Viral suppression in adolescents on antiretroviral treatment: review of the literature and critical appraisal of methodological challenges.

OBJECTIVE: Medication adherence is often suboptimal for adolescents with HIV, and establishing correct weight-based antiretroviral therapy dosing is difficult, contributing to virological failure. This review aimed to determine the proportion of adolescents achieving virological suppression after initiating ART. METHODS: MEDLINE, EMBASE and Web of Science databases were searched. Studies published between January 2004 and September 2014 including ≥50 adolescents taking ART and reporting on the proportion of virological suppressed participants were included. RESULTS: From a total of 5316 potentially relevant citations, 20 studies were included. Only eight studies reported the proportion of adolescents that were virologically suppressed at a specified time point. The proportion of adolescents with virological suppression at 12 months ranged from 27 to 89%. CONCLUSION: Adolescent achievement of HIV virological suppression was highly variable. Improved reporting of virological outcomes from a wider range of settings is required to support efforts to improve HIV care and treatment for adolescents

National Stereotypes and Robots' Perception: The “Made in” Effect

In the near future, the human social environment worldwide might be populated by humanoid robots. The way we perceive these new social agents could depend on basic social psychological processes such as social categorization. Recent results indicate that humans can make use of social stereotypes when faced with robots based on their characterization as “male” or “female” and a perception of their group membership. However, the question of the application of nationality-based stereotypes to robots has not yet been studied. Given that humans attribute different levels of warmth and competence (the two universal dimensions of social perception) to individuals based in part on their nationality, we hypothesized that the way robots are perceived differs depending on their country of origin. In this study, participants had to evaluate four robots differing in their anthropomorphic shape. For each participant, these robots were presented as coming from one of four different countries selected for their level of perceived warmth and competence. Each robot was evaluated on their anthropomorphic and human traits. As expected, the country of origin's warmth and competence level biased the perception of robots in terms of the attribution of social and human traits. Our findings also indicated that these effects differed according to the extent to which the robots were anthropomorphically shaped. We discuss these results in relation to the way in which social constructs are applied to robots

Research response to coronavirus disease 2019 needed better coordination and collaboration: a living mapping of registered trials

Objectives: Researchers worldwide are actively engaging in research activities to search for preventive and therapeutic interventions against coronavirus disease 2019 (COVID-19). Our aim was to describe the planning of randomized controlled trials (RCTs) in terms of timing related to the course of the COVID-19 epidemic and research question evaluated. Study Design and Setting: We performed a living mapping of RCTs registered in the WHO International Clinical Trials Registry Platform. We systematically search the platform every week for all RCTs evaluating preventive interventions and treatments for COVID-19 and created a publicly available interactive mapping tool at https://covid-nma.com to visualize all trials registered. Results: By August 12, 2020, 1,568 trials for COVID-19 were registered worldwide. Overall, the median ([Q1–Q3]; range) delay between the first case recorded in each country and the first RCT registered was 47 days ([33–67]; 15–163). For the 9 countries with the highest number of trials registered, most trials were registered after the peak of the epidemic (from 100% trials in Italy to 38% in the United States). Most trials evaluated treatments (1,333 trials; 85%); only 223 (14%) evaluated preventive strategies and 12 postacute period intervention. A total of 254 trials were planned to assess different regimens of hydroxychloroquine with an expected sample size of 110,883 patients. Conclusion: This living mapping analysis showed that COVID-19 trials have relatively small sample size with certain redundancy in research questions. Most trials were registered when the first peak of the pandemic has passed

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Smart nanofibrous electrospun membrane for bone regeNEration

