bluuebunny/crossref_metadata_2025 huggingface dataset:
Mapping and Inventory of Forest Fires in Andhra Pradesh, India: Current Status and Conservation Needs
Authors: Reddy C. Sudhakar , Krishna P. Hari , Anitha K. , Joseph Shijo
Published: November 2012

Analyzing the spatial extent and distribution of forest fires is essential for sustainable forest management. The present study appraises the distribution of forest fires in one of the largest states in India, Andhra Pradesh, using satellite remote sensing. Advanced Wide Field Sensor (AWiFS) onboard on Indian Remote Sensing Satellite (IRS P6) was used for mapping and analyzing the spatial extent of burnt areas. Comparative analysis was carried out with respect to different forest types, protected areas and across elevation zones to demarcate and identify the fire-affected areas. The results show that about 19% (8594 km2) of forest area were burnt in the state during 2009. Burnt area statistics for Protected Areas reveal that 24% of forest cover was affected by fire. Nagarjunasagar Srisailam Tiger Reserve, the largest tiger reserve of the country, shows an area of 793 km2 (22%) under forest fire. Higher elevation areas which are predominantly dominated by savannah and woodlands experienced higher fire occurrence in comparison with lower elevation areas. Similarly, fires were prevalent near edges compared to core forest. Results of the study suggested that forests of Andhra Pradesh are prone to high fire occurrences and current fire regime poses a severe conservation threat to biodiversity both within and outside the Protected Areas.
Nickel-Containing Alloys for Medical Application Obtained by Methods of Mechanochemistry and Powder Metallurgy
Authors: Radev D. D.
Published: November 2012

The methods of mechanochemistry, in combination with cold pressing and pressureless sintering, were used to obtain the most popular nickel-based and nickel-containing alloys used in dentistry and implantology. It was shown that the intense mechanical treatment of Ni, Ti, and Cr powders used as reagents, and the application of the above-mentioned simple powder metallurgical technique for densification allows obtaining NiCr and NiTi alloys with controlled structural properties. The nickel-based dental alloys obtained by mechanically activated sintering possess excellent mechanical, technological, and aesthetic properties. These alloys are suitable as dental restorative materials and for production of porcelain veneered constructions like crowns and bridges using the so-called metal-to-ceramic dental technique. It was shown that the method of mechanically assisted synthesis allows obtaining nanosized NiTi alloy at significantly lower temperature in comparison with the traditional high-temperature alloying. It was also shown that after 40 hours intense mechanical treatment of reagents, a direct synthesis of NiTi alloy proceeds. The product has excellent sinterability which enables to produce bodies with controlled porosity appropriate for application in implantology.
The Spatial Pattern of the Sun-Hurricane Connection across the North Atlantic
Authors: Hodges Robert E. , Elsner James B.
Published: November 2012

The authors define the spatial response of hurricanes to extremes in the solar cycle. Using an equal-area hexagon tessellation, regional hurricane counts are examined during the period 1851–2010. The response features fewer hurricanes across the Caribbean, Gulf of Mexico, and along the eastern seaboard of the United States when sunspots are numerous. In contrast fewer hurricanes are observed in the central North Atlantic when sunspots are few. The sun-hurricane connection is as important as the El Niño Southern Oscillation toward statistically explaining regional hurricane occurrences.
Acute Pyelonephritis in Pregnancy: A Retrospective Descriptive Hospital Based-Study
Authors: Dawkins J. C. , Fletcher H. M. , Rattray C. A. , Reid M. , Gordon-Strachan G.
Published: November 2012

Introduction. Pyelonephritis is a common complication of pregnancy. It is also exacerbated by immunocompromised states and also the sickle cell gene. We reviewed this condition in Jamaican women.Method. We did a six year hospital database docket review. We found 102 confirmed cases.Results. Pyelonephritis was found in 0.7% of deliveries. The mean maternal age was years with 51% primiparity. Most (58.8%) occurred in the second trimester. The main symptoms were loin pain (96.2%) and abdominal pain (84.6%). It was more common on the right side in 67% of cases. On urinalysis, 81.4% had pyuria. The commonest organism wasEscherichia coli, in 61% of cases. Patients given Antibiotics prior to admission had quicker resolution, . Haemoglobin S was found in 16% cases (general population 10%; . However diabetes was only found in 1.3% cases (1.5% expected). 61.3% had positive urine culture after treatment showed that 61.3% and 25% had recurrent pyelonephritis. Complications included 32% threatened preterm labour and 17% preterm delivery. About 6% of neonates had intrauterine growth restriction. There were no ICU admissions and no deaths.Conclusion. Early recognition and treatment of pyelonephritis result in good outcome. The condition is more prevalent in patients with the sickle cell gene and recurrence is high.
Accuracy of Four Tooth Size Prediction Methods on Malay Population
Authors: Mahmoud Belal Khaled , Abu Asab Saifeddin Hamed I. , Taib Haslina
Published: November 2012

