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Find video protocols related to scientific articles indexed in Pubmed.
Effects of switching to protease inhibitor monotherapy on nucleoside analogue-related adverse events.
AIDS Rev
PUBLISHED: 10-29-2014
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Switching from triple combination treatment to protease inhibitor monotherapy may increase the risk of elevations in HIV RNA, and is not recommended in most international treatment guidelines. However, the use of protease inhibitor monotherapy could prevent or reverse adverse events related to long-term use of nucleoside analogues, such as lipoatrophy, renal adverse events, osteopenia, and anemia. A detailed MEDLINE search was conducted to identify randomized clinical trials of triple-combination treatment versus protease inhibitor monotherapy with detailed analyses of safety. Summary results from analysis of changes in body composition, changes in lipids, renal adverse events, and anemia were evaluated for patients taking either protease inhibitor monotherapy or triple therapy. In six trials with dual-energy X-ray absorptiometry data available, the percentage of patients with lipoatrophy was significantly lower in the protease inhibitor monotherapy arms than the triple therapy arms (p = 0.03). In these trials there was also no significant difference in the risk of lipohypertrophy between protease inhibitor monotherapy and triple therapy arms. In one trial there was a higher risk of renal adverse events for patients taking tenofovir in the triple therapy arm. In two trials there were rises in total cholesterol when patients stopped taking tenofovir in the protease inhibitor monotherapy arms. In conclusion, there is a mixed pattern of changes in nucleoside analogue-related adverse events after switching from triple therapy to protease inhibitor therapy. The potential for safety benefits of stopping nucleoside analogues needs to be set against a higher risk of HIV RNA elevations during protease inhibitor monotherapy.
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Cost-effectiveness of different strategies to monitor adults on antiretroviral treatment: a combined analysis of three mathematical models.
Lancet Glob Health
PUBLISHED: 08-09-2014
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WHO's 2013 revisions to its Consolidated Guidelines on antiretroviral drugs recommend routine viral load monitoring, rather than clinical or immunological monitoring, as the preferred monitoring approach on the basis of clinical evidence. However, HIV programmes in resource-limited settings require guidance on the most cost-effective use of resources in view of other competing priorities such as expansion of antiretroviral therapy coverage. We assessed the cost-effectiveness of alternative patient monitoring strategies.
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The Efficacy of Patient Initiated Follow Up Clinics In Secondary Care: A Systematic Review.
Intern Med J
PUBLISHED: 07-06-2014
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Patient Initiated Follow-Up (PIFU) is an initiative that allows patients to initiate hospital follow up appointments on an 'as required' basis compared to the traditional 'physician-initiated' model. The main principle is to reduce inappropriate regular follow-up appointments. In this systematic review, we attempt to address its efficacy for outpatient secondary level care.
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Early guenon from the late Miocene Baynunah Formation, Abu Dhabi, with implications for cercopithecoid biogeography and evolution.
Proc. Natl. Acad. Sci. U.S.A.
PUBLISHED: 06-30-2014
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A newly discovered fossil monkey (AUH 1321) from the Baynunah Formation, Emirate of Abu Dhabi, United Arab Emirates, is important in a number of distinct ways. At ? 6.5-8.0 Ma, it represents the earliest known member of the primate subfamily Cercopithecinae found outside of Africa, and it may also be the earliest cercopithecine in the fossil record. In addition, the fossil appears to represent the earliest member of the cercopithecine tribe Cercopithecini (guenons) to be found anywhere, adding between 2 and 3.5 million y (? 50-70%) to the previous first-appearance datum of the crown guenon clade. It is the only guenon--fossil or extant--known outside the continent of Africa, and it is only the second fossil monkey specimen so far found in the whole of Arabia. This discovery suggests that identifiable crown guenons extend back into the Miocene epoch, thereby refuting hypotheses that they are a recent radiation first appearing in the Pliocene or Pleistocene. Finally, the new monkey is a member of a unique fauna that had dispersed from Africa and southern Asia into Arabia by this time, suggesting that the Arabian Peninsula was a potential filter for cross-continental faunal exchange. Thus, the presence of early cercopithecines on the Arabian Peninsula during the late Miocene reinforces the probability of a cercopithecoid dispersal route out of Africa through southwest Asia before Messinian dispersal routes over the Mediterranean Basin or Straits of Gibraltar.
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Is there a higher risk of CNS adverse events for PI monotherapy versus triple therapy? A review of results from randomized clinical trials.
HIV Clin Trials
PUBLISHED: 06-21-2014
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Protease inhibitor (PI) monotherapy for treatment could avoid the adverse events, drug resistance, and additional costs associated with other antiretrovirals that are normally used, particularly the nucleoside analogues. PI monotherapy has mainly been compared with standard triple therapy in randomized clinical trials of patients who have HIV RNA suppression at screening and no history of virological failure.
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Building reproductive health research and audit capacity and activity in the pacific islands (BRRACAP) study: methods, rationale and baseline results.
BMC Med Educ
PUBLISHED: 06-12-2014
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Clinical research and audit in reproductive health is essential to improve reproductive health outcomes and to address the Millennium Development Goals 4 and 5. Research training, mentoring and a supportive participatory research environment have been shown to increase research activity and capacity in low to middle income countries (LMIC). This paper details the methods, rationale and baseline findings of a research program aimed at increasing clinical research activity and audit in the six Pacific Islands of Fiji, Samoa, Tonga, Vanuatu, Cook Islands and the Solomon Islands.
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Health economics in Enhanced Recovery After Surgery programs.
Can J Anaesth
PUBLISHED: 06-01-2014
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The Enhanced Recovery After Surgery (ERAS) program aims to combine and coordinate evidence-based perioperative care interventions that support standardizing and optimizing surgical care. In conjunction with its clinical benefits, it has been suggested that ERAS reduces costs through shorter convalescence and reduced morbidity. Nevertheless, few studies have evaluated the cost-effectiveness of ERAS programs. The aim of this systematic review, therefore, is to evaluate the claims that ERAS is cost-effective and to characterize how these costs were reported and evaluated.
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Efficacy of general practitioners with specialty interests for surgical procedures.
