After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). Adherence to ART is among the key ...determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV.
A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation.
Recommendations are provided for monitoring entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.
Animal pollinators contribute to human food production and security thereby ensuring an important component of human well-being. The recent decline of these agents in Europe and North America has ...aroused the concern of a potential global pollinator crisis. In order to prioritize efforts for pollinator conservation, we evaluated the extent to which food production depends on animal pollinators in Brazil-one of the world's agriculture leaders-by comparing cultivated area, produced volume and yield value of major food crops that are pollinator dependent with those that are pollinator non-dependent. In addition, we valued the ecosystem service of pollination based on the degree of pollinator dependence of each crop and the consequence of a decline in food production to the Brazilian Gross Domestic Product and Brazilian food security. A total of 68% of the 53 major food crops in Brazil depend to some degree on animals for pollination. Pollinator non-dependent crops produce a greater volume of food, mainly because of the high production of sugarcane, but the cultivated area and monetary value of pollinator dependent crops are higher (59% of total cultivated area and 68% of monetary value). The loss of pollination services for 29 of the major food crops would reduce production by 16.55-51 million tons, which would amount to 4.86-14.56 billion dollars/year, and reduce the agricultural contribution to the Brazilian GDP by 6.46%- 19.36%. These impacts would be largely absorbed by family farmers, which represent 74.4% of the agricultural labor force in Brazil. The main effects of a pollinator crisis in Brazil would be felt by the poorer and more rural classes due to their lower income and direct or exclusive dependence on this ecosystem service.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
•Oil scrubber and char adsorber for tar removal has been installed to rotary kiln pyrolysis plant.•Used oil and char will be utilized again as fuel of IC engine and heat source for pyrolysis ...reactor.•The demonstrating test was successfully accomplished with 98.7% gravimetric tar removal.
An effective pyrogas cleaning system is necessary for downstream application of biomass pyrolysis technology for power generation. Particularly, tar must be lowered to a satisfying level in order to avoid the problem of tar blockage for preventing damage to the engine and to prolong the engine lifetime. This research was carried out from previous successful research on oil scrubbers and char adsorption for tar removal. Further lab scale experimentation was done to find the appropriate quantity of oil to be used in the scrubber; the results were used for scaling up and showed that the optimum system needed for 0.045m3/h pyrogas the quantity of 1l, during a test lasted 30min. The 1l oil scrubber was combined with a 41g char adsorption bed and 97.6% gravimetric tar removal efficiency was obtained. The combination of the oil scrubber and the char adsorption bed was scaled up and installed into the IPRP (Integrated Pyrolysis Regenerated Plant) at the University of Perugia, with chestnut wood (Castanea Sativa Miller) as feedstock, and connected to a 6kWe Lombardini engine with a power generator and electric load. Pyrogas was sampled at 0.7m3/h and connected to the cleaning system, consisting of a 15l oil scrubber combined with a 922g char adsorption bed. The demonstrating test was successfully accomplished with 98.7% gravimetric tar removal at the exit of the char adsorption bed. The engine ran smoothly and the electric load was constant.
Antiretroviral therapy (ART) during pregnancy is important for both maternal health and prevention of perinatal HIV-1 transmission; however adequate data on the safety and efficacy of different ART ...regimens that are likely to be used by pregnant women are scarce. In this trial we compared the safety and efficacy of three antiretroviral regimens started in pregnancy: dolutegravir, emtricitabine, and tenofovir alafenamide fumarate; dolutegravir, emtricitabine, and tenofovir disoproxil fumarate; and efavirenz, emtricitabine, and tenofovir disoproxil fumarate.
This multicentre, open-label, randomised controlled, phase 3 trial was done at 22 clinical research sites in nine countries (Botswana, Brazil, India, South Africa, Tanzania, Thailand, Uganda, the USA, and Zimbabwe). Pregnant women (aged ≥18 years) with confirmed HIV-1 infection and at 14–28 weeks' gestation were eligible. Women who had previously taken antiretrovirals in the past were excluded (up to 14 days of ART during the current pregnancy was permitted), as were women known to be pregnant with multiple fetuses, or those with known fetal anomaly or a history of psychiatric illness. Participants were randomly assigned (1:1:1) using a central computerised randomisation system. Randomisation was done using permuted blocks (size six) stratified by gestational age (14–18, 19–23, and 24–28 weeks' gestation) and country. Participants were randomly assigned to receive either once-daily oral dolutegravir 50 mg, and once-daily oral fixed-dose combination emtricitabine 200 mg and tenofovir alafenamide fumarate 25 mg; once-daily oral dolutegravir 50 mg, and once-daily oral fixed-dose combination emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg; or once-daily oral fixed-dose combination of efavirenz 600 mg, emtricitabine 200 mg, and tenofovir disoproxil fumarate 300 mg. The primary efficacy outcome was the proportion of participants with viral suppression, defined as an HIV-1 RNA concentration of less than 200 copies per mL, at or within 14 days of delivery, assessed in all participants with an HIV-1 RNA result available from the delivery visit, with a prespecified non-inferiority margin of −10% in the combined dolutegravir-containing groups versus the efavirenz-containing group (superiority was tested in a pre-planned secondary analysis). Primary safety outcomes, compared pairwise among treatment groups, were the occurrence of a composite adverse pregnancy outcome (ie, either preterm delivery, the infant being born small for gestational age, stillbirth, or spontaneous abortion) in all participants with a pregnancy outcome, and the occurrence of grade 3 or higher maternal and infant adverse events in all randomised participants. This trial was registered with ClinicalTrials.gov, NCT03048422.