Objective. To examine the accuracy of Moyers 50%, Tanaka and Johnston, Ling and Wong and
Jaroontham and Godfrey methods in predicting the mesio-distal crown width of the permanent canines and
premolars () in Malay population. Materials and Methods. The study models of 240
Malay children (120 males and 120 females) aged 14 to 18 years, all free of any signs of dental pathology or
anomalies, were measured using a digital caliper accurate to 0.01 mm. The predicted widths () in both arches derived from the tested prediction equations were compared with the actual measured
widths. Results. Moyers and Tanaka and Johnston methods showed significant difference between
the actual and predicted widths of () for both sexes. Ling and Wong method also showed statistically
significant difference for males, however, there was no significant difference for females. Jaroontham and Godfrey method
showed statistical significant difference for females, but the male values did not show any significant difference.
Conclusion. For male Malay, the method proposed by Jaroontham and Godfrey for male Thai proved to be
highly accurate. For female Malay, the method proposed by Ling and Wong for southern Chinese females proved
to be highly accurate.
An Efficient Protocol for the Green and Solvent-Free Synthesis of Azine Derivatives at Room Temperature Using BiCl3-Loaded Montmorillonite K10 as a New Recyclable Heterogeneous Catalyst
Authors: Ravi K. , Krishnakumar B. , Swaminathan M.
Published: November 2012

A new BiCl3-loaded montmorillonite K10 catalyst has been prepared by solid dispersion method and was characterized by X-ray diffraction (XRD), field emission scanning electron microscopy (FE-SEM), and cyclic voltammetry (CV) measurements. BiCl3 loaded K10 (BiCl3-K10) has been used as solid acid catalyst for the synthesis of azine derivatives from benzophenone hydrazone and ketones/aldehydes by simple physical grinding. This BiCl3-K10 gives an excellent yield with short reaction time and is an inexpensive, easily recyclable catalyst for this reaction.
Investigation of Structural Phase Transition of PbS
Authors: Bhardwaj Purvee
Published: November 2012

The high-pressure structural phase transition of semiconductor PbS has been investigated, using the three body potential (TBP) model. Phase transition pressures are associated with a sudden collapse in volume. The phase transition pressures and related volume collapses obtained from this model show a generally good agreement with available results. Moreover, the elastic properties of PbS are also investigated.
Design of Ericsson Heat Engine with Micro Channel Recuperator
Authors: Kussul Ernst , Makeyev Oleksandr , Baidyk Tatiana , Olvera Omar
Published: November 2012

Stirling cycle and Rankine cycle heat engines are used to transform the heat energy of solar concentrators to mechanical and electrical energy. The Rankine cycle is used for large-scale solar power plants. The Stirling cycle can be used for small-scale solar power plants. The Stirling cycle heat engine has many advantages such as high efficiencyand long service life. However, the Stirling cycle is good for high-temperature difference. It demands the use of expensive materials. Its efficiency depends on the efficiency of the heat regenerator. The design and manufacture of a heat regenerator are not a trivial problem because the regenerator has to be placed in the internal space of the engine. It is possible to avoid this problem if we place the regenerator out of the internal engine space. To realize this idea it is necessary to develop the Ericsson cycle heat engine. We propose theoretical model and design of this engine.
Microwave-Mediated Rapid Synthesis of Gold Nanoparticles UsingCalotropis proceraLatex and Study of Optical Properties
Authors: Das Ratul Kumar , Babu Punuri Jayasekhar , Gogoi Nayanmoni , Sharma Pragya , Bora Utpal
Published: November 2012

We report a microwave-mediated simple and rapid method of gold nanoparticles (GNPs) synthesis using latex ofCalotropis procera. UV-Vis spectroscopic studies indicated the formation of GNPs. The GNPs were stable at room temperature (25°C) for six months. Transmission electron microscope (TEM) micrographs of the synthesized GNPs showed the formation of spherical nanoparticles with an average size of 13 ± 5 nm. SAED and XRD confirmed the crystalline nature of GNPs. Fourier transform infrared (FTIR) analysis indicated the presence of organic coating on the nanoparticles. Cytotoxicity of the GNPs was tested on HeLa and A549 and found to be nontoxic which was indicating that latex ofCalotropis proceraprovided the nontoxic coating on GNPs, thus can be used as biomedical and pharmacological applications.
Mindfulness-Based Interventions for Physical Conditions: A Narrative Review Evaluating Levels of Evidence
Authors: Carlson Linda E.
Published: November 2012

Research on mindfulness-based interventions (MBIs) for treating symptoms of a wide range of medical conditions has proliferated in recent decades. Mindfulness is the cultivation of nonjudgmental awareness in the present moment. It is both a practice and a way of being in the world. Mindfulness is purposefully cultivated in a range of structured interventions, the most popular of which is mindfulness-based stress reduction (MBSR), followed by mindfulness-based cognitive therapy (MBCT). This paper begins with a discussion of the phenomenological experience of coping with a chronic and potentially life-threatening illness, followed by a theoretical discussion of the application of mindfulness in these situations. The literature evaluating MBIs within medical conditions is then comprehensively reviewed, applying a levels of evidence rating framework within each major condition. The bulk of the research looked at diagnoses of cancer, pain conditions (chronic pain, low back pain, fibromyalgia, and rheumatoid arthritis), cardiovascular disease, diabetes, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and irritable bowel syndrome. Most outcomes assessed are psychological in nature and show substantial benefit, although some physical and disease-related parameters have also been evaluated. The field would benefit from more adequately powered randomized controlled trials utilizing active comparison groups and assessing the moderating role of patient characteristics and program “dose” in determining outcomes.
G73e Nuclear Magnetic Resonance Spectroscopy of Germanium Compounds
Authors: Weinert Charles S.
Published: November 2012