ANZ J Surg
PUBLISHED: 04-17-2014
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General practitioners with specialty interests (GPwSIs) have been an emerging entity in the last decade or so and aim to improve patient's access to specialist level care in the primary care setting. This is achieved by them providing equivalent quality and outcomes to secondary consultant-led services, while not necessarily providing the same breadth of clinical care as them. In this systematic review, we attempt to address their efficacy for surgical procedures and specialties.
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Junior doctors in their first year: mental health, quality of life, burnout and heart rate variability.
Perspect Med Educ
PUBLISHED: 04-08-2014
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There is a burgeoning interest in, and evidence of, quality of life and burnout issues among doctors. It was hypothesized that the junior doctors in this study would experience psychosocial and physiological changes over time, and that the obtained measures would indicate psychosocial and physiological anomalies. In addition, it was hypothesized that their psychosocial perceptions would be significantly associated with their physiological measures. A total sample of 17 junior doctors in their first year of training volunteered for this study. Over four time periods separated by 6 week phases, the doctors completed a set of quality of life and psychosocial inventories and wore a Polar RS800 Heart Rate Monitor over a day and night time interval. The findings showed that this sample of doctors did not report any problems associated with depression, anxiety, stress, burnout or quality of life (psychosocial measures). In addition, their heart rate variability scores (physiological measures) did not show any significant fluctuations. Furthermore, the responses from the self-report instruments measuring stress, anxiety, depression, quality of life and burnout did not consistently correlate with the HRV information suggesting a mind-body disconnection. More work needs to be done on larger samples to investigate these findings further given that the literature shows that junior doctors are likely to be stressed and working in stress-provoking environments.
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Systematic review and meta-analysis: Patient and programme impact of fixed-dose combination antiretroviral therapy.
Trop. Med. Int. Health
PUBLISHED: 03-17-2014
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To compare the advantages to patients and to programmes between fixed-dose combination (FDC) antiretroviral therapy and separate tablet regimens.
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An exploration and comparison of food and drink availability in homes in a sample of families of White and Pakistani origin within the UK.
Public Health Nutr
PUBLISHED: 03-11-2014
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Knowledge of the types and quantities of foods and drinks available in family homes supports the development of targeted intervention programmes for obesity prevention or management, or for overall diet improvement. In the UK, contemporary data on foods that are available within family homes are lacking. The present study aimed to explore home food and drink availability in UK homes.
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Sustained virological response with telaprevir in 1078 patients with advanced hepatitis C: The international telaprevir access program.
J. Hepatol.
PUBLISHED: 02-24-2014
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There is little information regarding the extent to which difficult to cure patients with advanced liver fibrosis, due to hepatitis C virus genotype-1 (HCV-1) can successfully and safely be treated with triple therapy with telaprevir (TVR), pegylated interferon alpha (P) and ribavirin (R). In the TVR early access program HEP3002 we aimed to explore treatment safety and efficacy, and identify predictors of sustained virological response at week 24 (SVR24).
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Efficacy of 400 mg efavirenz versus standard 600 mg dose in HIV-infected, antiretroviral-naive adults (ENCORE1): a randomised, double-blind, placebo-controlled, non-inferiority trial.
Lancet
PUBLISHED: 02-10-2014
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The optimum dose of key antiretroviral drugs is often overlooked during product development. The ENCORE1 study compared the efficacy and safety of reduced dose efavirenz with standard dose efavirenz in combination with tenofovir and emtricitabine as first-line treatment for HIV infection. An effective and safe reduced dose could yield meaningful cost savings.
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Harnessing Yarrowia lipolytica lipogenesis to create a platform for lipid and biofuel production.
Nat Commun
PUBLISHED: 01-22-2014
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Economic feasibility of biosynthetic fuel and chemical production hinges upon harnessing metabolism to achieve high titre and yield. Here we report a thorough genotypic and phenotypic optimization of an oleaginous organism to create a strain with significant lipogenesis capability. Specifically, we rewire Yarrowia lipolytica's native metabolism for superior de novo lipogenesis by coupling combinatorial multiplexing of lipogenesis targets with phenotypic induction. We further complete direct conversion of lipid content into biodiesel. Tri-level metabolic control results in saturated cells containing upwards of 90% lipid content and titres exceeding 25?g?l(-1) lipids, which represents a 60-fold improvement over parental strain and conditions. Through this rewiring effort, we advance fundamental understanding of lipogenesis, demonstrate non-canonical environmental and intracellular stimuli and uncouple lipogenesis from nitrogen starvation. The high titres and carbon-source independent nature of this lipogenesis in Y. lipolytica highlight the potential of this organism as a platform for efficient oleochemical production.
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Etravirine as a Switching Option for Patients with HIV RNA Suppression: A Review of Recent Trials.
AIDS Res Treat
PUBLISHED: 01-20-2014
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Unlike other nonnucleoside reverse transcriptase inhibitors, etravirine is only approved for use in treatment-experienced patients. In the DUET 1 and 2 trials, 1203 highly treatment-experienced patients were randomized to etravirine or placebo, in combination with darunavir/ritonavir and optimized background treatment. In these trials, etravirine showed significantly higher rates of HIV RNA suppression when compared with placebo (61% versus 40% at Week 48). There was no significant rise of lipids or neuropsychiatric adverse events, but there was an increase in the risk of rash with etravirine treatment. In the SENSE trial, which evaluated etravirine and efavirenz in 157 treatment-naïve patients in combination with 2 nucleoside analogues, there was a lower risk of lipid elevations and neuropsychiatric adverse events with etravirine when compared to efavirenz. Etravirine has been evaluated in three randomized switching studies. In the SSAT029 switch trial, 38 patients who had neuropsychiatric adverse events possibly related to efavirenz showed an improvement in these after switching to etravirine. The Swiss Switch-EE recruited 58 individuals without neuropsychiatric adverse events who were receiving efavirenz, and no benefit was shown when switching to etravirine. In the Spanish ETRA-SWITCH trial (n = 46), there were improvements in lipids when individuals switched from a protease inhibitor to etravirine. These switching trials were conducted in patients with full HIV RNA suppression: <50 copies/mL and with no history of virological failure or resistance to therapy. The results from these three randomized switching studies suggest a possible new role for etravirine, in combination with two nucleoside analogues, as a switching option for those with HIV RNA suppression but who are reporting adverse events possibly related to antiretroviral therapy. However a large well-powered trial would need to be conducted to strengthen the evidence from the pilot studies conducted so far.
