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Since its introduction, Bentall procedure has remained the standard of care for management of ascending aortic aneurysms with associated aortic valve pathologies. It involves replacement of aortic root, ascending aorta and the aortic valve, using a hybrid vascular graft with built in valves. The openings of the main coronary arteries are then rejoined with the graft. The procedure has satisfactory long term survival rate. However, there are some complications including graft infection, stroke from dislodged plaques and coronary insufficiency due to kinking of the reconnected main coronary arteries. Here, we report a rare and life-threatening complication following Bentall procedure. A 76-year-old female developed left main stenosis following Bentall procedure, successfully treated with percutaneous coronary intervention (PCI). We discuss various etiologies and treatment options for this complication. We recommend routine surveillance with coronary angiography at six months post Bentall.

Item does not contain fulltext BACKGROUND: Children with human immunodeficiency virus type 1 (HIV-1) infection have limited options for effective antiretroviral treatment (ART). METHODS: We conducted an open-label, randomized, noninferiority trial comparing three-drug ART based on the HIV integrase inhibitor dolutegravir with standard care (non-dolutegravir-based ART) in children and adolescents starting first- or second-line ART. The primary end point was the proportion of participants with virologic or clinical treatment failure by 96 weeks, as estimated by the Kaplan-Meier method. Safety was assessed. RESULTS: From September 2016 through June 2018, a total of 707 children and adolescents who weighed at least 14 kg were randomly assigned to receive dolutegravir-based ART (350 participants) or standard care (357). The median age was 12.2 years (range, 2.9 to 18.0), the median weight was 30.7 kg (range, 14.0 to 85.0), and 49% of the participants were girls. By design, 311 participants (44%) started first-line ART (with 92% of those in the standard-care group receiving efavirenz-based ART), and 396 (56%) started second-line ART (with 98% of those in the standard-care group receiving boosted protease inhibitor-based ART). The median follow-up was 142 weeks. By 96 weeks, 47 participants in the dolutegravir group and 75 in the standard-care group had treatment failure (estimated probability, 0.14 vs. 0.22; difference, -0.08; 95% confidence interval, -0.14 to -0.03; P = 0.004). Treatment effects were similar with first- and second-line therapies (P = 0.16 for heterogeneity). A total of 35 participants in the dolutegravir group and 40 in the standard-care group had at least one serious adverse event (P = 0.53), and 73 and 86, respectively, had at least one adverse event of grade 3 or higher (P = 0.24). At least one ART-modifying adverse event occurred in 5 participants in the dolutegravir group and in 17 in the standard-care group (P = 0.01). CONCLUSIONS: In this trial involving children and adolescents with HIV-1 infection who were starting first- or second-line treatment, dolutegravir-based ART was superior to standard care. (Funded by ViiV Healthcare; ODYSSEY ClinicalTrials.gov number, NCT02259127; EUDRACT number, 2014-002632-14; and ISRCTN number, ISRCTN91737921.).

Contains fulltext : 283099.pdf (Publisher’s version ) (Open Access) BACKGROUND: Young children living with HIV have few treatment options. We aimed to assess the efficacy and safety of dolutegravir-based antiretroviral therapy (ART) in children weighing between 3 kg and less than 14 kg. METHODS: ODYSSEY is an open-label, randomised, non-inferiority trial (10% margin) comparing dolutegravir-based ART with standard of care and comprises two cohorts (children weighing ≥14 kg and

Contains fulltext : 282959.pdf (Publisher’s version ) (Open Access) BACKGROUND: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. METHODS: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to

BACKGROUND: Pre-exposure prophylaxis (PrEP) is a novel HIV prevention method whereby HIV-negative individuals take the drugs tenofovir and emtricitabine to prevent HIV acquisition. Optimal adherence is critical for PrEP efficacy. Chemsex describes sexual activity under the influence of psychoactive drugs, in the UK typically; crystal methamphetamine, gamma-hydroxybutyrate(GHB) and/or mephedrone. Chemsex drug use has been associated with increased HIV transmission risk among gay, bisexual and other men who have sex with men (GBM) and poor ART adherence among people living with HIV. This study assessed whether self-reported chemsex events affected self-reported daily PrEP adherence among PROUD study participants. METHODS: The PROUD study was an open-label, randomised controlled trial, conducted in thirteen English sexual health clinics, assessing effectiveness of TruvadaⓇ-PrEP among 544 HIV-negative GBM. The study reported an 86% risk-reduction of HIV from daily PrEP. Participants were asked about chemsex engagement at follow-up visits. Monthly self-reports of missed PrEP tablets were aggregated to assess adherence between visits. Univariable and multivariable regression analyses were performed to test for associations between chemsex and reporting less than seven out of seven intended doses(

