Switching from tenofovir disoproxil fumarate to tenofovir alafenamide in antiretroviral regimens for virologically suppressed adults with HIV-1 infection: a randomised, active-controlled, multicentre, open-label, phase 3, non-inferiority study.

BACKGROUND: Antiretroviral regimens containing tenofovir disoproxil fumarate have been associated with renal toxicity and reduced bone mineral density. Tenofovir alafenamide is a novel tenofovir prodrug that reduces tenofovir plasma concentrations by 90%, thereby decreasing off-target side-effects. We aimed to assess whether efficacy, safety, and tolerability were non-inferior in patients switched to a regimen containing tenofovir alafenamide versus in those remaining on one containing tenofovir disoproxil fumarate. METHODS: In this randomised, actively controlled, multicentre, open-label, non-inferiority trial, we recruited HIV-1-infected adults from Gilead clinical studies at 168 sites in 19 countries. Patients were virologically suppressed (HIV-1 RNA <50 copies per mL) with an estimated glomerular filtration rate of 50 mL per min or greater, and were taking one of four tenofovir disoproxil fumarate-containing regimens for at least 96 weeks before enrolment. With use of a third-party computer-generated sequence, patients were randomly assigned (2:1) to receive a once-a-day single-tablet containing elvitegravir 150 mg, cobicistat 150 mg, emtricitabine 200 mg, and tenofovir alafenamide 10 mg (tenofovir alafenamide group) or to carry on taking one of four previous tenofovir disoproxil fumarate-containing regimens (tenofovir disoproxil fumarate group) for 96 weeks. Randomisation was stratified by previous treatment regimen in blocks of six. Patients and treating physicians were not masked to the assigned study regimen; outcome assessors were masked until database lock. The primary endpoint was the proportion of patients who received at least one dose of study drug who had undetectable viral load (HIV-1 RNA <50 copies per mL) at week 48. The non-inferiority margin was 12%. This study was registered with ClinicalTrials.gov, number NCT01815736. FINDINGS: Between April 12, 2013 and April 3, 2014, we enrolled 1443 patients. 959 patients were randomly assigned to the tenofovir alafenamide group and 477 to the tenofovir disoproxil fumarate group. Viral suppression at week 48 was noted in 932 (97%) patients assigned to the tenofovir alafenamide group and in 444 (93%) assigned to the tenofovir disoproxil fumarate group (adjusted difference 4·1%, 95% CI 1·6-6·7), with virological failure noted in ten and six patients, respectively. The number of adverse events was similar between the two groups, but study drug-related adverse events were more common in the tenofovir alafenamide group (204 patients [21%] vs 76 [16%]). Hip and spine bone mineral density and glomerular filtration were each significantly improved in patients in the tenofovir alafenamide group compared with those in the tenofovir disoproxil fumarate group. INTERPRETATION: Switching to a tenofovir alafenamide-containing regimen from one containing tenofovir disoproxil fumarate was non-inferior for maintenance of viral suppression and led to improved bone mineral density and renal function. Longer term follow-up is needed to better understand the clinical impact of these changes. FUNDING: Gilead Sciences.

Safety and immunogenicity of a chimpanzee adenovirus-vectored Ebola vaccine in healthy adults: a randomised, double-blind, placebo-controlled, dose-finding, phase 1/2a study.

