Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [-5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [-5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. Funding: Bill & Melinda Gates Foundation

Timing of oviposition by western flower thrips (Thysanoptera: Thripidae) in apple fruit

Adult western flower thrips, Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae), were most abundant on flower clusters of apple, Malus × domestica Borkhausen, from king bloom to full bloom. Low numbers of thrips remained on the clusters after petal fall as fruit enlarged. Thrips larvae peaked in numbers after densities of adults had peaked, usually by petal fall. Two staining procedures were developed for detecting thrips eggs in the surface of fruit ovary tissues (the edible portion of fruit), and in other blossom tissues (stamen, style, calyx, stem and leaves). Eggs were abundant in the latter tissues throughout the bloom and post—bloom periods; the calyx appeared to be highly preferred. Few eggs were detected in fruit ovary tissues during bloom. Egg numbers in ovary tissues began to increase about 8-13 d after full bloom, when fruit had grown beyond 5 mm diameter. The most effective timing of pesticides corroborated the oviposition data. Formetanate hydrochloride or spinosad caused the greatest reduction in oviposition injury (pansy spot) when applied from full bloom to about 5 mm fruit diameter

Modus Vivendi Beyond the Social Contract: Peace, Justice, and Survival in Realist Political Theory

This essay examines the promise of the notion of modus vivendi for realist political theory. I interpret recent theories of modus vivendi as affirming the priority of peace over justice, and explore several ways of making sense of this idea. I proceed to identify two key problems for modus vivendi theory, so conceived. Normatively speaking, it remains unclear how this approach can sustain a realist critique of Rawlsian theorizing about justice while avoiding a Hobbesian endorsement of absolutism. And conceptually, the theory remains wedded to a key feature of social contract theory: political order is conceived as based on agreement. This construes the horizontal tensions among individual or group agents in society as prior to the vertical, authoritative relations between authorities and their subjects. Political authority thereby appears from the start as a solution to societal conflict, rather than a problem in itself. I argue that this way of framing the issue abstracts from political experience. Instead I attempt to rethink the notion of modus vivendi from within the lived experience of political conflict, as oriented not primarily toward peace, but political survival. With this shift of perspective, the idea of modus vivendi shows us, pace Bernard Williams, that the “first political question” is not how to achieve order and stability, but rather: what can I live with

Putting knowledge to work in clinical practice: understanding experiences of preceptorship as outcomes of interconnected domains of learning

Aim: To understand newly qualified nurses’ learning during the preceptorship period. Background: Newly qualified nurses’ learning during their transition to confident professional practice is facilitated by effective and supportive preceptorship. Several studies have alluded to, but not directly investigated or addressed contextual factors which may prevent the delivery of effective and supportive preceptorship. Design: Two-phase ethnographic case study design in three hospital sites in England from 2011-2014. Methods: Phase One included participant observation, interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers, the design of a tool to develop newly qualified nurses’ delegation skills during their preceptorship period. This tool was piloted in Phase Two with thirteen newly qualified nurses in the same sites. Data were analysed using thematic analysis. Findings: Constraints on available time for preceptorship, unsupportive ward cultures, and personal learning styles may limit effective preceptorship if time for learning and knowledge recontextualisation is restricted. For newly qualified nurses in supportive ward cultures, limited access to formal preceptorship can be bolstered by team support. Newly qualified nurses in less supportive ward cultures may have both a greater need for preceptorship and have fewer compensatory mechanisms available to them when formal preceptorship is not available. We argue that organisational learning contexts and individual learning styles which facilitate recontextualisation of knowledge in this group of nurses are key to understanding effective preceptorship. Conclusions: This study reports constraints to effective preceptorship which affect newly qualified nurses in their early careers. We recommend a need for greater prioritisation and ‘ring-fencing’ of time for formal preceptorship to ensure newly qualified nurses are appropriately supported in their transition to confident professional practice. Relevance to clinical practice: We discuss ways to improve preceptorship at ward and organizational level through policy, practice and education and suggest future research in this are

