Time to undetectable viral load after highly active antiretroviral therapy initiation among HIV-infected pregnant women

Background. There have been no clinical trials in resource-rich regions that have addressed the question of which highly active antiretroviral therapy (HAART) regimens are more effective for optimal viral response in antiretroviral-naive, human immunodeficiency virus (HIV)-infected pregnant women.Methods. Data on 240 HIV-1-infected women starting HAART during pregnancy who were enrolled in the prospective European Collaborative Study from 1997 through 2004 were analyzed. An interval-censored survival model was used to assess whether factors, including type of HAART regimen, race, region of birth, and baseline immunological and virological status, were associated with the duration of time necessary to suppress viral load below undetectable levels before delivery of a newborn.Results. Protease inhibitor-based HAART was initiated in 156 women (65%), 125 (80%) of whom received nelfinavir, and a nevirapine-based regimen was initiated in the remaining 84 women (35%). Undetectable viral loads were achieved by 73% of the women by the time of delivery. Relative hazards of time to achieving viral suppression were 1.54 (95% confidence interval, 1.05-2.26) for nevirapine-based HAART versus PI-based regimens and 1.90 (95% confidence interval, 1.16-3.12) for western African versus non-African women. The median duration of time from HAART initiation to achievement of an undetectable viral load was estimated to be 1.4 times greater in women receiving PI-based HAART, compared with women receiving nevirapine-based HAART. Baseline HIV RNA load was also a significant predictor of the rapidity of achieving viral suppression by delivery, but baseline immune status was not.Conclusions. In this study, nevirapine-based HAART (compared with PI [mainly nelfinavir]-based HAART), western African origin, and lower baseline viral load were associated with shorter time to achieving viral suppression

Crowdsourcing to promote HIV testing among MSM in China: study protocol for a stepped wedge randomized controlled trial.

BACKGROUND: HIV testing for marginalized populations is critical to controlling the HIV epidemic. However, the HIV testing rate among men who have sex with men (MSM) in China remains low. Crowdsourcing, the process of shifting individual tasks to a group, has been increasingly adopted in public health programs and may be a useful tool for spurring innovation in HIV testing campaigns. We designed a multi-site study to develop a crowdsourced HIV test promotion campaign and evaluate its effectiveness against conventional campaigns among MSM in China. METHODS: This study will use an adaptation of the stepped wedge, randomized controlled trial design. A total of eight major metropolitan cities in China will be randomized to sequentially initiate interventions at 3-month intervals. The intervention uses crowdsourcing at multiple steps to sustain crowd contribution. Approximately 1280 MSM, who are 16 years of age or over, live in the intervention city, have not been tested for HIV in the past 3 months, and are not living with HIV, will be recruited. Recruitment will take place through banner advertisements on a large gay dating app along with other social media platforms. Participants will complete one follow-up survey every 3 months for 12 months to evaluate their HIV testing uptake in the past 3 months and secondary outcomes including syphilis testing, sex without condoms, community engagement, testing stigma, and other related outcomes. DISCUSSION: MSM HIV testing rates remain poor in China. Innovative methods to promote HIV testing are urgently needed. With a large-scale, stepped wedge, randomized controlled trial our study can improve understanding of crowdsourcing's long-term effectiveness in public health campaigns, expand HIV testing coverage among a key population, and inform intervention design in related public health fields. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02796963 . Registered on 23 May 2016

Copper cable theft: revisiting the price–theft hypothesis

Objectives: To test the commonly espoused but little examined hypothesis that fluctuations in the price of metal are associated with changes in the volume of metal theft. Specifically, we analyze the relationship between the price of copper and the number of police recorded 'live’ copper cable thefts from the British railway network (2006 to 2012)

Feasibility of collecting oral fluid samples in the home setting to determine seroprevalence of infections in a large-scale cohort of preschool-aged children

Oral fluid is a non-invasive biological sample, which can be returned by post, making it suitable for large-scale epidemiological studies in children. We report our experience of oral fluid collection from 14 373 preschool-aged children in the UK Millennium Cohort Study. Samples were collected by mothers in the home setting following the guidance of trained interviewers, and posted to the laboratory. Samples were received from 11698 children (81.4 %). Children whose mothers were of Black Caribbean ethnicity and who lived in non-English-speaking households were less likely to provide a sample, and those with a maternal history of asthma more likely to provide a sample [adjusted risk ratio (95 % CI) 0.85 (0.73-0.98), 0.87 (0.77-0.98) and 1.03 (1.00-1.05) respectively]. Collection of oral fluid samples is feasible and acceptable in large-scale child cohort studies. Formal interpreter support may be required to increase participation rates in surveys that collect biological samples from ethnic minorities

