Physicians' preference values for hepatitis C health states and antiviral therapy: A survey

BACKGROUND: Physicians' perspectives regarding hepatitis C shape their approach to patient management. We used utility analysis to evaluate physicians' perceptions of hepatitis C-related health states (HS) and their threshold to recommend treatment. METHODS: A written questionnaire was administered to practicing physicians. They were asked to rate hepatitis C health states on a visual analog scale ranging from 0% (death) to 100% (health without hepatitis C). Physicians then judged quality of life associated with the side effects of antiviral therapy for hepatitis C and indicated the sustained virological response rate that they would require to recommend treatment. RESULTS: One hundred and thirteen physicians from five states were included. Median utility ratings for hepatitis C health states declined significantly with increasing severity of symptoms: HS1-No Symptoms, No Cirrhosis (88%; 12% reduction from good health), HS2-Mild Symptoms, No Cirrhosis (66%), HS3-Moderate Symptoms, No Cirrhosis (49%), HS4-Mild Symptoms, Cirrhosis (40%), HS5-Severe Symptoms, Cirrhosis (18%) [p < 0.001]. The median rating for life with side effects of antiviral therapy was 47%, suggesting a 53% reduction from good health. That was similar to the utility value for HS3-Moderate Symptoms, No Cirrhosis. The median threshold value for recommending treatment was a sustained response rate of 60%. CONCLUSIONS: 1) Physicians' utility ratings for hepatitis C health states were inversely related to the severity of disease manifestations described. 2) Physicians viewed side effects of therapy unfavorably and indicated that on average, they would require a 60% sustained response rate before recommending treatment, which far exceeds the efficacy of current antiviral therapy for hepatitis C in the majority of patients

Emergent quantum state designs from individual many-body wavefunctions

Quantum chaos in many-body systems provides a bridge between statistical and quantum physics with strong predictive power. This framework is valuable for analyzing properties of complex quantum systems such as energy spectra and the dynamics of thermalization. While contemporary methods in quantum chaos often rely on random ensembles of quantum states and Hamiltonians, this is not reflective of most real-world systems. In this paper, we introduce a new perspective: across a wide range of examples, a single non-random quantum state is shown to encode universal and highly random quantum state ensembles. We characterize these ensembles using the notion of quantum state $k$-designs from quantum information theory and investigate their universality using a combination of analytic and numerical techniques. In particular, we establish that $k$-designs arise naturally from generic states as well as individual states associated with strongly interacting, time-independent Hamiltonian dynamics. Our results offer a new approach for studying quantum chaos and provide a practical method for sampling approximately uniformly random states; the latter has wide-ranging applications in quantum information science from tomography to benchmarking.Comment: 7+19 pages, 6 figure

Entanglement Dynamics after a Quench in Ising Field Theory: A Branch Point Twist Field Approach

We extend the branch point twist field approach for the calculation of entanglement entropies to time-dependent problems in 1+1-dimensional massive quantum field theories. We focus on the simplest example: a mass quench in the Ising field theory from initial mass m0 to final mass m. The main analytical results are obtained from a perturbative expansion of the twist field one-point function in the post-quench quasi-particle basis. The expected linear growth of the Rényi entropies at large times mt ≫ 1 emerges from a perturbative calculation at second order. We also show that the Rényi and von Neumann entropies, in infinite volume, contain subleading oscillatory contributions of frequency 2m and amplitude proportional to (mt)−3/2. The oscillatory terms are correctly predicted by an alternative perturbation series, in the pre-quench quasi-particle basis, which we also discuss. A comparison to lattice numerical calculations carried out on an Ising chain in the scaling limit shows very good agreement with the quantum field theory predictions. We also find evidence of clustering of twist field correlators which implies that the entanglement entropies are proportional to the number of subsystem boundary points

Emergent Randomness and Benchmarking from Many-Body Quantum Chaos

Chaotic quantum many-body dynamics typically lead to relaxation of local observables. In this process, known as quantum thermalization, a subregion reaches a thermal state due to quantum correlations with the remainder of the system, which acts as an intrinsic bath. While the bath is generally assumed to be unobserved, modern quantum science experiments have the ability to track both subsystem and bath at a microscopic level. Here, by utilizing this ability, we discover that measurement results associated with small subsystems exhibit universal random statistics following chaotic quantum many-body dynamics, a phenomenon beyond the standard paradigm of quantum thermalization. We explain these observations with an ensemble of pure states, defined via correlations with the bath, that dynamically acquires a close to random distribution. Such random ensembles play an important role in quantum information science, associated with quantum supremacy tests and device verification, but typically require highly-engineered, time-dependent control for their preparation. In contrast, our approach uncovers random ensembles naturally emerging from evolution with a time-independent Hamiltonian. As an application of this emergent randomness, we develop a benchmarking protocol which estimates the many-body fidelity during generic chaotic evolution and demonstrate it using our Rydberg quantum simulator. Our work has wide ranging implications for the understanding of quantum many-body chaos and thermalization in terms of emergent randomness and at the same time paves the way for applications of this concept in a much wider context.Comment: JC and ALS contributed equally to this wor

Prevalence of hepatic iron overload and association with hepatocellular cancer in end-stage liver disease: results from the National Hemochromatosis Transplant Registry