The field of G73e NMR spectroscopy is reviewed in this paper, from early developments in the 1950s to present day research. Specific attention is paid to recent investigations, including the observation of fluxional behavior of hypervalent germanium species having five or six attached ligands by 73Ge NMR spectroscopy, the spectral properties of linear and branched oligogermanes that contain single germanium-germanium bonds, and the relatively new field of solid-state germanium-73 NMR.
Ethnobotanical Knowledge of Sterculia setigera Del. in the Sudanian Zone of Togo (West Africa)
Authors: Atakpama Wouyo , Batawila Komlan , Dourma Marra , Pereki Hodabalo , Wala Kpérkouma , Dimobe Kangbéni , Akpagana Koffi , Gbeassor Messanvi
Published: November 2012

Ethnobotanical knowledge is useful in development of management and conservation of plant genetic resources. In this study, ethnobotanical investigations were conducted in Sudanian zone of Togo to identify use values knowledge of Sterculia setigera tree. Information was obtained with the aid of semistructured interviews. Three (3) ethnic groups: Bassar, Moba, and Konkomba belonging to ten (10) localities were investigated. Use knowledge of Sterculia setigera through these ethnic groups was assessed using four use indices: reported use (RU), plant part value (PPV), specific reported use (SU), and intraspecific use value (IUV). Sixty (60) informants of 43 years old were interviewed. The plant parts values and specific uses are raised more in the Moba's ethnic group. The main quoted uses are medicinal, religious, food, and cosmetic. Thus, fourteen (14) treatments of ailments are assigned to it. Considering the various uses, it is crucial to validate scientifically the therapeutic uses and safety of these plants through phytochemical screening, different biological activity tests, and toxicological studies.
Soil Erosion on Abandoned Land in Andalusia: A Comparison of Interrill- and Rill Erosion Rates
Authors: Wirtz S. , Iserloh T. , Rock G. , Hansen R. , Marzen M. , Seeger M. , Betz S. , Remke A. , Wengel R. , Butzen V. , Ries J. B.
Published: November 2012

The present paper is based on several field investigations (monitoring soil and rill erosion by aerial photography, rainfall simulations with portable rainfall simulators, and manmade rill flooding) in southern Spain. Experiments lead now to a closer understanding of the dynamics and power of different soil erosion processes in a gully catchment area. The test site Freila (Andalusia, Spain) covers an area of 10.01 ha with a rill density of 169 m ha−1, corresponding to a total rill length of 1694 m. Assuming an average rill width of 0.15 m, the total rill surface can be calculated at 250 m2 (0.025 ha). Given that, the surface covered by rills makes up only 0.25% of the total test site. Since the rill network drains 1.98 ha, 20% of the total runoff comes from rills. The rills’ sediment erosion was measured and the total soil loss was then calculated for detachment rates between 1685 g m−2 and 3018 g m−2. The interrill areas (99.75% of the test site) show values between 29 and 143 g m−2. This suggests an important role of rill erosion concerning runoff and soil detachment.
Time-Dependent Oxidative Capacities of La2O3, Lu2O3, CeO2, and Bi2O3 Materials Interacting with Air-CO or Air-CH4 Flows
Authors: Bakiz Bahcine , Bourja Lamia , Benlhachemi Abdeljalil , Guinneton Frederic , Villain Sylvie , Ezahri Mohamed , Gavarri Jean-Raymond
Published: November 2012

Using Fourier transform infrared (FTIR) spectroscopy analyses, we have studied the oxidation processes of methane or carbon monoxide in air-CH4 or air-CO flows interacting with polycrystalline catalytic oxides, as a function of temperature (T) and time (t). The gas flows crossed through La2O3, Lu2O3, CeO2, or Bi2O3 porous walls with constant composition and rate. The oxidation capacities of materials were determined from the intensities I(t,T) of CO2 vibrational bands resulting from the total oxidation of CH4 or CO into CO2. To interpret the time-dependent variations of these intensities, we have applied a model derived from Johnson-Mehl-Avrami approaches. This simple approach delivers pertinent parameters describing time-dependent oxidation rates.
The Effect of Geometrical Parameters on Heat Transfer Characteristics of Compact Heat Exchanger with Louvered Fins
Authors: Gunnasegaran P. , Shuaib N. H. , Abdul Jalal M. F.
Published: November 2012

Compact heat exchangers (CHEs) have been widely used in various applications in thermal fluid systems including automotive thermal management systems. Among the different types of heat exchangers for engine cooling applications, cross-flow CHEs with louvered fins are of special interest because of their higher heat rejection capability with the lower flow resistance. In this study, the effects of geometrical parameters such as louver angle and fin pitch on air flow and heat transfer characteristics on CHEs are numerically investigated. Numerical investigations using five different cases with increased and decreased louver angles (+2°, +4°, −2°, −4°, and uniform angle 20°), with a fixed fin pitch and using three different fin pitches (1.0 mm, 2.0 mm, and 4.0 mm), and with the fixed louver angle are examined. The three-dimensional (3D) governing equations for the fluid flow and heat transfer are solved using a standard finite-volume method (FVM) for the range of Reynolds number between 100 and 1000. The computational model is used to study the variations of pressure drop, flow temperature, and Nusselt number.
Propagation of Electric Dipole Radiation through a Medium
Authors: Li Xin , Arnoldus Henk F.
Published: November 2012

