Objectives
The objective of the paper is to present the outcomes of the HepHIV 2019 conference, held in Bucharest under the Romanian EU Presidency and focusing on challenges of timely and integrated ...testing and care.
Methods
The conference programme was put together by the organizing committee. It consisted of invited talks and peer‐reviewed s.
Results
In all, 65 s from 20 countries were presented during the conference, which had nearly 250 delegates, including high‐profile political representation. The conference highlighted the need to shift towards further disease integration because of the epidemiological characteristics of the hepatitis B (HBV), hepatitis C (HCV), HIV, sexually transmitted infection (STIs) and tuberculosis (TB) epidemics in the WHO European region. Integration should be a priority in the response to the epidemics to better reach key populations and to ensure better testing coverage. This relates to both the integration of services in shared care models and the integration of different settings and stakeholders in national strategies.
Conclusions
The conference demonstrated the need for greater political support for the policy changes required to implement integration. Testing normalization efforts are key to maximizing the impact of integration efforts. The conference call to action can help to guide developments in testing and linkage‐to‐care interventions across the European region.
The World Health Organization (WHO) recommends countries introduce new anti-TB drugs in the treatment of multidrug-resistant tuberculosis.
The aim of the study is to prospectively evaluate the ...effectiveness of bedaquiline (and/or delamanid)- containing regimens in a large cohort of consecutive TB patients treated globally.
This observational, prospective study is based on data collected and provided by Global Tuberculosis Network (GTN) centres and analysed twice a year.
All consecutive patients (including children/adolescents) treated with bedaquiline and/or delamanid were enrolled, and managed according to WHO and national guidelines.
Overall, 52 centres from 29 countries/regions in all continents reported 883 patients as of January 31st 2021, 24/29 countries/regions providing data on 100% of their consecutive patients (10–80% in the remaining 5 countries).
The drug-resistance pattern of the patients was severe (>30% with extensively drug-resistant -TB; median number of resistant drugs 5 (3−7) in the overall cohort and 6 (4−8) among patients with a final outcome).
For the patients with a final outcome (477/883, 54.0%) the median (IQR) number of months of anti-TB treatment was 18 (13−23) (in days 553 (385–678)). The proportion of patients achieving sputum smear and culture conversion ranged from 93.4% and 92.8% respectively (whole cohort) to 89.3% and 88.8% respectively (patients with a final outcome), a median (IQR) time to sputum smear and culture conversion of 58 (30−90) days for the whole cohort and 60 (30−100) for patients with a final outcome and, respectively, of 55 (30−90) and 60 (30−90) days for culture conversion.
Of 383 patients treated with bedaquiline but not delamanid, 284 (74.2%) achieved treatment success, while 25 (6.5%) died, 11 (2.9%) failed and 63 (16.5%) were lost to follow-up.
Indicator condition guided HIV testing is a proven effective strategy for increasing HIV diagnosis in health care facilities. As part of the INTEGRATE Joint Action, we conducted four pilot studies, ...aiming to increase integrated testing for HIV/HCV/HBV and sexually transmitted infections, by introducing and expanding existing indicator condition guided HIV testing methods.
Pilot interventions included combined HIV/HCV testing in a dermatovenerology clinic and a clinic for addictive disorders in Lithuania; Increasing HIV testing rates in a tuberculosis clinic in Romania by introducing a patient information leaflet and offering testing for HIV/HCV/sexually transmitted infections to chemsex-users in Barcelona. Methods for implementing indicator condition guided HIV testing were adapted to include integrated testing. Testing data were collected retrospectively and prospectively. Staff were trained in all settings, Plan-do-study-act cycles frequently performed and barriers to implementation reported.
In established indicator conditions, HIV absolute testing rates increased from 10.6 to 71% in the dermatovenerology clinic over an 18 months period. HIV testing rates improved from 67.4% at baseline to 94% in the tuberculosis clinic. HCV testing was added to all individuals in the dermatovenerology clinic, eight patients of 1701 tested positive (0.47%). HBV testing was added to individuals with sexually transmitted infections with a 0.44% positivity rate (2/452 tested positive). The Indicator condition guided HIV testing strategy was expanded to offer HIV/HCV testing to people with alcohol dependency and chemsex-users. 52% of chemsex-users tested positive for ≥ 1 sexually transmitted infection and among people with alcohol dependency 0.3 and 3.7% tested positive for HIV and HCV respectively.
