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Objective: To develop and validate novel prediction models to personalise the risk of conversion from laparoscopic to open hysterectomy in benign conditions. Design: Retrospective cohort study. Settings: English NHS Hospitals between 2011 and 2018. Population: 68 752 women undergoing laparoscopic hysterectomy for benign conditions. Methods: We developed two multivariable logistic models using readily available clinical information, one for the pre‐operative setting and another for operative decision‐making using additional surgical information, using 2011–2016 data in five regions (24 806 women). We validated them (a) temporally in the same regions using 2017–2018 data (12 438 women); (b) geographically in the same time‐period using data from three different regions (22 024 women); and (c) temporally and geographically using 2017–2018 data in three different regions (9484 women). Main Outcome Measures: Conversion from laparoscopic to open hysterectomy. Results: Conversions occurred in 6.8% (1687/24 806) of hysterectomies in the development group, and in 5.5% (681/12 438) in the temporal, 5.9% (1297/22 204) in the geographical and 5.2% (488/9484) in the temporal and geographical validation groups. In the development cohort, the area under the receiver operating characteristic curve values for the pre‐operative and operative models were 0.65 and 0.67, respectively. In the validation cohorts the corresponding values were 0.65 and 0.66 (temporal), 0.66 and 0.68 (geographical) and 0.65 and 0.68 (temporal and geographical), respectively. Factors predictive of conversion included age, Asian ethnicity, obesity, fibroids, adenomyosis, endometriosis and adhesions. Adhesions were the most predictive (odds ratio 2.54, 95% confidence interval 2.22–2.90). Conclusion: The models for predicting conversions showed acceptable performance and transferability. Novel tool to personalise the risk of conversion from laparoscopic to open hysterectomy in benign conditions. Novel tool to personalise the risk of conversion from laparoscopic to open hysterectomy in benign conditions. [ABSTRACT FROM AUTHOR]

There are several prognostic models to estimate the risk of mortality after surgery for active infective endocarditis (IE). However, these models incorporate different predictors and their performance is uncertain. We systematically reviewed and critically appraised all available prediction models of postoperative mortality in patients undergoing surgery for IE, and aggregated them into a meta-model. We searched Medline and EMBASE databases from inception to June 2020. We included studies that developed or updated a prognostic model of postoperative mortality in patient with IE. We assessed the risk of bias of the models using PROBAST (Prediction model Risk Of Bias ASsessment Tool) and we aggregated them into an aggregate meta-model based on stacked regressions and optimized it for a nationwide registry of IE patients. The meta-model performance was assessed using bootstrap validation methods and adjusted for optimism. We identified 11 prognostic models for postoperative mortality. Eight models had a high risk of bias. The meta-model included weighted predictors from the remaining three models (EndoSCORE, specific ES-I and specific ES-II), which were not rated as high risk of bias and provided full model equations. Additionally, two variables (age and infectious agent) that had been modelled differently across studies, were estimated based on the nationwide registry. The performance of the meta-model was better than the original three models, with the corresponding performance measures: C-statistics 0.79 (95% CI 0.76–0.82), calibration slope 0.98 (95% CI 0.86–1.13) and calibration-in-the-large –0.05 (95% CI –0.20 to 0.11). The meta-model outperformed published models and showed a robust predictive capacity for predicting the individualized risk of postoperative mortality in patients with IE. PROSPERO (registration number CRD42020192602). [ABSTRACT FROM AUTHOR]

• Sepsis was more common in males than females • Males with sepsis presented higher disease severity than females • Sex did not affect mortality in patients with sepsis and admitted to intensive care units Men have been considered to have a higher incidence of infectious diseases, with controversy over the possibility that sex could influence the prognosis of the infection. This study aimed to explore this assumption in patients admitted to the intensive care unit (ICU) with septic bacteremia. A retrospective analysis (2006-2017) of septic patients with microbiologically confirmed bacteremia (n=440) was performed. Risk of ICU and in-hospital mortality in males versus females was compared by univariate analysis and a propensity score analysis integrating their clinical characteristics. Sepsis more frequently occurred in males (80.2% vs 76.1%) as well as in-hospital (48.0% vs 41.3%) and ICU (39.9% vs 36.5%) mortality. Univariate analyses showed that males had a higher Charlson comorbidity index and worse McCabe prognostic score. However, the propensity score in 296 matched patients demonstrated that females had higher risk of both ICU (OR 1.39; 95% CI 0.89-2.19) and in-hospital mortality (OR 1.18; 95% CI 0.77-1.83), but without statistical significance. Males with sepsis had worse clinical characteristics when admitted to the ICU, but sex had no influence on mortality. These data contribute to helping reduce the sex-dependent gap present in healthcare provision. [ABSTRACT FROM AUTHOR]

The increased use of silver nanoparticles (AgNPs) is expected to result in negative environmental impact, particularly on aquatic ecosystems. The effect of AgNPs to aquatic plants has received little attention. Azolla filiculoides is an interesting aquatic fern with phytoremediation capacities. Therefore, the objective of this research was to evaluate the interaction of AgNPs with A. filiculoides, observing NPs internalization, accumulation, and effects on growth and root structure with high-resolution imaging and analytical techniques. The AgNPs bio-synthesized with Camellia sinensis extracts showed regular shape (quasi-spherical) and size (26.74 ± 0.52 nm). A. filiculoides plants were grown in Yoshida nutrient solution (pH 5) and exposed to AgNPs (0.0, 0.1, 1.0, 5.0, 10.0, 100.0 mg L−1), under a completely random experimental design. The Spearman's correlation indicated a high negative relation between the AgNPs concentration, and dry biomass (DB), associated with a higher duplication rate (DR). AgNP internalization and distribution were studied with high-resolution scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDS) combined with backscattered electron (BSE) images on surfaces and thin (70 nm) sections of roots and fronds. Our results support the hypothesis that AgNPs deposit on roots and fronds subphases and dissociate into Ag+ that enter the root and accumulate in the endodermis, where they form AgNPs. Structural damages on the rhizodermis and vascular cylinder at high concentrations (100.0 mg AgNPs L−1) suggest the impairment of the main functions of roots, reducing either Ag+ or AgNP uptake and translocation, affecting plant growth and silver accumulation in the fern. [ABSTRACT FROM AUTHOR]