When electromagnetic energy propagates through a material medium, the paths of energy flow may be altered, as compared to propagation in free space. We consider radiation emitted by an electric dipole, embedded in a medium with permittivity and permeability . For a linear dipole in free space, the field lines of energy flow are straight, but when the imaginary part of is finite, the field lines in the material become curves in the near field of the dipole. Therefore, the energy flow is redistributed due to the damping in the material. For a circular dipole in free space, the field lines of energy flow wind around the axis perpendicular to the plane of rotation of the dipole moment. When has an imaginary part, this flow pattern is altered drastically. Furthermore, when the real part of is negative, the direction of rotation of the flow lines reverses. In that case, the energy in the field rotates opposite to the direction of rotation of the dipole moment. It is indicated that in metamaterials with a negative index of refraction this may lead to an observable effect in the far field.
Single OTRA Based Analog Multiplier and Its Applications
Authors: Pandey Rajeshwari , Pandey Neeta , Sriram B. , Paul Sajal K.
Published: November 2012

This paper presents an analog multiplier using single operational transresistance amplifier (OTRA). The proposed circuit is suitable for integration as it does not use any external passive component. It can be used as a four-quadrant multiplier. Theoretical propositions are verified through PSPICE simulations using 0.5 μm CMOS parameters provided by MOSIS (AGILENT). The simulation results are in close agreement with theoretical predictions. The workability of the proposed multiplier is also tested through two applications, namely, a squarer and an amplitude modulator.
A New 5-Point Ternary Interpolating Subdivision Scheme and Its Differentiability
Authors: Mustafa Ghulam , Irum Jayyada , Bari Mehwish
Published: November 2012

A new 5-point ternary interpolating scheme with a shape parameter is
introduced. The resulting curve is for a certain range of
parameters. The differentiable properties of the proposed scheme to extend its application in the generation of smooth curves are explored. Application of the proposed scheme is given to show its visual smoothness. The scheme is also extended to a 5-point tensor product ternary interpolating scheme, and its numerical examples are also included.
Implications of Weight and Body Mass Index for Plasma Donation and Health
Authors: Jerrard Genna A. , Liu Jing , Case Rosemary C. , Motevalli Mahnaz , Bolton Stephen G. , King Karen E. , Beigel John , Brooks Jackson J.
Published: November 2012

This study determined the percentage of potential plasma donors who could donate plasma in the 3 allowable plasma volume limit categories as specified by the Food and Drug Administration (FDA), as well as the association of the body mass index (BMI) of these individuals with age, blood pressure, oral temperature, and pulse. Of 315 plasma donors analyzed, 107 (34.0%) weighed between 110 and 149 lbs (50.0–67.7 kg), 89 (28.2%) weighed between 150 and174 lbs (68.2–79.1 kg), and 119 (37.8%) weighed >175 lbs (79.5 kg), theoretically allowing collection of an additional 101.4 liters (16% more plasma) from both heavier categories based on FDA standards for plasma donor quantities. BMI was positively associated with age, mean arterial pressure (MAP), and pulse (Pearson’s r=0.36, 0.24, and 0.18, resp., P values <0.05), but not with oral temperature. Average BMI for females was higher than for males (+1.8, P=0.01), and BMI for African Americans was higher than for White and Asian participants (+2.2 and +5.1, resp., Ps <0.05). A significant association was also found in the sex by race interaction with BMI (P=0.0004). Follow-up analyses suggested a significant difference in BMI by sex among African Americans, higher BMI among African American females than Asian and White males, and higher BMI among White females than African American males (Ps <0.05).
Percutaneous Cryoablation of Metastatic Lesions from Colorectal Cancer: Efficacy and Feasibility with Survival and Cost-Effectiveness Observations
Authors: Bang Hyun J. , Littrup Peter J. , Currier Brandt P. , Goodrich Dylan J. , Choi Minsig , Heilbrun Lance K. , Goodman Allen C.
Published: November 2012

Purpose. To assess feasibility, complications, local tumor recurrences, overall survival (OS) and estimates of cost-effectiveness for multi-site cryoablation (MCA) of oligo-metastatic colorectal cancer (mCRC) in a prospective study. Materials and Methods. 111 CT and/or US-guided percutaneous MCA procedures were performed on 151 tumors in 59 oligo mCRC patients. Mean patient age was 63 years (range 21–92 years), consisting of 29 males and 30 females. Tumor location was grouped according to common metastatic sites. Median OS was determined using the Kaplan-Meier. Estimates of MCA costs per LYG were compared to historical values for systemic therapies. Results. A mean 1.9 MCAs per patient were performed with a median clinical follow-up of 12 months. Major complication and local recurrence rates were 8% (9/111) and 12% (18/151), respectively. Median overall-survival (OS) was 23.6 months with an estimated 3-year survival rate of ~30%. Cryoablation remained cost effective with or without the presence of systemic therapies, with an adjunctive cost-effectiveness ratio (ACER) of $39,661–$85,580 per LYG. Conclusions. Multi-site cryoablation had very low complication and local recurrence rates, and was able to provide local control even for diverse soft tissue locations. Even as an adjunct to systemic therapies, MCA appeared cost-effective, with apparent increased survival.
The Prevalence of Human T-Cell lymphotropic Virus Type 1 in Pregnant Women and Their Newborns
Authors: Hamedi A. , Akhlaghi F. , Meshkat Z. , Sezavar M. , Nomani H. , Meshkat M.
Published: November 2012

