16 research outputs found
The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis
Background: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in "real-life" settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia.
Methods and findings: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5-5.2) years for the total cohort and 6.4 (3.6-8.0) years in Europe, 3.7 (2.0-5.4) years in North America, 2.5 (1.2-4.4) years in South and Southeast Asia, 5.0 (2.7-7.5) years in South America and the Caribbean, and 2.1 (0.9-3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3-2.1) years in North America to 7.1 (5.3-8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4-2.6) years in North America to 7.9 (6.0-9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%-2.8%), 15.6% (15.1%-16.0%), and 11.3% (10.9%-11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%-1.1%]) and highest in South America and the Caribbean (4.4% [3.1%-6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%-6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%-13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria.
Conclusion: To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses.info:eu-repo/semantics/publishedVersio
Incidence of Heterotopic Ossification in Minimally Invasive Short-Stem THA using the Modified Anterolateral Approach
Contact Patch to Rim Distance: The Quintessential Tool for Metal-On-Metal Bearing in Vivo Performance Analysis â a Review
The epidemiology of adolescents living with perinatally acquired HIV: A cross-region global cohort analysis
textabstractBackground: Globally, the population of adolescents living with perinatally acquired HIV (APHs) continues to expand. In this study, we pooled data from observational pediatric HIV cohorts and cohort networks, allowing comparisons of adolescents with perinatally acquired HIV in âreal-lifeâ settings across multiple regions. We describe the geographic and temporal characteristics and mortality outcomes of APHs across multiple regions, including South America and the Caribbean, North America, Europe, sub-Saharan Africa, and South and Southeast Asia. Methods and findings: Through the Collaborative Initiative for Paediatric HIV Education and Research (CIPHER), individual retrospective longitudinal data from 12 cohort networks were pooled. All children infected with HIV who entered care before age 10 years, were not known to have horizontally acquired HIV, and were followed up beyond age 10 years were included in this analysis conducted from May 2016 to January 2017. Our primary analysis describes patient and treatment characteristics of APHs at key time points, including first HIV-associated clinic visit, antiretroviral therapy (ART) start, age 10 years, and last visit, and compares these characteristics by geographic region, country income group (CIG), and birth period. Our secondary analysis describes mortality, transfer out, and lost to follow-up (LTFU) as outcomes at age 15 years, using competing risk analysis. Among the 38,187 APHs included, 51% were female, 79% were from sub-Saharan Africa and 65% lived in low-income countries. APHs from 51 countries were included (Europe: 14 countries and 3,054 APHs; North America: 1 country and 1,032 APHs; South America and the Caribbean: 4 countries and 903 APHs; South and Southeast Asia: 7 countries and 2,902 APHs; sub-Saharan Africa, 25 countries and 30,296 APHs). Observation started as early as 1982 in Europe and 1996 in sub-Saharan Africa, and continued until at least 2014 in all regions. The median (interquartile range [IQR]) duration of adolescent follow-up was 3.1 (1.5â5.2) years for the total cohort and 6.4 (3.6â8.0) years in Europe, 3.7 (2.0â5.4) years in North America, 2.5 (1.2â4.4) years in South and Southeast Asia, 5.0 (2.7â7.5) years in South America and the Caribbean, and 2.1 (0.9â3.8) years in sub-Saharan Africa. Median (IQR) age at first visit differed substantially by region, ranging from 0.7 (0.3â2.1) years in North America to 7.1 (5.3â8.6) years in sub-Saharan Africa. The median age at ART start varied from 0.9 (0.4â2.6) years in North America to 7.9 (6.0â9.3) years in sub-Saharan Africa. The cumulative incidence estimates (95% confidence interval [CI]) at age 15 years for mortality, transfers out, and LTFU for all APHs were 2.6% (2.4%â2.8%), 15.6% (15.1%â16.0%), and 11.3% (10.9%â11.8%), respectively. Mortality was lowest in Europe (0.8% [0.5%â1.1%]) and highest in South America and the Caribbean (4.4% [3.1%â6.1%]). However, LTFU was lowest in South America and the Caribbean (4.8% [3.4%â6.7%]) and highest in sub-Saharan Africa (13.2% [12.6%â13.7%]). Study limitations include the high LTFU rate in sub-Saharan Africa, which could have affected the comparison of mortality across regions; inclusion of data only for APHs receiving ART from some countries; and unavailability of data from high-burden countries such as Nigeria. Conclusion: To our knowledge, our study represents the largest multiregional epidemiological analysis of APHs. Despite probable under-ascertained mortality, mortality in APHs remains substantially higher in sub-Saharan Africa, South and Southeast Asia, and South America and the Caribbean than in Europe. Collaborations such as CIPHER enable us to monitor current global temporal trends in outcomes over time to inform appropriate policy responses
System Innovation and a New âGreat Transformationâ: Re-embedding Economic Life in the Context of âDe-Growthâ
Shock wave physics and detonation physics â a stimulus for the emergence of numerous new branches in science and engineering
In the period of the Cold War (1945â1991), Shock Wave Physics and Detonation Physics
(SWP&DP) â until the beginning of WWII mostly confined to gas dynamics, high-speed
aerodynamics, and military technology (such as aero- and terminal ballistics, armor
construction, chemical explosions, supersonic gun, and other firearms developments) â
quickly developed into a large interdisciplinary field by its own. This rapid expansion
was driven by an enormous financial support and two efficient feedbacks: the
Terminal Ballistic Cycle and the Research &
Development Cycle. Basic knowledge in SWP&DP, initially gained
in the Classic Period (from 1808) and further extended in the
Post-Classic Period (from the 1930s to present), is now increasingly
used also in other branches of Science and Engineering (S&E). However, also
independent S&E branches developed, based upon the fundamentals of SWP&DP,
many of those developments will be addressed (see Tab. 2). Thus, shock wave and detonation
phenomena are now studied within an enormous range of dimensions, covering microscopic,
macroscopic, and cosmic dimensions as well as enormous time spans ranging from
nano-/picosecond shock durations (such as produced by ultra-short laser pulses) to shock
durations that continue for centuries (such as blast waves emitted from ancient supernova
explosions). This paper reviews these developments from a historical perspective