Background: The CD4/CD8 ratio is an indicator of immunosenescence and a predictor of all-cause mortality in HIV-infected patients. The effects of different ART regimens on CD4/CD8 ratio recovery remain unclear.Methods: Clinical cohort study of ART-treated patients from the CFAR Network of Integrated Clinical Systems (CNICS). We included ART-naive adults with HIV infection who achieved undetectable HIV RNA during the first 48 weeks of treatment and had additional follow-up 48 weeks after virological suppression (VS). Primary endpoints included increase in CD4/CD8 ratio at both timepoints and secondary endpoints were CD4/CD8 ratio recovery at cut-offs of ≥0.5 or ≥1.0.Results: Of 3971 subjects who met the study criteria, 1876 started ART with an NNRTI, 1804 with a PI and 291 with an integrase strand transfer inhibitor (INSTI). After adjusting for age, sex, race, year of entry, risk group, HCV serostatus, baseline viral load and baseline CD4/CD8 ratio, subjects on an NNRTI showed a significantly greater CD4/CD8 ratio gain compared with those on a PI, either 48 weeks after ART initiation or after 48 weeks of HIV RNA VS. The greater CD4/CD8 ratio improvement in the NNRTI arm was driven by a higher decline in CD8 counts. The INSTI group showed increased rates of CD4/CD8 ratio normalization at the ≥1.0 cut-off compared with the PI group.Conclusions: NNRTI therapy was associated with a greater increase in the CD4/CD8 ratio compared with PIs. NNRTI- and INSTI-based first-line ART were associated with higher rates of CD4/CD8 ratio normalization at a cut-off of 1.0 than a PI-based regimen, which might have clinical implications. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer–Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland–Altman agreement analysis and a scatterplot graph. RESULTS The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72–0.77) and calibration (calibration slope = 1.03; Hosmer–Lemeshow test P  = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort. [ABSTRACT FROM AUTHOR]

Morphological and behavioural traits influence contest development and outcome. We analysed morphological and behavioural traits in male and female staged contests of Chalcides viridanus along breeding time. There was no significant difference in any morphologic trait for winner and looser male contenders; larger hind-limbs and heads were significantly associated to winner females. 'Approach' was positively while 'flee' negatively associated to winner males. 'Tongue-flick' and 'approach' were positively associated to female winners and 'flee' to losers. Contest intensity was higher in male than in female contests. For males it was higher in May than in March or April but for females in April and May than in March. Contest intensity was positively related to head width in loser males, suggesting fitting to a pure self-assessment model. For females there was no significant association. For the first time we have shown that skink female contests are as complex as those of males. [ABSTRACT FROM AUTHOR]

Subnational governments entering the international arena through lobbying may be a turning point in global governance, but numerous challenges remain at regional level. This paper charts a municipal geography of the planet that is strongly conditioned by its capacity to respond to the dynamics of urbanisation and rural depopulation, and reflects on the need to structure more representative, supportive regional governance. With the global implementation of the 2030 Agenda focussing on the ability of local governments to institutionalise the "right to the city" and "leave no one behind", the regional level becomes the ground in which territorial intermediation can help germinate the right to "leave no municipality behind". [ABSTRACT FROM AUTHOR]

Background: Seizures are the main cause of maternal death in women with epilepsy, but there are no tools for predicting seizures in pregnancy. We set out to develop and validate a prognostic model, using information collected during the antenatal booking visit, to predict seizure risk at any time in pregnancy and until 6 weeks postpartum in women with epilepsy on antiepileptic drugs.Methods and Findings: We used datasets of a prospective cohort study (EMPiRE) of 527 pregnant women with epilepsy on medication recruited from 50 hospitals in the UK (4 November 2011-17 August 2014). The model development cohort comprised 399 women whose antiepileptic drug doses were adjusted based on clinical features only; the validation cohort comprised 128 women whose drug dose adjustments were informed by serum drug levels. The outcome was epileptic (non-eclamptic) seizure captured using diary records. We fitted the model using LASSO (least absolute shrinkage and selection operator) regression, and reported the performance using C-statistic (scale 0-1, values > 0.5 show discrimination) and calibration slope (scale 0-1, values near 1 show accuracy) with 95% confidence intervals (CIs). We determined the net benefit (a weighted sum of true positive and false positive classifications) of using the model, with various probability thresholds, to aid clinicians in making individualised decisions regarding, for example, referral to tertiary care, frequency and intensity of monitoring, and changes in antiepileptic medication. Seizures occurred in 183 women (46%, 183/399) in the model development cohort and in 57 women (45%, 57/128) in the validation cohort. The model included age at first seizure, baseline seizure classification, history of mental health disorder or learning difficulty, occurrence of tonic-clonic and non-tonic-clonic seizures in the 3 months before pregnancy, previous admission to hospital for seizures during pregnancy, and baseline dose of lamotrigine and levetiracetam. The C-statistic was 0.79 (95% CI 0.75, 0.84). On external validation, the model showed good performance (C-statistic 0.76, 95% CI 0.66, 0.85; calibration slope 0.93, 95% CI 0.44, 1.41) but with imprecise estimates. The EMPiRE model showed the highest net proportional benefit for predicted probability thresholds between 12% and 99%. Limitations of this study include the varied gestational ages of women at recruitment, retrospective patient recall of seizure history, potential variations in seizure classification, the small number of events in the validation cohort, and the clinical utility restricted to decision-making thresholds above 12%. The model findings may not be generalisable to low- and middle-income countries, or when information on all predictors is not available.Conclusions: The EMPiRE model showed good performance in predicting the risk of seizures in pregnant women with epilepsy who are prescribed antiepileptic drugs. Integration of the tool within the antenatal booking visit, deployed as a simple nomogram, can help to optimise care in women with epilepsy. [ABSTRACT FROM AUTHOR]

Presents information on a study which observed structural changes on and near surfaces of zinc tellurium crystals by the surface profile imaging method in a high-resolution transmission electron microscope. Methodology of the study; Results and discussion; Conclusion.

Presents a study which examined the intermediate phases during icosahedral-crystal transition in aluminum magnesium alloy. Methods; Results; Discussion.

