Exploring patient characteristics and barriers to Hepatitis C treatment in patients on opioid substitution treatment (OST) attending a community based fibro-scanning clinic.

Background and Objectives: Hepatitis C virus (HCV) infection is a major public health issue. There is substandard uptake in HCV assessment and treatment among people who inject drugs (PWID). Community fibroscanning is used to assess disease severity and target treatment. Methods: A survey was administered to a cohort of chronically HCV infected patients attending a community fibroscanning clinic. Questions targeted diagnosis of HCV, suitability, willingness and barriers to engagement in treatment. Descriptive and regression analysis, with thematic analysis of open-ended data was conducted. Results: There was high acceptance of community fibroscanning among this cohort with over 90% (68) attending. High levels of unemployment (90%) and homelessness (40%) were identified. Most patients were on methadone treatment and had been HCV infected for greater than 10 years with length of time since HCV diagnosis being significantly longer in patients with fibroscan scores > 8.5 kPa (P = 0.016). With each unit increase in methadone dose, the odds of the >8.5 fibroscan group increased by 5.2%. Patient identified barriers to engagement were alcohol and drug use, fear of HCV treatment and liver biopsy, imprisonment, distance to hospital and early morning appointments. Conclusion: The study highlights the usefulness of community fibroscanning. Identifying barriers to treatment in this cohort affords an opportunity to increase the treatment uptake. The availability of afternoon clinics and enhanced prison linkage are warranted

Identifying Pathway Proteins in Networks using Convergence

One of the key goals of systems biology concerns the analysis of experimental biological data available to the scientific public. New technologies are rapidly developed to observe and report whole-scale biological phenomena; however, few methods exist with the ability to produce specific, testable hypotheses from this noisy ‘big’ data. In this work, we propose an approach that combines the power of data-driven network theory along with knowledge-based ontology to tackle this problem. Network models are especially powerful due to their ability to display elements of interest and their relationships as internetwork structures. Additionally, ontological data actually supplements the confidence of relationships within the model without clouding critical structure identification. As such, we postulate that given a (gene/protein) marker set of interest, we can systematically identify the core of their interactions (if they are indeed working together toward a biological function), via elimination of original markers and addition of additional necessary markers. This concept, which we refer to as “convergence,” harnesses the idea of “guilt-by-association” and recursion to identify whether a core of relationships exists between markers. In this study, we test graph theoretic concepts such as shortest-path, k-Nearest- Neighbor and clustering) to identify cores iteratively in data- and knowledge-based networks in the canonical yeast Pheromone Mating Response pathway. Additionally, we provide results for convergence application in virus infection, hearing loss, and Parkinson’s disease. Our results indicate that if a marker set has common discrete function, this approach is able to identify that function, its interacting markers, and any new elements necessary to complete the structural core of that function. The result below find that the shortest path function is the best approach of those used, finding small target sets that contain a majority or all of the markers in the gold standard pathway. The power of this approach lies in its ability to be used in investigative studies to inform decisions concerning target selection

Competing priorities and second chances - A qualitative exploration of prisoners’ journeys through the Hepatitis C continuum of care.

High levels of undiagnosed and untreated HCV infection exist in prison populations globally. Prisons are a key location to identify, treat and prevent HCV infection among people who inject drugs (PWID). Understanding prisoners’ lived experiences of the HCV continuum of care informs how HCV care can be effectively delivered to this marginalised and high-risk population. This study aimed to explore Irish prisoners’ experience of prison and community-based HCV care. We conducted one-to-one interviews with 25 male prisoners with chronic HCV infection. Data collection and analysis was informed by grounded theory. The mean age of participants and first incarceration was 39.5 and 18.3 years respectively. The mean number of incarcerations was eight. The following themes were identified: medical and social factors influencing engagement (fear of treatment and lack of knowledge, HCV relevance and competing priorities), adverse impact of HCV on health and wellness, positive experience of prison life and health care and the transformative clinical and non-clinical changes associated with HCV treatment and cure. Findings suggest that prison release was associated with multiple stressors including homelessness and drug dependence which quickly eroded the health benefits gained during incarceration. The study generated a substantive theory of the need to increase the importance of HCV care among the routine competing priorities associated with the lives of PWID. HCV infected prisoners often lead complex lives and understanding their journeys through the HCV continuum can inform the development of meaningful HCV care pathways. Many challenges exist to optimising HCV treatment uptake in this group and incarceration is an opportunity to successfully engage HCV infected prisoners who underutilise and are underserved by community-based medical services. Support and linkage to care on release is essential to optimising HCV management

