Durability and outcome of initial antiretroviral treatments received during 2000--2005 by patients in the Swiss HIV Cohort Study

BACKGROUND: Little is known about time trends, predictors, and consequences of changes made to antiretroviral therapy (ART) regimens early after patients initially start treatment. METHODS: We compared the incidence of, reasons for, and predictors of treatment change within 1 year after starting combination ART (cART), as well as virological and immunological outcomes at 1 year, among 1866 patients from the Swiss HIV Cohort Study who initiated cART during 2000--2001, 2002--2003, or 2004--2005. RESULTS: The durability of initial regimens did not improve over time (P = .15): 48.8% of 625 patients during 2000--2001, 43.8% of 607 during 2002--2003, and 44.3% of 634 during 2004--2005 changed cART within 1 year; reasons for change included intolerance (51.1% of all patients), patient wish (15.4%), physician decision (14.8%), and virological failure (7.1%). An increased probability of treatment change was associated with larger CD4+ cell counts, larger human immunodeficiency virus type 1 (HIV-1) RNA loads, and receipt of regimens that contained stavudine or indinavir/ritonavir, but a decreased probability was associated with receipt of regimens that contained tenofovir. Treatment discontinuation was associated with larger CD4+ cell counts, current use of injection drugs, and receipt of regimens that contained nevirapine. One-year outcomes improved between 2000--2001 and 2004--2005: 84.5% and 92.7% of patients, respectively, reached HIV-1 RNA loads of <50 copies/mL and achieved median increases in CD4+ cell counts of 157.5 and 197.5 cells/microL, respectively (P < .001 for all comparisons). CONCLUSIONS: Virological and immunological outcomes of initial treatments improved between 2000--2001 and 2004--2005, irrespective of uniformly high rates of early changes in treatment across the 3 study intervals.

SO2 emissions at Volcan de Colima, 2003-2007

Volcán de Colima has been continuously erupting since the onset of dome growth in 1998. This period of unrest has had 4 prominent periods; 1998-1999, 2003, 2004-2005, and the current dome growth that began in February of 2007. Each of these episodes was marked by lava extrusion forming a dome and lava flows, followed by explosions that destroyed the dome. The Correlation Spectrometer (COSPEC) was used to determine SO2 emission rates on 164 days from May 2003 to February 2007, using both stationary ground based scans and some flight traverses. Scans were separated into the categories of explosive degassing and passive, or background degassing. These scans show variation in the SO2 flow rate from below detection limit (~3 t/d depending on environmental conditions) during background, passive emissions to a peak of 2949 t/d (34 kilograms/second) during an explosion on 9 October, 2004. Both passive and explosive degassing increased when there was lava extrusion in 2004 and with the increased explosive activity in 2005. These two different processes of degassing wax with each other when activity increases and wane together as well, indicating a parallel cyclicity in the volcanic eruption and degassing rates, where the conduit partially seals (pressurizes) between explosions. Colima’s gas and eruptive behavior is compared to similar systems such as Santiaguito and Soufrière Hills, Montserrat. About 2/3 of Colima’s SO2 degassing, amounting to 1.3 x 105 tonnes in 3.74 yrs has come in short lived small (VEI=0-1) vertical explosions that occurred at the rate of 100-3000explosions/ month, and the remaining third has occured in continuous passive degassing. Colima emits sulfur at a rate equivalent to about 0.04 to 0.08 wt % S, similar to other andesitic convergent plate boundary volcanoes. There has been an explosive destruction of the dome in every cycle for that past 5 years, and it is assumed that the current dome which began growth in February, 2007 (just at the end of this study) will be destroyed. Higher emission rates seen in the quiescence of 2006 may have eased the pressure at the time, resulting in the slow effusion of the current dome and lack of explosivity.

C4I Roadmap March 2005

Patients expect to be safe from harm inside the walls of a hospital. Increasing reports of medical errors and adverse events have brought these concerns to public attention. Although we have celebrated many scientific advances over the past several decades, many patients do not benefit because the healthcare infrastructure is inadequate to deliver care to all. Studies confirm opportunities to improve in areas such as inpatient vaccination for flu and outpatient screening for breast, cervical or colon cancer. (Institute of Medicine, (IOM), 2000, 2001, 2004). This document outlines the steps needed to further increase our focus on patient safety in John Dempsey Hospital through the development of a multi-disciplinary Collaborative Center for Clinical Care Improvement (CCCCI). The dimensions of safety and outcomes are briefly discussed to provide some perspective on the scope of these challenges (Strongwater, 2003).