CD41 T cell recovery during suppression of HIV replication: an international comparison of the immunological efficacy of antiretroviral therapy in North America, Asia and Africa.

BACKGROUND Even among HIV-infected patients who fully suppress plasma HIV RNA replication on antiretroviral therapy, genetic (e.g. CCL3L1 copy number), viral (e.g. tropism) and environmental (e.g. chronic exposure to microbial antigens) factors influence CD4 recovery. These factors differ markedly around the world and therefore the expected CD4 recovery during HIV RNA suppression may differ globally. METHODS We evaluated HIV-infected adults from North America, West Africa, East Africa, Southern Africa and Asia starting non-nucleoside reverse transcriptase inhibitorbased regimens containing efavirenz or nevirapine, who achieved at least one HIV RNA level <500/ml in the first year of therapy and observed CD4 changes during HIV RNA suppression. We used a piecewise linear regression to estimate the influence of region of residence on CD4 recovery, adjusting for socio-demographic and clinical characteristics. We observed 28 217 patients from 105 cohorts over 37 825 person-years. RESULTS After adjustment, patients from East Africa showed diminished CD4 recovery as compared with other regions. Three years after antiretroviral therapy initiation, the mean CD4 count for a prototypical patient with a pre-therapy CD4 count of 150/ml was 529/ml [95% confidence interval (CI): 517–541] in North America, 494/ml (95% CI: 429–559) in West Africa, 515/ml (95% CI: 508–522) in Southern Africa, 503/ml (95% CI: 478–528) in Asia and 437/ml (95% CI: 425–449) in East Africa. CONCLUSIONS CD4 recovery during HIV RNA suppression is diminished in East Africa as compared with other regions of the world, and observed differences are large enough to potentially influence clinical outcomes. Epidemiological analyses on a global scale can identify macroscopic effects unobservable at the clinical, national or individual regional level.

Morphological differentiation of Betula (birch) pollen in northwest North America and its palaeoecological application

Lake sediments from arcto-boreal regions commonly contain abundant Betula pollen. However, palaeoenvironmental interpretations of Betula pollen are often ambiguous because of the lack of reliable morphological features to distinguish among ecologically distinct Betula species in western North America. We measured the grain diameters and pore depths of pollen from three tree-birch species (B. papyrifera, B. kenaica and B. neoalaskana) and two shrub-birch species (B. glandulosa and B. nana), and calculated the ratio of grain diameter to pore depth (D/P ratio). No statistical difference exists in all three parameters between the shrub-birch species or between two of the tree-birch species (B. kenaica and B. papyrifera), and B. neoalaskana is intermediate between the shrub-birch and the other two tree-birch species. However, mean pore depth is significantly larger for the tree species than for the shrub species. In contrast, mean grain diameter cannot distinguish tree and shrub species. Mean D/P ratio separates tree and shrub species less clearly than pore depth, but this ratio can be used for verification. The threshold for distinguishing pollen of tree versus shrub birch lies at 2.55 μm and 8.30 for pore depth and D/P ratio, respectively. We'applied these thresholds to the analysis of Betula pollen in an Alaskan lake-sediment core spanning the past 800 years. Results show that shrub birch increased markedly at the expense of tree birch during the‘Little Ice Age’; this patten is not discernible in the profile of total birch pollen.

An intercontinental comparison of chironomid palaeotemperature inference models: Europe vs North America

Chironomid-temperature inference models based on North American, European and combined surface sediment training sets were compared to assess the overall reliability of their predictions. Between 67 and 76 of the major chironomid taxa in each data set showed a unimodal response to July temperature, whereas between 5 and 22 of the common taxa showed a sigmoidal response. July temperature optima were highly correlated among the training sets, but the correlations for other taxon parameters such as tolerances and weighted averaging partial least squares (WA-PLS) and partial least squares (PLS) regression coefficients were much weaker. PLS, weighted averaging, WA-PLS, and the Modern Analogue Technique, all provided useful and reliable temperature inferences. Although jack-knifed error statistics suggested that two-component WA-PLS models had the highest predictive power, intercontinental tests suggested that other inference models performed better. The various models were able to provide good July temperature inferences, even where neither good nor close modern analogues for the fossil chironomid assemblages existed. When the models were applied to fossil Lateglacial assemblages from North America and Europe, the inferred rates and magnitude of July temperature changes varied among models. All models, however, revealed similar patterns of Lateglacial temperature change. Depending on the model used, the inferred Younger Dryas July temperature decrease ranged between 2.5 and 6°C.

