Loss to follow-up of HIV-infected women after delivery: The Swiss HIV Cohort Study and the Swiss Mother and Child HIV Cohort Study.

INTRODUCTION HIV-infected pregnant women are very likely to engage in HIV medical care to prevent transmission of HIV to their newborn. After delivery, however, childcare and competing commitments might lead to disengagement from HIV care. The aim of this study was to quantify loss to follow-up (LTFU) from HIV care after delivery and to identify risk factors for LTFU. METHODS We used data on 719 pregnancies within the Swiss HIV Cohort Study from 1996 to 2012 and with information on follow-up visits available. Two LTFU events were defined: no clinical visit for >180 days and no visit for >360 days in the year after delivery. Logistic regression analysis was used to identify risk factors for a LTFU event after delivery. RESULTS Median maternal age at delivery was 32 years (IQR 28-36), 357 (49%) women were black, 280 (39%) white, 56 (8%) Asian and 4% other ethnicities. One hundred and seven (15%) women reported any history of IDU. The majority (524, 73%) of women received their HIV diagnosis before pregnancy, most of those (413, 79%) had lived with diagnosed HIV longer than three years and two-thirds (342, 65%) were already on antiretroviral therapy (ART) at time of conception. Of the 181 women diagnosed during pregnancy by a screening test, 80 (44%) were diagnosed in the first trimester, 67 (37%) in the second and 34 (19%) in the third trimester. Of 357 (69%) women who had been seen in HIV medical care during three months before conception, 93% achieved an undetectable HIV viral load (VL) at delivery. Of 62 (12%) women with the last medical visit more than six months before conception, only 72% achieved an undetectable VL (p=0.001). Overall, 247 (34%) women were LTFU over 180 days in the year after delivery and 86 (12%) women were LTFU over 360 days with 43 (50%) of those women returning. Being LTFU for 180 days was significantly associated with history of intravenous drug use (aOR 1.73, 95% CI 1.09-2.77, p=0.021) and not achieving an undetectable VL at delivery (aOR 1.79, 95% CI 1.03-3.11, p=0.040) after adjusting for maternal age, ethnicity, time of HIV diagnosis and being on ART at conception. CONCLUSIONS Women with a history of IDU and women with a detectable VL at delivery were more likely to be LTFU after delivery. This is of concern regarding their own health, as well as risk for sexual partners and subsequent pregnancies. Further strategies should be developed to enhance retention in medical care beyond pregnancy.

Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature

PURPOSE Thoracoscopic sympathetic surgery is nowadays a broadly accepted technique in the treatment of primary hyperhidrosis as well as facial blushing. The objective of this study was to compare the two currently most commonly used methods for thoracic sympathicotomy: transection (ETS) and clipping (ETC.). METHODS This is a retrospective study on a total of 63 patients, who underwent rib-oriented sympathicotomy, either by transection (n = 36, 57 %) or by clipping (n = 27, 43 %). Moreover, the up-to-date international literature is reviewed concerning which level(s) of the sympathetic trunk should be addressed, depending on the patients underlying condition. Furthermore, the highly controversial topic of reversibility of sympathetic clipping is debated. RESULTS Our results confirm that clipping is at least as effective as transection of the sympathetic chain in the treatment of hyperhidrosis and facial blushing. Furthermore, the analysis of all larger studies on unclipping in humans shows a surprisingly high reported reversal rate between 48 and 77 %. CONCLUSIONS Depending on the symptoms of the patient, different levels of the sympathetic chain should be addressed. When a higher rib level such as R2 is approached, which more likely will result in moderate to severe compensatory sweating, clipping should be preferred as it seems that this technique has indeed a potential for reversibility. As demonstrated, this method is at least as effective as an irreversible transection of the sympathetic chain.

Functionally Optimized Neuritogenic Farinosone C Analogs: SAR-Study and Investigations on Their Mode of Action

Several natural products derived from entomopathogenic fungi have been shown to initiate neuronal differentiation in the rat pheochromocytoma PC12 cell line. After the successful completion of the total synthesis program, the reduction of structural complexity while retaining biological activity was targeted. In this study, farinosone C served as a lead structure and inspired the preparation of small molecules with reduced complexity, of which several were able to induce neurite outgrowth. This allowed for the elaboration of a detailed structure-activity relationship. Investigations on the mode of action utilizing a computational similarity ensemble approach suggested the involvement of the endocannabinoid system as potential target for our analogs and also led to the discovery of four potent new endocannabinoid transport inhibitors.

