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Objective: Although observational cohort studies report that interventions to achieve functionality are clinically successful in 85% of patients, the proportion of newly created autologous arteriovenous fistulas that result in functional vascular access typically is only 70 -80%. To address this discrepancy, the selection and outcomes of interventions to achieve functionality in a multicentre prospective cohort study were analysed. Methods: The Shunt Simulation Study enrolled 222 patients who needed a first arteriovenous fistula in nine dialysis units in The Netherlands from 2015 to 2018 and followed these patients until one year after access creation. In this observational study, the technical and clinical success rates of interventions to achieve functionality based on lesion and intervention characteristics were analysed and the clinical outcomes of arteriovenous fistulas with assisted and unassisted functionality were compared. Results: For patients who were on dialysis treatment at the end of the study, unassisted fistula functionality was 54% and overall fistula functionality was 78%. Thirty-four per cent of arteriovenous fistulas required an intervention to achieve functionality, 68% of which eventually became functional. Seventy-five per cent of these interventions were percutaneous balloon angioplasties of vascular access stenoses. Patients with clinically successful interventions to achieve functionality had larger pre-operative vein diameters (2.8 + 1.0 mm vs. 2.3 + 0.6 mm, p = .036) and less often presented with thrombosed fistulas than patients with unsuccessful interventions (7% vs. 43%, p = .006). Arteriovenous fistulas with assisted functionality had similar secondary patency as fistulas with unassisted functionality (100% and 98% at six months, p = .44), although they required more interventions to maintain function (2.6 vs. 1.7 per year; rate ratio 1.52, 95% CI 1.04 -2.18, p = .032). Conclusion: Interventions to achieve functionality were needed in about a third of newly created arteriovenous fistulas. Most thrombosed fistulas were abandoned, and when selected for thrombectomy rarely reached clinical success. On the other hand, interventions to achieve functionality of patent fistulas had high clinical success rates and therefore can be done repeatedly until the fistula has become functional.

Summary Background Few large projects have evaluated the factors that influence the HIV RNA concentrations (viral load) in cerebrospinal fluid (CSF) during antiretroviral therapy (ART) over time. We aimed to determine the correlates of HIV RNA in CSF in a large cohort. Methods We analysed longitudinal data from adults living with HIV in the US CHARTER cohort. Participants in the CHARTER study were recruited from six US academic medical centres—in Baltimore (MD), Galveston (TX), New York (NY), St Louis (MO), San Diego (C92A), and Seattle (WA). Participants in this study had been assessed at least three times between Sept 4, 2003, and Sept 14, 2010, and were taking ART and underwent venous and lumbar puncture with measurement of HIV RNA concentration at all assessments. The lower limit of quantification of the HIV RNA assays was 50 copies per mL. Data were analysed with longitudinal mixed effects logistic regression to identify correlates of HIV RNA concentration (as a binary [detectable or not] and as a continuous variable) in CSF over time. We tested demographic characteristics, plasma HIV RNA, nadir and current CD4 cell count in blood, current CD8 cell count in blood, estimated duration of HIV infection, AIDS diagnosis, duration of ART, adherence to ART, ART characteristics, and CSF characteristics as potential correlates. Findings At the time of analysis, 2207 assessments from 401 participants met the criteria for inclusion in this study. Mean duration of observation was 33·7 months (range 12–84). HIV RNA concentrations in 710 (32·2%) plasma specimens and in 255 (11·6%) CSF specimens were greater than the lower limit of quantification. The best multivariate model of HIV RNA concentration in CSF greater than the lower limit of quantification over time included increased plasma HIV RNA concentration (odds ratio 18·0 per 1 log10 copy per mL, 95% CI 11·3 to 28·8; p Interpretation The identified correlates of HIV RNA concentration in CSF during ART could strengthen clinical prediction of risk for failure to achieve or maintain HIV RNA suppression in CSF. Because most participants in this analysis were ART-experienced and were taking a three-drug regimen that did not include an integrase inhibitor, future research should focus on participants who are taking their first ART regimens or regimens that include integrase inhibitors or two drugs. Funding The work was supported by the National Institute of Mental Health and the National Institute of Neurological Disorders and Stroke.

Non-pharmacological therapies are now used in many nursing homes often with residents presenting a risk of behavioural disorders. They include music therapy, animal-assisted therapy, physical activity as well as other approaches such as light therapy or aromatherapy. It requires rigorous assessment, the permanent involvement and engagement of residents as well as the staff as part of a compassionate and participative approach.

Faced with the ageing of the French population, it is essential to envisage new technologies to improve the living conditions of elderly people and enable them to communicate more effectively. A study sought to understand the views of senior citizens and the caregivers who look after them regarding these new tools, their appropriation, the support required and their uses. This analysis highlights areas to reflect upon and improve in terms of the services which need to be provided to overcome the reticence of certain users.

