A Younger Demographic Defines Hepatitis C Patient Profiles in the Recent Direct-Acting Antiviral Era

A Younger Demographic Defines Hepatitis C Patient Profiles in the Recent Direct-Acting Antiviral Era Authors: Minawala, Ria1; Naylor, Paul H.2; Ehrinpreis, Murray N.2; Mutchnick, Milton G.2 Institutions: 1. Wayne State University School of Medicine, Detroit, MI, United States. 2. Wayne State University School of Medicine, Division of Gastroenterology, Detroit, MI, United States. Background: Highly effective and safe direct-acting antivirals (DAAs) against hepatitis C virus (HCV) combined with U.S. Preventive Services Task Force recommendation to screen for HCV in individuals born between 1945 and 1965 (age cohort; 54-79 years of age in 2019) was expected to reduce the number of actively infected patients via identification and treatment. Nevertheless, HCV infections remain a significant health concern. A study of HCV infected patients in our urban internal medicine practice, during the interferon era and prior to the introduction of DAAs, demonstrated a population within the age cohort. The objective of this study was to characterize the current patient population seen in the same practice with respect to age, race, and treatment status to determine the impact of DAA therapy on patient profiles and to test the hypothesis that there would be an increase in younger population among those infected. Methods: Using electronic medical records, we identified patients who presented to our urban GI practice in 2019. Data collected from patient charts included demographics, liver function tests, HCV genotype, viral load, imaging studies, and treatment history. Results: There were 601 patients with HCV seen in 2019 and the majority were African American (AA) (85%) and male (66%). Comparison of age alongside gender and race revealed that non-AA patients (51 years, SEM = 0.9) were significantly younger than AA patients (63 years, SEM = 0.4; p Conclusion: The primary shift in patient demographics as compared to the interferon era has been toward younger, non- AA females. In contrast, the predominant AA patients are still within the age cohort. The emergence of younger patients has important implications for screening, patient outreach, and treatment plans. A more intensive evaluation for risk factors and the role of COVID-19 in treatment is warranted. Many AA and non- AA patients were not started on any treatment in 2019, signifying a need for continued follow-up after initial visit to close the linkage to care gap

FAILURE TO TREAT HCV IN PATIENTS SEEN IN A PREDOMINATELY AFRICAN AMERICAN SOCIOECONOMICALLY CHALLENGED POPULATION

The research objective of this proposal is to investigate the impediment with respect to moving a patient from initial antibody/PCR positive to successful completion of treatment. Secondary objectives include determining the most effective way for patients to progress from initial antibody/PCR positive to treatment and identifying the roadblocks for HCV antibody/PCR positive patients to be treated effectively. Data was collected from 2019 HCV patient EMR charts, including demographics, laboratory studies, and treatment history. Concerning treatment, we evaluated linkage to the care; we defined success as treatment within six months of the initial visit. Thus, data on treatment initiation was collected through the first six months of 2020

CHARACTERISTICS OF PATIENTS WITH LOW HEPATITIS C TREATMENT RATES IN URBAN MEDICAL CENTER CLINICS

The objective of this study was to determine whether there were different characteristics between HCV patients who were treated and those not treated after their first visit to a Gastroenterology (GI) or Infectious Disease (ID) clinic. This information might identify potential targets for remedial actions that could be performed to increase the number of treated patients. Data was collected from 2019 HCV patient EMR charts including patient demographics, treatment history, and laboratory studies. We defined success as receiving treatment by July 2020 (6-18 months after the first visit). We found that of 587 patients with HCV who were seen at least once in the Wayne Health system, 441 patients (441/587=75%) were not treated and only 189 (189/441= 43%) were treated by July 2020. Treated and not treated patients were similar with respect to race, gender, age, and median income defined by zip code. They were also not different with respect to the clinic seen (ID vs GI), the type of insurance, or the degree of fibrosis. However, patients with an average of 4 visits were more likely to be treated than those having 2 visits. Having 1 visit was the most dramatic factor in the lack of treatment (42% vs 8% p\u3c0.0001). PCR available at first visit was an important factor with respect to treatment (treated 38% vs not treated 25% p\u3c0.02)

