Once-daily dolutegravir is superior to once-daily darunavir/ritonavir in treatment-naïve HIV-1-positive individuals: 96 week results from FLAMINGO.

INTRODUCTION: Dolutegravir (DTG) 50 mg once daily was superior to darunavir/ritonavir (DRV/r) 800 mg/100 mg once daily through Week 48, with 90% vs. 83% of participants achieving HIV RNA 50 c/mL (p=0.025) [1]. We present data through Week 96. MATERIAL AND METHODS: FLAMINGO is a multicentre, randomized, open-label, Phase IIIb non-inferiority study, in which HIV-1-positive ART-naïve adults with HIV-1 RNA≥1000 c/mL and no evidence of viral resistance were randomized 1:1 to receive DTG or DRV/r, with investigator-selected backbone NRTIs (TDF/FTC or ABC/3TC). Participants were stratified by screening HIV-1 RNA (≤100K c/mL) and NRTI backbone. RESULTS: A total of 484 adults were randomized and treated; 25% had baseline HIV RNA 100K c/mL. At Week 96, the proportion of participants with HIV RNA 50 c/mL was 80% in the DTG arm vs. 68% in the DRV/r arm (adjusted difference 12.4%; 95% CI 4.7, 20.2%; p=0.002). Secondary analyses supported primary results: per-protocol [(DTG 83% vs. DRV/r 70%), 95% CI 12.9 (5.3, 20.6)] and treatment-related discontinuation = failure [(98% vs. 95%), 95% CI 3.2 (-0.3, 6.7)]. Overall virologic non-response (DTG 8%; DRV/r 12%) and non-response due to other reasons (DTG 12%; DRV/r 21%) occurred less frequently on DTG. As at Week 48, the difference between arms was most pronounced in participants with high baseline viral load (82% vs. 52% response through Week 96) and in the TDF/FTC stratum (79% vs. 64%); consistent responses were seen in the ABC/3TC stratum (82% vs. 75%). Six participants (DTG 2, none post-Week 48; DRV/r 4, two post-Week 48) experienced protocol-defined virologic failure (PDVF; confirmed viral load 200 c/mL on or after Week 24); none had treatment-emergent resistance to study drugs. Most frequent drug-related adverse events (AEs) were diarrhoea, nausea and headache, with diarrhoea significantly more common on DRV/r (24%) than DTG (10%). Significantly more participants had Grade 2 fasting LDL toxicities on DRV/r (22%) vs. DTG (7%), p<0.001; mean changes in creatinine for DTG (~0.18 mg/dL) observed at Week 2 were stable through Week 96. CONCLUSIONS: Once-daily DTG was superior to once-daily DRV/r in treatment-naïve HIV-1-positive individuals, with no evidence of emergent resistance to DTG in virologic failure and relatively similar safety profiles for DTG and DRV/r through 96 Weeks.

Análise faunística de afídeos (Hemiptera, Aphididae) na Serra do Mar, Paraná, Brasil

Foram coletados na Serra do Mar, Paraná, 8134 espécimes de afídeos pertencentes a 87 espécies usando armadilhas amarelas de água durante 13 meses em onze locais com um gradiente altitudinal entre 10 m sobre o nível do mar (s.n.m.) e 1000 m s.n.m. A ocorrência e a dominância dos afídeos foram correlacionadas com características ambientais de cada área, principalmente com a altitude, flora local e alterações antrópicas. O número mais elevado de espécimes foi entre 78 m e 555 m s.n.m., sendo a grande maioria das espécies classificada como raras. As espécies consideradas comuns coletadas em todos os locais foram as de hábito polífago e aquelas cujos hospedeiros preferenciais estavam presentes na área, como: Aphis spiraecola, Toxoptera aurantii, Brevicoryne brassicae, Tetraneura nigriabdominalis e Uroleucon ambrosiae. Não foi observada uma relação clara entre os índices faunísticos obtidos com a flora local e a altitude das áreas. As armadilhas colocadas em áreas de transição entre os macro-ambientes de Floresta Ombrófila Densa Atlântica Montana e de Floresta Ombrófila Mista capturaram o maior número de espécies de afídeos.