1906 Polk's Medical Register and Directory of North America (Texas Portion Only)

List of Physicians and Surgeons arranged by location, giving post office address with population and location, the School practiced, date and college of graduation, all the existing and extinct medical colleges in North America, with locations, officers, number of professors, lecturers, demonstrators, etc., the various medical societies, penal, reformatory and charitable state institutions, hospitals, sanitariums, dispensaries, asylums and other medical institutions, boards of health, boards of medical examiners, health officers at principal points, the laws of registration and other laws relating to the profession, medical journals with names of editors, frequency of publication and subscription rates, medical libraries, a therapeutic classification of American health resorts, mineral springs, official list of officers of the medical departments of the U.S. Army, Navy and Marine Hospital Service, the U.S. Indian Service, roster of examining surgeons of the U.S. Pension Department, a descriptive sketch of each state, territory and province, embodying such matters as location, boundary, extent in miles and acres, latitude and longitude, statistics relating to climate, temperature, rate of mortality, etc. Full particulars of all national and inter-state associations and societies relating to medicine and surgery, and an INDEX TO THE PHYSICIANS OF THE UNITED STATES. Arranged alphabetically, with the number of the page and column in which the name appears.

Molar gas ratios and stable oxygen and nitrogen isotopes of air entrapped in ice, North America

The molar ratios of atmospheric gases change during dissolution in water due to differences in their relative solubilities. We exploited this characteristic to develop a tool to clarify the origin of ice formations in permafrost regions. Extracted from ice, molar gas ratios can distinguish buried glacier ice from intrasedimental ground ice formed by freezing groundwaters. An extraction line was built to isolate gases from ice by melting and trapping with liquid He, followed by analysis of N2, O2, Ar, 18O-O2 and 15N-N2, by continuous flow mass spectrometry. The method was tested using glacier ice, aufeis ice (river icing) and intrasedimental ground ice from sites in the Canadian Arctic. O2/Ar and N2/Ar ratios clearly distinguish between atmospheric gas in glacial ice and gases from intrasedimental ground ice, which are exsolved from freezing water. 615NN2 and 618OO2 in glacier ice, aufeis ice and intrasedimental ground ice do not show clear distinguishing trends as they are affected by various physical processes during formation such as gravitational settling, excess air addition, mixing with snow pack, and respiration.

Maximum and mean diameter record of Orbulina universa from DSDP Hole 47-397 of Cape Bojador, eastern North Atlantic

Measurements of the diameter of O. universa carried out on 30 specimens from 39 samples covering a sediment thickness of 78 m and going back in time to approximately 750 000 y resulted in the construction of a curve of the mean diameter and a curve of the maximum diameter. Both curves, as well as those calculated with the running-averages technique, display cyclic fluctuations with durations of the order of 100 000 y and downwards decreasing amplitudes. These curves are compared with a carbonate curve (on bulk sediment) and an isotopic curve (on benthic foraminifers) obtained from the same set of samples. Correlations are fair to good, but a timelag is noticed between the isotopic curve and the faunal (O. universa mean diameter) curve, with the isotopic signal coming first, in the middle part of the Brunhes Epoch. Biostratigraphic calibration to the paleomagnetic record is provided by four datum planes (two based on calcareous nannofossils, two on diatoms) identified in the succession. Changes recorded in test porosity seem to be less meaningful than changes in test size.

Hydrographical and chemical observations during an achor station in the eastern North Atlantic

Serial observations of temperature, salinity, oxygen, alkalinity and pH are presented. They were carried out during an anchor station of R.V. "Meteor" west of Cape Sao Vincente (Portugal) in the area of the maximum Mediterranean water outflow, which follows the continental slope off Portugal. Two observational results are pointed out: The Mediterranean water masses spread out into the Atlantic Ocean, consisting of two distinct layers at depth of 700 m (T=12.0 °C, S=36.15 ?) and 1250 m (T=11.3 °C, S=36.40 ?). The salinity proved to be the most significant indicator of the observed stratification. The values of dissolved oxygen content, alkalinity and pH in the very near bottom layer (1 m above the bottom at depth of 3250 m) are different from the values at depth of 15 m to 100 m above the bottom. As this phenomenon is not observed for the salinity, the changes may be interpreted in terms of chemical and biological processes at the sediment-water interface.