Objectives: We aimed to study the risk of developing post-traumatic stress disorder (PTSD) symptoms in people who resided in an affected area by an extremely severe flood, and sociodemographic risk factors associated with this condition. Study design: A geographic information system (GIS) was used to distribute the rainfall data. A case-control study was developed to study the relationship between PTSD and sociodemographic risk factors. Methods: To delineate the areas affected by the flood and the intensity of this rainfall in comparison with historical hydrological data, we employed geographical information systems (GIS). Then, we recruited a representative sample of the affected population and another population sample that lived at the time of this disaster in adjacent geographical areas that were not affected. Both groups were randomly selected in primary care practices, from December 1st 2012 to January 31st 2013. All participants, 70 from the affected areas and 91 from the non-affected, filled a sociodemographic questionnaire and the trauma questionnaire (TQ) to identify and rate PTSD symptoms. Results: Our GIS analysis confirmed that the amount of precipitation in 2012 in the areas affected by the flood was exceptionally high compared with historical average rainfall data (461l per square metre vs 265). Individuals who resided in the affected areas at the time of the flood were at much higher risk of developing PTSD symptoms (OR: 8.18; 95% CI: 3.99e17.59) than those living in adjacent, non-affected localities. Among the sociodemographic variables included in this study, only material and financial losses were strongly associated with the onset of PTSD (P < 0.001). Physical risk during this life-threatening catastrophe also indicated a positive correlation with later development of PTSD symptoms; however, it did not reach statistical significance (P = 0.06). Conclusions: Populations affected by severe floods may suffer an increase of PTSD symptoms in the following months. This finding, along with the importance of material losses as a predictor for such disorder, may help develop effective plans to minimize the negative impact of these natural disasters on public health. [ABSTRACT FROM AUTHOR]

Objective: To describe the changing demographic profile of diagnosed HIV-infected pregnant women over time and trends in pregnancy outcome, uptake of interventions and mother-to-child transmission. Design: National surveillance study. Setting: UK and Ireland. Population: Diagnosed HIV-infected pregnant women, 1990-2006. Methods: Active surveillance of obstetric and paediatric HIV conducted through the National Study of HIV in Pregnancy and Childhood. Main Outcome Measures: Maternal characteristics, pregnancy outcome, use of antiretroviral therapy, mode of delivery and mother-to-child transmission. Results: A total of 8327 pregnancies were reported, increasing from 82 in 1990 to 1394 in 2006, with an increasing proportion from areas outside London. Injecting drug use as the reported risk factor for maternal HIV acquisition declined from 49.2% (185/376) in 1990-1993 to 3.1% (125/4009) in 2004-2006 (P < 0.001), while the proportion of women born in sub-Saharan Africa increased from 43.5% (93/214) in 1990-1993 to 78.6% (3076/3912) in 2004-2006 (P < 0.004). Reported pregnancy terminations decreased from 29.6% (111/376) in 1990-1993 to 3.4% (135/4009) in 2004-2006 (P < 0.001). Most (56.4%, 3717/6593) deliveries were by elective caesarean section, with rates highest in 1999 (66.4%, 144/217). Vaginal deliveries increased from 16.6% (36/217) in 1999 to 28.3% (321/1136) in 2006 (P < 0.001). Use of antiretroviral therapy in pregnancy increased over time, reaching 98.4% (1092/1110) in 2006, and the overall mother-to-child transmission rate declined from 18.5% (35/189) in 1990-1993 to 1.0% (29/2832) in 2004-2006. Conclusions: The annual number of reported pregnancies increased dramatically between 1990 and 2006, with changing demographic and geographic profiles and substantial changes in pregnancy management and outcome. [ABSTRACT FROM AUTHOR]

"Economies of agglomeration" have acted as catalysts of the progress and modernisation of many nations in the Global South but have also contributed to unbalancing the territory, widening the gap between urban and rural populations and the accumulation of high environmental and social deficits. In contrast to the BRICS (Brazil, Russia, India, China and South Africa), the economies that make up the MINTs (Mexico, Indonesia, Nigeria and Turkey) have better territorial integration of their urban systems, with intermediate cities that act as "economies of intermediation" with the rural hinterlands, and which could contribute to achieving the United Nations' 2030 Agenda for Sustainable Development Goals. The United Nations Habitat iii of October 2016 placed intermediary cities at the heart of the New Urban Agenda. The aim is to promote national urban policies in many of the economies of the Global South, allowing them to strengthen their role as the main instrument of economic integration and regional cohesion. [ABSTRACT FROM AUTHOR]

Light emission in the three primary colors was achieved in cubic GaN/InGaN/GaN heterostructures grown by molecular beam epitaxy on MgO substrates in a single growth process. A heterostructure with four quantum wells with a width of 10 nm was grown; this quantum wells width decrease the segregation effect of In. Photoluminescence emission produced four different emission signals: violet, blue, green-yellow and red. Thus, we were able to tune energy transitions in the visible spectrum modifying the In concentration in cubic In x Ga 1− x N ternary alloy. [ABSTRACT FROM AUTHOR]

Wildfires affecting forest ecosystems and post-fire silvicultural treatments may cause considerable changes in soil properties. The capacity of different microbial groups to recolonise soil after disturbances is crucial for proper soil functioning. The aim of this work was to investigate some microbial soil properties and enzyme activities in semiarid and dry Aleppo pine (Pinus halepensis M.) forest stands. Different plots affected by a wildfire event 17 years ago without or with post-fire silvicultural treatments 5 years after the fire event were selected. A mature Aleppo pine stand, unaffected by wildfire and not thinned was used as a control. Physico-chemical soil properties (soil texture, pH, carbonates, organic matter, electrical conductivity, total N and P), soil enzymes (urease, phosphatase, β-glucosidase and dehydrogenase activities), soil respiration and soil microbial biomass carbon were analysed in the selected forests areas and plots. The main finding was that long time after this fire event produces no differences in the microbiological soil properties and enzyme activities of soil after comparing burned and thinned, burned and not thinned, and mature plots. Moreover, significant site variation was generally seen in soil enzyme activities and microbiological parameters. We conclude that total vegetation recovery normalises post-fire soil microbial parameters, and that wildfire and post-fire silvicultural treatments are not significant factors affecting soil properties after 17 years. [ABSTRACT FROM AUTHOR]

The informal city, as a conurbation of informal human settlements, is in practice the opposite model to the formal city. By taking an objective view of a global urban reality polarised into urban informal metro-conurbations, multilateral and international development agencies continue to insist on channelling much of their resources into a social context that has converted their political invisibility, financial self-sufficiency and environmental resilience into the Achilles' heel of local governments, weighed down by endless administrative and fiscal decentralisation processes. Who are governmental actions being implemented for? How and with whom should local governance be shared? These are crucial questions which, prior to any prioritisation of urban strategy public policy, will continue to create tension for the governing bodies in their daily management of the emerging city. [ABSTRACT FROM AUTHOR]

