Evaluation of subcutaneous proleukin (Interleukin-2) in a randomized international trial (ESPRIT): Geographical and gender differences in the baseline characteristics of participants

Background: ESPRIT, is a phase III, open-label, randomized, international clinical trial evaluating the effects of subcutaneous recombinant interleukin-2 (rIL-2) plus antiretroviral therapy (ART) versus ART alone on HIV-disease progression and death in HIV-1-infected individuals with CD4+ T-cells ≥300 cells/μL. Objectives: To describe the baseline characteristics of participants randomized to ESPRIT overall and by geographic location. Method: Baseline characteristics of randomized participants were summarized by region. Results: 4,150 patients were enrolled in ESPRIT from 254 sites in 25 countries. 41%, 27%, 16%, 11%, and 5% were enrolled in Europe, North America, South America, Asia, and Australia, respectively. The median age was 40 years, 81% were men, and 76%, 11%, and 9% were Caucasian, Asian, and African American or African, respectively. 44% of women enrolled (n = 769) were enrolled in Thailand and Argentina. Overall, 55% and 38% of the cohort acquired HIV through male homosexual and heterosexual contact, respectively. 25% had a prior history of AIDS-defining illness; Pneumocystis jirovecii pneumonia, M. tuberculosis, and esophageal candida were most commonly reported. Median nadir and baseline CD4+ T-cell counts were 199 and 458 cells/μL, respectively. 6% and 13% were hepatitis B or C virus coinfected, respectively. Median duration of antiretroviral therapy (ART) was 4.2 years; the longest median duration was in Australia (5.2 years) and the shortest was in Asia (2.3 years). 17%, 13%, and 69% of participants began ART before 1995, between 1996 and 1997, and from 1998 onward, respectively. 86% used ART from two or more ART classes, with 49% using a protease inhibitor-based regimen and 46% using a nonnucleoside reverse transcriptase inhibitor-based regimen. 78% had plasma HIV RNA below detection (<500 cp/mL). Conclusion: ESPRIT has enrolled a diverse population of HIV-infected individuals including large populations of women and patients of African-American/African and Asian ethnicity often underrepresented in HIV research. As a consequence, the results of the study may have wide global applicability

Hepatitis B and C co-Infection are independent predictors of progressive kidney disease in HIV-positive, antiretroviral-treated adults

Chronic kidney disease (CKD) is an important cause of morbidity and mortality in HIV-positive individuals. Hepatitis C (HCV) co-infection has been associated with increased risk of CKD, but prior studies lack information on potential mechanisms. We evaluated the association between HCV or hepatitis B (HBV) co-infection and progressive CKD among 3,441 antiretroviral-treated clinical trial participants. Progressive CKD was defined as the composite of end-stage renal disease, renal death, or significant glomerular filtration rate (eGFR) decline (25% decline to eGFR 800,000 IU/ml had increased odds (OR 3.07; 95% CI 1.60–5.90). Interleukin-6, hyaluronic acid, and the FIB-4 hepatic fibrosis index were higher among participants who developed progressive CKD, but were no longer associated with progressive CKD after adjustment. Future studies should validate the relationship between HCV viremia and CKD

Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.

Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice

Senior Project Journal

This project documents the character development of the character America in Jessica Dickey\u27s The Amish Project. This first half of this project is an exploration of character through personal research. It addresses topics central to the character America such as Puerto Rican culture and heritage as it pertains to Lancaster County, PA, the Catholic religion, the Old Order Amish of Lancaster County, PA, and Titania in Shakespeare\u27s A Midsummer Night\u27s Dream. The second half of this project provides daily documentation of character growth throughout the rehearsal process, as well as rehearsal notes or developments

