A randomized, controlled trial of initial anti-retroviral therapy with abacavir/lamivudine/zidovudine twice-daily compared to atazanavir once-daily with lamivudine/zidovudine twice-daily in HIV-infected patients over 48 weeks (ESS100327, the ACTION Study)

<p>Abstract</p> <p>Background</p> <p>Traditional first line regimens containing a non-nucleoside reverse transcriptase inhibitor or protease inhibitor may not be suitable for a subset of antiretroviral-naïve patients such as those with certain co-morbidities, women of child-bearing potential, and intolerability to components of standard first line therapy. This study was conducted to determine if alternate treatment options may meet the needs of both general and special patient populations. The ACTION study was a randomized, open-label, multicenter, 48-week trial that compared the safety and efficacy of a triple nucleoside regimen versus a protease inhibitor plus a dual nucleoside regimen in HIV-1 treatment-naïve subjects.</p> <p>Results</p> <p>279 HIV-infected subjects with HIV-1 RNA (VL) >5000 but < 200,000 copies/mL (c/mL) and CD4+ count ≥ 100 cells/mm³were randomized (1:1) to receive abacavir sulfate/lamivudine/zidovudine (ABC/3TC/ZDV) twice-daily or atazanavir (ATV) once-daily plus lamivudine/zidovudine (3TC/ZDV) twice-daily. Protocol-defined virologic failure was based on multiple failure criteria.</p> <p>Non-inferiority of ABC/3TC/ZDV to ATV+3TC/ZDV was established with 62% vs. 59% of subjects achieving a VL < 50 c/mL at week 48, [ITT(E), M/S = F, 95% CI: -5.9, 10.4]. Similar results were observed in the 230 (82%) subjects with baseline VL<100,000 c/mL (ABC/3TC/ZDV vs. ATV+3TC/ZDV), 66% vs. 59%; 95% CI: -5.6, 19.5. However, ABC/3TC/ZDV did not meet the non-inferiority criterion compared to ATV+3TC/ZDV in the 48 subjects with baseline VL ≥ 100,000 c/mL, 39% vs. 60%; 95% CI: -49.2, 7.4, respectively. Protocol-defined virologic failure was similar between groups.</p> <p>Conclusion</p> <p>ABC/3TC/ZDV demonstrated comparable virologic efficacy to ATV+3TC/ZDV in this population over 48 weeks. In those with a baseline VL ≥ 100,000 c/mL, subjects in the ATV+3TC/ZDV showed better virologic efficacy. Both regimens offer benefits in select therapy-naïve subjects.</p> <p>Trial Registration</p> <p>[Clinical Trials Identifier, NCT00082394].</p

A list of reptiles and amphibians from Box Gum Grassy Woodlands in south-eastern Australia

A large-scale biodiversity monitoring program examining the response of herpetofauna to the Australian Government’s Environmental Stewardship Program is taking place in south-eastern Australia within the critically endangered Box Gum Grassy Woodland vegetation community. Field surveys involve counting reptiles in areas under Environmental Stewardship management. These “Stewardship” areas have been matched with areas managed for primary production (domestic livestock grazing). We list reptiles recorded during surveys conducted between 2010 and 2012. We recorded sixty-nine species from ten families. The list will be useful for workers interested in the zoogeographical distribution of reptiles and amphibians in fragmented agricultural woodland ecosystems

Drivers of temperate woodland condition through time in an agricultural landscape

Conversion of natural woodlands to grazing pastures is a major driver of biodiversity loss. In response to this threat, regenerative management approaches have been proposed to balance agriculture with biodiversity conservation. Yet rigorous experiments investigating the effectiveness of such approaches are rare. We used time‐series data from a broad‐scale experiment in south‐eastern Australian woodlands to explore the effects of agricultural practices and environmental factors on regeneration, bare ground, and native and exotic cover and richness. Our study included historical fertilization, three past grazing regimes (continuous, short‐conversion rotational, and long-conversion rotational), two present‐day grazing measures (grazing duration and stocking rate), and three environmental covariates (natural soil fertility, native woody cover, and rainfall). We found that fertilizer application was associated with altered trajectories of native overstorey cover, native plant richness, exotic cover, and bare ground. Changes in woodland condition also were associated with a combination of present‐day grazing and environmental drivers. Natural regeneration, native plant richness, and native herb cover were negatively associated with increased grazing intensity. Conversely, increased landscape‐scale native woody cover and local‐scale natural soil fertility were associated with increases in native overstorey cover and native plant richness and decreases in exotic cover and bare ground. Our results indicate that land‐use history, present grazing intensity, and landscape context alter woodland ecosystem responses to intervention. This may explain why some conservation actions fail to meet objectives. Our results indicate that the effectiveness of conservation actions can be improved by considering the combined influence of past and present agricultural management and landscape context on woodland condition.Australian Government Environmental Stew-ardship Programme; National Environmental Research Program (NERP); ARC Laureate Fellowship, Grant/Award Number: FL120100108;Australian Research Council (ARC) LinkageProject, Grant/Award Number: LP10010046

