Antiretroviral treatment of adult HIV infection: 2014 recommendations of the International Antiviral Society-USA Panel.

IMPORTANCE: New data and antiretroviral regimens expand treatment choices in resource-rich settings and warrant an update of recommendations to treat adults infected with human immunodeficiency virus (HIV). OBJECTIVE: To provide updated treatment recommendations for adults with HIV, emphasizing when to start treatment; what treatment to start; the use of laboratory monitoring tools; and managing treatment failure, switches, and simplification. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: An International Antiviral Society-USA panel of experts in HIV research and patient care considered previous data and reviewed new data since the 2012 update with literature searches in PubMed and EMBASE through June 2014. Recommendations and ratings were based on the quality of evidence and consensus. RESULTS: Antiretroviral therapy is recommended for all adults with HIV infection. Evidence for benefits of treatment and quality of available data increase at lower CD4 cell counts. Recommended initial regimens include 2 nucleoside reverse transcriptase inhibitors (NRTIs; abacavir/lamivudine or tenofovir disoproxil fumarate/emtricitabine) and a third single or boosted drug, which should be an integrase strand transfer inhibitor (dolutegravir, elvitegravir, or raltegravir), a nonnucleoside reverse transcriptase inhibitor (efavirenz or rilpivirine) or a boosted protease inhibitor (darunavir or atazanavir). Alternative regimens are available. Boosted protease inhibitor monotherapy is generally not recommended, but NRTI-sparing approaches may be considered. New guidance for optimal timing of monitoring of laboratory parameters is provided. Suspected treatment failure warrants rapid confirmation, performance of resistance testing while the patient is receiving the failing regimen, and evaluation of reasons for failure before consideration of switching therapy. Regimen switches for adverse effects, convenience, or to reduce costs should not jeopardize antiretroviral potency. CONCLUSIONS AND RELEVANCE: After confirmed diagnosis of HIV infection, antiretroviral therapy should be initiated in all individuals who are willing and ready to start treatment. Regimens should be selected or changed based on resistance test results with consideration of dosing frequency, pill burden, adverse toxic effect profiles, comorbidities, and drug interactions.

PHA supports World No Tobacco Day

The Public Health Agency is taking the opportunity to highlight this year's World No Tobacco Day which takes place on Tuesday 31 May.In Northern Ireland, around 340,000 people aged 16 and over smoke. Smoking contributes not only to many cancers, heart disease, bronchitis and asthma, but to other illnesses, including stroke. In fact, smoking causes around 2,700 deaths per year here, all of them avoidable.The PHA is committed to saving lives by reducing the percentage of people who smoke. The PHA:works with councils to ensure smoking-related laws are enforced; funds a range of support to smokers who want to quit; educates young people to not start smoking, through programmes like 'Teenage Kicks' and 'Smokebusters'. In January this year, the PHA also launched its smoking campaign 'Things to do before you die' to encourage smokers, particularly those aged 20-49, to stop smoking.Health Minister Edwin Poots said:"Smoking is the greatest cause of preventable illness and premature death in Northern Ireland. While good progress has been made in the last number of years to reduce the number of people who smoke, more needs to be done."I would appeal to all smokers to use the wide range of support services available to make every effort to stop smoking - it is the single best step you can take to improve your health and quality of life."Mark Mc Bride, Health Improvement Manager, PHA, said "Smoking is the single greatest preventable cause of death in the world today. Across Northern Ireland there are over 600 support services for people who wish to stop smoking. These are based in GP surgeries, community pharmacies, hospitals, community centres and workplaces."From April 2010 to end March 2011 more than 1 in 10 of all adult smokers sought help from the support services and approximately half had quit after four weeks. This is a substantial - roughly 50% increase - on previous years and shows the benefit of the PHA campaigns and the dedication of the many specialists who help smokers quit."I would encourage everyone who is either thinking about quitting or ready to log on to our Want 2 Stop website www.want2stop.info or to contacting the Smokers' Helpline on 0808 812 8008 a Quit Kit free of charge."

