Asking about adherence - from flipping the coin to strong evidence.

In the era of antiretroviral therapy (ART) as prevention for transmission of HIV as well as treatment for HIV-positive individuals irrespective of CD4 cell counts, the importance of adherence has grown. Although adherence is not the only determinant of treatment success, it is one of the only modifiable risk factors. Treatment failure reduces future treatment options and therefore long-term clinical success as well as increases the possibility of developing drug resistant mutations. Drug-resistant strains of HIV can then be transmitted to uninfected or drug-naïve individuals limiting their future treatment options, making adherence an important public-health topic, especially in resource-limited settings. Adherence should be monitored as a part of routine clinical care; however, no gold standard for assessment of adherence exists. For use in daily clinical practice, self-report is the most likely candidate for widespread use due to its many advantages over other measurement methods, such as low cost and ease of administration. Asking individuals about their adherence behaviour has been shown to yield valid and predictive data - well beyond the mere flip of a coin. However, there is still work to be done. This article reviews the literature and evidence on self-reported adherence, identifies gaps in adherence research, and makes recommendations for clinicians on how to best utilise self-reported adherence data to support patients in daily clinical practice.

The impact of cyclin D1 mRNA isoforms, morphology and p53 in mantle cell lymphoma: p53 alterations and blastoid morphology are strong predictors of a high proliferation index.

BACKGROUND: Mantle cell lymphoma is a clinically heterogeneous disease characterized by overexpression of cyclin D1 protein. Blastoid morphology, high proliferation, and secondary genetic aberrations are markers of aggressive behavior. Expression profiling of mantle cell lymphoma revealed that predominance of the 3'UTR-deficient, short cyclin D1 mRNA isoform was associated with high cyclin D1 levels, a high "proliferation signature" and poor prognosis. DESIGN AND METHODS: Sixty-two cases of mantle cell lymphoma were analyzed for cyclin D1 mRNA isoforms and total cyclin D1 levels by real-time reverse transcriptase polymerase chain reaction, and TP53 alterations were assessed by immunohistochemistry and molecular analysis. Results were correlated with proliferation index and clinical outcome. RESULTS: Predominance of the short cyclin D1 mRNA was found in 14 (23%) samples, including four with complete loss of the standard transcript. TP53 alterations were found in 15 (24%) cases. Predominance of 3'UTR-deficient mRNA was significantly associated with high cyclin D1 mRNA levels (P=0.009) and more commonly found in blastoid mantle cell lymphoma (5/11, P=0.060) and cases with a proliferation index of >20% (P=0.026). Both blastoid morphology (11/11, P<0.001) and TP53 alterations (15/15, P<0.001) were significantly correlated with a high proliferation index. A proliferation index of 10% was determined to be a significant threshold for survival in multivariate analysis (P=0.01). CONCLUSIONS: TP53 alterations are strongly associated with a high proliferation index and aggressive behavior in mantle cell lymphoma. Predominance of the 3'UTR-deficient transcript correlates with higher cyclin D1 levels and may be a secondary contributing factor to high proliferation, but failed to reach prognostic significance in this study.

Comparative electron impact and fast atom bombardment mass spectrometric studies of some HMPA adducts of phenyltin and phenyllead halides and studies of strong hydrogen bonding by FAB-MS

The fragmentation patterns and mass spectra of some phenyl tin and -lead halide adducts with hexamethylphosphoramide are compared by subjecting them t~ electron impact and fast atom bombardment ionization in a mass spectrometer. This comparison is restricted to the metal-containing ions. Ligand-exchange mechanisms of some of the metal-containing species are explored by FAB-MS. Several moisturesensitive organo-metallics and H-bonded systems have been examined by FAB for attempted characterization, but without any success. Scavenging and trapping of water molecules by complex aggregates in solutions of quaternary ammonium fluorides and hydroxides are investigated by FAB to complement previous NMR-studies.