Effects of past and present livestock grazing on herpetofauna in a landscape-scale experiment

Livestock grazing is the most widespread land use on Earth and can have negative effects on biodiversity. Yet, many of the mechanisms by which grazing leads to changes in biodiversity remain unresolved. One reason is that conventional grazing studies often target broad treatments rather than specific parameters of grazing (e.g., intensity, duration, and frequency) or fail to account for historical grazing effects. We conducted a landscape-scale replicated grazing experiment (15,000 km2, 97 sites) to examine the impact of past grazing management and current grazing regimes (intensity, duration, and frequency) on a community of ground-dwelling herpetofauna (39 species). We analyzed community variables (species richness and composition) for all species and built multiseason patch-occupancy models to predict local colonization and extinction for the 7 most abundant species. Past grazing practices did not influence community richness but did affect community composition and patch colonization and extinction for 4 of 7 species. Present grazing parameters did not influence community richness or composition, but 6 of the 7 target species were affected by at least one grazing parameter. Grazing frequency had the most consistent influence, positively affecting 3 of 7 species (increased colonization or decreased extinction). Past grazing practice affected community composition and population dynamics in some species in different ways, which suggests that conservation planners should examine the different grazing histories of an area. Species responded differently to specific current grazing practices; thus, incentive programs that apply a diversity of approaches rather than focusing on a change such as reduced grazing intensity should be considered. Based on our findings, we suggest that determining fine-scale grazing attributes is essential for advancing grazing as a conservation strategy. © 2016 Society for Conservation Biology. **Please note that there are multiple authors for this article therefore only the name of the first 5 including Federation University Australia affiliate “Philip Barton” is provided in this record*

NSQIP 30-day outcome measures for below-knee amputations by ICD-10 diagnoses

Background: The indications for Below-Knee Amputation (BKA) are expansive and etiologic subgroups are not well defined. This analysis uses primary ICD-10 diagnosis codes to stratify patients undergoing BKA, and examines differences in subgroup characteristics and 30-day outcomes. Methods: We performed a retrospective analysis of patients in the NSQIP database who underwent BKA between 2015 and 2020. Approximately 80% of the 12,157 NSQIP BKA entries with primary ICD-10 diagnosis codes were stratified to diabetic (n = 3,363), vascular (n = 3,632), or infectious (n = 2,743) etiological subgroups. Results: Patients with vascular etiologies were older, more likely to be female, underweight, ASA classification of four, and active tobacco users than patients in the other groups. Across all groups, there were incidences of 37.5% for 30-day inpatient complications, 7.0% for Clavien-Dindo Grade IV 30-day complications, 10.2% for 30-day readmission, and 4.2% for 30-day mortality. On bivariate analysis, infectious patients had the highest incidences of inpatient complications (38.6%, p = 0.030) and Clavien-Dindo Grade IV complications (7.8%, p = 0.055). Patients in the vascular group had the highest rates of readmission (12.7%, p<0.001) and mortality (4.9%, p = 0.006). In multivariate analysis, infectious etiology was an independent risk factor for 30-day mortality with an odds ratio of 1.48 (1.11–19.6, p = 0.007). Conclusions: Despite significant clinical overlap of diabetic, vascular, and infectious etiologies of BKA, this study demonstrates that these patients can be grouped by primary ICD-10 code with statistically significant differences in patient characteristics and 30-day outcomes. Further delineation by etiology could focus clinical and research efforts

Using empirical models of species colonization under multiple threatening processes to identify complementary threat-mitigation strategies

Approaches to prioritize conservation actions are gaining popularity. However, limited empirical evidence exists on which species might benefit most from threat mitigation and on what combination of threats, if mitigated simultaneously, would result in the best outcomes for biodiversity. We devised a way to prioritize threat mitigation at a regional scale with empirical evidence based on predicted changes to population dynamics-information that is lacking in most threat-management prioritization frameworks that rely on expert elicitation. We used dynamic occupancy models to investigate the effects of multiple threats (tree cover, grazing, and presence of an hyperaggressive competitor, the Noisy Miner (Manorina melanocephala) on bird-population dynamics in an endangered woodland community in southeastern Australia. The 3 threatening processes had different effects on different species. We used predicted patch-colonization probabilities to estimate the benefit to each species of removing one or more threats. We then determined the complementary set of threat-mitigation strategies that maximized colonization of all species while ensuring that redundant actions with little benefit were avoided. The single action that resulted in the highest colonization was increasing tree cover, which increased patch colonization by 5% and 11% on average across all species and for declining species, respectively. Combining Noisy Miner control with increasing tree cover increased species colonization by 10% and 19% on average for all species and for declining species respectively, and was a higher priority than changing grazing regimes. Guidance for prioritizing threat mitigation is critical in the face of cumulative threatening processes. By incorporating population dynamics in prioritization of threat management, our approach helps ensure funding is not wasted on ineffective management programs that target the wrong threats or species. </p