BACKGROUND: The ongoing Ebola outbreak led to accelerated efforts to test vaccine candidates. On the basis of a request by WHO, we aimed to assess the safety and immunogenicity of the monovalent, recombinant, chimpanzee adenovirus type-3 vector-based Ebola Zaire vaccine (ChAd3-EBO-Z). METHODS: We did this randomised, double-blind, placebo-controlled, dose-finding, phase 1/2a trial at the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Participants (aged 18-65 years) were randomly assigned (2:2:1), via two computer-generated randomisation lists for individuals potentially deployed in endemic areas and those not deployed, to receive a single intramuscular dose of high-dose vaccine (5 × 10(10) viral particles), low-dose vaccine (2·5 × 10(10) viral particles), or placebo. Deployed participants were allocated to only the vaccine groups. Group allocation was concealed from non-deployed participants, investigators, and outcome assessors. The safety evaluation was not masked for potentially deployed participants, who were therefore not included in the safety analysis for comparison between the vaccine doses and placebo, but were pooled with the non-deployed group to compare immunogenicity. The main objectives were safety and immunogenicity of ChAd3-EBO-Z. We did analysis by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT02289027. FINDINGS: Between Oct 24, 2014, and June 22, 2015, we randomly assigned 120 participants, of whom 18 (15%) were potentially deployed and 102 (85%) were non-deployed, to receive high-dose vaccine (n=49), low-dose vaccine (n=51), or placebo (n=20). Participants were followed up for 6 months. No vaccine-related serious adverse events were reported. We recorded local adverse events in 30 (75%) of 40 participants in the high-dose group, 33 (79%) of 42 participants in the low-dose group, and five (25%) of 20 participants in the placebo group. Fatigue or malaise was the most common systemic adverse event, reported in 25 (62%) participants in the high-dose group, 25 (60%) participants in the low-dose group, and five (25%) participants in the placebo group, followed by headache, reported in 23 (57%), 25 (60%), and three (15%) participants, respectively. Fever occurred 24 h after injection in 12 (30%) participants in the high-dose group and 11 (26%) participants in the low-dose group versus one (5%) participant in the placebo group. Geometric mean concentrations of IgG antibodies against Ebola glycoprotein peaked on day 28 at 51 μg/mL (95% CI 41·1-63·3) in the high-dose group, 44·9 μg/mL (25·8-56·3) in the low-dose group, and 5·2 μg/mL (3·5-7·6) in the placebo group, with respective response rates of 96% (95% CI 85·7-99·5), 96% (86·5-99·5), and 5% (0·1-24·9). Geometric mean concentrations decreased by day 180 to 25·5 μg/mL (95% CI 20·6-31·5) in the high-dose group, 22·1 μg/mL (19·3-28·6) in the low-dose group, and 3·2 μg/mL (2·4-4·9) in the placebo group. 28 (57%) participants given high-dose vaccine and 31 (61%) participants given low-dose vaccine developed glycoprotein-specific CD4 cell responses, and 33 (67%) and 35 (69%), respectively, developed CD8 responses. INTERPRETATION: ChAd3-EBO-Z was safe and well tolerated, although mild to moderate systemic adverse events were common. A single dose was immunogenic in almost all vaccine recipients. Antibody responses were still significantly present at 6 months. There was no significant difference between doses for safety and immunogenicity outcomes. This acceptable safety profile provides a reliable basis to proceed with phase 2 and phase 3 efficacy trials in Africa. FUNDING: Swiss State Secretariat for Education, Research and Innovation (SERI), through the EU Horizon 2020 Research and Innovation Programme.

Combined dielectrophoretic and impedance system for on-chip controlled bacteria concentration: Application to Escherichia coli

The present paper reports a bacteria autonomous controlled concentrator prototype with a user-friendly interface for bench-top applications. It is based on a micro-fluidic lab-on-a-chip and its associated custom instrumentation, which consists in a dielectrophoretic actuator, to pre-concentrate the sample, and an impedance analyser, to measure concentrated bacteria levels. The system is composed by a single micro-fluidic chamber with interdigitated electrodes and a instrumentation with custom electronics. The prototype is supported by a real-time platform connected to a remote computer, which automatically controls the system and displays impedance data used to monitor the status of bacteria accumulation on-chip. The system automates the whole concentrating operation. Performance has been studied for controlled volumes of Escherichia coli (E. coli) samples injected into the micro-fluidic chip at constant flow rate of 10 μL/min. A media conductivity correcting protocol has been developed, as the preliminary results showed distortion of the impedance analyser measurement produced by bacterial media conductivity variations through time. With the correcting protocol, the measured impedance values were related to the quantity of bacteria concentrated with a correlation of 0.988 and a coefficient of variation of 3.1%. Feasibility of E. coli on-chip automated concentration, using the miniaturized system, has been demonstrated. Furthermore, the impedance monitoring protocol had been adjusted and optimized, to handle changes in the electrical properties of the bacteria media over time.

