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.

Should aortic arch replacement be performed during initial surgery for aortic root aneurysm in patients with Marfan syndrome?

OBJECTIVES: The aim of this study was to investigate whether total arch replacement (TAR) during initial surgery for root aneurysm should be routinely performed in patients with Marfan syndrome (MFS). METHODS: Retrospective analysis of 94 consecutive MFS patients fulfilling Ghent criteria who underwent 148 aortic surgeries and were followed at this institution during the past 16 years. RESULTS: The mean follow-up interval was 8.8 ± 7 years. Initial presentation was acute aortic dissection (AAD) in 35% of patients (76% Type A and 24% Type B) and aneurismal disease in 65%. TAR was performed in 8% of patients during initial surgery for AAD (otherwise a hemi-arch replacement was performed) and 1.6% in elective root repair. Secondary TAR had to be performed in only 3% of patients without, but in 33% following AAD (33% Type A and 33% Type B; P = 0.0001). Thirty-day, 6-month, 1-year and overall mortalities were 3.2, 5.3, 6.4 and 11.7%, respectively. Operative and 30-day mortalities in secondary aortic arch replacement were zero. Secondary TAR after AAD did not increase the need for the replacement of the entire thoracoabdominal aorta during follow-up compared with patients without secondary TAR (37 vs 40%, P = 1.0). CONCLUSIONS: MFS patients undergoing elective root repair have small risk of reinterventions on the aortic arch, and primary prophylactic replacement does not seem to be justified. In patients with AAD, the need for reinterventions is precipitated by the dissection itself and not by limiting the procedure to the hemi-arch replacement in the emergency setting. Limiting surgery to the aortic root, ascending aorta and proximal aortic arch is associated with low mortality in MFS patients presenting with AAD.

Copper and human health: biochemistry, genetics, and strategies for modeling dose-response relationships

Copper (Cu) and its alloys are used extensively in domestic and industrial applications. Cu is also an essential element in mammalian nutrition. Since both copper deficiency and copper excess produce adverse health effects, the dose-response curve is U-shaped, although the precise form has not yet been well characterized. Many animal and human studies were conducted on copper to provide a rich database from which data suitable for modeling the dose-response relationship for copper may be extracted. Possible dose-response modeling strategies are considered in this review, including those based on the benchmark dose and categorical regression. The usefulness of biologically based dose-response modeling techniques in understanding copper toxicity was difficult to assess at this time since the mechanisms underlying copper-induced toxicity have yet to be fully elucidated. A dose-response modeling strategy for copper toxicity was proposed associated with both deficiency and excess. This modeling strategy was applied to multiple studies of copper-induced toxicity, standardized with respect to severity of adverse health outcomes and selected on the basis of criteria reflecting the quality and relevance of individual studies. The use of a comprehensive database on copper-induced toxicity is essential for dose-response modeling since there is insufficient information in any single study to adequately characterize copper dose-response relationships. The dose-response modeling strategy envisioned here is designed to determine whether the existing toxicity data for copper excess or deficiency may be effectively utilized in defining the limits of the homeostatic range in humans and other species. By considering alternative techniques for determining a point of departure and low-dose extrapolation (including categorical regression, the benchmark dose, and identification of observed no-effect levels) this strategy will identify which techniques are most suitable for this purpose. This analysis also serves to identify areas in which additional data are needed to better define the characteristics of dose-response relationships for copper-induced toxicity in relation to excess or deficiency.

