Nevirapine- and efavirenz-associated hepatotoxicity under programmatic conditions in Kenya and Mozambique.

To describe the frequency, risk factors, and clinical signs and symptoms associated with hepatotoxicity (HT) in patients on nevirapine- or efavirenz-based antiretroviral therapy (ART), we conducted a retrospective cohort analysis of patients attending the ART clinic in Kibera, Kenya, from April 2003 to December 2006 and in Mavalane, Mozambique, from December 2002 to March 2007. Data were collected on 5832 HIV-positive individuals who had initiated nevirapine- or efavirenz-based ART. Median baseline CD4+ count was 125 cells/μL (interquartile range [IQR] 55-196). Over a median follow-up time of 426 (IQR 147-693) days, 124 (2.4%) patients developed HT. Forty-one (54.7%) of 75 patients with grade 3 HT compared with 21 (80.8%) of 26 with grade 4 had associated clinical signs or symptoms (P = 0.018). Four (5.7%) of 124 patients with HT died in the first six months compared with 271 (5.3%) of 5159 patients who did not develop HT (P = 0.315). The proportion of patients developing HT was low and HT was not associated with increased mortality. Clinical signs and symptoms identified 50% of grade 3 HT and most cases of grade 4 HT. This suggests that in settings where alanine aminotransferase measurement is not feasible, nevirapine- and efavirenz-based ART may be given safely without laboratory monitoring

Analysis of Sustainability Propensity of Bike-Sharing Customers Using Partially Ordered Sets Methodology

The propensity for sustainability actions and awareness among population might be driven by ad hoc policies. For example, in the transportation framework, the bike is (re)gaining popularity as a mean of transportation both convenient and environmental-prone,and consequently more and more cities around the world are developing bike-sharing systems in urban areas to let their citizens be more \u2018green\u2019. Satisfaction for bike-sharing systems could be influenced in general by how the service is managed and by users\u2019 attitudes towards sustainability:if users\u2019 participation in sustainability is high, then the level of satisfaction will increase and the service will result more successful. In this paper we analyze the connection between propensity and orientation towards sustainability and satisfaction for a particular bike-sharing system via Partially Ordered Sets based methodology

Inversion of electrical conductivity data with Tikhonov regularization approach: some considerations

Electromagnetic induction measurements, which are generally used to determine lateral variations of apparent electrical conductivity, can provide quantitative estimates of the subsurface conductivity at different depths. Quantitative inference about the Earth's interior from experimental data is, however, an ill-posed problem. Using the generalised McNeill's theory for the EM38 ground conductivity meter, we generated synthetic apparent conductivity curves (input data vector) simulating measurements at different heights above the soil surface. The electrical conductivity profile (the Earth model) was then estimated solving a least squares problem with Tikhonov regularization optimised with a projected conjugate gradient algorithm. Although the Tikhonov approach improves the conditioning of the resulting linear system, profile reconstruction can be surprisingly far from the desired true one. On the contrary, the projected conjugate gradient provided the best solution without any explicit regularization ( a= 0) of the objective function of the least squares problem. Also, if the initial guess belongs to the image of the system matrix, Im(A), we found that it provides a unique solution in the same subspace Im(A)

WHO Clinical Staging of HIV Infection and Disease, Tuberculosis and Eligibility for Antiretroviral Treatment: Relationship to CD4 Lymphocyte Counts.

SETTING: Thyolo district, Malawi. OBJECTIVES: To determine in HIV-positive individuals aged over 13 years CD4 lymphocyte counts in patients classified as WHO Clinical Stage III and IV and patients with active and previous tuberculosis (TB). DESIGN: Cross-sectional study. METHODS: CD4 lymphocyte counts were determined in all consecutive HIV-positive individuals presenting to the antiretroviral clinic in WHO Stage III and IV. RESULTS: A CD4 lymphocyte count of < or = 350 cells/microl was found in 413 (90%) of 457 individuals in WHO Stage III and IV, 96% of 77 individuals with active TB, 92% of 65 individuals with a history of pulmonary TB (PTB) in the last year, 91% of 89 individuals with a previous history of PTB beyond 1 year, 81% of 32 individuals with a previous history of extra-pulmonary TB, 93% of 107 individuals with active or past TB with another HIV-related disease and 89% of 158 individuals with active or past TB without another HIV-related disease. CONCLUSIONS: In our setting, nine of 10 HIV-positive individuals presenting in WHO Stage III and IV and with active or previous TB have CD4 counts of < or = 350 cells/microl. It would thus be reasonable, in this or similar settings where CD4 counts are unavailable for clinical management, for all such patients to be considered eligible for antiretroviral therapy

Comparative measurements of carbon dioxide fluxes from two nearby towers in a central Amazonian rainforest: the Manaus LBA site