Abstract: Nanobiotechnology, bionanotechnology, and nanobiology are terms that have emerged in reference to the combination of nanotechnology and biology. Through the convergence of these disciplines, the production of metallic nanoparticles (NPs) using biological material as reducing agents is rapidly progressing. In the near future, the application of clean, non-toxic, and eco-friendly nanostructured material will be possible in industry and/or biomedicine. Currently, there is a wide range of organisms that have been reported to be useful in producing NPs. However, the development of finer protocols and the applicability of biosynthesized nanostructures are presently under study. Silver and gold are among the most studied metals due to their potential use in medical treatment. In fact, silver NPs have been evaluated as antimicrobial agents, having been successfully used against several types of fungi and bacteria. However, the use of such material in our daily life must be carefully evaluated. This article summarizes some of the most significant results using organisms to produce metallic NPs as well as the microscopic analyses used to characterize the nanostructured material obtained, providing a valuable database for future research. [Copyright &y& Elsevier]

Highlights: [•] Template-free synthesis of rods of CoMoO4 was achieved under hydrothermal conditions. [•] The width of the rods is about 100nm and the length varies from 1 to 5μm. [•] Low temperature and pressure of synthesis favour the formation of longer rods. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2012; 18: 1206-1211 Abstract Comparisons of bloodstream infection (BSI) rates between neonatal intensive-care units (NICUs) should take into account differences in babies' vulnerability and invasive procedures that can introduce infection. Our aim was to investigate which risk factors recorded in routine records should be adjusted for when NICUs are compared. This was a retrospective cohort study using routine records for two London NICUs. We analysed rates of BSI with Poisson regression models. The level of neonatal care used by the National Health Service was the strongest predictor of BSI incidence. The rate ratios for BSI, adjusted for birthweight, inborn/outborn status, and postnatal age, were 3.15 (95% CI 2.01-4.94) for intensive care and 6.58 (95% CI 4.18-10.36) for high-dependency care, relative to special care. Total parenteral nutrition was significantly associated with BSI incidence, but explained less of the variance among babies than level of care. A case-control study with the same dataset gave similar results. Further multicentre studies are required to confirm our predictive model. Until then, we recommend that comparisons of BSI rates between NICUs should include adjustments for level of care, birthweight, inborn/outborn status, and postnatal age, with the use of routinely recorded standardized measures in hospital administrative data. [ABSTRACT FROM AUTHOR]

The aim of this work was to examine the effect of pine forests on the soil microbial community along an altitudinal gradient in the Cuenca Mountains, Spain. Six experimental forest areas and two tree diversity levels (monospecific and mixed pine forest) were selected according to the following types: (i) at lower altitudes (up to 960 m above sea level), a monospecific Spanish black pine ( Pinus nigra Arn. ssp salzmannii) forest stand and a mixed forest stand (maritime pine ( Pinus pinaster Ait.) and Spanish black pine); (ii) at medium altitudes (up to 1350 m), a monospecific Spanish black pine forest stand and a mixed forest stand (Scots pine ( Pinus sylvestris L.) and Spanish black pine); and (iii) above 1670 m, a monospecific Spanish black pine forest stand and a mixed forest stand (Scots pine and Spanish black pine). Soil moisture and temperature and different forest stand variables such as tree species composition, tree height, basal area and shrub cover were measured. Physicochemical soil properties including texture, pH, carbonates, total organic carbon, organic matter, electrical conductivity, N, P, soil enzyme activities, soil respiration and soil microbial biomass carbon were analysed at the selected forest areas and tree diversity levels. Results showed that soil moisture and temperature differed significantly across the altitudinal gradient. Carbon:nitrogen ratio, total carbonates, total organic carbon, phosphorus and total N values also differed at each experimental area but tree diversity level was not an influential factor. Soil respiration, microbial biomass carbon and enzyme activities tended to be less at low altitudes whereas no differences were found between monospecific and mixed pine forests across the altitudinal gradient. This work suggests that the soils of the Cuenca Mountains may be more sensitive to some physical and chemical site-specific aspects such as soil temperature and moisture than changes in tree stand composition (when considering only pine species). In addition, differences in soil physicochemical properties found at each experimental area may also act as additional factors for regulating enzymatic activities. [ABSTRACT FROM AUTHOR]

Aims: We investigated the link between tree community composition and soil microbial community biomass and structure in central-eastern Spain. Methods: The effects of the forest stand composition on the soil organic matter dynamics and on the structure and activity of the soil microbial community have been determined using phospholipid fatty acid profiles and soil enzymatic activities. Results: The soil and litter N and C contents were higher in Pinus nigra Arn. ssp. salzmannii and Quercus ilex mixed forest stands (SBHO) and in long-term unmanaged Pinus nigra Arn. ssp. salzmannii forest stands (SBPC) than in pure Pinus nigra Arn. ssp. salzmannii forest stands (SBPA) and Pinus nigra Arn. ssp. salzmannii and Juniperus thurifera mixed forest stands (SBSJ). The bacterial biomass was significantly higher in SBSJ and SBPA than in SBPC and SBHO. The results show an uncoupling of the soil microbial biomass and its activity. pH is related to microbial biomass and its community structure under a Mediterranean humid climate. Conclusions: The tree species seem to affect the biomass of the soil microbial community and its structure. The pH, but not the C/N ratio, is a factor influencing the microbial dynamics, biomass, and community structure. [ABSTRACT FROM AUTHOR]

Abstract: The formation of individual graphene foils (GF) has been evidenced in the present study inside multi-walled carbon nanotubes. The graphene foils are attached on one side to a catalyst nanoparticle and on the other side to the internal walls of the nanotube. Moreover, results suggest that a necking process occurs in which internal carbon walls are deformed until formation of the graphene foil. A possible mechanism for the GF formation is then proposed. [Copyright &y& Elsevier]

Abstract: This paper describes the “one-step” bio-reduction synthesis method (using sinensis extract) for the preparation of Au and AgAu catalysts supported on SiO2–Al2O3 (SA) material and their catalytic activity in the oxidation and hydrogenation of CO. For comparison the catalytic activity over reference Au/SA catalyst prepared by conventional deposition–precipitation (DP) method was included. The catalysts have been proved effectively as catalysts in the hydrogenation and oxidation of carbon monoxide in comparison with the sample prepared by DP procedure. The bimetallic AgAu/SA sample showed better behaviour in the CO oxidation, while in the CO hydrogenation reaction was the Au/SA monometallic sample which showed superior catalytic performance. Ours results showed that “one-step” bio-reduction synthesis method have proved to be uncomplicated, cost effectiveness and environmental friendly, that we expected this approach can be efficient to obtain nanostructured-supported Au and AgAu catalysts, with lower crystal size, homogeneous morphology and high catalytic performance and stability in the reactions involving the CO. [Copyright &y& Elsevier]