Healthy breaks: tasty tips for the under fives

Today the Public Health Agency is launching a new resource pack designed to assist nursery schools and playgroups deliver a healthy breaks scheme.All nursery schools and playgroups in Northern Ireland will receive the pack - 'Healthy breaks for pre-school children' - which includes a poster and information leaflets for parents explaining why a healthy break is so important for pre-school children and some tips and ideas for healthy nutritious breaks.Judith Hanvey, Regional Food in Schools Co-ordinator, appointed jointly by the PHA and the Department of Education, said: "Break-time snacking schemes currently operate in many pre-school settings across Northern Ireland, however they are implemented in different ways. The PHA has developed this new guidance so that any existing or future schemes have the information that they need to deliver a healthy break programme."Judith explained why a healthy break is so important for pre-school pupils."Young children have small stomachs but high requirements for energy (calories) and nutrients. This means that healthy snacks between meals are very important to make sure that they get all the nourishment they need."Childhood is also an important time to establish good eating and drinking habits for later life."Healthy eating schemes give children the knowledge and opportunity to make healthier choices."The Department of Education and Department of Health, Social Services and Public Safety recently launched 'Healthy Food for Healthy Outcomes: Food in Schools Policy', which builds on the nutritional standards which were introduced in 2007 by the Department of Education.The policy encourages a 'whole school approach' to all food and drink provided and consumed in schools. This ensures that children have the opportunity to benefit from a healthy balanced diet, which can aid learning, leading to improved educational outcomes. It also requires that every school should have their own whole-school food policy in place by September 2014. Nursery schools that receive funding from the Department of Education must follow this policy.This is also in line with the position taken by the Department of Health, Social Services and Public Safety's 10 year obesity prevention strategy, A Fitter Future for All, which aims to take a consistent approach to healthy food within early years settings.

Fridge hygiene

This report contains some rules for making sure your fridge is a safe place to keep food.

Trinity AM

Trinity AM was set up in January 2013. The aim of the breakfast club is to provide food for children before class to assist them in their school performance.The club is run by a group of volunteers including teachers, parents and local community members. On average, 30 children come to the club each morning. A selection of cereals, toast, fruit and fruit juice are served each morning. There is also a hot food option each morning, such as eggs or baked beans. This club is part of the Pilot Programme of Breakfast Clubs which is funded through Kellogg's Corporate Citizenship Fund. Part of theBreakfast Clubs Pilot Programme Initiative Type Breakfast Clubs Location Dublin 13 Target Groups Children ( 4-12 years) Funding This club is part of the Pilot Programme of Breakfast Clubs which is funded through Kellogg's Corporate Citizenship Fund. Start 13th Jan 2013

Anàlisi, disseny i implementació d'unaaplicació de gestió de menjadors escolars mitjançant Java Enterprise Edition

Aquest Treball Final de Carrera té per objecte l'anàlisi, disseny i implementació d'una aplicació degestió de menjadors escolars. Aquesta aplicació neix de la necessitat de donar resposta a unademanda dels responsables d'aquests menjadors que es veuen desbordats per controlar totes lesincidències que tenen a veure amb el menjador d'un centre educatiu: des del registre d'un client (alumne, professor o convidat) que entra al menjador a dinar fins al cobrament dels serveiscorresponents.

Construcció i explotació d'un magatzem de dades per a l'anàlisi estadístic dels resultats del Campionat de Fórmula 1