Esta tese apresenta um estudo comparativo entre as literaturas das escritoras Maria Judite de Carvalho (1921, Lisboa – 1998, Lisboa) e Lygia Fagundes Telles (1923, São Paulo –), tendo por objetivo analisar como o espaço social da autoria feminina é definido no campo literário luso-brasileiro e como os espaços narrativos são construídos nos contos “Além do Quadro” e “As Palavras Poupadas”, da autora portuguesa, “Venha Ver o Pôr do Sol” e “Noturno Amarelo”, da escritora brasileira. Para tanto, o trabalho foi estruturado a partir de dois eixos teórico-metodológicos: o primeiro, com base nas ideias sobre campo literário e habitus de Pierre Bourdieu (1996, 2003, 2012, 2015), investiga-se por um viés sociológico a trajetória da autoria feminina em contextos heterogêneos para se compreender a maneira como as autoras interpretaram a sua época e conquistaram um lugar de consolidação no campo literário luso-brasileiro. A segunda perspectiva de análise tem como foco a construção do espaço enquanto categoria narrativa, objetivando examinar como os espaços heterotópicos são representados, de acordo com Michel Foucault ([1967] 2001). Portanto, analisa-se os lugares heterotópicos como sanatório, asilo, cemitério, espelho e jardim, observando as relações entre espaço e poder simbólico em confronto com os corpos-espaços femininos representados nos contos. Por considerar-se os corpos das personagens femininas analisadas também como heterotopias, algumas tipologias foram traçadas visando a compreensão de questões relativas à violência simbólica que o poder androcêntrico impõe ao corpo-espaço das mulheres, são elas: corpo-espaço doente, corpo-espaço insubmisso, corpo-espaço dócil, corpo-espaço órfão, corpo-espaço coisificado, corpo-espaço cativo e corpo-espaço culpado. A partir da análise observa-se, portanto, que os espaços representados nas narrativas juditianas e lygianas refratam o contexto de opressão do sujeito feminino, são contra-espaços que unidos ao simbólico traduzem o medo e a insegurança, o silêncio e a solidão, a precisa angústia da escritura feminina. This dissertation presents a comparative study between the literary work of the writers Maria Judite de Carvalho (1921, Lisbon – 1998, Lisbon) and Lygia Fagundes Telles (1923, São Paulo –) and it aims at analyzing how the social space of female authorship is defined in the Portuguese-Brazilian literary field and how the narrative spaces are constructed in the short stories “Além do Quadro” and “As Palavras Poupadas”, by the Portuguese author, “Venha Ver o Pôr do Sol” and “Noturno Amarelo”, by the Brazilian writer, respectively. Therefore, this work was structured from two theoreticalmethodological axes: the first one, based on Pierre Bourdieu (1996, 2003, 2012, 2015) and the ideas of the literary field and habitus, examines, from a sociological perspective, the trajectory of female authorship in heterogeneous contexts in order to understand the way in which Carvalho and Telles interpreted the period they lived as well as how such writers attained a place of consolidation in the Portuguese-Brazilian literary field. The second perspective of analysis focuses on the construction of space as a narrative category, as it seeks to examine how heterotopic spaces, according to Michel Foucault ([1967] 2001), are represented. Therefore, heterotopic places such as sanatoriums, asylums, cemeteries, mirrors, and gardens were studied, taking the relations between space and symbolic power in confrontation with the female bodiesspaces depicted in aforementioned short stories into consideration. Moreover, for the bodies of the female characters looked into this research are also viewed as heterotopies, some typologies were drawn in order to understand issues related to the symbolic violence that androcentric power imposes on women's body-space, for instance: ill body-space, unruly body-space, docile body-space, orphan body-space, objectified body-space, captive body-space, and guilty body-space. Through the analysis, it was thus observed that the spaces represented in the Juditian and Lygian narratives resound the context of oppression towards the female subject, once they are counter spaces that, when placed with the symbolic, translate fear and insecurity, silence and loneliness, as well as the precise anguish of women’s scripture.

ObjectivesPre-exposure prophylaxis (PrEP) is a highly effective method of HIV prevention for men who have sex with men (MSM). However, uncertainty remains around the optimal eligibility criteria for PrEP, specifically whether there are subgroups at low risk of HIV for whom PrEP might not be warranted.MethodsPROUD was an open-label waitlist trial design that randomised MSM attending participating sexual health centres in England to receive PrEP immediately (IMM) or after a deferral period of 1 year (DEF). This analysis is based on participants who were randomised to the deferred arm, when they did not have access to PrEP. HIV incidence was compared between subgroups defined by baseline characteristics.ResultsOverall, 21 participants acquired HIV infection over 239.3 person-years (PY) follow-up, yielding an incidence rate of 8.8/100 PY (95% CI 5.4 to 13.4). Two highly significant predictors for HIV acquisition were identified. Men with a self-reported diagnosis of syphilis, rectal chlamydia (CT) or rectal gonorrhoea (GC) in the previous 12 months had an incidence of 17.2/100 PY (95% CI 9.7 to 28.5); those reporting receptive anal intercourse without a condom (ncRAI) with two or more partners in the previous 3 months had an incidence of 13.6/100 PY (95% CI 7.9 to 21.7). The incidence rate among participants lacking both of these risk factors was 1.1/100 PY (1/87.6, 95% CI 0.03 to 6.4).ConclusionsThe high HIV incidence in PROUD suggests that most participants appropriately judged their need for PrEP. Eligibility criteria for a PrEP programme can therefore be broad, as in the current guidelines. However, a recent history of syphilis or rectal CT/GC, or multiple ncRAI partners indicates a high imminent risk of HIV infection. MSM with any of these characteristics should be offered PrEP as a matter of urgency.

ObjectivesThe aim of this analysis is to: (i) assess the prevalence of clinically significant depressive symptoms at baseline and follow-up for participants in the PROUD trial of HIV pre-exposure prophylaxis (PrEP), examining changes in prevalence over time and (ii) investigate the association of socioeconomic and psychosocial factors with depression.MethodsPROUD was an open label randomised trial evaluating the benefit of PrEP for 544 HIV-negative gay, bisexual and other men who have sex with men (GBMSM) in England. Enrolment was between 2012 and 2014, with at least 2 years follow-up. Prevalence of depression (score ≥10 on Patient Health Questionnaire-9) was assessed and compared across time-points (using McNemar’s χ2tests) and between trial arms (using χ2tests). Cross-sectional associations with socioeconomic and psychosocial factors were examined using baseline data in modified Poisson regression models and combined 12 and 24 month follow-up data in generalised estimating equations (GEEs). Prevalence ratios (PRs) were presented as unadjusted PR and adjusted PR (aPR) for age, UK birth, sexual identity, university education, London study clinic site and calendar time (and follow-up time-point in GEEs).ResultsDepression increased significantly from baseline (9.1%; 49/540) to the 12 month (14.4%; 59/410) and 24 month (14.4%; 48/333) follow-ups, possibly explained by underreporting at baseline. The prevalence of depression did not differ by study trial arm, at any time-point. In the baseline analysis, younger age, unemployment and crystal methamphetamine use, was associated with depression. In combined analysis of 12 and 24 month data, measures of intimate partner violence (IPV) (lifetime IPV victimisation aPR 2.57 (95% CI: 1.71 to 3.86)), internalised homophobia (aPR 1.91 (95% CI: 1.29 to 2.83)) and concealment of sexual identity (aPR 1.75 (95% CI: 1.16 to 2.65)), were strongly associated with depression.ConclusionsThere is a high concomitant burden of psychosocial factors with depression among GBMSM.Trial registration numberISRCTN (ISRCTN94465371) and ClinicalTrials.gov (NCT02065986).

