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Accelerating climate change and climate-related emergencies require cities to improve resilience across multiple short- and long-lived systems. Urban systems have individual change dynamics that are highly interconnected. However, the aftermath of disruptions is often characterised by myopic decision-making that disregards the long-term implications across systems. In this study, we develop the theoretical foundation for temporal dynamics for urban resilience. (1) We briefly characterise and conceptualise the interplay of major temporal dynamics in urban planning, including endogenous lifecycles and exogenous drivers. (2) We empirically examine temporal dynamics through climate urbanism in regions representing the Global North (GN-Amsterdam, the Netherlands) and Global South (GS-Mumbai, India). Our findings reinforce the need to embed short-term planning goals within long-term resilience visions. To address the lack of systematic planning approaches incorporating temporalities, we present options for temporal planning processes that harmonise the lifecycles of urban systems, adapt to disruptions and align planning horizons toward resilience. We discuss the potential applications of both options in the Global North and South.

BackgroundPeople with HIV (PWH) with access to antiretroviral therapy (ART) experience excess morbidity and mortality compared with uninfected patients, particularly those with persistent viremia and without CD4+ cell recovery. We compared outcomes for medical intensive care unit (MICU) survivors with unsuppressed (>500 copies/ml) and suppressed (≤500 copies/ml) HIV-1 RNA and HIV-uninfected survivors, adjusting for CD4+ cell count.SettingWe studied 4537 PWH [unsuppressed = 38%; suppressed = 62%; 72% Veterans Affairs-based (VA) and 10 531 (64% VA) uninfected Veterans who survived MICU admission after entering the Veterans Aging Cohort Study (VACS) between fiscal years 2001 and 2015.MethodsPrimary outcomes were all-cause 30-day and 6-month readmission and mortality, adjusted for demographics, CD4+ cell category (≥350 (reference); 200-349; 50-199

Clinical practice strongly relies on patients' self-report. Former professional American-style football players are hesitant to seek help for mental health problems, but may be more willing to report cognitive symptoms. We sought to assess the association between cognitive symptoms and diagnosed mental health problems and quality of life among a cohort of former professional players. In a cross-sectional design, we assessed self-reported cognitive function using items from the Quality of Life in Neurological Disorders (Neuro-QOL) Item Bank. We then compared mental health diagnoses and quality of life, assessed by items from the Patient-Reported Outcome Measurement Information System (PROMIS®), between former professional players reporting daily problems in cognitive function and former players not reporting daily cognitive problems. Of the 3758 former professional players included in the analysis, 40.0% reported daily problems due to cognitive dysfunction. Former players who reported daily cognitive problems were more likely to also report depression (18.0% vs. 3.3%, odds ratio [OR] = 6.42, 95% confidence interval [CI] [4.90–8.40]) and anxiety (19.1% vs. 4.3%, OR = 5.29, 95% CI [4.14–6.75]) than those without daily cognitive problems. Further, former players reporting daily cognitive problems were more likely to report memory loss and attention deficit(/hyperactivity) disorder and poorer general mental health, lower quality of life, less satisfaction with social activities and relationships, and more emotional problems. These findings highlight the potential of an assessment of cognitive symptoms for identifying former players with mental health, social, and emotional problems.

BACKGROUND Veterans with hepatitis C virus (HCV) infection may face geographic obstacles to obtaining treatment. OBJECTIVE We studied the influence of region and rural versus urban residence on receipt of direct-acting antiretroviral (DAA) medications for HCV. SUBJECTS Veterans receiving care within Veterans Affairs Healthcare System born between 1945 and 1965. RESEARCH DESIGN This is a observational study using national electronic health record data. MEASURES Receipt of DAAs was defined as ≥1 filled prescription from January 1, 2014 to December 31, 2016. Region (South, Northeast, Midwest, and West) and residence (urban, rural-micropolitan, small rural towns, and isolated rural towns) variables were created using residential zone improvement plan codes and rural-urban commuting area (RUCA) codes. Multivariable models were adjusted for age, race, sex, severity of liver disease, comorbidities, and prior treatment experience. RESULTS Among 166,353 eligible patients 64,854 received, DAAs. Variation by rural-urban residence depended on region. In unadjusted analyses, receipt varied by rural-urban designations within Midwest, and West regions (P

