Risk of All-Cause Mortality in Alcohol-Dependent Individuals: A Systematic Literature Review and Meta-Analysis.

BACKGROUND: Alcohol dependence (AD) carries a high mortality burden, which may be mitigated by reduced alcohol consumption. We conducted a systematic literature review and meta-analysis investigating the risk of all-cause mortality in alcohol-dependent subjects. METHODS: MEDLINE, MEDLINE In-Process, Embase and PsycINFO were searched from database conception through 26th June 2014. Eligible studies reported all-cause mortality in both alcohol-dependent subjects and a comparator population of interest. Two individuals independently reviewed studies. Of 4540 records identified, 39 observational studies were included in meta-analyses. FINDINGS: We identified a significant increase in mortality for alcohol-dependent subjects compared with the general population (27 studies; relative risk [RR] = 3.45; 95% CI [2.96, 4.02]; p < 0.0001). The mortality increase was also significant compared to subjects qualifying for a diagnosis of alcohol abuse or subjects without alcohol use disorders (AUDs). Alcohol-dependent subjects continuing to drink heavily had significantly greater mortality than alcohol-dependent subjects who reduced alcohol intake, even if abstainers were excluded (p < 0.05). INTERPRETATION: AD was found to significantly increase an individual's risk of all-cause mortality. While abstinence in alcohol-dependent subjects led to greater mortality reduction than non-abstinence, this study suggests that alcohol-dependent subjects can significantly reduce their mortality risk by reducing alcohol consumption

Modelling the consequences of a reduction in alcohol consumption among patients with alcohol dependence based on real-life observational data.

BACKGROUND: Most available pharmacotherapies for alcohol-dependent patients target abstinence; however, reduced alcohol consumption may be a more realistic goal. Using randomized clinical trial (RCT) data, a previous microsimulation model evaluated the clinical relevance of reduced consumption in terms of avoided alcohol-attributable events. Using real-life observational data, the current analysis aimed to adapt the model and confirm previous findings about the clinical relevance of reduced alcohol consumption. METHODS: Based on the prospective observational CONTROL study, evaluating daily alcohol consumption among alcohol-dependent patients, the model predicted the probability of drinking any alcohol during a given day. Predicted daily alcohol consumption was simulated in a hypothetical sample of 200,000 patients observed over a year. Individual total alcohol consumption (TAC) and number of heavy drinking days (HDD) were derived. Using published risk equations, probabilities of alcohol-attributable adverse health events (e.g., hospitalizations or death) corresponding to simulated consumptions were computed, and aggregated for categories of patients defined by HDDs and TAC (expressed per 100,000 patient-years). Sensitivity analyses tested model robustness. RESULTS: Shifting from >220 HDDs per year to 120-140 HDDs and shifting from 36,000-39,000 g TAC per year (120-130 g/day) to 15,000-18,000 g TAC per year (50-60 g/day) impacted substantially on the incidence of events (14,588 and 6148 events avoided per 100,000 patient-years, respectively). Results were robust to sensitivity analyses. CONCLUSIONS: This study corroborates the previous microsimulation modeling approach and, using real-life data, confirms RCT-based findings that reduced alcohol consumption is a relevant objective for consideration in alcohol dependence management to improve public health

The cost-effectiveness and public health benefit of nalmefene added to psychosocial support for the reduction of alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels: a Markov model.

OBJECTIVES: To determine whether nalmefene combined with psychosocial support is cost-effective compared with psychosocial support alone for reducing alcohol consumption in alcohol-dependent patients with high/very high drinking risk levels (DRLs) as defined by the WHO, and to evaluate the public health benefit of reducing harmful alcohol-attributable diseases, injuries and deaths. DESIGN: Decision modelling using Markov chains compared costs and effects over 5 years. SETTING: The analysis was from the perspective of the National Health Service (NHS) in England and Wales. PARTICIPANTS: The model considered the licensed population for nalmefene, specifically adults with both alcohol dependence and high/very high DRLs, who do not require immediate detoxification and who continue to have high/very high DRLs after initial assessment. DATA SOURCES: We modelled treatment effect using data from three clinical trials for nalmefene (ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)). Baseline characteristics of the model population, treatment resource utilisation and utilities were from these trials. We estimated the number of alcohol-attributable events occurring at different levels of alcohol consumption based on published epidemiological risk-relation studies. Health-related costs were from UK sources. MAIN OUTCOME MEASURES: We measured incremental cost per quality-adjusted life year (QALY) gained and number of alcohol-attributable harmful events avoided. RESULTS: Nalmefene in combination with psychosocial support had an incremental cost-effectiveness ratio (ICER) of £5204 per QALY gained, and was therefore cost-effective at the £20,000 per QALY gained decision threshold. Sensitivity analyses showed that the conclusion was robust. Nalmefene plus psychosocial support led to the avoidance of 7179 alcohol-attributable diseases/injuries and 309 deaths per 100,000 patients compared to psychosocial support alone over the course of 5 years. CONCLUSIONS: Nalmefene can be seen as a cost-effective treatment for alcohol dependence, with substantial public health benefits. TRIAL REGISTRATION NUMBERS: This cost-effectiveness analysis was developed based on data from three randomised clinical trials: ESENSE 1 (NCT00811720), ESENSE 2 (NCT00812461) and SENSE (NCT00811941)

