Scaling up antiretroviral therapy for HIV-infected children in Côte d'Ivoire: determinants of survival and loss to programme.

OBJECTIVE: To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV-infected children in Côte d'Ivoire. METHODS: Between 2004 and 2007, HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged < 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections, (ii) losses to the programme (i.e. death or loss to follow-up) before ART, (iii) mortality and loss-to-programme rates during 12 months of ART, and (iv) determinants of mortality and losses to the programme. FINDINGS: The analysis included 3876 ART-naïve children. Of the 1766 with HIV-1 infections (17% aged < 18 months), 124 (7.0%) died, 52 (2.9%) left the programme, 354 (20%) were lost to follow-up before ART, 259 (15%) remained in care without ART, and 977 (55%) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up, respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pre-ART weight-for-age z-score < -2, percentage of CD4+ T lymphocytes < 10, World Health Organization HIV/AIDS clinical stage 3 or 4, and blood haemoglobin < 8 g/dl. CONCLUSION: The large-scale programme to scale up paediatric ART in Côte d'Ivoire was effective. However, ART was often given too late, and early mortality and losses to programme before and just after ART initiation were major problems.

Scaling up antiretroviral therapy for HIV-infected children in Côte d'Ivoire: determinants of survival and loss to programme

Objective: To investigate deaths and losses to follow-up in a programme designed to scale up antiretroviral therapy (ART) for HIV- infected children in Cote d'Ivoire. Methods Between 2004 and 2007; HIV-exposed children at 19 centres were offered free HIV serum tests (polymerase chain reaction tests in those aged 18 months) and ART. Computerized monitoring was used to determine: (i) the number of confirmed HIV infections; (ii) losses to the programme (i.e. death or loss to follow-up) before ART; (iii) mortality and loss-to-programme rates during 12 months of ART; and (iv) determinants of mortality and losses to the programme. Findings The analysis included 3876 ART-naive children. Of the 1766 with HIV-1 infections (17aged 18 months); 124 (7.0) died; 52 (2.9) left the programme; 354 (20) were lost to follow-up before ART; 259 (15) remained in care without ART; and 977 (55) started ART (median age: 63 months). The overall mortality rate during ART was significantly higher in the first 3 months than in months 4-12: 32.8 and 6.9 per 100 child-years of follow-up; respectively. Loss-to-programme rates were roughly double mortality rates and followed the same trend with duration of ART. Independent predictors of 12-month mortality on ART were pre-ART weight- for-age z-score -2; percentage of CD4+ T lymphocytes 10; World Health Organization HIV/AIDS clinical stage 3 or 4; and blood haemoglobin 8 g/dl. Conclusion The large-scale programme to scale up paediatric ART in Cote d'Ivoire was effective. However; ART was often given too late; and early mortality and losses to programme before and just after ART initiation were major problems

Adsorption of reactive dyes to granulated iron hydroxide and its oxidative regeneration.

Granulated iron hydroxide (beta-FeOOH) is used as a regenerable sorbent and catalyst for reactive dye removal in textile wastewater treatment. In oxidative regeneration the previously sorbed reactive dye is catalytically oxidized after activation of hydrogen peroxide to hydroxyl radicals on the FeOOH surfaces to regain adsorption capacity and reuse the sorbents. A high initial H2O2 concentration is needed for an efficient mass transfer water/solid but its consumption per oxidized dye results only in 7-25 mg mg(-1). At room temperature a regeneration time of 3.5 h is necessary for decolorization and 6 h for further decomposition of the formed oxidation products to enable a reloading without any loss in adsorption capacity. Compared to Fenton's reagent, this oxidation process takes advantage of pH-independence between 4 and 8 and additionally no sludge is produced. Salts are commonly used in textile dying processes. While chloride improves the dye sorption, the presence of sulfate results in deteriorating sorption. Carbonate reacts as a scavenger of hydroxyl radicals resulting in a higher hydrogen peroxide consumption, but the efficiency of dye oxidation is only slightly affected. Nearly 20% of DOC of the sorbed dye can be attributed to short chain organic acids (formate, acetate, oxalate) indicating the far-reaching catalytic oxidation and enabling biological post-treatment.

Cucurbituril for water treatment. Part I: Solubility of cucurbituril and sorption of reactive dyes.

Cucurbituril was investigated regarding its potential as a sorbent for the removal of reactive dyes from model solutions and authentic wastewaters. The solubility of cucurbituril is low in pure water but increases in the presence of salts. When dyes sorbing onto cucurbituril are present, solubility is drastically decreased compared to dye-free media. Sorption efficiency depends on salt concentration and salt species. Moderate salt concentrations favor sorption, high concentrations lead to cucurbituril dissolution. Divalent ions have a stronger effect than monovalent ions and larger ions more than smaller ones. In tests with authentic wastewaters cucurbituril was partially (20-100%) dissolved and contaminant removal was inefficient. Because of its solubility, cucurbituril is not feasible as a sorbent in wastewater treatment unless it could be covalently fixed onto a suitable support material.

Cucurbituril for water treatment. Part II: Ozonation and oxidative regeneration of cucurbituril.

In Part I it was shown, that cucurbituril has high sorption capacities for the removal of reactive dyes from textile wastewater; despite the partial dissolution of this sorbent. Ozonation has been suggested as a regeneration step for loaded cucurbituril. Ozonation of loaded and pure cucurbituril was therefore evaluated. Dissolved cucurbituril reacts with ozone forming oxidation products like nitrite, nitrate, formate, acetate and oxalate. Oxidation is enhanced at alkaline pH. Dye-loaded cucurbituril suspended in water can be decolorized by ozone, but the ozone consumption is tip to seven times higher than for ozonation of the dissolved dyes without cucurbituril. Loaded columns can be regenerated by ozone gas, but dissolution of cucurbituril results in a higher DOC content than the initial one to be removed. Therefore oxidative regeneration does not seem to be a feasible approach in this case.