MATURE FINE TAILINGS (MFTs): A STUDY OF COMPRESSIVE STRENGTH AND RHEOLOGICAL PROPERTIES OF ATHABASCA OIL SANDS PETROLEUM MINING WASTE APPLIED IN CONCRETE MIXTURES

This study investigates the compressive properties of concrete incorporating Mature Fine Tailings (MFTs) waste stream from a tar sands mining operation. The objectives of this study are to investigate material properties of the MFT material itself, as well as establish general feasibility of the utilization of MFT material in concrete mixtures through empirical data and visual observations. Investigations undertaken in this study consist of moisture content, materials finer than No. 200 sieve, Atterburg Limits as well as visual observations performed on MFT material as obtained. Control concrete mixtures as well as MFT replacement mixture designs (% by wt. of water) were guided by properties of the MFT material that were experimentally established. The experimental design consists of compression testing of 4”-diameter concrete cylinders of a control mixture, 30% MFT, 50% MFT and 70% MFT replacement mixtures with air-entrainer additive, as well as a control mixture and 30% MFT replacement mixture with no air-entrainer. A total of 6 mixtures (2 control mixtures, 4 replacement mixtures) moist-cured in lime water after 24 hours initial curing were tested for ultimate compressive strength at 7 days and 28 days in accordance to ASTM C39. The test results of fresh concrete material show that the addition of air-entrainer to the control mixture increases slump from 4” to 5.5”. However, the use of MFT material in concrete mixtures significantly decreases slump as compared to controls. All MFT replacement mixtures (30%, 50%, and 70%) with air-entrainer present slumps of 1”. 30% MFT with no air-entrainer presents a slump of 1.5”. It was found that 7-day ultimate compressive stress was not a good predictor of 28-day ultimate compressive stress. 28-day results indicate that the use of MFT material in concrete with air-entrainer decreases ultimate compressive stress for 30%, 50% and 70% MFT replacement amounts by 14.2%, 17.3% and 25.1% respectively.

Market Access in Switzerland and in the European Union for Agricultural Products from Least Developed Countries

The introduction of the so-called “duty free quota free” treatment (DFQF) for all products from least developed countries (LDCs), in particular by the European Communities (EC) and by Switzerland, raised expectations of increased agricultural exports for these 49 countries. Despite the high tariff differential LDCs now enjoy over their competitors, especially for agricultural products and particularly in Switzerland, the results until 2007 are dismal: with the exception of sugar exports to the EC, LDCs have not been able to substantially increase their agricultural exports to Europe. This study analyses the result-ing tariff situation and the remaining non-tariff barriers. In many instances it is not cus-toms duties but the sanitary and phytosanitary barriers which turn out to be the single most important hurdle preventing trade. For instance, almost no LDC-based company can supply animal-based products. Similarly, certain private standards set by proces-sors and retailers prevent imports, particularly from LDCs, far more effectively than tar-iffs. Several gateways into this “European cordon sanitaire” are proposed. Only if offered in the context of a package of various carefully coordinated measures, DFQF could yet have a real impact on trade from LDCs. As it stands, this treatment constitutes only a nice-to-have but still largely ineffective instrument of trade development.

Pollen record and lithology of a profile from Dumfriesshire, Scotland

Four samples, G5, G7, G8, and G10, collected by Dr W. W. Bishop from an exposed section in the bank of the River Annan, at Roberthill Farm, Dumfriesshire (S35, 110794) were submitted for pollen analysis (Table I.). The samples, with the exception of the uppermost, were from thin peat layers that lie in the middle of a series of water- laid sands, silts and clays several feet in thickness and now rather strongly arched. The lowermost sample, G5, was taken from an organic layer about | in. thick overlying fine sand and underlying some 2.5 in. of grey, silty fine sand. A narrow layer of sandy peat immediately above the silty, fine sand yielded sample G7, and G8 was collected from a similar peaty layer separated from G7 by more sandy- silty peat. The uppermost sample, G10, was taken from light grey clay 13 in. above sample G8.