Background Urinary tract infection (UTI) is caused by uropathogenic Escherichia coli (UPEC). The UPEC initiate pathogenesis by expressing type 1 pili, which attach to membrane receptors on the uroepithelial cells. Inhibition of attachment can provide a valuable target for prophylaxis in symptom-free milieu. Methods The antibacterial efficacy of alcoholic, hydroalcoholic and aqueous extracts of four plants namely Achyranthes aspera, Andrographis paniculata, Artemissia vulgaris and Glycyrrhiza glabra was evaluated against seven isolated bacterial strains and procured E. coli (UTI89/UPEC) strain. Screening of isolated strains was based on morphological characteristics and biofilm forming ability followed by physiological and biochemical analysis. Results The hydroalcoholic extracts of G. glabra at 50 μg/ml showed an impending antioxidant (DPPH) effect of 95.65% compared to ascorbic acid. The MIC values of all the plant extracts against selected bacterial strains ranged between 125 to 1000 μg/ml. In silico molecular docking performed to make out the antiadhesive role of 115 documented phytochemicals from selected plants identified quercetin-3-glucoside, ethyl caffeate, liquiritoside, liquiritin and isoliquiritigenin as potential phytochemicals. Molecular dynamics simulation performed by PTRAJ module of Amber11 package to monitor the stability of hydrogen bond showed that quercetin-3-glucoside and ethyl caffeate are potential phytochemicals as antiadhesive forming H-bonds with the FimH protein ligand. Conclusions Aforesaid phytochemicals demonstrate effective antibacterial activity through the anti-adhesion mechanism.

Background: Among HIV-positive individuals, increased levels of inflammation and immune activation persist even in the setting of effective antiretroviral therapy (ART) and are associated with greater rates of non-AIDS events. The etiology of this persistent inflammation is incompletely understood.Methods: Using a well-characterized cohort of 322 HIV-infected individuals on suppressive ART, we conducted a case-control study. Cytomegalovirus (CMV) immunoglobulin G (IgG) levels, plasma biomarkers, and T-cell phenotypes were measured/characterized from samples collected 1 year after ART initiation. Conditional logistic regression for matched case-control studies analyzed the associations of year 1 CMV-specific IgG level with the subsequent occurrence of any non-AIDS event. Correlations between continuous CMV IgG antibody levels and soluble and cellular markers were assessed.Results: We found that higher levels of CMV IgG were associated with increased risk of non-AIDS events (OR = 1.58 per IQR [95% CI: 1.12, 2.24], P = 0.01) and with elevated soluble and cellular markers of inflammation.Conclusions: The magnitude of the host immune response to CMV may play a role in the persistent inflammation and resultant morbid events observed in the HIV-positive population.

Context Improving end-of-life care (EOLC) quality among heart failure patients is imperative. Data are limited as to the hospital processes of care that facilitate this goal. Objectives To determine associations between hospital-level EOLC quality ratings and the EOLC delivered to heart failure patients. Methods Retrospective analysis of the Veterans Health Administration (VA) and the Bereaved Family Survey data of heart failure patients from 2013 to 2015 who died in 107 VA hospitals. We calculated hospital-level observed-to-expected casemix-adjusted ratios of family reported excellent EOLC, dividing hospitals into quintiles. Using logistic regression, we examined associations between quintiles and palliative care consultation, receipt of chaplain and bereavement services, inpatient hospice, and intensive care unit death. Results Of 6256 patients, mean age was 77.4 (SD = 11.1), 98.3% were male, 75.7% were white, and 18.2% were black. Median hospital scores of “excellent” EOLC ranged from 41.3% (interquartile range 37.0%–44.8%) in the lowest quintile to 76.4% (interquartile range 72.9%–80.3%) in the highest quintile. Patients who died in hospitals in the highest quintile, relative to the lowest, were slightly although not significantly more likely to receive a palliative care consultation (adjusted proportions 57.6% vs. 51.2%; P = 0.32) but were more likely to receive chaplaincy (92.6% vs. 81.2%), bereavement (86.0% vs. 72.2%), and hospice (59.7% vs. 35.9%) and were less likely to die in the intensive care unit (15.9% vs. 31.0%; P Conclusion Patients with heart failure who die in VA hospitals with higher overall EOLC quality receive more supportive EOLC. Research is needed that integrates care processes and develops scalable best practices in EOLC across health care systems.

BACKGROUND: Professional American-style football players are among the largest athletes across contemporary sporting disciplines, and weight gain during the years of football participation is common. At present, the health implications of this early-life weight gain remain incompletely understood. We sought to define weight trajectories of former professional American-style football athletes and to establish their relationship with 5 health afflictions common in this population (cardiovascular disease, cardiometabolic disease, neurocognitive impairment, sleep apnea, and chronic pain). METHODS: A comprehensive health survey was distributed to former National Football League (NFL) players. Former players reported body weight at 4 key time points (high school, college, professional, and time of survey response) as well as maximal retirement weight. Logistic regression was used to assess associations between weight gain during and after football participation with health affliction. RESULTS: In this cohort of former NFL players (n=3,506, age 53±14 years), mean total weight increase from high school to time of survey response was 40±36 pounds, with the majority of weight gain occurring during and not after football participation. The prevalence of self-reported health afflictions ranged from 9% for cardiovascular disease to 28% for chronic pain. Weight gain during periods of active football participation (high school to college and college to professional) was independently associated with risk of multiple later life health afflictions in models adjusted for football exposure, post-career lifestyle variables, and post-career weight gain. CONCLUSIONS: Early-life weight gain among American-style football athletes is common and is associated with risk of adverse health profiles during later-life. These findings establish football-associated weight gain as a key predictor of post-career health and raise important questions about the central role of targeted weight gain in this population.

