Durability of antiretroviral therapy and predictors of virologic failure among perinatally HIV-infected children in Tanzania: a four-year follow-up.

BACKGROUND: In Tanzania, HIV-1 RNA testing is rarely available and not standard of care. Determining virologic failure is challenging and resistance mutations accumulate, thereby compromising second-line therapy. We evaluated durability of antiretroviral therapy (ART) and predictors of virologic failure among a pediatric cohort at four-year follow-up. METHODS: This was a prospective cross-sectional study with retrospective chart review evaluating a perinatally HIV-infected Tanzanian cohort enrolled in 2008-09 with repeat HIV-1 RNA in 2012-13. Demographic, clinical, and laboratory data were extracted from charts, resistance mutations from 2008-9 were analyzed, and prospective HIV RNA was obtained. RESULTS: 161 (78%) participants of the original cohort consented to repeat HIV RNA. The average age was 12.2 years (55% adolescents ≥12 years). Average time on ART was 6.4 years with 41% receiving second-line (protease inhibitor based) therapy. Among those originally suppressed on a first-line (non-nucleoside reverse transcriptase based regimen) 76% remained suppressed. Of those originally failing first-line, 88% were switched to second-line and 72% have suppressed virus. Increased level of viremia and duration of ART trended with an increased number of thymidine analogue mutations (TAMs). Increased TAMs increased the odds of virologic failure (p = 0.18), as did adolescent age (p < 0.01). CONCLUSIONS: After viral load testing in 2008-09 many participants switched to second-line therapy. The majority achieved virologic suppression despite multiple resistance mutations. Though virologic testing would likely hasten the switch to second-line among those failing, methods to improve adherence is critical to maximize durability of ART and improve virologic outcomes among youth in resource-limited settings.

Domain decomposition methods for welding problems

This paper, a 2-D non-linear electric arc-welding problem is considered. It is assumed that the moving arc generates an unknown quantity of energy which makes the problem an inverse problem with an unknown source. Robust algorithms to solve such problems e#ciently, and in certain circumstances in real-time, are of great technological and industrial interest. There are other types of inverse problems which involve inverse determination of heat conductivity or material properties [CDJ63][TE98], inverse problems in material cutting [ILPP98], and retrieval of parameters containing discontinuities [IK90]. As in the metal cutting problem, the temperature of a very hot surface is required and it relies on the use of thermocouples. Here, the solution scheme requires temperature measurements lied in the neighbourhood of the weld line in order to retrieve the unknown heat source. The size of this neighbourhood is not considered in this paper, but rather a domain decomposition concept is presented and an examination of the accuracy of the retrieved source are presented. This paper is organised as follows. The inverse problem is formulated and a method for the source retrieval is presented in the second section. The source retrieval method is based on an extension of the 1-D source retrieval method as proposed in [ILP].

The bactericidal effect of dendritic copper microparticles, contained in an alginate matrix, on Escherichia coli

Although the bactericidal effect of copper has been known for centuries, there is a current resurgence of interest in the use of this element as an antimicrobial agent. During this study the use of dendritic copper microparticles embedded in an alginate matrix as a rapid method for the deactivation of Escherichia coli ATCC 11775 was investigated. The copper/alginate produced a decrease in the minimum inhibitory concentration from free copper powder dispersed in the media from 0.25 to 0.065 mg/ml. Beads loaded with 4% Cu deactivated 99.97% of bacteria after 90 minutes, compared to a 44.2% reduction in viability in the equivalent free copper powder treatment. There was no observed loss in the efficacy of this method with increasing bacterial loading up to 10(6) cells/ml, however only 88.2% of E. coli were deactivated after 90 minutes at a loading of 10(8) cells/ml. The efficacy of this method was highly dependent on the oxygen content of the media, with a 4.01% increase in viable bacteria observed under anoxic conditions compared to a >99% reduction in bacterial viability in oxygen tensions above 50% of saturation. Scanning electron micrographs (SEM) of the beads indicated that the dendritic copper particles sit as discrete clusters within a layered alginate matrix, and that the external surface of the beads has a scale-like appearance with dendritic copper particles extruding. E. coli cells visualised using SEM indicated a loss of cellular integrity upon Cu bead treatment with obvious visible blebbing. This study indicates the use of microscale dendritic particles of Cu embedded in an alginate matrix to effectively deactivate E. coli cells and opens the possibility of their application within effective water treatment processes, especially in high particulate waste streams where conventional methods, such as UV treatment or chlorination, are ineffective or inappropriate.