Objectives Routine screening for rubella susceptibility is recommended in the UK so that women found to be susceptible can be offered immunization in the post partum period. We demonstrate the use of newborn dried blood spot samples linked to routine vital statistics datasets to monitor rubella susceptibility in pregnant women and to investigate maternal characteristics as determinants of rubella seronegativity. Setting North Thames region of England (including large parts of inner London). Methods Maternally acquired rubella IgG antibody levels were measured in 18882 newborn screening blood spot samples. Latent class regression finite mixture models were used to classify samples as seronegative to rubella. Data on maternal country of birth were available through linkage to birth registration data. Results An estimated 2.7% (95% CI 2.4%-3.0%) of newly delivered women in North Thames were found to be seronegative. Mothers born abroad, particularly in Sub-Saharan Africa and South Asia, were more likely to be seronegative than UK-born mothers, with adjusted odds ratios of 4.2 (95% CI 3.1-5.6) and 5.0 (3.8-6.5), respectively. Mothers under 20 years were more likely to be seronegative than those aged 30 to 34. Conclusion Our findings highlight the need for vaccination to be targeted specifically at migrant women and their families to ensure that they are protected from rubella in pregnancy and its serious consequences. [ABSTRACT FROM AUTHOR]

Objective To describe the changing demographic profile of diagnosed HIV-infected pregnant women over time and trends in pregnancy outcome, uptake of interventions and mother-to-child transmission. Design National surveillance study. Setting UK and Ireland. Population Diagnosed HIV-infected pregnant women, 1990–2006. Methods Active surveillance of obstetric and paediatric HIV conducted through the National Study of HIV in Pregnancy and Childhood. Main outcome measures Maternal characteristics, pregnancy outcome, use of antiretroviral therapy, mode of delivery and mother-to-child transmission. Results A total of 8327 pregnancies were reported, increasing from 82 in 1990 to 1394 in 2006, with an increasing proportion from areas outside London. Injecting drug use as the reported risk factor for maternal HIV acquisition declined from 49.2% (185/376) in 1990–1993 to 3.1% (125/4009) in 2004–2006 ( P < 0.001), while the proportion of women born in sub-Saharan Africa increased from 43.5% (93/214) in 1990–1993 to 78.6% (3076/3912) in 2004–2006 ( P < 0.004). Reported pregnancy terminations decreased from 29.6% (111/376) in 1990–1993 to 3.4% (135/4009) in 2004–2006 ( P < 0.001). Most (56.4%, 3717/6593) deliveries were by elective caesarean section, with rates highest in 1999 (66.4%, 144/217). Vaginal deliveries increased from 16.6% (36/217) in 1999 to 28.3% (321/1136) in 2006 ( P < 0.001). Use of antiretroviral therapy in pregnancy increased over time, reaching 98.4% (1092/1110) in 2006, and the overall mother-to-child transmission rate declined from 18.5% (35/189) in 1990–1993 to 1.0% (29/2832) in 2004–2006. Conclusions The annual number of reported pregnancies increased dramatically between 1990 and 2006, with changing demographic and geographic profiles and substantial changes in pregnancy management and outcome. [ABSTRACT FROM AUTHOR]

Phenylketonuria (PKU) is an autosomal recessive inborn error of metabolism (OMIM 261600). Treatment with a low-phenylalanine diet following early ascertainment by newborn screening prevents impaired cognitive development, the major disease phenotype in PKU. The overall birth prevalence of PKU in European, Chinese and Korean populations is ∼1/10,000. Since the human PAH locus contains PKU-causing alleles and polymorphic core haplotypes that describe and corroborate an out-of-Africa range expansion in modern human populations, it is of interest to know the prevalence of PKU in different ethnic groups with diverse geographical origin. We estimated PKU prevalence in South East England, where a sizeable proportion of the population are of Sub-Saharan African or South Asian ancestry. Over the period 1994 to 2004 167 children were diagnosed with PKU. Using birth registration and census data to derive denominators, PKU birth prevalence per 10,000 live births (95% Bayesian credible intervals) was estimated to be 1.14 (0.96–1.33) among white, 0.11 (0.02–0.37) among black, and 0.29 (0.10–0.63) among Asian ethnic groups. This suggests that PKU is up to an order of magnitude less prevalent in populations with Sub-Saharan African and South Asian ancestry that have migrated to the UK. [ABSTRACT FROM AUTHOR]

Sex and population differences in the ultraviolet (UV) reflectance patterns of two phenotypically divergent lacertids from Tenerife, Gallotia galloti eisentrauti and G. g. galloti, are described. Adults in both populations have rows of lateral and ventro-lateral blue patches on either side of the trunk that show a single peak of reflectance in the near UV. The lateral patches of males are more intensely reflective than those of females, but females have more chromatic and UV-shifted lateral patches than males. Most G. g. eisentrauti and some G. g. galloti also have blue cheek patches on either side of the gular area. Male cheek patches have reflectance peaks in the near UV, whereas those of females peak in the visible part of the spectrum. The lateral patches of males from the two populations differ in hue but not in intensity, those of G. g. galloti being more UV-shifted than those of G. g. eisentrauti. Female G. g. galloti have more intensely reflective lateral patches than female G. g. eisentrauti. Interindividual variation in peak wavelength and/or UV chroma is present in both sexes and populations. This is the first demonstration of sexual dichromatism in the UV reflectance of colour patches in a lacertid. [ABSTRACT FROM AUTHOR]

Abstract: The present study shows results on radiation grafting of acrylic acid (AAc) and N-isopropylacrylamide (NIPAAm) mixtures onto polytetrafluoroethylene (PTFE) films. The main objective is to use the modified polymer for immobilization of the avidin-streptavidin systems or other bio-compounds. Grafting onto PTFE was carried out by the pre-irradiation oxidative method in air at different dose rates and irradiation doses. The irradiation was produced with the electron beam of a 2MV van de Graaff accelerator, and gamma-rays, from a Gamma Beam 651 PT. The samples were placed in glass ampoules with the AAc and NIPAAm mixtures, in an aqueous solution. Graft polymerization was performed by heating of the polymer–monomer composition in an argon atmosphere at temperature of 50°C. Surface funcionalization was studied by X-ray photoelectron spectroscopy (XPS); morphology of the surface was studied by scanning electron microscopy (SEM) and hydrophylization of the surface, by contact angle measurements (static method). [Copyright &y& Elsevier]