En els darrers anys les organitzacions han anat agafant consciència de la importància de la gestió de la seva informació. D'aquesta necessitat d'organitzar les pròpies dades d'una forma coherent i eficient per al seu anàlisi sorgeixen els magatzems de dades. El projecte "Construcció i explotació d'un magatzem de dades per a l'anàlisi estadístic dels resultats del Campionat de Fórmula 1" s'emmarca dins aquest context i te com a objectiu el disseny d'un magatzem de dades per a cobrir les necessitats del Institut Català d'Esports de Motor (ICEM) en la gestió de les seves dades referents a la Fórmula 1. En aquest projecte s'han executat les diferents fases necessàries per a la creació d'un nou magatzem. En primer lloc s'ha fet l'anàlisi de requeriments i de les dades disponibles. A continuació s'ha fet el disseny i la implementació física del magatzem de dades. Seguidament s'ha procedit amb l'extracció, transformació i càrrega de dades originals (ETL) i per finalitzar s'han creat els informes. Com a resultat s'han obtingut una sèrie d'informes per a ser consumits de manera immediata pels usuaris del ICEM. Aquests informes han de permetre l'anàlisi de les dades d'una forma senzilla i àgil. A més s'ha implementat un sistema d'actualització automàtic de les dades que per al manteniment de la informació del magatzem.La implementació del magatzem de dades s'ha fet sobre una base de dades Oracle 10g Express Edition i els informes s'ha dissenyat amb l'eina Oracle Discoverer. Per a l'automatització de les dades s'ha fet servir a més visual basic script i l'eina de càrrega SQL*Loader.

Paleoparasitological remains revealed by seven historic contexts from "Place d'Armes", Namur, Belgium

Human occupation for several centuries was recorded in the archaeological layers of "Place d'Armes", Namur, Belgium. Preventive archaeological excavations were carried out between 1996/1997 and seven historical strata were observed, from Gallo-Roman period up to Modern Times. Soil samples from cesspools, latrines, and structures-like were studied and revealed intestinal parasite eggs in the different archaeological contexts. Ascaris lumbricoides, A. suum, Trichuris trichiura, T. suis. Taenia sp., Fasciola hepatica, Diphyllobothrium sp., Capillaria sp. and Oxyuris equi eggs were found. Paleoparasitology confirmed the use of structures as latrines or cesspit as firstly supposed by the archaeologists. Medieval latrines were not only used for rejection of human excrements. The finding of Ascaris sp. and Trichuris sp. eggs may point to human's or wild swine's feces. Gallo-Roman people used to eat wild boar. Therefore, both A. suum and T. suis, or A. lumbricoides and T. trichuris, may be present, considering a swine carcass recovered into a cesspit. Careful sediment analysis may reveal its origin, although parasites of domestic animals can be found together with those of human's. Taenia sp. eggs identified in latrine samples indicate ingestion of uncooked beef with cysticercoid larvae. F. hepatica eggs suggest the ingestion of raw contaminated vegetables and Diphyllobothrium sp. eggs indicate contaminated fresh-water fish consumption. Ascaris sp. and Trichuris sp. eggs indicate fecal-oral infection by human and/or animal excrements.

Toxoplasma gondii in animals used for human consumption

Food-borne toxoplasmosis in humans may result from exposure to different stages of Toxoplasma gondii, in particular from the ingestion of tissue cysts or tachyzoites contained in meat, primary offal (viscera) or meat-derived products of many different animals, or the ingestion of sporulated oocysts that are contained in the environment and may contaminate food and water. Although the potential for transmission of the parasite to humans via food has been known for several decades, it is not known which routes are most important from a public health point of view. It is likely that transmission of the parasite to humans is influenced not only by the potential contamination of various food sources, but also by the individual behaviour of consumers in different ethnic groups and geographical regions. Most current methods for detection of T. gondii in meat-producing animals, in products of animal origin, or in the environment are insufficient because they do not allow quantification of infectious stages. Hence, most studies report only qualitative data from which it is difficult to assess the true risk of infection in individual cases. There is a need for quantitative data so that efficient strategies to reduce food-borne transmission of T. gondii to humans can be developed.

Fortalezas y amenazas en torno a la seguridad del paciente según la opinión de los profesionales de enfermería

The aim of this research is to know the barriers and opportunities that nursing professionals detect in their clinical practice in order to develop the culture of patient safety and to identify future research lines. This qualitative study is based on the DELPHI method, with a group of 19 nursing professionals from education and care practice, involving both primary and specialized care. Weaknesses and threats revolve around five categories: profession, organization and infrastructure; indicators; communication and safety culture; and safety training. Opportunities to improve safety cover six categories: organizational change; promotion of the safety culture, professional training and development; relationship with the patients; research; and strategic planning. Work is needed to improve safety and nursing should be ready to assume this leadership.