O setor público vem passando por mudanças na gestão, motivadas, sobretudo, pela escassez de recursos e necessidade de otimização dos serviços. A contabilidade de custos pode auxiliar, oferecendo informações estruturadas e confiáveis. Com esse foco, o objetivo deste estudo é verificar o uso de sistemas de custos nesse setor, a partir de evidências extraídas de publicações empírico-científicas. O referencial principal é composto de artigos selecionados nas bases do portal de periódicos da CAPES. Os resultados demonstram que o uso desses sistemas contribui para o aprimoramento da gestão, gerando melhorias nos serviços prestados. No Brasil, o governo federal desenvolveu o SICSP, utilizando o método direto. Nos municípios brasileiros analisados pelos estudos empíricos identificados nesta pesquisa, verifica-se que o uso desses sistemas ainda é precário, com baixo nível de utilização. Mas, em outros países, ficou demonstrado que a presença do gerenciamento dos custos é maior e o método mais empregado é o ABC. Verificou-se, também, a literatura tem apontado potencialidades de pesquisa, como investigações sobre a integração entre sistemas de custos e (I) modelagem de processos, (II) avaliação de desempenho, (III) qualidade de serviços e produtos. Como oportunidades de pesquisa, destacam-se: averiguações sobre dificuldades e barreiras à implementação de sistemas de custos.

TRIM5α polymorphism limits and complicates the use of simian immunodeficiency virus (SIV) for evaluation of human immunodeficiency virus (HIV) vaccine strategies in rhesus macaques. We previously reported that the TRIM5α-sensitive SIV from sooty mangabeys (SIVsm) clone SIVsmE543-3 acquired amino acid substitutions in the capsid that overcame TRIM5α restriction when it was passaged in rhesus macaques expressing restrictive TRIM5α alleles. Here we generated TRIM5α-resistant clones of the related SIVsmE660 strain without animal passage by introducing the same amino acid capsid substitutions. We evaluated one of the variants in rhesus macaques expressing permissive and restrictive TRIM5α alleles. The SIVsmE660 variant infected and replicated in macaques with restrictive TRIM5α genotypes as efficiently as in macaques with permissive TRIM5α genotypes. These results demonstrated that mutations in the SIV capsid can confer SIV resistance to TRIM5α restriction without animal passage, suggesting an applicable method to generate more diverse SIV strains for HIV vaccine studies. IMPORTANCE Many strains of SIV from sooty mangabey monkeys are susceptible to resistance by common rhesus macaque TRIM5α alleles and result in reduced virus acquisition and replication in macaques that express these restrictive alleles. We previously observed that spontaneous variations in the capsid gene were associated with improved replication in macaques, and the introduction of two amino acid changes in the capsid transfers this improved replication to the parent clone. In the present study, we introduced these mutations into a related but distinct strain of SIV that is commonly used for challenge studies for vaccine trials. These mutations also improved the replication of this strain in macaques with the restrictive TRIM5α genotype and thus will eliminate the confounding effects of TRIM5α in vaccine studies.

Background Little is known about the prevalence and correlates of intimate partner violence (IPV) among gay, bisexual and other men who have sex with men (GBMSM) in the UK. The aim of this study was to investigate the prevalence of IPV, associations of socio-economic and psychosocial factors with IPV, and the association of IPV with depression and sexual behaviour, among GBMSM in the PROUD trial of pre-exposure prophylaxis (PrEP). Methods PROUD enrolled 544 HIV-negative participants in England from 2012 to 2014; participants were randomised to immediate or deferred PrEP. This analysis included 436 GBMSM who had IPV data at month-12 and/or 24. Prevalence of IPV victimization and perpetration (lifetime, and in the past year) was assessed at these time-points. Generalized estimating equations were used to investigate associations with IPV, using pooled data from both time-points. Results At month-12 (N = 410), 44.9% of men reported ever being a victim of IPV, 15.6% in the last year, and 19.5% reported ever perpetrating IPV, 7.8% in the last year. At month-24 (N = 333), the corresponding prevalence was 40.2 and 14.7% for lifetime and past year IPV victimization and 18.0 and 6.9% for lifetime and past year IPV perpetration. IPV prevalence did not differ by randomised arm. Men reporting internalized homophobia and sexualized drug use were more likely to report IPV. Lifetime and last year experience of IPV victimization and perpetration were strongly associated with depressive symptoms (PHQ-9 ≥ 10) (adjusted for socio-demographics: lifetime IPV victimization PR 2.57 [95% CI: 1.71, 3.86]; past year IPV victimization PR 2.93 [95% CI: 1.96, 4.40]; lifetime IPV perpetration PR 2.87 [95% CI: 1.91, 4.32]; past year IPV perpetration PR 3.47 [95% CI: 2.13, 5.64], p