Occasions for Reading: Literary Encounters and the Making of the West Indies

"Occasions for Reading" argues for a new methodology of postcolonial reading that traces the origins of Anglophone Caribbean literary history and redirects the routes of West Indian literary production and canon formation. Historically, West Indian writers have sought an "ideal" reader of their work, though the definition and depiction of that ideal reader have varied. Anglophone Caribbean authors' own relationships to the act of reading and to the influence of reading on their own and on their characters' identity formation also direct or re-direct nation and canon formation. By engaging postcolonial theory, reader-response theory, post-structuralism, and reception studies, the dissertation investigates the production of the reader in and of Caribbean literary texts and of the social spaces in which they circulate. This dissertation situates the act of reading at the core of colonial and postcolonial representations of the Anglophone Caribbean and offers the culture of reception as a mode through which the geography of the West Indies is implicated in connecting West Indian people and identities across the diaspora. Acts and scenes of reading in West Indian novels produce a critique of Imperial knowledge production and illustrate how Caribbean subjects transform the intellectual, psychological or political meanings derived from reading colonial texts into a postcolonial epistemology. Such transformations provoke a range of consequences for these character-readers who must either leave the Caribbean region or continue to stake out their legitimacy and rootedness. Reading prompts characters' transgressions or resistance against persistent political, aesthetic or cultural narratives of colonialism historically informing Caribbean identity. By extension, characters' engagements with reading reveal twentieth-century West Indian authors' preoccupations with and resistance to colonial ontology. Issues of race, class, and gender influence the acts and scenes of reading in canonical West Indian novels analyzed in this study, including C.L.R. James's Minty Alley, V.S. Naipaul's The Mystic Masseur, Phyllis Shand Allfrey's The Orchid House, Michelle Cliff's Abeng and Jamaica Kincaid's Annie John. Following the historiography of the function of the reader in West Indian novels, the dissertation contends with contemporary concerns, in the late twentieth and into the twenty-first century, about where and how novels on the Caribbean experience are read, particularly by non-academic reading publics. Significant moments of literary reception in the U.K. and reception culture of Caribbean literature in the United States allow for a focus on contemporary novels and memoirs including Andrea Levy's Small Island and Jamaica Kincaid's My Brother. In an examination of how writers such as Kincaid and Edwidge Danticat have responded to the readers who encounter and assess their work, I critique apparent conflations of Caribbean literature, Caribbean geography or landscape, and Caribbean identity. Slippages in understanding the differences and boundaries between these concepts - literature, geography, and identity - in reading practices warrant a more methodological view of the impact of reading and reception on Caribbean literary history and its global reach. While representations of readers within the Caribbean space reveal a desire for a distinct origin and rootedness in the Caribbean landscape, migrant writers redefine the legacy and relevance of Caribbean literature through a discourse of emotion without boundaries or frontiers. As a whole, this dissertation challenges the dominant view of primarily political origins of postcolonial Caribbean literature, upholding its less recognized genealogy in intellectual and aesthetic discourses

