Monitoring and Switching of First-line Antiretroviral Therapy in sub-Saharan Africa: Collaborative Analysis of Adult Treatment Cohorts.

BACKGROUND HIV-1 viral load (VL) testing is recommended to monitor antiretroviral therapy (ART) but not universally available. We examined monitoring of first-line and switching to second-line ART in sub-Saharan Africa, 2004-2013. METHODS Adult HIV-1 infected patients starting combination ART in 16 countries were included. Switching was defined as a change from a non-nucleoside reverse-transcriptase inhibitor (NNRTI)-based regimen to a protease inhibitor (PI)-based regimen, with a change of ≥1 NRTI. Virological and immunological failures were defined per World Health Organization criteria. We calculated cumulative probabilities of switching and hazard ratios with 95% confidence intervals (CI) comparing routine VL monitoring, targeted VL monitoring, CD4 cell monitoring and clinical monitoring, adjusted for programme and individual characteristics. FINDINGS Of 297,825 eligible patients, 10,352 patients (3·5%) switched during 782,412 person-years of follow-up. Compared to CD4 monitoring hazard ratios for switching were 3·15 (95% CI 2·92-3·40) for routine VL, 1·21 (1·13-1·30) for targeted VL and 0·49 (0·43-0·56) for clinical monitoring. Overall 58.0% of patients with confirmed virological and 19·3% of patients with confirmed immunological failure switched within 2 years. Among patients who switched the percentage with evidence of treatment failure based on a single CD4 or VL measurement ranged from 32·1% with clinical to 84.3% with targeted VL monitoring. Median CD4 counts at switching were 215 cells/µl under routine VL monitoring but lower with other monitoring (114-133 cells/µl). INTERPRETATION Overall few patients switched to second-line ART and switching occurred late in the absence of routine viral load monitoring. Switching was more common and occurred earlier with targeted or routine viral load testing.

Vapnikite Ca<SUB>3SUB>UO<SUB>6SUB> – a new double-perovskite mineral from pyrometamorphic larnite rocks of the Jabel Harmun, Palestinian Autonomy, Israel

The new mineral species vapnikite, Ca3UO6, was found in larnite pyrometamorphic rocks of the Hatrurim Formation at Jabel Harmun in the Judean desert, Palestinian Autonomy, Israel. Vapnikite is an analogue of the synthetic ordered double-perovskite β-Ca3UO6 and is isostructural with the natural fluorperovskite – cryolite Na3AlF6. Vapnikite Ca3UO6 (P21/n,Z = 2, a = 5.739(1), b = 5.951(1), c = 8.312(1) Å, β = 90.4(1)°, V = 283.9(1) Å3) forms yellow-brown xenomorphic grains with a strong vitreous lustre. Small grains up to 20 – 30 m m in size are wedged between larnite, brownmillerite and ye'elimite. Vapnikite has irregular fracture, cleavage and parting were not observed. The calculated density is 5.322 g cm–3, the microhardness is VHN25 = 534 kg mm–2 (mean of seven measurements) corresponding to the hardness of ~5 on the Mohs scale. The crystal structure of vapnikite Ca3UO6 differs from that of its synthetic analogue β-Ca3UO6 by having a larger degree of Ca, U disorder. Vapnikite formed at the high-temperature retrograde stage of pyrometamorphism when larnite rocks were altered by fluids/melts of high alkalinity.

Shaping the PSF to nearly top-hat profile: CHEOPS laboratory results

Spreading the PSF over a quite large amount of pixels is an increasingly used observing technique in order to reach extremely precise photometry, such as in the case of exoplanets searching and characterization via transits observations. A PSF top-hat profile helps to minimize the errors contribution due to the uncertainty on the knowledge of the detector flat field. This work has been carried out during the recent design study in the framework of the ESA small mission CHEOPS. Because of lack of perfect flat-fielding information, in the CHEOPS optics it is required to spread the light of a source into a well defined angular area, in a manner as uniform as possible. Furthermore this should be accomplished still retaining the features of a true focal plane onto the detector. In this way, for instance, the angular displacement on the focal plane is fully retained and in case of several stars in a field these look as separated as their distance is larger than the spreading size. An obvious way is to apply a defocus, while the presence of an intermediate pupil plane in the Back End Optics makes attractive to introduce here an optical device that is able to spread the light in a well defined manner, still retaining the direction of the chief ray hitting it. This can be accomplished through an holographic diffuser or through a lenslet array. Both techniques implement the concept of segmenting the pupil into several sub-zones where light is spread to a well defined angle. We present experimental results on how to deliver such PSF profile by mean of holographic diffuser and lenslet array. Both the devices are located in an intermediate pupil plane of a properly scaled laboratory setup mimicking the CHEOPS optical design configuration. © (2014) COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE). Downloading of the abstract is permitted for personal use only.