Resumo Este artigo busca compreender como o trágico se manifesta na narrativa moderna por meio da análise comparativa dos contos “Natal na barca”, de Lygia Fagundes Telles e “Noite de Natal”, de Maria Judite de Carvalho. Esses contos, que põem em evidência as experiências interpessoais de protagonistas femininas, aproximam-se por mostrarem personagens que começam a trama dominadas pela apatia ao outro, mas que no decorrer da narrativa passam por transformações ao serem impulsionadas à alteridade por meio da tragédia. Para as reflexões sobre as configurações da tragédia na modernidade, utiliza-se como respaldo teórico as ideias de Terry Eagleton (2013) e Raymond Williams (2002). Abstract This article aims to examine how tragedy is manifested in modern narrative through the comparative analysis of the short stories “Natal na barca”, by Lygia Fagundes Telles and “Noite de Natal” by Maria Judite de Carvalho. These short stories, which expose the interpersonal experiences of their female protagonists, are related in the way they show characters who, as the plot begins, are filled with apathy for others, but as the narrative unfolds, are transformed when they themselves are thrust into otherness through tragedy. The theoretical framework for the reflections on configurations of tragedy in modernity is based on the ideas of Terry Eagleton (2013) and Raymond Williams (2002). Resumen Este texto busca comprender como lo trágico se manifesta en la narrativa moderna por medio del análisis comparativo de los cuentos “Natal na barca”, de Lygia Fagundes Telles y “Noite de Natal”, de Maria Judite de Carvalho. Estos cuentos, que ponen en evidencia las experiencias interpersonales de protagonistas femeninas, son parecidos por mostrar personajes que al inicio de la trama son dominadas por la apatía hacia el otro, pero que en el desarrollo de la narrativa pasan por transformaciones al ser impulsados a la alteridad por medio de la tragedia. Para las reflexiones sobre las configuraciones de la tragedia en la modernidad, se utiliza como apoyo teórico las ideias de Terry Eagleton (2013) y Raymond Williams (2002).

Made available in DSpace on 2022-04-28T19:08:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-01-02 Microcephaly (MC), previously considered rare, is now a health emergency of international concern because of the devastating Zika virus pandemic outbreak of 2015. The authors describe the electroencephalogram (EEG) findings in sleep EEG of epileptic children who were born with microcephaly in areas of Brazil with active Zika virus transmission between 2014 and 2017. The authors reviewed EEGs from 23 children. Nine were females (39.2%), and the age distribution varied from 4 to 48 months. MC was associated with mother positive serology to toxoplasmosis (toxo), rubella (rub), herpes, and dengue (1 case); toxo (1 case); chikungunya virus (CHIKV) (1 case); syphilis (1 case); and Zika virus (ZIKV) (10 cases). In addition, 1 case was associated with perinatal hypoxia and causes of 9 cases remain unknown. The main background EEG abnormality was diffuse slowing (10 cases), followed by classic (3 cases) and modified (5 cases) hypsarrhythmia. A distinct EEG pattern was seen in ZIKV (5 cases), toxo (2 cases), and undetermined cause (1 case). It was characterized by runs of frontocentrotemporal 4.5–13 Hz activity (7 cases) or diffuse and bilateral runs of 18–24 Hz (1 case). In ZIKV, this rhythmic activity was associated with hypsarrhythmia or slow background. Further studies are necessary to determine if this association is suggestive of ZIKV infection. The authors believe that EEG should be included in the investigation of all newly diagnosed congenital MC, especially those occurring in areas of autochthonous transmission of ZIKV. Neurovale EEG Laboratory Neurophysiology Department Municipal Government of Teresina Neurology Department Center for Treatment and Early Stimulation Federal University of Ceara Municipal Department of Health Pediatric Complex Arlinda Marques Neurology Department Municipal Hospital of Governador Valadares Neurology Department Marcio Cunha HospitalIpatinga Neurology Department Federal University of Juiz de Fora, Campus Governador Valadares Neurology Department Samaritan Hospital of Cacoal School of Medicine State University of São Paulo Julio de Mesquita Filho School of Medicine State University of São Paulo Julio de Mesquita Filho

Objectives HIV-1 transmitted drug resistance (TDR) in treatment-naive individuals is a well-described phenomenon. Baseline genotypic resistance testing is considered standard of care in most developed areas of the world. The aim of this analysis was to characterize HIV-1 TDR and the use of resistance testing in START trial participants. Methods In the Strategic Timing of AntiRetroviral Treatment (START) trial, baseline genotypic resistance testing results were collected at study entry and analysed centrally to determine the prevalence of TDR in the study population. Resistance was based on a modified 2009 World Health Organization definition to reflect newer resistance mutations. Results Baseline resistance testing was available in 1946 study participants. Higher rates of testing occurred in Europe (86.7%), the USA (81.3%) and Australia (89.9%) as compared with Asia (22.2%), South America (1.8%) and Africa (0.1%). The overall prevalence of TDR was 10.1%, more commonly to nonnucleoside reverse transcriptase inhibitors (4.5%) and nucleoside reverse transcriptase inhibitors (4%) compared with protease inhibitors (2.8%). The most frequent TDR mutations observed were M41L, D67N/G/E, T215F/Y/I/S/C/D/E/V/N, 219Q/E/N/R, K103N/S, and G190A/S/E in reverse transcriptase, and M46I/L and L90M in protease. By country, the prevalence of TDR was highest in Australia (17.5%), France (16.7%), the USA (12.6%) and Spain (12.6%). No participant characteristics were identified as predictors of the presence of TDR. Conclusions START participants enrolled in resource-rich areas of the world were more likely to have baseline resistance testing. In Europe, the USA and Australia, TDR prevalence rates varied by country.