Background Despite treatment with virologically suppressive antiretroviral therapy (ART), neurocognitive impairment may persist or develop de novo in aging HIV-infected individuals. We evaluated advancing age as a predictor of neurocognitive impairment in a large cohort of previously ART-naive individuals on long-term ART. Design The AIDS Clinical Trials Group Longitudinal Linked Randomized Trials was a prospective cohort study of HIV-infected individuals originally enrolled in randomized ART trials. This analysis examined neurocognitive outcomes at least 2 years after ART initiation. Methods All participants underwent annual neurocognitive testing consisting of Trail making A and B, the wechsler adult intelligence scale-revised Digit Symbol and Hopkins Verbal Learning Tests. Uni and multivariable repeated measures regression models evaluated factors associated with neurocognitive performance. Predictors at parent study entry (ART naive) included entry demographics, smoking, injection drug use, hepatitis B surface antigen, hepatitis C virus serostatus, history of stroke, ART regimen type, pre-ART nadir CD4 cell count, and plasma viral load and as well as time-updated plasma viral load and CD4 cell count. Results The cohort comprised 3313 individuals with median pre-ART age of 38 years, 20% women; 36% Black, non-Hispanic; 22% Hispanic. Virologic suppression was maintained at 91% of follow-up visits. Neurocognitive performance improved with years of ART. After adjusting for the expected effects of age using norms from HIV-negative individuals, the odds of neurocognitive impairment at follow-up visits among the HIV infected increased by nearly 20% for each decade of advancing age. Conclusion Despite continued virologic suppression and neurocognitive improvement in the cohort as a whole, older individuals were more likely to have neurocognitive impairment than younger individuals.

Twelve F1 hybrids of cucumber derived from a top cross involving twelve monoecious parents and a stable gynoecious inbred (EC 709119) as female parent were evaluated in randomized block design (RBD) with three replications to assess general combining ability (GCA). Significant GCA effects were observed for all the characters except days to first male flower anthesis. The estimates of GCA effects revealed that none of the parents exhibited good GCA for all the characters together. Among 12 parents, CS123 was observed as the good general combiner for fruit yield per vine, length of main vine, branches per plant, number of harvests, duration of the crop, fruits per plant and number of seeds per fruit. The parents, CS128 and IC 538186 were general good combiners for earliness. The parent CS127 was found to be superior for fruit length, weight and girth.

India has been rapidly urbanizing. Its state of health, well-being, and infrastructure capacity are in a period of transformation. Through the perspective of a rapidly urbanizing nation, the chapter presents an overview of India’s health capacity in managing disaster risks. It looks at demographic, epidemiological, and developmental transitions in India and how that is impacting decision-making for the health sector. It reflects upon relevant experiences and the current status of healthcare provisioning to identify issues aiding and ailing the achievement of health outcomes in times of disasters and otherwise.

BACKGROUND: Cure from chronic hepatitis C virus (HCV) infection is readily achievable with direct-acting antivirals (DAA), but little is known about optimal management after treatment. Weight gained after DAA treatment may mitigate benefits or increase risk for liver disease progression. As the single largest sample of HCV-infected individuals receiving DAA treatment in the United States, the Veterans Affairs (VA) Birth Cohort is an ideal setting to assess weight gain after DAA treatment. METHODS: We performed a prospective study of patients dispensed DAA therapy from January 2014 to June 2015. Weight change was calculated as the difference in weight from sustained virologic response (SVR) determination to 2 years later. Demographic, weight, height, prescription, laboratory, and diagnosis code data were used for covariate definitions. We used multiple logistic regression to assess the association between candidate predictors and excess weight gain (≥ 10 lbs) after 2 years. RESULTS: Among 11,469 patients, 78.0% of patients were already overweight or obese at treatment initiation. Overall, SVR was achieved in 97.0% of patients. After 2 years, 52.6% of patients gained weight and 19.8% gained excess weight. In those with SVR, weight gain was as high as 38.2 lbs, with the top 10% gaining ≥ 16.5 lbs. Only 1% of those with obesity at treatment initiation normalized their weight class after 2 years. Significant predictors of post-SVR weight gain were SVR achievement, lower age, high FIB-4 score, cirrhosis, and weight class at treatment initiation. CONCLUSION: Weight gain is common after DAA treatment, even among those who are overweight or obese prior to treatment. Major predictors include age, baseline weight, alcohol, cirrhosis, and SVR. Everyone receiving DAAs should be counseled against weight gain with a particular emphasis among those at higher risk. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-020-05782-6) contains supplementary material, which is available to authorized users.

Background: Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. Methods: Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. Results: The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]). Conclusion: Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.

JGIM published the article matched with the editorial in this issue in the July 2020 issue. Our apologies to the authors of the paper and the editorial.