Combination of diatomaceous earth and powder deltamethrin for insect control in stored corn

The use of diatomaceous earth (DE) is a very efficient insect control measure in stored grain IPM due to its low cost, easy application, reduction of active ingredient residues, lower environmental contamination and operator safety. The objective of this research was to evaluate the efficacy of different dosages of DE mixed with powder deltamethrin for controlling Sitophilus zeamais in stored corn. Samples of 100 g of clean and dry corn, in three replicates, were submitted to the following treatments: DE (Keepdry®), at the dosages of 500, 750 and 1000 g/t; powder deltamethrin (K-Obiol®) at 0,5 g a.i. /t and 1,0 g a.i. /t; and combinations of the lowest and highest DE dosages with the two dosages of deltamethrin. Thirty adults of S. zeamais were placed in each vial with the treated grains and kept in environment chambers at 25ºC. Mortality was evaluated from the 1st to the 28th day. In the treatments mixing DE with deltamethrin or deltamethrin alone, the mortalyti was registered since the first day. In the treatments using only DE, the first dead insects were recorded after the 3rd day, especially in the highest dosages. After the 7th day, however, there was no statistical difference among all treatments, except for the lowest dosage of DE which reached a satisfactory control level only by the 14th day. It was concluded that treatments using DE combined with low dosages of powder deltamethrin represent an efficient control measure against S. zeamais in stored corn because insect mortality is faster than in treatments using DE alone and residues of active ingredients are much lower than using the insecticide in high dosages.

The magmatic to hydrothermal evolution of the intrusive Mont Saint-Hilaire Complex: Insights into the late-stage evolution of peralkaline rocks

The Cretaceous Mont Saint-Hilaire complex (Quebec, Canada) comprises three major rock units that were emplaced in the following sequence: (I) gabbros; (II) diorites; (III) diverse partly agpaitic foid syenites. The major element compositions of the rock-forming minerals, age-corrected Nd and oxygen isotope data for mineral separates and trace element data of Fe-Mg silicates from the various lithologies imply a common source for all units. The distribution of the rare earth elements in clinopyroxene from the gabbros indicates an ocean island basalt type composition for the parental magma. Gabbros record temperatures of 1200 to 800 degrees C, variable silica activities between 0 center dot 7 and 0 center dot 3, and f(O2) values between -0 center dot 5 and +0 center dot 7 (log delta FMQ, where FMQ is fayalite-magnetite-quartz). The diorites crystallized under uniform a(SiO2) (a(SiO2) = 0 center dot 4-0 center dot 5) and more reduced f(O2) conditions (log delta FMQ similar to-1) between similar to 1100 and similar to 800 degrees C. Phase equilibria in various foid syenites indicate that silica activities decrease from 0 center dot 6-0 center dot 3 at similar to 1000 degrees C to < 0 center dot 3 at similar to 550 degrees C. Release of an aqueous fluid during the transition to the hydrothermal stage caused a(SiO2) to drop to very low values, which results from reduced SiO(2) solubilities in aqueous fluids compared with silicate melts. During the hydrothermal stage, high water activities stabilized zeolite-group minerals. Fluid inclusions record a complex post-magmatic history, which includes trapping of an aqueous fluid that unmixed from the restitic foid syenitic magma. Cogenetic aqueous and carbonic fluid inclusions reflect heterogeneous trapping of coexisting immiscible external fluids in the latest evolutionary stage. The O and C isotope characteristics of fluid-inclusion hosted CO(2) and late-stage carbonates imply that the surrounding limestones were the source of the external fluids. The mineral-rich syenitic rocks at Mont Saint-Hilaire evolved as follows: first, alkalis, high field strength and large ion lithophile elements were pre-enriched in the (late) magmatic and subsequent hydrothermal stages; second, percolation of external fluids in equilibrium with the carbonate host-rocks and mixing processes with internal fluids as well as fluid-rock interaction governed dissolution of pre-existing minerals, element transport and precipitation of mineral assemblages determined by locally variable parameters. It is this hydrothermal interplay between internal and external fluids that is responsible for the mineral wealth found at Mont Saint-Hilaire.

An European Organisation for Research and Treatment of Cancer phase I study of lapatinib and docetaxel as neoadjuvant treatment for Human Epidermal Growth Factor Receptor 2 (HER2) positive locally-advanced/inflammatory or large operable breast cancer.

