Electronic reminder systems have been available for decades, yet medication adherence remains poor. Most systems rely on simple alarms and do not address other determinants of health-related ...behavior. This paper describes a collaborative awareness system for chronic disease medication adherence that relies on patient self-reflection and clinician support. Visualizations of adherence performance, including estimated plasma concentration graphs and a dynamic, personalized, disease-state simulation, are available to the patient (cell phone and internet media display) and clinician (computer) in real-time. The clinician can send asynchronous video messages of advice and encouragement to the patient regularly. A pilot was conducted with four HIV positive patients for four weeks. Three patients who started with suboptimal adherence improved (93.0% to 99.1%, 83.0% to 96.3%, and 63.9% to 81.3%). One patient who started with optimal medication adherence (>95%) maintained this level. All four patients appreciated the rich feedback and wanted to continue using the system.
OBJECTIVE:
To review the impact that factors such as HIV infection, antiretrovirals, and other commonly used drug therapies have on glucose metabolism in HIV-infected patients.
DATA SOURCES:
...Pertinent literature was identified via a MEDLINE search from 1980 to April 2000 and through secondary sources (abstracts presented at recent scientific meetings, manufacturers' package inserts). The key words used were antiretroviral therapy, HIV infection, insulin resistance, and metabolic abnormalities. All information deemed relevant to evaluate the impact that HIV infection and drug therapy have on glucose metabolism in HIV-infected patients was included.
DATA SYNTHESIS:
The viral burden and stress that are present in HIV-infected patients elicit a complex hormonal and immunologic response that may alter various biochemical pathways, including glucose metabolism. Although rare before the era of potent antiretroviral therapy, insulin resistance has now been described as an important component of the lipodystrophy syndrome. The complex and multifactorial nature of glucose metabolism dysregulation makes management of hyperglycemia or diabetes mellitus challenging in HIV-infected patients. In such a context, a set of recommendations was developed to guide practitioners in assessing, treating, and monitoring hyperglycemia or diabetes mellitus in HIV-infected patients.
CONCLUSIONS:
Alterations of glucose metabolism observed in HIV-infected patients are more frequent since the introduction of potent antiretroviral therapy. Although the etiology of such abnormalities remains unknown, protease inhibitors and, to a lesser extent, nucleoside reverse transcriptase inhibitors are believed to participate in their pathogenic mechanisms. Because of similarities to the pathogenesis of diabetes mellitus, management of antiretroviral-induced hyperglycemia could follow that the recommendations of the American Diabetes Association, with special considerations for monitoring patients with HIV infection. Future studies of altered glucose metabolism in HIV-infected patients should focus on understanding the precise mechanism or causes of this complication so that preventive and therapeutic guidelines can be further evaluated.
Background: Treatment during acute or early human immunodeficiency virus (HIV)-1 infection is associated with immunologic and virologic benefits.
Objective: To evaluate ...darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) efficacy/safety among patients with acute or early HIV-1 infection who rapidly initiate treatment.
Methods: DIAMOND (ClinicalTrials.gov Identifier: NCT03227861), a phase 3 study, evaluated the efficacy/safety of D/C/F/TAF 800/150/200/10 mg in rapid initiation. Adults aged ≥18 years began D/C/F/TAF within 14 days of diagnosis, prior to the availability of screening/baseline laboratory results. In this subgroup analysis, virologic response (HIV-1 RNA <50 copies/mL) was assessed at Week 48 by intent-to-treat FDA snapshot (ITT-FDA snapshot) and observed (excluding patients with missing data) analyses in patients with acute (HIV-1 antibody negative and HIV-1 RNA positive/p24 positive) or early (HIV-1 antibody positive and suspected infection ≤6 months before screening/baseline) infection.
Results: Among 109 patients, 13 had acute and 43 had early HIV-1 infection. High rates of virologic response were demonstrated at Week 48 by ITT-FDA snapshot (acute: 10/13 76.9%; early: 37/43 86.0%) and observed (acute: 10/11 90.9%; early: 37/38 97.4%) analyses. No patients discontinued or required regimen change due to baseline resistance or lack of efficacy, or developed protocol-defined virologic failure. Through Week 48, 7 (53.8%) acute and 22 (51.2%) early infection patients had a D/C/F/TAF-related adverse event (AE); none had a D/C/F/TAF-related grade 4 or serious AE.
Conclusions: High rates of viral suppression during acute/early infection were achieved with D/C/F/TAF rapid initiation, no treatment-emergent resistant mutations were observed, and D/C/F/TAF was safe and well tolerated.
A Top 10 List for Vegetative Roofing Systems Pierce, Helene Hardy
Environmental Design + Construction,
05/2009, Letnik:
12, Številka:
5
Magazine Article, Trade Publication Article
The emergence of garden or "vegetative" roofing systems has introduced a whole new level of complexity for the building professional with proportionate opportunities for miscommunication, design ...errors, scheduling errors, and installation mishaps. Many professionals may choose to ignore this market segment, and why not?
