The life expectancy in well-treated HIV-infected persons approaches that of the general population, but HIV-infected persons have a greater incidence of fractures and osteoporosis. A decrease in bone ...mineral density is observed primarily during the first 1-2 years of antiretroviral therapy. Dual X-ray absorptiometry scan should be considered in HIV-infected men ≥ 50 years and postmenopausal women. In case of osteoporosis, bisphosphonate treatment should follow guidelines for the general population. Future research should focus on pathogenesis and prevention of bone density loss in HIV.
Introduction
As the human immunodeficiency virus (HIV)‐positive population ages, issues concerning sexuality and fertility, among others, are becoming relevant. HIV is still surrounded by stigma and ...taboos, and there have been few studies conducted in industrialized settings concerning these questions. We therefore wanted to investigate the perception of sexuality and fertility in women living with HIV (WLWH) in an industrialized setting, using a questionnaire.
Methods
WLWH were recruited at their regular outpatient clinic visits, at the major Departments of Infectious Diseases in Denmark and Finland, from January 2012 to October 2013. A questionnaire was developed, study participants were informed of the nature of study and, if they agreed to participate and signed a consent form, they filled in the questionnaire. Demographic information on the participants was obtained from patient files (in Finland) or from a national HIV cohort (in Denmark). Statistical analysis was performed using STATA®, version 11.
Results
In total, 560 women were included in the study. The median age was 44 years. The majority were of white European origin, with fully suppressed HIV viral load, CD4 cell count >350 µL and mild or no symptoms of their HIV infection. A total of 62% were sexually active, stating condom use as their sole form of contraception. Of the sexually inactive women, one‐third were in steady relationships. Eighty percent reported prior pregnancies, of which the majority had one or more children. Most children were born prior to the women's HIV diagnosis and the mode of conception was predominantly natural. One‐quarter of the participating women desired pregnancy, while more than half did not. The remaining quarter either stated that they already had the desired number of children or chose not to answer the question. Fourteen percent stated that their HIV diagnosis ended their wish for children; of these women, the median time of diagnosis was between 1995 and 1996. Pregnancy had been attempted unsuccessfully in one‐quarter of study participants. The final question inquired what the risk of mother‐to‐child transmission was, with all precautions taken. Fifteen percent estimated the risk to be above two percent.
Conclusions
In conclusion, the majority of WLWH in industrialized settings in Denmark and Finland have few HIV‐related symptoms, are sexually active and have a strong desire for children.
Abstract
In 2009, 2.5 million children under the age of 15 y were living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS); 370,000 were diagnosed with HIV and 260,000 ...died due to AIDS. More than 90% of the children infected with HIV live in sub-Saharan Africa. Most children infected with HIV contract the infection in utero, during delivery, or via breast milk. This review outlines the current diagnostic methods to determine the HIV status of infants born to HIV-infected mothers. The HIV DNA and RNA polymerase chain reaction (PCR) tests are highly accurate and are recommended as the first-choice diagnostic methods. However, they are expensive and require complex laboratory procedures. Consequently, a search for less costly and complicated methods has led to the testing of p24 antigen analyses as an alternative to the gold-standard PCR tests, with encouraging results. The p24 antigen Perkin Elmer assay currently most often used has a sensitivity of 98.8% and a specificity of 100% (infants 6 weeks of age). Larger-scale studies should be performed in resource-limited settings to confirm these findings.
Abstract
Background
Despite the existing evidence regarding the interrelated relationship between pain and obesity, knowledge about patients’ perspectives of this relationship is scarce, especially ...from patients with chronic pain and obesity after completing Interdisciplinary Pain Rehabilitation Program (IPRP).
Aims
This qualitative study expands the understanding of patients’ perspectives on how chronic pain and obesity influence each other and how the two conditions affect the ability to make lifestyle changes.
Method
A purposive sample of patients with Body Mass Index (BMI) ≥ 30 kg/m
2
and who had completed an IPRP were recruited for individual semi-structured interviews. The transcribed interviews were analysed using latent content analysis and a pattern of theme and categories was constructed based on the participants’ perspectives.
Results
Sixteen patients (aged 28–63 years, 11 female, BMI 30–43 kg/m
2
) shared their experiences of chronic pain, obesity and lifestyle changes after IPRP. The analysis revealed one overall theme (
lifestyle changes are burdensome with a body broken by both pain and obesity
) and four categories (
pain disturbing days and nights worsens weight control
,
pain-related stress makes lifestyle changes harder
, a
painful and obese body intertwined with negative emotions
and
the overlooked impact of obesity on chronic pain
). Most participants perceived that their pain negatively impacted their obesity, but they were uncertain whether their obesity negatively impacted their pain. Nevertheless, the participants desired and struggled to make lifestyle changes.
Conclusion
After IPRP, patients with chronic pain and obesity perceived difficulties with self-management and struggles with lifestyle changes. They experienced a combined burden of the two conditions. Their perspective on the unilateral relationship between pain and obesity differed from the existing evidence. Future tailored IPRPs should integrate nutritional interventions and address the knowledge gaps as well.