Background: Chagas disease is a major neglected vector-borne disease. In this study, we investigated the safety and efficacy of three oral E1224 (a water-soluble ravuconazole prodrug) regimens and benznidazole versus placebo in adult chronic indeterminate Chagas disease. Method: In this proof-of-concept, double-blind, randomised phase 2 clinical trial, we recruited adults (18–50 years) with confirmed diagnosis of Trypanosoma cruzi infection from two outpatient units in Bolivia. Patients were randomised with a computer-generated randomisation list, which was stratified by centre and used a block size of ten. Patients were randomly assigned (1:1:1:1:1) to five oral treatment groups: high-dose E1224 (duration 8 weeks, total dose 4000 mg), low-dose E1224 (8 weeks, 2000 mg), short-dose E1224 (4 weeks + 4 weeks placebo, 2400 mg), benznidazole (60 days, 5 mg/kg per day), or placebo (8 weeks, E1224-matched tablets). Double-blinding was limited to the E1224 and placebo arms, and assessors were masked to all treatment allocations. The primary efficacy endpoint was parasitological response to E1224 at the end of treatment, assessed by PCR. The secondary efficacy endpoints were parasitological response to benznidazole at end of treatment, assessed by PCR; sustainability of parasitological response until 12 months; parasite clearance and changes in parasite load; incidence of conversion to negative response in conventional and non-conventional (antigen trypomastigote chemiluminescent ELISA [AT CL-ELISA]) serological response; changes in levels of biomarkers; and complete response. The primary analysis population consisted of all randomised patients by their assigned treatment arms. This trial is registered with ClinicalTrials.gov, number NCT01489228. Findings: Between July 19, 2011, and July 26, 2012, we screened 560 participants with confirmed Chagas disease, of whom 231 were enrolled and assigned to high-dose E1224 (n=45), low-dose E1224 (n=48), short-dose E1224 (n=46), benznidazole (n=45), or placebo (n=47). Parasite clearance was observed with E1224 during the treatment phase, but no sustained response was seen with low-dose and short-dose regimens, whereas 13 patients (29%, 95% CI 16·4–44·3) had sustained response with the high-dose regimen compared with four (9%, 2·4–20·4) in the placebo group (p

Animal-assisted interventions are designed for personal well-being. The objective of this study was to evaluate the effectiveness of these interventions in the context of residential facilities for dependent elderly people. Animal-assisted therapy, which can be delivered by trained staff, could be a tool to helpinstitutionalised elderly people cope with loneliness.

Oxygen-related Thermal Donors in n-type Czochralski silicon (Cz-Si) wafers have been investigated using hyperspectral photoluminescence imaging and OxyMap. Thermal Donors give rise to two photoluminescence emissions, one narrow peak at 0.767 eV, and one broad band with centre peak at 0.72 eV that is also measurable at room temperature. The spectral imaging was first carried out on the sample cooled to 90 K, then repeated at room temperature (300 K). The possibility to delimitate at room temperature defects-rich zones with hyperspectral photoluminescence imaging is evidenced.

We report on a degradation of the electronic properties of uncompensated seed-end n-type (phosphorus-doped) Czochralski silicon wafers under light soaking. We unambiguously demonstrate that this degradation is related to the formation and/or activation of a bulk defect under illumination. We bring general information about its activation/formation (illumination intensities, spatial distribution) as well as deactivation features. We show that this defect can be permanently suppressed in a few seconds at high temperatures (850 °C). Conversely annealing at low temperature (200 °C) was found to lead only to a temporary deactivation, the defect being reactivated/reformed after subsequent illumination. As a consequence, this defect could be harmful to solar cell technologies processed at low temperature, such as amorphous/crystalline silicon heterojunction (SHJ). The impact of the defect on SHJ cells performances is experimentally assessed at device level. Eventually the possible nature of the defect is discussed in the light of all collected data.

A study analysed, on the one hand, the efficacy of the use of music therapy with residents and, on the other, the feasibility of the implementation of such a technique in nursing homes and in follow-up and rehabilitation units. In this context, music therapy seems to be an effective alternative to traditional approaches.

In this work, Cu(In,Ga)Se2 (CIGS) absorbers with thicknesses ranging from 2 µm to 370 nm were prepared by a two-step process using electrodeposition of Cu-In-Ga followed by annealing under a pure Se atmosphere. Based on compositional characterizations, it is shown that in order to decrease the thickness of the precursors, it is not enough to reduce only the deposition time of Cu-In-Ga layers without working on the composition and deposition parameters of the thin films. After the optimization of annealing conditions, the properties of the absorbers and solar cells with three different thicknesses (2 µm, 0.7 µm and 0.37 µm) were compared. It is shown that, in spite of the decreasing thickness, hence a decrease in JSC, the VOC of ultrathin CIGS electrodeposited solar cells can be improved due to an increase in the Ga content of the electrodeposited absorbers. Without deliberate light trapping and anti-reflecting coating from the very thin absorber layer of 0.37 µm, an efficiency of 8.7% with VOC of 685 mV, JSC of 19 mA/cm2 and FF of 67%, was achieved.