Background : It is unclear whether mild to moderate iron overload in liver diseases other than hereditary haemochromatosis (HH) contributes to hepatocellular carcinoma. This study examined the association between hepatic iron grade and hepatocellular carcinoma in patients with end-stage liver disease of diverse aetiologies. Methods : The prevalence of hepatic iron overload and hepatocellular carcinoma was examined in 5224 patients undergoing liver transplantation. Explant pathology reports were reviewed for the underlying pathological diagnosis, presence of hepatocellular carcinoma and degree of iron staining. The distribution of categorical variables was studied using Χ 2 tests. Results : Both iron overload and hepatocellular carcinoma were the least common with biliary cirrhosis (1.8 and 2.8% respectively). Hepatocellular carcinoma was the most common in patients with hepatitis B (16.7%), followed by those with hepatitis C (15.1%) and HH (14.9%). In the overall cohort, any iron overload was significantly associated with hepatocellular carcinoma ( P =0.001), even after adjustment for the underlying aetiology of liver disease. The association between hepatic iron content and hepatocellular carcinoma was the strongest in patients with biliary cirrhosis ( P <0.001) and hepatitis C ( P <0.001). Conclusions : Iron overload is associated with hepatocellular carcinoma in patients with end-stage liver disease, suggesting a possible carcinogenic or cocarcinogenic role for iron in chronic liver disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/75573/1/j.1478-3231.2007.01596.x.pd

Illness perceptions and explanatory models of viral hepatitis B & C among immigrants and refugees: a narrative systematic review.

© 2015 Owiti et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.BACKGROUND: Hepatitis B and C (HBV, HCV) infections are associated with high morbidity and mortality. Many countries with traditionally low prevalence (such as UK) are now planning interventions (screening, vaccination, and treatment) of high-risk immigrants from countries with high prevalence. This review aimed to synthesise the evidence on immigrants' knowledge of HBV and HCV that might influence the uptake of clinical interventions. The review was also used to inform the design and successful delivery of a randomised controlled trial of targeted screening and treatment. METHODS: Five databases (PubMed, CINHAL, SOCIOFILE, PsycINFO & Web of Science) were systematically searched, supplemented by reference tracking, searches of selected journals, and of relevant websites. We aimed to identify qualitative and quantitative studies that investigated knowledge of HBV and HCV among immigrants from high endemic areas to low endemic areas. Evidence, extracted according to a conceptual framework of Kleinman's explanatory model, was subjected to narrative synthesis. We adapted the PEN-3 model to categorise and analyse themes, and recommend strategies for interventions to influence help-seeking behaviour. RESULTS: We identified 51 publications including quantitative (n = 39), qualitative (n = 11), and mixed methods (n = 1) designs. Most of the quantitative studies included small samples and had heterogeneous methods and outcomes. The studies mainly concentrated on hepatitis B and ethnic groups of South East Asian immigrants residing in USA, Canada, and Australia. Many immigrants lacked adequate knowledge of aetiology, symptoms, transmission risk factors, prevention strategies, and treatment, of hepatitis HBV and HCV. Ethnicity, gender, better education, higher income, and English proficiency influenced variations in levels and forms of knowledge. CONCLUSION: Immigrants are vulnerable to HBV and HCV, and risk life-threatening complications from these infections because of poor knowledge and help-seeking behaviour. Primary studies in this area are extremely diverse and of variable quality precluding meta-analysis. Further research is needed outside North America and Australia

Informing the design of a national screening and treatment programme for chronic viral hepatitis in primary care: qualitative study of at-risk immigrant communities and healthcare professionals

n Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise statedThis paper presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme (RP-PG-1209-10038).

Limits of JT gravity

We construct various limits of JT gravity, including Newton-Cartan and Carrollian versions of dilaton gravity in two dimensions as well as a theory on the three-dimensional light cone. In the BF formulation our boundary conditions relate boundary connection with boundary scalar, yielding as boundary action the particle action on a group manifold or some Hamiltonian reduction thereof. After recovering in our formulation the Schwarzian for JT, we show that AdS-Carroll gravity yields a twisted warped boundary action. We comment on numerous applications and generalizations.Comment: 41 pages, 3 figures, 1 table; v2: Matches published version + Footnote 11; v3: Corrected typo in Carrollian/Galilean generalized dilaton potentia

Broker Fixed: The Racialized Social Structure and the Subjugation of Indigenous Populations in the Andes

Responding to calls to return racial analysis to indigenous Latin America, this article moves beyond the prejudicial attitudes of dominant groups to specify how native subordination gets perpetuated as a normal outcome of the organization of society. I argue that a naturalized system of indirect rule racially subordinates native populations through creating the position of mestizo “authoritarian intermediary.” Natives must depend on these cultural brokers for their personhood, while maintaining this privileged position requires facilitating indigenous exploitation. Institutional structures combine with cultural practices to generate a vicious cycle in which increased village intermediary success increases native marginalization. This racialized social structure explains my ethnographic findings that indigenous villagers continued to support the same coterie of mestizos despite their regular and sometimes extreme acts of peculation. My findings about the primacy of race suggest new directions for research into indigenous studies, ethnic mobilizations, and the global dimensions of racial domination