Engineering for flood resilience of dense coastal regions often neglects the resultant impact on urban design quality. Vital subsurface infrastructure such as hydraulic systems, water networks, civil construction, transport, energy supply and soil systems are especially important in shaping the urban environment and integrating resilience. However, the complexity and resource intensive nature of these engineering domains make it a challenge to incorporate them into design measures. In the process of planning, this impedes proactive collaboration between the design and engineering communities. This study presents a collaborative design engineering exercise undertaken to find spatial solutions to flood-prone Edogawa ward in Tokyo, Japan. The team included urbanists, hydraulic engineers, water resource managers, and landscape architects. Hydraulic engineering solutions were combined with spatial planning methods to deliver two alternative strategies for the chosen site. Each alternative was then evaluated for its urban design quality and effectiveness in reducing flood risk. The exercise highlighted that successful design requires comprehensive interdisciplinary collaboration to arrive at a sustainable bargain between hard and soft measures.

We have enrolled a cohort of former National Football League players (n = 3,506) who played since 1960 to assess potential long term health consequences associated with participating in the sport. Each participant has completed a self-administered questionnaire including reporting of physician-diagnosed health conditions. One of the early assessments was to evaluate whether anterior cruciate ligament (ACL) tears were associated with later life co-morbidities, including cardiovascular effects. We used Cox proportional hazards to estimate hazard ratios (HR) for joint replacement surgeries, myocardial infarction, sleep apnea, arthritis, dementia, and stroke by history of ACL tear during their professional career. For additional outcomes without date of occurrence reported we used logistic regression to estimate odds ratios adjusted for potential confounding variables in all models. After adjusting for covariates, former National Football League players who tore their ACL had approximately a twofold increase in muscular skeletal co-morbidities, including knee joint replacement and arthritis, compared with those without ACL tears. In addition, those with a history of ACL tears also had more than a 50% increased risk of myocardial infarction (HR 1.52; 95% confidence interval 0.97 to 2.38) and a slight increase in sleep apnea (HR 1.15; 95% confidence interval 0.96 to 1.38). ACL tears sustained by athletes may increase the risk of co-morbidities beyond the musculoskeletal system. As there are more than 100,000 ACL reconstructions annually in the United States, our findings could have widespread public health importance if these findings generalize to a population beyond professional football players. In conclusion, enhanced screening for other risk factors for these conditions in patients who have torn their ACL might identify those who could most benefit from prevention strategies.

This study evaluates the antidiabetic activities of methanolic extract of Withania coagulans Dunal (Ashutosh booti) fruit (WCFE) in poloxamer-407 induced type 2 diabetic Wistar rats. The electrochemical behaviour of WCFE with anodic peak of 1.19± 0.01V was found similar to standards used indicating that extract is antioxidant in nature. Unlike diabetic control rats, the WCFE treated diabetic rats presented significant amelioration of glycaemia, insulinamia and lipid dysmetabolism, remarkable reduction of oxidative markers and improved cecal and pancreatic characteristics. HYBRID and FRED docking were performed for 25 documented WCFE botanicals for putative action mechanism concerning three diabetic therapeutic proteins namely PTP-1B, PPAR-γ and DPP-IV fully support the in vivo findings. Botanicals like nicandrenone10 and Acnistin F have shown considerable interaction potential with aforesaid proteins. Results provide pharmacological evidence of WCFE as antihyperglyceamic mediated by interaction of various botanicals with various targets operating in diabetes mellitus.

The objective of this study is to assess the financial feasibility of setting up Rooftop Photovoltaic (RTPV) systems in Bengaluru which is in the state of Karnataka, India. The Renewable Energy Policy of the state mandates the installation of 250 MW of RTPV systems by 2014, while research shows that the domestic RTPV potential in Bengaluru alone is around 560 MW. To achieve this potential, the Karnataka Renewable Energy Development Limited (KREDL) and the Karnataka Electricity Regulatory Commission (KERC) formulated policy incentives in the form of net metering at rates of Rs. 9.56/kWh (without the Ministry of New and Renewable Energy (MNRE) capital subsidy) and Rs. 7.2/kWh (with MNRE capital subsidy). Techno-economic assessment of RTPV systems show that these rates lead to viable business cases for the consumers. However, due to Bangalore Electricity Supply Company׳s (BESCOM) poor finances, a cap of 75% on the capacity of any installed RTPV system based on rated load has been set for all interested parties. Unless this cap is removed, the net metering scheme can never gain momentum in Karnataka because the power generated from the RTPV system will not exceed the monthly consumption. An additional amount of Rs. 81.6 crores per annum is required to reach the 250 MW target. BESCOM can tap the proposed State Clean Energy Fund (SCEF) to pay RTPV project developers. Other revenue models such as feed in tariffs (FiT) and the Renewable Energy Certificates (REC) schemes have been considered for analysis of larger RTPV systems on industrial and commercial rooftops.