Plant distribution and climate data across western North America

Using an extensive network of occurrence records for 293 plant species collected over the past 40 years across a climatically diverse geographic section of western North America, we find that plant species distributions were just as likely to shift upwards (i.e., towards higher elevations) as downward (i.e., towards lower elevations) - despite consistent warming across the study area. Although there was no clear directional response to climate warming across the entire study area, there was significant region-to region- variation in responses (i.e. from as many as 73% to as few as32% of species shifting upward or downward). To understand the factors that might be controlling region-specific distributional shifts, we explored the relationship between the direction of change in distribution limits and the nature of recent climate change. We found that the direction of distribution limit shifts was explained by an interaction between the rate of change in local summer temperatures and seasonal precipitation. Specifically, species shifted upward at their upper elevational limit when snowfall declined at slower rates and minimum temperatures increased. By contrast, species shifted upwards at their lower elevation limit when maximum temperatures increased or both temperature and precipitation decreased. Our results suggest that future species' elevational distribution shifts will be complex, depending on the interaction between seasonal temperature and precipitation change.

(Table 2) Distribution of alkenone unsaturation index UK37 of the eastern North Atlantic

This paper reports the concentrations and within-class distributions of long-chain alkenones and alkyl alkenoates in the surface waters (0-50 m) of the eastern North Atlantic, and correlates their abundance and distribution with those of source organisms and with water temperature and other environmental variables. We collected these samples of >0.8 µm particulate material from the euphotic zone along the JGOFS 20°W longitude transect, from 61°N to 24°N, during seven cruises of the UK-JGOFS Biogeochemical Ocean Flux Study (BOFS) in 1989-1991; the biogeographical range of our 53 samples extends from the cold (<10°C), nutrient-rich and highly productive subarctic waters of the Iceland Basin to the warm (>25°C) oligotrophic subtropical waters off Africa. Surface water concentrations of total alkenone and alkenoates ranged from <50 ng/l in oligotrophic waters below 40°N to 2000-4500 ng/l in high latitude E. huxleyi blooms, and were well correlated with E. huxleyi cell densities, supporting the assumption that E. huxleyi is the predominant source of these compounds in the present day North Atlantic. The within-class distribution of the C37 and C38 alkenones and C36 alkenoates varied strongly as a function of temperature, and was largely unaffected by nutrient concentration, bloom status and other surface water properties. The biosynthetic response of the source organisms to growth temperature differed between the cold (<16°C) waters above 47°N and the warmer waters to the south. In cold (<16°C) waters above 47°N, the relative amounts of alkenoates and C38 alkenones synthesized was a strong function of growth temperature, while the unsaturation ratio of the alkenones (C37 and C38) was uncorrelated with temperature. Conversely, in warm (>16°C) waters below 47°N, the relative proportions of alkenoates and alkenones synthesized remained constant with increasing temperature while the unsaturation ratios of the C37 and C38 methyl alkenones (Uk37 and Uk38Me, respectively) increased linearly. The fitted regressions of Uk37 and Uk38Me versus temperature for waters >16°C were both highly significant (r**2 > 0.96) and had identical slopes (0.057) that were 50% higher than the slope (0.034) of the temperature calibration of Uk37 reported by Prahl and Wakeham (1987; doi:10.1038/330367a0) over the same temperature range. These observations suggest either a physiological adjustment in biochemical response to growth temperature above a 16-17°C threshold and/or variation between different E. huxleyi strains and/or related species inhabiting the cold and warm water regions of the eastern North Atlantic. Using our North Atlantic data set, we have produced multivariate temperature calibrations incorporating all major features of the alkenone and alkenoate data set. Predicted temperatures using multivariate calibrations are largely unbiased, with a standard error of approximately ±1°C over the entire data range. In contrast, simpler calibration models cannot adequately incorporate regional diversity and nonlinear trends with temperature. Our results indicate that calibrations based upon single variables, such as Uk37, can be strongly biased by unknown systematic errors arising from natural variability in the biosynthetic response of the source organisms to growth temperature. Multivariate temperature calibration can be expected to give more precise estimates of Integrated Production Temperatures (IPT) in the sedimentary record over a wider range of paleoenvironmental conditions, when derived using a calibration data set incorporating a similar range of natural variability in biosynthetic response.