Delegation and supervision of health care assistants’ work in the daily management of uncertainty and the unexpected in clinical practice: invisible learning among newly qualified nurses

The invisibility of nursing work has been discussed in the international literature but not in relation to learning clinical skills. Evans and Guile’s (2012) theory of recontextualisation is used to explore the ways in which invisible or unplanned and unrecognised learning takes place as newly qualified nurses learn to delegate to and supervise the work of the health care assistant. In the British context, delegation and supervision are thought of as skills which are learnt ‘on the job’. We suggest that learning ‘on-the-job’ is the invisible construction of knowledge in clinical practice and that delegation is a particularly telling area of nursing practice which illustrates invisible learning. Using an ethnographic case study approach in three hospital sites in England from 2011-2014, we undertook participant observation, interviews with newly qualified nurses, ward managers and health care assistants. We discuss the invisible ways newly qualified nurses learn in the practice environment and present the invisible steps to learning which encompass the embodied, affective and social, as much as the cognitive components to learning. We argue that there is a need for greater understanding of the ‘invisible learning’ which occurs as newly qualified nurses learn to delegate and supervise

Post-treatment follow-up study of abdominal cystic echinococcosis in Tibetan communities of northwest Sichuan Province, China

Background: Human cystic echinococcosis (CE), caused by the larval stage of Echinococcus granulosus, with the liver as the most frequently affected organ, is known to be highly endemic in Tibetan communities of northwest Sichuan Province. Antiparasitic treatment with albendazole remains the primary choice for the great majority of patients in this resource-poor remote area, though surgery is the most common approach for CE therapy that has the potential to remove cysts and lead to complete cure. The current prospective study aimed to assess the effectiveness of community based use of cyclic albendazole treatment in Tibetan CE cases, and concurrently monitor the changes of serum specific antibody levels during treatment. Methodology/Principal Findings: Ultrasonography was applied for diagnosis and follow-up of CE cases after cyclic albendazole treatment in Tibetan communities of Sichuan Province during 2006 to 2008, and serum specific IgG antibody levels against Echinococcus granulosus recombinant antigen B in ELISA was concurrently monitored in these cases. A total of 196 CE cases were identified by ultrasound, of which 37 (18.9%) showed evidence of spontaneous healing/involution of hepatic cyst(s) with CE4 or CE5 presentations. Of 49 enrolled CE cases for treatment follow-up, 32.7% (16) were considered to be cured based on B-ultrasound after 6 months to 30 months regular albendazole treatment, 49.0% (24) were improved, 14.3% (7) remained unchanged, and 4.1% (2) became aggravated. In general, patients with CE2 type cysts (daughter cysts present) needed a longer treatment course for cure (26.4 months), compared to cases with CE1 (univesicular cysts) (20.4 months) or CE3 type (detached cyst membrane or partial degeneration of daughter cysts) (9 months). In addition, the curative duration was longer in patients with large (.10 cm) cysts (22.3 months), compared to cases with medium (5– 10 cm) cysts (17.3 months) or patients with small (,5 cm) cysts (6 months). At diagnosis, seven (53.8%) of 13 cases with CE1 type cysts without any previous intervention showed negative specific IgG antibody response to E. granulosus recombinant antigen B (rAgB). However, following 3 months to 18 months albendazole therapy, six of these 7 initially seronegative CE1 cases sero-converted to be specific IgG antibody positive, and concurrently ultrasound scan showed that cysts changed to CE3a from CE1 type in all the six CE cases. Two major profiles of serum specific IgG antibody dynamics during albendazole treatment were apparent in CE cases: (i) presenting as initial elevation followed by subsequent decline, or (ii) a persistent decline. Despite a decline, however, specific antibody levels remained positive in most improved or cured CE cases. Conclusions: This was the first attempt to follow up community-screened cystic echinococcosis patients after albendazole therapy using ultrasonography and serology in an endemic Tibetan region. Cyclic albendazole treatment proved to be effective in the great majority of CE cases in this resource-poor area, but periodic abdominal ultrasound examination was necessary to guide appropriate treatment. Oral albendazole for over 18 months was more likely to result in CE cure. Poor drug compliance resulted in less good outcomes. Serology with recombinant antigen B could provide additional limited information about the effectiveness of albendazole in CE cases. Post-treatment positive specific IgG antibody seroconversion, in initially seronegative, CE1 patients was considered a good indication for positive therapeutic efficacy of albendazole