This study evaluates the relative beneficial effects of 10% dietary intake of fructooligosaccharides (FOSs) and isomaltooligosaccharides (IMOs) and combination of FOS + IMO in poloxamer-407 (PX-407) induced type 2 diabetic Wistar rats. FOSs was produced from Aspergillus oryzae (MTCC5154) while IMOs and standards of 1-kestose, 1-nystose, 1-fructofuranosyl nystose and panose were procured. In silico docking studies were performed by GLIDE program for each of the FOSs and IMOs for PPAR-γ activation and DPP-IV inhibition. Diabetic rats treated with FOS + IMO showed relatively more amelioration of glycemic and lipid dysmetabolism, remarkable reduction in oxidative markers, increased GLP-1 content as well as Bifidobacteria/Lactobacilli population in caecum than lone FOSs/IMOs treatment. Out of nine oligosaccharides docked from FOS and IMO; panose, nystose and kestose showed highest ranking binding mode with DPP-IV and PPAR-γ and were selected for in vitro study either alone or in combinations. On its own nystose showed potent DPP-IV inhibitory activity with an IC50 of 146.8 μM while panose at 20.2 μM concentrations showed 50% binding ability to PPAR-γ-LBD. Combinations of oligosaccharides tested namely Nys + Pan, Nys + Kes and Pan + Kes demonstrated significant (p

Diabetes Mellitus, characterized by persistent hyperglycaemia, is a heterogeneous group of disorders of multiple aetiologies. It affects the human body at multiple organ levels thus making it difficult to follow a particular line of the treatment protocol and requires a multimodal approach. The increasing medical burden on patients with diabetes-related complications results in an enormous economic burden, which could severely impair global economic growth in the near future. This shows that today’s healthcare system has conventionally been poorly equipped towards confronting the mounting impact of diabetes on a global scale and demands an urgent need for newer and better options. The overall challenge of this field of diabetes treatment is to identify the individualized factors that can lead to improved glycaemic control. Plants are traditionally used worldwide as remedies for diabetes healing. They synthesize a diverse array of biologically active compounds having antidiabetic properties. This review is an endeavour to document the present armamentarium of antidiabetic herbal drug discovery and developments, highlighting mechanism-based antidiabetic properties of over 300 different phytoconstituents of various chemical categories from about 100 different plants modulating different metabolic pathways such as glycolysis, Krebs cycle, gluconeogenesis, glycogen synthesis and degradation, cholesterol synthesis, carbohydrate metabolism as well as peroxisome proliferator activated receptor activation, dipeptidyl peptidase inhibition and free radical scavenging action. The aim is to provide a rich reservoir of pharmacologically established antidiabetic phytoconstituents with specific references to the novel, cost-effective interventions, which might be of relevance to other low-income and middle-income countries of the world.

Metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease and diabetes, many of which are associated with HIV and antiretroviral therapy (ART). We examined prevalence and incidence of MetS and risk factors for MetS in ART-naive HIV-infected individuals starting ART.MetS, defined by the Adult Treatment Panel III criteria, was assessed at and after ART initiation in HIV-infected individuals who enrolled in selected AIDS Clinical Trials Group trials and were followed long-term after these trials as part of the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials cohort. Cox proportional hazards models were used to examine risk factors of incident MetS. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) are reported.At ART initiation, the prevalence of MetS was 20%. After ART initiation, the incidence of MetS was 8.5 per 100 person-years. After adjusting for demographics and body mass index, the risk of MetS was decreased for CD4+ T-cell counts50 cells per cubic millimeter (aHR = 0.62, 95% CI = 0.43 to 0.90 for CD4500), and the risk was increased for HIV-1 RNA400 copies per milliliter (aHR = 1.55 (95% CI = 1.25 to 1.92) and use of a protease-inhibitor (PI)-based regimen [relative to no PI use, aHR = 1.25 (95% CI = 1.04 to 1.51) for any PI use].In HIV-infected individuals on ART, virologic suppression and maintenance of high CD4+ T-cell counts may be potentially modifiable factors that can reduce the risk of MetS. The effect of MetS on the risk of cardiovascular disease and diabetes needs to be evaluated.

Examine incidence and factors associated with loss to follow-up (LTFU) in the AIDS Clinical Trials Group (ACTG) Longitudinal Linked Randomized Trials (ALLRT) cohort.ALLRT is a prospective cohort of HIV-infected persons randomized to antiretroviral (ARV) regimens/strategies in ACTG trials and followed long-term after the trial ends. Person-years were calculated from ALLRT entry until loss to follow-up (LTFU; defined using off-study reasons or ≥ 3 consecutive missed visits), death/ severe debilitation/site closures, or June 2009 (censored). Poisson regression was used to examine LTFU factors separately among participants who were ARV naïve or ARV experienced at trial entry.Among 4,630 participants (22,524 person-years), 1,140 were lost to follow-up, 237 died, 29 were severely debilitated, and 443 were at sites that closed. The LTFU incidence was 5.5 and 4.2 per 100 person-years among previously ARV-naïve and ARV-experienced participants, respectively. In both groups, age ≤ 50, site location, being off ARVs, and viral load ≥ 400 copies/mL were associated with a higher risk of LTFU. Among ARV-naïve participants, male sex, education16 years, intravenous drug use, and cigarette smoking were also associated with LTFU.Knowledge of differential LTFU can help researchers identify participants at risk of LTFU in longitudinal HIV cohorts and design retention strategies, thereby limiting study bias. The identified factors should be included in inverse probability of weighting models to account for LTFU.