The prevalence of HTLV1 virus antibodies was determined in pregnant women and their neonates in Mashhad, northeast of Iran, as shown in this prospective cross-sectional study. 407 women who were hospitalized for delivery participated in this study. Venous blood sampling of pregnant women and umbilical cord of their neonates was done. The first samples of all women were tested for HTLV1 seropositivity by ELISA test and confirmed by PCR method. Then, the presence of HTLV1 in samples of umbilical cords blood in neonates who were delivered to an HTLV1-positive mother was determined by PCR method. All HTLV1-positive infants were called again at the age of 9–12 months, and PCR test was done using HTLV1-specific primers for them. Of all the participating women, 6 persons were HTLV1 seropositive by ELIZA test which was confirmed by PCR test. HTLV1 antibodies were found in cord blood samples by PCR test in 6 newborns who were born to HTLV1-seropositive women. All the six infants at the age of 9–12 months showed positive PCR results by HTLV1 LTR-specific primers; however, only one of them was PCR positive using HTLV1 TAX-specific primers. The prevalence of HTLV1 antibodies in pregnant women was 1.5%, and the vertical transmission rate to their neonates was 16.6%.
A new Reliable Numerical Algorithm Based on the First Kind of Bessel Functions to Solve Prandtl–Blasius Laminar Viscous Flow over a Semi-Infinite Flat Plate
Authors: Parand Kourosh , Nikarya Mehran , Rad Jamal Amani , Baharifard Fatemeh
Published: November 2012

In this paper, a new numerical algorithm is introduced to solve the Blasius equation, which is a third-order nonlinear ordinary differential equation arising in the problem of two-dimensional steady state laminar viscous flow over a semi-infinite flat plate. The proposed approach is based on the first kind of Bessel functions collocation method. The first kind of Bessel function is an infinite series, defined on ℝ and is convergent for any x ∊ℝ. In this work, we solve the problem on semi-infinite domain without any domain truncation, variable transformation basis functions or transformation of the domain of the problem to a finite domain. This method reduces the solution of a nonlinear problem to the solution of a system of nonlinear algebraic equations. To illustrate the reliability of this method, we compare the numerical results of the present method with some well-known results in order to show the applicability and efficiency of our method.
A Note on the Carathéodory Approximation Scheme for Stochastic Differential Equations under G-Brownian Motion
Authors: Faizullah Faiz
Published: November 2012

In this note, the Carathéodory approximation scheme for vector valued stochastic differential equations under G-Brownian motion (G-SDEs) is introduced. It is shown that the Carathéodory approximate solutions converge to the unique solution of the G-SDEs. The existence and uniqueness theorem for G-SDEs is established by using the stated method.
Descriptive Plans: An Approach to Administrative Descriptions by Ontario’s Ministry of Natural Resources
Authors: Martin Robert
Published: November 2012

This paper briefly looks at the use of graphical descriptions (Descriptive Plans) of land for provincial administrative purposes in Ontario. The four “W’s” of Descriptive Plans—Why use them/ When can they be used/ What they are and/ Where they can be found are discussed. The paper also touches on some recent applications and some of the perceived benefits and limitations with a description plan approach as Ontario’s land administration system continues to evolve.
Ratings of animal personality as a tool for improving the breeding, management and welfare of zoo mammals
Authors: Tetley CL , O’Hara SJ
Published: November 2012

The effect of individual differences on the behaviour and reproduction of zoo animals has long been recognised by zoo biologists, yet only recently has the quantitative assessment of personality been used to investigate some of the challenges faced in zoo animal management. We review the findings of animal personality studies carried out in zoos since 1995. Our results reveal that zoo animal personality is most commonly assessed using observer ratings, where people who are familiar with the animals are asked to rate them on various personality traits. The reviewed studies indicate that zoo keepers are able to reliably rate animal personality traits, and these ratings are valid and related to behaviour. We identify promising areas of development in zoo animal personality research and suggest applications of personality profiling to zoo animal welfare and management. We argue that a validated personality questionnaire is a valuable tool for zoo professionals and advocate the implementation of personality assessment into existing zoo management practices to inform decisions on welfare and captive breeding.
Negative affective states and their effects on morbidity, mortality and longevity
Authors: Walker MD , Duggan G , Roulston N , Van Slack A , Mason G
Published: November 2012