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Minimum costs for producing hepatitis C direct-acting antivirals for use in large-scale treatment access programs in developing countries.
Clin. Infect. Dis.
PUBLISHED: 01-06-2014
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Several combinations of 2 or 3 direct-acting antivirals (DAAs) can cure hepatitis C virus (HCV) in the majority of treatment-naive patients. DAAs for HCV infection have similar mechanisms of action and chemical structures to antiretrovirals for human immunodeficiency virus (HIV) infection. Generic antiretrovirals are currently manufactured at very low prices, to treat 10 million people with HIV/AIDS in developing countries.
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Effect of hyperbilirubinaemia on neurocognitive, renal, bone and cardiovascular markers in HIV infection treated with boosted protease inhibitors.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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Use of some protease inhibitors (PI) is associated with unconjugated hyperbilirubinaemia (HBR), due to inhibition of UGT1A1. As observed in Gilbert's syndrome, HBR may have antioxidant and anti-inflammatory effects. Inflammation may be relevant to neurocognitive (NC) impairment, cardiovascular, renal and bone co-morbidities in HIV infection. This study aimed to analyse correlations between antiretroviral associated HBR and NC impairment as well as renal, bone and cardiovascular parameters.
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Efficacy of a reduced dose of DARUNAVIR/RTV in a cohort of antiretroviral-naïve and experienced HIV-infected patients: a medium-term follow-up.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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The currently approved dose of darunavir/ritonavir is 800/100 mg once daily for PI-naïve patients, and 600/100 mg twice daily for PI-pretreated patients. However, in DRV-sensitive patients at baseline in the POWER 1/2 trials, similar rates of HIV RNA suppression (1 log reduction) were achieved with doses ranging from 400/100 mg once daily to 600/100 mg twice daily. In previously virologically suppressed patients, a reduced dose of DRV (600/100 QD) is non-inferior to the standard dose (800 mg QD)1 and DRV concentrations in plasma and CSF are similar in patients receiving the above different doses (1, 2).
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Efficacy of PI monotherapy versus triple therapy for 1964 patients in 10 randomised trials.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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The efficacy of protease inhibitor monotherapy has been analyzed with different endpoints: initial HIV-1 RNA rebound, long-term HIV-1 RNA suppression after re-intensification, treatment-emergent drug resistance, neurocognitive testing and HIV-1 RNA in the cerebrospinal fluid (CSF).
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Prices of second-line antiretroviral treatment for middle-income countries inside versus outside sub-Saharan Africa.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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Antiretrovirals are available at low prices in sub-Saharan Africa, but these prices may not be consistently available for middle-income countries in other regions with large HIV epidemics. Over 30% of HIV infected people live in countries outside sub-Saharan Africa. Several key antiretrovirals are still on patent, with generic production restricted. We assessed price variations for key antiretroviral drugs inside versus outside sub-Saharan Africa.
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Should the dose of tenofovir be reduced to 200-250 mg/day, when combined with protease inhibitors?
J Int AIDS Soc
PUBLISHED: 01-01-2014
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The approved dose of tenofovir disproxil fumarate, 300 mg once daily, was established in clinical trials in combination with efavirenz, which does not significantly affect tenofovir concentrations. Combining tenofovir with lopinavir/r, darunavir/r or atazanavir/r increases tenofovir concentrations, which could raise the risk of renal adverse events. Newly approved tenofovir tablets are available at lower strength (200 or 250 mg) for use in paediatrics.
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Impact of NRTI backbone on renal, bone and cardiovascular markers in HIV-infected individuals receiving a boosted protease inhibitor.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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We have previously shown in the SSAT 044 study that unconjugated hyperbilirubinaemia in subjects receiving a boosted protease inhibitor (PI/r) has limited impact on renal, cardiovascular (CV) and bone biomarkers, as well as on neurocognitive performance, relative to those receiving PI/r with a normal bilirubin. We present here a secondary analysis comparing markers in those receiving abacavir- vs tenofovir- based antiretroviral therapy (ART).
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The PROTEA trial: darunavir/ritonavir with or without nucleoside analogues, for patients with HIV-1 RNA below 50 copies/mL.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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In previous studies, protease inhibitor (PI) monotherapy has shown trends for higher low-level elevations in HIV-1 RNA compared to triple therapy, but no increase in the risk of drug resistance.
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Large disparities in HIV treatment cascades between eight European and high-income countries - analysis of break points.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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Patients on antiretroviral treatment with undetectable HIV RNA levels have a significantly lower risk of clinical disease progression and onward HIV transmission. This study aimed to estimate and compare the percentage of all HIV-positive people who are diagnosed, are linked to care, are taking antiretroviral treatment and have undetectable HIV RNA, in eight European and high-income countries: the United States, the United Kingdom, France, the Netherlands, Denmark, Australia, British Columbia (Canada) and Georgia.
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Predicted savings to the UK National Health Service from switching to generic antiretrovirals, 2014-2018.
J Int AIDS Soc
PUBLISHED: 01-01-2014
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In other disease areas, generic drugs are normally used after patent expiry. Patents on zidovudine, lamivudine, nevirapine and efavirenz have already expired. Patents will expire for abacavir in late 2014, lopinavir/r in 2016, and tenofovir, darunavir and atazanavir in 2017. However, patents on single-tablet regimens do not expire until after 2026.
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No Difference in the Rate of Change in Telomere Length or Telomerase Activity in HIV-Infected Patients after Three Years of Darunavir/Ritonavir with and without Nucleoside Analogues in the MONET Trial.
PLoS ONE
PUBLISHED: 01-01-2014
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To determine whether nucleos(t)ide reverse transcriptase inhibitors (NRTI) contribute to an accelerated loss in telomere length (TL) in HIV-infected patients on antiretroviral therapy (ART).