DIVA-GIS, a Geographical Information System is designed to assist the plant genetic resources and biodiversity communities to map the range of distribution of species in which they are interested. The regions where diverse accessions occur could be found by analysing the geographical diversity distribution. In the present study, 50 landraces of cucumber procured from ICAR-NBPGR, New Delhi was evaluated for six yield contributing traits in Augmented Block Design. To study the diversity and distribution of germplasm, geo-referenced points of the collection sites of the genotypes and the agro-morphological data recorded were supplemented to shape files and map geo-referenced points using DIVA-GIS software. A wide range of variability was observed for the quantitative traits studied, as evidenced by the wide range of SDI for days to first harvest (0- 0.350 to 1.356 - 2.000) to fruit length (0 - 0.450 to 1.840 - 3.000). Highest yield per plant was observed in IC613477 (2205.29 g), a collection from West Bengal and lowest in IC331627 (94.53 g), from Uttarakhand, with an overall mean of 1189.03 g. High SDI of 1.73 to 3.00 was recorded for accessions collected from Andaman and Nicobar Islands, Tripura and Uttarakhand for yield per plant. Collections from West Bengal, Tripura and Mizoram possessed diversity for days to first harvest, fruit weight, fruit diameter and yield per plant, as indicated by the appearance of red grids in these states for these characters. Hence, future germplasm collections can be targeted from these diversity rich states and adjoining areas.

The experiment was conducted at the Department of vegetable science, College of Horticulture, Vellanikkara, Kerala Agricultural University during the year 2016-2017 to evaluate the performance of bitter gourd hybrids. The experimental material comprised of 16 hybrids and 5 check varieties collected from public (IARI, New Delhi and KAU, Thrissur) and private sectors. Observations were recorded for 14 characters and ranking of hybrids was done based on cumulative index worked out for the characters like, nodes to 1st female flower appearance, days to 1st picking, fruit weight (g), fruit length (cm), fruit diameter (cm), relative early yield (kg), yield/plant (kg) and number of fruits per plant. Significant difference was observed among the hybrids for the selected characters. Promising 5 F1 hybrids selected based on the cumulative index were MC-142, MC-136, MC-139, MC-138 and MC-133.

The authors examined the relation between individual and neighborhood socioeconomic status (SES) and type 2 diabetes incidence among African-American women in the prospective Black Women's Health Study. Participants have completed mailed biennial follow-up questionnaires since 1995. US Census block group characteristics were used to measure neighborhood SES. Incidence rate ratios were estimated in clustered survival regression models. During 12 years of follow-up of 46,382 participants aged 30-69 years, 3,833 new cases of type 2 diabetes occurred. In models that included both individual and neighborhood SES factors, incidence rate ratios were 1.28 (95% confidence interval: 1.15, 1.43) foror = 12 years of education relative toor = 17 years, 1.57 (95% confidence interval: 1.30, 1.90) for household income$15,000 relative to$100,000, and 1.65 (95% confidence interval: 1.46, 1.85) for lowest quintile of neighborhood SES relative to highest. The associations were attenuated after adjustment for body mass index, suggesting it is the key intermediate factor in the pathway between SES and diabetes. The association of neighborhood SES with diabetes incidence was present even among women who were more educated and had a higher family income. Efforts to reduce the alarming rate of diabetes in African-American women must focus on both individual lifestyle changes and structural changes in disadvantaged neighborhoods.

Background: Type 2 diabetes is a major problem in Western nations. Profound secular changes in the food environment and eating habits may play a role. In particular, consumption of foods prepared outside the home has greatly increased. Objective: We investigated the relation of restaurant meal consumption to incidence of type 2 diabetes among African American women with the use of data from the prospective Black Women's Health Study. Design: The participants have completed mailed follow-up questionnaires every 2 y since 1995, including food-frequency questionnaires that asked about the frequency of eating restaurant meals of various types. Cox proportional hazards models were used to calculate incidence rate ratios and 95% CIs for the association of type 2 diabetes incidence with various categories of consumption of each restaurant food relative to the lowest category, with adjustment for diabetes risk factors. Results: Among 44,072 participants aged 30–69 y and free of diabetes at baseline, 2873 incident cases of type 2 diabetes occurred during 10 y of follow-up. Consumption of restaurant meals of hamburgers, fried chicken, fried fish, and Chinese food were independently associated with an increased risk of type 2 diabetes. Incidence rate ratios for ≥2 such meals per week relative to none were 1.40 (95% CI: 1.14, 1.73) for hamburgers and 1.68 (95% CI: 1.36, 2.08) for fried chicken. Control for body mass index greatly reduced the estimates, which suggests that the associations are mediated through weight gain and obesity. Conclusion: The present study has identified a risk factor for type 2 diabetes that may be readily modifiable by dietary changes.

