Self-reported nonadherence to antiretroviral therapy as a predictor of viral failure and mortality

OBJECTIVE: To determine the effect of nonadherence to antiretroviral therapy (ART) on virologic failure and mortality in naive individuals starting ART. DESIGN: Prospective observational cohort study. METHODS: Eligible individuals enrolled in the Swiss HIV Cohort Study, started ART between 2003 and 2012, and provided adherence data on at least one biannual clinical visit. Adherence was defined as missed doses (none, one, two, or more than two) and percentage adherence (>95, 90-95, and <90) in the previous 4 weeks. Inverse probability weighting of marginal structural models was used to estimate the effect of nonadherence on viral failure (HIV-1 viral load >500 copies/ml) and mortality. RESULTS: Of 3150 individuals followed for a median 4.7 years, 480 (15.2%) experienced viral failure and 104 (3.3%) died, 1155 (36.6%) reported missing one dose, 414 (13.1%) two doses and, 333 (10.6%) more than two doses of ART. The risk of viral failure increased with each missed dose (one dose: hazard ratio [HR] 1.15, 95% confidence interval 0.79-1.67; two doses: 2.15, 1.31-3.53; more than two doses: 5.21, 2.96-9.18). The risk of death increased with more than two missed doses (HR 4.87, 2.21-10.73). Missing one to two doses of ART increased the risk of viral failure in those starting once-daily (HR 1.67, 1.11-2.50) compared with those starting twice-daily regimens (HR 0.99, 0.64-1.54, interaction P = 0.09). Consistent results were found for percentage adherence. CONCLUSION: Self-report of two or more missed doses of ART is associated with an increased risk of both viral failure and death. A simple adherence question helps identify patients at risk for negative clinical outcomes and offers opportunities for intervention.

The HIV care cascade in Switzerland: reaching the UNAIDS/WHO targets for patients diagnosed with HIV.

OBJECTIVES: To describe the HIV care cascade for Switzerland in the year 2012. DESIGN/METHODS: Six levels were defined: (i) HIV-infected, (ii) HIV-diagnosed, (iii) linked to care, (iv) retained in care, (v) on antiretroviral treatment (ART), and (vi) with suppressed viral load. We used data from the Swiss HIV Cohort Study (SHCS) complemented by a nationwide survey among SHCS physicians to estimate the number of HIV-patients not registered in the cohort. We also used Swiss ART sales data to estimate the number of patients treated outside the SHCS network. Based on the number of patients retained in care, we inferred the estimates for levels (i) to (iii) from previously published data. RESULTS: We estimate that (i) 15 200 HIV-infected individuals lived in Switzerland in 2012 (margins of uncertainty, 13 400-19 300). Of those, (ii) 12 300 (81%) were diagnosed, (iii) 12 200 (80%) linked, and (iv) 11 900 (79%) retained in care. Broadly based on SHCS network data, (v) 10 800 (71%) patients were receiving ART, and (vi) 10 400 (68%) had suppressed (<200 copies/ml) viral loads. The vast majority (95%) of patients retained in care were followed within the SHCS network, with 76% registered in the cohort. CONCLUSION: Our estimate for HIV-infected individuals in Switzerland is substantially lower than previously reported, halving previous national HIV prevalence estimates to 0.2%. In Switzerland in 2012, 91% of patients in care were receiving ART, and 96% of patients on ART had suppressed viral load, meeting recent UNAIDS/WHO targets.

[(18)F]FDG-PET/CT metabolic parameters as useful prognostic factors in cervical cancer patients treated with chemo-radiotherapy.