'Doing the writing' and 'working in parallel': how 'distal nursing' affects delegation and supervision in the emerging role of the newly qualified nurse

Background: The role of the acute hospital nurse has moved away from the direct delivery of patient care and more towards the management of the delivery of bedside care by healthcare assistants. How newly qualified nurses delegate to and supervise healthcare assistants is important as failures can lead to care being missed, duplicated and/or incorrectly performed. Objectives: The data described here form part of a wider study which explored how newly qualified nurses recontextualise knowledge into practice, and develop and apply effective delegation and supervision skills. This article analyses team working between newly qualified nurses and healthcare assistants, and nurses' balancing of administrative tasks with bedside care. Methods and Analysis: Ethnographic case studies were undertaken in three hospital sites in England, using a mixed methods approach involving: participant observations; interviews with 33 newly qualified nurses, 10 healthcare assistants and 12 ward managers. Data were analysed using thematic analysis, aided by the qualitative software NVivo. Findings:Multiple demands upon the newly qualified nurses' time, particularly the pressures tomaintain records, can influence how effectively they delegate to, and supervise, healthcare assistants. While some nurses and healthcare assistants work successfully together, others work ‘in parallel’ rather than as an efficient team. Conclusions: While some ward cultures and individual working styles promote effective team working, others lead to less efficient collaboration between newly qualified nurses and healthcare assistants. In particular the need for qualified nurses to maintain records can create a gap between them, and between nurses and patients. Newly qualified nurses require more assistance in managing their own time and developing successful working relationships with healthcare assistants

Quasi-Two-Dimensional Dynamics of Plasmas and Fluids

In the lowest order of approximation quasi-twa-dimensional dynamics of planetary atmospheres and of plasmas in a magnetic field can be described by a common convective vortex equation, the Charney and Hasegawa-Mirna (CHM) equation. In contrast to the two-dimensional Navier-Stokes equation, the CHM equation admits "shielded vortex solutions" in a homogeneous limit and linear waves ("Rossby waves" in the planetary atmosphere and "drift waves" in plasmas) in the presence of inhomogeneity. Because of these properties, the nonlinear dynamics described by the CHM equation provide rich solutions which involve turbulent, coherent and wave behaviors. Bringing in non ideal effects such as resistivity makes the plasma equation significantly different from the atmospheric equation with such new effects as instability of the drift wave driven by the resistivity and density gradient. The model equation deviates from the CHM equation and becomes coupled with Maxwell equations. This article reviews the linear and nonlinear dynamics of the quasi-two-dimensional aspect of plasmas and planetary atmosphere starting from the introduction of the ideal model equation (CHM equation) and extending into the most recent progress in plasma turbulence.U. S. Department of Energy DE-FG05-80ET-53088Ministry of Education, Science and Culture of JapanFusion Research Cente

Continuum Model for River Networks

The effects of erosion, avalanching and random precipitation are captured in a simple stochastic partial differential equation for modelling the evolution of river networks. Our model leads to a self-organized structured landscape and to abstraction and piracy of the smaller tributaries as the evolution proceeds. An algebraic distribution of the average basin areas and a power law relationship between the drainage basin area and the river length are found.Comment: 9 pages, Revtex 3.0, 7 figures in compressed format using uufiles command, to appear in Phys. Rev. Lett., for an hard copy or problems e-mail to [email protected]