Hepatitis c treatment and prevention in people who inject drugs (PWID) and prisoners: A narrative review of the extant literature

Background. Hepatitis C is a curable and preventable disease. People who inject drugs (PWID) and prisoners are at-risk groups for acquisition of Hepatitis C Virus (HCV), yet treatment rates remain low. Agonist Opioid Treatment (AOT) and needle syringe programs (NSP) reduce HCV transmission, yet coverage, particularly in prisons, is inadequate. ‘Treatment as prevention’ is a key public health strategy to help achieve the World Health Organisation (WHO) goal of HCV elimination by 2030. Aim: To review the recent literature on HCV treatment and prevention in PWID and prisoners. Methods: Electronic data base (Medline, PubMed, Cochrane library and Embase) and key website search using search terms related to the topic. Results: HCV related disease burden in PWID and prisoners is greater than the general population, yet treatment rates remain low. Direct acting anti-virals, mobile elastography, integration of treatment into community and prison settings and less restrictive treatment guidelines have removed many treatment barriers. Treatment adherence and outcomes, among PWID (even current injectors) and prisoners are equivalent to the general population. HCV treatment in both groups is cost-effective but is dependent on up scaling treatment levels, continuing treatment on prison release and preventing re-infection. The public health strategies of treatment as prevention and micro-elimination along with adequate coverage of AOT and NSP has the potential to achieve the WHO goal of HCV elimination by 2030. Conclusion: Upscaling HCV treatment levels and increasing AOT and NSP coverage among PWID and prisoners remains a challenge but is an essential public health strategy to reduce the increasing HCV burden

Hepatitis C Virus (HCV) screening in people who inject drugs (PWID) and prisoners - a narrative review of extant literature

Background: Injecting drug use (IDU) is the major driver of Hepatitis C Virus (HCV) infection in European and other developed countries. People who inject drugs (PWID) and prisoners, both marginalised and underserved populations are recognised as key groups to target for HCV screening and treatment. Aim: To review the most up to date published literature on HCV screening in PWID and prisoners Methods: Electronic data base (Medline, PubMed, Cochrane library and Embase) and relevant website search using key search terms related to the topic. Results: Data on HCV screening in these two groups is incomplete. Over half of PWID and a quarter of prisoners globally have been exposed to HCV. Multiple personal and institutional barriers, including; lack of knowledge, fear, stigma , complex testing procedures and competing priorities , have been identified to the upscaling of screening in these two groups. Focussed screening at targeted locations, increasing screening methods including the use of dried blood spot testing (DBS), peer-worker involvement and opt-out screening in prisons has the potential to enable uptake. Reflex-RNA testing streamlines identification of active infection and improves linkage to care. Supporting community linkage on prison release is critical to optimise HCV management. Active case finding in PWID and prisoners, provided within an ethical and human rights framework, increases diagnosis, assessment, and treatment, reduces transmission and is cost-effective. Conclusion: Optimising HCV screening in PWID and prisoners underpins any public and prison health strategy aimed at HCV elimination but requires political will and targeted resources to be successfully implemented

A Full PFPF Shell Model Study of a~=~48 Nuclei

Exact diagonalizations with a minimally modified realistic force lead to detailed agreement with measured level schemes and electromagnetic transitions in $^{48}$Ca, $^{48}$Sc, $^{48}$Ti, $^{48}$V, $^{48}$Cr and $^{48}$Mn. Gamow-Teller strength functions are systematically calculated and reproduce the data to within the standard quenching factor. Their fine structure indicates that fragmentation makes much strength unobservable. As a by-product, the calculations suggest a microscopic description of the onset of rotational motion. The spectroscopic quality of the results provides strong arguments in favour of the general validity of monopole corrected realistic forces, which is discussed.Comment: 30 pages, LaTeX with epsf.sty, 14 Postscript figures included and compressed using uufiles. Completely new version of previous preprint nucl-th/9307001. FTUAM-93/01, CRN/PT 93-3

Asia-Pacific consensus statement on the optimal use of high-sensitivity troponin assays in acute coronary syndromes diagnosis: focus on hs-TnI

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