A brain-computer interface for navigation in virtual reality

L'interface cerveau-ordinateur (ICO) décode les signaux électriques du cerveau requise par l’électroencéphalographie et transforme ces signaux en commande pour contrôler un appareil ou un logiciel. Un nombre limité de tâches mentales ont été détectés et classifier par différents groupes de recherche. D’autres types de contrôle, par exemple l’exécution d'un mouvement du pied, réel ou imaginaire, peut modifier les ondes cérébrales du cortex moteur. Nous avons utilisé un ICO pour déterminer si nous pouvions faire une classification entre la navigation de type marche avant et arrière, en temps réel et en temps différé, en utilisant différentes méthodes. Dix personnes en bonne santé ont participé à l’expérience sur les ICO dans un tunnel virtuel. L’expérience fut a était divisé en deux séances (48 min chaque). Chaque séance comprenait 320 essais. On a demandé au sujets d’imaginer un déplacement avant ou arrière dans le tunnel virtuel de façon aléatoire d’après une commande écrite sur l'écran. Les essais ont été menés avec feedback. Trois électrodes ont été montées sur le scalp, vis-à-vis du cortex moteur. Durant la 1re séance, la classification des deux taches (navigation avant et arrière) a été réalisée par les méthodes de puissance de bande, de représentation temporel-fréquence, des modèles autorégressifs et des rapports d’asymétrie du rythme β avec classificateurs d’analyse discriminante linéaire et SVM. Les seuils ont été calculés en temps différé pour former des signaux de contrôle qui ont été utilisés en temps réel durant la 2e séance afin d’initier, par les ondes cérébrales de l'utilisateur, le déplacement du tunnel virtuel dans le sens demandé. Après 96 min d'entrainement, la méthode « online biofeedback » de la puissance de bande a atteint une précision de classification moyenne de 76 %, et la classification en temps différé avec les rapports d’asymétrie et puissance de bande, a atteint une précision de classification d’environ 80 %.

Video-based postural sway analysis in a controlled environment

À mesure que la population des personnes agées dans les pays industrialisés augmente au fil de années, les ressources nécessaires au maintien du niveau de vie de ces personnes augmentent aussi. Des statistiques montrent que les chutes sont l’une des principales causes d’hospitalisation chez les personnes agées, et, de plus, il a été démontré que le risque de chute d’une personne agée a une correlation avec sa capacité de maintien de l’équilibre en étant debout. Il est donc d’intérêt de développer un système automatisé pour analyser l’équilibre chez une personne, comme moyen d’évaluation objective. Dans cette étude, nous avons proposé l’implémentation d’un tel système. En se basant sur une installation simple contenant une seule caméra sur un trépied, on a développé un algorithme utilisant une implémentation de la méthode de détection d’objet de Viola-Jones, ainsi qu’un appariement de gabarit, pour suivre autant le mouvement latéral que celui antérieur-postérieur d’un sujet. On a obtenu des bons résultats avec les deux types de suivi, cependant l’algorithme est sensible aux conditions d’éclairage, ainsi qu’à toute source de bruit présent dans les images. Il y aurait de l’intérêt, comme développement futur, d’intégrer les deux types de suivi, pour ainsi obtenir un seul ensemble de données facile à interpréter.