Deux principaux événements colonisateurs ont apporté de nouvelles vagues de migration au Québec : La fondation de la Nouvelle France, de 1608 à 1763 et la conquête du territoire par les Britanniques ...après 1763. Afin d’étudier les différences et similarités entre ces dernières et les interactions possibles entre les migrants et les communautés locales déjà présentes sur le territoire, la morphologie dentaire, un outil permettant de proposer des interprétations d’ordre paléogénétique sur l’origine des populations passées, a été analysée pour les deux groupes suivants: 37 individus provenant du cimetière de la première église Notre-Dame à Montréal (1691-1796); et 61 individus provenant du cimetière de Saint-Matthew à Québec (1771-1860). À cette fin, le protocole de l’Arizona State University -Dental Anthropology System a été utilisé pour la collecte de données. La mesure moyenne de divergence et une analyse d’hétérogénéité des populations (Matrice R et Fst modifiés pour les données non-métriques) ont été ensuite calculées. Les valeurs de biodistance confirment que la majorité des individus observés pour les deux collections sont d’ascendance européenne. L’analyse intra-populationnelle a aussi permis d’identifier certains individus, probablement métis, qui s’approchent de la variation amérindienne. Il semble aussi, selon la matrice R et les valeurs Fst calculées pour les deux échantillons, que Notre-Dame est légèrement plus hétérogène et semble avoir incorporé une composante amérindienne un peu plus importante que Saint-Matthew, probablement par métissage, faisant suite, par exemple, à l’incorporation d’individus Amérindiens convertis dans les premières sociétés coloniales. Bien que nos résultats soient très préliminaires, la relation qu’ont entretenue ces deux populations d’origine européenne avec les populations locales, semble avoir varié au cours du temps, en fonction du contexte politique et économique des différentes vagues de migration européenne. Le degré de métissage plus élevé à Montréal au XVIIIe siècle qu’à Québec au XIXe siècle pourrait ainsi refléter un besoin plus pressant de la part des premiers migrants européens de se faire des alliés amérindiens en vue de la réussite du projet colonisateur.
Two colonisation events occurred in Quebec, from 1608 to 1763 (New France), and after 1763 (British Regime), providing new waves of immigrants. In order to examine differences and similarities between the latter waves and the possible interactions between the immigrants and the local communities already living on the territory, dental morphology, which allows us to propose paleogenetic interpretations on the ancestry of past populations, has been analysed for the following two groups: 37 individuals from the cemetery of the Première Église Notre-Dame in Montreal (1691-1796); and 61 individuals from the cemetery of Saint-Matthew in Quebec City (1771-1860). We used the Arizona State University’s -Dental Anthropology System protocol for the observation of dental traits. Mean measures of divergence and population heterogeneity analysis (R Matrix and Fst modified for non-metric data) were calculated. Biodistance values confirm that the majority of the analysed individuals from both collections were of European ancestry. However, intra-population analysis was able to identify certain individuals who were closer to Native American variation. Furthermore, results of R matrix and Fst tests showed that Notre-Dame sample was slightly more heterogeneous. It seemed to have incorporated more of a Native American component than Saint-Matthew, probably through admixture, which was a consequence of the assimilation of “Christianised” Native Americans within the early colonial society. Therefore, although our results are preliminary, interactions between Europeans and local groups seem to have changed through time as a result of colonisation. The higher levels of admixture in the 18th century Montreal (in comparison to the 19th century Quebec City) might reflect a rather urgent need from the first European migrants to set up alliances with Native Americans for the long-term viability of the colony.
Neanderthals are most often portrayed as big game hunters who derived the vast majority of their diet from large terrestrial herbivores while birds, fish and plants are seen as relatively unimportant ...or beyond the capabilities of Neanderthals. Although evidence for exploitation of other resources (small mammals, birds, fish, shellfish, and plants) has been found at certain Neanderthal sites, these are typically dismissed as unusual exceptions. The general view suggests that Neanderthal diet may broaden with time, but that this only occurs sometime after 50,000 years ago. We present evidence, in the form of lithic residue and use-wear analyses, for an example of a broad-based subsistence for Neanderthals at the site of Payre, Ardèche, France (beginning of MIS 5/end of MIS 6 to beginning of MIS 7/end of MIS 8; approximately 125-250,000 years ago). In addition to large terrestrial herbivores, Neanderthals at Payre also exploited starchy plants, birds, and fish. These results demonstrate a varied subsistence already in place with early Neanderthals and suggest that our ideas of Neanderthal subsistence are biased by our dependence on the zooarchaeological record and a deep-seated intellectual emphasis on big game hunting.
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