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Interhospital transfer of acute general surgical patients in the Taranaki region of New Zealand.
N. Z. Med. J.
PUBLISHED: 12-24-2013
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This study investigated the transfer of acute general surgical patients from HPH to TBH in order to evaluate Interhospital transfer time in a rural New Zealand setting. It specifically investigates the prioritisation and time to transfer of unwell patients who required ICU/HDU admission following transfer.
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Time to HIV-1 RNA Suppression Below 5 copies/ml During First-Line Protease Inhibitor-Based Antiretroviral Treatment - Any Impact of Residual Viremia on Treatment Success?
AIDS Rev
PUBLISHED: 12-11-2013
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When antiretroviral treatment suppresses HIV RNA levels to below 50 copies/ml, traces of viremia may still be detected with more sensitive assays. In the ARTEMIS trial, 689 antiretroviral treatment-naive patients were randomized to tenofovir/emtricitabine plus either darunavir/ritonavir (n = 343) or lopinavir/ritonavir (n = 346). HIV-1 RNA was evaluated using the Roche Amplicor® Ultrasensitive assay: plasma samples with HIV RNA < 50 copies/ml were classified as either "No HIV RNA detected" (< 5 HIV RNA copies/ml, optical density = background) or HIV RNA detected (5-50 copies/ml). The percentage of patients in each arm with HIV RNA < 5 copies/ml rose progressively from week 2 to week 192. For patients with baseline HIV RNA ? 100,000, the percentage with HIV RNA < 5 copies/ml at week 192 was 66% for darunavir/ritonavir and 63% for lopinavir/ritonavir. For patients with baseline HIV RNA < 100,000 copies/ml, the percentage with HIV RNA < 5 copies/ml at week 192 was 79% for darunavir/ritonavir versus 77% for lopinavir/ritonavir. Of the patients on darunavir/ritonavir with HIV RNA < 50 copies/ml, 63% had levels < 5 copies/ml at week 48, versus 80% at week 192. In summary, HIV-1 RNA suppression to < 5 copies/ml is dependent on baseline HIV RNA levels. The HIV RNA levels can remain under quantification limits but still detectable after 2-4 years of antiretroviral treatment.
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Sensitive testing of plasma HIV-1 RNA and Sanger sequencing of cellular HIV-1 DNA for the detection of drug resistance prior to starting first-line antiretroviral therapy with etravirine or efavirenz.
J. Antimicrob. Chemother.
PUBLISHED: 11-27-2013
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This study investigated strategies that may increase the yield of drug resistance testing prior to starting antiretroviral therapy (ART), and whether transmitted and polymorphic resistance-associated mutations (RAMs) correlated with virological outcomes.
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Historical aspects of appendicitis in children.
ANZ J Surg
PUBLISHED: 09-10-2013
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Evidence of appendicitis exists from ancient Egyptian mummies but the appendix was not discovered as an anatomical entity until the renaissance in Western European literature. Much confusion reigned over the cause of right iliac fossa inflammatory disease until the late 19th century, when the appendix was recognized as the cause of the great majority of cases. Coining the term appendicitis and making the case for early surgery, Fitz in 1886 set the scene for recovery from appendicitis through operative intervention.
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Phase I drug-interaction study of effects of calcium and magnesium infusions on oxaliplatin pharmacokinetics and acute neurotoxicity in colorectal cancer patients.
BMC Cancer
PUBLISHED: 08-01-2013
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Calcium and magnesium (Ca/Mg) infusions have been suggested as an effective intervention for preventing oxaliplatin-induced neurotoxicity, but the effects of Ca/Mg infusions on oxaliplatin pharmacokinetics, motor nerve hyperexcitability and acute neurotoxicity symptoms are unclear.
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Can we stop CD4+ testing in patients with HIV-1 RNA suppression on antiretroviral treatment?
AIDS
PUBLISHED: 07-12-2013
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It is unclear whether regular CD4 testing is necessary for all patients during long-term antiretroviral treatment, after patients achieve full HIV-1 RNA suppression.
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Pharmacokinetics and pharmacodynamics of etravirine 400 mg once daily in treatment-naïve patients.
HIV Clin Trials
PUBLISHED: 07-10-2013
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Etravirine is currently approved for HIV treatment-experienced patients at a dose of 200 mg twice daily. The long terminal elimination half-life of etravirine should support once-daily dosing.
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Observation charts with overlapping blood pressure and heart rate graphs do not yield the performance advantage that health professionals assume: an experimental study.
J Adv Nurs
PUBLISHED: 07-06-2013
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To investigate whether overlapping blood pressure and heart rate graphs improve chart-users ability to recognize derangements in these vital signs on hospital observation charts.
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Duration of Postoperative Intravenous Antibiotics in Childhood Complicated Appendicitis: A Propensity Score-Matched Comparison Study.
Eur J Pediatr Surg
PUBLISHED: 06-25-2013
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Introduction Postoperative antibiotics complement surgery in managing childhood-complicated appendicitis. However, there is limited evidence to guide clinicians on appropriate duration of therapy. A comparison cohort study was performed to determine whether tailoring duration of inpatient intravenous (IV) antibiotic therapy to patient response, assessed using a set of clinical criteria, leads to shortened hospital length of stay (LOS) without compromising patient outcomes.Patients and Methods Over a 6-month period, 47 children (aged 5-14 years) with complicated appendicitis were treated with postoperative IV antibiotics until each satisfied a set of bedside clinical parameters suggesting resolved intraperitoneal infection (core temperature < 38°C for 24 hours, tolerated two consecutive meals, mobilizing independently, requiring only oral analgesia). Complicated appendicitis was defined as the presence of generalized peritonitis, appendiceal perforation or gangrene, and/or abscess. Postoperative recovery parameters were prospectively recorded and compared with those of 47 historical control patients, matched by propensity scores, who received 5 days minimum of postoperative IV antibiotics. Sample size was determined by a priori power calculation based on reduction in LOS. Severity of postoperative complications was graded using the Clavien-Dindo system.Results Study group variables were comparable including patient demographics, duration of presenting symptoms, severity of presenting disease, preoperative antibiotics received, length of operation, seniority of primary surgeon, surgical approach taken, and intraoperative findings. The prospective cohort had a significantly shorter median LOS compared with the historical control cohort (5 vs. 6 nights, p = 0.010) while readmission rates and the incidence and severity of complications were similar, including incidence of postoperative intra-abdominal infections (6 vs. 8 cases, p = 0.562).Conclusion Using bedside clinical parameters indicative of resolved intraperitoneal infection to tailor duration of postoperative IV antibiotics for children with complicated appendicitis shortens LOS without apparent compromise to patient outcomes.