Few modifiable risk factors for type 2 diabetes have been documented in the high-risk population of US black women. The authors used data from 45,668 black women aged 21-69 years, followed biennially from 1995 to 2005 in the Black Women's Health Study, to estimate incidence rate ratios for type 2 diabetes comparing various levels of physical activity and television watching. Cox proportional hazards models were used to control confounding factors. During 10 years of follow-up, 2,928 incident cases of type 2 diabetes were identified. Vigorous activity was inversely associated with type 2 diabetes risk (P(trend)0.0001); the incidence rate ratio foror= 7 hours per week was 0.43 (95% confidence interval (CI): 0.31, 0.59) relative to no activity. Brisk walking foror= 5 hours per week was associated with reduced type 2 diabetes risk (incidence rate ratio=0.67, 95% CI: 0.49, 0.92) relative to no walking. Television watching was associated with an increased type 2 diabetes risk: The incidence rate ratio was 1.86 (95% CI: 1.54, 2.24) foror= 5 hours relative to1 hour of television per day, independent of physical activity. These observational data suggest that black women might reduce their risk of developing type 2 diabetes by increasing their time spent walking or engaged in vigorous physical activity and by limiting television watching.

Objective: Obesity has risen to epidemic proportions in the United States, leading to an emerging epidemic of type 2 diabetes. African-American women are disproportionately affected by both conditions. While an association of overall obesity with increasing risk of diabetes has been documented in black women, the effect of fat distribution, specifically abdominal obesity, has not been studied. We examined the association of BMI, abdominal obesity, and weight gain with risk of type 2 diabetes. Research Methods and Procedures: During eight years of follow-up of 49,766 women from the Black Women's Health Study, 2472 incident cases of diabetes occurred. Cox proportional hazard models were used to estimate incidence rate ratios (IRRs), with control for age, physical activity, family history of diabetes, cigarette smoking, years of education, and time period of data collection. Results: Sixty-one percent of participants had a BMI ≥25 kg/m2 (WHO definition of overweight). Compared with a BMI of 45 kg/m2 was 23 (95% confidence interval, 17.0 to 31.0). The IRR for the highest quintile of waist-to-hip ratio relative to the lowest was 2.3 (95% confidence interval, 2.0 to 2.7) after control for BMI. Furthermore, at every level of BMI, an increased risk was observed for high waist-to-hip ratio relative to low. Discussion: Central obesity, as well as overall obesity, is a strong risk factor for diabetes in African-American women. Efforts to reduce the prevalence of obesity in African-American women are of paramount importance.

OBJECTIVE—Inverse associations between magnesium and calcium intakes and risk of type 2 diabetes have been reported for studies in predominantly white populations. We examined magnesium, calcium, and major food sources in relation to type 2 diabetes in African-American women. RESEARCH DESIGN AND METHODS—This is a prospective cohort study including 41,186 participants of the Black Women’s Health Study without a history of diabetes who completed validated food frequency questionnaires at baseline. During 8 years of follow-up (1995–2003), we documented 1,964 newly diagnosed cases of type 2 diabetes. RESULTS—The multivariate-adjusted hazard ratio of type 2 diabetes for the highest compared with the lowest quintile of intake was 0.69 (95% CI 0.59–0.81; P trend CONCLUSIONS—These findings indicate that a diet high in magnesium-rich foods, particularly whole grains, is associated with a substantially lower risk of type 2 diabetes in U.S. black women.

Data on changes in metabolic syndrome (MetS) status in HIV-infected adults on antiretroviral therapy (ART) are limited.MetS was assessed at ART initiation and every 48 weeks on ART in ART-naive HIV-infected individuals from the AIDS Clinical Trials Group Longitudinal Linked Randomized Trials (ALLRT) cohort. MetS, defined using the Adult Treatment Panel III criteria, required at least 3 of the following: elevated fasting glucose, hypertension, elevated waist circumference, elevated triglycerides, low high-density lipoprotein (HDL) cholesterol. Prevalence of MetS and the individual criteria were compared between ART initiation and during follow-up using McNemar test.At ART initiation, 450 (20%) ALLRT participants had MetS. After 96 weeks of ART, 37% of the 411 with MetS at ART initiation and with available data at this time point did not meet the MetS criteria. Among these participants, there was a dramatic decline in the proportion with low HDL (95% versus 26%, P0.0001). Among the 63% who continued to meet MetS criteria at week 96, the proportion with ≥4 criteria was higher at week 96 compared to at the time of ART initiation (48% versus 40%, P = 0.03); at week 96, the proportion with high triglycerides was greater (87% versus 69%, P0.0001) as was the proportion with high glucose (59% versus 42%, P0.0001).One in 5 ART-naive subjects met criteria for MetS at ART initiation. Although more than half of these individuals continued to have MetS after 96 weeks of ART, 37% with MetS at ART initiation no longer met criteria for MetS; this decrease was driven largely by increases in HDL cholesterol.