BACKGROUND: To compare the prognostic value of different anatomical and functional metabolic parameters determined using [(18)F]FDG-PET/CT with other clinical and pathological prognostic parameters in cervical cancer (CC). METHODS: Thirty-eight patients treated with standard curative doses of chemo-radiotherapy (CRT) underwent pre- and post-therapy [(18)F]FDG-PET/CT. [(18)F]FDG-PET/CT parameters including mean tumor standardized uptake values (SUV), metabolic tumor volume (MTV) and tumor glycolytic volume (TGV) were measured before the start of CRT. The post-treatment tumor metabolic response was evaluated. These parameters were compared to other clinical prognostic factors. Survival curves were estimated by using the Kaplan-Meier method. Cox regression analysis was performed to determine the independent contribution of each prognostic factor. RESULTS: After 37 months of median follow-up (range, 12-106), overall survival (OS) was 71 % [95 % confidence interval (CI), 54-88], disease-free survival (DFS) 61 % [95 % CI, 44-78] and loco-regional control (LRC) 76 % [95 % CI, 62-90]. In univariate analyses the [(18)F]FDG-PET/CT parameters unfavorably influencing OS, DFS and LRC were pre-treatment TGV-cutoff ≥562 (37 vs. 76 %, p = 0.01; 33 vs. 70 %, p = 0.002; and 55 vs. 83 %, p = 0.005, respectively), mean pre-treatment tumor SUV cutoff ≥5 (57 vs. 86 %, p = 0.03; 36 vs. 88 %, p = 0.004; 65 vs. 88 %, p = 0.04, respectively) and a partial tumor metabolic response after treatment (9 vs. 29 %, p = 0.0008; 0 vs. 83 %, p < 0.0001; 22 vs. 96 %, p < 0.0001, respectively). After multivariate analyses a partial tumor metabolic response after treatment remained as an independent prognostic factor unfavorably influencing DFS and LRC (RR 1:7.7, p < 0.0001, and RR 1:22.6, p = 0.0003, respectively) while the pre-treatment TGV-cutoff ≥562 negatively influenced OS and DFS (RR 1:2, p = 0.03, and RR 1:2.75, p = 0.05). CONCLUSIONS: Parameters capturing the pre-treatment glycolytic volume and metabolic activity of [(18)F]FDG-positive disease provide important prognostic information in patients with CC treated with CRT. The post-therapy [(18)F]FDG-PET/CT uptake (partial tumor metabolic response) is predictive of disease outcome.

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants.

One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. We used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries. Wellcome Trust.

Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants.

BACKGROUND: Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. METHODS: We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m(2) [underweight], 18·5 kg/m(2) to <20 kg/m(2), 20 kg/m(2) to <25 kg/m(2), 25 kg/m(2) to <30 kg/m(2), 30 kg/m(2) to <35 kg/m(2), 35 kg/m(2) to <40 kg/m(2), ≥40 kg/m(2) [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. FINDINGS: We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m(2) (95% credible interval 21·3-22·1) in 1975 to 24·2 kg/m(2) (24·0-24·4) in 2014 in men, and from 22·1 kg/m(2) (21·7-22·5) in 1975 to 24·4 kg/m(2) (24·2-24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m(2) in central Africa and south Asia to 29·2 kg/m(2) (28·6-29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m(2) (21·4-22·3) in south Asia to 32·2 kg/m(2) (31·5-32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5-17·4) to 8·8% (7·4-10·3) in men and from 14·6% (11·6-17·9) to 9·7% (8·3-11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8-29·2) in men and 24·0% (18·9-29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4-4·1) in 1975 to 10·8% (9·7-12·0) in 2014 in men, and from 6·4% (5·1-7·8) to 14·9% (13·6-16·1) in women. 2·3% (2·0-2·7) of the world's men and 5·0% (4·4-5·6) of women were severely obese (ie, have BMI ≥35 kg/m(2)). Globally, prevalence of morbid obesity was 0·64% (0·46-0·86) in men and 1·6% (1·3-1·9) in women. INTERPRETATION: If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia. FUNDING: Wellcome Trust, Grand Challenges Canada.

Recreational Development and the Lake Erie Shore Photographs,1967

John N. Jackson was born and raised in London England. He served in the Royal Navy, acquired a B.A. and a Ph.D, conducted research for a city planning office and lectured at the University of Manchester. He joined Brock University’s faculty in 1965 as a Professor of Applied Geography. Since his retirement in 1991 he has been Professor Emeritus to Brock. Throughout his time in academia Jackson has focused his research on the history of the modern city, both throughout Europe and Canada. Jackson has also completed specific research on the Niagara Peninsula; including industrial geography, recreation along the Lake Erie shore, St. Catharines early history, the Welland Canals, railway development, comparisons across the Niagara River. While living in the Niagara region Jackson has become involved in many community events. He has been the Director for the Bruce Trail Association, President of the Welland Canals Foundation, and been involved in local historical groups throughout the Niagara region.

The New-York Weekly Museum Newspaper, Vol. II, No.24- October 16, 1813

A weekly paper that was published from 1805 to 1814. War related news includes: Page 95 - Weekly Retrospect: relief effort in London, England for those affected by the war in British North America; naval battles on Lake Ontario by Commodore Chauncey in late September; movements of Major Grant, De Rottenburgh's regiment, General Wilkinson, Commodore Yoe's fleet, General Hampton; the capture of Fort Malden by William Harrison. The rest of the newspaper contains literary works (poems and translations), marriages, deaths and other anecdotes. The motto on the front page states: "Visiting Every Flower with Labour Meet, and Gathering all its Treasures, Sweet by Sweet."

