Supervised Treatment Interruption (STI) in an Urban HIV Clinical Practice: A Prospective Analysis

Background: In acute HIV-1 infection, STI may induce immunologic control of HIV-1 replication. Several prospective trials of STI in chronic HIV-1 infection have been less encouraging. A previously presented retrospective analysis of our patients showed that in those with a significant CD4 increase (\u3e200 cells) on antiretroviral therapy (ART), 2 or more interruptions may significantly lower viral set point. This prospective study describes STI in a cohort of patients. Methods: 10 patients with either a positive response to therapy interruption retrospectively or those expressing interest in the strategy who met inclusion criteria (VL BLQ on ART, good adherence, robust CD4 response) were selected. Interruptions analyzed were prospective and supervised. Timing of STI cycles was based on CD4 and Viral Load (VL) responses not a predetermined schedule. Data collected included demographics, ART, VL, CD4, and illnesses during STI. Results: Of 7/10 patients with data at 4 weeks off ART, the mean VL was 1.78 log10 copies/ml below baseline (BL). In 10 patients \u3e 8 weeks off ART, the mean VL was 1.38 log10 below BL. 7/10 maintained VL 8 weeks off ART (mean 27 weeks, 1 \u3e 2 years). 4/7 with data during more than one STI showed an increase in time to reach 5000 copies/ml. None developed resistance-conferring mutations nor HIV-related illnesses during interruption. ART regimen or Hepatitis C seropositivity were not statistically significant factors affecting response to STI (durationΔVL; p\u3e0.05). Conclusions: Although no consensus exists concerning the effectiveness of STI in chronic HIV infection, a majority of our subjects were able to stop ART and maintain viral control for a period of time. Closely monitored STI was associated with lowered viral set point during the interruption in most cases. A larger prospective study is warranted but we recommend future trials measure additional parameters and avoid using the same STI schedule for all subjects

Hospitalization Rates for Coronary Heart Disease in Relation to Residence Near Areas Contaminated with Persistent Organic Pollutants and Other Pollutants

Exposure to environmental pollutants may contribute to the development of coronary heart disease (CHD). We determined the ZIP codes containing or abutting each of the approximately 900 hazardous waste sites in New York and identified the major contaminants in each. Three categories of ZIP codes were then distinguished: those containing or abutting sites contaminated with persistent organic pollutants (POPs), those containing only other types of wastes (“other waste”), and those not containing any identified hazardous waste site (“clean”). Effects of residence in each of these ZIP codes on CHD and acute myocardial infarction (AMI) hospital discharge rates were assessed with a negative binomial model, adjusting for age, sex, race, income, and health insurance coverage. Patients living in ZIP codes contaminated with POPs had a statistically significant 15.0% elevation in CHD hospital discharge rates and a 20.0% elevation in AMI discharge rates compared with clean ZIP codes. In neither of the comparisons were rates in other-waste sites significantly greater than in clean sites. In a subset of POP ZIP codes along the Hudson River, where average income is higher and there is less smoking, better diet, and more exercise, the rate of hospitalization for CHD was 35.8% greater and for AMI 39.1% greater than in clean sites. Although the cross-sectional design of the study prevents definite conclusions on causal inference, the results indirectly support the hypothesis that living near a POP-contaminated site constitutes a risk of exposure and of development of CHD and AMI

Associations of Hemostatic Variables with Cardiovascular Disease and Total Mortality: The Glasgow MONICA Study

The associations of plasma levels of hemostatic factors, other than fibrinogen, with risks of cardiovascular disease (CVD) and all-cause mortality are not well defined. In two phases of the Glasgow MONICA study, we assayed coagulation factors (VII, VIII, IX, and von Willebrand factor), coagulation inhibitors (antithrombin, protein C, protein S), coagulation activation markers (prothrombin fragment 1þ2, thrombin–antithrombin complexes, D-dimer), and the fibrinolytic factors, tissue plasminogen activator (t-PA) antigen and plasminogen activator inhibitor type 1. Over 15 to 20 years, we followed up between 382 and 1,123 men and women aged 30 to 74 years, without baseline CVD, for risks of CVD and mortality. Age- and sex-adjusted hazard ratios (HRs) for CVD (top third vs bottom third) were significant only for factor VIII (1.30; 95% confidence interval [CI], 1.06–1.58) and factor IX (1.18; 95% CI, 1.01–1.39); these HRs were attenuated by further adjustment for CVD risk factors: 1.17 (95% CI, 0.94–1.46) and 1.07 (95% CI, 0.92–1.25), respectively. In contrast, factor VIII (HR, 1.63; 95% CI, 1.35–1.96), D-dimer (HR, 2.34; 95% CI, 1.26–4.35), and t-PA (HR, 2.81; 95% CI, 1.43–5.54) were strongly associated with mortality after full risk factor adjustment. Further studies, including meta-analyses, are required to assess the associations of these hemostatic factors with the risks of stroke and heart disease and causes of mortality

