Telaprevir-based triple-therapy in patients with chronic hepatitis C in Germany: a 12-week interim analysis of real-life data

Telaprevir (TVR)-based triple therapy in patients (pts) with chronic hepatitis C (HCV) in daily practice in Germany is investigated in this non-interventional study. Aims are the evaluation of the implementation of futility rules, as well as safety and efficacy of TVR-based therapy. This prospective, multi-center study investigates TVR-based therapy in therapy-naïve and pretreated pts with genotype 1 chronic HCV in Germany, including pts with HIV co-infection. Patients are treated with a combination of TVR, ribavirin and peg-interferon. This interim analysis includes data from the first 100 pts (12.5% of the planned total) at 32 sites completing 12 weeks (W) of treatment. 66% of pts were pretreated for HCV. 36.4% of pts with pre-treatment were prior relapsers and 30.3% null or partial responders. Cirrhosis was present in 11% of all pts at baseline. HCV RNA levels below 800.000 IU/ml at baseline were present in 50% of pts. 67% of pts showed rapid virological response (RVR, undetectable HCV RNA at W4). Adherence to the futility rule (treatment stop if HCV-RNA>1000 IU/ml at W4) was 100% (N=9). At W12, 91.4% of pts had undetectable HCV RNA. 57.7% of therapy-naïve pts and 86.4% of previous relapsers were HCV-RNA negative at both W4 and 12 (70.8% in total). Only one patient achieving RVR at W4 suffered a virologic breakthrough. Nearly all pts (99%) had adverse events (AE) during the first 12W, 6% reported serious adverse events (SAE). AEs were mostly mild (63.9%) or moderate (34.6%) and frequently mentioned dry skin/pruritus (54%), gastrointestinal disorders (48%), anorectal discomfort (30%), rash (29%) and anemia (23%). Rash was mostly rated as mild or moderate (97.1%). An Hb decrease<12 g/dl (female) or<13 g/dl (male) was reported in 87% of pts. Mean Hb levels decreased from 14.8 g/dl at baseline to 10.6 g/dl at W12; Hb levels<8.5 g/dl at any time within the first 12W of treatment were present in 11% of anemia cases and 6.6% required transfusion. Only one patient received erythropoietin treatment. 2 cases each of anemia and rash were considered as SAE. These interim results suggest that TVR-based triple-therapy is efficient against GT1 chronic hepatitis C in a real life setting. Adherence to futility rules was confirmed in all patients. As observed in clinical trials, adverse events were reported frequently, including anemia and rash. As more data become available, results will be updated

Age-related efficiency loss of household refrigeration appliances: Development of an approach to measure the degradation of insulation properties

Despite the omnipresence of household refrigeration appliances, there is still a lack of knowledge about their age-related efficiency loss over time. Past studies provide basic evidence for increasing electricity consumption of cooling appliances with ageing but fail to investigate the associated technical wear. Concentrating on the degradation of the thermal insulation, we first determined the ageing process of sealed samples of polyurethane rigid foam by investigating changes in cell gas composition and thermal conductivity over time. Simultaneously, the main challenge was to develop an approach that investigates the age-related efficiency loss of the insulation without its destruction. This testing procedure is referred to as the Bonn method. The non-destructive Bonn method was applied to varying refrigerator models in a series of successive experiments to evaluate the insulation degradation over time. Subsequently, the physical relationship between the test value of the Bonn method and the heat transfer through the multi-layered compartment walls of domestic refrigeration appliances was established, ultimately characterising the degrading insulation in terms of increasing heat transfer. Our results give substantiated evidence that the efficiency loss of cooling appliances is greatly influenced by insulation degradation over time. The ageing of sealed samples of polyurethane rigid foam indicates a large initial increase of thermal conductivity by 15% within the first year, corresponding to a change in cell gas composition. These results are in line with those of the Bonn method, emphasising an increasing heat flow through the multi-layered compartment walls of domestic refrigerators with ageing. Therewith, the present study is of significance to a wide range of stakeholders and forms the basis for future research.BMWi, 03ET1544, ALGE: Alterungsmechanismen von Haushaltskältegeräte

Determining the heat flow through the cabinet walls of household refrigerating appliances

The increase of the thermal conductivity of PUR foam in the insulation of the cabinet is an important cause for aging processes of household refrigerating appliances. To determine the influence of the PUR foam aging on energy consumption, the development of a new measurement method is necessary because current methods influence the aging behavior of household refrigerators and are therefore not applicable in general. Based on a latent heat sink, constructed as an ice water bucket, a new measurement method is developed to determine the k · A value over time. With this method, the k · A value of four household refrigerating appliances was determined over an interval of 14 months. The k · A value increased between 3.6 % and 11.5 % during this period.BMWi, 03ET1544A, Verbundvorhaben ALGE: Alterungsmechanismen von Haushaltskältegeräte

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Einsatz eines Dreiphasen-Wirbelbettreaktors im halbtechnischen Massstab zum biologischen Schadstoffabbau in Industrieabwaessern

Available from the library of Paderborn Univ. (Gesamthochschule) (DE) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman

A puzzle with missing pieces : institutional analysis of irrigation schemes in Iringa Rural District, Tanzania

Irrigation management has been internationally discussed and shapes national water policies, also in Tanzania. Yet, farmers in Iringa Rural district still suffer from too dry or flooded fields, while officials are blamed for failing to implement the water policy. Thus, to better understand what accounts for this gap between national regulations of irrigation and local irrigation practices, this study investigated the formalization process of the irrigation institutions from basin to village level and farmers’ livelihoods and dependence on irrigation. Mixed methods were used; institutional characteristics of a traditional (TS) and semi-improved scheme (IS) were analysed and compared from a mainstream and critical institutionalist perspective, farmers’ livelihoods with help of the sustainable livelihoods approach (SLA) (Ellis 2000a). The findings suggest that communal irrigation management works; yet, the institutions resembled a bricolage rather than a fixed set of rules (Cleaver 2012; Ostrom 1990). The IS had a higher level of formalization than the TS, but water use-rules were informal and often unfair. The amount of allocated water and the area schemes serve is similar, yet, the IS is used by seven villages, while the TS only by two villages. SLA showed that farmers in the TS owned four times more land and had higher net-incomes than farmers in the IS. In both schemes, farmers highly depended on irrigation: 70% of their main income share came from irrigated paddies, yet, from input-extensive production. Thus, irrigated paddies have high investment potential; but high irrigation dependency and low crop diversity also comes with a high economic risk and may increase farmers’ economic vulnerability. Further, a lack of water-allocation criteria on basin level facilitated the prioritization of hydropower over irrigation. Thus, farmers only have water access during the rainy season. Thus, formalization of schemes may lead to increased control over small-scale farmers and less resource access. Hence, farmers may face threat of resource appropriation by the state. Thus, this study recommends further investigation of the basin-wide water re-allocation between different water sectors in general, and within the economic sector and between small-scale and large-scale users in particular. Moreover, Tanzania needs to define clearer criteria for and stricter monitoring of water allocation while leaving room for more community driven local irrigation management within schemes.M-IE

Die Methoden der Bakterien-Forschung

Layoutgetreues Digitalisat der Ausg.: Wiesbaden : Kreidel, 1885 Standort: Fachgebiet für Geschichte der Medizin (192) Signatur: 778/IV Provenienz: Behring, Emil vo

Die Methoden der Bakterien-Forschung

von Ferdinand Huepp