A Hybrid Architecture for Recognising Speech Signals in Malayalam

Speech is the primary, most prominent and convenient means of communication in audible language. Through speech, people can express their thoughts, feelings or perceptions by the articulation of words. Human speech is a complex signal which is non stationary in nature. It consists of immensely rich information about the words spoken, accent, attitude of the speaker, expression, intention, sex, emotion as well as style. The main objective of Automatic Speech Recognition (ASR) is to identify whatever people speak by means of computer algorithms. This enables people to communicate with a computer in a natural spoken language. Automatic recognition of speech by machines has been one of the most exciting, significant and challenging areas of research in the field of signal processing over the past five to six decades. Despite the developments and intensive research done in this area, the performance of ASR is still lower than that of speech recognition by humans and is yet to achieve a completely reliable performance level. The main objective of this thesis is to develop an efficient speech recognition system for recognising speaker independent isolated words in Malayalam.

Entwicklung und experimentelle Regelung eines servopneumatischen räumlichen Mehrachsenprüfstands

In dieser Arbeit wurde ein räumlich bewegter pneumatischer Mehrachsenprüfstand als spezielle mechanische Variante eines Parallelroboters entwickelt, im Labor aufgebaut und in Rechnersimulationen sowie in Laborexperimenten regelungstechnisch untersucht. Für diesen speziellen Parallelroboter MAP-RTS-6 wurden Regelalgorithmen, die mittels moderner Verfahren der linearen und nichtlinearen Regelungstheorie abgeleitet wurden, hinsichtlich ihrer praktischen Anwendbarkeit, Echtzeitfähigkeit und Qualität entwickelt, implementiert und überprüft. Mit diesen Regelalgorithmen ist der MAP-RTS-6 in der Lage, große räumliche Transienten schnell und präzise nachzufahren. Der MAP-RTS-6 wird in erster Linie als räumlicher Bewegungsmanipulator für große nichtlineare Transienten (Translationen und Rotationen), als räumlicher Vibrationsprüfstand für starre und flexible Prüfkörper unterschiedlicher Konfigurationen und als Mechanismus für die Implementierung und experimentelle Überprüfung unterschiedlicher Regelungs- und Identifikationsalgorithmen und Sicherheitskonzepte verwendet. Die Voraussetzung zum Betrieb des Mehrachsenprüfstands für unterschiedliche redundante Antriebskonfigurationen mit sieben und acht Antrieben MAP-RTS-7 und MAP-RTS-8 wurde in dieser Arbeit geschaffen. Dazu zählen die konstruktive Vorbereitung der Prüfstandsmechanik und Pneumatik zum Anschluss weiterer Antriebe, die Vorbereitung zusätzlicher I/O-Schnittstellen zur Prüfstandselektronik und zum Regelungssystem und die Ableitung von Algorithmen zur analytischen Arbeitsraumüberwachung für redundante Antriebskonfigurationen mit sieben und acht Antrieben.

Large-Size AlGaN/GaN HEMT Large-Signal Electrothermal Characterization and Modeling for Wireless Digital Communications

The rapid growth in high data rate communication systems has introduced new high spectral efficient modulation techniques and standards such as LTE-A (long term evolution-advanced) for 4G (4th generation) systems. These techniques have provided a broader bandwidth but introduced high peak-to-average power ratio (PAR) problem at the high power amplifier (HPA) level of the communication system base transceiver station (BTS). To avoid spectral spreading due to high PAR, stringent requirement on linearity is needed which brings the HPA to operate at large back-off power at the expense of power efficiency. Consequently, high power devices are fundamental in HPAs for high linearity and efficiency. Recent development in wide bandgap power devices, in particular AlGaN/GaN HEMT, has offered higher power level with superior linearity-efficiency trade-off in microwaves communication. For cost-effective HPA design to production cycle, rigorous computer aided design (CAD) AlGaN/GaN HEMT models are essential to reflect real response with increasing power level and channel temperature. Therefore, large-size AlGaN/GaN HEMT large-signal electrothermal modeling procedure is proposed. The HEMT structure analysis, characterization, data processing, model extraction and model implementation phases have been covered in this thesis including trapping and self-heating dispersion accounting for nonlinear drain current collapse. The small-signal model is extracted using the 22-element modeling procedure developed in our department. The intrinsic large-signal model is deeply investigated in conjunction with linearity prediction. The accuracy of the nonlinear drain current has been enhanced through several issues such as trapping and self-heating characterization. Also, the HEMT structure thermal profile has been investigated and corresponding thermal resistance has been extracted through thermal simulation and chuck-controlled temperature pulsed I(V) and static DC measurements. Higher-order equivalent thermal model is extracted and implemented in the HEMT large-signal model to accurately estimate instantaneous channel temperature. Moreover, trapping and self-heating transients has been characterized through transient measurements. The obtained time constants are represented by equivalent sub-circuits and integrated in the nonlinear drain current implementation to account for complex communication signals dynamic prediction. The obtained verification of this table-based large-size large-signal electrothermal model implementation has illustrated high accuracy in terms of output power, gain, efficiency and nonlinearity prediction with respect to standard large-signal test signals.

