The Roadmap concept: using early on-treatment virologic responses to optimize long-term outcomes for patients with chronic hepatitis B

Several large observational, longitudinal studies of the natural history of chronic hepatitis B (CHB) have demonstrated that high levels of hepatitis B virus (HBV) replication are associated with long-term risk of cirrhosis, decompensation, hepatocellular carcinoma, and liver-related mortality. The corollary is also true—profound and sustained suppression either spontaneously or during antiviral therapy will prevent disease progression and complications. Multiple analyses of various baseline factors and on-treatment responses have identified the absolute HBV DNA level after 24 weeks of therapy as the best predictor of long-term efficacy. Lower 24-week serum HBV DNA levels after lamivudine, telbivudine, or entecavir are associated with higher rates of maintained HBV DNA nondetectability, ALT normalization, HBeAg seroconversion, and lack of resistance. Patients with undetectable serum HBV DNA levels after 24 weeks have the best long-term outcomes while those with levels remaining above 10,000 copies per ml are unlikely to benefit from long-term therapy with that particular agent and either the addition or switch to another antiviral agent with increased potency but without cross resistance could be considered at this time point. In the future, improved on-treatment monitoring should facilitate treatment strategies to optimize long-term outcomes among patients receiving oral antiviral therapy for CHB

Nasal lysine aspirin challenge in the diagnosis of aspirin - exacerbated respiratory disease

Background Aspirin-exacerbated respiratory disease is under-diagnosed and therefore effective and inexpensive therapy with aspirin desensitization is rarely performed. Methods We present an audit of 150 patients with difficult to treat nasal polyposis, 132 of whom also had asthma, 131 of whom underwent challenge with the only soluble form of aspirin, lysine aspirin (LAS), to confirm or exclude the diagnosis of aspirin-exacerbated respiratory disease (AERD). Results One hundred patients proved positive on nasal challenge, 31 who were negative went onto oral LAS challenge and a further 14 gave positive results, leaving 17 who were negative to a dose equivalent to over 375 mg of aspirin. Nineteen were not challenged because of contraindications. With the exception of one patient who developed facial angioedema and two patients with > 20% drop in FEV1 (following nasal plus oral challenge) no other severe adverse events occurred. No hospitalization was required for these three patients. Nasal inspiratory peak flow monitoring was less sensitive to obstruction caused by aspirin than was acoustic rhinometry – which should be employed when aspirin challenge is an outpatient procedure. Conclusions Provided patients are carefully chosen and monitored LAS challenge is suitable for ENT day case practice where respiratory physician help with asthma is available and should reduce the under-diagnosis of this condition

Porometry, porosimetry, image analysis and void network modelling in the study of the pore-level properties of filters

We present fundamental and quantitative comparisons between the techniques of porometry (or flow permporometry), porosimetry, image analysis and void network modelling for seven types of filter, chosen to encompass the range of simple to complex void structure. They were metal, cellulose and glass fibre macro- and meso-porous filters of various types. The comparisons allow a general re-appraisal of the limitations of each technique for measuring void structures. Porometry is shown to give unrealistically narrow void size distributions, but the correct filtration characteristic when calibrated. Shielded mercury porosimetry can give the quaternary (sample-level anisotropic) characteristics of the void structure. The first derivative of a mercury porosimetry intrusion curve is shown to underestimate the large number of voids, but this error can be largely corrected by the use of a void network model. The model was also used to simulate the full filtration characteristic of each sample, which agreed with the manufacturer's filtration ratings. The model was validated through its correct a priori simulation of absolute gas permeabilities for track etch, cellulose nitrate and sintered powder filters. © 2011 Elsevier Ltd

The Institute of Archaeology & Siegfried H. Horn Museum Newsletter Volume 40.2

ASOR 2018 Annual Meeting, Paul J. Ray, Jr. New Collection, Constance E. Gane Al-Maktába: The Bookstore Random Surveyhttps://digitalcommons.andrews.edu/iaham-news/1078/thumbnail.jp

School Chaplaincy is Effective But Could it Be Better?