Time-order errors and standard-position effects in duration discrimination: An experimental study and an analysis by the sensation-weighting model

Studies have shown that the discriminability of successive time intervals depends on the presentation order of the standard (St) and the comparison (Co) stimuli. Also, this order affects the point of subjective equality. The first effect is here called the standard-position effect (SPE); the latter is known as the time-order error. In the present study, we investigated how these two effects vary across interval types and standard durations, using Hellström’s sensation-weighting model to describe the results and relate them to stimulus comparison mechanisms. In Experiment 1, four modes of interval presentation were used, factorially combining interval type (filled, empty) and sensory modality (auditory, visual). For each mode, two presentation orders (St–Co, Co–St) and two standard durations (100 ms, 1,000 ms) were used; half of the participants received correctness feedback, and half of them did not. The interstimulus interval was 900 ms. The SPEs were negative (i.e., a smaller difference limen for St–Co than for Co–St), except for the filled-auditory and empty-visual 100-ms standards, for which a positive effect was obtained. In Experiment 2, duration discrimination was investigated for filled auditory intervals with four standards between 100 and 1,000 ms, an interstimulus interval of 900 ms, and no feedback. Standard duration interacted with presentation order, here yielding SPEs that were negative for standards of 100 and 1,000 ms, but positive for 215 and 464 ms. Our findings indicate that the SPE can be positive as well as negative, depending on the interval type and standard duration, reflecting the relative weighting of the stimulus information, as is described by the sensation-weighting model.

Coherence and Historical understanding in children's Biography and Historical Nonfiction Literature: A Content Analysis of Selected Orbis Pictus Books

The purpose of this study was to investigate a selection of children's historical nonfiction literature for evidence of coherence. Although research has been conducted on coherence of textbook material and its influences on comprehension there has been limited study on coherence in children's nonfiction literature. Generally, textual coherence has been seen as critical in the comprehensibility of content area textbooks because it concerns the unity of connections among ideas and information. Disciplinary coherence concerns the extent to which authors of historical text show readers how historians think and write. Since young readers are apprentices in learning historical content and conventions of historical thinking, evidence of disciplinary coherence is significant in nonfiction literature for young readers. The sample of the study contained 32 books published between 1989 and 2000 ranging in length from less than 90 pages to more than 150 pages. Content analysis was the quantitative research technique used to measure 84 variables of textual and disciplinary coherence in three passages of each book, as proportions of the total number of words for each book. Reliability analyses and an examination of 750 correlations showed the extent to which variables were related in the books. Three important findings emerged from the study that should be considered in the selection and use of children's historical nonfiction literature in classrooms. First, characteristics of coherence are significantly related together in high quality nonfiction literature. Second, shorter books have a higher proportion of textual coherence than longer books as measured in three passages. Third, presence of the author is related to characteristics of coherence throughout the books. The findings show that nonfiction literature offers students content that researchers have found textbooks lack. Both younger and older students have the opportunity to learn the conventions of historical thinking as they learn content through nonfiction literature. Further, the children's literature, represented in the Orbis Pictus list, shows students that authors select, interpret, and question information, and give other interpretations. The implications of the study for teaching history, teacher preparation in content and literacy, school practices, children's librarians, and publishers of children's nonfiction are discussed.

Growth of the Firm and Economic Backwardness: A Case Study and Analysis of China's Mobile Handset Industry

Economic backwardness often influences the growth of firms in developing countries. In this paper, we investigate the growth conditions and paths available for latecomers competing with first movers. Employing the concepts of boundaries of the firm and the disadvantage of backwardness, we present a case study of China's mobile handset industry and proceed to develop a simple model. We find that although significant disadvantage does not allow latecomers to grow, there are possibilities for changing the conditions of growth if latecomers can utilize outside resources and/or indigenous advantages.