Pollen profiles from 8 sediment cores from the Degersee, Southern Germany

The discovery of a neolithic pile field in the shallow water near the eastern shore of the Degersee confirmed earlier palynological and sedimentological studies stating that early man was active in the region since more than 6000 years. The already available off-site data were freshly assessed, completed by additional data from old and new cores and the interpretations revised. A common time scale for the off-site data and the on-site data was obtained by AMS dating of terrestrial macro remains of the neolithic section of off-site core De_I+De_H. The ages can thus be parallelled with AMS ages of construction timber on-site. Pollen analyses from all cores provide a further time scale. The continuously and densely sampled pollen profile of the profundal zone embracing the entire Late glacial and Holocene serves as a reference. From the Boreal onwards the relative ages are transformed by AMS ages and varve counts into calibrated and absolute. A transect cored close to the neolithic pile field across the lake marl-platform demonstrates its geological architecture in the shallow water since the Lateglacial. Studies of the microfabric of thin sections of drilled cores and of box cores from the excavations demonstrate that neolithic settlements now at 2-3,5 m water depth had been erected on lake marl freshly fallen dry, thus indicating earlier lake levels dropped by 1.5-2 m. The neolithic section of the highly resolved off-site profile in the lake=s profundal zone has laminated and calcareous zones alternating with massive ones. Assemblages of diatoms and concentrations of trace elements changing simultaneously characterise the calcareous sections as deposits of low lake levels that lasted between some 40 and more than 300 years. The ages of discovered lake shore dwellings fall into calcareous segments with low lake levels. From the end of the Upper Atlantic period (F VII) appear Secondary Forest Cycles in the beech forest, a man-made sequence of repeated vegetational development with an identical pattern: With a decrease of beech pollen appear pollen of grasses, herbs and cultural indicators. These are suppressed by the light demanding hazel and birch, those again by ash, and finally by the shade demanding beech forming a new pollen peak. Seven main Forest Cycles are identified In the upper Neolithic period each comprising some 250, 450 or 800 years. They are subdivided into subcycles that can be broken down by very dense sampling in even shorter cycles of decadal length. Farming settlers have caused minor patchy clearances of the beech-mixed-forest with the use of fire. The phases of clearance coincide with peaks of charcoal and low stands of the lake levels. The Secondary Forest Cycles and the continuous occurrence of charcoal prove a continued occupation of the region. Together with the repeated restoration of the beech climax forest they point to pulsating occupation probably associated with dynamic demography. The synchronism of the many palynological, sedimentological and archaeological data point to an external forcing as the climate that affects comprehensively all these proxies. The fluctuations of the activity of the sun as manifested in the residual d14C go largely along with the proxies. The initial clearances at the begin of the forest cycles are linked to low lake levels and negative values of d14C that point to dry and warm phases of a more continental climate type. The subcycles exist independent from climatic changes, indicating that early man acted largely independent from external forces.

The Canyon System off Fimbulisen

In der vorliegenden Arbeit werden Daten einer systematischen Vermessung in der Lazarev Sea nahe des Fimbul-Ice-Shelfs (Fimbulisen) genutzt, die während der Expedition ANT XIX-2 mit dem Fächersonarsystem Hydrosweep DS-2 und dem Sedimentecholot Parasound erhoben wurden. Nach kurzer Darstellung der Hintergründe dieser durchgeführten Untersuchungen in dem Messgebiet wird allgemein auf wesentliche Aspekte der Hydroakustik hinsichtlich der Anwendung von Echolotsystemen eingegangen. Schwerpunktmäßig soll dabei der parametrischen Effekt, das Messprinzip parametrischer Sedimentecholote, behandelt werden. Nach anschließender Anführung zweier praktischer Anwendungen hydroakustischer Messverfahren anhand des Hydrosweep DS-2 und des Parasound-Systems wird eingehend deren Positionierung auf FS 'Polarstern' dargestellt, da sich bei der Aufbereitung der Messungen zeigte, dass sich das größte Problem der Daten beider Systeme in der minderwertigen Qualität der Navigationsdaten abzeichnete. Aus den bereinigten Tiefendaten der Fächersonarmessung wird ein digitales Geländemodell (DGM) mit einer Rasterweite von 100 m generiert. Dieses Modell liegt für die weitere Bearbeitung digital und in Form einer bathymetrischen Karte im Maßstab 1:250,000 vor, bei der die Topographie des Canyon-Systems nahe dem Fimbulisen durch Isolinien mit einer Aquidistanz von 50 m dargestellt wird. Die als Ergebnis der prozessierten Parasound-Daten erhaltenen Seismogramme, die gefiltert im digitalen Bildformat mit bekannter Start- und Endposition für einen definierten Tiefenbereich vorliegen, können zusammen mit dem DGM in einem dreidimensionalen Modell dargestellt werden. Dieses in digitaler Form vorliegende Modell kann durch den Nutzer interaktiv durchschritten und die darin enthaltenen Messergebnisse in ihrer Gesamtheit sowie in Detailansichten aus verschiedenen Perspektiven betrachtet werden, was das gegenseitige Verständnis und Einschätzung der Ergebnisse aus den beiden Messverfahren fördert. Diese gemeinsame Darstellungsweise eines digitalen Geländemodells in Kombination mit den Seismogramm-Bildern des Sedimentecholotes Parasound bietet sich auch hinsichtlich einer geologischen Klassifizierung der verschiedenen Echotypen und einer anschließenden Interpretation der Sedimentationsvorgänge in einem flächenhaft vermessenen Gebiet an.

