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Transformation via Calcineurin Inhibitor for you to Belatacept-based Servicing Immunosuppression throughout Renal Transplant Readers: the Randomized Phase 3b Test.
These trials were registered at clinicaltrials.gov as NCT00552409 (pilot study 1) and NCT01477034 (pilot study 2).
Primary health care has an important role to play in the management of weight and yet discussions of healthy weight management do not occur optimally, indicating a need for simple tools and training in brief weight counselling. The 'FABS' approach (focusing on four topic areas Food, Activity, Behaviour and Support) was developed to address this.

To explore the feasibility of the 'FABS' approach within routine general practice consultations and its effectiveness in facilitating healthy weight conversations.

The FABS approach was run for a trial period in five New Zealand general practices. The approach entailed staff training, the addition to the practice patient management system of a template outlining potential topics for discussion and a patient handout. GPs were asked to use the approach with any adult patient with a body mass index of over 28 kg/m2. A descriptive analysis of anonymized quantitative practice data was conducted, with limited qualitative data from an online clinician questionnaire ands within general practice so that patients receive supportive and consistent messages on a regular basis. General practice is an appropriate setting for this due to the ongoing relationships with patients and team-based approach, but there is a need for effective training and education to ensure appropriate and effectively delivery.
Midupper arm circumference (MUAC) is used as an independent diagnostic tool to detect wasting in children aged 6-59 mo. However, little is known about the diagnostic performance of MUAC for detecting wasting among infants aged 1-6 mo.

The objective of this study was to evaluate the diagnostic performance of MUAC in detecting severe wasting in infants aged 1-6 mo.

We conducted a facility-based cross-sectional study among 467 hospitalized infants aged 1-6 mo in Ethiopia. Severe wasting was defined as having a weight for length z score (WLZ) below the cutoff value of -3 SDs from the median as per the WHO 2006 child growth standards. UNC2250 operating characteristic (ROC) analysis along with the calibration test was used to test the discriminatory performance of MUAC. Furthermore, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value for the proposed optimal cutoffs.

The median age, MUAC, and WLZ were 100 d (IQR 69-145 d), 119 mm (IQR 103-130 mm), and -1.27 (IQR -2.66 to 0.34), respectively. The prevalence of severe and moderate wasting was n=101 (21.6%) and n=61 (13.0%), respectively. The MUAC area under the ROC curve accuracy level in identifying severe wasting was 0.86 (95% CI 0.82, 0.89). The optimal MUAC cutoff of ≤112 mm yielded the highest Youden index of 0.61, with a sensitivity of 85.1% (95% CI 76.7%, 91.4%) and a specificity of 76.0% (95% CI 71.2%, 80.2%).

A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1-6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged <6 mo.
A MUAC cutoff of ≤112 mm performed well in detecting severe wasting among infants aged 1-6 mo. Further research is needed to evaluate the performance of MUAC for detecting wasting at community level and for predicting mortality among infants aged less then 6 mo.Increasing parity is associated with an increased risk of ischemic heart disease (IHD) and stroke in women. This is likely attributed to biological responses of pregnancy. Male cells of presumed fetal origin are commonly present in women years after pregnancy-a phenomenon termed male origin microchimerism. Here, we investigated whether male origin microchimerism was associated with risk of IHD and ischemic stroke in women. We evaluated the association between male origin microchimerism and ischemic events in a cohort of 766 Danish women enrolled in the Diet, Cancer and Health cohort during 1993-1997 when aged 50-64 years. Of these, 545 (71.2%) tested positive for male origin microchimerism by targeting the Y-chromosome (DYS14) in women's blood. Multiple Cox regression models were used to report hazard ratios with 95% confidence intervals. We found male origin microchimerism was associated with a significantly reduced rate of IHD (HR=0.44, 95% CI 0.23, 0.83), but not ischemic stroke (HR=0.80, 95% CI 0.46, 1.41). Our findings show that microchimerism-positivity is associated with a lower rate of later IHD development in women. Although the underlying mechanisms are presently unknown, male origin microchimerism may be relevant in women's cardiovascular health. More studies are needed to confirm these findings.
There is evidence that low plasma vitamin B-12 and folate individually, as well as an imbalance of high folic acid and low vitamin B-12 status, may be associated with lower cognitive function.