Preliminary Study and Proposal for Restoring a Jesuit College at Saragossa, Spain

A historical study and a construction pathology survey were conducted prior to proposing a solution for restoring the upper windows on the south side of Old San Carlos College at Saragossa (16th-17th centuries), wich had been forteited to add a third storey to the cloister. Althought initially designed to a simple large hall format, the church is a harmonius blend of Aragonese Gothic architecture and typical Jesuit scheme, consisting in a central nave flanket by chapel-confessional and raised galleries for the community. A subsequent enlargement of the roof, wich rests on the original framing over the central nave, reduced the mechanical strength of the principal rafters on the opposite side, prompting a concomitant imbalance of forces that has affected the entire structure. In view of the foregoing, in addition to restituting the upper window, the proposal solution envisages restoring the roof over the central nave to its original design, and with the interior lighting in the church.

Comparison of V2IC control with voltage mode and current mode controls for high frequency (MHz) and very fast response applications

High switching frequencies (several MHz) allow the integration of low power DC/DC converters. Although, in theory, a high switching frequency would make possible to implement a conventional Voltage Mode control (VMC) or Peak Current Mode control (PCMC) with very high bandwidth, in practice, parasitic effects and robustness limits the applicability of these control techniques. This paper compares VMC and CMC techniques with the V2IC control. This control is based on two loops. The fast internal loop has information of the output capacitor current and the error voltage, providing fast dynamic response under load and voltage reference steps, while the slow external voltage loop provides accurate steady state regulation. This paper shows the fast dynamic response of the V2IC control under load and output voltage reference steps and its robustness operating with additional output capacitors added by the customer.

Analysis and optimized design of a distributed multi-stage EMC filter for an interleaved three-phase PWM-rectifier system for aircraft applications

Different possible input filter configurations for a modular three-phase PWM rectifier system consisting of three interleaved converter cells are studied. The system is designed for an aircraft application where MIL-STD-461E conducted EMI standards have to be met and system weight is a critical design issue. The importance of a LISN model on the simulated noise levels and the effect of interleaving and power unbalance between the different converter modules is discussed. The effect of the number of filter stages and the degree of distribution of the filter stages among the individual converter modules on the weight and losses of the input filter is studied and optimal filter structures are proposed.

VentanaTM power train features and performance

Most CPV systems are based on Fresnel lenses. Among these, LPI-patented Fresnel-Köhler (FK) concentrator outstands owing to performance and practical reasons. The VentanaTM power train is the first off-the-shelf commercial product based on the FK and comprises both the primary (POE) lenses (a 36-units 1×1 m2 acrylic panel manufactured by EVONIK and 10×) and glass (or Savosil) secondary optics (SOE). This high concentration optical train (Cg=1,024×, ~250mm optical depth) fits with 5×5 mm2 (at least) solar cells. The optical train is the fruit of a 1-year development that has included design, modeling, prototyping and characterization, and through the process LPI had the opportunity to find out how well the actual performance correlates with models, but also learned practical aspects of a CPV system of this kind, some of which have very positive impact on system performance and reliability.

Simplified small-signal stability analysis for optimized power system architecture

The optimization of power architectures is a complex problem due to the plethora of different ways to connect various system components. This issue has been addressed by developing a methodology to design and optimize power architectures in terms of the most fundamental system features: size, cost and efficiency. The process assumes various simplifications regarding the utilized DC/DC converter models in order to prevent the simulation time to become excessive and, therefore, stability is not considered. The objective of this paper is to present a simplified method to analyze small-signal stability of a system in order to integrate it into the optimization methodology. A black-box modeling approach, applicable to commercial converters with unknown topology and components, is based on frequency response measurements enabling the system small-signal stability assessment. The applicability of passivity-based stability criterion is assessed. The stability margins are stated utilizing a concept of maximum peak criteria derived from the behavior of the impedance-based sensitivity function that provides a single number to state the robustness of the stability of a well-defined minor-loop gain.

Design and Multi-Objective Optimization of EMI Input Filters

An EMI filter design procedure for power converters is proposed. Based on a given noise spectrum, information about the converter noise source impedance and design constraints, the design space of the input filter is defined. The design is based on component databases and detailed models of the filter components, including high frequency parasitics, losses, weight, volume, etc.. The design space is mapped onto a performance space in which different filter implementations are evaluated and compared. A multi-objective optimization approach is used to obtain optimal designs w.r.t. a given performance function.