Forests around Manaus have staged the oldest and the longest forest-atmosphere CO2 exchange studies made anywhere in the Amazon. Since July 1999 the exchange of CO2, water, and energy, as well as weather variables, have been measured almost continuously over two forests, 11 km apart, in the Cuieiras reserve near Manaus, Brazil. This paper presents the sites and climatology of the region based upon the new data sets. The landscape consists of plateaus dissected by often waterlogged valleys, and the two sites differ in terms of the relative areas of those two landscape components represented in the tower footprints. The radiation and wind climate was similar to both towers. Generally, both the long-wave and short-wave radiation input was less in the wet than in the dry season. The energy balance closure was imperfect (on average 80%) in both towers, with little variation in energy partitioning between the wet and dry seasons; likely a result of anomalously high rainfall in the 1999 dry season. Fluxes of CO2 also showed little seasonal variation except for a slightly shorter daytime uptake duration and somewhat lower respiratory fluxes in the dry season. The net effect is one of lower daily net ecosystem exchange (NEE) in the dry season. The tower, which has less waterlogged valley areas in its footprint, measured a higher overall CO2 uptake rate. We found that on first sight, NEE is underestimated during calm nights, as was observed in many other tower sites before. However, a closer inspection of the diurnal variation of CO2 storage fluxes and NEE suggests that at least part of the nighttime deficits is recovered from either lateral influx of CO2 from valleys or outgassing of soil storage. Therefore there is a high uncertainty in the magnitude of nocturnal NEE, and consequently preliminary estimates of annual carbon uptake reflecting this range from 1 to 8 T ha-1 y-1, with an even higher upper range for the less waterlogged area. The high uptake rates are clearly unsustainable and call for further investigations into the integral carbon balance of Amazon landscapes

Sexual violence in post-conflict Liberia: survivors and their care.

Using routine data from three clinics offering care to survivors of sexual violence (SV) in Monrovia, Liberia, we describe the characteristics of SV survivors and the pattern of SV and discuss how the current approach could be better adapted to meet survivors' needs. There were 1500 survivors seeking SV care between January 2008 and December 2009. Most survivors were women (98%) and median age was 13 years (Interquartile range: 9-17 years). Sexual aggression occurred during day-to-day activities in 822 (55%) cases and in the survivor's home in 552 (37%) cases. The perpetrator was a known civilian in 1037 (69%) SV events. Only 619 (41%) survivors sought care within 72 h. The current approach could be improved by: effectively addressing the psychosocial needs of child survivors, reaching male survivors, targeting the perpetrators in awareness and advocacy campaigns and reducing delays in seeking care

Morphometric maps of bilateral asymmetry in the human humerus: An implementation in the R package morphomap

In biological anthropology, parameters relating to cross-sectional geometry are calculated in paired long bones to evaluate the degree of lateralization of anatomy and, by inference, function. Here, we describe a novel approach, newly added to the morphomap R package, to assess the lateralization of the distribution of cortical bone along the entire diaphysis. The sample comprises paired long bones belonging to 51 individuals (10 females and 41 males) from The New Mexico Decedent Image Database with known biological profile, occupational and loading histories. Both males and females show a pattern of right lateralization. In addition, males are more lateralized than females, whereas there is not a significant association between lateralization with occupation and loading history. Body weight, height and long-bone length are the major factors driving the emergence of asymmetry in the humerus, while interestingly, the degree of lateralization decreases in the oldest individuals

The modulation of sirtuins and apoptotic proteins in rats after exhaustive exercise

A large body of evidence shows that a single bout of strenuous exercise induces oxidative stress in circu- lating human lymphocytes leading to lipid peroxide- tion, DNA damage, mitochondrial perturbations, and protein oxidation. In a training experiment, Wistar rats were divided into control group (CG) and exer- cise group (EG). After a running level exercise until exhaustion, we observed an increase in the mRNA content and protein expression of SIRT1 and SIRT7 in the EG compared to the CG. Moreover, such train- ing exercise did not change mRNA transcripts and protein expression of FOXO3A and GADD45. We also observed an increase of pro-apoptotic protein bax and a decrease of the anti-apoptotic protein bcl-2 in the EG. Accordingly, we observed a caspase-3 activation and poly (ADP-ribose) polymerase (PARP) cleavage only in EG rats. Statistical analysis of the data showed a significant correlation between SIRT1 and SIRT7 expression and apoptotic proteins such as bax, bcl-2 in both tissues. We conclude that, in both muscle, such exercise activates both a damaging apoptotic mecha- nism with bax increase and bcl-2 decrease and a counterbalancing protective mechanism with SIRT1 and SIRT7 increase

Aggiunte alla flora vascolare d’Abruzzo e aree limitrofe. IV contributo

Additions to the vascular flora of Abruzzo and surrounding. IV contribution. In this paper new floristic records for 22 units are reported for Central Italy, mainly for Abruzzo. In particular 14 taxa are native and 8 aliens, 16 are new or confirmed to Abruzzo, 1 is new to Marche. In addition new distribution data for 4 rare or interesting in Abruzzo and 1 in Lazio regions have been recorded. Some of these species are particularly interesting from a phytogeographical or conservational point of view as they are very rare in Central Italy (Antirrhinum siculum, Convolvulus pentapetaloides and Vicia melanops)