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Background Failure to achieve complete viral suppression with antiretroviral drugs (ARV) may lead to uncontrolled HIV replication, ARV resistance and negative outcomes. Monitoring and reporting of HIV resistance trends is important but problematic. We examined prevalent resistance rates in an HIV population over 20 years and document how rates may appear to vary greatly based solely on which parameters are utilized. Methods We determined the annual use of geno-typic antiretroviral resistance testing (GART) from 1995 to 2014 for all patients receiving HIV care in southern Alberta, Canada, and the presence of resistance mutations in those tested. The impact on prevalent resistance rates of using cumulative or latest GART was also determined. Results Between 1995 and 2014, the number of patients with GART increased from Conclusions While prevalence resistance rates are decreasing, the precise rates being reported may vary due to increasing number of patients tested annually, using either the entire population as denominator or only patients with GART, and using either last or cumulative GART. Defining these parameters is critical if prevalence is to be compared over time or between HIV populations.

An application of a simple hydrological model to likely climatic conditions of Lake Sambhar provides tighter bounds on the range of increased precipitation seen during the early- to mid-Holocene than those inferred from paleoclimatic proxies. To examine past lake levels, we developed a simple lake model, based on hydrological principles of a watershed balance between precipitation, evaporation, and runoff from the watershed to calculate daily depth and volume. Calculations reveal that early- to mid-Holocene rainfall was most likely in a range of 40–65% greater than present levels, resulting in lake depths of ~6–8 m. This estimate incorporates all major sources of uncertainty into the lake model, but it is likely that the value of mid-Holocene precipitation lies in the lower part of the 40–65% range. Additionally, a 40–65% greater precipitation could have led to greater interannual variability in lake levels, which may account for the lack of clear shorelines. We find, however, that it is unlikely that Lake Sambhar filled to its maximum depth of 21 m above the present-day lakebed during this period due both to the much greater precipitation than today required to maintain a lake of such depth (greater than double present-day precipitation) and to the lack of current evidence (no shorelines and little vegetation). We also find that differences between mid-Holocene and present-day winter insolation alone have virtually no effect on average annual lake depths.

Polymethylpentene (PMP) oxygenators, utilised for ECMO, are commonly believed to be resistant to plasma leakage. Whilst uncommon, plasma leakage has been previously reported with PMP fibres, both in vivo and in vitro. We describe a paediatric ECMO case during which plasma leakage occurred and oxygenator function gradually deteriorated, ultimately necessitating device replacement. To our knowledge, this is the first case of plasma leakage described using a PMP device during paediatric ECMO. Subsequent investigation is described, demonstrating that a protein coating reduces the free passage of solution across the PMP membrane.

Vaginal delivery is a risk factor for stress urinary incontinence (SUI). Mesenchymal stem cells (MSCs) home to injured organs and can facilitate repair. The goal of this study was to determine if MSCs home to pelvic organs after simulated childbirth injury and facilitate recovery from SUI via paracrine factors. Three experiments were performed. Eighteen female rats received vaginal distension (VD) or sham VD and labeled intravenous (IV) MSCs to investigate if MSCs home to the pelvic organs. Whole-organ imaging and immunofluorescence were performed 1 week later. Thirty-four female rats received VD and IV MSCs, VD and IV saline, or sham VD and IV saline to investigate if MSCs accelerate recovery of continence. Twenty-nine female rats received VD and periurethral concentrated conditioned media (CCM), VD and periurethral control media, or sham VD and periurethral control media to investigate if factors secreted by MSCs accelerate recovery from VD. Urethral histology and function were assessed 1 week later. Significantly more MSCs were observed in the urethra, vagina, and spleen after VD compared to sham VD. Continence as measured by leak point pressure (LPP) was significantly reduced after VD in rats treated with saline or control media compared to sham VD but not in those given MSCs or CCM. External urethral sphincter (EUS) function as measured by electromyography (EMG) was not improved with MSCs or CCM. Rats treated with MSCs or CCM demonstrated an increase in elastin fibers near the EUS and urethral smooth muscle more similar to that of sham-injured animals than rats treated with saline or control media. MSCs homed to the urethra and vagina and facilitated recovery of continence most likely via secretion of paracrine factors. Both MSCs and CCM have promise as novel noninvasive therapies for SUI.

When pupils learn to derive precise meaning From definite and indefinite quantitative concepts, then we will have reduced substantially the ex cessive prevalence of verbalism in this field.