As redes sociotécnicas da comunidade gamer : Habilidades cognitivas, capitalismo cognitivo e pirataria no orkut

In the perspective of the so called 'cognitive capitalism', this paper intends to analyze the sharing and customization strategies developed in Brazilian online game communities. Under Bruno Latour's Actor-Network Theory (ANT), this work describes these socio-technical networks electing the human and non human relevant actants for their role on what could also be depicted as an distributed cognitive process (HUTCHINS, 2000). This alternative way of participative consumption deals with the social and creative production of tutorials; in-game and out-game editing and all sorts of gathering, organization and distribution of virtual data. The communities studied are related to the game Pro Evolution Soccer (PES) in their multiple platforms

Ciudades imaginadas en Fernando Arrabal y Milton Hatoum

Este artículo propone una lectura comparativa de la obra teatral 'Fando y Lis', del dramaturgo español Fernando Arrabal, y el romance brasileño 'Los Huérfanos de El Dorado' (Órfãos do Eldorado), del amazónico Milton Hatoum, a través del espacio imaginado por los personajes, las ciudades 'Tar' y la 'Ciudad Encantada' (Cidade Encantada). En el texto teatral de Fernando Arrabal, los personajes Fando y Lis pasan su vida caminando hacia 'Tar' (espacio imaginado), que siempre se describe como un lugar que todos intentan alcanzar. En 'Los Huérfanos de El Dorado', Arminto pasa la vida buscando a una mujer que se fue a la 'Ciudad Encantada' (también un lugar imaginado). Este trabajo sostiene que 'Tar' y 'Ciudad Encantada' tiene algo en común: los personajes creen que ellas existen, pues son parte de la creación de los personajes. Gaston Bachelard en 'La poética del espacio' trata de la inmensidad íntima, de la dialéctica del exterior y del interior de los personajes. Es a través de este prisma teórico que se hará el análisis comparativo de las dos obras, de los dos espacios imaginados

"Como a señor natural" : Interpretaciones políticas del Cantar de Mio Cid

El artículo replantea bajo otra luz la proximidad del Cantar de mio Cid a ciertos hechos históricos de su tiempo, tomando en consideración un concepto político central en el texto que, de alguna forma, aflora en relación con las revueltas burguesas del siglo xii: el concepto de señor natural, que aparece cinco veces a lo largo del poema. Lo que sugiere la aparición del término, en documentos a comienzos del siglo XII, es que el concepto de señor natural se desarrolló en el marco de las revueltas burguesas (con las que Molho y Catalán ligan el espacio del Cantar, aunque justamente representa una posición política contraria a la de los burgueses y caballeros pardos), como un mecanismo para defender la legitimidad del rey y desposeer las aspiraciones de los sublevados. En el Cantar, la función de la idea de señor natural apunta a la sustitución de un orden previo, dominado exclusivamente por el vasallaje, por uno nuevo en el que tal idea se nivela con la de naturaleza, y propicia una mayor justicia social. La naturaleza, vista ahora como fundamento de la organización política, permite al Cid recuperar su posición en la corte y evita que sea meramente un príncipe independiente.