In vitro release of nonoxynol-9 from silicone matrix intravaginal rings

The controlled-release characteristics of matrix silicone intravaginal rings loaded with between 100 and 971 mg of nonoxynol-9 have been investigated with a view to developing a ring that may offer a new female-controlled method for the prevention of transmission of sexually transmitted diseases, particularly HIV. Intravaginal rings containing 253, 487 and 971 mg of nonoxynol-9 provided a daily release of 2 mg or more over the 8-day release period, the minimal amount of nonoxynol-9 considered to provide an effective vaginal concentration for the prevention of HIV. Furthermore, the maximum daily release of N9 was about 6 mg, an amount significantly smaller than that observed for other nonoxynol-9 products whose large daily doses may in fact increase the occurrence of HIV by causing epithelial damage to the vaginal tissue. The release mechanism of the liquid nonoxynol-9 from the intravaginal rings has also been investigated and compared to models describing the release of solid drugs from the rings. It has been demonstrated through release studies and surface microscopy that a drug depletion zone is not established in such liquid-loaded intravaginal ring systems, with implications for the release kinetics. (C) 2003 Elsevier B.V. All rights reserved.

Children with stable asthma have reduced airway matrix metalloproteinase-9 and matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 ratio

Background Childhood asthma is characterized by inflammation of the airways. Structural changes of the airway wall may also be seen in some children early in the course of the disease. Matrix metalloproteinases (MMPs) are key mediators in the metabolism of the extracellular matrix (ECM). Objective To investigate the balance of MMP-8, MMP-9 and tissue inhibitor of metalloproteinases (TIMP)-1 in the airways of children with asthma. Methods One hundred and twenty-four children undergoing elective surgical procedures also underwent non-bronchoscopic bronchoalveolar lavage (BAL). MMP-8, MMP-9 and TIMP-1 were measured by ELISA. Results There was a significant reduction in MMP-9 in atopic asthmatic children (n=31) compared with normal children (n=30) [median difference: 0.57 ng/mL (95% confidence interval: 0.18–1.1 ng/mL)]. The ratio of MMP-9 to TIMP-1 was also reduced in asthmatic children. Levels of all three proteins were significantly correlated to each other and to the relative proportions of particular inflammatory cells in BAL fluid (BALF). Both MMP-8 and MMP-9 were moderately strongly correlated to the percentage neutrophil count (r=0.40 and 0.47, respectively, P

Alterations in vascular matrix metalloproteinase due to ageing and chronic hypertension: effects of endothelin receptor blockade.

OBJECTIVE: To determine the effects of age and dual endothelin (ET)A/ETB receptor antagonism (bosentan) on aortic matrix metalloproteinase (MMP) abundance and tissue inhibitor of metalloproteinase (TIMP) expression in normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive rats (SHR). METHODS: Male SHR and control WKY rats were randomly assigned to receive placebo or bosentan (100 mg/kg per day) for 3 months. Animals were killed under terminal anaesthesia at either 20 weeks (adult) or 17-20 months (senescent). Aortic gelatinase activity was determined by zymography, whereas MT-1 MMP and TIMP-1 expression were assessed by immunoblotting. RESULTS: In WKY rats, aortic MMP-2 but not proMMP-2 activity was 3.6-fold higher (P <0.02) in the senescent compared with the adult group. TIMP-1 (twofold) and MT-1 MMP (3.8-fold) expression increased (P <0.05) with age in the WKY groups. Short-term hypertension (adult SHR versus adult WKY) increased MMP-2 to 74.7 +/- 14.1 from 18.9 +/- 3.5 arbitrary units (AU) (P = 0.0012), but did not alter proMMP-2 activity. This increased further on progression to chronic hypertension (117.4 +/- 12.2 versus 74.7 +/- 14.1 AU; P <0.02). Bosentan decreased MMP-2 (78.9 +/- 3.8 versus 117.4 +/- 12.2 AU; P = 0.014) and proMMP-2 activity (P <0.006) in the senescent SHR group. CONCLUSION: Ageing and the development/progression of hypertension are associated with increased MMP-2 activity in the aorta, which is consistent with ongoing remodelling of the vasculature. However, the underlying mechanisms regulating MMP-2 abundance in ageing and hypertension appear to be divergent, as MT-1 MMP expression is differentially altered. Dual ETA/ETB receptor antagonism did not alter the age-dependent increase in aortic MMP activity in normotensive rats. However, bosentan decreased pro and active MMP-2 activity in senescent SHR rats, indicating that ET modulates late events in vascular remodelling in hypertension.