An incomplete understanding of native human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV) envelope glycoproteins (Envs) impedes the development of structural models of Env and vaccine design. This shortcoming is due in part to the low number of Env trimers on virus particles. For SIV, this low expression level can be counteracted by truncating the cytoplasmic tail (CT) of Env. CT truncation has been shown to increase Env incorporation into the virion and is commonly used in vaccine and imaging studies, but its effects on viral antigenicity have not been fully elucidated. To study the effects of a CT truncation of Env in viruses in similar genetic contexts, we introduced stop codons into the CT of a SIVsmE660 molecular clone and two neutralizing antibody (NAb) escape variants. These viruses shared 98% sequence identity in Env but were characterized as either tier 1 (sensitive to neutralization), tier 2 (moderately resistant to neutralization), or tier 3 (resistant to neutralization). However, the introduction of premature stop codons in Env at position Q741/Q742 converted all three transfection-derived viruses to a tier 3-like phenotype, and these viruses were uniformly resistant to neutralization by sera from infected macaques and monoclonal antibodies (MAbs). These changes in neutralization sensitivity were not accompanied by an increase in either the virion Env content of infection-derived viruses or the infectivity of transfection-derived viruses in human cells, suggesting that CT mutations may result in global changes to the Env conformation. Our results demonstrate that some CT truncations can affect viral antigenicity and, as such, may not be suitable surrogate models of native HIV/SIV Env. IMPORTANCE Modifications to the SIV envelope protein (Env) are commonly used in structural and vaccine studies to stabilize and increase the expression of Env, often without consideration of effects on antigenicity. One such widespread modification is the truncation of the Env C-terminal tail. Here, we studied the effects of a particular cytoplasmic tail truncation in three SIVsm strains that have highly similar Env sequences but exhibit different sensitivities to neutralizing antibodies. After truncation of the Env CT, these viruses were all very resistant to neutralization by sera from infected macaques and monoclonal antibodies. The viruses with a truncated Env CT also did not exhibit the desired and typical increase in Env expression. These results underscore the importance of carefully evaluating the use of truncated Env as a model in HIV/SIV vaccine and imaging studies and of the continued need to find better models of native Env that contain fewer modifications.

In this short study we explore allusions to the Jacob Cycle in 1 Samuel, and the network of correspondences between Genesis 31 (Jacob fleeing from Laban, and Rachel stealing the teraphim) and 1 Samuel 19 (David fleeing from Saul, and Michal aiding his escape through teraphim). Both of these episodes feature deceptive fathers-in-law (Saul and Laban), younger daughters (Michal and Rachel), fugitive husbands (David and Jacob), and hidden idols (Michal hides the teraphim in the bed to fool Saul’s agents, and Rachel hides her father’s teraphim under her camel’s saddle). We suggest that this example of intertextuality between Genesis and Samuel has a number of theological and literary purposes.

Objectives: HIV-1 subtype C might have a greater propensity to develop K65R mutations in patients with virological failure compared with other subtypes. However, the strong association between viral subtype and confounding factors such as exposure groups and ethnicity affects the calculation of this propensity. We exploited the diversity of viral subtypes within the UK to undertake a direct comparative analysis. Patients and methods: We analysed only sequences with major IAS-defined mutations from patients with virological failure. Prevalence of K65R was related to subtype and exposure to the NRTIs that primarily select for this mutation (tenofovir, abacavir, didanosine and stavudine). A multivariate logistic regression model quantified the effect of subtype on the prevalence of K65R, adjusting for previous and current exposure to all four specified drugs. Results: Subtype B patients (n = 3410) were mostly MSM (78%) and those with subtype C (n = 810) were mostly heterosexual (82%). K65R was detected in 7.8% of subtype B patients compared with 14.2% of subtype C patients. The subtype difference in K65R prevalence was observed irrespective of NRTI exposure and K65R was frequently selected by abacavir, didanosine and stavudine in patients with no previous exposure to tenofovir. Multivariate logistic regression confirmed that K65R was significantly more common in subtype C viruses (adjusted OR = 2.02, 95% CI = 1.55–2.62, P

Vascular access in children carries a significant risk of accidental extravasation of IV fluids and medications with the potential for tissue injury. In this prospective controlled study we assessed the diagnostic utility of using IV diluted sodium bicarbonate to confirm placement of IV catheters in ventilated children. Diluted sodium bicarbonate was created using undiluted standard 8.4% (1 mEq/mL) sodium bicarbonate mixed in a 1:3 and 1:5 ratio with sterile water to achieve a final diluted concentration of 2.1% (0. 25 mEq/mL) and 1.05% (0.125 mEq/mL) sodium bicarbonate, respectively.In 18 ASA I-II mechanically ventilated children ages 1 to 8 years, the effects of 1 mL/kg of dilute 2.1%, 1.05% sodium bicarbonate, or 0.9% normal saline, injected in a randomized order, were analyzed. All children had oxygen saturation, arterial blood pressure, electrocardiograph, and end-tidal carbon dioxide (ETCO(2)) monitoring. In addition, venous blood samples were taken before injection and 10 minutes after the final injection for analysis of venous blood pH and electrolytes.In children, IV diluted 2.1% sodium bicarbonate resulted in significantly increased etco(2) (mean of 32.8 ± 3.4 mm Hg to 39.0 ± 3.5 mm Hg, P0.001), a mean increase of 6.2 mm Hg (95% prediction interval: 4.3 to 8.1 mm Hg) within 3 breaths. Intravenous diluted 1.05% sodium bicarbonate caused a less pronounced but still significant increase in etco(2) (33.4 ± 3.8 mm Hg to 36.3 ± 3.4 mm Hg, P0.001), a mean increase of 2.9 mm Hg (95% prediction interval: 1.8 to 4.1 mm Hg) within 3 breaths. Normal saline did not result in any significant changes, with a mean increase of 0.06 mm Hg (95% prediction interval: -1.3 to 1.4 mm Hg). Both concentrations of sodium bicarbonate were easily differentiated from normal saline injection by blinded anesthesiologists observing the change in etco(2) values immediately after injection. Analysis of pre- and postinjection venous pH, bicarbonate, and sodium levels could not detect clinically significant changes. A small but statistically significant increase in venous bicarbonate was noted.The injection of 2.1% sodium bicarbonate in mechanically ventilated ASA I-II children identified intravascular placement and patency of an IV catheter by an increase in the exhaled CO(2) concentration. The injections did not have any clinically significant effects on blood pH, bicarbonate, or sodium concentration.