Between Jan 19, 2018, and Feb 8, 2019, we enrolled and randomly assigned 643 pregnant women: 217 to the dolutegravir, emtricitabine, and tenofovir alafenamide fumarate group, 215 to the dolutegravir, emtricitabine, and tenofovir disoproxil fumarate group, and 211 to the efavirenz, emtricitabine, and tenofovir disoproxil fumarate group. At enrolment, median gestational age was 21·9 weeks (IQR 18·3–25·3), the median HIV-1 RNA concentration among participants was 902·5 copies per mL (152·0–5182·5; 181 28% of 643 participants had HIV-1 RNA concentrations of <200 copies per mL), and the median CD4 count was 466 cells per μL (308–624). HIV-1 RNA concentrations at delivery were available for 605 (94%) participants. Of these, 395 (98%) of 405 participants in the combined dolutegravir-containing groups had viral suppression at delivery compared with 182 (91%) of 200 participants in the efavirenz, emtricitabine, and tenofovir disoproxil fumarate group (estimated difference 6·5% 95% CI 2·0 to 10·7, p=0·0052; excluding the non-inferiority margin of −10%). Significantly fewer participants in the dolutegravir, emtricitabine, and tenofovir alafenamide fumarate group (52 24% of 216) had a composite adverse pregnancy outcome than those in the dolutegravir, emtricitabine, and tenofovir disoproxil fumarate group (70 33% of 213; estimated difference −8·8% 95% CI −17·3 to −0·3, p=0·043) or the efavirenz, emtricitabine, and tenofovir disoproxil fumarate group (69 33% of 211; −8·6% –17·1 to −0·1, p=0·047). The proportion of participants or infants with grade 3 or higher adverse events did not differ among the three groups. The proportion of participants who had a preterm delivery was significantly lower in the dolutegravir, emtricitabine, and tenofovir alafenamide fumarate group (12 6% of 208) than in the efavirenz, emtricitabine, and tenofovir disoproxil fumarate group (25 12% of 207; −6·3% –11·8 to −0·9, p=0·023). Neonatal mortality was significantly higher in the efavirenz, emtricitabine, and tenofovir disoproxil fumarate group (ten 5% of 207 infants) than in the dolutegravir, emtricitabine, and tenofovir alafenamide fumarate group (two 1% of 208; p=0·019) or the dolutegravir, emtricitabine, and tenofovir disoproxil fumarate group (three 2% of 202; p=0·050).
When started in pregnancy, dolutegravir-containing regimens had superior virological efficacy at delivery compared with the efavirenz, emtricitabine, and tenofovir disoproxil fumarate regimen. The dolutegravir, emtricitabine, and tenofovir alafenamide fumarate regimen had the lowest frequency of composite adverse pregnancy outcomes and of neonatal deaths.
National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the National Institute of Mental Health.
Abstract Objective A patulous esophagus on high-resolution computed tomography (HRCT) of the thorax is frequently observed in patients with systemic sclerosis (SSc). Microaspiration has been ...purported to play a role in the development and progression of SSc interstitial lung disease (ILD), but studies examining the role of microaspiration in SSc-ILD have yielded conflicting results. This study was conducted to determine the association between esophageal diameter and SSc-ILD. Methods A cross-sectional study of Northwestern Scleroderma Registry patients with available HRCT exams was conducted. The predictor variable was the widest esophageal diameter (WED) on HRCT, and the primary and secondary outcome variables were radiographic ILD and pulmonary function tests respectively. The degree of radiographic ILD was assessed using a semi-quantitative score adapted from published methods. Estimated regression coefficients adjusted for age, sex, race, body mass index, smoking; SSc disease subtype, serum autoantibodies and disease duration; modified Rodnan skin score, proton pump inhibitor and immune suppressant medication use and erythrocyte sedimentation rate were calculated. Results 270 subjects were studied. In the adjusted analyses, there were positive associations between WED and total ILD score (β=0.27; 95% CI, 0.09 to 0.41), fibrosis (β=0.15; 95% CI, 0.07 to 0.23), and ground glass opacities (β=0.12; 95% CI, 0.04 to 0.20); there were negative associations between WED and FVC % predicted (β=-0.42; 95% CI, -0.69 to -0.13), and adjusted DLCO % predicted (β=-0.45; 95% CI, -0.80 to -0.09) after adjusting for potential confounders. Conclusions Increasing esophageal diameter on HRCT in patients with SSc is associated with more severe radiographic ILD, lower lung volumes, and lower DLCO % predicted. Longitudinal studies are needed to determine if esophageal dilatation is associated with the incidence and/or progression of ILD in patients with SSc.