A comparison of theoretical line intensity ratios for Ni XII with extreme ultraviolet observations from the JET tokamak

Recent R-matrix calculations of electron impact excitation rates in Ni XII are used to derive the emission line ratios R-1 = I(154.17 Angstrom)/I(152.15 Angstrom), R-2 = I(152.95 Angstrom)/I(152.15 Angstrom) and R-3 = 1(160.55 Angstrom)/I(152.15 Angstrom). This is the first time (to our knowledge) that theoretical emission line ratios have been calculated for this ion. The ratios are found to be insensitive to changes in the adopted electron density (N-e) when N-e greater than or equal to 5 x 10(11) cm(-3), typical of laboratory plasmas. However, they do vary with electron temperature (T-e), with for example R-1 and R-3 changing by factors of 1.3 and 1.8, respectively, between T-e = 10(5) and 10(6) K. A comparison of the theoretical line ratios with measurements from the Joint European Tents (JET) tokamak reveals very good agreement between theory and observation for R-1, with an average discrepancy of only 7%. Agreement between the calculated and experimental ratios for R-2 and R-3 is less satisfactory, with average differences of 30 and 33%, respectively. These probably arise from errors in the JET instrument calibration curve. However, the discrepancies are smaller than the uncertainties in the R-2 and R-3 measurements. Our results, in particular for R-1, provide experimental support for the accuracy of the Ni XIII line ratio calculations, and hence for the atomic data adopted in their derivation.

Emission-line ratios for [N II] in gaseous nebulae and a comparison between theory and observation

R-matrix calculations of electron impact excitation rates among the 2s(2)2p(2) P-3, D-1, S-1, and 2s2p(3) S-5 levels of N II are presented. These results are used in conjunction with other recent calculations of electron impact excitation rates and Einstein A-coefficients for N II to derive the emission-line ratio: ratio diagrams and where (R-1, R-2) (R-1, R-3), where R-1 = I(5756.2 Angstrom)/I(6549.9 + 6585.2 Angstrom), R-2 = I(2143.5 Angstrom)/I(6549.9 + 6585.2 Angstrom), and R-3 = I(2139.7 Angstrom)/I(6549.9 + 658.2 Angstrom), for a range of electron temperatures (T-e = 5000-20,000 K) and electron densities (N-e = 10(2)-10(7) cm(-3)) appropriate to gaseous nebulae. These diagrams should, in principle, allow the simultaneous determination of T-e and N-e from measurements of the [N II] lines in a spectrum. Plasma parameters deduced for a sample of gaseous nebulae, using observational data obtained from ground-based telescopes plus the International Ultraviolet Explorer and Hubble Space Telescope satellites, are found to show generally excellent internal consistency and to be in good agreement with the values of T-e and N-e estimated from other line ratios. These results provide observational support for the accuracy of the theoretical ratios and hence the atomic data adopted in their derivation. Theoretical ratios are also presented for the infrared line pair R-4 = I(122 mum)/I(205 mum), and the usefulness of R-4 as an electron density diagnostic is briefly discussed.

A comparison of theoretical Si VIII emission line ratios with observations from SERTS

Recent R-matrix calculations of electron impact excitation rates in N-like Si VIII are used to derive theoretical emission line intensity ratios involving 2s(2)2p(3)-2s2p(4) transitions in the 216 -320 Angstrom wavelength range. A comparison of these with an extensive dataset of solar active region, quiet- Sun, sub-flare and off-limb observations, obtained during rocket flights of the Solar EUV Research Telescope and Spectrograph (SERTS), indicates that the ratio R-1 = I(216.94 Angstrom)/I(319.84 Angstrom) may provide a usable electron density diagnostic for coronal plasmas. The ratio involves two lines of comparable intensity, and varies by a factor of about 5 over the useful density range of 10(8)-10(11) cm(-3). However R-2 = I(276.85 Angstrom)/I(319.84 Angstrom) and R-3 = I(277.05 Angstrom)/I(319.84 Angstrom) show very poor agreement between theory and observation, due to the severe blending of the 276.85 and 277.05 Angstrom lines with Si VII and Mg VII transitions, respectively, making the ratios unsuitable as density diagnostics. The 314.35 Angstrom feature of Si VIII also appears to be blended, with the other species contributing around 20% to the total line flux.

A comparison of theoretical MgVI emission line strengths with active-region observations from serts

R-matrix calculations of electron impact excitation rates in N-like Mg vi are used to derive theoretical electron-density-sensitive emission line ratios involving 2s(2)2p(3)-2s2p(4) transitions in the 269-403 Angstrom wavelength range. A comparison of these with observations of a solar active region, obtained during the 1989 flight of the Solar EUV Rocket Telescope and Spectrograph (SERTS), reveals good agreement between theory and observation for the 2s(2)2p(3) S-4-2s2p(4) P-4 transitions at 399.28, 400.67, and 403.30 Angstrom, and the 2s(2)2p(3) P-2-2s2p(4) D-2 lines at 387.77 and 387.97 Angstrom. However, intensities for the other lines attributed to Mg vi in this spectrum by various authors do not match the present theoretical predictions. We argue that these discrepancies are not due to errors in the adopted atomic data, as previously suggested, but rather to observational uncertainties or mis-identifications. Some of the features previously identified as Mg vi lines in the SERTS spectrum, such as 291.36 and 293.15 Angstrom, are judged to be noise, while others (including 349.16 Angstrom) appear to be blended.