Background Darunavir is considered to have a high genetic barrier to resistance. Most darunavir-associated drug resistance mutations (DRMs) have been identified through correlation of baseline genotype with virological response in clinical trials. However, there is little information on DRMs that are directly selected by darunavir in clinical settings. Objectives We examined darunavir DRMs emerging in clinical practice in the UK. Patients and methods Baseline and post-exposure protease genotypes were compared for individuals in the UK Collaborative HIV Cohort Study who had received darunavir; analyses were stratified for PI history. A selection analysis was used to compare the evolution of subtype B proteases in darunavir recipients and matched PI-naive controls. Results Of 6918 people who had received darunavir, 386 had resistance tests pre- and post-exposure. Overall, 2.8% (11/386) of these participants developed emergent darunavir DRMs. The prevalence of baseline DRMs was 1.0% (2/198) among PI-naive participants and 13.8% (26/188) among PI-experienced participants. Emergent DRMs developed in 2.0% of the PI-naive group (4 mutations) and 3.7% of the PI-experienced group (12 mutations). Codon 77 was positively selected in the PI-naive darunavir cases, but not in the control group. Conclusions Our findings suggest that although emergent darunavir resistance is rare, it may be more common among PI-experienced patients than those who are PI-naive. Further investigation is required to explore whether codon 77 is a novel site involved in darunavir susceptibility.

Concern has been expressed that tenofovir-containing regimens may have reduced effectiveness in the treatment of human immunodeficiency virus type 1 (HIV-1) subtype C infections because of a propensity for these viruses to develop a key tenofovir-associated resistance mutation. We evaluated whether subtype influenced rates of virological failure in a cohort of 8746 patients from the United Kingdom who received a standard tenofovir-containing first-line regimen and were followed for a median of 3.3 years. In unadjusted analyses, the rate of failure was approximately 2-fold higher among patients infected with subtype C virus as compared to those with subtype B virus (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.50-2.31; P.001). However, the increased risk was greatly attenuated in analyses adjusting for demographic and clinical factors (adjusted HR, 1.14; 95% CI, .83-1.58; P = .41). There were no differences between subtypes C and subtypes non-B and non-C in either univariate or multivariate analysis. These observations imply there is no intrinsic effect of viral subtype on the efficacy of tenofovir-containing regimens.

Interpretation is always done within one’s own context. It is impossible to interpret a text without the impact of one’s worldview and ideological positions seeping into the interpretive process. Due to this contextual approach to interpretation, one must analyze the history of interpretation from a critical viewpoint, rather than blindly accepting a historical understanding. The character of Michal in the books of Samuel is a good example of how the history of interpretation can be guided by the interpreter’s ideology and also why the historical understandings need to be re-evaluated. This article contains one example of how such interpretations can be challenged and reassigned in relation to Michal.

Esta dissertação apresenta um estudo comparativo entre os romances Ciranda de Pedra (1954) e Verão no Aquário (1963), de Lygia Fagundes Telles (1923 -), com o objetivo de analisar a representação da família e a formação individual das protagonistas ante as tensões familiares e afetivas. Esses primeiros romances da escritora paulista têm em comum o fato de trazerem como heroínas duas jovens mulheres, Virgínia e Raíza, respectivamente, que sofrem violentas crises de identidade ocasionadas, sobretudo, pelos conflitos provenientes das relações familiares. Em ambas as obras, a família é marcada pela ausência de afetos e pela desordem em sua estrutura: os laços parentais são frágeis e o amor é quase inexistente. Nesses lares, em que reina a hipocrisia, o modelo de família nuclear burguesa é desconstruído e as consequências dessa desestruturação é o surgimento de filhos perturbados emocionalmente e carentes de referências para formarem-se como indivíduos autônomos. Sendo assim, sob a perspectiva do Bildungsroman, foi realizada a análise da construção das personagens Virgínia e Raíza com a intenção de verificar como se estabelece o aperfeiçoamento individual dessas heroínas ante o desajustado ambiente familiar. Nas duas narrativas, a trajetória de aprendizagem das personagens principais é complexa, contudo, mesmo com as adversidades em decorrência da família, a bildung/formação das protagonistas culmina em desfechos positivos. Como suporte para análise e desenvolvimento desta pesquisa, o trabalho teve como orientação os estudos de Antonio Candido (2004, 2008), Luiz Costa Lima (2000) e José Guilherme Merquior (1997), quanto aos pontos referentes à representação social da literatura, e ainda Mikhail Bakhtin (1997), Marcus Vinicius Mazzari (2010) e Cristina Ferreira Pinto (1990) sobre as definições e estrutura do Bildungsroman. Esta dissertação apresenta um estudo comparativo entre os romances Ciranda de Pedra (1954) e Verão no Aquário (1963), de Lygia Fagundes Telles (1923 -), com o objetivo de analisar a representação da família e a formação individual das protagonistas ante as tensões familiares e afetivas. Esses primeiros romances da escritora paulista têm em comum o fato de trazerem como heroínas duas jovens mulheres, Virgínia e Raíza, respectivamente, que sofrem violentas crises de identidade ocasionadas, sobretudo, pelos conflitos provenientes das relações familiares. Em ambas as obras, a família é marcada pela ausência de afetos e pela desordem em sua estrutura: os laços parentais são frágeis e o amor é quase inexistente. Nesses lares, em que reina a hipocrisia, o modelo de família nuclear burguesa é desconstruído e as consequências dessa desestruturação é o surgimento de filhos perturbados emocionalmente e carentes de referências para formarem-se como indivíduos autônomos. Sendo assim, sob a perspectiva do Bildungsroman, foi realizada a análise da construção das personagens Virgínia e Raíza com a intenção de verificar como se estabelece o aperfeiçoamento individual dessas heroínas ante o desajustado ambiente familiar. Nas duas narrativas, a trajetória de aprendizagem das personagens principais é complexa, contudo, mesmo com as adversidades em decorrência da família, a bildung/formação das protagonistas culmina em desfechos positivos. Como suporte para análise e desenvolvimento desta pesquisa, o trabalho teve como orientação os estudos de Antonio Candido (2004, 2008), Luiz Costa Lima (2000) e José Guilherme Merquior (1997), quanto aos pontos referentes à representação social da literatura, e ainda Mikhail Bakhtin (1997), Marcus Vinicius Mazzari (2010) e Cristina Ferreira Pinto (1990) sobre as definições e estrutura do Bildungsroman.

