Nevirapine Resistance and Breast-Milk HIV Transmission: Effects of Single and Extended-Dose Nevirapine Prophylaxis in Subtype C HIV-Infected Infants

Daily nevirapine (NVP) prophylaxis to HIV-exposed infants significantly reduces breast-milk HIV transmission. We assessed NVP-resistance in Indian infants enrolled in the "six-week extended-dose nevirapine" (SWEN) trial who received single-dose NVP (SD-NVP) or SWEN for prevention of breast-milk HIV transmission but who also acquired subtype C HIV infection during the first year of life.Standard population sequencing and cloning for viral subpopulations present at > or =5% frequency were used to determine HIV genotypes from 94% of the 79 infected Indian infants studied. Timing of infection was defined based on when an infant's blood sample first tested positive for HIV DNA. SWEN-exposed infants diagnosed with HIV by six weeks of age had a significantly higher prevalence of NVP-resistance than those who received SD-NVP, by both standard population sequencing (92% of 12 vs. 38% of 29; p = 0.002) and low frequency clonal analysis (92% of 12 vs. 59% of 29; p = 0.06). Likelihood of infection with NVP-resistant HIV through breast-milk among infants infected after age six weeks was substantial, but prevalence of NVP-resistance did not differ among SWEN or SD-NVP exposed infants by standard population sequencing (15% of 13 vs. 15% of 20; p = 1.00) and clonal analysis (31% of 13 vs. 40% of 20; p = 0.72). Types of NVP-resistance mutations and patterns of persistence at one year of age were similar between the two groups. NVP-resistance mutations did differ by timing of HIV infection; the Y181C variant was predominant among infants diagnosed in the first six weeks of life, compared to Y188C/H during late breast-milk transmission.Use of SWEN to prevent breast-milk HIV transmission carries a high likelihood of resistance if infection occurs in the first six weeks of life. Moreover, there was a continued risk of transmission of NVP-resistant HIV through breastfeeding during the first year of life, but did not differ between SD-NVP and SWEN groups. As with SD-NVP, the value of preventing HIV infection in a large number of infants should be considered alongside the high risk of resistance associated with extended NVP prophylaxis.ClinicalTrials.gov NCT00061321

A conceptual framework for the adoption of big data analytics by e-commerce startups: a case-based approach

E-commerce start-ups have ventured into emerging economies and are growing at a significantly faster pace. Big data has acted like a catalyst in their growth story. Big data analytics (BDA) has attracted e-commerce firms to invest in the tools and gain cutting edge over their competitors. The process of adoption of these BDA tools by e-commerce start-ups has been an area of interest as successful adoption would lead to better results. The present study aims to develop an interpretive structural model (ISM) which would act as a framework for efficient implementation of BDA. The study uses hybrid multi criteria decision making processes to develop the framework and test the same using a real-life case study. Systematic review of literature and discussion with experts resulted in exploring 11 enablers of adoption of BDA tools. Primary data collection was done from industry experts to develop an ISM framework and fuzzy MICMAC analysis is used to categorize the enablers of the adoption process. The framework is then tested by using a case study. Thematic clustering is performed to develop a simple ISM framework followed by fuzzy analytical network process (ANP) to discuss the association and ranking of enablers. The results indicate that access to relevant data forms the base of the framework and would act as the strongest enabler in the adoption process while the company rates technical skillset of employees as the most important enabler. It was also found that there is a positive correlation between the ranking of enablers emerging out of ISM and ANP. The framework helps in simplifying the strategies any e-commerce company would follow to adopt BDA in future. © 2019, Springer-Verlag GmbH Germany, part of Springer Nature

Tomorrow\u2019s Chemistry Today: Concepts in Nanoscience, Organic Materials and Environmental Chemistry

Providing a glimpse into the future, the young scientists contributing here were considered to be the most important for tomorrow's chemistry and materials science. They present the state of the art in their particular fields of research, with topics ranging from new synthetic pathways and nanotechnology to green chemistry. Of major interest to organic chemists, materials scientists and biochemists