The aim was to study as to how biometric and life-history traits of endemic lacertids in the Canary Islands (genus Gallotia) may have evolved, and possible factors affecting the diversification process of this taxon on successively appearing islands have been deduced. To that end, comparative analyses of sexual dimorphism and scaling of different body, head and life-history traits to body size in 10 species/subspecies of Gallotia have been carried out. Both Felsenstein's independent contrasts and Huey and Bennett's ‘minimum evolution’ analyses show that male and female snout-vent length (SVL) changed proportionally (sexual size dimorphism not changing with body size) throughout the evolution of these lizards and all within-sex biometric traits have changed proportionally to SVL. Life-history traits (size at sexual maturity, clutch size, hatchling SVL and mass, and life span) are highly correlated with adult female body size, the first two being the only traits with a positive allometry to female SVL. These results, together with the finding that the slope of hatchling SVL to female SVL regression was lower than that of SVL at maturity to female SVL, indicates that larger females reach maturity at a larger size, have larger clutches and, at the same time, have relatively smaller hatchlings than smaller females. There was no significant correlation between any pair of life-history traits after statistically removing the effect of body size. As most traits changed proportionally to SVL, the major evolutionary change has been that of body size (a ca. threefold change between the largest and the smallest species), that is suggested to be the effect of variable ecological conditions faced by founder lizards in each island. [ABSTRACT FROM AUTHOR]

Presents an assessment of non-linear estimation procedures for human growth models. Evidence of extreme curvature and relatively small, cyclical patterns in the residuals; Implications of the presence of cyclical patterns; Estimation of biases; Measures of non-linearity; Possibility of autocorrelated errors and heteroscedasticity.

A set of Pt, Ni and a bimetallic Ni50Pt50 catalysts supported on SiO2 of low and high surface area (S=50 and 200 m2/g) with a total metal loading of 2 wt.% was characterized by high-resolution electron microscopy (HREM), conventional transmission electron microscopy (TEM), energy-dispersive X-ray spectroscopy (EDS) and computational techniques such as digital processing and image simulation. Special attention was placed to the identification of intermetallic phases in the Ni50Pt50/SiO2 sample. Catalysts were prepared by impregnation and submitted to calcination–reduction activation treatments. For all the set, the increase in support’s surface area led to an improvement of the metal dispersion. TEM and HREM images showed significant differences in the shape and crystalline lattice of the Pt and Ni particles in the monometallic samples taken as reference. While in Pt/SiO2 catalyst we identified only reduced Pt particles, in Ni/SiO2 some NiO particles were detected. HREM characterization of the Ni50Pt50 catalysts showed that many particles have defects such as twinning and dislocations. Cubo-octahedral shapes were predominant in the bimetallic catalyst. Crystal lattice and angles measurements were consistent with the identification of NiPt and/or Ni3Pt intermetallic phases. Superlattice structures were also identified and confirmed by image simulation. EDS analysis on a particle by particle basis confirmed that in bimetallic catalysts supported in SiO2 of low and high surface area, particles were present consisting of Ni-rich, nominal and Pt-rich metal compositions. Pt-only particles were found but no Ni-only particles were detected. Among the possibilities, NiPt and Ni3Pt compositions were identified. [Copyright &y& Elsevier]

W/Al2O3 and WP/Al2O3 catalysts, prepared by co-impregnation at different pH values (1.5, 7 and 9), were characterised by several techniques (XRD, TPR, Raman spectroscopy, SEM-EDX, XPS and HRTEM) and tested in the parallel hydrodesulfurization (HDS) of gas oil and hydrodenitrogenation (HDN) of pyridine. The results show that P addition, whichever the pH of the impregnation solution is, has a positive effect on HDS activity and, to a minor extent, on HDN activity. The promoter effect of P for gas oil HDS was clearly influenced by the impregnation pH, which increased substantially by decreasing the impregnation pH. This improvement in HDS activity is interpreted as a result of an increased homogeneous distribution of tungsten on alumina, formation of more polytungsten oxide species and incipient WO3 crystallites, and slightly greater sulfidation of the oxo-tungsten species, as well as a slight increase in WS2-like stacking. By contrast, the P promotion for pyridine HDN was not significantly affected by the impregnation pH, indicating that HDN activity is less sensitive to the changes in the W distribution than the HDS activity. The possible role of P in the catalytic properties of W/Al2O3 catalysts is discussed. [Copyright &y& Elsevier]

Primers complementary to conserved sequences of cucumber mosaic virus (CMV) RNA 3 were designed and reverse transcription-polymerase chain reaction was directly performed in crude sap extracts of CMV-infected plants. All isolates assayed belonging to subgroups I or II from different Spanish geographical locations and infecting tobacco, tomato and cucumber plants were detected. No amplification was observed in healthy or tomato aspermy virus (TAV)-infected plants, nor in CMV-infected pepper plants. A dilution as low as 10-2 in tobacco crude sap extracts or 100 fg of purified virus (c 50 000 virus particles) could be detected, results showing that this procedure is 10² times more sensitive than enzyme-linked immunosorbent assay (ELISA). [ABSTRACT FROM AUTHOR]

Background: Hysterectomy, the most common gynecological operation, requires surgeons to counsel women about their operative risks. We aimed to develop and validate multivariable logistic regression models to predict major complications of laparoscopic or abdominal hysterectomy for benign conditions.Methods: We obtained routinely collected health administrative data from the English National Health Service (NHS) from 2011 to 2018. We defined major complications based on core outcomes for postoperative complications including ureteric, gastrointestinal and vascular injury, and wound complications. We specified 11 predictors a priori. We used internal-external cross-validation to evaluate discrimination and calibration across 7 NHS regions in the development cohort. We validated the final models using data from an additional NHS region.Results: We found that major complications occurred in 4.4% (3037/68 599) of laparoscopic and 4.9% (6201/125 971) of abdominal hysterectomies. Our models showed consistent discrimination in the development cohort (laparoscopic, C-statistic 0.61, 95% confidence interval [CI] 0.60 to 0.62; abdominal, C-statistic 0.67, 95% CI 0.64 to 0.70) and similar or better discrimination in the validation cohort (laparoscopic, C-statistic 0.67, 95% CI 0.65 to 0.69; abdominal, C-statistic 0.67, 95% CI 0.65 to 0.69). Adhesions were most predictive of complications in both models (laparoscopic, odds ratio [OR] 1.92, 95% CI 1.73 to 2.13; abdominal, OR 2.46, 95% CI 2.27 to 2.66). Other factors predictive of complications included adenomyosis in the laparoscopic model, and Asian ethnicity and diabetes in the abdominal model. Protective factors included age and diagnoses of menstrual disorders or benign adnexal mass in both models and diagnosis of fibroids in the abdominal model.Interpretation: Personalized risk estimates from these models, which showed moderate discrimination, can inform clinical decision-making for people with benign conditions who may require hysterectomy. [ABSTRACT FROM AUTHOR]

