Invasive Obstetric Procedures and Cesarean Sections in Women With Known Herpes Simplex Virus Status During Pregnancy.

BackgroundNeonatal herpes is a potentially devastating infection that results from acquisition of herpes simplex virus (HSV) type 1 or 2 from the maternal genital tract at the time of vaginal delivery. Current guidelines recommend (1) cesarean delivery if maternal genital HSV lesions are present at the time of labor and (2) antiviral suppressive therapy for women with known genital herpes to decrease HSV shedding from the genital tract at the time of vaginal delivery. However, most neonatal infections occur in infants born to women without a history of genital HSV, making current prevention efforts ineffective for this group. Although routine serologic HSV testing of women during pregnancy could identify women at higher risk of intrapartum viral shedding, it is uncertain how this knowledge might impact intrapartum management, and a potential concern is a higher rate of cesarean sections among women known to be HSV-2 seropositive.MethodsTo assess the effects of prenatal HSV-2 antibody testing, history of genital herpes, and use of suppressive antiviral medication on the intrapartum management of women, we investigated the frequency of invasive obstetric procedures and cesarean deliveries. We conducted a retrospective cohort study of pregnant women delivering at the University of Washington Medical center in Seattle, Washington. We defined the exposure of interest as HSV-2 antibody positivity or known history of genital herpes noted in prenatal records. The primary outcome was intrapartum procedures including fetal scalp electrode, artificial rupture of membranes, intrauterine pressure catheter, or operative vaginal delivery (vacuum or forceps). The secondary outcome was incidence of cesarean birth. Univariate and multivariable logistic regressions were performed.ResultsFrom a total of 449 women included in the analysis, 97 (21.6%) were HSV-2 seropositive or had a history of genital herpes (HSV-2/GH). Herpes simplex virus-2/GH women not using suppressive antiviral therapy were less likely to undergo intrapartum procedures than women without HSV-2/GH (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25-0.95; P = .036), but this relationship was attenuated after adjustment for potential confounders (adjusted OR, 0.69; 95% CI, 0.34-1.41; P = .31). There was no difference in intrapartum procedures for women on suppressive therapy versus women without HSV-2/GH (OR, 1.17; 95% CI, 0.66-2.07; P = .60). Similar proportions of cesarean sections were performed within each group of women: 25% without history of HSV-2/GH, 30% on suppressive treatment, and 28.1% without suppressive treatment (global, P = .73).ConclusionsIn this single-site study, provider awareness of genital herpes infection either by HSV serotesting or history was associated with fewer invasive obstetric procedures shown to be associated with neonatal herpes, but it was not associated with an increased rate of cesarean birth

Five-Dimensional Charged Rotating Black Holes

We consider charged rotating black holes in 5-dimensional Einstein-Maxwell theory. These black holes are asymptotically flat, they possess a regular horizon of spherical topology and two independent angular momenta associated with two distinct planes of rotation. We discuss their global and horizon properties, and derive a generalized Smarr formula. We construct these black holes numerically, focussing on black holes with a single angular momentum, and with two equal-magnitude angular momenta.Comment: 13 pages, 8 figure

Occupational Exposure to Hydrazine and Subsequent Risk of Lung Cancer: 50-Year Follow-Up

Hydrazine is carcinogenic in animals, but there is inadequate evidence to determine if it is carcinogenic in humans. This study aimed to evaluate the association between hydrazine exposure and the risk of lung cancer.The cause specific mortality rates of a cohort of 427 men who were employed at an English factory that produced hydrazine between 1945 and 1971 were compared with national mortality rates.By the end of December 2012 205 deaths had occurred. For men in the highest exposure category with greater than two years exposure and after more than ten years since first exposure the relative risks compared with national rates were: 0.85 (95% CI: 0.18-2.48) for lung cancer, 0.61 (95% CI: 0.07-2.21) for cancers of the digestive system, and 0.44 (95% CI: 0.05-1.57) for other cancers.After 50 years of follow up, the results provide no evidence of an increased risk of death from lung cancer or death from any other cause

Toll-like receptor gene variants and bacterial vaginosis among HIV-1 infected and uninfected African women.

