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Determination of HIV-1 co-receptor usage in German patients : comparison of genotypic methods with the TROFILE® phenotypic assay
(2008)
- Poster presentation: Background Maraviroc is a new drug used to treat HIV infection from the new class of drugs called CCR5 entry inhibitors. As the active principle of these drugs is to block the CCR5-receptor on the surface of the target cells, it has to be known if the virus in the patient is using only CCR5 as co-receptor or if there are populations that can also use CXCR4. Therefore, an assay to determine the tropism has to be performed before starting a therapy. Besides phenotypic assays like the TROFILE® assay by Monogram, used in the approval studies, there exist several genotyping systems like geno2pheno-coreceptor, Wetcat (providing five different genotypic tropism schemes) and WebPSSM. ...
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The L76V mutation in HIV-1 protease is potentially associated with hypersusceptibility to protease inhibitors Atazanavir and Saquinavir: is there a clinical advantage?
(2011)
- Background: Although being considered as a rarely observed HIV-1 protease mutation in clinical isolates, the L76V-prevalence increased 1998-2008 in some European countries most likely due to the approval of Lopinavir, Amprenavir and Darunavir which can select L76V. Beside an enhancement of resistance, L76V is also discussed to confer hypersusceptibility to the drugs Atazanavir and Saquinavir which might enable new treatment strategies by trying to take advantage of particular mutations. Results: Based on a cohort of 47 L76V-positive patients, we examined if there might exist a clinical advantage for L76V-positive patients concerning long-term success of PI-containing regimens in patients with limited therapy options. Genotypic- and phenotypic HIV-resistance tests from 47 mostly multi-resistant, L76V-positive patients throughout Germany were accomplished retrospectively 1999-2009. Five genotype-based drug-susceptibility predictions received from online interpretation-tools for Atazanavir, Saquinavir, Amprenavir and Lopinavir, were compared to phenotype-based predictions that were determined by using a recombinant virus assay along with a Virtual Phenotype™(Virco). The clinical outcome of the L76V-adapted follow-up therapy was determined by monitoring viral load for 96 weeks. Conclusions: In this analysis, the mostly used interpretation systems overestimated the L76V-mutation concerning Atazanavir- and SQV resistance. In fact, a clear benefit in drug susceptibility for these drugs was observed in phenotype analysis after establishment of L76V. More importantly, long-term therapy success was significantly higher in patients receiving Atazanavir and/or Saquinavir plus one L76V-selecting drug compared to patients without L76V-selecting agents (p = 0.002). In case of L76V-occurrence ATV and/or SQV may represent encouraging options for patients in deep salvage situations.
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Flexibilisierung von Arbeitszeiten und Arbeitsformen in Bibliotheken
(2001)
- Die vorliegende, von Studierenden der Fachhochschule für Bibliothekswesen in Frankfurt am Main erstellte Projektarbeit befaßt sich mit Fragen, Aspekten und Möglichkeiten der Flexibilisierung von Arbeitszeiten und Arbeitsformen in Bibliotheken. Im ersten Teil der Arbeit werden die wichtigsten Arbeitsteilzeitmodelle vorgestellt und deren Vorteile für Arbeitgeber und nehmer herausgearbeitet. Anschließend erfolgt eine durch Graphiken und Tabellen veranschaulichte Untersuchung von drei ausgewählte Universitätsbibliotheken (Gießen, Marburg, Mainz) in bezug auf bereits existierende Arbeitszeitflexibilisierung. Ein Ausblick geht der Frage nach, ob die dargestellten Teilzeitmodelle für Bibliotheken notwendig und ausreichend sind. Der zweite Themenkomplex befaßt sich mit der Telearbeit als einer innovativen Arbeitsform in Bibliotheken. Ausgehend von einer Begriffsbestimung werden verschiedene Formen der Telearbeit sowie deren Vor und Nachteile geschildert. Es wird erläutert, welche Bedingungen an den Telearbeiter und seinen Arbeitsplatz geknüpft sind, welche rechtlichen Voraussetzungen erfüllt werden müssen, welche finanziellen Aspekte eine Rolle spielen und welche Anwendungsmöglichkeiten für Telearbeit in Bibliotheken bestehen. An drei konkreten Beispielen wird dann geschildert, wie Telearbeit in Bibliotheken bereits verwirklicht wurde. Abschließend wird der Frage nachgegangen, welche Perspektiven der Einsatz von Telearbeit in Bibliotheken hat. Der dritte Abschnitt der Ausarbeitung stellt das bibliothekarische Call Center als neue Form einer benutzerorientierten Einrichtung vor. Zielsetzungen und Dienstleistungsformen des Call Centers werden ebenso abgehandelt wie Aspekte der Planung, Einrichtung und Arbeitsplatzergonomie sowie des Einsatzes von Telearbeit. Anhand des Beispiels der Zentral und Landesbibliothek Berlin wird schließlich dokumentiert, wie sich ein bibliothekarisches Call Center in der Praxis bereits bewährt hat.
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Development and validation of a paediatric long-bone fracture classification : a prospective multicentre study in 13 European paediatric trauma centres
(2011)
- Background: The aim of this study was to develop a child-specific classification system for long bone fractures and to examine its reliability and validity on the basis of a prospective multicentre study. Methods: Using the sequentially developed classification system, three samples of between 30 and 185 paediatric limb fractures from a pool of 2308 fractures documented in two multicenter studies were analysed in a blinded fashion by eight orthopaedic surgeons, on a total of 5 occasions. Intra- and interobserver reliability and accuracy were calculated. Results: The reliability improved with successive simplification of the classification. The final version resulted in an overall interobserver agreement of kappa=0.71 with no significant difference between experienced and less experienced raters. Conclusions: In conclusion, the evaluation of the newly proposed classification system resulted in a reliable and routinely applicable system, for which training in its proper use may further improve the reliability. It can be recommended as a useful tool for clinical practice and offers the option for developing treatment recommendations and outcome predictions in the future.
