Impact of previous hepatitis B infection on the clinical outcomes from chronic hepatitis C? A population-level analysis

Chronic coinfection with hepatitis C virus (HCV) and hepatitis B virus (HBV) is associated with adverse liver outcomes. The clinical impact of previous HBV infection on liver disease in HCV infection is unknown. We aimed at determining any association of previous HBV infection with liver outcomes using antibodies to the hepatitis B core antigen (HBcAb) positivity as a marker of exposure. The Scottish Hepatitis C Clinical Database containing data for all patients attending HCV clinics in participating health boards was linked to the HBV diagnostic registry and mortality data from Information Services Division, Scotland. Survival analyses with competing risks were constructed for time from the first appointment to decompensated cirrhosis, hepatocellular carcinoma (HCC) and liver‐related mortality. Records of 8513 chronic HCV patients were included in the analyses (87 HBcAb positive and HBV surface antigen [HBsAg] positive, 1577 HBcAb positive and HBsAg negative, and 6849 HBcAb negative). Multivariate cause‐specific proportional hazards models showed previous HBV infection (HBcAb positive and HBsAg negative) significantly increased the risks of decompensated cirrhosis (hazard ratio [HR]: 1.29, 95% CI: 1.01‐1.65) and HCC (HR: 1.64, 95% CI: 1.09‐2.49), but not liver‐related death (HR: 1.02, 95% CI: 0.80‐1.30). This is the largest study to date showing an association between previous HBV infection and certain adverse liver outcomes in HCV infection. Our analyses add significantly to evidence which suggests that HBV infection adversely affects liver health despite apparent clearance. This has important implications for HBV vaccination policy and indications for prioritization of HCV therapy

Clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for alzheimer’s disease

Objectives: Systematic review of the clinical and cost-effectiveness of donepezil, rivastigmine, and galantamine for people suffering from Alzheimer's disease.Methods: Sixteen electronic databases (including MEDLINE, the Cochrane Library, and Embase) and bibliographies of related papers were searched for published/unpublished English language studies, and experts and pharmaceutical companies were consulted for additional information. Randomized controlled trials (RCTs) and economic studies were selected. Clinical effectiveness was assessed on measurement scales assessing progression of Alzheimer's disease on the person's global health, cognition, functional ability, behavior and mood, and quality of life. Cost-effectiveness was presented as incremental cost per year spent in a nonsevere state (by Mini Mental Health State Examination) or quality-adjusted life-year.Results: Twelve of 15 RCTs included were judged to be of good quality. Although donepezil had beneficial effects in Alzheimer's patients on global health and cognition, rivastigmine on global health, and galantamine on global health, cognition, and functional scales, these improvements were small and may not be clinically significant. Measures of quality of life and behavior and mood were rarely assessed. Adverse effects were usually mild and transient. Cost-effectiveness base case estimates ranged from £2,415 savings to £49,476 additional cost (1997 prices) per unit of effect for donepezil and a small savings for rivastigmine. Estimates were not considered robust or generalizable.Conclusions: Donepezil, rivastigmine, and galantamine appear to have some clinical effect for people with Alzheimer's disease, although the extent to which these translate into real differences in everyday life remains unclear. Due to the nature of current economic studies, cost-effectiveness remains uncertain and the impact on different care sectors has been inadequately investigated. Further research is needed to establish the actual benefits of acetylcholinesterase inhibitors (AChEls) for people with Alzheimer's disease and their caregivers, the relationship of these changes to clinical management, and careful prospective evaluation of resource and budgetary consequences

Reaping New Harvests: Collaboration and Communication through Field Experiences

Created under the auspices of the field experience offices at two public, four-year institutions of higher education, and in conjunction with a local urban school district, the Teaching and Learning Collaborative (TLC) and Communities of Practice (COMPRAC) were constructed to support a year-long experience (practicum and student teaching) at the undergraduate and postbaccalaureate levels. These programs, structured to help preservice teachers junction effectively in an urban classroom, included clustering groups in the same school and providing additional support through course work, seminars, and interactive small and whole-group meetings. What began as two separate programs evolved into a reconceptualization of a model for field experiences that has transferability to any type of school district. Multiple face-to-face and electronic communication fora within and across triad roles are proposed for creating a community for professional development that celebrates talking about issues germane to teaching and learning

Events with a rapidity gap between jets in (p)over-bar-p collisions at root s=630 GeV

We report a measurement of the fraction of dijet events with a rapidity gap between jets produced by color-singlet exchange in (p) over bar p collisions at root s = 630 GeV at the Fermilab Tevatron. In events with two jets of transverse energy E-T(jet) > 8 GeV, pseudorapidity in the range 1.8 < \n(jet)\ < 3.5 and eta(1)eta(2) < 0, the color-singlet exchange fraction is found to be R = [2.7 +/- 0.7(stat) +/- 0.6(syst)]%. Comparisons are made with results obtained at root s = 1800 GeV and with theoretical expectations