NMR studies of strong hydrogen bond to fluoride ion

Systems such as MF/diol (M = alkali metal) and }1F/carboxylic acid were subjected to IH, I9F and 13C nmr study to investigate the nature of the very strong H-bonding of fluoride ions with these systems. Evidence indicates a strong H-bond in diol-fluoride systems (~H ~ -(56) kJ mol-I) which is stronger than most 'typical' H-bonds (~H = -(12-40) kJ mol-I), but weaker than that reported for carboxylic acid-fluoride systems (~H ~ -(120) kJ mol-I). Approximate fluoride H-bonded shifts (o(OH)OHF) were evaluated for MF/diol systems from IH chemical shift measurements. No direct correlation was observed between I9F chemical shift and H-bond strength. Thermodynamic parameters were calculated from temperature dependent IH and 19F shifts. Preliminary studies of BUn 4NF-acetylacetone by I9F nmr were conducted at low temperatures and a possible Jmax (ca. 400 Hz) is reported for the fluoride ion H-bonded to acetylacetone. Highfield shift for non-protonated carbons and downfield shift for protonated carbons were observed in carboxylic acid/KF systems. Significant decreas$in I3C TI due to strong H-bonding to fluoride ions were also detected in both diol and carboxylic acid systems. Anomalous results were obtained, such as increasing NOE with increasing temperature in neat 1,2-ethanediol (values above the theoretical maximum of 1.988) and in 1,2-ethanediol/KF. The large 13C NOE's for carboxy carbons in neat carboxylic acids which are. further enhanced by the addition of KF are also unusual.

Strong hydrogen bonding in organic synthesis

The preparation of phenacyl and para-phenylphenacyl esters, the reactions of carboxylic acids, phenols, 2-nitropropane and alcohols with alkyl halides in the presence of fluoride anion are described. The reactions are thought to be accelerated by the formation of hydrogen bonds between the fluoride anion and the organic electron acceptor. The fluoride ,carboxylic acids, fluoride-phenols and fluoride-2-nitropropane are better reaction systems than the fluoride-alcohol. The source of the fluoride anion and the choice of solvents are also discussed.

Reactions of steroidal epoxides with strong organic bases and an investigation into the syntheses of some labelled pregnane derivatives

Reactions of 5,6- and 4,5-epoxycholestane derivatives with strong bases were investigated. Epoxidation of 3a-acetoxycholest-5-ene also gave a new compound along with the anticipated epoxides. Interconversions of the latter were observed. Some possible mechanisms of its formation and rearrangements have been pIioposed. No reaction was observed with any of the 5,6- and 4,5-steroidal epoxides employed in the present study, using potassium tertiary butoxide under refluxing conditions. n-Butyllithium reacted only with 5,6-epoxycholestanes bearing a ketal moiety at the C3 carbon. Opening of the ketal group was observed with n-butyllithium in the case of a ~-epoxide. The reaction was also investigated in the absence of epoxide functionality. A possible mechanism for the opening of ketal group has been proposed. Lithium diethylamide (LDEA) was found effective in rearranging 5,6- and 4,5-epoxides to their ~orresponding allylic alcohols. These rearrangements presumably proceed via syn-eliminations, however the possibility of a corresponding anti-elimination has not been eliminated. A substituent effect of various functional groups (R = H, OH, OCH2CH20) at C3 has-been observed on product distribution in the LDEApromoted rearrangements of the corresponding epoxides. No reaction of these epoxides was observed with lithium diisopropylamide (LDA) • In the second part of the project, several attempts were made towards the sYRthesis of deoxycorticoste~one~17,2l,2l~d3' a compound desirable for the 2l-dehydroxylation studies of deoxycorticosterone. Several routes were investigated, and some deuterium labelled pregnane derivatives were prepared in this regard. Microbial 21-hydroxylation of progesteronel7,21,21,2l- d4 by ~ niger led to loss of deuterium from C21 of the product. An effort was made to hydroxylate progesterone microbially under neutral condtions.

Receipt from the Genesee, Buffalo, New York for rooms rented

Receipt from the Genesee, Buffalo, New York for rooms rented, Sept. 24, 1887.

The Search for New Resonances in Strong Symmetry Breaking Scenarios with the ATLAS Detector