Smart detection and prevention procedure for DoS attack in MANET

A self-organized wireless communication short-lived network containing collection of mobile nodes is mobile ad hoc network (MANET). The mobile nodes communicate with each other by wireless radio links without the use of any pre-established fixed communication network infrastructure or centralized administration, such as base stations or access points, and with no human intervention. In addition, this network has potential applications in conference, disaster relief, and battlefield scenario, and have received important attention in current years. There is some security concern that increases fear of attacks on the mobile ad-hoc network. The mobility of the NODE in a MANET poses many security problems and vulnerable to different types of security attacks than conventional wired and wireless networks. The causes of these issues are due to their open medium, dynamic network topology, absence of central administration, distributed cooperation, constrained capability, and lack of clear line of defense. Without proper security, mobile hosts are easily captured, compromised, and attacked by malicious nodes. Malicious nodes behavior may deliberately disrupt the network so that the whole network will be suffering from packet losses. One of the major concerns in mobile ad-hoc networks is a traffic DoS attack in which the traffic is choked by the malicious node which denied network services for the user. Mobile ad-hoc networks must have a safe path for transmission and correspondence which is a serious testing and indispensable issue. So as to provide secure communication and transmission, the scientist worked explicitly on the security issues in versatile impromptu organizations and many secure directing conventions and security measures within the networks were proposed. The goal of the work is to study DoS attacks and how it can be detected in the network. Existing methodologies for finding a malicious node that causes traffic jamming is based on node’s retains value. The proposed approach finds a malicious node using reliability value determined by the broadcast reliability packet (RL Packet). In this approach at the initial level, every node has zero reliability value, specific time slice, and transmission starts with a packet termed as reliability packet, node who responded properly in specific time, increases its reliability value and those nodes who do not respond in a specific time decreases their reliability value and if it goes to less than zero then announced that it’s a malicious node. Reliability approach makes service availability and retransmission time

Security at the Physical Layer over GG Fading and mEGG Turbulence Induced RF-UOWC Mixed System

This work was supported in part by the National Research Foundation of Korea grant funded by the Korean Government (Ministry of Science and ICT) under Grant 2019R1A2C1083988, in part by the Ministry of Science and ICT, South Korea, under the Information Technology Research Center Support Program supervised by the Institute for Information and Communications Technology Planning and Evaluation, under Grant IITP-2021-2016-0-00313, and in part by Sejong University through its Faculty Research Program under Grant 20202021.Peer reviewedPublisher PD

Acute Stroke, Hematocrit, and Blood Pressure.

A population-based study of the relation between hematocrit and stroke subtype was carried out among 2,077 individuals using the Lehigh Valley Stroke Register. This register identifies all stroke patients admitted to the 8 acute care hospitals serving the Lehigh Valley area of eastern Pennsylvania-western New Jersey. The mean hematocrit was higher in patients with lacunes than with thrombotic or embolic strokes (p = 0.02). However, when blood pressure was also considered the increase in hematocrit in patients with lacunar stroke was significant only when systolic hypertension (greater than or equal to 150 mm Hg) was also present (p = 0.029); no significant difference in hematocrit was found between stroke subtypes in normotensive individuals. Therefore, we cannot exclude the possibility that hypertension interacts with hematocrit in accounting for the observed association with lacunar infarcts. There was no trend for increased in-hospital mortality for stroke patients in either the low (less than or equal to 30, 30-36%) or high (greater than or equal to 47%) hematocrit groups

Measuring Resilience of Urban Slum to Climate Induced Disasters: A Study on Barishal City Corporation, Bangladesh

Measuring urban resilience is one of the important processes toward understanding the potential current and future risks of cities, assessing the challenges of urbanization and to guide the development of urban areas. The research was conducted in a slum named Bangabandhu Colony under Barishal City Corporation (BCC). The purpose of the research was to measure the urban disaster resilience and to find out a better way of future urban disaster resilience in this area. Climate Disaster Resilience Index (CDRI) was used to measure climate-related disaster resilience by considering five dimensions: physical, social, institutional, economic and natural which shows resilience level ranging from 1-5 where 1 representing very poor and 5 best. A semi-structured questionnaire was used for collecting the primary data and the secondary data was collected from secondary sources. Results revealed that the resilience level of physical, social, institutional, economic, and natural dimensions was 2.76, 2.79, 2.29, 2.53, 2.59 respectively, which indicates a medium resilience level of all dimensions. Finally, the research depicted that, the resilience level of the area will increase through hand to hand working of people with government and non-government officials, conducting public awareness programs, campaigns, seminars and discussions. The findings of the research can be used by researchers and development workers for enhancing disaster resilience of other areas under Barishal City Corporation as well as other city areas of Bangladesh