Thermomechanical processing of blades and disks can become challenging when the microstructure of the material consists of a high volume fraction of strengthening phases. In Rene 65, the precipitate ...volume fraction is 40 pct in the as-forged condition. The microstructure consists of a bimodal/trimodal
γ
′ precipitate distribution on the grain boundaries and intergranually. In order to control grain size and
reduce
hardness, primary
γ
′ should be present on the grain boundaries and the secondary and tertiary precipitates should be coarse. In this work, an attempt to optimize the heat treatments that coarsen those two populations by implementing tools from experimental design is attempted. Two sample categories were examined with different thermomechanical histories, one deformed and one deformed and annealed, in order to verify if the ultimate heat treatment can be applied at different processing steps. The results confirm that there is a definite effect of the original microstructure, since there were different heat treatments that were proven to be the most effective to reduce hardness for the two conditions. Microstructural analysis revealed precipitate splitting and coralloid microstructures were observed for the first time in this alloy. Two mechanisms are proposed for the reduction of hardness depending on the initial microstructure.
Tralokinumab is an anti-interleukin-13 human monoclonal antibody developed for the treatment of severe, uncontrolled asthma. These clinical trials aimed to assess the efficacy and safety of ...tralokinumab in this population.
STRATOS 1 and STRATOS 2 were randomised, double-blind, parallel-group, placebo-controlled, phase 3 clinical trials that enrolled participants aged 12-75 years with severe asthma that was inadequately controlled despite use of inhaled corticosteroids (≥500 μg per day fluticasone or equivalent) and a long-acting β
agonist (but not oral corticosteroids). STRATOS 1 was done at 246 sites in 14 countries, and STRATOS 2 was done at 242 sites in 13 countries. In STRATOS 1, participants were randomly assigned (2:1) to receive tralokinumab 300 mg or matching placebo subcutaneously every 2 weeks or every 4 weeks for 52 weeks. In STRATOS 2, participants were randomly assigned (1:1) to receive tralokinumab 300 mg or matching placebo subcutaneously every 2 weeks for 52 weeks. STRATOS 1 attempted to identify a biomarker-positive population with enhanced tralokinumab benefit, which was then tested in STRATOS 2. The primary endpoint was the annualised asthma exacerbation rate (AAER) reduction at week 52 in the all-comers population for STRATOS 1 and in the biomarker-positive population for STRATOS 2. All efficacy analyses for both trials were done on the full analysis set by an intention-to-treat approach. The safety analysis set comprised any participant who received the investigational drug and was categorised by treatment received. These trials are registered with ClinicalTrials.gov, numbers NCT02161757 (STRATOS 1) and NCT02194699 (STRATOS 2), and with the EU Clinical Trials Register, EudraCT 2013-005614-35 (STRATOS 1) and EudraCT 2013-005615-27 (STRATOS 2).
STRATOS 1 was done between June 13, 2014, and Feb 28, 2017. 1207 participants were randomly assigned and 1202 treated as follows: tralokinumab every 2 weeks (n=398), tralokinumab every 4 weeks (n=404), or placebo (n=400). STRATOS 2 was done between Oct 30, 2014, and Sept 21, 2017. 856 participants were randomly assigned and 849 treated as follows: tralokinumab every 2 weeks (n=427) and placebo every 2 weeks (n=422). In the STRATOS 1 all-comers population, tralokinumab every 2 weeks did not significantly reduce AAER compared with placebo (7·0% reduction 95% CI -20·8 to 28·4; rate ratio 0·93 95% CI 0·72 to 1·21; p=0·59). Baseline fractional exhaled nitric oxide (FENO) 37 ppb or greater was identified as the preferred biomarker in STRATOS 1; in FENO-high participants, tralokinumab every 2 weeks (n=97) reduced AAER by 44·0% (95% CI 6·0 to 66·0; rate ratio 0·56 95% CI 0·34 to 0·94; p=0·028) compared with placebo (n=102). In the STRATOS 2 FENO-high population, tralokinumab every 2 weeks (n=108) did not significantly improve AAER (15·8% reduction 95% CI -33·7 to 47·0; rate ratio 0·84 95% CI 0·53 to 1·34; p=0·47) compared with placebo (n=121). The safety profile was consistent with that of previous tralokinumab trials.
Tralokinumab reduced AAER in participants with severe asthma with baseline FENO 37 ppb or higher in STRATOS 1, but not in STRATOS 2. These inconsistent effects on AAER do not support a key role for interleukin 13 in severe asthma exacerbations.
AstraZeneca.
Rene 65 is a nickel-based superalloy used in aerospace components such as turbine blades and disks. The microstructure in the as-received condition of the superalloy consists of ~ 40% volume fraction ...of gamma prime precipitates, which gives such a high strength that thermomechanical processing is problematic. The goal of this study was to improve the processability of Rene 65 by developing a heat treatment to lower the strength through changes in the size distribution and volume fraction of those precipitates. Gamma prime in this alloy is observed in three sizes, ranging from a few μm to tens of nm. For the design of the heat treatments, Taguchi’s L8 matrix design of experiments was used. The four factors that are examined are cooling rate, hold temperature, hold time and cooling method to room temperature. The levels of the factors were two (high and low) with replication. Microstructures were characterized by scanning electron microscopy and mechanical properties by Vickers microhardness testing. Regression analysis on the results revealed that the most significant factor for this design is hold temperature. The softest sample and the hardest sample have a significant difference microstructurally, with the latter having a trimodal distribution of precipitates which is believed to cause the strength.
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