Mortality rates are often used in population-level animal welfare assessments because they are assumed to reflect rates of disease or injury and other problems likely to cause poor welfare. High mortality is thus assumed to correlate with factors likely to cause negative affective states. Here, we argue that negative affective states are also related to mortality rates more directly, via causal rather than merely correlational routes. In humans, negative affective states predict elevated morbidity and mortality rates as well as decreased longevity, while self-reported happiness does the opposite. This review investigates whether mortality rates and longevity can thus be used to make inferences regarding past affective states in animals. The proposed mechanism is that chronic stressors cause negative affective states and thence harmful physiological consequences through continual activation of the hypothalamic-pituitary-adrenal and sympathetic-adreno-medullary axes, which in turn can lead to increased mortality. The convergent validity of mortality as an indicator of past negative affect is demonstrated via examples of how stressors such as bereavement in humans and social isolation in social non-human species cause negative affective states, and then increase the morbidity of potentially lethal conditions such as cardiovascular disease, cancer and HIV/AIDS, ultimately leading to increased mortality and reduced longevity in both humans and animals. The potential drawbacks of using mortality rates to infer animal welfare are also discussed, including its low sensitivity and the multiplicity of factors unrelated to affective states that can influence mortality rates. However, providing these issues are accounted for, it is suggested that this indicator has value in welfare assessment, and is especially well suited for cases where animals are allowed to live out their natural lifespans, such as tends to be the case with zoo and companion animals.
From HIV to global health: opportunities and challenges
Authors: El‐Sadr W
Published: November 2012

Remarkable advances have been achieved over the past decade in confronting the global HIV epidemic. By the end of 2010, 6.5 million persons living with HIV had initiated antiretroviral therapy in low and middle‐income countries, the majority in sub Saharan Africa. Of the total of 2.5 new HIV infections that occurred in 2010, 1.9 million occurred in sub Saharan Africa. Nonetheless, 22 countries in sub Saharan Africa have experienced a decrease in HIV incidence. These remarkable achievements have involved a transformation of fragile health system. Examples include new models of care, task shifting, infrastructure enhancement, establishment of new data systems and mobilization of communities.

However, many of the same countries where HIV is prevalent also confront other health threats including high maternal and child mortality, high rates of tuberculosis and malaria as well as a burgeoning non‐communicable chronic disease threat. Addressing these health threats requires taking the lessons learned from the HIV response and adapting them to confront these threats. Through building on the foundation established, similar progress may be achieved in addressing these health threats while maintaining the momentum of the HIV response.
Pre‐exposure prophylaxis: where are we in Europe?
Authors: Molina JM
Published: November 2012

Despite major advances in HIV therapy, the number of new HIV infections remains very high, even in high‐income countries where resurgence among men who have sex with men (MSM) has been witnessed. New prevention strategies have therefore to be assessed in order to curb the incidence of HIV infection. Recent studies have explored the effectiveness of antiretroviral therapy (ART) for HIV prevention and have generally yielded encouraging results. ART has been used successfully to prevent mother‐to‐child transmission of HIV, HIV acquisition following occupational or sexual exposure to HIV (post‐exposure prophylaxis), and more recently, to reduce the risk of HIV transmission within a serodiscordant couple by treating the HIV‐positive partner (HPTN 052 study). Another possible use of ART in prevention is pre‐exposure prophylaxis, where ART is taken by an HIV‐seronegative individual before HIV exposure. This PrEP strategy has been validated in animal models and more recently assessed in clinical trials in humans. The results of six large efficacy trials of PrEP are now available, but results have been inconsistent. The use of tenofovir gel in women at higher risk in Sub‐Saharan Africa has shown efficacy when given before and after sex in the Caprisa 004 study (reduction of 39% of the incidence of HIV), whereas no efficacy was shown with daily use in the VOICE trial. Similarly, daily oral PrEP with tenofovir or tenofovir and emtricitabine has proved effective in the Iprex trial in MSM (reduction of 42% of HIV incidence), in the Partners PrEP study (reduction of 67 to 75% in HIV incidence) and in the TDF‐2 trial (reduction of 63% in HIV incidence), but not in the Fem‐PrEP or the VOICE trials in women. There are many potential explanations for these apparently conflicting results, such as the populations in which these strategies have been assessed, the differential pharmacokinetics of ART in the male and female genital tracts and most likely the high level of adherence which is required to confer protection against HIV acquisition. These results have also generated a lot of controversy about the implementation of PrEP. Some think that the data are good enough to rollout PrEP in key populations at higher risk. Others think more research is needed before PrEP is implemented because of concerns around safety, emerging resistance, cost and change in sexual behaviour that might offset the benefit of PrEP. Safety is indeed a major concern in healthy individuals. New studies are underway to address these issues and are assessing PrEP regimens in open‐label studies (Iprex‐OLE in MSM), intermittent PrEP regimens to try to improve adherence, new ART classes and new modalities of drug delivery. PrEP is therefore a promising biomedical intervention that might be used in the near future in addition to current prevention methods to prevent HIV infection and help control the spread of this infection.
When to start: as soon as possible
Authors: Saag M
Published: November 2012