The four pilot studies successfully increased integrated testing in health care settings, by introducing testing for HBV/HCV and sexually transmitted infections along with HIV testing for established indicator conditions and expanding the strategy to include new indicators; alcohol dependency and chemsex. HCV testing of individuals with alcohol abuse showed high positivity rates and calls for further implementation studies. Methods used for implementing indicator condition guided HIV Testing have proven transferable to implementation of integrated testing.
Root length density of maize (
Zea mays L.) and soybean
Glycine max (L.) Merr., measured with minirhizotrons, was compared with soil-water depletion, measured with neutron probes, to determine ...whether the soil-water-depletion method could indicate root length density and root depth in a stratified soil. The study was carried out in southeast Kansas, USA, on a Parsons silt loam soil (Mollic Albaqualf fine, mixed, thermic) overlying clay (a claypan). Measurements were taken during two dry periods, one in 1983 and one in 1984, to a depth of 1.35 m for soil water and to a depth of 1.15 m for root length density. At the beginning of the dry period, average soil water content for both crops throughout the profile was 0.47 m
3 m
−3 in 1983 and 0.42 m
3 m
−3 in 1984. During both dry periods, roots died back in the surface soil because the silt loam dried out; it was drier than the clay. The claypan inhibited root growth. In the clay, roots of both crops increased in root length density in the water year (1983) or decreased in root length density in the drier year (1984). In both years, the depth of maximum water depletion in the soil profile for maize (0.45 m in 1983, 0.90 m in 1984) corresponded well with the depth of maximum root length density measured with minirhizotrons (0.50 m in 1983, 0.80 m in 1984). The depths of maximum depletion for soybean (0.15 m and 0.30 m in 1983, and 0.60 m in 1984) also corresponded relatively well with the zones of maximum root length density (0.15 and 0.50 m in 1983, and 0.40 m in 1984). Depth of rooting was not evident from the soil-water measurements. Root length densities for both crops were low (less than about 1000 and 300 mm
−3 for maize and soybean, respectively) at bottom depths of the profile.
Arrays of electrical devices with each comprising multiple single-walled carbon nanotubes (SWNT) bridging metal electrodes are obtained by chemical vapor deposition (CVD) of nanotubes across ...prefabricated electrode arrays. The ensemble of nanotubes in such a device collectively exhibits large electrical conductance changes under electrostatic gating, owing to the high percentage of semiconducting nanotubes. This leads to the fabrication of large arrays of low-noise electrical nanotube sensors with 100% yield for detecting gas molecules. Polymer functionalization is used to impart high sensitivity and selectivity to the sensors. Polyethyleneimine coating affords n-type nanotube devices capable of detecting NO2 at less than 1 ppb (parts-per-billion) concentrations while being insensitive to NH3. Coating Nafion (a polymeric perfluorinated sulfonic acid ionomer) on nanotubes blocks NO2 and allows for selective sensing of NH3. Multiplex functionalization of a nanotube sensor array is carried out by microspotting. Detection of molecules in a gas mixture is demonstrated with the multiplexed nanotube sensors.
A virtual cocrystal screening method based on calculated gas phase molecular electrostatic potential surfaces (MEPS) of the individual components has been validated using experimental cocrystal ...screens reported in the literature. The noncovalent interactions of a molecule with its environment are described by a discrete set of independent surface site interaction points (SSIPs), whose properties can be calculated from the ab initio MEPS. The stability of a crystal is estimated based on pairing SSIPs such that the sum of the pairwise interaction energies is optimized. This provides a means of calculating the relative stability of a cocrystal compared with the pure components without knowing anything about the three-dimensional structures of the crystalline states. For a set of potential crystal coformers (CCF), the difference between interaction site pairing energies of different solid forms (ΔE) provides a method for ranking CCFs based on the calculated probability of cocrystal formation. The method was applied to cocrystal screens of 18 compounds that reported both hits and misses, and in most cases, the virtual cocrystal screen reproduces experimental results well. In lists of CCFs ranked by ΔE, the experimentally observed hits were significantly enriched at the top, and this indicates that virtual screening is a promising tool for focusing experimental efforts on the most promising CCF candidates.