Semantic mutation testing

This is the Pre-print version of the Article. The official published version can be obtained from the link below - Copyright @ 2011 ElsevierMutation testing is a powerful and flexible test technique. Traditional mutation testing makes a small change to the syntax of a description (usually a program) in order to create a mutant. A test suite is considered to be good if it distinguishes between the original description and all of the (functionally non-equivalent) mutants. These mutants can be seen as representing potential small slips and thus mutation testing aims to produce a test suite that is good at finding such slips. It has also been argued that a test suite that finds such small changes is likely to find larger changes. This paper describes a new approach to mutation testing, called semantic mutation testing. Rather than mutate the description, semantic mutation testing mutates the semantics of the language in which the description is written. The mutations of the semantics of the language represent possible misunderstandings of the description language and thus capture a different class of faults. Since the likely misunderstandings are highly context dependent, this context should be used to determine which semantic mutants should be produced. The approach is illustrated through examples with statecharts and C code. The paper also describes a semantic mutation testing tool for C and the results of experiments that investigated the nature of some semantic mutation operators for C

The impact of local authorities’ interventions on household waste collection: a case study approach using time series modelling

At a local Government level there have been many interventions and changes made to household waste collection services to meet new regulatory requirements. These changes include separate collection of recyclable and organic materials. This paper has used a time series model to quantify the success of interventions introduced by a LA. The case study was a medium sized UK LA, Charnwood Borough Council (CBC), the research analyses monthly data of quantities of recyclates, garden waste for composting and residual waste for landfill disposal. The time series model was validated with a five year data set and used to measure the impacts of the various changes to identify which intervention was the most successful, while controlling for season and number of working days. The results show the interventions analysed both had abrupt and permanent positive impacts on the yield of recyclable materials, and a corresponding negative impact on the residual waste. The model could be added to the National data base to help LAs to compare interventions and to understand which schemes encourage householder participation and improve recycling performance

Meeting Report: Threats to Human Health and Environmental Sustainability in the Pacific Basin

The coastal zone of the Pacific Rim is home for about one-third of the world’s population. Disproportionate growth of Far Eastern economies has produced a disproportionate share of related environmental difficulties. As the region searches for acceptable compromises between growth and environmental quality, its influence on global environmental health is certain to increase. Consequences of global environmental change such as habitat alteration, storms, and sealevel rise will be particularly acute among Pacific Rim nations. Adverse health effects from arsenic exposure in Pacific Rim nations have been used to justify drinking water standards in the United States and elsewhere. As global manufacturing in the Pacific Rim increases, the centroid of global air quality and waste management issues will shift further toward Far Eastern nations. The Eleventh International Conference of the Pacific Basin Consortium (PBC) was held in September 2005 in Honolulu, Hawaii. The purpose of the conference was to bring together individuals to discuss regional challenges to sustainable growth. The historic emphasis of the conference on hazardous wastes in relation to human health makes the PBC an ideal forum for discussing technical aspects of sustainable economic growth in the Pacific region. That role is reflected in the 2005 PBC conference themes, which included management of arsenic in potable waters, air quality, climate change, pesticides, mercury, and electronics industry waste—each with emphasis on relationships to human health. Arsenic management exemplifies the manner in which the PBC can focus interdisciplinary discussion in a single technical area. The conference program provided talks on arsenic toxicology, treatment technologies, management of arsenic-bearing residuals from water treatment, and the probable societal costs and benefits of arsenic management