The Challenges of Intensive Care Medicine

Over the last decades, the number of ICU admissions in Germany has steadily increased. Simultaneously, patients are more likely to survive their critical illness, but survivors of critical illness frequently face functional impairments regarding their cognitive function, mental health, mobility and health-related quality of life, summarized as “Post-Intensive Care Syndrome (PICS)”. For clinicians, it is imperative to ensure the highest quality of ICU care and utilize evidence-based measures to mitigate those detrimental patient outcomes. In Germany, the DIVI has issued evidence-based “German Quality Indicators of Intensive Care” (QIs), which reflect current best practice in critical care. Their application can help reduce PICS burden. The ERIC-care-program at Charité – Universitätsmedizin Berlin utilizes telemedicine to enhance adherence to these QIs in hospitals of the Berlin metropolitan area. The newly established tele-ICU at Campus Virchow-Klinikum, which has high-quality audio-visual equipment and is staffed with experienced intensivists and nurses, provides daily, multiprofessional and QI-centered medical rounds for eleven centers with ICUs in the region. For a comprehensive evaluation, the ERIC-care-program is designed as a multicentre, pragmatic, cluster-randomized controlled trial with an open cohort stepped-wedge design with continuous recruitment. As such, it investigates the clinical effectiveness of a telemedical intervention in the ICU to improve the adherence to the DIVI QIs and is funded by the Innovation Committee of the Federal Joint Committee (01NVF16011). The ERIC-care-program aims to deliver highest quality of care to ICU patients, no matter where they are admitted.In den letzten Jahrzehnten ist die Zahl der Intensiveinweisungen in Deutschland stetig gestiegen. Gleichzeitig erhöht sich die Wahrscheinlichkeit, dass Patienten ihre kritische Erkrankung überleben. Überlebende kritischer Erkrankungen erfahren jedoch häufig eine funktionelle Beeinträchtigung hinsichtlich ihrer kognitiven Funktionen, psychischen Gesundheit, Mobilität und gesundheitsbezogenen Lebensqualität, welche unter dem Begriff Post-Intensive Care Syndrom (PICS) zusammengefasst werden. Für Kliniker ist es zwingend erforderlich, die höchste Qualität der Intensivpflege anzubieten und evidenzbasierte Maßnahmen zu nutzen, um diese nachteiligen Patientenergebnisse abzumildern. In Deutschland hat die DIVI evidenzbasierte „Qualitätsindikatoren der Intensivmedizin“ (QIs) herausgegeben, die die aktuell bewährte Praxis in der Intensivmedizin reflektieren. Ihre Anwendung kann helfen, die gesundheitliche Belastung von PICS zu reduzieren. Das ERIC-Programm an der Charité – Universitätsmedizin Berlin nutzt die Telemedizin, um eine bessere Einhaltung dieser QIs in Krankenhäusern der Metropolregion Berlin zu ermöglichen. Die neu eingerichtete Tele-Intensivstation am Campus Virchow-Klinikum verfügt über eine hochwertige audiovisuelle Ausstattung und ist mit erfahrenen Intensivmedizinern und Pflegekräften besetzt. Sie bietet elf regionalen Gesundheitszentren mit Intensivstationen tägliche multiprofessionelle und QI-zentrierte Visiten. Um das ERIC-Programm umfassend zu evaluieren, wurde eine multizentrische, pragmatische, cluster-randomisierte kontrollierte Studie mit offenen Kohorten, Stepped-Wedge-Design und kontinuierlicher Patientenrekrutierung konzipiert. Als solches untersucht sie die klinische Wirksamkeit einer telemedizinischen Intervention auf Intensivstationen, um die Einhaltung der DIVI-QIs zu verbessern. Sie wird vom Innovationsausschuss des Gemeinsamen Bundesausschusses gefördert (01NVF16011). Das ERIC-Programm zielt darauf ab, Patienten auf der Intensivstation höchste Versorgungsqualität zu bieten, egal wo sie aufgenommen werden

Why won't she sleep? Screen exposure and sleep patterns in young infants.

The American Academy of Pediatrics recommends infants' exposure to electronic screen-based media be minimized; however, more research is needed to understand effects of viewing screen-based media. Here, we examine relations between media use and sleep. Data were collected from mothers when their infants (N = 429) were four months of age. Mothers answered questions about the time their infants spent watching electronic screen-based media. Exposure to electronic screen-based media was negatively associated with nighttime sleep (but not daytime sleep), such that an hour of screen time was associated with nearly 13 min less sleep on a typical night