Analytical studies of plant gum exudates

The gum exudate from Acacia calcigera, a species recently discovered in Australia, has been shown to have a highly positive specific rotation and high molecular weight with a low rhamnose con­tent. These results are characteristic of species within the Sec­tion Gummiferae, a predominantly African section of the genus Aca- cia.Analytical data for the gum exudate from a cultivar of Leucaena leucocephala from India and for gum arabic (Acacia senega!) fromAfrica were compared. The Leucaena gum had a chemical composition and properties sim ilar to gum arabic but was of higher viscosity and molecular weight; these differences could be commercially important if gum collection from Leucaena could be organised.in a series of studies in laboratory rats, gum arabic was com­pletely degraded on incorporation into a standard rat diet at levels of 2g/day/rat and 4g/day/rat. On incorporation into an elemental, low residue diet ( ‘Flexical1) gum arabic was partially degraded when fed to rats at 2g/day/rat but was found to be degraded more exten­sively if fed at a reduced level (lg/day/rat). Gum arabic, mixed with faeces from rats fed the elemental diet was partially degraded by faecal bacteria. The different results obtained when gum arabic was incorporated into two different diets indicated the importance of choice of type of diet and dose level used in dietary studies.VFaecal extracts obtained from rats fed a standard diet supple­mented with gum karaya (1.2g/day/rat) were shown to be similar, but not identical, to gum karaya that had been mixed with faeces then re-extracted. A similar result was obtained when an elemental diet was used. It was not possible to conclude whether or not the gum karaya extracted from test faeces had been degraded because of the difficulties found to be associated with attempted molecular weight measurements of the impure forms of the gum extracted.Seven commercial gum tragacanth samples from Iran were found to vary in composition and in viscosity and in the ratio of their water-insoluble and water-soluble components. Their amino acid con­tents did not differ extensively. Five commercial gum tragacanth samples from Turkey showed less variation than the Iranian samples; although having lower viscosity, their amino acid compositions were sim ilar to those of the Iranian samples. A Turkish gum tragacanth sample from Astragalus microcephalus (the major source of the gum) differed extensively analytically from Turkish gum tragacanth sam­ples from Astragalus kurdicus and Astragalus gummifer (minor sources)The Test Article used in a dietary study of gum tragacanth in Man was shown to have been well-chosen, representing gum tragacanth of fair average quality

Factors associated with D-dimer levels in HIV-infected individuals.

BACKGROUND: Higher plasma D-dimer levels are strong predictors of mortality in HIV+ individuals. The factors associated with D-dimer levels during HIV infection, however, remain poorly understood. METHODS: In this cross-sectional study, participants in three randomized controlled trials with measured D-dimer levels were included (N = 9,848). Factors associated with D-dimer were identified by linear regression. Covariates investigated were: age, gender, race, body mass index, nadir and baseline CD4+ count, plasma HIV RNA levels, markers of inflammation (C-reactive protein [CRP], interleukin-6 [IL-6]), antiretroviral therapy (ART) use, ART regimens, co-morbidities (hepatitis B/C, diabetes mellitus, prior cardiovascular disease), smoking, renal function (estimated glomerular filtration rate [eGFR] and cystatin C) and cholesterol. RESULTS: Women from all age groups had higher D-dimer levels than men, though a steeper increase of D-dimer with age occurred in men. Hepatitis B/C co-infection was the only co-morbidity associated with higher D-dimer levels. In this subgroup, the degree of hepatic fibrosis, as demonstrated by higher hyaluronic acid levels, but not viral load of hepatitis viruses, was positively correlated with D-dimer. Other factors independently associated with higher D-dimer levels were black race, higher plasma HIV RNA levels, being off ART at baseline, and increased levels of CRP, IL-6 and cystatin C. In contrast, higher baseline CD4+ counts and higher high-density lipoprotein cholesterol were negatively correlated with D-dimer levels. CONCLUSIONS: D-dimer levels increase with age in HIV+ men, but are already elevated in women at an early age due to reasons other than a higher burden of concomitant diseases. In hepatitis B/C co-infected individuals, hepatic fibrosis, but not hepatitis viral load, was associated with higher D-dimer levels

Fra Diavolo Opéra Comique en Trois Actes [Barcarolle]

Le gondolier fidèle brave pour voir sa belle les autans ennemis de loin s\u27il obtient d\u27elle un regard un souris c\u27est toujours ça toujours ça de pris c\u27est toujours c\u27est toujours c\u27est toujours ça de pris. Le gondolier fidèle brave pour voir sa belle les argus ennemis de son amour pour elle qu\u27un baiser soit le prix c\u27est toujours ça toujours ça de pris c\u27est toujours c\u27est toujours c\u27est toujours ça de pris. Le gondolier fidèle brave sur sa nacelle les jaloux les maris quand son coeur de sa belle presse les traits chéris c\u27est toujours ça toujours ça de pris c\u27est toujours c\u27est toujours c\u27est toujours ça de pris