42 research outputs found
Antenatal screening for Group B Streptococcus: A diagnostic cohort study
BACKGROUND: A range of strategies have been adopted to prevent early onset Group B Streptococcal (EOGBS) sepsis, as a consequence of Group B Streptococcal (GBS) vertically acquired infection. This study was designed to provide a scientific basis for optimum timing and method of GBS screening in an Australian setting, to determine whether screening for GBS infection at 35â37 weeks gestation has better predictive values for colonisation at birth than screening at 31â33 weeks, to examine the test characteristics of a risk factor strategy and to determine the test characteristics of low vaginal swabs alone compared with a combination of perianal plus low vaginal swabs per colonisation during labour. METHODS: Consented women received vaginal and perianal swabs at 31â33 weeks gestation, 35â38 weeks gestation and during labour. Swabs were cultured on layered horse blood agar and inoculated into selective broth prior to analysis. Test characteristics were calculated with exact confidence intervals for a high risk strategy and for antenatal screening at 31â33 and 35â37 weeks gestation for vaginal cultures alone, perianal cultures alone and combined low vaginal and perianal cultures. RESULTS: The high risk strategy was not informative in predicting GBS status during labour. There is an unequivocal benefit for the identification of women colonised with GBS during labour associated with delaying screening until 36 weeks however the results for method of screening were less definitive with no clear advantage in using a combined low vaginal and perianal swabbing regimen over the use of a low vaginal swab alone. CONCLUSION: This study can contribute to the development of prevention strategies in that it provides clear evidence for optimal timing of swabs. The addition of a perianal swab does not confer clear benefit. The quantification of advantages and disadvantages provided in this study will facilitate communication with clinicians and pregnant women alike
Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-Drug Resistant HIV Infection from the OPTIMA Trial
BACKGROUND: Guidance is needed on best medical management for advanced HIV disease with multidrug resistance (MDR) and limited retreatment options. We assessed two novel antiretroviral (ARV) treatment approaches in this setting. METHODS AND FINDINGS: We conducted a 2Ă2 factorial randomized open label controlled trial in patients with a CD4 countâ€300 cells/”l who had ARV treatment (ART) failure requiring retreatment, to two options (a) re-treatment with either standard (â€4 ARVs) or intensive (â„5 ARVs) ART and b) either treatment starting immediately or after a 12-week monitored ART interruption. Primary outcome was time to developing a first AIDS-defining event (ADE) or death from any cause. Analysis was by intention to treat. From 2001 to 2006, 368 patients were randomized. At baseline, mean age was 48 years, 2% were women, median CD4 count was 106/”l, mean viral load was 4.74 log(10) copies/ml, and 59% had a prior AIDS diagnosis. Median follow-up was 4.0 years in 1249 person-years of observation. There were no statistically significant differences in the primary composite outcome of ADE or death between re-treatment options of standard versus intensive ART (hazard ratio 1.17; CI 0.86-1.59), or between immediate retreatment initiation versus interruption before re-treatment (hazard ratio 0.93; CI 0.68-1.30), or in the rate of non-HIV associated serious adverse events between re-treatment options. CONCLUSIONS: We did not observe clinical benefit or harm assessed by the primary outcome in this largest and longest trial exploring both ART interruption and intensification in advanced MDR HIV infection with poor retreatment options. TRIAL REGISTRATION: Clinicaltrials.gov NCT00050089
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Extensive coronavirus-induced membrane rearrangements are not a determinant of pathogenicity
Positive-strand RNA (+RNA) viruses rearrange cellular membranes during replication, possibly in order to concentrate and arrange viral replication machinery for efficient viral RNA synthesis. Our previous work showed that in addition to the conserved coronavirus double membrane vesicles (DMVs), Beau-R, an apathogenic strain of avian Gammacoronavirus infectious bronchitis virus (IBV), induces regions of ER that are zippered together and tethered open-necked double membrane spherules that resemble replication organelles induced by other +RNA viruses. Here we compared structures induced by Beau-R with the pathogenic lab strain M41 to determine whether membrane rearrangements are strain dependent. Interestingly, M41 was found to have a low spherule phenotype. We then compared a panel of pathogenic, mild and attenuated IBV strains in ex vivo tracheal organ culture (TOC). Although the low spherule phenotype of M41 was conserved in TOCs, each of the other tested IBV strains produced DMVs, zippered ER and spherules. Furthermore, there was a significant correlation for the presence of DMVs with spherules, suggesting that these structures are spatially and temporally linked. Our data indicate that virus induced membrane rearrangements are fundamentally linked to the viral replicative machinery. However, coronavirus replicative apparatus clearly has the plasticity to function in different structural contexts
Write, draw, show, and tell: a child-centred dual methodology to explore perceptions of out-of-school physical activity
Background
Research to increase childrenâs physical activity and inform intervention design has, to date, largely underrepresented childrenâs voices. Further, research has been limited to singular qualitative methods that overlook childrenâs varied linguistic ability and interaction preference. The aim of this study was to use a novel combination of qualitative techniques to explore childrenâs current views, experiences and perceptions of out-of-school physical activity as well as offering formative opinion about future intervention design.