Bacterial vaginosis (BV) is a common vaginal syndrome associated with altered microflora that increases the risk of preterm delivery and acquisition of sexually transmitted diseases. The cause of BV is unknown although toll-like receptors (TLRs), that are central to innate immune responses, may be important. We evaluated associations between TLR SNPs and BV among HIV-1 infected and uninfected African women. Logistic regression was used to assess associations between SNPs (N=99) in TLRs 2-4, 7-9 and BV (as classified by Nugent's criteria). Among HIV-1 uninfected women, TLR7 rs5743737 and TLR7 rs1634323 were associated with a decreased risk of BV, whereas TLR7 rs179012 was associated with an increased risk. TLR2 SNP rs3804099 was associated with a decreased risk of BV among HIV-1 infected women. Our findings indicate that there may be differences in TLR association with BV among HIV-1 infected and HIV-1 uninfected women

CD4 T-cell memory responses to viral infections of humans show pronounced immunodominance independent of duration or viral persistence

Little is known concerning immunodominance within the CD4 T-cell response to viral infections and its persistence into longterm memory. We tested CD4 T-cell reactivity against each viral protein in persons immunized with vaccinia virus (VV), either recently or more than 40 years ago, as a model self-limited v

Effect of Pritelivir Compared With Valacyclovir on Genital HSV-2 Shedding in Patients With Frequent Recurrences A Randomized Clinical Trial

Importance Current therapy of herpes infections relies on nucleoside analogues. Pritelivir is a well-tolerated novel herpes simplex virus (HSV) helicase-primase inhibitor that reduced genital shedding and lesions. Objective To compare the efficacy of pritelivir with valacyclovir for suppression of genital HSV-2 infection. Design, Setting, and Participants A phase 2, randomized, double-blind, crossover clinical trial at clinical research centers in 4 US cities (October 2012-July 2013) compared daily oral doses of 100 mg of pritelivir with 500 mg of valacyclovir. The planned sample size was 98 adults, allowing for detection of a 50% reduction in viral shedding between the study treatments. Healthy adults with 4 to 9 annual genital HSV-2 recurrences were eligible. Ninety-one participants were randomized: 45 to receive pritelivir and 46 to receive valacyclovir first when the US Food and Drug Administration placed the trial on clinical hold based on findings in a concurrent nonclinical toxicity study, and the sponsor terminated the study. Interventions Participants took the first drug for 28 days followed by 28 days of washout before taking the second drug for 28 days. Throughout treatment, the participants collected genital swabs 4 times daily for testing by HSV polymerase chain reaction assays. Main Outcomes and Measures The primary end point was within-participant genital HSV shedding while receiving pritelivir compared with valacyclovir. Secondary end points included the quantity of HSV in positive swabs and the frequency of genital lesions and shedding episodes. Results Of the 91 randomized participants (median age, 48 years; 57 women [63%]), 56 had completed both treatment periods at the time of the study’s termination. In intent-to-treat analyses, HSV shedding was detected in 2.4% (173 of 7276 ) of swabs during pritelivir treatment compared with 5.3% (392 of 7453) during valacyclovir treatment (relative risk [RR], 0.42; 95% CI, 0.21 to 0.82; P = .01). In swabs with HSV, the mean quantity of HSV was 3.2 log10 copies/mL during pritelivir treatment vs 3.7 log10 copies/mL during valacyclovir treatment (difference, −0.1; 95% CI, −0.6 to 0.5; P = .83). Genital lesions were present on 1.9% of days in the pritelivir group vs 3.9% in the valacyclovir group (RR, 0.40; 95% CI, 0.17-0.96; P = .04). The frequency of shedding episodes did not differ by group, with 1.3 per person-month for pritelivir and 1.6 per person-month for valacyclovir (RR, 0.80; 95% CI, 0.52 to 1.22; P = .29). Treatment-emergent adverse events occurred in 62.3% of participants in the pritelivir group and 69.2% of participants in the valacyclovir group. Conclusions and Relevance Among adults with frequently recurring genital HSV-2, the use of pritelivir compared with valacyclovir resulted in a lower percentage of swabs with HSV detection over 28 days. Further research is needed to assess longer-term efficacy and safety