Les nanotechnologies sont en train de révolutionner le domaine biomédical et plus particulièrement l’ingénierie tissulaire. Elles permettent aujourd’hui, non seulement de réparer mais aussi de régénérer les tissus. Cette nanomédecine régénérative est particulièrement adaptée pour répondre aux besoins importants liés aux maladies dégénératives, au vieillissement et aux traumatismes.Mon travail de thèse s’inscrit dans ce contexte et concerne l’élaboration de biomatériaux nanofibreux et microporeux actifs pour la régénération osseuse. Notre objectif essentiel est de réaliser un implant biodégradable nanostructuré permettant d’accélérer la réparation du tissu osseux. Notre stratégie innovante repose non seulement sur la mise en oeuvre de membranes par électrospinning mais aussi sur leur fonctionnalisation par des facteurs de croissance. Cette fonctionnalisation originale a consisté à enrober ces principes actifs dans des nanoréservoirs en utilisant la technique multicouche de polyélectrolytes. Des membranes de polycaprolactone (PCL) nanofibreuses et microporeuses ont été obtenues par électrospinning puis les fibres ont été enrobées de réservoirs contenant le facteur ostéoinducteur, la protéine morphogénique osseuse 2 (BMP-2). L’induction osseuse engendrée par ces réservoirs actifs a été mise en évidence in vitro après culture d’ostéoblastes humains primaires. Des expérimentations in vivo chez la souris ont permis de confirmer l’accélération de la régénération osseuse grâce à ces nanoréservoirs.Cette même stratégie a été validée in vivo, chez la souris, en utilisant des membranes de collagène d’origine animal commerciales utilisées en clinique. L’activité de ces membranes fonctionnalisées par des nanoréservoirs de BMP-2 est en cours d’analyse dans le cadre de tests précliniques pour une application maxillofaciale et parodontale.Nanobiotechnology enables the emergence of entirely new classes of bioactive devices intended for targeted intracellular delivery for more efficiency and less toxicities. Tissue engineering is an interdisciplinary field that has attempted to implement a variety of processing methods for synthetic and natural polymers to fabricate tissue and organ regeneration scaffolds.We report here the first demonstration of bone regeneration by using a strategy based on a synthetic nanostructured membrane. This electrospun membrane is manufactured by using a FDA approved polymer, PCL, (polycaprolactone), and functionalized with nanoreservoirs of a growth factor (BMP-2). Our expected outcomes are the development of clinical applications in the field of tissue engineering and nanomedecine and particularly in bone regeneration.We propose the development of smart nanostructured active implants for regenerative medicine. Our strategycombines a synthetic biodegradable electrospun nanofibrous membrane based on PCL and a bioactive growth factor (BMP-2) entrapped into polymer nanoreservoirs built atop the nanofibers according to the layer-by-layer technology. In this study, by using primary osteoblasts, we have shown the capacity of these sophisticated implants to promote and accelerate not only in vitro bone induction; but also, in vivo, bone formation (mouse model).We have also validated our strategy, in vivo (mouse model), by using an already used in the clinic collagen membrane (animal origin) to accelerate bone regeneration. This unique strategy is used to entrap, protect and stabilize the therapeutic agent into polymer coating acting as nanoreservoirs enrobing fibers of membranes