Colin Duquemin fonds, 1935, 1968-2001, n.d.

Colin Duquemin was born in 1932 in Guernsey, British Channel Islands, and came to Canada as a young adult. He attended McMaster University (B.A.), the University of Toronto (B.Ed.), the State University of New York at Buffalo (M.A.) and the University of London, London, England (M.Sc.). He began his career as a tea taster and tea buyer in Colombo, Ceylon (Sri Lanka), but later became a teacher. He spent most of his teaching career as a manager of the St. Johns Outdoor Studies Centre, north of Fonthill, Ontario, developing environmentally related programmes for elementary and secondary school students. He was also active in many local organizations, serving as Associate Director of the St. Catharines Grape and Wine Festival Board, Chairman of the St. Catharines Historical Museum Board, President of the Niagara Military Institute and President of the Canadian Canal Society. In addition to the numerous curriculum materials he authored, Colin wrote the Driver’s Guide Series, highlighting the many points of interest in the Niagara region, including the Welland Canal, battlefields of the War of 1812, and the Niagara Parkway. He also wrote A Guide to the Grand River Canal (1980) with Daniel Glenney, The Fur Trade in Rupert’s Land: Opening up the Canadian Northwest (1992), Stick to the Guns! A short history of the 10th field battery, Royal Regiment of Canadian Artillery (1996), Niagara Rebels: the Niagara Frontier Incidents in the Upper Canada Rebellion, 1837-1838 ( 2001), and edited and contributed to A Lodge of Friendship: the History of Niagara Lodge, No. 2, A.F. & A.M, Niagara-on-the-Lake, Ontario, Canada, 1792-1992 (1991). He died in December 2012.

Photograph - Portrait Col. Frank Case McCordick

A portrait photograph of Col. Frank Case McCordick in his military uniform. undated. The photographers are Elliott & Fry and are located at 55 Baker street London W.

Bulloch, Lade & Co. Order Form, 31 August 1870

An order form for the exportation of scotch pure malt whiskies, distilled by Bulloch, Lade & Co.

Compendium of Festive and Seasonable Stingo Recipes

A recipe booklet with the full title "Compendium of Festive and Seasonable Stingo recipes for the Delectation of the Nobility and Gentry, our esteemed Patrons". The inside sentiment reads "Presented to you with Good wishes all Seasonable Cheer by Watneys Brewers of the Very Best Beers at Stag Brewery, Pimlico, London, S.W.I"

Act for Laying a Duty on the Retailers of Spirits and Liquors

An act to charge duty to retailers of liquor and for licensing retailers of liquor. The document beings "At the Parliament begun and holden at Westminster, the Fourteenth Day of January, Anno Dom. 1734 in the Eighth Year of the Reign of our Sovereign Lord George the Second, by the Grace of God, of Great Britain, France, and Ireland, Kind, Defender of the Faith, And from thence continued by federal Prorogation to the Fifteenth Day of January, 1735. being the Second Session of this present Parliament."

Wine for Sale at Garraway's Coffee-House in Cornhill

A list of wines for sale "by the candle at Garraway's Coffee-house in Exchange Alley, Cornhill..." six pages in length. The list begins with four conditions of sale and then lists types of wines, lot numbers and how many dozen are available. The wines available are: Excellent Old Hock, Old Hock, Rich Hungarian White Wine, Hungarian White Wine, Curious French Claret, White Perfian Wine, and Curious Rich Perfian Red Wine. The broker listed on the final page is Peter Fearon.

Hedges & Butler Advertisement

An advertisement for Hedges & Butler, Wine Merchants to the Queen, in London, England. The advertisement lists the prices for: Sherries, Ports, Clarets, Champagnes, Burgundies, and Madeiras.

The New Testament of Our Lord and Saviour Jesus Christ

This book was presented by the Canadian Bible Society (British & Foreign Bible Society) to the Canadian Soldiers in the war of 1914. There is an inscription which reads "Niagara-on-the-Lake, August 15th 1915 Presented to the 35th overseas Battalion Draft. P.C. Band to his father before his departure for the front". The word "confirmed" is written below this but the rest of the page is torn out. There is also a book plate that reads "Presented by the Canadian Bible Society (British & Foreign Bible Society) to the Canadian Soldiers in the War of 1914. 'Be strong and of a Good Courage'". See the full text in the Brock University Special Collections and Archives.