HCV microelimination in harm reduction centres has benefits beyond HCV cure but is hampered by high reinfection rates

Significant scale-up of treatment among people who inject drugs (PWID) is crucial to achieve WHO HCV elimination targets. We explored the impact of on-site HCV diagnosis and treatment on PWID in an externalised hepatology clinic at the biggest harm reduction centre (HRC) in Barcelona attending to a marginalised PWID population with ongoing high-risk practices.On-site HCV point-of-care testing was performed for diagnosis and treatment delivery. HCV-RNA was assessed at SVR12 (sustained virologic response at 12 weeks) and every 6 months. The programme included behavioural questionnaires at baseline and after treatment.Between 2018 and 2020, 919 individuals were prospectively enrolled. Of these, only 46% accepted HCV screening. HCV-RNA+ prevalence was 55.7% (n = 234). Of the 168 (72%) individuals starting treatment, 48% were foreigners, 32% homeless, 73% unemployed, and 62% had a history of incarceration. At enrolment, 70% injected drugs daily and 30% reported sharing needles or paraphernalia. Intention-to-treat SVR12 was 60%; only 4% were virological failures, the remaining were either early reinfections (20%) or losses to follow-up (16%). The overall reinfection rate during follow-up was 31/100 persons/year. HIV coinfection and daily injection were associated with a higher risk of reinfection. Nonetheless, beyond viral clearance, antiviral therapy was associated with a significant reduction in injection frequency, risk practices, and homelessness.HCV treatment can be successfully delivered to active PWID with high-risk practices and has a significant benefit beyond HCV elimination. However, approaching this difficult spectrum of the PWID population implies significant barriers such as low rate of screening acceptance and high dropout and reinfection rates.People who inject drugs attending harm reduction centres represent the most difficult population to treat for hepatitis C. We show that hepatitis C treatment has a significant benefit beyond viral cure, including improving quality of life, and decreasing injection frequency and risk practices. However, intrinsic barriers and the high reinfection rates hamper the achievement of viral microelimination in this setting.© 2022 The Author(s)

Experimental investigation of ground-state properties of ⁷H with transfer reactions

The properties of nuclei with extreme neutron–to–proton ratios, far from those naturally occurring on Earth, are key to understand nuclear forces and how nucleons hold together to form nuclei. 7H, with six neutrons and a single proton, is the nuclear system with the most unbalanced neutron–to–proton ratio known so far. However, its sheer existence and properties are still a challenge for experimental efforts and theoretical models. Here we report experimental evidences on the formation of 7H as a resonance, detected with independent observables, and the first measurement of the structure of its ground state. The resonance is found at ∼0.7 MeV above the 3H+4n mass, with a narrow width of ∼0.2 MeV and a 1/2+ spin and parity. These data are consistent with a 7H as a 3H core surrounded by an extended four-neutron halo, with a unique four-neutron decay and a relatively long half-life thanks to neutron pairing; a prime example of new phenomena occurring in what would be the most pure-neutron nuclear matter we can access in the laboratory.</p

Fission fragments mass distributions of nuclei populated by the multinucleon transfer channels of the 18O + 232Th reaction

It is shown that the multinucleon transfer reactions is a powerful tool to study fission of exotic neutron-rich actinide nuclei, which cannot be accessed by particle-capture or heavy-ion fusion reactions. In this work, multinucleon transfer channels of the 18O +  232Th reaction are used to study fission of fourteen nuclei 231,232,233,234Th, 232,233,234,235,236Pa, and 234,235,236,237,238U. Identification of fissioning nuclei and of their excitation energy is performed on an event-by-event basis, through the measurement of outgoing ejectile particle in coincidence with fission fragments. Fission fragment mass distributions are measured for each transfer channel, in selected bins of excitation energy. In particular, the mass distributions of 231,234Th and 234,235,236Pa are measured for the first time. Predominantly asymmetric fission is observed at low excitation energies for all studied cases, with a gradual increase of the symmetric mode towards higher excitation energy. The experimental distributions are found to be in general agreement with predictions of the fluctuation–dissipation model