Smart nanofibrous electrospun membrane for bone regeNEration

Les nanotechnologies sont en train de révolutionner le domaine biomédical et plus particulièrement l’ingénierie tissulaire. Elles permettent aujourd’hui, non seulement de réparer mais aussi de régénérer les tissus. Cette nanomédecine régénérative est particulièrement adaptée pour répondre aux besoins importants liés aux maladies dégénératives, au vieillissement et aux traumatismes.Mon travail de thèse s’inscrit dans ce contexte et concerne l’élaboration de biomatériaux nanofibreux et microporeux actifs pour la régénération osseuse. Notre objectif essentiel est de réaliser un implant biodégradable nanostructuré permettant d’accélérer la réparation du tissu osseux. Notre stratégie innovante repose non seulement sur la mise en oeuvre de membranes par électrospinning mais aussi sur leur fonctionnalisation par des facteurs de croissance. Cette fonctionnalisation originale a consisté à enrober ces principes actifs dans des nanoréservoirs en utilisant la technique multicouche de polyélectrolytes. Des membranes de polycaprolactone (PCL) nanofibreuses et microporeuses ont été obtenues par électrospinning puis les fibres ont été enrobées de réservoirs contenant le facteur ostéoinducteur, la protéine morphogénique osseuse 2 (BMP-2). L’induction osseuse engendrée par ces réservoirs actifs a été mise en évidence in vitro après culture d’ostéoblastes humains primaires. Des expérimentations in vivo chez la souris ont permis de confirmer l’accélération de la régénération osseuse grâce à ces nanoréservoirs.Cette même stratégie a été validée in vivo, chez la souris, en utilisant des membranes de collagène d’origine animal commerciales utilisées en clinique. L’activité de ces membranes fonctionnalisées par des nanoréservoirs de BMP-2 est en cours d’analyse dans le cadre de tests précliniques pour une application maxillofaciale et parodontale.Nanobiotechnology enables the emergence of entirely new classes of bioactive devices intended for targeted intracellular delivery for more efficiency and less toxicities. Tissue engineering is an interdisciplinary field that has attempted to implement a variety of processing methods for synthetic and natural polymers to fabricate tissue and organ regeneration scaffolds.We report here the first demonstration of bone regeneration by using a strategy based on a synthetic nanostructured membrane. This electrospun membrane is manufactured by using a FDA approved polymer, PCL, (polycaprolactone), and functionalized with nanoreservoirs of a growth factor (BMP-2). Our expected outcomes are the development of clinical applications in the field of tissue engineering and nanomedecine and particularly in bone regeneration.We propose the development of smart nanostructured active implants for regenerative medicine. Our strategycombines a synthetic biodegradable electrospun nanofibrous membrane based on PCL and a bioactive growth factor (BMP-2) entrapped into polymer nanoreservoirs built atop the nanofibers according to the layer-by-layer technology. In this study, by using primary osteoblasts, we have shown the capacity of these sophisticated implants to promote and accelerate not only in vitro bone induction; but also, in vivo, bone formation (mouse model).We have also validated our strategy, in vivo (mouse model), by using an already used in the clinic collagen membrane (animal origin) to accelerate bone regeneration. This unique strategy is used to entrap, protect and stabilize the therapeutic agent into polymer coating acting as nanoreservoirs enrobing fibers of membranes

"Longing Ladies" and Witty Heroines : ‎The Representation of Women in the Comedies by Molière and Etherege

This work will focus on the representation of women of all ages and social statuses in the comedies by Molière and Etherege. In England, the Restoration period is a tipping point in the relationship between women and theatre, with women being allowed to act on stage, the rise of female spectatorship and, in the second part of the era, the emergence of female playwrights. French theatre is also subject to some changes, albeit a bit earlier, in the 1630s, with the comedies becoming more polished, thus drawing in more women and upper-class people, creating a mixed audience that influences the development of the plays of the second half of the seventeenth century, including Molière’s. We shall endeavour to compare how these playwrights – who both also staged their own plays – build their female characters, both through the significance of their actions in the plays and through their discourse and that of the other characters, and how this representation evolves during the second half of the seventeenth century. This study will focus on three main questions: that of the importance of female characters in the structure of the plays, that of their comic role, as well as that of the feminisation of the stage, with the progressive appearance of, as has been mentioned already, actresses, as well as female playwrights and female perspectives on stage. These topics will also lead us to analyse the relation of the audience to these characters and whether they offered a “realistic” portrayal of the people and mores of their time, or even, in the case of young gentlewomen, an ideal to try and reproduce in real life. The central corpus studied here is comprised of Etherege’s three plays, The Comical Revenge or Love in a Tub (1664), She wou’d if she cou’d (1668) and The Man of Mode, or Sir Fopling Flutter (1676), as well as plays both representative of Molière’s vast production, containing typical elements of the comédie de moeurs, and that represent typical or particularly interesting female characters, L’École des femmes (1662), Le Tartuffe (1664) and Le Misanthrope (1666), as well as Les Fourberies de Scapin (1971), which is one of Molière’s later plays and is considered to be a blend of comédie de moeurs and farce in the Italian tradition, that is to say, a buffoon type of comedy that relies on exaggeration, absurdity and physical comedy. Occasional reference may be made to other plays, both by Molière and by other Restoration playwrights. Additionally, references will be made to present-day productions of the plays of the corpus, as sources on seventeenth-century productions are scarce and only studying the text of the plays amputates them from the essential feature of theatrical texts, which is that they are meant to be represented in front of an audience