Implementing antiretroviral resistance testing in a primary health care HIV treatment programme in rural KwaZulu-Natal, South Africa: early experiences, achievements and challenges.

BACKGROUND: Antiretroviral drug resistance is becoming increasingly common with the expansion of human immunodeficiency virus (HIV) treatment programmes in high prevalence settings. Genotypic resistance testing could have benefit in guiding individual-level treatment decisions but successful models for delivering resistance testing in low- and middle-income countries have not been reported. METHODS: An HIV Treatment Failure Clinic model was implemented within a large primary health care HIV treatment programme in northern KwaZulu-Natal, South Africa. Genotypic resistance testing was offered to adults (≥16 years) with virological failure on first-line antiretroviral therapy (one viral load >1000 copies/ml after at least 12 months on a standard first-line regimen). A genotypic resistance test report was generated with treatment recommendations from a specialist HIV clinician and sent to medical officers at the clinics who were responsible for patient management. A quantitative process evaluation was conducted to determine how the model was implemented and to provide feedback regarding barriers and challenges to delivery. RESULTS: A total of 508 specimens were submitted for genotyping between 8 April 2011 and 31 January 2013; in 438 cases (86.2%) a complete genotype report with recommendations from the specialist clinician was sent to the medical officer. The median turnaround time from specimen collection to receipt of final report was 18 days (interquartile range (IQR) 13-29). In 114 (26.0%) cases the recommended treatment differed from what would be given in the absence of drug resistance testing. In the majority of cases (n = 315, 71.9%), the subsequent treatment prescribed was in line with the recommendations of the report. CONCLUSIONS: Genotypic resistance testing was successfully implemented in this large primary health care HIV programme and the system functioned well enough for the results to influence clinical management decisions in real time. Further research will explore the impact and cost-effectiveness of different implementation models in different settings

A framework for the classification and prioritization of arrival and departure routes in Multi-Airport Systems Terminal Manoeuvring Areas

© 2015 American Institute of Aeronautics and Astronautics Inc, AIAA. All right reserved.Typically major cities (London, New York, Tokyo) are served by several airports effectively creating a Multi-Airport System or Metroplex. The operations of the Metroplex airports are highly dependent on one another, which renders their efficient management difficult. This paper proposes a framework for the prioritization of arrival and departure routes in Multi-Airport Systems Terminal Manoeuvring Areas. The framework consists of three components. The first component presents a new procedure for clustering arrival and departure flights into dynamic routes based on their temporal and spatial distributions through the identification of the important traffic flow patterns throughout the day of operations. The second component is a novel Analytic Hierarchy Process model for the prioritization of the dynamic routes, accounting for a set of quantitative and qualitative characteristics important for Multi-Airport Systems operations. The third component is a priority-based model for the facility location of the optimal terminal waypoints (fixes), which accounts for the derived priorities of each dynamic route, while meeting the required separation distances. The proposed Analytic Hierarchy Process model characteristics are validated by subject matter experts. The developed framework is applied to the London Metroplex case study

Characterization of two new CTX-M-25-group extended-spectrum β-lactamase variants identified in Escherichia coli isolates from Israel.

OBJECTIVES: We characterized two new CTX-M-type extended-spectrum β-lactamase (ESBL) variants in Escherichia coli isolates from stool samples of two elderly patients admitted at the Tel Aviv Sourasky Medical Center, Israel. Both patients underwent treatment with cephalosporins prior to isolation of the E. coli strains. METHODS: ESBLs were detected by the double-disk synergy test and PCR-sequencing of β-lactamase genes. The bla(CTX-M) genes were cloned into the pCR-BluntII-TOPO vector in E. coli TOP10. The role of amino-acid substitutions V77A and D240G was analyzed by site-directed mutagenesis of the bla(CTX-M-94) and bla(CTX-M-100) genes and comparative characterization of the resulting E. coli recombinants. MICs of β-lactams were determined by Etest. Plasmid profiling, mating experiments, replicon typing and sequencing of bla(CTX-M) flanking regions were performed to identify the genetic background of the new CTX-M variants. RESULTS: The novel CTX-M β-lactamases, CTX-M-94 and -100, belonged to the CTX-M-25-group. Both variants differed from CTX-M-25 by the substitution V77A, and from CTX-M-39 by D240G. CTX-M-94 differed from all CTX-M-25-group enzymes by the substitution F119L. Glycine-240 was associated with reduced susceptibility to ceftazidime and leucine-119 with increased resistance to ceftriaxone. bla(CTX-M-94) and bla(CTX-M-100) were located within ISEcp1 transposition units inserted into ∼93 kb non-conjugative IncFI and ∼130 kb conjugative IncA/C plasmids, respectively. The plasmids carried also different class 1 integrons. CONCLUSIONS: This is the first report on CTX-M-94 and -100 ESBLs, novel members of the CTX-M-25-group