Background
Risk factors established during adolescence affect health outcomes in adulthood, although little is known about how adolescent health risk behaviours (HRBs) affect testicular development ...and reproductive health.
Objectives
To assess prevalence of HRBs among last year high school students; to describe the most prevalent andrological disorders in this cohort; to explore HRBs associated with andrological disorders and investigate factors possibly associated with impaired testicular development in puberty.
Materials and methods
The Amico‐Andrologo Survey is a permanent nationwide surveillance programme conducted by the Italian Society of Andrology and Sexual Medicine and supported by the Ministry of Health. A nationally representative survey of final‐year male high school students was conducted using a validated structured interview (n = 10124) and medical examination (n = 3816).
Results
Smoking (32.6%), drinking (80.6%) and use of illegal drugs (46.5%) are common in adolescence. 16.6% of subjects were overweight, 3.1% were underweight and 2.3% were obese. Among sexually active students (60.3%), unprotected sex was very common (48.3%). Only 11.6% had been treated for andrological disorders, despite an abnormal clinical examination in 34.6%. Bilateral testicular hypotrophy (14.0%), varicocoele (27.1%) and phimosis (7.1%) were the most prevalent disorders; 5.1% complained of premature ejaculation and 4.7% had an STI. Underweight and heavy alcohol or drug use were associated with testicular hypotrophy. HRBs emerged as significant predictors of testicular hypotrophy, explaining up to 9.6% of its variance. Limitations include risk of selection bias for voluntary physical examination and recall bias for the self‐compiled questionnaire.
Discussion
There is an emerging global adverse trend of HRBs in male high school students. A significant proportion of adolescent males with unsuspected andrological disorders engage in behaviours that could impair testicular development.
Conclusion
Greater attention to the prevention of andrological health in adolescence is needed.
HIV-positive persons who do not maintain consistently high levels of adherence to often complex and toxic highly active antiretroviral therapy (HAART) regimens may experience therapeutic failure and ...deterioration of health status and may develop multidrug-resistant HIV that can be transmitted to uninfected others. The current analysis conceptualizes social and psychological determinants of adherence to HAART among HIV-positive individuals. The authors propose an information-motivation-behavioral skills (IMB) model of HAART adherence that assumes that adherence-related information, motivation, and behavioral skills are fundamental determinants of adherence to HAART. According to the model, adherence-related information and motivation work through adherence-related behavioral skills to affect adherence to HAART. Empirical support for the IMB model of adherence is presented, and its application in adherence-promotion intervention efforts is discussed.
Biological invasions are often complex phenomena because many factors influence their outcome. One key aspect is how non-natives interact with the local biota. Interaction with local species may be ...especially important for exotic species that require an obligatory mutualist, such as Pinaceae species that need ectomycorrhizal (EM) fungi. EM fungi and seeds of Pinaceae disperse independently, so they may use different vectors. We studied the role of exotic mammals as dispersal agents of EM fungi on Isla Victoria, Argentina, where many Pinaceae species have been introduced. Only a few of these tree species have become invasive, and they are found in high densities only near plantations, partly because these Pinaceae trees lack proper EM fungi when their seeds land far from plantations. Native mammals (a dwarf deer and rodents) are rare around plantations and do not appear to play a role in these invasions. With greenhouse experiments using animal feces as inoculum, plus observational and molecular studies, we found that wild boar and deer, both non-native, are dispersing EM fungi. Approximately 30% of the Pinaceae seedlings growing with feces of wild boar and 15% of the seedlings growing with deer feces were colonized by non-native EM fungi. Seedlings growing in control pots were not colonized by EM fungi. We found a low diversity of fungi colonizing the seedlings, with the hypogeous Rhizopogon as the most abundant genus. Wild boar, a recent introduction to the island, appear to be the main animal dispersing the fungi and may be playing a key role in facilitating the invasion of pine trees and even triggering their spread. These results show that interactions among non-natives help explain pine invasions in our study area.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We study the influence of topology on the quench dynamics of a system driven across a quantum critical point. We show how the appearance of certain edge states, which fully characterize the topology ...of the system, dramatically modifies the process of defect production during the crossing of the critical point. Interestingly enough, the density of defects is no longer described by the Kibble-Zurek scaling, but determined instead by the nonuniversal topological features of the system. Edge states are shown to be robust against defect production, which highlights their topological nature.
The information-motivation-behavioral skills (1MB) model of health behavior change informed the design of a brief, culturally tailored diabetes self-care intervention for Puerto Ricans with type 2 ...diabetes. Participants (n = 118) were recruited from an outpatient, primary care clinic at an urban hospital in the northeast United States. ANCOVA models evaluated intervention effects on food label reading, diet adherence, physical activity, and glycemic control (HbAlc). At follow-up, the intervention group was reading food labels and adhering to diet recommendations significantly more than the control group. Although the mean HbAlc values decreased in both groups (Intervention: 0.48% vs. Control: 0.27% absolute decrease), only the intervention group showed a significant improvement from baseline to follow-up (p < .008), corroborating improvements in diabetes self-care behaviors. Findings support the use of the IMB model to culturally tailor diabetes interventions and to enhance patients' knowledge, motivation, and behavior skills needed for self-care.
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