Impact of Hepatitis C Treatment as Prevention for People Who Inject Drugs is sensitive to contact network structure

Treatment as Prevention (TasP) using directly-acting antivirals has been advocated for Hepatitis C Virus (HCV) in people who inject drugs (PWID), but treatment is expensive and TasP’s effectiveness is uncertain. Previous modelling has assumed a homogeneously-mixed population or a static network lacking turnover in the population and injecting partnerships. We developed a transmission-dynamic model on a dynamic network of injecting partnerships using data from survey of injecting behaviour carried out in London, UK. We studied transmission on a novel exponential-clustered network, as well as on two simpler networks for comparison, an exponential unclustered and a random network, and found that TasP’s effectiveness differs markedly. With respect to an exponential-clustered network, the random network (and homogeneously-mixed population) overestimate TasP’s effectiveness, whereas the exponential-unclustered network underestimates it. For all network types TasP’s effectiveness depends on whether treated patients change risk behaviour, and on treatment coverage: higher coverage requires fewer total treatments for the same health gain. Whilst TasP can greatly reduce HCV prevalence, incidence of infection, and incidence of reinfection in PWID, assessment of TasP’s effectiveness needs to take account of the injecting-partnership network structure and post-treatment behaviour change, and further empirical study is required

Evaluating the Impact of Intravitreal Aflibercept on Diabetic Retinopathy Progression in the VIVID-DME and VISTA-DME Studies

Purpose To evaluate the impact of intravitreal aflibercept (EYLEA, Regeneron Pharmaceuticals, Tarrytown, NY) versus laser on progression of diabetic retinopathy (DR) severity in Intravitreal Aflibercept Injection in Vision Impairment due to DME (VIVID-DME) and Study of Intravitreal Aflibercept Injection in Patients with Diabetic Macular Edema (VISTA-DME). Design Secondary and exploratory analyses of 2 phase 3, randomized, controlled studies. Participants All patients with a baseline Diabetic Retinopathy Severity Scale (DRSS) score based on fundus photograph (full analysis), patients who progressed to proliferative DR (PDR) (safety analysis) in VIVID-DME (n = 403) and VISTA-DME (n = 459), or both. Methods We randomized patients with diabetic macular edema (DME) to intravitreal aflibercept 2 mg every 4 weeks (2q4), intravitreal aflibercept 2 mg every 8 weeks after 5 initial monthly doses (2q8), or macular laser photocoagulation at baseline and sham injections at every visit. Main Outcome Measures Proportions of patients with 2-step or more and 3-step or more improvements from baseline in DRSS score, who progressed to PDR, and who underwent panretinal photocoagulation (PRP). Results Among patients with an assessable baseline DRSS score, most showed moderately severe or severe nonproliferative DR. The proportions of patients treated with 2q4, 2q8, and laser with a 2-step or more improvement in DRSS score at week 100 were 29.3%, 32.6%, and 8.2%, respectively, in VIVID-DME and 37.0%, 37.1%, and 15.6%, respectively, in VISTA-DME; the proportions with a 3-step or more improvement in DRSS score were 7.3%, 2.3%, and 0%, respectively, and 22.7%, 19.9%, and 5.2%, respectively. Fewer patients in the 2q4 and 2q8 groups versus the laser group progressed to PDR at week 100 in VISTA-DME (1.5% and 2.2% vs. 5.3%) and VIVID-DME (3.2% and 2.0% vs. 12.3%). The proportions of patients who underwent PRP were 2.9%, 0.7%, and 4.5%, respectively, in VIVID-DME and 1.9%, 0.7%, and 5.2%, respectively, in VISTA-DME. The most frequent serious ocular adverse event at week 100 was cataract (pooled intravitreal aflibercept, 1.7% of patients; laser, 3.5% of patients). Conclusions These analyses demonstrate the benefit of intravitreal aflibercept over laser with respect to DR progression, suggesting a benefit on DME, and on underlying DR

Kommunikation und Konfrontation - Diplomatie und Gesandtschaftswesen Kaiser Maximilians I. (1486-1519)

1000 Worte Forschung: Abgeschlossenes Dissertationsprojekt an der FU Berlin Johannes Cuspinian, Öl auf Holz, Lucas Cranach d. Ä., um 1502 (Quelle: Wikimedia Commons) Ob es sich bei dem Tagebuch des diplomatischen Routiniers Johannes Cuspinian wirklich um das „Memoirenwerk eines Staatsmannes“ (H. Ankwicz-Kleehoven) im Sinne eines Kissinger oder Gorbatschow handelt, sei dahingestellt. Ein kritischer Blick in diese Aufzeichnungen zu den sich im Frühjahr des Jahres 1515 konkretisierenden Verhand..

Material Culture in Modern Diplomacy from the 15th to the 20th Century

The present volume aims at outlining a new field of research with regard to the history of diplomacy: the material culture of diplomatic interaction in early modern and modern times. The material culture of diplomacy includes all practices in foreign policy communication in which single artifacts, samples of artifacts, or else the whole material setting of diplomatic interaction is supposed to be constitutive for creating an intended effect in terms of diplomatic objectives. The chapters of this volume focus on intercultural diplomacy in different regions of the world wherein diplomatic actors of various kinds might have been confronted by a whole universe of unfamiliar artifacts and artifact-related practices. Most of them concentrate on gift giving as a diplomatic practice that offers multiple insights in the complex dynamics of diplomatic relations between representatives of culturally highly diverse political entities. In doing so, they gainfully apply different theoretical approaches of material culture as an interdisciplinary field of study to the investigation of diplomatic cultures across the globe. As a result, it becomes obvious that future research into the history of diplomacy should take into account material practices much more thoroughly than has been done before