Summary The clinical importance of anterior foregut endoderm (AFE) derivatives, such as thyrocytes, has led to intense research efforts for their derivation through directed differentiation of pluripotent stem cells (PSCs). Here, we identify transient overexpression of the transcription factor (TF) NKX2-1 as a powerful inductive signal for the robust derivation of thyrocyte-like cells from mouse PSC-derived AFE. This effect is highly developmental stage specific and dependent on FOXA2 expression levels and precise modulation of BMP and FGF signaling. The majority of the resulting cells express thyroid TFs (Nkx2-1, Pax8, Foxe1, Hhex) and thyroid hormone synthesis-related genes (Tg, Tpo, Nis, Iyd) at levels similar to adult mouse thyroid and give rise to functional follicle-like epithelial structures in Matrigel culture. Our findings demonstrate that NKX2-1 overexpression converts AFE to thyroid epithelium in a developmental time-sensitive manner and suggest a general methodology for manipulation of cell-fate decisions of developmental intermediates., Graphical Abstract, Highlights • Transient Nkx2-1 overexpression robustly converts foregut endoderm to thyroid lineage • The effect is highly developmental stage specific and dependent on BMP/FGF signals • The progeny self-organizes to 3D structures reminiscent of follicular thyroid tissue • Mature cultures produce T4 hormone at levels comparable with mouse thyroid tissue, Ikonomou and colleagues found that pluripotent stem cell-derived anterior foregut endoderm can be robustly converted to thyroid progenitors through transient expression of the transcription factor Nkx2-1. This inductive effect is highly stage specific and relies on thyroid specification signals. The thyrocyte-like progeny self-organize into follicle structures in 3D culture and express mature thyroid proteins indicative of functionality (TG, NIS, T4).

A significant fraction of Czochralski (Cz) Silicon (Si) wafers suffer from oxygen-related bulk quality issues. The detection of such wafers in the as-cut state during incoming inspection has become a topic of attention as higher efficiency solar cell structures are developing. However such detection - for instance using photoluminescence images – has not yet proven successful due to a high risk of detection errors Shih et al. (2015) [1] . In this work, we tentatively introduce a material quality indicator referred to as “Thermal History Index” (THI) and investigate its ability, in conjunction with the interstitial oxygen concentration ([Oi]), to allow a better identification of low bulk quality wafers.

This article uses the customer portfolio management (CPM) approach to examine how a company can define the value of customers and segment these customers into portfolios. By segmenting customers into portfolios, an organization can better understand the relative importance of each customer to the company's total profit. Such an understanding will help companies retain valuable customers create additional value with these customers through relationship development. The purpose of this article is to contribute to the body of customer relationship management (CRM) literature by introducing a conceptual framework of the customer portfolio management (CPM) matrix, which focuses on two issues: (1) cost to serve and (2) value of the customer to the company. From this framework, a firm can segment its customer base into four portfolios, platinum, gold, silver, and bronze, and deliver services accordingly.

Resume Les mots sont a considerer comme les signes emergeants de valeurs, de normes sociales et de modeles culturels penses et vecus par les individus de notre societe. Notre ambition est ici d’explorer le lexique de « l’âge » qui soit plus juste, plus positif et surtout plus en phase avec la realite actuelle liee au vocabulaire utilise pour aborder ces thematiques. Notre objectif etait d’identifier les grands champs lexicaux actuellement employes pour determiner les representations sociales associees aux personnes âgees, aux structures d’accueil, a la maladie et aux activites. La complexite de cette etude reside dans son ambition. En effet, pour determiner les champs lexicaux actifs sur les sujets concernant les personnes âgees, il est necessaire de concevoir un veritable « panorama » semantique. Dans ce contexte, nous avons utilise la semiotique comme outil de classification et de structuration adapte a la complexite du sujet. Sa pratique nous a permis de classer les mots en fonction de leur appartenance signifiante, de les structurer en themes, d’en identifier les valeurs sous-jacentes (le sens) et de determiner de nouveaux axes semantiques potentiels. Cette recherche s’articule autour de 4 grandes etapes : une phase prealable de cadrage, la composition du corpus de donnees, l’analyse et le positionnement des differents items sous forme de cartographie. Les definitions du Domicile – en opposition a Maison de retraite – font emerger des attributs nouveaux. La notion du repere, du lieu de l’identite (chez soi), du lieu de l’intimite (mon lit), du lieu des habitudes (habitus, habitation), du lieu de la securite (un refuge) ou encore du lieu de la stabilite (une demeure) sont necessaires lorsque l’on s’adresse a des structures d’accueil. De la meme facon, pour parler des personnes âgees, de nombreux registres semantiques sont possibles : on peut caracteriser la personne sous l’angle de l’evolution des attributs physiques (personnes fragiles, etre use, etre depasse, les tempes grises, les silvers), sous l’angle de l’âge chronologique (les aieux, les matures), de la sagesse (les anciens, les aines), de l’experience, de la bonification (l’âge d’or, les vermeils), sous l’angle du positivisme sportif (les veterans, la reserve), ou de la joie de vivre affichee (les happy boomers, les jubilatoires, les flamboyants). Nos resultats identifient une reelle richesse et une grande diversite semantique utilisee pour aborder ces quatre thematiques. Cette richesse nous indique de reelles possibilites quant a l’evolution de la semantique vers une approche plus positive de ces thematiques.