Prevalence and Trends in Transmitted and Acquired Antiretroviral Drug Resistance, Washington, DC, 1999-2014.

Background Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC. Methods We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, we assessed associations between patient characteristics and transmitted resistance to any antiretroviral. Results Prevalence of TDR was 20.5%, of ADR 40.5%, and of CDR 45.1% in the respective analysis groups. From 2004 to 2013, TDR prevalence decreased for nucleoside and nucleotide analogue reverse transcriptase inhibitors (15.0 to 5.5%; p = 0.0003) and increased for integrase strand transfer inhibitors (INSTIs) (0.0–1.4%; p = 0.04). In multivariable analysis, TDR was not associated with age, race/ethnicity, HIV risk group, or years from HIV diagnosis. Conclusions In this urban cohort of HIV-infected persons, almost half of participants tested had evidence of CDR; and resistance to INSTIs was increasing. If this trend continues, inclusion of the integrase-encoding region in baseline genotype testing should be strongly considered

Human immunodeficiency virus (HIV) in Washington, D.C.: Prevalence of antiretroviral resistance in treatment naïve patients from 2007 to 2010

HIV treatment has been greatly impacted by transmitted resistance to antiretrovirals (ARV). Several studies have documented resistance in naïve individuals and estimates of transmitted drug resistance mutations range from \u3c5% to as high as 25%. Washington, D.C. has one of the highest human immunodeficiency virus (HIV) prevalence rates in the United States (3.2% in 2009), but local data regarding the frequency of major mutations and antiretroviral (ARV) resistance has been limited. Medical records of HIV positive, ARV-naïve adults at two facilities in Washington, D.C., The George Washington University Medical Center and the Veterans Affairs Medical Center, were retrospectively analyzed in subjects who had genotypic resistance testing from 2007 to 2010. Of 407 ARV-naïve patients, at least one transmitted drug resistance mutation was detected in 17% of our patients, with non-nucleoside reverse transcriptase (NNRTI) mutations observed in 15%. Among patients with at least one reverse transcriptase (RT) or major protease region (Pr) resistance mutation, 85% had resistance against a single ARV class. Dual and triple class resistance mutations were seen in 8 patients (2%) and 3 patients (0.7%), respectively. Most of the multiple class resistance was seen in 2010. A gradual increase in NNRTI resistance was noted during 2008 to 2010. Our prevalence of transmitted RT, major Pr mutations (17.4%) and ARV resistance (8.6%) were high but similar to rates reported by others within the United States. Given the high HIV prevalence in the District of Columbia, this has important implications for treatment of these ARV-naïve patients

Care of HIV-Infected Pregnant Women in Maternal–Fetal Medicine Programs

Objective: To survey the evolution over the past decade of attitudes and practices of obstetricians in maternal–fetal medicine fellowship programs regarding the management of human immunodeficiency virus (HIV)-infected pregnant women. Methods: Directors of all 65 approved maternal–fetal medicine training programs were sent questionnaires, responses to which were to reflect the consensus among members of their faculties. Programs were stratified based upon the number of HIV-infected pregnant patients cared for in the previous year. Results: Responses reflect experience with over 1000 infected pregnantwomen per year, nearly one-quarter with advanced disease. Combination antiretroviral therapy was prescribed by all respondents, universally in the 2nd and 3rd trimesters. A three-drug regimen (often containing a protease inhibitor) was used more often by those who treated at least 20 HIV-infected pregnant patients per year than by those programs seeing a lower number of patients (80 vs 59%).Despite the known and unknown risks of the use of antiretrovirals during pregnancy, only half of all responding programs report adverse events to the Antiretroviral Pregnancy Registry; reporting was more common among the institutions seeing a higher number of patients (61 vs 45%). Seventy-eight percent of higher volume programs enroll their patients in clinical studies, usually multicenter, versus 35% of lower volume programs. Conclusions: Care for HIV² pregnant women has dramatically changed over the past decade. Antiretroviral therapy is now universally prescribed by physicians involved in maternal–fetal medicine training programs. Given limited experience with these agents in the setting of pregnancy, it is essential for maternal–fetal medicine practitioners to actively report on adverse events and participate in clinical trials

Comparative biogeography of Southeast Asia and the West Pacific region

The file attached is the accepted/final draft post-refereeing version of the articl

Slow solar wind sources

Context. The origin of the slow solar wind is still an open issue. One possibility that has been suggested is that upflows at the edge of an active region can contribute to the slow solar wind. Aims. We aim to explain how the plasma upflows are generated, which mechanisms are responsible for them, and what the upflow region topology looks like. Methods. We investigated an upflow region using imaging data with the unprecedented temporal (3 s) and spatial (2 pixels = 236 km) resolution that were obtained on 30 March 2022 with the 174 Å channel of the Extreme-Ultraviolet Imager (EUI)/High Resolution Imager (HRI) on board Solar Orbiter. During this time, the EUI and Earth-orbiting satellites (Solar Dynamics Observatory, Hinode, and the Interface Region Imaging Spectrograph, IRIS) were located in quadrature (∼92°), which provides a stereoscopic view with high resolution. We used the Hinode/EIS (Fe XII) spectroscopic data to find coronal upflow regions in the active region. The IRIS slit-jaw imager provides a high-resolution view of the transition region and chromosphere. Results. For the first time, we have data that provide a quadrature view of a coronal upflow region with high spatial resolution. We found extended loops rooted in a coronal upflow region. Plasma upflows at the footpoints of extended loops determined spectroscopically through the Doppler shift are similar to the apparent upward motions seen through imaging in quadrature. The dynamics of small-scale structures in the upflow region can be used to identify two mechanisms of the plasma upflow: Mechanism I is reconnection of the hot coronal loops with open magnetic field lines in the solar corona, and mechanism II is reconnection of the small chromospheric loops with open magnetic field lines in the chromosphere or transition region. We identified the locations in which mechanisms I and II work