To evaluate the effects of droxidopa or atomoxetine on intravenous (IV) vasoactive agent discontinuation in cardiothoracic intensive care unit (ICU) patients with hypotension refractory to midodrine.
...Single-center, retrospective cohort study.
Tertiary- and quaternary-care university teaching hospital.
Included patients who received at least 4 consecutive doses of droxidopa or atomoxetine and remained on concurrent midodrine. Patients were excluded if they received study medication before admission, had clinical deterioration after study medication initiation requiring additional vasoactives/escalation of IV vasoactive dosage for at least 12 hours, had a diagnosis of hepatorenal syndrome, were prisoners, or were pregnant.
Droxidopa, atomoxetine, or both.
The primary endpoint was time to discontinuation of IV vasoactive agents after initiation of study medication, analyzed using a Kaplan-Meier estimate with the Wilcoxon method, censoring death within 24 hours of the last dose of study medication. No adjustment for repetitive analyses was made, as the analysis was hypothesis-generating. Of the 72 charts reviewed, 45 patients met inclusion criteria (18 atomoxetine, 17 droxidopa, and 10 both). There were no differences in median time to discontinuation of IV vasoactive agents (21.9 days v 8.0 days v 13.9 days, respectively; p = 0.259) or ICU or hospital length of stay between groups. A higher percentage of patients who survived to hospital discharge received both study medications or droxidopa alone (90% v 76.5%) than atomoxetine alone (44.4%, p = 0.028).
Droxidopa and atomoxetine are oral vasoactive agents with potential mechanisms to facilitate IV vasopressor weaning for patients in the ICU with hypotension refractory to midodrine, but further prospective research is needed.
Human activity causes vibrations that propagate into the ground as high-frequency seismic waves. Measures to mitigate the coronavirus disease 2019 (COVID-19) pandemic caused widespread changes in ...human activity, leading to a months-long reduction in seismic noise of up to 50%. The 2020 seismic noise quiet period is the longest and most prominent global anthropogenic seismic noise reduction on record. Although the reduction is strongest at surface seismometers in populated areas, this seismic quiescence extends for many kilometers radially and hundreds of meters in depth. This quiet period provides an opportunity to detect subtle signals from subsurface seismic sources that would have been concealed in noisier times and to benchmark sources of anthropogenic noise. A strong correlation between seismic noise and independent measurements of human mobility suggests that seismology provides an absolute, real-time estimate of human activities.
In this study, a nonparametric method to estimate precipitating ice from multiple-frequency radar observations is investigated. The method does not require any assumptions regarding the distribution ...of ice particle sizes and relies on an efficient search procedure to incorporate information from observed particle size distributions (PSDs) in the estimation process. Similar to other approaches rooted in optimal-estimation theory, the nonparametric method is robust in the presence of noise in observations and uncertainties in the forward models. Over 200 000 PSDs derived from in situ observations collected during the Olympic Mountains Experiment (OLYMPEX) and Integrated Precipitation and Hydrology Experiment (IPHEX) field campaigns are used in the development and evaluation of the nonparametric estimation method. These PSDs are used to create a database of ice-related variables and associated computed radar reflectivity factors at the Ku, Ka, and W bands. The computed reflectivity factors are used to derive precipitating ice estimates and investigate the associated errors and uncertainties. The method is applied to triple-frequency radar observations collected during OLYMPEX and IPHEX. Direct comparisons of estimated ice variables with estimates from in situ instruments show results consistent with the error analysis. Global application of the method requires an extension of the supporting PSD database, which can be achieved through the processing of information from additional past and future field campaigns.
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