GM Master Sale and Purchase Agreement

Contains Definitions, Purchase and Sale, Closing; Purchase Price, Representations and Warranties of Sellers, Representation and Warranties of Purchaser, and Covenants, Conditions to Closing, Termination, Miscellaneous

Nasally-Administered Oxytocin Has Limited Effects on Owner-Directed Attachment Behavior in Pet Dogs (Canis lupus familiaris)

The present study explored the effects of intranasal oxytocin, a naturally occurring hormone, on the behavior of pet dogs during an attachment test. Each dog participated in two testing sessions. On one visit saline was administered nasally, and on another, oxytocin was administered nasally. For half of the dogs (n = 20), solutions were administered with a Mucosal Atomization Device (MAD) and for half of the dogs (n = 20), solutions were administered using a nasal spray bottle. Condition order was counterbalanced and a double-blind methodology was employed. Following a 30-min wait period after administration of solutions, dog-owner pairs participated in the Secure Base Test, a short attachment test consisting of three 2-min phases: (1) Baseline- the owner was present, dogs were able to freely explore the testing room (2) Alone- dogs were left alone in the testing room (3) Return- owners re-entered the room and were reunited with their dog. In each phase the dog was evaluated for contact seeking, exploration, and avoidance behaviors. Although, oxytocin administration was expected to increase owner-directed proximity and contact seeking behavior, this effect was not observed. In fact, in the baseline phase, dogs spent significantly more time seeking the proximity of their owners when they received saline than when they received OT (p \u3c 0.05). Sex differences were also assessed for the behavioral variables of interest in the Secure Base Test, and results indicated that OT did not affect dogs\u27 behavior in the alone phase, but when saline was administered, females spent significantly more time in contact with the door than males in the alone phase (p \u3c 0.05). Overall, the effects of nasally administered oxytocin on attachment related behavior appeared to be limited or inconsistent for this pet dog population

Short alleles, bigger smiles? The effect of 5-HTTLPR on positive emotional expressions.

The present research examined the effect of the 5-HTTLPR polymorphism in the serotonin transporter gene on objectively coded positive emotional expressions (i.e., laughing and smiling behavior objectively coded using the Facial Action Coding System). Three studies with independent samples of participants were conducted. Study 1 examined young adults watching still cartoons. Study 2 examined young, middle-aged, and older adults watching a thematically ambiguous yet subtly amusing film clip. Study 3 examined middle-aged and older spouses discussing an area of marital conflict (that typically produces both positive and negative emotion). Aggregating data across studies, results showed that the short allele of 5-HTTLPR predicted heightened positive emotional expressions. Results remained stable when controlling for age, gender, ethnicity, and depressive symptoms. These findings are consistent with the notion that the short allele of 5-HTTLPR functions as an emotion amplifier, which may confer heightened susceptibility to environmental conditions

Concert recording 2019-11-20

[Track 1]. Quatour pour saxophones. I. Gaiete Villageoise / F. & M. Jeanjean -- [Track 2]. Memory from Nepomuk\u27s dances / Marcelo Zarvos -- [Track 3]. Quatour pour saxophones. II. Doloroso III. Spirituoso / P.M. Dubois -- [Track 4]. Danza 2016 / Lucky Chops -- [Track 5]. Howler back / Zack Browning -- [Track 6]. Dusk / Steven Bryant -- [Track 7]. Oileain reel / Craig Richards