BACKGROUND: Lapatinib is an effective anti-HER2 therapy in advanced breast cancer and docetaxel is one of the most active agents in breast cancer. Combining these agents in pre-treated patients with metastatic disease had previously proved challenging, so the primary objective of this study aimed to determine the maximum tolerated dose (MTD) in treatment-naive patients, by identifying acute dose-limiting toxicities (DLT) during cycle 1 in the first part of a phases 1-2 neoadjuvant European Organisation for Research and Treatment of Cancer (EORTC) trial. PATIENTS AND METHODS: Patients with large operable or locally-advanced HER2 positive breast cancer were treated with continuous lapatinib, and docetaxel every 21days for 4 cycles. Dose levels (DLs) were: 1000/75, 1250/75, 1000/85, 1250/85, 1000/100 and 1250/100 (mg/day)/(mg/m(2)). RESULTS: Twenty-one patients were included. Two DLTs occurred at dose level 5 (1000/100); one grade 4 neutropenia ⩾7days and one febrile neutropenia. A further 3 patients were therefore treated at the same dose with prophylactic granulocyte-colony stimulating factor (G-CSF), and 3 patients at dose level 6. No further DLTs were observed. CONCLUSIONS: Our recommended dose for phase II is lapatinib 1000mg/day and docetaxel 100mg/m(2) with G-CSF in HER2 positive non-metastatic breast cancer. The dose of lapatinib should have been 1250mg/day but we were mindful of the high rate of treatment discontinuation in GeparQuinto with lapatinib 1250mg/day combined with docetaxel. No grade 3-4 diarrhoea was observed. Pharmacodynamics analysis suggests that concomitant medications altering P-glycoprotein activity (in addition to lapatinib) can modify toxicity, including non-haematological toxicities. This needs verification in larger trials, where it may contribute to understanding the sources of variability in clinical toxicity and treatment discontinuation.

Audit report on KCCK-FM Radio, a public telecommunications entity operated by Kirkwood Community College in Cedar Rapids, Iowa for the year ended June 30, 2007

Audit report on KCCK-FM Radio, a public telecommunications entity operated by Kirkwood Community College in Cedar Rapids, Iowa for the year ended June 30, 2007

Audit report on Community Colleges for International Development, Inc., Cedar Rapids, Iowa for the year ended June 30, 2007

Audit report on Community Colleges for International Development, Inc., Cedar Rapids, Iowa for the year ended June 30, 2007

Percutaneous central venous catheterization in premature infants: a method for facilitating insertion of silastic catheters via peripheral veins.

Peripheral venous cannulation is the preferred method of inserting central venous silastic catheters in premature infants. The standard techniques are placement of the catheter using a breakaway introducer needle or introduction of the catheter through a cannula. In extremely low birth weight infants (<1000 g) successful cannulation is impeded by the small size of the vessels. After repeated attempts, both procedures can be time-consuming and stressful to the infant. We present a modified insertion technique of the standard 2-French silastic catheter with an increased success rate, thus reducing insertion time, stress to the infant, and costs. The method uses the tip of a 20-gauge cannula as dilator/introducer for the 2-French catheter. This tip is inserted into the vessel with a standard 24-gauge cannula. After successful insertion of the dilator/introducer cannula, the standard 2-French catheter can then be advanced easily.

1.° Codicis Theodosiani libri sexdecim ; hîc solae occurrunt interpretationes : author hujus breviarii Monachus, qui in prologo testatur se illud opus fuisse aggressum sui Abbatis jussu. — 2.° Theodosii Junioris, Valentiniani III. Martiani, Majoriani et Severi novellae constitutiones. — 3.° Gaii institutionum epitome. — 4.° Julii Pauli sententiarum libri quinque, cum interpretationibus. — 5.° Excerpta ex Codicibus Gregoriano, Hermogeniano et Papianeo : subjicitur ad calcem epitaphium Richardi, Burgundiae Ducis

Colbertinus

historia ecclesiastica gentis Anglorum, libris quinque : authore venerabili Beda, Presbytero ; ad calcem subjicitur scholium Isidori Hispalensis et Gregorii Junioris de consanguinitate.

nuper comparatus

Audit report on Kirkwood Community College in Cedar Rapids, Iowa for the year ended June 30, 2007

Audit report on Kirkwood Community College in Cedar Rapids, Iowa for the year ended June 30, 2007