Abstract: Data from psychiatric research frequently exhibit departures from Normality. Methods which utilise the data optimally to model the distribution directly are available. We highlight the issue of modelling skewness, resulting from screening instruments where the majority of respondents are healthy individuals and few participants have a value reflecting particular disorders. [Copyright &y& Elsevier]

Objective: In South Asia, studies show secular trends toward slightly later women's marriage and first reproduction. However, data on related biological and social events, such as menarche and age of coresidence with husband, are often missing from these analyses. We assessed generational trends in key life events marking the transition to womanhood in rural lowland Nepal. Methods: We used data on 110 co‐resident mother‐in‐law (MIL) and daughter‐in‐law (DIL) dyads. We used paired t‐tests and chi‐squared tests to evaluate generational trends in women's education, and mean age at menarche, marriage, cohabitation with husband, and first reproduction of MIL and DIL dyads. We examined norms held by MILs and DILs on a daughter's life opportunities. Results: On average, MIL was 29 years older than DIL (60 years vs. 31 years). Both groups experienced menarche at average age 13.8 years. MIL was married at average 12.4 years, before menarche, and cohabitated with husbands at average 14.8 years. DIL was simultaneously married and cohabitated with husbands after menarche, at average 15 years. DIL was marginally more educated than MIL but had their first child on average 0.8 years earlier (95% CI −1.4, −0.1). MIL and DIL held similar norms on daughters' education and marriage. Conclusion: While social norms remain similar, the meaning of "early marriage" and use of menarche in marriage decisions has changed in rural lowland Nepal. Compared to DIL, MIL who was married earlier transitioned to womanhood more gradually. However, DIL was still married young, and had an accelerated trajectory to childbearing. [ABSTRACT FROM AUTHOR]

The melting of 13-atom clusters interacting via Lennard-Jones potentials has been revisited using molecular dynamics coupled to steepest descent quenches. A procedure was devised to account for the fraction of times the global and local minima of the potential energy surface are accessed during a long trajectory. This quantity presents a sigmoid shape. A phenomenological model of melting is given in terms of a correlated walk that maps the short time excursions among the global and local minima in configuration space. Comparison between the simulation results and the theoretical model shows that the melting transition is well described in terms of the temperature changes of the fraction of high energy minima accessed during the cluster trajectory. Cooperativity is clear from the S shape of this quantity, i.e., the access to a local minimum favours the access to other local minima. [ABSTRACT FROM AUTHOR]

The decay mechanisms of argon clusters have been studied using Molecular Dynamics simulations and Lennard-Jones potentials. Heating up processes were applied to Ar up to temperatures in the melting region. In this range of temperatures large fluctuations in the mean kinetic energy of the system are present and a sequential evaporation is observed. The thermal decay of these aggregates occurs in a time scale of nanoseconds. [ABSTRACT FROM AUTHOR]

Faujasite-type zeolite X (FAU-X) with a layered morphology was successfully synthesized by an additive-free route at a crystallization temperature of 90 °C for 24 h. The sample was dried at 70 °C for 40 h (designated FAU) and then calcined at 450 °C for 5 h (designated FAU-450). Both samples were analyzed by X-ray diffraction (XRD), which confirmed the formation of the FAU structure. In addition, from the XRD data and Energy Dispersive Spectroscopy, the Si/Al ratio was determined to be ~ 1.20, which is typical for FAU-X zeolite. Scanning Electron Microscopy revealed that both samples have morphologies corresponding to sheet agglomerate, with FAU-450 having an agglomerate size of 1.41 µm and a sheet thickness of about 0.13 µm. These values are close to the data obtained by transmission electron microscopy, where an agglomerate size of ~ 1.39 µm and a sheet thickness of ~ 0.12 µm were observed. From the Tauc's plots for FAU and FAU-450, the values of direct and indirect band gaps were determined and found to be close for both samples. In the case of FAU-450, values of 4.35 eV and 3.12 eV were obtained for the direct and indirect transition, respectively. From the TGA/DTA data, it was found that FAU loses mass due to dehydration of the zeolite at temperatures below 350 °C, while the sample is structurally stable up to 700 °C. [ABSTRACT FROM AUTHOR]

[Display omitted] [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to develop models for predicting the evolution of a neck pain (NP) episode.Methods: Three thousand two hundred twenty-five acute and chronic patients seeking care for NP, were recruited consecutively in 47 health care centers. Data on 37 variables were gathered, including gender, age, employment status, duration of pain, intensity of NP and pain referred down to the arm (AP), disability, history of neck surgery, diagnostic procedures undertaken, imaging findings, clinical diagnosis, and treatments used. Three separate multivariable logistic regression models were developed for predicting a clinically relevant improvement in NP, AP and disability at 3 months.Results: Three thousand one (93.5%%) patients attended follow-up. For all the models calibration was good. The area under the ROC curve was ≥0.717 for pain and 0.664 for disability. Factors associated with a better prognosis were: a) For all the outcomes: pain being acute (vs. chronic) and having received neuro-reflexotherapy. b) For NP: nonspecific pain (vs. pain caused by disc herniation or spinal stenosis), no signs of disc degeneration on imaging, staying at work, and being female. c) For AP: nonspecific NP and no signs of disc degeneration on imaging. d) For disability: staying at work and no signs of facet joint degeneration on imaging.Conclusions: A prospective registry can be used for developing valid predictive models to quantify the odds that a given patient with NP will experience a clinically relevant improvement. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Optimal treatment of replicate measurements in anthropometric studies" in the 2006 issue.

The aim of this study was to evaluate the Bouyoucos method, at different stirring times and using two chemical dispersants, for particle size determination and distribution in slightly alkaline soils of Córdoba, Colombia. Eight soils were mechanically dispersed applying a slow stirring; 60 rpm with five stirring times as follows: 2, 4, 6, 10 and 16 hours and a control experiment at 0 h. Chemical dispersion of samples was performed using two dispersants: Calgon (0.058 molL-1 (NaPO3)6 + 0.075 molL-1 Na2CO3) and a mixture of Calgon and 0.1 molL-1 Na4P2O7 at pH 9.1, which was proposed by authors. In addition, particle size distribution was determined by Pipette method, which was used as reference method. Tests of means and regression models were performed for sand, silt and clay contents using SAS statistical software. According to the results, significant differences were not found between 10 and 16 h of stirring, therefore maximum state of dispersion had achieved at stirring time of 10 h. Content of sand fraction showed an exponential decreasing which can be described following model given by , with determination coefficients higher than 0.90. Clay fraction showed exponentially increasing behavior of first order given by with determination coefficients greater than 90%. Soil textural classification was performed by Bouyoucos method using the proposed dispersant at 10 h of stirring was 75% similar to that determined by Pipette method whereas for Calgon, was 62.5%. [ABSTRACT FROM AUTHOR]

