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A substantial number of patients with HIV in South Africa have failed first-line antiretroviral therapy (ART). Although individual predictors of first-line ART failure have been identified, few studies in resource-limited settings have been large enough for predictive modelling. Understanding the absolute risk of first-line failure is useful for patient monitoring and for effectively targeting limited resources for second-line ART. We developed a predictive model to identify patients at the greatest risk of virologic failure on first-line ART, and to estimate the proportion of patients needing second-line ART over five years on treatment.
A cohort of patients aged ≥18 years from nine South African HIV clinics on first-line ART for at least six months were included. Viral load measurements and baseline predictors were obtained from medical records. We used stepwise selection of predictors in accelerated failure-time models to predict virologic failure on first-line ART (two consecutive viral load levels >1000 copies/mL). Multiple imputations were used to assign missing baseline variables. The final model was selected using internal-external cross-validation maximizing model calibration at five years on ART, and model discrimination, measured using Harrell’s C-statistic. Model covariates were used to create a predictive score for risk group of ART failure.
A total of 72,181 patients were included in the analysis, with an average of 21.5 months (IQR: 8.8-41.5) of follow-up time on first-line ART. The final predictive model had a Weibull distribution and the final predictors of virologic failure were men of all ages, young women, nevirapine use in first-line regimen, low baseline CD4 count, high mean corpuscular volume, low haemoglobin, history of TB and missed visits during the first six months on ART. About 24.4% of patients in the highest quintile and 9.4% of patients in the lowest quintile of risk were predicted to experience treatment failure over five years on ART.
Age, sex, CD4 count and having any missed visits during the first six months on ART were the strongest predictors of ART failure. The predictive model identified patients at high risk of failure, and the predicted failure rates over five years closely reflected actual rates of failure.
antiretroviral therapy, predictive model, prognostic score, treatment failure, South Africa, resource-limited settings, public health
Developing a predictive risk model for first-line antiretroviral therapy failure in South Africa
Julia K Rohr,§,1 Prudence Ive,2 C Robert Horsburgh,1,3 Rebecca Berhanu,2 Kate Shearer,4 Mhairi Maskew,4 Lawrence Long,4 Ian Sanne,4,5 Jean Bassett,6 Osman Ebrahim,7 and Matthew P Fox1,3,4
Wastewater from a potash mine in the central region of Catalonia is transported by means of a collector that runs more than 100 km, spilling into the sea on the Catalan central coast. To analyze the hydraulics of this infrastructure, the values of the basic parameters that condition the flow, such as the absolute roughness of poly(vinyl chloride) (PVC) pipes and the viscosity of the transported brine mixtures, must be characterized. There exists uncertainty about the value of absolute roughness of a PVC pipe as described in the literature; nevertheless, if the pipe is smooth, the influence of the absolute roughness in the hydraulic determination of viscosity will not be significant. In this work, an experimental procedure based on a hydraulic analysis was applied to estimate the kinematic viscosity of a brine mixture, depending on its temperature and concentrations of salts and fines. The results obtained were compared with the results from experiments using an Ostwald viscometer.
Hydrodynamic Determination of the Kinematic Viscosity of Waste Brines
Marti Sanchez-Juny,corresponding author*† Arnau Triadú,‡ Antoni Andreu,§ and Ernest Blade†
2019 Dec 17
Childhood obesity increases the risk of obstructive sleep apnea syndrome, type 2 diabetes mellitus, cardiovascular abnormalities, and psychological and behavioral disorders. But it is unclear whether obesity is associated with childhood nocturnal enuresis (NE). This study aimed to assess the relationship between childhood obesity and NE in a nationally representative large sample in China. Subjects were enrolled from Urumqi, Chengdu, Xi’an, Hohhot, Wuhan, Canton, Shanghai, and Harbin cities in China in November and December 2005. The survey included 20,987 children aged 5-12 years and they and their caregivers completed questionnaires. Height and weight were measured by school teachers trained in healthcare. According to the WHO child growth standards, obesity was defined as a body mass index >95th percentile of peers with the same age and gender. NE was defined as bed wetting for more than twice a week for 3 consecutive months. Demographic variables were compared among different groups. The prevalence of obesity, asthma, attention-deficit/hyperactivity disorder (ADHD), depressive moods, and snoring were different between the NE and without-NE groups (P < 0.05). The raw odds ratio (OR) for NE and obesity was 1.36 (95%CI = 1.07-1.74; P = 0.013) and the adjusted OR was 1.42 (95%CI = 1.11-1.82; P = 0.005) in the multivariable analysis. When adjusting for co-occurring conditions, the results showed that asthma did not affect the risk of NE (OR = 1.42, 95%CI = 1.11-1.82; P = 0.005), but ADHD (OR = 1.41; 95%CI = 1.10-1.81; P = 0.006) and depressive moods (OR = 1.34; 95%CI = 1.07-1.76; P = 0.012) slightly weakens the association between NE in children and obesity, while snoring weakens the association between obesity and NE and the risk became non-significant (OR = 1.21; 95%CI = 0.94-1.56; P = 0.138). In conclusion, obese children were at a higher risk of incurring NE compared to non-obese children. This association was weaker in children who either snored, had ADHD, or had depressive mood. Subject terms: Diseases, Health care
Nocturnal enuresis in obese children: a nation-wide epidemiological study from China
Anyi Zhang,1,2,3 Shenghui Li,4 Yiwen Zhang,1,2,3 Fan Jiang,1,2,3 Xingming Jin,1,2,3 and Jun Macorresponding author1,2,3