Analysis of the data collected in the Valuegenesis II study of 3263 students in Seventh-day Adventist schools, indicates that 63% consider the school chaplain has influenced their development of faith. Further, school chaplaincy is associated with statistically significant positive differences in the levels of Faith Maturity, Christian Commitment, Intrinsic Orientation to Religion, Positive Views of God, Denominational Loyalty and Social Responsibility, being a medium to large effect impacting students lives. The potential of reflective practice to improve the outcomes of chaplaincy in the current context of low levels of job satisfaction and chaplaincy retention is considered

A Nexus of Eyes: The Praxis of Chaplaincy in One Faith Based Educational System Through Emerging Emic Perspectives

Internationally chaplaincy as a whole, and school based chaplaincy in particular, is morphing into new forms within emerging national uncertainties, and cultural diversity. Drawing on their work in Ireland, King and Norman (2009) believe that the role of school chaplains everywhere needs to be carefully realigned and rethought. This paper seeks in part to address this situation, unpacking the initial ‘emic-journey’ of a three year multi-case study research agenda that seeks to holistically investigate how key stakeholders in three faith based schools understand the role and practice of school chaplains. In this instance, the stakeholders included administrators, chaplains and students. The multi-case study approach and the stratified sets of respondents were deemed to be the best ‘goodness of fit’ as Parekh’s (2000) axiom clearly states an understanding that one group’s place within an organisation needs to be considered not in isolation, but as intersecting forces that act as a “locus of identity.

Exploring access to end of life care for ethnic minorities with end stage kidney disease through recruitment in action research

BACKGROUND: Variation in provision of palliative care in kidney services and practitioner concerns to provide equitable access led to the development of this study which focussed on the perspectives of South Asian patients and their care providers. As people with a South Asian background experience a higher risk of Type 2 Diabetes (T2DM) and end stage kidney failure (ESKF) compared to the majority population but wait longer for a transplant, there is a need for end of life care to be accessible for this group of patients. Furthermore because non English speakers and people at end of life are often excluded from research there is a dearth of research evidence with which to inform service improvement. This paper aims to explore issues relating to the process of recruitment of patients for a research project which contribute to our understanding of access to end of life care for ethnic minority patients in the kidney setting. METHODS: The study employed an action research methodology with interviews and focus groups to capture and reflect on the process of engaging with South Asian patients about end of life care. Researchers and kidney care clinicians on four NHS sites in the UK recruited South Asian patients with ESKF who were requiring end of life care to take part in individual interviews; and other clinicians who provided care to South Asian kidney patients at end of life to take part in focus groups exploring end of life care issues. In action research planning, action and evaluation are interlinked and data were analysed with emergent themes fed back to care providers through the research cycle. Reflections on the process of patient recruitment generated focus group discussions about access which were analysed thematically and reported here. RESULTS: Sixteen patients were recruited to interview and 45 different care providers took part in 14 focus groups across the sites. The process of recruiting patients to interview and subsequent focus group data highlighted some of the key issues concerning access to end of life care. These were: the identification of patients approaching end of life; and their awareness of end of life care; language barriers and informal carers' roles in mediating communication; and contrasting cultures in end of life kidney care. CONCLUSIONS: Reflection on the process of recruitment in this action research study provided insight into the complex scenario of end of life in kidney care. Some of the emerging issues such as the difficulty identifying patients are likely to be common across all patient groups, whilst others concerning language barriers and third party communication are more specific to ethnic minorities. A focus on South Asian ethnicity contributes to better understanding of patient perspectives and generic concepts as well as access to end of life kidney care for this group of patients in the UK. Action research was a useful methodology for achieving this and for informing future research to include informal carers and other ethnic groups.Peer reviewedFinal Published versio

The Institute of Archaeology & Siegfried H. Horn Museum Newsletter Volume 34.4

Jordan Conference in Berlin, Paul J. Ray, Jr. Students at Gezer, Constance E. Gane Al-Maktába: The Bookstore Random Surveyhttps://digitalcommons.andrews.edu/iaham-news/1056/thumbnail.jp

The Institute of Archaeology & Siegfried H. Horn Museum Newsletter Volume 30.3

The 2009 Excavations at Jalul, Constance E. Gane and Randall W. Younker Chesnut Lecture, Paul J. Ray, Jr. Ziese Lecture, Owen Chesnut Random Surveyhttps://digitalcommons.andrews.edu/iaham-news/1039/thumbnail.jp

The Institute of Archaeology & Siegfried H. Horn Museum Newsletter Volume 43.3

Khirbat Safra 2022, Paul Gregor, Robert Bates, Constance Gane, Trisha Broy, and Paul J. Ray, Jr. Random Surveyhttps://digitalcommons.andrews.edu/iaham-news/1091/thumbnail.jp