Antimatter from the cosmological baryogenesis and the anisotropies and polarization of the CMB radiation

We discuss the hypotheses that cosmological baryon asymmetry and entropy were produced in the early Universe by phase transition of the scalar fields in the framework of spontaneous baryogenesis scenario. We show that annihilation of the matter-antimatter clouds during the cosmological hydrogen recombination could distort of the CMB anisotropies and polarization by delay of the recombination. After recombination the annihilation of the antibaryonic clouds (ABC) and baryonic matter can produce peak-like reionization at the high redshifts before formation of quasars and early galaxy formation. We discuss the constraints on the parameters of spontaneous baryogenesis scenario by the recent WMAP CMB anisotropy and polarization data and on possible manifestation of the antimatter clouds in the upcoming PLANCK data.Comment: PRD in press with minor change

Elastic scattering and breakup of 17^F at 10 MeV/nucleon

Angular distributions of fluorine and oxygen produced from 170 MeV 17^F incident on 208^Pb were measured. The elastic scattering data are in good agreement with optical model calculations using a double-folding potential and parameters similar to those obtained from 16^O+208^Pb. A large yield of oxygen was observed near \theta_lab=36 deg. It is reproduced fairly well by a calculation of the (17^F,16^O) breakup, which is dominated by one-proton stripping reactions. The discrepancy between our previous coincidence measurement and theoretical predictions was resolved by including core absorption in the present calculation.Comment: 9 pages, 5 figure

On the variation of the gauge couplings during inflation

It is shown that the evolution of the (Abelian) gauge coupling during an inflationary phase of de Sitter type drives the growth of the two-point function of the magnetic inhomogeneities. After examining the constraints on the variation of the gauge coupling arising in a standard model of inflationary and post-inflationary evolution, magnetohydrodynamical equations are generalized to the case of time evolving gauge coupling. It is argued that large scale magnetic fields can be copiously generated. Other possible implications of the model are outlined.Comment: 5 pages in RevTex style, one figur

EBAG9-silencing exerts an immune checkpoint function without aggravating adverse effects

Chimeric antigen receptor (CAR) T cells have revolutionized treatment of B-cell malignancies. However, enhancing the efficacy of engineered T cells without compromising their safety is warranted. The estrogen receptor-binding fragment-associated antigen 9 (EBAG9) inhibits release of cytolytic enzymes from cytotoxic T lymphocytes. Here, we examined the potency of EBAG9-silencing for the improvement of adoptive T cell therapy. Micro-RNA-mediated EBAG9 downregulation in transplanted CTLs from immunized mice improved their cytolytic competence in a tumor model. In tolerant female recipient mice that received organ transplants, a minor histocompatibility antigen was turned into a rejection antigen by Ebag9 deletion, indicating an immune checkpoint function for EBAG9. Considerably less EBAG9-silenced human CAR T cells were needed for tumor growth control in a xenotransplantation model. Transcriptome profiling did not reveal additional risks regarding genotoxicity or aberrant differentiation. A single-step retrovirus transduction process links CAR or TCR expression with miRNA-mediated EBAG9 downregulation. Despite higher cytolytic efficacy, release of cytokines associated with cytokine release syndrome remains unaffected. Collectively, EBAG9-silencing enhances effector capacity of TCR- and CAR-engineered T cells, results in improved tumor eradication, facilitates efficient manufacturing, and decreases the therapeutic dose

First-order cosmological phase transitions in the radiation dominated era

We consider first-order phase transitions of the Universe in the radiation-dominated era. We argue that in general the velocity of interfaces is non-relativistic due to the interaction with the plasma and the release of latent heat. We study the general evolution of such slow phase transitions, which comprise essentially a short reheating stage and a longer phase equilibrium stage. We perform a completely analytical description of both stages. Some rough approximations are needed for the first stage, due to the non-trivial relations between the quantities that determine the variation of temperature with time. The second stage, instead, is considerably simplified by the fact that it develops at a constant temperature, close to the critical one. Indeed, in this case the equations can be solved exactly, including back-reaction on the expansion of the Universe. This treatment also applies to phase transitions mediated by impurities. We also investigate the relations between the different parameters that govern the characteristics of the phase transition and its cosmological consequences, and discuss the dependence of these parameters with the particle content of the theory.Comment: 38 pages, 3 figures; v2: Minor changes, references added; v3: several typos correcte

Magnetogenesis and the dynamics of internal dimensions

The dynamical evolution of internal space-like dimensions breaks the invariance of the Maxwell's equations under Weyl rescaling of the (conformally flat) four-dimensional metric. Depending upon the number and upon the dynamics of internal dimensions large scale magnetic fields can be created. The requirements coming from magnetogenesis together with the other cosmological constraints are examined under the assumption that the internal dimensions either grow or shrink (in conformal time) prior to a radiation dominated epoch. If the internal dimensions are growing the magnitude of the generated magnetic fields can seed the galactic dynamo mechanism.Comment: 27 in RevTex style, four figure