Results at 1 Year from SATURN, A European, Prospective, Multicenter Registry for Male Stress Urinary Incontinence Surgery

Background and objective: The European, prospective, multicenter SATURN registry was developed to analyze surgical devices for male stress urinary incontinence. The primary objective is the cure rate during follow-up. Methods: Efficacy, complications, patient-reported outcomes, and prognostic factors are being analyzed at various intervals during 10-yr follow-up. The results at 1-yr follow-up are presented here. Key findings and limitations: The cohort included 1046 patients (mean age 70 yr) from 28 centers in nine countries. The main cause of incontinence was radical prostatectomy (83.5%), followed by radiotherapy (4.5%), endourological procedures (9.7%), neurogenic conditions (1.0%), and trauma (0.2%). Some 19.5% of the patients underwent at least one incontinence procedure before registry inclusion. A baseline pad test was performed in 64% of the patients (mean 525 g, range 3.5–3600), urodynamics in 66%, and cystoscopy in 80%. The main implants used were AMS800 (n = 684) and Advance (n = 210) devices, followed by Atoms (n = 63) Victo/Plus (n = 33), ProACT (n = 30), and others (n = 24). A total of 896 patients had 1-yr follow-up data, of whom 164 completed a 1-yr pad test. Self-reported complete incontinence rates at baseline by device were as follows: Advance, 17%; other slings, 33%; ProACT, 0%; AMS800, 49%; other sphincter prosthesis, 100%; and overall group, 44%. The corresponding 1-yr self-reported continence rates were 73%, 37%, 50%, 76%, 11%, and 68%. Some 32% of the patients were still incontinent. Overall, 132 patients had at least one revision. Among the 110 patients with an artificial urinary sphincter (AUS), 122 revisions were performed, while there were 29 revisions for the 22 patients with a sling or ProACT device. International Consultation on Incontinence Questionnaire Short Form and EuroQol 5-dimensions 5-levels scores improved with all devices. Conclusions and clinical implications: AUS implants are used in cases with more severe incontinence and are associated with better outcomes but more revisions than the alternatives. Patients report that every improvement is important. Choices for procedures should be made on the basis of these considerations. Patient summary: We collected data from 29 urology departments in Europe on surgical treatments for patients who suffer from incontinence during exercise, sneezing, and coughing. Results after 1 year show that an artificial urinary sphincter has the best outcomes overall and for patients with heavy urine loss. However, this surgery also requires more revisions. Patients report that every improvement in continence is important to them

The Social Significance of Spirituality: New Perspectives on the Compassion-Altruism Relationship

In the current research we tested a comprehensive model of spirituality, religiosity, compassion, and altruism, investigating the independent effects of spirituality and religiosity on compassion and altruism. We hypothesized that, even though spirituality and religiosity are closely related, spirituality and religiosity would have different and unique associations with compassion and altruism. In Study 1 and 2 we documented that more spiritual individuals experience and show greater compassion. The link between religiosity and compassion was no longer significant after controlling for the impact of spirituality. Compassion has the capacity to motivate people to transcend selfish motives and act altruistically towards strangers. Therefore, we reasoned that spirituality (but not religiosity) would predict altruistic behavior and that compassion would help explain this link. Indeed, in Studies 3, 4, and 5 we found that more spiritual individuals behaved more altruistically in economic choice and decision-making tasks, and that the tendency of spiritual individuals to feel greater compassion mediated the spirituality-to-altruism relationship. In contrast, more religious participants did not consistently feel more compassion nor behave more altruistically. Moreover, in Studies 3 and 4 we found that the broader traits of Agreeableness, Openness, and Extraversion did not help explain why more spiritual individuals behaved more altruistically. Our findings argue that spirituality—above and beyond religiosity—is uniquely associated with greater compassion and enhanced altruism towards strangers.Keywords: altruism, behavioral economics, religion, spirituality, compassio