Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up.

BACKGROUND: In Tanzania, HIV-1 RNA testing is rarely available and not standard of care. Determining virologic failure is challenging and resistance mutations accumulate, thereby compromising second-line therapy. We evaluated durability of antiretroviral therapy (ART) and predictors of virologic failure among a pediatric cohort at four-year follow-up. METHODS: This was a prospective cross-sectional study with retrospective chart review evaluating a perinatally HIV-infected Tanzanian cohort enrolled in 2008-09 with repeat HIV-1 RNA in 2012-13. Demographic, clinical, and laboratory data were extracted from charts, resistance mutations from 2008-9 were analyzed, and prospective HIV RNA was obtained. RESULTS: 161 (78%) participants of the original cohort consented to repeat HIV RNA. The average age was 12.2 years (55% adolescents ≥12 years). Average time on ART was 6.4 years with 41% receiving second-line (protease inhibitor based) therapy. Among those originally suppressed on a first-line (non-nucleoside reverse transcriptase based regimen) 76% remained suppressed. Of those originally failing first-line, 88% were switched to second-line and 72% have suppressed virus. Increased level of viremia and duration of ART trended with an increased number of thymidine analogue mutations (TAMs). Increased TAMs increased the odds of virologic failure (p = 0.18), as did adolescent age (p < 0.01). CONCLUSIONS: After viral load testing in 2008-09 many participants switched to second-line therapy. The majority achieved virologic suppression despite multiple resistance mutations. Though virologic testing would likely hasten the switch to second-line among those failing, methods to improve adherence is critical to maximize durability of ART and improve virologic outcomes among youth in resource-limited settings.

Information and attitudes about VIH-SIDA in Portuguese adolescents : State of art and changes in a four year period

Resumen tomado de la publicaci??n

Four year efficacy of prophylactic human papillomavirus quadrivalent vaccine against low grade cervical, vulvar, and vaginal intraepithelial neoplasia and anogenital warts: randomised controlled trial

Objectives: To evaluate the prophylactic efficacy of the human papillomavirus (HPV) quadrivalent vaccine in preventing low grade cervical, vulvar, and vaginal intraepithelial neoplasias and anogenital warts (condyloma acuminata). Design: Data from two international, double blind, placebo controlled, randomised efficacy trials of quadrivalent HPV vaccine (protocol 013 (FUTURE I) and protocol 015 (FUTURE II)). The trials were to be 4 years in length, and the results reported are from final study data of 42 months' follow-up. Setting: Primary care centres and university or hospital associated health centres in 24 countries and territories around the world. Participants: 17 622 women aged 16-26 years enrolled between December 2001 and May 2003. Major exclusion criteria were lifetime number of sexual partners (>4), history of abnormal cervical smear test results, and pregnancy. Intervention: Three doses of quadrivalent HPV vaccine (for serotypes 6, 11, 16, and 18) or placebo at day 1, month 2, and month 6. Main outcome measures: Vaccine efficacy against cervical, vulvar, and vaginal intraepithelial neoplasia grade I and condyloma in a per protocol susceptible population that included subjects who received all three vaccine doses, tested negative for the relevant vaccine HPV types at day 1 and remained negative through month 7, and had no major protocol violations. Intention to treat, generally HPV naive, and unrestricted susceptible populations were also studied. Results: In the per protocol susceptible population, vaccine efficacy against lesions related to the HPV types in the vaccine was 96% for cervical intraepithelial neoplasia grade I (95% confidence interval 91% to 98%), 100% for both vulvar and vaginal intraepithelial neoplasia grade I (95% CIs 74% to 100%, 64% to 100% respectively), and 99% for condyloma (96% to 100%). Vaccine efficacy against any lesion (regardless of HPV type) in the generally naive population was 30% (17% to 41%), 75% (22% to 94%), and 48% (10% to 71%) for cervical, vulvar, and vaginal intraepithelial neoplasia grade I, respectively, and 83% (74% to 89%) for condyloma. Conclusions: Quadrivalent HPV vaccine provided sustained protection against low grade lesions attributable to vaccine HPV types (6, 11, 16, and 18) and a substantial reduction in the burden of these diseases through 42 months of follow-up. Trial registrations: NCT00092521 and NCT00092534.