Evolution of dynamic fibrils from the cooler chromosphere to the hotter corona

Dynamic fibrils (DFs) are commonly observed chromospheric features in solar active regions. Recent observations from the Extreme Ultraviolet Imager (EUI) aboard the Solar Orbiter have revealed unambiguous signatures of DFs at the coronal base, in extreme ultraviolet (EUV) emission. However, it remains unclear if the DFs detected in the EUV are linked to their chromospheric counterparts. Simultaneous detection of DFs from chromospheric to coronal temperatures could provide important information on their thermal structuring and evolution through the solar atmosphere. In this paper, we address this question by using coordinated EUV observations from the Atmospheric Imaging Assembly (AIA), Interface Region Imaging Spectrograph (IRIS), and EUI to establish a one-to-one correspondence between chromospheric and transition region DFs (observed by IRIS) with their coronal counterparts (observed by EUI and AIA). Our analysis confirms a close correspondence between DFs observed at different atmospheric layers, and reveals that DFs can reach temperatures of about 1.5 million Kelvin, typical of the coronal base in active regions. Furthermore, intensity evolution of these DFs, as measured by tracking them over time, reveals a shock-driven scenario in which plasma piles up near the tips of these DFs and, subsequently, these tips appear as bright blobs in coronal images. These findings provide information on the thermal structuring of DFs and their evolution and impact through the solar atmosphere.Comment: Accepted for publication in A&A Letters. Animation files are available https://drive.google.com/drive/folders/17-fqQz_P2T18llJ1jB6MJISMRvT5063F?usp=sharin

Evolution of dynamic fibrils from the cooler chromosphere to the hotter corona

Dynamic fibrils (DFs) are commonly observed chromospheric features in solar active regions. Recent observations from the Extreme Ultraviolet Imager (EUI) aboard the Solar Orbiter have revealed unambiguous signatures of DFs at the coronal base in extreme ultraviolet (EUV) emission. However, it remains unclear if the DFs detected in the EUV are linked to their chromospheric counterparts. Simultaneous detection of DFs from chromospheric to coronal temperatures could provide important information on their thermal structuring and evolution through the solar atmosphere. In this paper, we address this question by using coordinated EUV observations from the Atmospheric Imaging Assembly (AIA), Interface Region Imaging Spectrograph (IRIS), and EUI to establish a one-to-one correspondence between chromospheric and transition region DFs (observed by IRIS) with their coronal counterparts (observed by EUI and AIA). Our analysis confirms a close correspondence between DFs observed at different atmospheric layers and reveals that DFs can reach temperatures of about 1.5 million Kelvin, typical of the coronal base in active regions. Furthermore, the intensity evolution of these DFs, as measured by tracking them over time, reveals a shock-driven scenario in which plasma piles up near the tips of these DFs and, subsequently, these tips appear as bright blobs in coronal images. These findings provide information on the thermal structuring of DFs and their evolution and impact through the solar atmosphere

Signatures of dynamic fibrils at the coronal base: Observations from Solar Orbiter/EUI

The solar chromosphere hosts a wide variety of transients, including dynamic fibrils (DFs) that are characterised as elongated, jet-like features seen in active regions, often through H$\alpha$ diagnostics. So far, these features have been difficult to identify in coronal images primarily due to their small size and the lower spatial resolution of the current EUV imagers. Here we present the first unambiguous signatures of DFs in coronal EUV data using high-resolution images from the Extreme Ultraviolet Imager (EUI) on board Solar Orbiter. Using the data acquired with the 174~{\AA} High Resolution Imager (HRI$_{EUV}$) of EUI, we find many bright dot-like features (of size 0.3-0.5 Mm) that move up and down (often repeatedly) in the core of an active region. In a space-time map, these features produce parabolic tracks akin to the chromospheric observations of DFs. Properties such as their speeds (14 km~s$^{-1}$), lifetime (332~s), deceleration (82 m~s$^{-2}$) and lengths (1293~km) are also reminiscent of the chromospheric DFs. The EUI data strongly suggest that these EUV bright dots are basically the hot tips (of the cooler chromospheric DFs) that could not be identified unambiguously before because of a lack of spatial resolution.Comment: Accepted for publication in A&A Letters. Event movie can be downloaded from https://drive.google.com/file/d/1o_4jHA5JbyQtrpUBtB3ItE_s3HjF6ncc/view?usp=sharin

Measurement of event shapes in deep inelastic scattering at HERA

Inclusive event-shape variables have been measured in the current region of the Breit frame for neutral current deep inelastic ep scattering using an integrated luminosity of 45.0 pb^-1 collected with the ZEUS detector at HERA. The variables studied included thrust, jet broadening and invariant jet mass. The kinematic range covered was 10 < Q^2 < 20,480 GeV^2 and 6.10^-4 < x < 0.6, where Q^2 is the virtuality of the exchanged boson and x is the Bjorken variable. The Q dependence of the shape variables has been used in conjunction with NLO perturbative calculations and the Dokshitzer-Webber non-perturbative corrections (`power corrections') to investigate the validity of this approach.Comment: 7+25 pages, 6 figure