Bictegravir/Emtricitabine/Tenofovir Alafenamide in a Multicentre Cohort: Real-Life Experience From Spain.

BACKGROUND: The evaluation of bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) in clinical trials has shown high rates of virological suppression but information about its use in real-life settings is scarce. OBJECTIVE: To evaluate the effectiveness, safety, durability, and predictive variables of therapeutic failure of BIC/FTC/TAF in a real-life cohort. METHODS: This observational, retrospective, multicentered cohort study included treatment-naive (TN) and treatment-experienced (TE) adult patients living with HIV (PLWH) who started treatment with BIC/FTC/TAF from January 1, 2019, to January 31, 2022. Treatment effectiveness (based on intention-to-treat [ITT], modified ITT [mITT], and on-treatment [OT]), tolerability, and safety were evaluated in all patients who started BIC/FTC/TAF antiretroviral therapy. RESULTS: We included a total of 505 PLWH of whom 79 (16.6%) were TN and 426 (83.4%) were TE. Patients were followed up for a median (interquartile range [IQR]) of 19.6 (9.6-27.3) months, and 76% and 56% of PLWH reached month 6 and month 12 of treatment, respectively. Rates of TN PLWH with HIV-RNA <50 copies/mL in the OT, mITT, and ITT groups were 94%, 80%, and 62%, respectively, after 12 months of BIC/FTC/TAF treatment. Rates of TE PLWH with HIV-RNA <50 copies/mL were 91%, 88%, and 75% at month 12. The multivariate analysis revealed that neither age, sex, CD4 cell count <200 cells/µL, or viral load >100 000 copies/mL were associated with therapeutic failure. CONCLUSION AND RELEVANCE: Our real-life data showed that BIC/FTC/TAF is effective and safe for use in the treatment of both TN and TE patients in clinical practice.

Attachment of Hydrogen Molecules to Atomic Ions (Na+ , Cl- ): Examination of an Adiabatic Separation of the H2 Rotational Motion.

Interactions between molecular hydrogen and ions are of interest in cluster science, astrochemistry and hydrogen storage. In dynamical simulations, H2 molecules are usually modelled as point particles, an approximation that can fail for anisotropic interactions. Here, we apply an adiabatic separation of the H2 rotational motion to build effective pseudoatom-ion potentials and in turn study the properties of (H2 )n Na+ /Cl- clusters. These interaction potentials are based on high-level ab initio calculations and Improved Lennard-Jones parametrizations, while the subsequent dynamics has been performed by quantum Monte Carlo calculations. By comparisons with simulations explicitly describing the molecular rotations, it is concluded that the present adiabatic model is very adequate. Interestingly, we find differences in the cluster stabilities and coordination shells depending on the spin isomer considered (para- or ortho-H2 ), especially for the anionic clusters.

Molecular hydrogen isotope separation by a graphdiyne membrane: a quantum-mechanical study.

Graphdiyne (GDY) has emerged as a very promising two-dimensional (2D) membrane for gas separation technologies. One of the most challenging goals is the separation of deuterium (D2) and tritium (T2) from a mixture with the most abundant hydrogen isotope, H2, an achievement that would be of great value for a number of industrial and scientific applications. In this work we study the separation of hydrogen isotopes in their transport through a GDY membrane due to mass-dependent quantum effects that are enhanced by the confinement provided by its intrinsic sub-nanometric pores. A reliable improved Lennard-Jones force field, optimized on accurate ab initio calculations, has been built to describe the molecule-membrane interaction, where the molecule is treated as a pseudoatom. The quantum dynamics of the molecules impacting on the membrane along a complete set of incidence directions have been rigorously addressed by means of wave packet calculations in the 3D space, which have allowed us to obtain transmission probabilities and, in turn, permeances, as the thermal average of the molecular flux per unit pressure. The effect of the different incidence directions on the probabilities is analyzed in detail and it is concluded that restricting the simulations to a perpendicular incidence leads to reasonable results. Moreover, it is found that a simple 1D model-using a zero-point energy-corrected interaction potential-provides an excellent agreement with the 3D probailities for perpendicular incidence conditions. Finally, D2/H2 and T2/H2 selectivities are found to reach maximum values of about 6 and 21 at ≈50 and 45 K, respectively, a feature due to a balance between zero-point energy and tunneling effects in the transport dynamics. Permeances at these temperatures are below recommended values for practical applications, however, at slightly higher temperatures (77 K) they become acceptable while the selectivities preserve promising values, particularly for the separation of tritium.

Implementation of an Online Multimedia Pediatric Tracheostomy Care Module for Healthcare Providers.