Dominant nestlings displaying female-like melanin coloration behave altruistically in the barn owl

When competing over parental resources, young animals may be typically selfish to the point of siblicide. This suggests that limited parental resources promote the evolution of sibling competition rather than altruistic or cooperative behaviours. In striking contrast, we show here that in 71% of experimental three-chick broods, nestling barn owls, Tyto alba, gave food to their siblings on average twice per night. This behaviour prevailed in the first-born dominant nestlings rather than the last-born subordinate nestlings. It was also more prevalent in individuals displaying a heritable dark phaeomelanin-based coloration, a typical female-specific plumage trait (owls vary from dark reddish to white, females being on average darker reddish than males). Stealing food items from siblings, which occurred in 81% of the nests, was more frequent in light than dark phaeomelanic dominant nestlings. We suggest that food sharing has evolved in the barn owl because parents store prey items in their nest that can be used by the offspring to feed their nestmates to derive indirect (kin selection) or direct benefits (pseudoreciprocity or by-product mutualism). The cost of feeding siblings may be relatively low for dominant individuals while the indirect genetic benefits could be high given that extrapair paternity is infrequent in this species. Thus, in situations in which young animals have access to more food resources than they currently need, they can altruistically share them with their siblings.

Evaluation of factors affecting plate waste of inpatients in different healthcare settings.

INTRODUCTION AND AIMS: Satisfaction of inpatients with served food within a hospital care system still constitutes one of the main attempts to modernize food services. The impact of type of menu, food category, hospital centre and timetable on the meals wastage produced in different Spanish healthcare settings, was evaluated. METHODS: Meal wastage was measured through a semiquantitative 5-point scale ("nothing on plate"; "¼ on plate"; "half on plate"; "¾ on plate" and "all on plate"). The study was carried out in two periods of three months each in 2010 and 2011. A trained person took charge of measuring plate waste classified into 726 servings belonging to 11 menus. In total 31,392 plates were served to 7,868 inpatients. A Kruskal-Wallis non-parametric test (p < 0.05) was applied to evaluate significant differences among the variables studied. RESULTS: The menus were satisfactorily consumed because more than 50% of the plates were classified as "nothing on plate". Regarding food categories, 26.78% of the plates corresponded to soups and purées, while pasta and rice, and prepared foods were only distributed in 4-5% of the servings. Desserts were mostly consumed, while cooked vegetables were less accepted by the inpatients evaluated. Other factors such as hospital centre influenced plate waste (p < 0.05) but timetable did not (p > 0.05). CONCLUSION: Visual inspections of plate waste might be useful to optimize type and quality of menus served. The type of menu served and the food category could have a great influence on food acceptability by the inpatientsstudied.

Modelització de la producció de melanina a partir de polifenol oxidasa d'Agaricus bisporus

Les melanines són un grup heterogeni de polímers producte de reaccions enzimàtiques en els teixits vegetals que contenen compostos fenòlics o polifenòlics. Estudis recents han descobert algunes propietats benèfiques de les melanines sobre la salut, tals com antioxidants, antiinflamatòries, immunològiques i propietats anti-tumorals. Així, no només la seva eliminació ha de ser examinada, sinó que també podria considerar-se la seva addició a aliments funcionals de nova creació. D’aquesta manera, es requereix conèixer el mecanisme cinètic de la lanogènesi abans de la seva possible utilització industrial. S’ha desenvolupat un model cinètic per explicar la formació de melanina a partir de L-tirosina utilitzant polifenol oxidasa d’Agaricus bisporus i monitoritzant l'absorbància de la solució. Aquesta expressió permet descriure la formació de melanina en funció del temps de reacció i obtenir alguns paràmetres importants que defineixen el producte, com el coeficient d'extinció. L’absorbància comença a créixer després d'un període de latència en què es produeixen productes intermedis incolors. El coeficient d'extinció dels productes resultants no és un valor constant, perquè depèn de les condicions de cada experiment. La tirosinasa tingué un menor efecte catalitzador sobre la L-tirosina (primera reacció que catalitza), que sobre L-DOPA (segona reacció).