Debate regarding “When to start” antiretroviral (ARV) therapy has raged since the introduction of zidovudine in 1987. Based on the entry criteria for the original Burroughs Wellcome (002) study, the field has been anchored to “CD4 counts” as the prime metric to indicate ARV treatment initiation for asymptomatic HIV‐positive individuals. The pendulum has swung back and forth, based mostly on the efficacy and toxicity of available regimens. In today's world, several factors have converged that compel us to initiate therapy as soon as possible: (i) The biology of viral replication (1 to 10 billion viruses/day) screams that we should be starting early. (ii) Resultant inflammation from unchecked replication is associated with earlier onset of multiple co‐morbid conditions. (iii) The medications available today are more efficacious and less toxic than in years past. (iv) Clinical trials have demonstrated benefit for all but the highest CD4 strata (>450 to 500 cells/µL). (v) Some cohort studies have demonstrated clear benefit of ARV therapy at any CD4 count, and almost all cohort studies have demonstrated no detrimental effects of early treatment. (vi) In addition to the demonstrated and inferred benefits to the individual patient, we now have a public health benefit of earlier intervention: treatment is prevention. Finally, from a practical/common sense perspective, we are talking about life‐long therapy. Whether we start at a CD4 count of 732 or 493/µL, the patient will be on therapy for over 40 to 50 years! There does not seem to be much benefit in waiting, and there is likely to be significant long‐term harm. Treat early!
When to start: not so fast
Authors: Lundgren J
Published: November 2012

It remains controversial whether and, if so, the extent to which antiretroviral therapy (ART) results in net benefit if used by HIV‐positive persons with a high CD4 count, particularly those with early HIV infection. This controversy is primarily reflecting lack of solid evidence from randomized controlled trials. Currently published trials have compared early ART with initiation of ART below currently globally accepted thresholds for initiation (i.e. CD4 count at 350 cells/µL) and, hence, are unable to inform this discussion. Analyses on large observational studies that have attempted to address this question have shown inconsistent results; therefore, those results are considered low‐quality evidence, as per the GRADE criteria used by, for example, WHO when formulating guidelines. In resource‐constrained regions, not even observational data are available to inform this question. The START study is underway to answer this question. Data remain blinded, but START may show net harm from early use of ART; such a result would severely undermine use of ART as prevention in early HIV infection. Prescription of any type of medicine is guided by the principle of “do no harm” – that is, “the doctor should not prescribe medications unless s/he knows that the treatment is unlikely to be harmful.” Hence, the balance of risk/benefit to individuals versus prevention benefit is important to accurately determine, and current guidelines of generally initiating ART once the patient develops HIV‐related symptoms or the CD4 count drops to levels around 350 cells/µL should be adhered to until further evidence has emerged.
TB and HIV: how can we reduce mortality?
Authors: Lawn S
Published: November 2012

Despite ART scale‐up, tuberculosis (TB) remains a leading cause of HIV‐related deaths worldwide and much of this disease may remain unascertained. In patients receiving ART, TB incidence is highest during the first few months of treatment (many cases of which were prevalent disease missed by baseline screening) and long‐term rates remain several‐fold higher than background. We identify three groups of patients starting ART for which different interventions are required to reduce TB‐related deaths. First, diagnostic screening is needed in patients who have undiagnosed active TB so that timely anti‐tuberculosis treatment can be started. This may be greatly facilitated by new diagnostic assays such as the Xpert MTB/RIF assay and a novel point‐of‐care urine test for lipoarabinomannan (LAM). Second, patients with a diagnosis of active TB need optimised case management, which includes early initiation of ART (with early timing now defined by randomised controlled trials), trimethoprim‐sulphamethoxazole prophylaxis and treatment of co‐morbidity. Third, in high TB burden settings, all remaining patients who are TB‐free at enrolment have high ongoing risk of developing TB and require optimised immune recovery (with ART ideally started early in the course of HIV infection), isoniazid preventive therapy and infection control to reduce infection risk. Further specific measures are needed to address multi‐drug resistant TB (MDR‐TB) and there are now new promising developments in antimycobacterial agents. Finally, in high burden settings, scale‐up of all these interventions requires nationally and locally tailored models of care that are patient‐centred and provide integrated health care delivery for TB, HIV and other co‐morbidities.
HIV in women
Authors: Mulcahy F
Published: November 2012

Globally over 50% of HIV‐infected individuals are women. With the widespread use of HAART, we can expect women to have mortality rates approaching normal. Indeed, studies have shown that women may expect a slower disease progression than men following seroconversion; furthermore, it appears that female who injects drugs can live longer than their male counterparts. However, other studies from cohort analysis have reported worse outcomes in women. In essence, many studies are consistently underpowered to adequately address these questions. The proportion of women in clinical trials remains at 20 to 30%, with pregnancy potential being a major exclusion factor. Hence, many questions remain unanswered. Recent data suggest women are more likely to present late with a new AIDS diagnosis. Why this should be the case is not well understood. In addition, HIV‐positive women should have the same access to reproduction health as their negative counterparts, but unfortunately many inequalities remain. Advise on contraception and fertility services are very variable across both the developed and developing world. Data are limited on the most appropriate use of contraceptives in the presence of HAART, the possible drug interactions and possible increased risk of HIV transmission. There remain significant differences in guidelines regarding prevention of mother‐to‐child transmission (MTCT) across Europe, and implications of stopping and starting HAART for MTCT have not been adequately addressed. The mode of timing of delivery, and the effect of length of time of ruptured membranes on this decision is also contentious. Further issues relate to the desire for HIV‐positive women to breastfeed in the setting of HIV viral suppression, where some guidelines now support women in this situation and others categorically would inform child protection authorities. Finally as women age it is more difficult to separate the effect of the menopause and its symptoms from the increased HIV‐related cardiovascular and bone fracture risk. This presentation aims to discuss key issues which conflicting or inadequate data fail to resolve.
Currently available medications may not be sufficient for lifelong treatment of HIV
Authors: Jansson J , Wilson D , Carr A , Petoumenos K , Boyd M
Published: November 2012

Purpose of the study

Combination antiretroviral therapy (cART) has greatly improved the life expectancy of people living with HIV (PLHIV). A series of cohort studies have predicted near‐to‐normal life expectancies for PLHIV receiving cART but have not considered the impact of multi‐class resistance on long‐term survival. Our study aims to project the future life expectancy of PLHIV in a resource‐rich setting in the context of the currently available antiretroviral treatments.