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Disgust sensitivity and the non-rational aspects of a career choice in surgery.
N. Z. Med. J.
PUBLISHED: 06-25-2013
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Fitting trainee physicians to career paths remains an ongoing challenge in a highly fluid health workforce environment. Studies attempting to explain low interest in surgical careers have typically examined the relative impact of career and lifestyle values. The current work argues that emotional proclivities are potentially more important and that disgust sensitivity may help explain both low surgical interest as well as the tendency for female students to avoid surgical careers.
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General surgical interns contributing to the clerkship learning environment of medical students.
Med Teach
PUBLISHED: 06-19-2013
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Junior doctors are increasingly promoted as clinical teachers but there is limited understanding of how they contribute to medical student clerkship learning.
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Does microbicide use in consumer products promote antimicrobial resistance? A critical review and recommendations for a cohesive approach to risk assessment.
Microb. Drug Resist.
PUBLISHED: 06-14-2013
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The increasing use of microbicides in consumer products is raising concerns related to enhanced microbicide resistance in bacteria and potential cross resistance to antibiotics. The recently published documents on this topic from the European Commission have spawned much interest to better understand the true extent of the putative links for the benefit of the manufacturers, regulators, and consumers alike. This white paper is based on a 2-day workshop (SEAC-Unilever, Bedford, United Kingdom; June 2012) in the fields of microbicide usage and resistance. It identifies gaps in our knowledge and also makes specific recommendations for harmonization of key terms and refinement/standardization of methods for testing microbicide resistance to better assess the impact and possible links with cross resistance to antibiotics. It also calls for a better cohesion in research in this field. Such information is crucial to developing any risk assessment framework on microbicide use notably in consumer products. The article also identifies key research questions where there are inadequate data, which, if addressed, could promote improved knowledge and understanding to assess any related risks for consumer and environmental safety.
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Resistance at virological failure using boosted protease inhibitors versus nonnucleoside reverse transcriptase inhibitors as first-line antiretroviral therapy--implications for sustained efficacy of ART in resource-limited settings.
J. Infect. Dis.
PUBLISHED: 05-21-2013
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Increases in the prevalence of resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs) have been observed among previously untreated individuals in all areas of sub-Saharan Africa. We aimed to examine whether first-line use of 2 NRTIs plus a boosted protease inhibitor (bPI) could protect against emergence of NRTI resistance mutations, compared to the use of 2 NRTIs plus 1 NNRTI.
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Optimizing HIV treatment.
Curr Opin HIV AIDS
PUBLISHED: 04-30-2013
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There are at least seven million people eligible for antiretroviral treatment but not receiving it. An additional 19 million people will need to start treatment in the future, as their HIV disease progresses. Funding for Universal Access to HIV treatment has been restricted by the Global Financial Crisis.
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Expanding the metabolic engineering toolbox with directed evolution.
Biotechnol J
PUBLISHED: 04-25-2013
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Cellular systems can be engineered into factories that produce high-value chemicals from renewable feedstock. Such an approach requires an expanded toolbox for metabolic engineering. Recently, protein engineering and directed evolution strategies have started to play a growing and critical role within metabolic engineering. This review focuses on the various ways in which directed evolution can be applied in conjunction with metabolic engineering to improve product yields. Specifically, we discuss the application of directed evolution on both catalytic and non-catalytic traits of enzymes, on regulatory elements, and on whole genomes in a metabolic engineering context. We demonstrate how the goals of metabolic pathway engineering can be achieved in part through evolving cellular parts as opposed to traditional approaches that rely on gene overexpression and deletion. Finally, we discuss the current limitations in screening technology that hinder the full implementation of a metabolic pathway-directed evolution approach.
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Phase III, randomized, double-blind, placebo-controlled study of modafinil for fatigue in patients treated with docetaxel-based chemotherapy.
Support Care Cancer
PUBLISHED: 04-21-2013
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Modafinil has been reported to benefit a subgroup of patients suffering severe fatigue while undergoing chemotherapy. Docetaxel is associated with fatigue that may lead to premature therapy withdrawal. We investigated whether modafinil could reduce fatigue during docetaxel chemotherapy.
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A kinome-wide siRNA screen identifies multiple roles for protein kinases in hypoxic stress adaptation, including roles for IRAK4 and GAK in protection against apoptosis in VHL-/- renal carcinoma cells, despite activation of the NF-?B pathway.
J Biomol Screen
PUBLISHED: 04-16-2013
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Hypoxia induces changes to cancer cells that make them more resistant to treatment. We have looked at signaling pathways that facilitate these changes by screening the human kinome for effects on hypoxic responses in SW480 colon cancer cells. Hits identified in the screen were examined for effects on multiple molecular responses to hypoxia, including the endoplasmic reticulum stress and DNA damage responses in colon, melanoma, and renal cancer lines. To validate the hits from the small interfering RNA studies, we developed cell lines expressing stable short hairpin RNAs (shRNAs) in the A498 renal carcinoma cell line. Several lines, including those expressing shRNAs against DYRK1B, GAK, IHPK2, IRAK4, and MATK, showed an inability to form spheroid cultures. In addition, shRNAs targeting IRAK4 and GAK were incapable of 2D growth under anoxia. In the GAK shRNA-expressing line, nuclear factor-?B (NF-?B) was localized to the nucleus, but in the IRAK4 shRNA line, NF-?B levels were increased but the extent of nuclear localization was unchanged. Dominant negative mutants of IRAK4 and GAK also showed strong apoptotic effects in A498 cells under anoxia, supporting a direct link between these kinases and survival of the VHL(-/-) RCC line, which is typically highly resistant to hypoxic stress as a result of high and constitutive levels of Hif-1?.