Fire test of timber-fibre concrete composite floor

Furnace test was performed on one full-size floor specimen at the Fire testing laboratory PAVUS. Floor specimen was 4.5 m long and 3 m wide, consisting of 60 mm fibre concrete topping on plywood formwork, connected to GL floor joists. It was subjected the standard fire for over 150 min. The membrane effect of the floor was progressively activated. The project is part of the experimental research that deals with the effect of membrane action of composite steel fibre reinforced floor slabs exposed to fire and continuous on previous research on steel fibre reinforced concrete slabs. The main objective of the project is the preparation of the analytical prediction model for the fire resistance of the steel-concrete and timber-concrete slab with steel fibre concrete

Cats and Conservationists: The Debate Over Who Owns the Outdoors

Cats and Conservationists is the first multidisciplinary analysis of the heated debate about free-roaming cats. The debate pits conservationists against cat lovers, who disagree both on the ecological damage caused by the cats and the best way to manage them. An impassioned and spirited conflict, it also sheds light on larger questions about how we interpret science, incorporate diverse perspectives, and balance competing values in order to encourage constructive dialogue on contentious social and environmental issues. On one side of the cat debate stand many environmentalists, especially birders and conservation organizations, who believe that outdoor cats seriously threaten native wildlife. On the other side are many animal welfare advocates, who believe that outdoor cats generally do not pose a major ecological threat and that it is possible for cats and wildlife to coexist. They believe that it is possible, mainly through trap-neuter-return projects (TNR), to keep free-roaming cat populations in check without killing large numbers of cats. Careful analysis suggests that there remain important questions about the science on both cat predation and TNR effectiveness. Yet both sides of the conflict insist that the evidence is clear-cut. This false certainty contributes to conflict between conservationists and cat lovers, and obscures common goals that could generate constructive discussions and collaborative efforts among scientists, policymakers, conservationists, and animal welfare advocates. Cats and Conservationists aims to facilitate such collaboration in order to manage outdoor cats and minimize the damage they cause. It also offers models for constructive debates about the public role of science in other polarized public conflicts over science and environmental topics.https://docs.lib.purdue.edu/purduepress_previews/1046/thumbnail.jp

Cats and Conservationists

Cats and Conservationists is the first multidisciplinary analysis of the heated debate about free-roaming cats. The debate pits conservationists against cat lovers, who disagree both on the ecological damage caused by the cats and the best way to manage them. An impassioned and spirited conflict, it also sheds light on larger questions about how we interpret science, incorporate diverse perspectives, and balance competing values in order to encourage constructive dialogue on contentious social and environmental issues. On one side of the cat debate stand many environmentalists, especially birders and conservation organizations, who believe that outdoor cats seriously threaten native wildlife. On the other side are many animal welfare advocates, who believe that outdoor cats generally do not pose a major ecological threat and that it is possible for cats and wildlife to coexist. They believe that it is possible, mainly through trap-neuter-return projects (TNR), to keep free-roaming cat populations in check without killing large numbers of cats. Careful analysis suggests that there remain important questions about the science on both cat predation and TNR effectiveness. Yet both sides of the conflict insist that the evidence is clear-cut. This false certainty contributes to conflict between conservationists and cat lovers, and obscures common goals that could generate constructive discussions and collaborative efforts among scientists, policymakers, conservationists, and animal welfare advocates. Cats and Conservationists aims to facilitate such collaboration in order to manage outdoor cats and minimize the damage they cause. It also offers models for constructive debates about the public role of science in other polarized public conflicts over science and environmental topics