Leslie Allen and Timothy Laniak, Ezra, Nehemiah, Esther, reviewed by Michael W. Duggan Robert T. Anderson and Terry Giles, The Keepers: An Introduction to the History and Culture of the Samaritans, reviewed by Cathy A. Mirecki David L. Balch and Carolyn Osiek, eds., Early Christian Families in Context, reviewed by Joan Campbell Craig G. Bartholomew and Michael W. Goheen, The Drama of Scripture: Finding Our Place in the Biblical Story., reviewed by Matthew W.I. Dunn Helen K. Bond, Caiaphas: Friend of Rome and Judge of Jesus?, reviewed by Paul Spilsbury Oded Borowski, Daily Life in Biblical Times, reviewed by Brian P.Irwin Jo-Ann A. Brant, Dialogue and Drama: Elements of Greek Tragedy in the Fourth Gospel, reviewed by David J. Hawkin Athalya Brenner, I am ... Biblical Women Tell Their Own Stories, reviewed by AnnCulp Walter Brueggemann, The Land: The Place as Gift, Promise, and Challenge in Biblical Faith. 2nd ed, reviewed by Rebecca G.S. Idestrom Richard A. Burridge, What Are the Gospels? A Comparison with Graeco-Roman Biography, reviewed by Catherine Sider Hamilton Brevard S. Childs, The Struggle to Understand Isaiah as Christian Scripture, reviewed by Matthew W. I. Dunn Kathleen E. Corley and Robert L. Webb, eds., Jesus and Mel Gibson's The Passion of the Christ: The Film, the Gospels and the Claims of History., reviewed by Mary Ann Beavis David A. de Silva, Introducing theApocrypha: Message, Context, and Significance, reviewed by Stanley E. Porter John P. Dickson, Mission-Commitment in Ancient Judaism and in the Pauline Communities, reviewed by Stephen L. Chambers Carl S. Ehrlich, Bibel und Judentum: Beiträge aus dem christlich-jädischen Gespräch, reviewed by Ian W Scott Craig Evans, ed., From Prophecy to Testament: The Function of the Old Testament in the New, reviewed by Ryan D. Wettlaufer Roger W. Gehring, House Church and Mission: The Importance of Household Structures in Early Christianity, reviewed by Allison A. Trites Paduthottu G. George, The Rod in the Old Testament, reviewed by Ellen White Yizhar Hirschfeld, Qumran in Context: Reassessing the Archaeological Evidence, reviewed by Cecilia Wassen Frank-Lothar Hossfeld and Erich Zenger, Die Psalmen II: Psalm 51-100., reviewed by Tyler F. Williams Otto Kaiser, The Old TestamentApocrypha:Anlntroduction, reviewed by Edith M. Humphrey Gary N. Knoppers, I Chronicles. 2 vols. Anchor Bible, reviewed by Steven L. McKenzie A. Lindemann, ed., The Sayings Source Q and the Historical Jesus, reviewed by Robert Derrenbacker William R.G. Loader, Jesus'Attitude towards the Law: A Study a/the Gospels, reviewed by Daniel A. Smith William R.G. Loader, The Septuagint, Sexuality, and the New Testament: Case Studies on the Impact of the LXX in Philo and the New Testament, reviewed by William Richards Gary A. Long, Grammatical Concepts 101 for Biblical Hebrew: Learning Biblical Hebrew Grammatical Concepts through English Grammar., reviewed by Tyler F. Williams Harry O. Maier, Apocalypse Recalled: The Book of Revelation after Christendom, reviewed by John W. Marshall Yvan Mathieu, La figure de Pierre dans l' oeuvre de Luc (Evangile et Actes des Apotres),' Une approche synchronique, reviewed by Jean-François Racine Michele Murray, Playing a Jewish Game: Gentile Christian Judaizing in the First and Second Centuries CE, reviewed by Tony Chartrand-Burke Filip Noill, The Travel Narrative in the Gospel of Luke: Interpretation ofLk. 9,51-19,28, reviewed by Allison Trites Todd Penner, In Praise of Christian Origins: Stephen and the Hellenists in Lukan Apologetic Historiography, reviewed by Laura D. Alary Todd Penner and Caroline Vander Stichele, eds., Contextualizing Acts: Lukan Narrative and Greco-Roman Discourse, reviewed by Ian H. Henderson Stanley Porter, ed., Reading the Gospels Today, reviewed by Adrian M. Leske Andy M. Reimer, Miracle and Magic: A Study in the Acts of the Apostles and the Life of Apollonius of Tyana, reviewed by Steven C. Muir Rolf Rendtorff and Robert A. Kugler, eds., The Book of Leviticus: Composition & Reception, reviewed by Bernon P. Lee William A. Richards, Difference and Distance in Post-Pauline Christianity, reviewed by Mona Tokarek LaFosse Erin Runions, How Hysterical: Identification and Resistance in the Bible and Film, reviewed by David Jobling Leo Dupree Sandgren, The Shadow of God: Stories from Early Judaism, reviewed by Cathy A. Mirecki Charles H.H. Scobie, The Ways o/Our God: An Approach to Biblical Theology., reviewed by John J.Yeo David Shepherd, Targum and Translation: A Reconsideration of the Qumran Aramaic Version of Job, reviewed by WesleyHu Mark S. Smith, The Memoirs of God: History, Memory, and the Experience of the Divine in Ancient Israel., reviewed by Gordon Oeste F. Scott Spencer, Journeying Through Acts: A Literary-Cultural Reading, reviewed by David M. Miller Louis Stulman, Jeremiah, Abingdon Old Testament Commentaries, reviewed