Precision medicine (PM) is a contemporary therapeutic model en route for elucidating customized perfect medical treatments approach to an individual patient according to the molecular and genomic profiling and systems of biological components involved in the patient’s disease process. PM is a grown-up and preferred term of ‘personalized medicine’ with a similar meaning as the word ‘personalized’ which may possibly be misconstrued to entail that disease interventions are exclusively for each patient while PM intervention strategies accentuate to make out appropriate and effective approaches based on patient’s genetic, environmental and lifestyle factors.

BackgroundDefining the association of non-AIDS-defining events with inflammation and immune activation among human immunodeficiency virus (HIV)-infected persons with antiretroviral therapy (ART)-associated virological suppression is critical to identifying interventions to decrease the occurrence of these events.MethodsWe conducted a case-control study of HIV-infected subjects who had achieved virological suppression within 1 year after ART initiation. Cases were patients who experienced non-AIDS-defining events, defined as myocardial infarction, stroke, non-AIDS-defining cancer, non-AIDS-defining serious bacterial infection, or death. Controls were matched to cases on the basis of age, sex, pre-ART CD4(+) T-cell count, and ART regimen. Peripheral blood mononuclear cells and plasma specimens obtained at the visit before ART initiation (hereafter, baseline), the visit approximately 1 year after ART initiation (hereafter, year 1), and the visit immediately preceding the non-AIDS-defining event (hereafter, pre-event) were analyzed for activated CD4(+) and CD8(+) T cells, plasma interleukin 6 (IL-6) level, soluble tumor necrosis factor receptor I (sTNFR-I) level, sTNFR-II level, soluble CD14 level, kynurenine-to-tryptophan (KT) ratio, and D-dimer level. Conditional logistic regression analysis was used to study the association between biomarkers and outcomes, with adjustment for potential confounders.ResultsHigher IL-6 level, sTNFR-I level, sTNFR-II level, KT ratio, and D-dimer level at year 1 were associated with the occurrence of a non-AIDS-defining event. Significant associations were also seen between non-AIDS-defining events and values of these biomarkers in specimens obtained at baseline and the pre-event time points. Effects remained significant after control for confounders. T-cell activation was not significantly related to outcomes.ConclusionsInterventional trials to decrease the incidence of non-AIDS-defining events among HIV-infected persons with virological suppression should consider targeting the pathways represented by these soluble markers. Clinical Trials Registration. NCT00001137.

The first cure of HIV-1 infection was achieved through complex, multimodal therapy including myeloablative chemotherapy, total body irradiation, anti-thymocyte globulin, and allogeneic stem cell transplantation with a CCR5 delta32 homozygous donor. The contributions of each component of this therapy to HIV-1 eradication are unclear. To assess the impact of cytotoxic chemotherapy alone on HIV-1 persistence, we longitudinally evaluated low-level plasma viremia and HIV-1 DNA in PBMC from patients in the ACTG A5001/ALLRT cohort on suppressive antiretroviral therapy (ART) who underwent chemotherapy for HIV-1 related lymphoma without interrupting ART. Plasma HIV-1 RNA, total HIV-1 DNA and 2-LTR circles (2-LTRs) in PBMC were measured using sensitive qPCR assays. In the 9 patients who received moderately intensive chemotherapy for HIV-1 related lymphoma with uninterrupted ART, low-level plasma HIV-1 RNA did not change significantly with chemotherapy: median HIV-1 RNA was 1 copy/mL (interquartile range: 1.0 to 20) pre-chemotherapy versus 4 copies/mL (interquartile range: 1.0 to 7.0) post-chemotherapy. HIV-1 DNA levels also did not change significantly, with median pre-chemotherapy HIV-1 DNA of 355 copies/106 CD4+ cells versus 228 copies/106 CD4+ cells post-chemotherapy. 2-LTRs were detectable in 2 of 9 patients pre-chemotherapy and in 3 of 9 patients post-chemotherapy. In summary, moderately intensive chemotherapy for HIV-1 related lymphoma in the context of continuous ART did not have a prolonged impact on HIV-1 persistence. Clinical trials registration unique identifier: NCT00001137.

Two flavonol glycosides have been isolated and characterised from leaves of Syzygium samarangense. One is the rare mearnsitrin (1) while the second, 2′-C-methyl-5′-O-galloylmyricetin-3-O-a- l -rhamnopyranoside (2), is new. Detailed spectral data are provided for both.