Utilisant les plus récentes données recueillies par le détecteur ATLAS lors de collisions pp à 7 et 8 TeV au LHC, cette thèse établira des contraintes sévères sur une multitude de modèles allant au-delà du modèle standard (MS) de la physique des particules. Plus particulièrement, deux types de particules hypothétiques, existant dans divers modèles théoriques et qui ne sont pas présentes dans le MS, seront étudiés et sondés. Le premier type étudié sera les quarks-vectoriels (QV) produits lors de collisions pp par l’entremise de couplages électrofaibles avec les quarks légers u et d. On recherchera ces QV lorsqu’ils se désintègrent en un boson W ou Z, et un quark léger. Des arguments théoriques établissent que sous certaines conditions raisonnables la production simple dominerait la production en paires des QV. La topologie particulière des évènements en production simple des QV permettra alors la mise en oeuvre de techniques d’optimisation efficaces pour leur extraction des bruits de fond électrofaibles. Le deuxième type de particules recherché sera celles qui se désintègrent en WZ lorsque ces bosons de jauges W, et Z se désintègrent leptoniquement. Les états finaux détectés par ATLAS seront par conséquent des évènements ayant trois leptons et de l’énergie transverse manquante. La distribution de la masse invariante de ces objets sera alors examinée pour déterminer la présence ou non de nouvelles résonances qui se manifesterait par un excès localisé. Malgré le fait qu’à première vue ces deux nouveaux types de particules n’ont que très peu en commun, ils ont en réalité tous deux un lien étroit avec la brisure de symétrie électrofaible. Dans plusieurs modèles théoriques, l’existence hypothétique des QV est proposé pour annuler les contributions du quark top aux corrections radiatives de la masse du Higgs du MS. Parallèlement, d’autres modèles prédisent quant à eux des résonances en WZ tout en suggérant que le Higgs est une particule composite, chambardant ainsi tout le sector Higgs du MS. Ainsi, les deux analyses présentées dans cette thèse ont un lien fondamental avec la nature même du Higgs, élargissant par le fait même nos connaissances sur l’origine de la masse intrinsèque des particules. En fin de compte, les deux analyses n’ont pas observé d’excès significatif dans leurs régions de signal respectives, ce qui permet d’établir des limites sur la section efficace de production en fonction de la masse des résonances.

Multiple edges of a quantum Hall system in a strong electric

In this paper we show that if the electrons in a quantum Hall sample are subjected to a constant electric field in the plane of the material, comparable in magnitude to the background magnetic field on the system of electrons, a multiplicity of edge states localized at different regions of space is produced in the sample. The actions governing the dynamics of these edge states are obtained starting from the well-known Schrödinger field theory for a system of nonrelativistic electrons, where on top of the constant background electric and magnetic fields, the electrons are further subject to slowly varying weak electromagnetic fields. In the regions between the edges, dubbed as the "bulk," the fermions can be integrated out entirely and the dynamics expressed in terms of a local effective action involving the slowly varying electromagnetic potentials. It is further shown how the bulk action is gauge noninvariant in a particular way, and how the edge states conspire to restore the U(1) electromagnetic gauge invariance of the system. In the edge action we obtain a heretofore unnoticed gauge-invariant term that depends on the particular edge. We argue that this term may be detected experimentally as different edges respond differently to a monochromatic probe due to this term

Intrinsic channel closing in strong-field single ionization of H2

Die Ionisation von H2 in intensiven Laserpulsen wird mit Hilfe der numerischen Integration der zeitabhängigen Schrödingergleichung für ein Einelektronenmodell untersucht, das die Vibrationsbewegung berücksichtigt. Die Spektren der kinetischen Elektronenenergie hängen stark von der Vibrationsquantenzahl des erzeugten H2+ Ions ab. Für bestimmte Vibrationszustände ist die Ausbeute der Elektronen in der Mitte des Plateaus stark erhöht. Der Effekt wird "channel closings" zugeschrieben, die in Atomen durch Variation der Laserintensität beobachtet wurden. The ionization of H2 in intense laser pulses is studied by numerical integration of the time-dependent Schrödinger equation for a single-active-electron model including the vibrational motion. The electron kinetic energy spectra in high-order above-threshold ionization are strongly dependent on the vibrational quantum number of the created H2+ ion. For certain vibrational states, the electron yield in the mid-plateau region is strongly enhanced. The effect is attributed to channel closings, which were previously observed in atoms by varying the laser intensity.

Non-Born-Oppenheimer Dynamics of Hydrogen Molecules in Strong Laser-Fields

Die Arbeit behandelt die numerische Untersuchung von Wasserstoff-Moleküldynamik in starken Laserfeldern. Im Speziellen wird die Struktur von Ionisationsspektren bei Einfach-Photoionisation betrachtet. Korrelationen zwischen Elektron- und Kernbewegung werden identifiziert und mit Effekten in den Energiespektren in Verbindung gebracht. Dabei wird stets auf die Integration der zeitabhängigen Schrödingergleichung zurückgegriffen.

Molecular Imaging using Strong-Field Processes

Die Arbeit befasst sich mit dem Zusammenhang zwischen einfachen Molekülen und deren Verhalten in starken, kurzen Laserfeldern. Einerseits wird versucht, strukturelle Daten des Moleküls in den Elektronen- und Photonenspektren wiederzuerkennen. Andererseits geht es darum, ein Bild der elektronischen Wellenfunktion aus den spektralen Daten abzuleiten.