Methods

Patient antiretroviral treatment data, including time on each regimen until treatment failure, were sourced from an observational cohort of 3434 predominantly male (94.2%) PLHIV in Australia over the period 1997 to 2010. These data were analyzed in an individual‐based mathematical model to calculate the time until exhaustion of all treatment options and the expected impact on HIV‐associated mortality. Standardized mortality ratios were used to simulate expected survival before and after treatment exhaustion.

Summary of results

The model estimated that the median time until exhaustion of currently available treatment options is 43.4 years (interquartile range = 31.4 to 58.6 years). However, the model predicts that 10% of PLHIV will use up all currently available cART options after just 22.6 years. The figure shows the survival proportions of males from age 20 years in four mortality scenarios: (1) the general population mortality rate; (2) the mortality rate in PLHIV as currently measured (without considering exhaustion of currently available treatments); (3) mortality rate in PLHIV considering additional mortality due to limited cART options; and (4) mortality rate if no cART is available. PLHIV who start currently available cART regimens at age 20 years are expected to live to a median of 64.7 (95% uncertainty bound (UB) = 61.8 to 69.3) years of age, when adjusting for treatment option exhaustion. This is a substantial improvement on no cART (median survival to 27.6 [95% UB = 27.2 to 28.1] years of age) but is lower than the expected life expectancy (82.2 years of age) of an HIV‐negative male in the general population. The gap between life expectancy among PLHIV and the general population is greater for those infected at younger ages.

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Conclusions

As treatment options are exhausted in the coming years, a substantial difference in life expectancy between PLHIV and the general population is expected, particularly for people who acquire HIV at a younger age or who are currently highly treatment‐experienced.
HIV drug resistance surveillance in low‐ and middle‐income countries: 2004 to 2010
Authors: Bertagnolio S , Parkin N , Jordan M
Published: November 2012

Background

At the end of 2011, over 8 million people were receiving antiretroviral therapy (ART) in low‐ and middle‐income countries (LMIC), a 26‐fold increase from 2003. Some degree of HIV drug resistance (HIVDR) will emerge among populations on combination ART even when high levels of adherence are achieved. In 2004, the World Health Organization (WHO) initiated global HIVDR surveillance to monitor emergence and transmission of HIVDR in countries scaling‐up ART.

Methods

WHO HIVDR surveillance strategy was designed to inform public health decision‐making regarding choice of ART and to identify ART programme factors which could be adjusted to minimize HIVDR emergence. The strategy includes (1) surveillance of transmitted HIVDR (TDR) in recently infected populations, (2) surveillance of acquired HIVDR (ADR) in populations on ART and (3) monitoring of early warning indicators (EWI) of HIVDR which are ART programme factors favouring HIVDR emergence. Surveys used standardized protocols. Epidemiological and sequence data were quality assured.

Results

TDR: Eighty‐two surveys were conducted in 30 countries in 2004 to 2010, assessing 3588 recently infected individuals. Pooled analysis indicates an overall prevalence of 3.1% TDR to at least one drug class, 1.6% to non‐nucleoside reverse transcriptase inhibitor (NNRTI), 1.3% to nucleoside reverse transcriptase inhibitor (NRTI) and 0.7% to protease inhibitor (PI). Levels of NNRTI resistance, particularly in the areas surveyed in Africa, increased over time, reaching 3.4% (95% CI=1.8 to 5.2%) in 2009. Greater ART coverage was associated, though modestly, with increased prevalence of TDR to NNRTI (P‐value adjusted for region=0.039). ADR: Thirty‐six ADR surveys assessing 6370 people in 12 LMIC were conducted in 2007 to 2010. HIVDR prevalence to any drug among those initiating ART ranged from 4.8% (95% CI=3.8 to 6.0%) in 2007 to 6.8% (95% CI=4.8 to 9.0%) in 2010. Ninety per cent of patients alive and on therapy at 12 months achieved viral load <1000 c/mL. Among people with virological failure, 72% had HIVDR to at least one drug. EWI: EWIs were monitored at 2017 clinics in 50 countries assessing 131,686 people since 2004. Overall, 75% of clinics met the target of 100% of patients receiving appropriate ART; 69% of clinics met the <20% target for lost to follow‐up at 12 months; and only 65% of clinics provided a continuous supply of ART during a 12‐month period.

Conclusion

Expansion of ART in LMIC has resulted in an overall increase in HIVDR, particularly to NNRTI in Africa. EWIs reveal important gaps in service delivery and programme performance. While these data call for continued and improved scale up of surveillance, they also suggest that resistance is under control in the areas surveyed, and the majority of patients initiating or switching therapy are likely to respond to currently available first‐ and second‐line therapy.