A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B

OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naive CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading >/= 7 or fibrosis score >/= 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 x upper limit of normal (ULN) and > x 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.published_or_final_versio

Crowdsourcing hypothesis tests: Making transparent how design choices shape research results

To what extent are research results influenced by subjective decisions that scientists make as they design studies? Fifteen research teams independently designed studies to answer fiveoriginal research questions related to moral judgments, negotiations, and implicit cognition. Participants from two separate large samples (total N > 15,000) were then randomly assigned to complete one version of each study. Effect sizes varied dramatically across different sets of materials designed to test the same hypothesis: materials from different teams renderedstatistically significant effects in opposite directions for four out of five hypotheses, with the narrowest range in estimates being d = -0.37 to +0.26. Meta-analysis and a Bayesian perspective on the results revealed overall support for two hypotheses, and a lack of support for three hypotheses. Overall, practically none of the variability in effect sizes was attributable to the skill of the research team in designing materials, while considerable variability was attributable to the hypothesis being tested. In a forecasting survey, predictions of other scientists were significantly correlated with study results, both across and within hypotheses. Crowdsourced testing of research hypotheses helps reveal the true consistency of empirical support for a scientific claim.</div

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Water pollution in a densely populated megapolis, Dhaka

Rapid urbanization has been a boon for industrial growth in Bangladesh, leading the Dhaka megapolis to become one of the least livable places in the world. These circumstances, however, have received little attention by policy makers and in academic research. Using mainly secondary data, this article explores the water quality of the river Buriganga that flows across Dhaka and identifies major sources of pollutants. While much of the article analyzes the sources and extent of pollution, it also points toward a great threat to public health from the presence of high levels of heavy metals, such as chromium, lead, and iron, as well as chemicals, including ammonia and phosphate. Moreover, the article recommends some policy changes that could potentially reduce pollution levels and boost water sustainability not only in Dhaka but also in other fast-growing cities in the least developed countries (LDCs)

A feasibility study of introducing chin straps of safety helmets as a statutory requirement in Hong Kong construction industry

Safety helmets contribute to the protection of head and wearing it is a statutory requirement in Hong Kong construction sites. However, there is a lack of secured system between the helmet and head which caused rolling off of helmet in few circumstances. A chin strap has a design function that secures the head and helmet in order to prevent it from rolling off. This paper aims to identify the current usage, safety performance and negative impact of using chin straps on safety helmets in the Hong Kong construction industry. It is found that effectively using chin straps can secure the helmets onto head and prevent it from rolling off. However, retractable chin straps brought greater discomfort to the workers than adjustable chin straps. It is also figured out when workers did not wear chin straps, there are few circumstances that will cause the helmets to roll off such as heading up/down, windy condition and slight impact. The most significant finding is that there is inadequate knowledge and cognition for workers who did not wear chin straps. It is thus necessary for the relevant government departments to revise the statutory requirements on safety helmets. Construction companies should also encourage the workers to use chin straps so that the safety performance of construction industry can be improved

Efficacy of gross floor area concession policy : empirical study in Hong Kong

In 2001, the Hong Kong government implemented a concession policy allowing green and amenity features to be exempted from gross floor area (GFA) calculations in new residential properties. There have recently been community concerns that developers are using this policy to substantially increase the floor area of buildings. In the 2010-2011 policy address, the Hong Kong government decided to tighten the existing policy. This paper attempts to estimate the efficacy of the proposed GFA concession policy. Five case studies are selected to demonstrate the change in GFA concession. It is found that the proposed GFA concessionary has a positive effect in controlling the height and bulk of buildings, and a reduction of approximately 4.58% GFA concession can be achieved, compared to the existing policy. However, some negative effects are also created, including the increase of housing price (or the drop of land auction price) and the discouragement of green features

Identification of Safety-Related Opinion Leaders among Construction Workers: Evidence from Scaffolders of Metro Construction in Wuhan, China

This study aimed to reveal opinion leaders who could impact their coworkers&rsquo; safety-related performance in Chinese construction teams. Questionnaires were distributed to 586 scaffolders in Wuhan to understand their opinions about influencing their coworkers, serving as the foundation for a social network analysis to identify the potential opinion leaders among workers. A further controlled trial with the identified workers was conducted to select real opinion leaders by comparing their influence on others&rsquo; safety-related behavior, followed by an association analysis to profile these opinion leaders. Two main sources of opinion leaders were identified: foremen and seasoned workers. Implementing interventions through opinion leaders resulted in better safety-related behavior performance. Furthermore, compared with education level, the association analysis results indicated that one&rsquo;s practical skills and familiarity with respondents was more important in the formulation of opinion leaders. This research introduces the concept of opinion leaders into construction safety and proposes an approach to identify and validate opinion leaders within a crew, thus providing a tool to improve behavior promotion on sites, as well as a new perspective for viewing interactions among workers