by Martin Kessler Bernard Taylor, John Lee, Peter Burton and Richard Whitaker, eds., Biblical Greek Language and Lexicography: Essays in Honor of Frederick W. Danker, reviewed by Murray Baker Brian J. Walsh and Sylvia Keesmaat, Colossians Remixed: Subverting the Empire, reviewed by Steve D. Black Jane S. Webster, Ingesting Jesus: Eating and Drinking in the Gospel of John, reviewed by Dan Froese Stephen Westerholm, Perspectives Old and New on Paul: The "Lutheran" Paul and His Critics, reviewed by Ryan D. Wettlaufer Bruce W. Winter, Roman Wives, Roman Widows, reviewed by Zeba A. Crook Patrick Collinson, The Reformation:A History, reviewed by Victor Shepherd D´niel Deme, The Christology of Anselm of Canterbury, reviewed by Greg Peters Alexis James Doval, Cyril of Jerusalem, Mystagogue: The Authorship of the Mystagogic Catecheses, reviewed by Pablo F. Argarate W. Ian P. Hazlett, The Reformation in Britain and Ireland, reviewed by Jon Vickery Charles Kannengiesser, Handbook of Patristic Exegesis, reviewed by Shawn W.J. Keough Christopher J. Kauffman, Patriotism and Fraternalism in the Knights of Columbus: A History of the Fourth Degree, reviewed by Mark G. McGowan A. Donald MacLeod, W. Stanford Reid: An Evangelical Calvinist in the Academy, reviewed by Victor Shepherd Hugh McCullum, Radical Compassion: The Life & Times of Archbishop Ted Scott, reviewed by Lynda Katsuno John Anthony McGuckin, ed., The Westminster Handbook to Origen, reviewed by Shawn w.J. Keough Jean-François Racine, The Text of Matthew in the Writings of Basil of Caesarea, reviewed by Shawn W.I. Keough Sam Reimer, Evangelicals and the Continental Divide, reviewed by Peter Beyer Robert F. Anderson and Mary K. Fukuyama, eds., Ministry in the Spiritual and Cultural Diversity of Healthcare: Increasing the Competency of Chaplains, reviewed by Colleen Lashmar Henry Close, Becoming a Forgiving Person: A Pastoral Perspective, reviewed by Colleen Lashmar Pamela Cooper-White, Shared Wisdom: Use of the Self in Pastoral Care and Counseling, reviewed by Kathleen O'Neill Richard Cote, Lazarus! Come Out! Why Faith Needs Imagination, reviewed by Dennis Patrick O'Hara Michael J. Gilmour, Tangled Up in the Bible: Bob Dylan and Scripture, reviewed by Andrew Donaldson Ivan Illich, The Rivers North of the Future: The Testament of Ivan Illich, reviewed by Stephen Morris Linda Jones and Sophie Stanes, eds. In a Dark Wood: Journeys of Faith and Doubt, reviewed by Kathleen O'Neill Andrew Sung Park, From Hurt to Healing: A Theology o/the Wounded, reviewed by Joseph G. Schner William E. Phipps, Clerical Celibacy: The Heritage, reviewed by Darren J. Dias James L. Resseguie, Spiritual Landscape: Images of the Spiritual Life in the Gospel of Luke, reviewed by Andrea K. Di Giovanni Robert Boak Slocum, ed., A Heart for the Future: Writings on the Christian Hope, reviewed by Mark L. Yenson Laurence F. Wilmot, M.C. Through the Hitler Line: Memoirs of an Infantry Chaplain, reviewed by Duff Crerar Dana R. Wright and John D. Kuentzel, eds., Redemptive Transformation in Practical Theology: Essays in Honour of James E. Loder, Jr., reviewed by Gary L. Redcliffe Phyllis D. Airhart, Marilyn J. Legge and Gary L. Redcliffe, eds., Doing Ethics in a Pluralistic World: Essays in Honour of Roger C. Hutchinson, reviewed by Ronald A. Mercier Daniel M. Bell, Liberation Theology After the End of History: The Rejitsal to Cease Suffering., reviewed by Michael Bourgeois Eberhard Busch, The Great Passion: An Introduction to Karl Barth s Theology, reviewed by Victor Shepherd Sung Wook Chung, Admiration and Challenge: Karl Barth's Theological Relationship with John Calvin, reviewed by Philip G. Ziegler John D. Dadosky, The Structure of Religious Knowing, reviewed by Robin Koning David F. Ford and Graham Stanton, eds., Reading Texts, Seeking Wisdom: Scripture and Theology, reviewed by Mark L. Yenson Roger Haight, Christian Community in History: Historical Ecclesiology. Vol. 1, reviewed by John D. Dadosky Reinhard Hutter, Bound to Be Free: Evangelical Catholic Engagements in Ecclesiology, Ethics, and Ecumenism, reviewed by Jeremy M. Bergen Robin M. Jensen, The Substance o/Things Seen: Art, Faith, and Christian Community., reviewed by Brenda Llewellyn Ihssen Veli-Matti Kärkkäinen, The Doctrine of God: A Global Introduction: A Biblical, Historical & Contemporary Survey, reviewed by Jaroslav Z. Skira Gordon D. Kaufinan, In the beginning ... Creativity, reviewed by Cora Twohig-Moengangongo Paul D. Molnar, Divine Freedom and the Doctrine of the Immanent Trinity: In Dialogue with Karl Barth and Contemporary Theology, reviewed by Victor Shepherd Stephen J. Pope, ed., The Ethics of Aquinas, reviewed by Gilles Mongeau John G. Stackhouse, Jr., ed., Evangelical Ecclesiology, reviewed by Christopher M. Cook Stephen H. Webb, American Providence: A Nation with a Mission, reviewed by Brenda Llewellyn Ihssen