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Early cercopithecid monkeys from the Tugen Hills, Kenya.
Proc. Natl. Acad. Sci. U.S.A.
PUBLISHED: 03-18-2013
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The modern Old World Monkeys (Superfamily Cercopithecoidea, Family Cercopithecidae) can be traced back into the late Miocene, but their origin and subsequent diversification is obscured by the scarcity of terrestrial fossil sites in Africa between 15 and 6 Ma. Here, we document the presence of cercopithecids at 12.5 Ma in the Tugen Hills of Kenya. These fossils add 3 My to the known antiquity of crown Cercopithecidae. The two specimens represent one or possibly two species of early colobine, and their morphology suggests that they were less folivorous than their modern relatives.
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Gentamicin-collagen implants to reduce surgical site infection: systematic review and meta-analysis of randomized trials.
Ann. Surg.
PUBLISHED: 03-15-2013
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To determine whether gentamicin-impregnated collagen sponges (gentamicin-collagen implants) decrease the incidence of surgical site infection (SSI).
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A new fossil thryonomyid from the Late Miocene of the United Arab Emirates and the origin of African cane rats.
Naturwissenschaften
PUBLISHED: 03-07-2013
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Cane rats (Thryonomyidae) are represented today by two species inhabiting sub-Saharan Africa. Their fossil record is predominately African, but includes several Miocene species from Arabia and continental Asia that represent dispersal events from Africa. For example, Paraulacodus indicus, known from the Miocene of Pakistan, is closely related to living Thryonomys. Here we describe a new thryonomyid, Protohummus dango, gen. et sp. nov., from the late Miocene Baynunah Formation of the United Arab Emirates. The new thryonomyid is less derived than "Thryonomys" asakomae from the latest Miocene of Ethiopia and clarifies the origin of crown Thryonomys and the evolutionary transition from Paraulacodus. A phylogenetic analysis shows Protohummus dango to be morphologically intermediate between Paraulacodus spp. and extinct and living Thryonomys spp. The morphological grade and phylogenetic position of Protohummus dango further supports previous biochronological estimates of the age of the Baynunah Formation (ca. 6-8 Ma).
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Fast-track elective colectomy: single-surgeon experience of 100 consecutive cases.
N. Z. Med. J.
PUBLISHED: 03-07-2013
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In 2005, the senior author (AGH) initiated an Enhanced Recovery After Surgery (ERAS) or fast-track programme for elective colonic surgery at the Manukau Surgery Centre aimed at improving perioperative care. We reviewed the senior authors experience of elective colectomy conducted within the ERAS programme and evaluated clinical outcomes.
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Initial experience with the Ventana fenestrated system for endovascular repair of juxtarenal and pararenal aortic aneurysms.
J. Vasc. Surg.
PUBLISHED: 03-05-2013
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Customized fenestrated endovascular stent grafts have been investigated as an alternative to open surgery for repair of more complex juxtarenal aortic aneurysms (JAAs). The substantial time required to design and manufacture these devices has led to the desire for a standardized fenestrated endovascular system. We report the initial pilot study results of a potential "off-the-shelf" fenestrated device system to assess its initial safety and feasibility for endovascular repair of JAAs and pararenal aortic aneurysms (PAAs).
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A Rangwapithecus gordoni mandible from the early Miocene site of Songhor, Kenya.
J. Hum. Evol.
PUBLISHED: 02-19-2013
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A mandible of Rangwapithecus gordoni from the early Miocene site of Songhor, Kenya, provides additional information about this relatively poorly known taxon. The R. gordoni sample is small, being composed of dental and a few gnathic parts. The fossil described here provides examples of previously unknown dental and mandibular anatomy, and confirms former reassignments of isolated anterior teeth based on less certain evidence. The phylogenetic status of Rangwapithecus, its distribution, and paleobiology are briefly reviewed. Rangwapithecus shows a suite of dental and gnathic features that warrants its generic distinction from Proconsul. Derived features shared with Nyanzapithecus and Turkanapithecus indicate that it is an early member of the subfamily Nyanzapithecinae. Its molar morphology suggests a considerable component of folivory in its diet. A review of the hypodigm shows Rangwapithecus to be restricted to Songhor. This distribution parallels that of Limnopithecus evansi, and is mirrored by Limnopithecus legetet and Micropithecus clarki suggesting that Songhor may have differed ecologically from other more or less contemporary sites in the region.
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Are what happens next exercises and self-generated commentaries useful additions to hazard perception training for novice drivers?
Accid Anal Prev
PUBLISHED: 02-08-2013
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We investigated whether self-generated commentaries and what happens next exercises are useful additions to hazard perception training. Two hundred and thirty-three novice drivers experienced one of four different video-based training interventions derived from an existing hazard perception training package: (1) what happens next training; (2) expert commentary training; (3) hybrid commentary training (i.e., expert plus self-generated commentaries); or (4) the full training package (i.e., what happens next plus hybrid commentary training). There was also a placebo control condition. Drivers hazard perception skill was measured using video-based tests featuring real driving footage at three times: immediately prior to the intervention; immediately post-intervention; and after a one-week delay. Compared to the placebo control, all training interventions significantly improved hazard perception response times immediately after the intervention. The full training resulted in the largest improvement, and the what happens next training the least. The addition of self-generated commentaries to the expert commentary training (hybrid commentary condition) did not significantly improve response times. The what happens next training was found to be significantly less effective than the expert commentary training condition both immediately after the intervention, and also after a one week delay. All training effects decayed significantly after the delay, but the effect of full training remained significant. Although no benefit was found in adding self-generated commentaries to expert commentaries, the possibility remains that the what happens next exercises may provide an additional benefit when combined with commentary training. The results provide further support for hazard perception training as an evidence-based alternative to traditional methods of improving novice driver safety.
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Goal-directed fluid therapy- a survey of anaesthetists in the UK, USA, Australia and New Zealand.
BMC Anesthesiol
PUBLISHED: 02-07-2013
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Goal-directed fluid therapy (GDFT) has been shown to reduce complications and hospital length of stay following major surgery. However, there has been no assessment regarding its use in clinical practice.
