspects sont abordés dans le cadre théorique des systèmes d’innovation nationaux et régionaux, en termes d’évolution, de dépendance au sentier et d’interactions.

Développement de l'écotourisme dans la région du Triangle Bleu, Littoral Nord-Est de Madagascar: Collecte de données auprès de voyagistes en Suisse

Rapport des enquêtes menées en Suisse quant au secteur de l'écotourisme: tendances, entretiens auprès des voyagistes en Suisses et des touristes à Madagascar.