Methods
Write, draw, show and tell (WDST) groups were conducted with 35 children aged 10â11 years from 7 primary schools. Data were analysed through a deductive and inductive process, firstly using the Youth Physical Activity Promotion Model as a thematic framework, and then inductively to enable emergent themes to be further explored. Pen profiles were constructed representing key emergent themes.
Results
The WDST combination of qualitative techniques generated complimentary interconnected data which both confirmed and uncovered new insights into factors relevant to childrenâs out-of-school physical activity. Physical activity was most frequently associated with organised sports. Fun, enjoyment, competence, and physical activity provision were all important predictors of childrenâs out-of-school physical activity. Paradoxically, parents served as both significant enablers (i.e. encouragement) and barriers (i.e. restricting participation) to physical activity participation. Some of these key findings would have otherwise remained hidden when compared to more traditional singular methods based approaches.
Conclusions
Parents are in a unique position to promote health promoting behaviours serving as role models, physical activity gatekeepers and choice architects. Given the strong socialising effect parents have on childrenâs physical activity, family-based physical activity intervention may offer a promising alternative compared to traditional school-based approaches. Parents' qualitative input is important to supplement childrenâs voices and inform future family-based intervention design. The WDST method developed here is an inclusive, interactive and child-centred methodology which facilitates the exploration of a wide range of topics and enhances data credibility
The Aguablanca Niâ(Cu) sulfide deposit, SW Spain: geologic and geochemical controls and the relationship with a midcrustal layered mafic complex
The Aguablanca Niâ(Cu) sulfide deposit is
hosted by a breccia pipe within a gabbroâdiorite pluton.
The deposit probably formed due to the disruption of a
partially crystallized layered mafic complex at about 12â
19 km depth and the subsequent emplacement of melts and
breccias at shallow levels (<2 km). The ore-hosting breccias
are interpreted as fragments of an ultramafic cumulate,
which were transported to the near surface along with a
molten sulfide melt. Phlogopite ArâAr ages are 341â
332 Ma in the breccia pipe, and 338â334 Ma in the layered
mafic complex, and are similar to recently reported UâPb
ages of the host Aguablanca Stock and other nearby calcalkaline
metaluminous intrusions (ca. 350â330 Ma). Ore
deposition resulted from the combination of two critical
factors, the emplacement of a layered mafic complex deep
in the continental crust and the development of small
dilational structures along transcrustal strike-slip faults that
triggered the forceful intrusion of magmas to shallow
levels. The emplacement of basaltic magmas in the lower
middle crust was accompanied by major interaction with
the host rocks, immiscibility of a sulfide melt, and the
formation of a magma chamber with ultramafic cumulates
and sulfide melt at the bottom and a vertically zoned mafic
to intermediate magmas above. Dismembered bodies of
mafic/ultramafic rocks thought to be parts of the complex
crop out about 50 km southwest of the deposit in a
tectonically uplifted block (Cortegana Igneous Complex,
Aracena Massif). Reactivation of Variscan structures that
merged at the depth of the mafic complex led to sequential
extraction of melts, cumulates, and sulfide magma. Lithogeochemistry
and Sr and Nd isotope data of the Aguablanca
Stock reflect the mixing from two distinct reservoirs, i.e.,
an evolved siliciclastic middle-upper continental crust and a
primitive tholeiitic melt. Crustal contamination in the deep
magma chamber was so intense that orthopyroxene
replaced olivine as the main mineral phase controlling the early fractional crystallization of the melt. Geochemical
evidence includes enrichment in SiO2 and incompatible
elements, and Sr and Nd isotope compositions (87Sr/86Sri
0.708â0.710; 143Nd/144Ndi 0.512â0.513). However, rocks