Blood plasma lipidomic signature of epicardial fat in healthy obese women.

OBJECTIVES: A lipidomic approach was employed in a clinically well-defined cohort of healthy obese women to explore blood lipidome phenotype ascribed to body fat deposition, with emphasis on epicardial adipose tissue (EAT). METHODS: The present investigation delivered a lipidomics signature of epicardial adiposity under healthy clinical conditions using a cohort of 40 obese females (age: 25-45 years, BMI: 28-40 kg/m(2) ) not showing any metabolic disease traits. Lipidomics analysis of blood plasma was employed in combination with in vivo quantitation of mediastinal fat depots by computerized tomography. RESULTS: All cardiac fat depots correlated to indicators of hepatic dysfunctions (ALAT and ASAT), which describe physiological connections between hepatic and cardiac steatosis. Plasma lipidomics encompassed overall levels of lipid classes, fatty acid profiles, and individual lipid species. EAT and visceral fat associated with diacylglycerols (DAG), triglycerides, and distinct phospholipid and sphingolipid species. A pattern of DAG and phosphoglycerols was specific to EAT. CONCLUSIONS: Human blood plasma lipidomics appears to be a promising clinical and potentially diagnostic readout for patient stratification and monitoring. Association of blood lipidomics signature to regio-specific mediastinal and visceral adiposity under healthy clinical conditions may help provide more biological insights into obese patient stratification for cardiovascular disease risks.

Extended bottom-up proteomics with secreted aspartic protease Sap9.

We investigate the benefits and experimental feasibility of approaches enabling the shift from short (1.7kDa on average) peptides in bottom-up proteomics to about twice longer (~3.2kDa on average) peptides in the so-called extended bottom-up proteomics. Candida albicans secreted aspartic protease Sap9 has been selected for evaluation as an extended bottom-up proteomic-grade enzyme due to its suggested dibasic cleavage specificity and ease of production. We report the extensive characterization of Sap9 specificity and selectivity revealing that protein cleavage by Sap9 most often occurs in the vicinity of proximal basic amino acids, and in select cases also at basic and hydrophobic residues. Sap9 is found to cleave a large variety of proteins in a relatively short, ~1h, period of time and it is efficient in a broad pH range, including slightly acidic, e. g., pH5.5, conditions. Importantly, the resulting peptide mixtures contain representative peptides primarily in the target 3-7kDa range. The utility and advantages of this enzyme in routine analysis of protein mixtures are demonstrated and the limitations are discussed. Overall, Sap9 has a potential to become an enzyme of choice in an extended bottom-up proteomics, which is technically ready to complement the traditional bottom-up proteomics for improved targeted protein structural analysis and expanded proteome coverage. BIOLOGICAL SIGNIFICANCE: Advances in biological applications of mass spectrometry-based bottom-up proteomics are oftentimes limited by the extreme complexity of biological samples, e.g., proteomes or protein complexes. One of the reasons for it is in the complexity of the mixtures of enzymatically (most often using trypsin) produced short (<3kDa) peptides, which may exceed the analytical capabilities of liquid chromatography and mass spectrometry. Information on localization of protein modifications may also be affected by the small size of typically produced peptides. On the other hand, advances in high-resolution mass spectrometry and liquid chromatography have created an intriguing opportunity of improving proteome analysis by gradually increasing the size of enzymatically-derived peptides in MS-based bottom-up proteomics. Bioinformatics has already confirmed the envisioned advantages of such approach. The remaining bottle-neck is an enzyme that could produce longer peptides. Here, we report on the characterization of a possible candidate enzyme, Sap9, which may be considered for producing longer, e.g., 3-7kDa, peptides and lead to a development of extended bottom-up proteomics.