147 research outputs found

    Micronutrients in HIV: A Bayesian MetaAnalysis

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    Background: Approximately 28.5 million people living with HIV are eligible for treatment (CD4&500), but currently have no access to antiretroviral therapy. Reduced serum level of micronutrients is common in HIV disease. Micronutrient supplementation (MNS) may mitigate disease progression and mortality. Objectives: We synthesized evidence on the effect of micronutrient supplementation on mortality and rate of disease progression in HIV disease. Methods: We searched MEDLINE, EMBASE, the Cochrane Central, AMED and CINAHL databases through December 2014, without language restriction, for studies of greater than 3 micronutrients versus any or no comparator. We built a hierarchical Bayesian random effects model to synthesize results. Inferences are based on the posterior distribution of the population effects; posterior distributions were approximated by Markov chain Monte Carlo in OpenBugs. Principal Findings: From 2166 initial references, we selected 49 studies for full review and identified eight reporting on disease progression and/or mortality. Bayesian synthesis of data from 2,249 adults in three studies estimated the relative risk of disease progression in subjects on MNS vs. control as 0.62 (95% credible interval, 0.37, 0.96). Median number needed to treat is 8.4 (4.8, 29.9) and the Bayes Factor 53.4. Based on data reporting on 4,095 adults reporting mortality in 7 randomized controlled studies, the RR was 0.84 (0.38, 1.85), NNT is 25 (4.3, ∞). Conclusions: MNS significantly and substantially slows disease progression in HIV+ adults not on ARV, and possibly reduces mortality. Micronutrient supplements are effective in reducing progression with a posterior probability of 97.9%. Considering MNS low cost and lack of adverse effects, MNS should be standard of care for HIV+ adults not yet on ARV

    Factors influencing patients’ recovery and the efficacy of a psychosocial post-discharge intervention : post hoc analysis of a randomized controlled trial

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    Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Purpose: The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme. Methods: RCT using parallel group block randomisation, including 151 patients with ≤3 hospitalisations within the last 3 years, a GAF score ≤60, and aged 18–64 years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU). Results: Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d = 0.44). In the TAU group, 15.6 % remained clinically impaired at 12-month follow-up as opposed to 48.1 % in the intervention group (p = 0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d = 0.46). Involuntary index admission (d = 0.42) and high educational degree (d = 0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU. Conclusions: According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients’ social networks

    Stickstoffmonitoring sächsischer Böden

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    Mit der vorliegenden Broschüre werden die Ergebnisse des Sächsischen Landesamtes für Umwelt, Landwirtschaft und Geologie, des Staatsbetriebes Sachsenforst und der Staatlichen Betriebsgesellschaft für Umwelt und Landwirtschaft gemeinsam vorgestellt. Aus mehrjährigen acker- und pflanzenbaulichen sowie forstlichen Untersuchungen liegen umfangreiche Ergebnisse zu Stickstoffdüngung, -aufnahme, -bilanz und -dynamik unter sächsischen Bedingungen vor. Die zusammenfassende Darstellung der Ergebnisse zeigt, dass regelmäßige Auswertungen der in den verschiedenen Messnetzen erhobenen Parameter und Messreihen die Plattform für ein integriertes und ressortübergreifendes Stickstoffmonitoring bilden können. Die Broschüre liefert einen Beitrag zur Bewertung der Stickstoffbelastung und enthält Handlungsempfehlungen für Flächenbewirtschafter sowie für die Verwaltung

    Antidepressant Use During Acute Inpatient Care Is Associated With an Increased Risk of Psychiatric Rehospitalisation Over a 12-Month Follow-Up After Discharge

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    Background: Some evidence suggests that antidepressants may relate to poor outcomes in depression. The aim of this study was, therefore, to examine, whether antidepressant use may worsen the long-term outcome in real-world psychiatric patients with both primarily affective and non-affective mental disorders.Methods: Based on a total of n = 151 inpatients with a mixed range of diagnoses enrolled at two psychiatric hospitals in Zurich, Switzerland, matched pairs of n = 45 antidepressant users and n = 45 non-users were selected via nearest neighbor propensity score matching. Pairs were matched according to 14 clinically relevant covariates assessing psychosocial impairments, functioning deficits and illness severity. The two outcomes of interest were the number and total duration of all rehospitalisations over a 12-month follow-up after discharge from the hospital based on the official clinical registry.Results: Altogether 35.6% of antidepressant users were rehospitalised at least once, as compared to 22.2% in matched non-users. Two or more rehospitalisations occurred in 22.2% of antidepressant users but only in 2.2% of non-users. In antidepressant users, the mean total duration of rehospitalisations was 22.22 days, as compared to 8.51 in matched non-users. According to Poisson regression analyses, antidepressant use during acute inpatient care prospectively relates to both a higher risk (incidence rate ratio [IRR] = 3.64, 95% confidence interval [95%-CI] = 1.71–7.75, p = 0.001) and a longer duration (IRR = 2.61, 95%-CI = 1.01–6.79, p = 0.049) of subsequent rehospitalisations. These findings were consistently replicated when traditional multivariable regression analysis was applied to the full sample. Findings also replicated when patients with affective and non-affective disorders were analyzed separately.Conclusions: Our findings raise the possibility that, in the long-term, antidepressants may impair recovery and increase the risk of rehospitalisation in patients with both primarily affective and non-affective disorders. More work is required to explore possible aetiopathological pathways leading to psychiatric rehospitalisation

    Can a “state of the art” chemistry transport model simulate Amazonian tropospheric chemistry?