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Experiences, understandings and support needs of family carers of older patients with delirium: a descriptive mixed methods study in a hospital delirium unit.
Int J Older People Nurs
PUBLISHED: 02-06-2013
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BACKGROUND: Delirium is common in older patients. Little is known of support needs of families of older hospital patients with delirium. AIMS AND OBJECTIVES: To inform nursing practice, we sought to describe families experiences, understanding of delirium and delirium care, and support needs. DESIGN: Descriptive mixed methods. METHODS: Review of questionnaire items used with families of people with terminal delirium informed development of a new questionnaire to evaluate the support needs in our study population. In a tertiary hospital delirium unit, we recruited 17 family carers of older patients with (non-terminal) delirium to respond to this questionnaire. Twelve participants (11 female) also took part in interviews addressing the studys aims. Descriptive statistics were calculated and thematic analysis was undertaken. RESULTS: From the survey, key family issues included distress about the patients condition, worries about future care, and a need for more information about how the patient might feel and how families could support the patient. Themes from interviews included The admission experience, Worries and concerns, Feeling supported, and The discharge experience. Limited understanding of delirium underpinned all themes. Families experienced shock and sadness at the change in the patient; they were reassured by the specialist care but needed more information about delirium, its effects and outcomes, and how they could help with care. Meeting long-term postdischarge needs was a key concern. CONCLUSIONS: In this study, families with a hospitalised older relative who had delirium described a distressing experience and needs for informational support. Further research is needed outside of delirium-specific units and in samples including a greater proportion of male relatives. IMPLICATIONS FOR PRACTICE: Nurses should work within the interdisciplinary team to ensure a planned, sensitive and timely approach to informing the patients family about delirium and its implications for their relative, recognising the family carers role and likely distress.
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Dynamics of cellular HIV-1 DNA levels over 144 weeks of darunavir/ritonavir monotherapy versus triple therapy in the MONET trial.
HIV Clin Trials
PUBLISHED: 02-02-2013
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In patients receiving combination antiretroviral therapy (ART), switching to monotherapy with ritonavir-boosted darunavir (DRV/r) can maintain plasma HIV-1 RNA suppression with no treatment-emergent drug resistance; effects on cellular HIV-1 DNA burden are less well characterized.
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Pacific Island publications in the reproductive health literature 2000-2011: with New Zealand as a reference.
Aust N Z J Obstet Gynaecol
PUBLISHED: 02-01-2013
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There is a keen interest to develop research systems and increase research output in the 14 Pacific Island Forum Countries (PIFC) to support development of policies and practice based on locally relevant research evidence.
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Early re-presentation to hospital after discharge from an acute medical unit: perspectives of older patients, their family caregivers and health professionals.
J Clin Nurs
PUBLISHED: 01-11-2013
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To explore the perceptions of older patients who re-presented to hospital within 28 days of discharge from an acute medical unit (AMU), their family caregivers and appropriately experienced health professionals.
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Even highly experienced drivers benefit from a brief hazard perception training intervention.
Accid Anal Prev
PUBLISHED: 01-09-2013
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We examined the proposal that hazard perception ability is suboptimal even in highly experienced mid-age drivers. First, we replicated previous findings in which police drivers significantly outperformed highly experienced drivers on a validated video-based hazard perception test, indicating that the ability of the experienced participants had not reached ceiling despite decades of driving. Second, we found that the highly experienced drivers hazard perception test performance could be improved with a mere 20 min of video-based training, and this improvement remained evident after a delay of at least a week. One possible explanation as to why hazard perception skill may be suboptimal even in experienced drivers is a dearth of self-insight, potentially resulting in a lack of motivation to improve this ability. Consistent with this proposal, we found no significant relationships between self-ratings and objective measures of hazard perception ability in this group. We also found significant self-enhancement biases in the self-ratings and that participants who received training did not rate their performance (either in real driving or in the test) as having improved, contrary to what was indicated by their objective performance data.
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Comparative efficacy of Lamivudine and emtricitabine: a systematic review and meta-analysis of randomized trials.
PLoS ONE
PUBLISHED: 01-01-2013
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Lamivudine and emtricitabine are considered equivalent by several guidelines, but evidence of comparable efficacy is conflicting.
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Pharmacokinetics of lamivudine and lamivudine-triphosphate after administration of 300 milligrams and 150 milligrams once daily to healthy volunteers: results of the ENCORE 2 study.
Antimicrob. Agents Chemother.
PUBLISHED: 12-19-2011
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There is interest in evaluating the efficacy of lower doses of certain antiretrovirals for clinical care. We determined here the bioequivalence of plasma lamivudine (3TC) and intracellular 3TC-triphosphate (3TC-TP) concentrations after the administration of two different doses. ENCORE 2 was a randomized crossover study. Subjects received 3TC at 300 and 150 mg once daily for 10 days (arm 1; n = 13) or vice versa (arm 2; n = 11), separated by a 10-day washout. Pharmacokinetic (PK) profiles (0 to 24 h) were assessed on days 10 and 30. Plasma 3TC and 3TC-TP levels in peripheral blood mononuclear cells were quantified by high-performance liquid chromatography-tandem mass spectrometry. Within-subject changes in PK parameters (the area under the concentration-time curve from 0 to 24 h [AUC(0-24)], the trough concentration of drug in plasma at 24 h [C(24)], and the maximum concentration of drug in plasma [C(max)]) were evaluated by determining the geometric mean ratios (GMRs) adjusted for study arm, period, and intra-individual variation. Regimens were considered bioequivalent if the 90% confidence interval (90% CI) fell within the range of 0.8 to 1.25. A total of 24 subjects completed the study. The GM (90% CI) 3TC AUC(0-24)), expressed as ng·h/ml, for the 300- and 150-mg doses were 8,354 (7,609 to 9,172) and 4,773 (4,408 to 5,169), respectively. Bioequivalence in 3TC PK following the administration of 300 and 150 mg was not demonstrated: the GMRs for AUC(0-24), C(24), and C(max) were 0.57 (0.55 to 0.60), 0.63 (0.59 to 0.67), and 0.56 (0.53 to 0.60), respectively. The GM (90% CI) 3TC-TP AUC(0-24) values (pmol·h/10(6) cells) for the 300- and 150-mg doses were 59.5 (51.8 to 68.3) and 44.0 (38.0 to 51.0), respectively. Bioequivalence in 3TC-TP PK following the administration of 300 and 150 mg was not demonstrated: the GMRs for AUC(0-24), C(24), and C(max) were 0.73 (0.64 to 0.83), 0.82 (0.68 to 0.99), and 0.70 (0.61 to 0.82), respectively. We found that 3TC at 150 mg is not bioequivalent to the standard regimen of 300 mg, indicating that saturation of cytosine phosphorylation pathways is not achieved at a dose of 150 mg.