We examined dietary and plasma folate and vitamin B-12 status, and their interaction, in relation to cognitive function in a cohort of older Puerto Rican adults.

The design is cross-sectional, with 1408 participants from the Boston Puerto Rican Health Study (mean±SD age 57.1±7.9 y). #link# Cognitive function was assessed with a comprehensive test battery and a global composite score was derived. Plasma folate, vitamin B-12, and methylmalonic acid (MMA) were assessed in fasting blood samples.

After adjusting for covariates, high plasma folate and high plasma vitamin B-12 were each positively associated with global cognitive score (β 0.063; 95% CI -0.0008, 0.127; P=0.053 and β 0.062; 95% CI 0.009, 0.12; P=0.023, respectively, for logged values, and β 0.002; 95% CI 0.00005, 0.004; P-trend=0.044 and β 0.00018; 95% CI 0.000d.
Low plasma vitamin B-12 and low plasma folate were each associated with worse cognitive function in this population. Vitamin B-12 deficiency was prevalent and clearly associated with poorer cognitive function. More attention should be given to identification and treatment of vitamin B-12 deficiency in this population. Additional, larger studies are needed to examine the effect of vitamin B-12 deficiency in the presence of high exposure to folic acid.Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. link2 We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a "shooting gallery"). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.Toxoplasma gondii is an obligate intracellular protozoan parasite that can infect all nucleated cells through active invasion. Some non-canonical pathways for T. link3 gondii infection of macrophages have recently been reported. We report a new mode of T. gondii invasion using a time-lapse imaging system, in which T. gondii tachyzoites are engulfed by a tube-like structure on peritoneal macrophage phagosomes and then escape from the phagosomes. Escaped parasites re-invade macrophages through intercellular junctions between their apical end and host cell membranes. We call this invasion pathway of T. gondii "pseudopod-assisted invasion" (PAI). The completion of this invasion process depends on parasitic motility and secretion of adhesins from parasitic micronemes. Our results provide new information about T. gondii infection and establish another platform for studying interactions between T. gondii and macrophages.
The development of HIV drug resistance against the integrase strand transfer inhibitor dolutegravir is rare. We report here the transient detection, by near full-genome ultradeep sequencing, of minority HIV-1 subtype B variants bearing the S153F and R263K integrase substitutions in the proviral DNA from blood cells of one patient who successfully initiated dolutegravir-based ART, over 24 weeks. Our objective was to study the effects of these substitutions.

Strand transfer and DNA-binding activities of recombinant integrase proteins were measured in cell-free assays. Cell-based resistance, infectivity and replicative capacities were measured using molecular clones. Structural modelling was performed to understand experimental results.

R263K emerged first, followed by the addition of S153F at Week 12. By Week 24, both mutations remained present, but at lower prevalence. We confirmed the coexistence of S153F and R263K on single viral genomes. Combining S153F or S153Y with R263K decreased integration and vivariants did not compromise viral suppression in one individual treated with dolutegravir.
Dairy foods, particularly yogurt, and plasma biomarkers of dairy fat intake are consistently inversely associated with incident type 2 diabetes. Yet, few trials assessing the impact of dairy on glucose homeostasis include fermented or full-fat dairy foods.

We aimed to compare the effects of diets rich in low-fat or full-fat milk, yogurt, and cheese on glucose tolerance and its determinants, with those of a limited dairy diet.

In this parallel-design randomized controlled trial, 72 participants with metabolic syndrome completed a 4-wk wash-in period, limiting dairy intake to ≤3 servings/wk of nonfat milk. Participants were then randomly assigned to either continue the limited dairy diet, or switch to a diet containing 3.3 servings/d of either low-fat or full-fat dairy for 12 wk. Outcome measures included glucose tolerance (area under the curve glucose during an oral-glucose-tolerance test), insulin sensitivity, pancreatic β-cell function, systemic inflammation, liver-fat content, and body weight and composition.
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