We assessed whether low CD4 count and high viral load (VL) affect the response to currently preferred ART. We performed a systematic review of randomized, controlled clinical trials that analyzed preferred first-line ART and a subgroup analysis by CD4 count (≤ or >200 CD4/μL) or VL (≤ or >100 000 copies/mL). We computed the odds ratio (OR) of treatment failure (TF) for each subgroup and individual treatment arm. Patients with ≤200 CD4 cells or VL ≥100 000 copies/mL showed an increased likelihood of TF at 48 weeks: OR, 1.94; 95% confidence interval (CI): 1.45–2.61 and OR, 1.75; 95% CI: 1.30–2.35, respectively. A similar increase in the risk of TF was observed at 96 weeks. There was no significant heterogeneity regarding integrase strand transfer inhibitor or nucleoside reverse transcriptase inhibitor backbone. Our results show that CD4 <200 cells/μL and VL ≥100,000 copies/mL impair ART efficacy in all preferred regimens. [ABSTRACT FROM AUTHOR]

Background Antiretroviral therapy (ART) has resulted in increasing median survival times in HIV-infected individuals by sustaining viral load suppression. Since children and adolescents are likely to have long-term exposure to ART, it is important to understand patterns of drug use to investigate the emergence of unintended sequelae. Aim To investigate patterns of ART in children and adolescents. Study Design Cross-sectional analysis of HIV-infected subjects aged 2–22 years across 15 clinical sites in Belgium, Italy and Poland. Method Prevalence of both “ever-use” and “current-use” (at recruitment) of ART drug classes: nucleoside analogue reverse transcriptase inhibitors (NRTIs); non-nucleoside analogue reverse transcriptase inhibitors (NNRTIs); and protease inhibitors (PIs), and individual drugs were investigated. Results Among 468 participants (51% female) the median age was 13.5 years (IQR 9.9–17.0) with 320(68%) of white ethnicity and 104 (22%) Black African. Overall, 291(62%) were virologically suppressed (HIV-RNA ≤50copies/ml) at enrolment and 35(7%) had severe immuno-suppression (age-stratified CD4%). Only 23 (5%) subjects were ART-naive (median age=10.0 years, IQR; 6.1–14.3); 15 had experienced moderate or severe immuno-suppression/HIV-disease, with 15 having detectable viral load at recruitment. Of the ever-treated subjects, 98% (n=436) had received zidovudine or lamivudine in the past and 72% (n=324) currently; 82% (n=368) and 72% (n=323) had been ever-exposed to PIs and NNRTIs, respectively. Median and modal lifetime number of drugs was six. Over their lifetime, 119 (27%) subjects had been exposed to ≥8 drugs (median age=15.7 years, IQR; 12.3–18.0). Age was associated with duration of total drug use (p<0.001), with median age of ART initiation of 3.6 years (IQR: 1.1–7.4) Median total duration of drug use was 8.7 years (IQR=5.7–11.2 years). Nine percent of currently treated subjects (n=38) had suboptimal management, defined as NRTIs-only (24 showing evidence of incomplete viral suppression), and 91% (n=384) had treatment with combination ART (cART).The most common PI in current-use was kaletra (n=170, 40%), possibly reflecting its availability as the only combination PI accessible in tablet/liquid form. Current use of PIs was associated (p<0.001) with hypercholesterolaemia in adjusted analyses indicating a long-term consequence of specific ART. Conclusions The majority of subjects had been managed with ART, with first exposure occurring at an early age. At least a quarter of participants had been treated with multiple individual drugs suggesting cumulative exposure and switching between regimens. The most prevalent treatment approach at recruitment was cART. However, there is evidence of continued use of suboptimal management strategies, and hypercholesterolaemia being associated with PI use. [ABSTRACT FROM AUTHOR]

Background Antiretroviral therapy (ART) has resulted in increasing median survival times in HIV-infected individuals by sustaining viral load suppression. Since children and adolescents are likely to have long-term exposure to ART, it is important to understand patterns of drug use to investigate the emergence of unintended sequelae. Aim To investigate patterns of ART in children and adolescents. Study Design Cross-sectional analysis of HIV-infected subjects aged 2–22 years across 15 clinical sites in Belgium, Italy and Poland. Method Prevalence of both “ever-use” and “current-use” (at recruitment) of ART drug classes: nucleoside analogue reverse transcriptase inhibitors (NRTIs); non-nucleoside analogue reverse transcriptase inhibitors (NNRTIs); and protease inhibitors (PIs), and individual drugs were investigated. Results Among 468 participants (51% female) the median age was 13.5 years (IQR 9.9–17.0) with 320(68%) of white ethnicity and 104 (22%) Black African. Overall, 291(62%) were virologically suppressed (HIV-RNA ≤50copies/ml) at enrolment and 35(7%) had severe immuno-suppression (age-stratified CD4%). Only 23 (5%) subjects were ART-naive (median age=10.0 years, IQR; 6.1–14.3); 15 had experienced moderate or severe immuno-suppression/HIV-disease, with 15 having detectable viral load at recruitment. Of the ever-treated subjects, 98% (n=436) had received zidovudine or lamivudine in the past and 72% (n=324) currently; 82% (n=368) and 72% (n=323) had been ever-exposed to PIs and NNRTIs, respectively. Median and modal lifetime number of drugs was six. Over their lifetime, 119 (27%) subjects had been exposed to ≥8 drugs (median age=15.7 years, IQR; 12.3–18.0). Age was associated with duration of total drug use (p<0.001), with median age of ART initiation of 3.6 years (IQR: 1.1–7.4) Median total duration of drug use was 8.7 years (IQR=5.7–11.2 years). Nine percent of currently treated subjects (n=38) had suboptimal management, defined as NRTIs-only (24 showing evidence of incomplete viral suppression), and 91% (n=384) had treatment with combination ART (cART).The most common PI in current-use was kaletra (n=170, 40%), possibly reflecting its availability as the only combination PI accessible in tablet/liquid form. Current use of PIs was associated (p<0.001) with hypercholesterolaemia in adjusted analyses indicating a long-term consequence of specific ART. Conclusions The majority of subjects had been managed with ART, with first exposure occurring at an early age. At least a quarter of participants had been treated with multiple individual drugs suggesting cumulative exposure and switching between regimens. The most prevalent treatment approach at recruitment was cART. However, there is evidence of continued use of suboptimal management strategies, and hypercholesterolaemia being associated with PI use. [ABSTRACT FROM PUBLISHER]