Aversive learning in patients with unilateral lesions of the amygdala and hippocampus.

The present study applied a visual half field paradigm with emotional facial expressions in patients with selective unilateral amygdalo-hippocampectomy (AHE) to elucidate the contributions of the left and right medial temporal lobe and amygdala to emotional learning. Electrodermal indicators of aversive learning were studied in 14 left AHE and 12 right AHE patients, as well as 13 controls matched in sex and age. In a differential conditioning paradigm with negative (CS+) and positive (CS-) facial expressions, CS+ were associated with an aversive vocalization (US, 95 dB, 3 s). During extinction, stimuli were presented laterally and preattentively using backward masking. Appropriate CS durations yielding preattentive presentation were individually determined prior to conditioning. In contrast to controls, both left and right AHE patients failed to show an autonomic conditioning effect following left visual field presentations of masked negative CS+ during extinction. AHE patients also showed no clear differential acquisition. Moreover, right AHE patients poorly recognised that negative valence was an affiliating dimension of the CS-US compound.

Differential conditioning to facial emotional expressions: effects of hemispheric asymmetries and CS identification.

Previous studies on aversive learning have suggested a right hemispheric advantage for eliciting autonomic reactions to a masked conditioned facial stimulus (CS) depicting anger. The present study investigated the effects of visual field (VF), stimulus awareness, and emotional valence of the CSs on indicators of conditioning (bilateral SCRs, HR) using a differential conditioning paradigm (N = 41). In Group 1, four different negatively valenced facial expressions (CS+) but not four positively valenced CS- were associated with an unconditioned stimulus (US, aversive vocalization, 97 dB, 3 s) during acquisition. Group 2 received a treatment reversal with positive CS+ associated with the US. In a repeated measures design, CSs were presented with or without awareness during extinction (two weeks interval, order counterbalanced). SOAs were adapted for each subject and condition prior to the experiment so that identification performance was approaching chance level. The results revealed that both negative and positive facial expressions could be aversively conditioned providing evidence for a generalization of learning in the valence dimension. During extinction, preattentive negative CS+ presented to the left VF showed a trend towards greater electrodermal and cardiac reactions. However, no such effect emerged under full awareness of the CSs. These results confirm and further specify the nature of hemispheric asymmetries in emotional associative learning.

Genetic and molecular analyses of picA, a plant-inducible locus on the Agrobacterium tumefaciens chromosome.

picA is an Agrobacterium tumefaciens chromosomal locus, identified by Mu d11681 mutagenesis, that is inducible by certain acidic polysaccharides found in carrot root extract. Cloning and genetic analysis of a picA::lacZ fusion defined a region of the picA promoter that is responsible for the induction of this locus. Furthermore, we identified a possible negative regulator of picA expression upstream of the picA locus. This sequence, denoted pgl, has extensive homology to polygalacturonase genes from several organisms and inhibited the induction of the picA promoter when present in multiple copies in A. tumefaciens. DNA sequence analysis indicated at least two long open reading frames (ORFs) in the picA region. S1 nuclease mapping was used to identify the transcription initiation site of picA. Mutation of ORF1, but not ORF2, of the picA locus was responsible for an increased aggregation of A. tumefaciens, forming "ropes" in the presence of pea root cap cells. In addition, a potato tuber disk virulence assay indicated that a preinduced picA mutant was more virulent than was the wild-type control, a further indication that the picA locus regulates the surface properties of the bacterium in the presence of plant cells or plant cell extracts.

picA, a novel plant-inducible locus on the Agrobacterium tumefaciens chromosome.

We used the transposon Mu dI1681 to identify genes on the Agrobacterium tumefaciens chromosome that are inducible by extracts from carrot roots. One such locus (picA, for plant inducible chromosomal), harbored by A. tumefaciens At156, was inducible 10- to 50-fold by these extracts. Mutation of picA had no detectable effect upon bacterial growth or virulence under laboratory assay conditions. However, A. tumefaciens cells harboring a mutated picA locus aggregated into long "ropes" when incubated with pea root tip cells. Such aggregation was not displayed by the parental strain A. tumefaciens A136. A preliminary characterization of the inducing compound in the carrot root extract suggests that the active substance is an acidic polysaccharide that is most likely derived from the pectic portion of the plant cell wall.

Methylation of the T-DNA in Agrobacterium tumefaciens and in several crown gall tumors.

Methylation of the T-DNA in Agrobacterium tumefaciens and in four octopine-type (A6S/2, E9, 15955/1, 15955/01) and one nopaline-type (HT37#15) crown gall tumors was investigated using the isoschizomeric restriction endonucleases Msp I and Hpa II. T-DNA in the octopine-type Ti-plasmid pTiB6(806) was not methylated at the sequence 5'CCGG3' in Agrobacterium. With two possible exceptions, neither was the T-DNA of the nopaline-type Ti-plasmid pTiT37 methylated in the bacterium. In all tumor lines investigated, at least one copy of the T-DNA was not methylated. DNA methylation was not detected in the lines A6S/2, 15955/1, HT37#15, and the TL region of E9. DNA methylation of some copies of TR in the E9 tumor line, and possibly in the 15955/01 line, was detected. The methylation of some copies of TR in the E9 line may indicate that not all copies of TR are transcribed in this tumor.