OBJECTIVES/HYPOTHESIS: To investigate the effect of a multimedia educational module on provider attitudes toward pediatric tracheostomy care. We also describe the process of module development and dissemination at an academic children's hospital. STUDY DESIGN: Prospective observational study. METHODS: The pediatric airway committee at an urban tertiary care center developed a multimedia pediatric tracheostomy care module. Nurses, respiratory therapists, as well as resident, fellow, and attending physicians caring for pediatric patients with tracheostomies were eligible. Managers and clinical supervisors from various units recruited participants to complete the pediatric tracheostomy care electronic module and pre- and postassessment knowledge quizzes and surveys. Provider confidence was analyzed using Kruskal-Wallis H-test and Mann-Whitney U-test, and paired t-test was used to compare pre- and postmodule quiz scores. RESULTS: A total of 422 participants completed the module. A total of 275 participants completed the premodule survey, 385 completed the premodule quiz, 253 completed the postmodule survey, and 233 completed the postmodule quiz. Participants included providers in the neonatal intensive care unit, pediatric intensive care unit, pediatric emergency department, and pediatric wards. Postmodule surveys demonstrated a significant reduction in the average percentage of participants indicating lack of confidence with regards to changing an established tracheostomy, responding to accidental decannulation of established tracheostomy, and responding to accidental decannulation of fresh tracheostomy (P < .001). Average quiz scores increased by 5.6 points from 83.0% to 88.6% (P < .00001). CONCLUSIONS: A multimedia educational module can improve provider perception of their knowledge and confidence surrounding pediatric tracheostomy management. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:1893-1901, 2021.

Intimate partner violence under forced cohabitation and economic stress: Evidence from the COVID-19 pandemic.

With the COVID-19 outbreak imposing stay at home and social distancing policies, warnings about the impact of lockdown and its economic consequences on domestic violence have surged. This paper disentangles the effect of forced cohabitation and economic stress on intimate partner violence. Using an online survey data set, we find a 23% increase of intimate partner violence during the lockdown. Our results indicate that the impact of economic consequences is twice as large as the impact of lockdown. We also find large but statistically imprecise estimates of a large increase of domestic violence when the relative position of the man worsens, especially in contexts where that position was already being threatened. We view our results as consistent with the male backlash and emotional cue effects.

Immigration Enforcement and Children's Living Arrangements.

Tougher immigration enforcement was responsible for 1.8 million deportations between 2009 and 2013 alone--many of them were fathers of American children. We exploit the geographic and temporal variation in the escalation of interior immigration enforcement to assess its impact on the structure of families to which many of the deported fathers of U.S.-born children belonged. We find that the average increase in immigration enforcement during the 2005 to 2015 period has raised by 19 percent the likelihood that Hispanic U.S.-born children might live without their parents in households headed by naturalized relatives or friends unthreatened by deportation. Likewise, the same increase in immigration enforcement has raised by 20 percent these children's propensity to live with likely undocumented mothers who report their spouses as being absent--a reasonable finding given that most children with a likely undocumented father have undocumented mothers. Given the negative consequences of being raised by a single parent or without parents, plus the parallel increase in interior immigration enforcement, gaining a better understanding of the collateral damage of heightened enforcement on the families to which these children belong is well warranted.

The association of overweight and obesity with spirometric values in minority children referred for asthma evaluation.

BACKGROUND: Overweight, obesity, and asthma are more prevalent in minority children; yet, the association of overweight and obesity with spirometric values in asthmatic minorities is not well characterized. OBJECTIVE: To study the relationship between weight, ethnicity, and spirometric values in children referred for asthma evaluation to a large inner-city hospital in Bronx, NY. METHODS: Retrospective review of spirometry done at the first pulmonary clinic visit of 980 asthmatic children, aged 7-20 years, was conducted. Linear regression analysis was performed to elucidate the association of overweight and obesity with pulmonary function among Whites, African Americans, and Hispanics compared with their normal weight counterparts. RESULTS: More African Americans (58%) and Hispanics (65.4%) were overweight and obese than Whites (51.2%) (p < .05). Compared with their normal weight counterparts, percent forced expiratory volume in the 1st second (FEV(1))/forced vital capacity (FVC) ratio was lower in both overweight and obese African Americans (2.99%, p < .05 and 3.56%, p < .01, respectively) and Hispanics (2.64%, p < .05 and 2.36%, p < .05, respectively); these differences were found in obese (3.73%, p < .05) but not in overweight (0.68%, p = .7) Whites. CONCLUSIONS: FEV(1)/FVC ratio was lower in both overweight and obese African American and Hispanic children, while this association was present only among obese Whites compared with their normal weight counterparts. These results suggest that spirometric measures of lower airway obstruction decrease with smaller weight increments in minority children when compared with White children. In the context of the higher prevalence of overweight and obesity among African Americans and Hispanics, our findings offer one potential explanation for increased asthma among minority children.

Cardiopulmonary exercise testing in children and adolescents with asthma who report symptoms of exercise-induced bronchoconstriction.

Patients with asthma often report symptoms of exercise-induced bronchoconstriction. We performed cardiopulmonary exercise testing to establish the cause of exercise limitation in patients with asthma, under treatment, who reported symptoms of exercise-induced bronchoconstriction. Ten of the 42 patients meeting criteria for inclusion in our study (24%) developed exercise-induced bronchoconstriction. Exercise limitation without exercise-induced bronchoconstriction was found in both obese and non-obese patients, suggesting that poor fitness is a problem independent of body habitus. Including cardiopulmonary exercise testing in the management of children with suspected exercise-induced bronchoconstriction would provide a better understanding of the etiology of their symptoms and facilitate more appropriate treatment.