Four year multitrophic food web: source food web description, methodology accuracy and species diversity

Food webs have been used in order to understand the trophic relationship among organisms within an ecosystem, however the extension by which sampling efficiency could affect food web responses remain poorly understood. Still, there is a lack of long-term sampling data for many insect groups, mainly related to the interactions between herbivores and their host plants. In the first chapter, I describe a source food web based on the Senegalia tenuifolia plant by identifying the associated insect species and the interactions among them and with this host plant. Furthermore, I check for the data robustness from each trophic level and propose a cost-efficiently methodology. The results from this chapter show that the collected dataset and the methodology presented are a good tool for sample most insect richness of a source food web. In total the food web comprises 27 species belonging to four trophic levels. In the second chapter, I demonstrate the temporal variation in the species richness and abundance from each trophic level, as well as the relationship among distinct trophic levels. Moreover, I investigate the diversity patterns of the second and third trophic level by assessing the contribution of alfa and beta-diversity components along the years. This chapter shows that in our system the parasitoid abundance is regulated by the herbivore abundances. Besides, the species richness and abundances of the trophic levels vary temporally. It also shows that alfa-diversity was the diversity component that most contribute to the herbivore species diversity (2nd trophic level), while the contribution of alfa- and beta-diversity changed along the years for parasitoid diversity (3rd level). Overall, this dissertation describes a source food web and bring insights into some food web challenges related to the sampling effort to gather enough species from all trophic levels. It also discuss the relation among communities associated with distinct trophic levels and their temporal variation and diversity patterns. Finally, this dissertation contributes for the world food web database and in understanding the interactions among its trophic levels and each trophic level pattern along time and space

A four-year record of UK'37- and TEX86-derived sea surface temperature estimates from sinking particles in the filamentous upwelling region off Cape Blanc, Mauritania

Lipid biomarker records from sinking particles collected by sediment traps are excellent tools to study the seasonality of biomarker production as well as processes of particle formation and settling, ultimately leading to the preservation of the biomarkers in sediments. Here we present records of the biomarker indices UK'37 based on alkenones and TEX86 based on isoprenoid glycerol dialkyl glycerol tetraethers (GDGTs), both used for the reconstruction of sea surface temperatures (SST). These records were obtained from sinking particles collected using a sediment trap moored in the filamentous upwelling zone off Cape Blanc, Mauritania, at approximately 1300 water depth during a four-year time interval between 2003 and 2007. Mass and lipid fluxes are highest during peak upwelling periods between October and June. The alkenone and GDGT records both display pronounced seasonal variability. Sinking velocities calculated from the time lag between measured SST maxima and minima and corresponding index maxima and minima in the trap samples are higher for particles containing alkenones (14-59 m/d) than for GDGTs (9-17 m/d). It is suggested that GDGTs are predominantly exported from shallow waters by incorporation in opal-rich particles. SST estimates based on the UK'37 index faithfully record observed fluctuations in SST during the study period. Temperature estimates based on TEX86 show smaller seasonal amplitudes, which can be explained with either predominant production of GDGTs during the warm season, or a contribution of GDGTs exported from deep waters carrying GDGTs in a distribution that translates to a high TEX86 signal.

Effect of asthma and its treatment on growth: four year follow up of cohort of children from general practices in Tayside, Scotland

Objective: To investigate whether asthma or its treatment impairs children’s growth, after allowing for socioeconomic group.

A dictionary of Sanscrit and English, designed for the use of private students and of Indian colleges and schools.

Mode of access: Internet.

Four year course in physical education and athletic coaching.

"Amended curriculum. Approved by Board of Trustees, Dec. 4, 1929."

The church history of England, from the year 1500, to the year 1688. Chiefly with regard to the Catholicks ... with ... the lives of the most eminent Catholicks ... also, a distinct ... account of the works of the learned ... with the foundation of all the English colleges and monasteries abroad ... To which is prefixed, A general history of ecclesiastical affairs under the British, Saxon, and Norman periods ...

Probably printed in England. of. Halkett & Laing, Brit. mus. Catalogue.

Syllabus for reading, writing, and criticism B : syllabus for the second year of a three-year course given in the first, second, and third years of the four-year curriculum in the College The University of Chicago. /

Mimeographed.

Commercial and industrial geography; a text book for schools, colleges, and private reference,

Mode of access: Internet.

A collection of sundry publications, and other documents, in relation to the attack made during the late war upon the private armed brig General Armstrong, of New-York, commanded by S. C. Reid, on the night of the 26th of September, 1814, at the island of Fayal, by his Britannic Majesty's ships Plantagenet seventy-four, Rota frigate, and Carnation sloop of war.

Howes C582.