Guarantie-Schein von acht gesessenen Bürgerlichen Deputirten, die Einkünffte der Stadt auff hundert tausend Gülden jährlichen Einkünfften, auff den Fuß, wie sie Magistratus bißher erhebt, gleich in primo anno weiter und hernach viel höher zuverrechnen : In Causa Commissionis Impetrantischer Bürgerschafft der Kayserl. Freyen Reichs- auch Wahl- und Crönungs-Stadt Franckfurth Contra E. E. Rath allda ; Ihro Röm. Kayserl. Majestät benebenst einem allerunterthänigsten Memorial sub lit. B originaliter ... den 28. Jan. 1715 ... überreicht

[David Düring, Peter Bischoff, Johannes Klotz, Johann Conrad Siegling, Paul Hennrici, David Klotz, Joh. Dietrich Notebohm, Joachim Hoppe] [[Elektronische Ressource]]

Allerunterthänigst-gründliche Gegen-Information Und Exceptiones Sub- & Obreptionis : An Die Römis. Kayserl. ... Majestät ... Auff das am 12. May nup. und 19. currentis mensis erlassene Kayserl. Rescript, Juncta Petitione Humillima Pro Clementissima cassatione ejusdem ... ; In Sachen Judenschafft zu Franckfurth am Mayn Contrà Den Magistrat daselbsten ; Bey höchst-preyßlichen Reichs-Hof-Rath Den 23. Julii 1714 übergeben ; Mit Beylagen A, B, C & D ; Das Bau-Weesen betreffend

Burgerschafftl. Abgeordneter [Johann Dieterich Notebohm ; Joachim Hoppe] [[Elektronische Ressource]]

Upper Ewaso Ngiro River Basin Sub-Catchments Directory

Maps: Information on water resources and their uses (technical, legal, etc. issues)

Possible involvement of plant ABC transporters in cadmium detoxification: a cDNA sub-microarray approach

As a nontolerant plant to a large number of toxic compounds, Arabidopsis thaliana is a suitable model to study regulation of genes involved in response to heavy metals. Using a cDNA-microarray approach, we identified some ABC transporters that are differentially regulated after cadmium treatments, making them putative candidates for being involved in Cd sequestration and redistribution in plants. Regarding yeast and fission yeast, in which Cd is able to form complexes either with glutathione (GSH) or phytochelatins (PC) subsequently transported into vacuoles via ABC transporters, it is also very likely that some plant ABC transporters are able to transport GS2–Cd or PC–Cd complexes into subcellular compartments or outside of the cell. The characterization of such transporters is of great interest for developing molecular biology approaches in phytoremediation.

Low Risk of Death, but Substantial Program Attrition, in Pediatric HIV Treatment Cohorts in Sub-Saharan Africa

BACKGROUND: To date, an estimated 10% of children eligible for antiretroviral treatment (ART) receive it, and the frequency of retention in programs is unknown. We evaluated the 2-year risks of death and loss to follow-up (LTFU) of children after ART initiation in a multicenter study in sub-Saharan Africa. METHODS: Pooled analysis of routine individual data from 16 participating clinics produced overall Kaplan-Meier estimates of the probabilities of death or LTFU after ART initiation. Risk factors analysis used Weibull regression, accounting for between-cohort heterogeneity. RESULTS: The median age of 2405 children at ART initiation was 4.9 years (12%, younger than 12 months), 52% were male, 70% had severe immunodeficiency, and 59% started ART with a nonnucleoside reverse transcriptase inhibitor. The 2-year risk of death after ART initiation was 6.9% (95% confidence interval [CI]: 5.9 to 8.1), independently associated with baseline severe anemia (adjusted hazard ratio [aHR]: 4.10 [CI: 2.36 to 7.13]), immunodeficiency (adjusted aHR: 2.95 [CI: 1.49 to 5.82]), and severe clinical status (adjusted aHR: 3.64 [CI: 1.95 to 6.81]); the 2-year risk of LTFU was 10.3% (CI: 8.9 to 11.9), higher in children with severe clinical status. CONCLUSIONS: Once on treatment, the 2-year risk of death is low but the LTFU risk is substantial. ART is still mainly initiated at advanced disease stage in African children, reinforcing the need for early HIV diagnosis, early initiation of ART, and procedures to increase program retention.