TRATAMENTO DE EFLUENTES DE TANQUES DE PISCICULTURA APLICANDO A TECNOLOGIA DE ELETROCOAGULAÇÃO

Para a realização deste trabalho, foi utilizada a técnica da eletrocoagulação (EC) para o tratamento de efluente de piscicultura. Um reator de EC em escala de laboratório, com capacidade de 1,5 L foi montado, utilizando um conjunto de quatro placas de eletrodos de alumínio, um agitador mecânico de alto torque microprocessado, fios condutores com garras de jacaré e uma fonte de tensão com potência regulável. Os eletrodos foram arranjados dentro da célula eletrolítica de forma monopolar, em paralelo e a uma distância de 11 mm. O efluente utilizado neste estudo foi coletado em tanques de piscicultura do centro de criação de peixes do Departamento de Engenharia de Pesca da Universidade Federal do Ceará. Para a determinação da melhor condição de operação do reator, foi feito um planejamento experimental por intermédio do Software “Statgrafics”, definindo, as variáveis operacionais e os seus respetivos intervalos de variação (pH inicial de 4 a 8, condutividade de 1000 a 4000 μS cm-1, tempo de eletrolise de 15 a 35 min., agitação de 200 a 600 rpm e corrente de 1 a 2,5 A), que combinadas entre si totalizaram um total de 35 ensaios experimentais. Com base nos resultados obtidos por meio das análises físico-químicas em laboratório, pode-se afirmar que o pH inicial=8, condutividade=1000 μS cm-1, tempo=35 min., agitação=200 rpm e corrente=2,5 A, são as condições ótimas de operação do reator. Nestas condições, alcançaram remoção de 84,95% para DQO, 98,06% para nitrito, 82,43% para nitrato, 98,05% para fósforo total e 95,32% para a turbidez, sendo o custo operacional de 4,59 R$/m3 de efluente tratado. Com base nos resultados obtidos, pode-se concluir que alguns dos parâmetros analisados (pH, turbidez, temperatura, STD, nitrito, nitrato e fósforo total) estão de acordo com os padrões estabelecidos para água doce, classe 2, pela Resolução CONAMA nº 357/05, e de acordo com a Resolução CONAMA nº 430/2011 e a Portaria nº 154/2002 da SEMACE (CE), para lançamento do efluente final nos corpos receptores. A técnica de eletrocoagulação além de ser um método alternativo, eficiente e promissor para tratamento de efluentes de piscicultura, também mostrou ser ecologicamente correto por dispensar o consumo elevado de reagentes, ao contrário do que acontece no tratamento convencional.

Epiphytic lichens as surrogates for biodiversity and ecosystem resilience in native oakwoods of the Baixo Tamega region (Northern Portugal)

In the last 50 years, concern about the loss of lichen diversity associated with forest management and forest fragmentation has led to many studies designed to assess patterns and monitor trends of lichen biodiversity in forests worldwide. However there are surprisingly few studies focusing on the effect of natural disturbance for epiphytic lichens in forest ecosystems and, especially, on how these changes affect the relationships between epiphytic lichens and other organisms. The major goal of this thesis was to characterize and valuate the epiphytic lichens in the Baixo Tamega region (northern Portugal) and to assess its vulnerability to several drivers of change, particularly fire. The study area is located in Aboboreira and Castelo, a mountain area with 105 km2 and a top altitude of approximately 1000 m.a.s.l. In this region, fire is one of the worst natural catastrophes not only because of its high frequency and wide extension but also because of their enormous destructive effects. This thesis has included three case studies that proved the need to develop management and conservation actions for the area. In the first study we assessed the epiphytic lichen diversity in the oak woods of the Aboboreira and Castelo mountains. Results have revealed high diversity value and presence of a lichen community that has suffered general decline throughout Europe. The second study has addressed the impact of fire over epiphytic lichens and community recovering patterns. Results observed along the fire gradient showed that the most common and abundant lichen species establish themselves early in post-fire gradient while “old-growth” associated lichens tend to recover slowly along the same gradient. The third study intended to evaluate the potential use of selected lichen species or groups as biodiversity surrogates, in a scenario of fire-controlled ecological changes. Results showed that the use of epiphytic lichens as surrogates of bryophyte and vascular plant diversity should consider not only species richeness and composition, but also occurrence of disturbing factors, such fire. among the studied groups, lichen genera is the only group that can be used as surrogate of total epiphytic lichen diversity, independently of fire induced changes

Tulo- ja omaisuusvero, 2K

Puhe

Troubles emotionnels en médecine de famille ou le visage caché d'une souffrance [Mental disorders in primary care].

Mental disorders (depression, anxiety and somatization) are frequent in Primary care and are often associated to physical complaints and to psychosocial stressors. Mental disorders have in this way a specific presentation and in addition patients may present different associations of them. Sometimes it is difficult to recognize them, but it is important to do so and to take rapidly care of these patients. Specific screening questions exist and have been used in a research of the Institute of General Medicine and the Department of Ambulatory Care and Community Medicine (PMU), University of Lausanne, Switzerland.