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Effects of fatigue on surgeon performance and surgical outcomes: a systematic review.
ANZ J Surg
PUBLISHED: 10-31-2011
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Sleep deprivation and disturbances in circadian rhythms generally lead to poor performance, but is there a link in surgery? This review aimed to determine whether fatigue has an impact on surgeon performance or surgical outcomes.
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Phase 2 double-blind, randomized trial of etravirine versus efavirenz in treatment-naive patients: 48-week results.
AIDS
PUBLISHED: 09-02-2011
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The Study of Etravirine Neuropsychiatric Symptoms versus Efavirenz (SENSE) trial compared etravirine with efavirenz in treatment-naive patients. The primary endpoint was neuropsychiatric adverse events up to week 12; HIV RNA suppression at week 48 was a secondary endpoint.
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Clinical supervisor evaluations during general surgery clerkships.
Med Teach
PUBLISHED: 08-23-2011
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Clerkship performance is commonly evaluated by consultant surgeons who seldom supervise medical students directly. In contrast, surgical residents and interns frequently supervise students and provide essential teaching but are not tasked with evaluating them.
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Gastric cancer location and histological subtype in Pacific people and M?ori defies international trends.
N. Z. Med. J.
PUBLISHED: 07-05-2011
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Gastric cancer location and histopathology in Pacific people (mostly of Samoan, Tongan, Niuean, or Cook Islands origin) and M?ori in New Zealand has not been specifically examined.
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The colorectal cancer patients journey: the Auckland region.
N. Z. Med. J.
PUBLISHED: 07-05-2011
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To identify the time taken from referral to first treatment of patients with colorectal cancer (CRC) in the Auckland region and benchmark these against available guidelines for timeliness.
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Inferential reasoning by exclusion in children (Homo sapiens).
J Comp Psychol
PUBLISHED: 07-04-2011
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The cups task is the most widely adopted forced-choice paradigm for comparative studies of inferential reasoning by exclusion. In this task, subjects are presented with two cups, one of which has been surreptitiously baited. When the empty cup is shaken or its interior shown, it is possible to infer by exclusion that the alternative cup contains the reward. The present study extends the existing body of comparative work to include human children (Homo sapiens). Like chimpanzees (Pan troglodytes) that were tested with the same equipment and near-identical procedures, children aged three to five made apparent inferences using both visual and auditory information, although the youngest children showed the least-developed ability in the auditory modality. However, unlike chimpanzees, children of all ages used causally irrelevant information in a control test designed to examine the possibility that their apparent auditory inferences were the product of contingency learning (the duplicate cups test). Nevertheless, the childrens ability to reason by exclusion was corroborated by their performance on a novel verbal disjunctive syllogism test, and we found preliminary evidence consistent with the suggestion that children used their causal-logical understanding to reason by exclusion in the cups task, but subsequently treated the duplicate cups information as symbolic or communicative, rather than causal. Implications for future comparative research are discussed.
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Ramping up biodiversity discovery via online quantum contributions.
Trends Ecol. Evol. (Amst.)
PUBLISHED: 07-02-2011
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The pace of species discovery and documentation remains too slow on a human-altered planet in the midst of a massive extinction event. Increasing this pace requires altering conventional workflows. In this review, we propose that systematics needs to shift to a model of quantum contributions whereby species hypotheses are published as they are formulated and data as they are collected in web-based repositories and content-management systems. If our recommendation is followed, many species will make their first appearance on the Internet as candidate new species before documentation is complete. Acknowledging the changes that we describe may be controversial, we discuss problems that may be encountered along with possible solutions.
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Preoperative glucocorticoid use in major abdominal surgery: systematic review and meta-analysis of randomized trials.
Ann. Surg.
PUBLISHED: 06-23-2011
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To determine the clinical safety and efficacy of preoperative glucocorticoid (GC) administration in major abdominal surgery with regards to short term outcomes.
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Cost-efficacy analysis of the MONET trial using UK antiretroviral drug prices.
Appl Health Econ Health Policy
PUBLISHED: 06-21-2011
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In virologically suppressed patients, switching to darunavir/ritonavir (DRV/r) monotherapy maintains HIV RNA suppression, and could also lower treatment costs.
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Intraperitoneal local anesthetic improves recovery after colon resection: a double-blinded randomized controlled trial.
Ann. Surg.
PUBLISHED: 06-15-2011
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Two wounds are created after abdominal surgery. The surgical insult to the peritoneal cavity and viscera has not been emphasized as a target for interventions. In animal models vagotomy blunts the intraperitoneal response to induced inflammation. This is not feasible in humans. However a transient chemical afferentectomy after colectomy by using neuraxial blockade (epidural) and intraperitoneal blockade may be possible. We investigated the effects of intraoperative instillation and postoperative infusion of intraperitoneal local anesthetic (IPLA) on recovery parameters after colectomy, in the setting of an established enhanced recovery after surgery (ERAS) program.
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96 week results from the MONET trial: a randomized comparison of darunavir/ritonavir with versus without nucleoside analogues, for patients with HIV RNA <50 copies/mL at baseline.
J. Antimicrob. Chemother.
PUBLISHED: 06-07-2011
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In virologically suppressed patients, switching to darunavir/ritonavir monotherapy could avoid resistance and adverse events from continuing nucleoside analogues.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

How does it work?

We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.