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    We present an evaluation of a nested high-resolution Goddard Earth Observing System (GEOS)-Chem chemistry transport model simulation of tropospheric chemistry over tropical South America. The model has been constrained with two isoprene emission inventories: (1) the canopy-scale Model of Emissions of Gases and Aerosols from Nature (MEGAN) and (2) a leaf-scale algorithm coupled to the Lund-Potsdam-Jena General Ecosystem Simulator (LPJ-GUESS) dynamic vegetation model, and the model has been run using two different chemical mechanisms that contain alternative treatments of isoprene photo-oxidation. Large differences of up to 100 Tg C yr^(−1) exist between the isoprene emissions predicted by each inventory, with MEGAN emissions generally higher. Based on our simulations we estimate that tropical South America (30–85°W, 14°N–25°S) contributes about 15–35% of total global isoprene emissions. We have quantified the model sensitivity to changes in isoprene emissions, chemistry, boundary layer mixing, and soil NO_x emissions using ground-based and airborne observations. We find GEOS-Chem has difficulty reproducing several observed chemical species; typically hydroxyl concentrations are underestimated, whilst mixing ratios of isoprene and its oxidation products are overestimated. The magnitude of model formaldehyde (HCHO) columns are most sensitive to the choice of chemical mechanism and isoprene emission inventory. We find GEOS-Chem exhibits a significant positive bias (10–100%) when compared with HCHO columns from the Scanning Imaging Absorption Spectrometer for Atmospheric Chartography (SCIAMACHY) and Ozone Monitoring Instrument (OMI) for the study year 2006. Simulations that use the more detailed chemical mechanism and/or lowest isoprene emissions provide the best agreement to the satellite data, since they result in lower-HCHO columns

    An intercomparison of measurement systems for vapor and particulate phase concentrations of formic and acetic acids

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    During June 1986, eight systems for measuring vapor phase and four for measuring particulate phase concentrations of formic acid (HCOOH) and acetic acid (CH_3COOH) were intercompared in central Virginia. HCOOH and CH_3COOH vapors were sampled by condensate, mist, Chromosorb 103 GC resin, NaOH-coated annular denuders, NaOH impregnated quartz filters, K_2CO_3 and Na_2CO_3 impregnated cellulose filters, and Nylasorb membranes. Atmospheric aerosol was collected on Teflon and Nuclepore filters using both hi-vol and lo-vol systems to measure particulate phase concentrations. Samples were collected during 31 discrete day and night intervals of 0.5–2 hour duration over a 4-day period. Performance of the mist chamber and K_2CO_3 impregnated filter techniques were also evaluated using zero air and ambient air spiked with HCOOH_g, CH_3COOH_g, and formaldehyde (CH_2O_g) from permeation sources. Results of this intercomparison show significant systematic and episodic artifacts among many currently deployed measurement systems for HCOOH_g and CH_3COOH_g. The spiking experiments revealed no significant interferences for the mist chamber technique and results generated by the mist chamber and denuder techniques were statistically indistinguishable. The condensate technique showed general agreement with the mist chamber and denuder methods, but episodic bias between these systems was inferred from large and significant differences observed during the first day of sampling. Nylasorb membranes are unacceptable for collecting carboxylic acid vapors as they did not retain HCOOH_g and CH_3COOH_g quantitatively. Strong base impregnated filter and GC resin sampling techniques are prone to large positive interferences apparently resulting, in part, from reactions involving CH_2O_g to generate HCOOH and CH_3COOH subsequent to collection. Significant bias presumably associated with differences in postcollection handling was observed for particulate phase measurements by participating groups. Analytical bias did not contribute significantly to differences in vapor and particulate phase measurements

    Theory of Light Hydrogenlike Atoms

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    The present status and recent developments in the theory of light hydrogenic atoms, electronic and muonic, are extensively reviewed. The discussion is based on the quantum field theoretical approach to loosely bound composite systems. The basics of the quantum field theoretical approach, which provide the framework needed for a systematic derivation of all higher order corrections to the energy levels, are briefly discussed. The main physical ideas behind the derivation of all binding, recoil, radiative, radiative-recoil, and nonelectromagnetic spin-dependent and spin-independent corrections to energy levels of hydrogenic atoms are discussed and, wherever possible, the fundamental elements of the derivations of these corrections are provided. The emphasis is on new theoretical results which were not available in earlier reviews. An up-to-date set of all theoretical contributions to the energy levels is contained in the paper. The status of modern theory is tested by comparing the theoretical results for the energy levels with the most precise experimental results for the Lamb shifts and gross structure intervals in hydrogen, deuterium, and helium ion He+He^+, and with the experimental data on the hyperfine splitting in muonium, hydrogen and deuterium.Comment: 230 pages, 106 figures, 24 tables. Discussion of muonic hydrogen is added, list of references expanded, some minor corrections and amendment
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