of the Cortegana Igneous Complex have low initial
87Sr/86Sr and high initial 143Nd/144Nd values suggesting
contamination by lower crustal rocks. Comparison of the
geochemical and geological features of igneous rocks in the
Aguablanca deposit and the Cortegana Igneous Complex
indicates that, although probably part of the same magmatic
system, they are rather different and the rocks of the
Cortegana Igneous Complex were not the direct source of
the Aguablanca deposit. Crustâmagma interaction was a
complex process, and the generation of orebodies was
controlled by local but highly variable factors. The model
for the formation of the Aguablanca deposit presented in
this study implies that dense sulfide melts can effectively
travel long distances through the continental crust and that
dilational zones within compressional belts can effectively
focus such melt transport into shallow environments
Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes
BACKGROUND: Data are lacking on the long-term effect on cardiovascular events of adding sitagliptin, a dipeptidyl peptidase 4 inhibitor, to usual care in patients with type 2 diabetes and cardiovascular disease. METHODS: In this randomized, double-blind study, we assigned 14,671 patients to add either sitagliptin or placebo to their existing therapy. Open-label use of antihyperglycemic therapy was encouraged as required, aimed at reaching individually appropriate glycemic targets in all patients. To determine whether sitagliptin was noninferior to placebo, we used a relative risk of 1.3 as the marginal upper boundary. The primary cardiovascular outcome was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. RESULTS: During a median follow-up of 3.0 years, there was a small difference in glycated hemoglobin levels (least-squares mean difference for sitagliptin vs. placebo, -0.29 percentage points; 95% confidence interval [CI], -0.32 to -0.27). Overall, the primary outcome occurred in 839 patients in the sitagliptin group (11.4%; 4.06 per 100 person-years) and 851 patients in the placebo group (11.6%; 4.17 per 100 person-years). Sitagliptin was noninferior to placebo for the primary composite cardiovascular outcome (hazard ratio, 0.98; 95% CI, 0.88 to 1.09; P<0.001). Rates of hospitalization for heart failure did not differ between the two groups (hazard ratio, 1.00; 95% CI, 0.83 to 1.20; P = 0.98). There were no significant between-group differences in rates of acute pancreatitis (P = 0.07) or pancreatic cancer (P = 0.32). CONCLUSIONS: Among patients with type 2 diabetes and established cardiovascular disease, adding sitagliptin to usual care did not appear to increase the risk of major adverse cardiovascular events, hospitalization for heart failure, or other adverse events
Regional differences in portion size consumption behaviour: Insights for the global food industry
Abstract: Given the influence of globalization on consumer food behaviour across the world, the purpose of this paper is to contribute to the theoretical discourse around food portion size as a global consumption-related symbol and its underlying socio-economic drivers for food industry strategy. Overall, 25,000 global food consumers were surveyed across 24 countries to elicit insight on portion size consumption behaviour as well as consumer perception on eating and drinking small portion size within selected socio-economic classes. The data was quantitatively analysed to answer the pertinent research objectives. In 20 out of the 24 global markets surveyed, large food portion size was statistically established as a prevalent consumption-related symbol. The paper found that there are regional differences in portion size food consumption behaviour, and further disparities exist across age, gender and income status in 24 countries covering all regions, including Australia, China, Mexico, South Africa, United Kingdom and United States of America. The outlined food industry implications reveal that adaptation and standardisation strategies are still relevant in global food and nutrition strategy as revealed by the variations in the preference for food portion sizes across various countries of the world