Apatite-Polymer Composites for the Controlled Dual Delivery of BMP-2 and BMP-6 for Bone Tissue Engineering

The release of growth factors from tissue engineering scaffolds provides signals that influence the migration, differentiation, and proliferation of cells. The incorporation of a drug delivery platform that is capable of tunable release will give tissue engineers greater versatility in the direction of tissue regeneration. We have prepared a novel composite of two biomaterials with proven track records - apatite and poly(lactic-co-glycolic acid) (PLGA) – as a drug delivery platform with promising controlled release properties. These composites have been tested in the delivery of a model protein, bovine serum albumin (BSA), as well as therapeutic proteins, recombinant human bone morphogenetic protein-2 (rhBMP-2) and rhBMP-6. The controlled release strategy is based on the use of a polymer with acidic degradation products to control the dissolution of the basic apatitic component, resulting in protein release. Therefore, any parameter that affects either polymer degradation or apatite dissolution can be used to control protein release. We have modified the protein release profile systematically by varying the polymer molecular weight, polymer hydrophobicity, apatite loading, apatite particle size, and other material and processing parameters. Biologically active rhBMP-2 was released from these composite microparticles over 100 days, in contrast to conventional collagen sponge carriers, which were depleted in approximately 2 weeks. The released rhBMP-2 was able to induce elevated alkaline phosphatase and osteocalcin expression in pluripotent murine embryonic fibroblasts. To augment tissue engineering scaffolds with tunable and sustained protein release capabilities, these composite microparticles can be dispersed in the scaffolds in different combinations to obtain a superposition of the release profiles. We have loaded rhBMP-2 into composite microparticles with a fast release profile, and rhBMP-6 into slow-releasing composite microparticles. An equi-mixture of these two sets of composite particles was then injected into a collagen sponge, allowing for dual release of the proteins from the collagenous scaffold. The ability of these BMP-loaded scaffolds to induce osteoblastic differentiation in vitro and ectopic bone formation in a rat model is being investigated. We anticipate that these apatite-polymer composite microparticles can be extended to the delivery of other signalling molecules, and can be incorporated into other types of tissue engineering scaffolds.

Graphical tracking systems revisited: a practical approach to computer scheduling in horticulture

Graphical tracking is a technique for crop scheduling where the actual plant state is plotted against an ideal target curve which encapsulates all crop and environmental characteristics. Management decisions are made on the basis of the position of the actual crop against the ideal position. Due to the simplicity of the approach it is possible for graphical tracks to be developed on site without the requirement for controlled experimentation. Growth models and graphical tracks are discussed, and an implementation of the Richards curve for graphical tracking described. In many cases, the more intuitively desirable growth models perform sub-optimally due to problems with the specification of starting conditions, environmental factors outside the scope of the original model and the introduction of new cultivars. Accurate specification for a biological model requires detailed and usually costly study, and as such is not adaptable to a changing cultivar range and changing cultivation techniques. Fitting of a new graphical track for a new cultivar can be conducted on site and improved over subsequent seasons. Graphical tracking emphasises the current position relative to the objective, and as such does not require the time consuming or system specific input of an environmental history, although it does require detailed crop measurement. The approach is flexible and could be applied to a variety of specification metrics, with digital imaging providing a route for added value. For decision making regarding crop manipulation from the observed current state, there is a role for simple predictive modelling over the short term to indicate the short term consequences of crop manipulation.