Electron densities in the coronae of the Sun and Procyon from extreme-ultraviolet emission line ratios in Fe XI

New R-matrix calculations of electron impact excitation rates for Fe XI are used to determine theoretical emission line ratios applicable to solar and stellar coronal observations. These are subsequently compared to solar spectra of the quiet Sun and an active region made by the Solar EUV Rocket Telescope and Spectrograph (SERTS-95), as well as Skylab observations of two flares. Line blending is identified, and electron densities of 10(9.3), 10(9.7), greater than or equal to 10(10.8), and greater than or equal to 10(11.3) cm(-3) are found for the quiet Sun, active region, and the two flares, respectively. Observations of the F5 IV-V star Procyon, made with the Extreme Ultraviolet Explorer (EUVE) satellite, are compared and contrasted with the solar observations. It is confirmed that Procyon's average coronal conditions are very similar to those seen in the quiet Sun, with N-e = 10(9.4) cm(-3). In addition, although the quiet Sun is the closest solar analog to Procyon, we conclude that Procyon's coronal temperatures are slightly hotter than solar. A filling factor of 25(-12)(+38)% was derived for the corona of Procyon.

Transmission Loss Allocation Through Complex Power Flow Tracing

This paper presents a new method for transmission loss allocation. The method is based on tracing the complex power flow through the network and determining the share of each load on the flow and losses through each line. Transmission losses are taken into consideration during power flow tracing. Unbundling line losses is carried out using an equation, which has a physical basis, and considers the coupling between active and reactive power flows as well as the cross effects of active and reactive power on active and reactive losses. A tracing algorithm which can be considered direct to a good extent, as there is no need for exhaustive search to determine the flow paths as these are determined in a systematic way during the course of tracing. Results of application of the proposed method are also presented.

Safety and Pharmacokinetics of Dapivirine Delivery From Matrix and Reservoir Intravaginal Rings to HIV-Negative Women

Vaginal microbicides for the prevention of HIV transmission may be an important option for protecting women from infection. Incorporation of dapivirine, a lead candidate nonnucleoside reverse transcriptase inhibitor, into intravaginal rings (IVRs) for sustained mucosal delivery may increase microbicide product adherence and efficacy compared with conventional vaginal formulations. Twentyfour
healthy HIV-negative women 18–35 years of age were randomly assigned (1:1:1) to dapivirine matrix IVR, dapivirine reservoir IVR, or placebo IVR. Dapivirine concentrations were measured in plasma
and vaginal fluid samples collected at sequential time points over the 33-day study period (28 days of IVR use, 5 days of follow-up). Safety was assessed by pelvic/colposcopic examinations, clinical laboratory tests, and adverse events. Both IVR types were safe and well tolerated with similar adverse events observed in the placebo and dapivirine groups. Dapivirine from both IVR types was successfully distributed throughout the lower genital tract at concentrations over 4 logs greater than the EC50 against wild-type HIV-1 (LAI) in MT4 cells. Maximum concentration (Cmax) and area under the concentration–time curve (AUC) values were significantly higher with the matrix than reservoir IVR. Mean plasma concentrations of dapivirine were ,2 ng/mL. These findings suggest that IVR delivery of microbicides is a viable option meriting further study.

A new Jacobian matrix for optimal learning of single-layer neural networks

This paper investigates the learning of a wide class of single-hidden-layer feedforward neural networks (SLFNs) with two sets of adjustable parameters, i.e., the nonlinear parameters in the hidden nodes and the linear output weights. The main objective is to both speed up the convergence of second-order learning algorithms such as Levenberg-Marquardt (LM), as well as to improve the network performance. This is achieved here by reducing the dimension of the solution space and by introducing a new Jacobian matrix. Unlike conventional supervised learning methods which optimize these two sets of parameters simultaneously, the linear output weights are first converted into dependent parameters, thereby removing the need for their explicit computation. Consequently, the neural network (NN) learning is performed over a solution space of reduced dimension. A new Jacobian matrix is then proposed for use with the popular second-order learning methods in order to achieve a more accurate approximation of the cost function. The efficacy of the proposed method is shown through an analysis of the computational complexity and by presenting simulation results from four different examples.