Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

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Chloroplast function is orchestrated by the organelle's intricate architecture. By combining cryo-focused ion beam milling of vitreous Chlamydomonas cells with cryo-electron tomography, we acquired three-dimensional structures of the chloroplast in its native state within the cell. Chloroplast envelope inner membrane invaginations were frequently found in close association with thylakoid tips, and the tips of multiple thylakoid stacks converged at dynamic sites on the chloroplast envelope, implicating lipid transport in thylakoid biogenesis. Subtomogram averaging and nearest neighbor analysis revealed that RuBisCO complexes were hexagonally packed within the pyrenoid, with similar to 15 nm between their centers. Thylakoid stacks and the pyrenoid were connected by cylindrical pyrenoid tubules, physically bridging the sites of light-dependent photosynthesis and light-independent carbon fixation. Multiple parallel minitubules were bundled within each pyrenoid tubule, possibly serving as conduits for the targeted one-dimensional diffusion of small molecules such as ATP and sugars between the chloroplast stroma and the pyrenoid matrix

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background 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. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

Analyse qualitative des outils de coordination et de coopération dans le cadre de la politique portuaire française : le cas des grands ports maritimes

En 2008, les grands ports maritimes français ont été réformés à bien des égards. La coordination et la coopération interportuaires ont à ce titre émergé comme de nouveaux modes de relations entre les acteurs du secteur, et sont maintenant des éléments à part entière de la politique portuaire française. Le conseil de coordination interportuaire, élément fort et central de cette dynamique de partenariat conforte cependant les rapports de force traditionnels entre les parties prenantes du développement portuaire. En outre cet instrument n’est pas seul en mesure de répondre au besoin de cohérence entre les grands ports maritimes, et d’autres outils comme les groupements d’intérêt public et les prises de participation étoffent les possibilités d’action. Dans tous les cas, la question du rapport au territoire est posée, de même que celle du bénéfice de la coopération.In 2008, French major ports have been reformed in many ways. Coordination and cooperation between ports have emerged as new forms of relationships between stakeholders, and are now a part of the French ports policy. However the interport coordinating council, a strong and central component of the dynamics of the partnership, reinforces the traditional power relationships between stakeholders of the port development. Furthermore this component is not the sole that can meet the need for coherence between major seaports, and other tools such as public interest groups and joint-ventures strengthen the possibility of joint actions. In any cases, it raises three issues in relation with the territory, the hierarchy between ports and the benefits of cooperation

Gouverner les ports de commerce à l’heure libérale

En 2008, le gouvernement français lance sa réforme de libéralisation des activités portuaires. Celle-ci impose la concession des terminaux au secteur privé et transforme profondément le rôle joué par les anciens ports autonomes dans leur territoire d’insertion. La France s’inscrit ainsi dans un processus de diffusion d’un modèle de gestion portuaire à l’échelle mondiale, initié dans l’Angleterre de Margaret Thatcher ou le Chili des Chicago boys dès le début des années 1980. Ce qui se joue sur les quais depuis trente ans s’inscrit dans un mouvement global de redéfinition du rôle des États dans les affaires économiques du monde. La réflexion proposée dans cet ouvrage est le fruit d’un travail d’enquêtes menées auprès des acteurs entrepreneuriaux et institutionnels, entre 2009 et 2012, dans une dizaine de ports du sud de l’Europe occidentale (France, Italie, Espagne). Cette analyse interdisciplinaire en sciences humaines et sociales propose un éclairage sur les grands principes politiques et économiques ayant conduit à ces transformations et s’interroge sur I évolution des conditions d’exercice des activités portuaires que 1ère libérale engage

Alternatives to cyanide in the gold mining industry: what prospects for the future

This paper reviews a series of alternative lixiviant systems for the recovery of gold from ores and concentrates. For over 100 years, cyanide has been the leach reagent of choice in gold mining because of its high gold recoveries, robustness and relatively low costs. The environmental damages resulting from its mismanagement, however, have initiated widespread research aimed at identifying and developing less toxic leaching agents. The most widely-researched alternative lixiviants for gold ores are examined in this paper, but it is evident that none has yet made any significant inroad into the dominant position of cyanide as the reagent of choice at the vast majority of gold mines worldwide. (c) 2005 Published by Elsevier Ltd