The role of visual and nonvisual information in the control of locomotion

During locomotion, retinal flow, gaze angle, and vestibular information can contribute to one's perception of self-motion. Their respective roles were investigated during active steering: Retinal flow and gaze angle were biased by altering the visual information during computer-simulated locomotion, and vestibular information was controlled through use of a motorized chair that rotated the participant around his or her vertical axis. Chair rotation was made appropriate for the steering response of the participant or made inappropriate by rotating a proportion of the veridical amount. Large steering errors resulted from selective manipulation of retinal flow and gaze angle, and the pattern of errors provided strong evidence for an additive model of combination. Vestibular information had little or no effect on steering performance, suggesting that vestibular signals are not integrated with visual information for the control of steering at these speeds.

Towards natural human computer interaction in BCI

BCI systems require correct classification of signals interpreted from the brain for useful operation. To this end this paper investigates a method proposed in [1] to correctly classify a series of images presented to a group of subjects in [2]. We show that it is possible to use the proposed methods to correctly recognise the original stimuli presented to a subject from analysis of their EEG. Additionally we use a verification set to show that the trained classification method can be applied to a different set of data. We go on to investigate the issue of invariance in EEG signals. That is, the brain representation of similar stimuli is recognisable across different subjects. Finally we consider the usefulness of the methods investigated towards an improved BCI system and discuss how it could potentially lead to great improvements in the ease of use for the end user by offering an alternative, more intuitive control based mode of operation.

Toward construction of an inexpensive brain computer interface for goal oriented applications

The paper describes the implementation of an offline, low-cost Brain Computer Interface (BCI) alternative to more expensive commercial models. Using inexpensive general purpose clinical EEG acquisition hardware (Truscan32, Deymed Diagnostic) as the base unit, a synchronisation module was constructed to allow the EEG hardware to be operated precisely in time to allow for recording of automatically time stamped EEG signals. The synchronising module allows the EEG recordings to be aligned in stimulus time locked fashion for further processing by the classifier to establish the class of the stimulus, sample by sample. This allows for the acquisition of signals from the subject’s brain for the goal oriented BCI application based on the oddball paradigm. An appropriate graphical user interface (GUI) was constructed and implemented as the method to elicit the required responses (in this case Event Related Potentials or ERPs) from the subject.

Single-trial event-related potential analysis for brain-computer interfaces

Abstract. Different types of mental activity are utilised as an input in Brain-Computer Interface (BCI) systems. One such activity type is based on Event-Related Potentials (ERPs). The characteristics of ERPs are not visible in single-trials, thus averaging over a number of trials is necessary before the signals become usable. An improvement in ERP-based BCI operation and system usability could be obtained if the use of single-trial ERP data was possible. The method of Independent Component Analysis (ICA) can be utilised to separate single-trial recordings of ERP data into components that correspond to ERP characteristics, background electroencephalogram (EEG) activity and other components with non- cerebral origin. Choice of specific components and their use to reconstruct “denoised” single-trial data could improve the signal quality, thus allowing the successful use of single-trial data without the need for averaging. This paper assesses single-trial ERP signals reconstructed using a selection of estimated components from the application of ICA on the raw ERP data. Signal improvement is measured using Contrast-To-Noise measures. It was found that such analysis improves the signal quality in all single-trials.

Speed sensorless vector control of induction machines

A novel rotor velocity estimation scheme applicable to vector controlled induction motors has been described. The proposed method will evaluate rotor velocity, ωr, on-line, does not require any extra transducers or injection of any signals, nor does it employ complicated algorithms such as MRAS or Kalman filters. Furthermore, the new scheme will operate at all velocities including zero with very little error. The procedure employs motor model equations, however all differential and integral terms have been eliminated giving a very fast, low-cost, effective and practical alternative to the current available methods. Simulation results verify the operation of the scheme under ideal and PWM conditions.