Longitudinal outcomes of obeticholic acid therapy in ursodiol-nonresponsive primary biliary cholangitis: Stratifying the impact of add-on fibrates in real-world practice

Background Suboptimal response to ursodeoxycholic acid occurs in 40% of primary biliary cholangitis (PBC) patients, affecting survival. Achieving a deep response (normalisation of alkaline phosphatase [ALP] and bilirubin ≤0.6 upper limit of normal) improves survival. Yet, the long-term effectiveness of second-line treatments remains uncertain. Aims To evaluate the long-term effectiveness of obeticholic acid (OCA) ± fibrates. Focusing on biochemical response (ALP ≤1.67 times the upper limit of normal, with a decrease of at least 15% from baseline and normal bilirubin levels), normalisation of ALP, deep response and biochemical remission (deep response plus aminotransferase normalisation). Methods We conducted a longitudinal, observational, multicentre study involving ursodeoxyccholic acid non-responsive PBC patients (Paris-II criteria) from Spain and Portugal who received OCA ± fibrates. Results Of 255 patients, median follow-up was 35.1 months (IQR: 20.2–53). The biochemical response in the whole cohort was 47.2%, 61.4% and 68.6% at 12, 24 and 36 months. GLOBE-PBC and 5-year UK-PBC scores improved (p < 0.001). Triple therapy (ursodeoxycholic acid plus OCA plus fibrates) had significantly higher response rates than dual therapy (p = 0.001), including ALP normalisation, deep response and biochemical remission (p < 0.001). In multivariate analysis, triple therapy remained independently associated with biochemical response (p = 0.024), alkaline phosphatase normalisation, deep response and biochemical remission (p < 0.001). Adverse effects occurred in 41.2% of cases, leading to 18.8% discontinuing OCA. Out of 55 patients with cirrhosis, 12 developed decompensation. All with baseline portal hypertension. Conclusion Triple therapy was superior in achieving therapeutic goals in UDCA-nonresponsive PBC. Decompensation was linked to pre-existing portal hypertension

Coulomb dissociation of P 27 at 500 MeV/u

The proton-capture reaction Si26(p,γ)P27 was studied via Coulomb dissociation (CD) of P27 at an incident energy of about 500 MeV/u. The three lowest-lying resonances in P27 have been populated and their resonance strengths have been measured. In addition, a nonresonant direct-capture component was clearly identified and its astrophysical S factor measured. The experimental results are compared to Monte Carlo simulations of the CD process using a semiclassical model. Our thermonuclear reaction rates show good agreement with the rates from a recent compilation. With respect to the nuclear structure of P27 we have found evidence for a negative-parity intruder state at 2.88-MeV excitation energy

Re-examining the transition into the N=20 island of inversion: structure of 30Mg

Intermediate energy single-neutron removal from $^{31}$Mg has been employed to investigate the transition into the N=20 island of inversion. Levels up to 5~MeV excitation energy in $^{30}$Mg were populated and spin-parity assignments were inferred from the corresponding longitudinal momentum distributions and $\gamma$-ray decay scheme. Comparison with eikonal-model calculations also permitted spectroscopic factors to be deduced. Surprisingly, the 0$^{+}_{2}$ level in $^{30}$Mg was found to have a strength much weaker than expected in the conventional picture of a predominantly $2p - 2h$ intruder configuration having a large overlap with the deformed $^{31}$Mg ground state. In addition, negative parity levels were identified for the first time in $^{30}$Mg, one of which is located at low excitation energy. The results are discussed in the light of shell-model calculations employing two newly developed approaches with markedly different descriptions of the structure of $^{30}$Mg. It is concluded that the cross-shell effects in the region of the island of inversion at Z=12 are considerably more complex than previously thought and that $np - nh$ configurations play a major role in the structure of $^{30}$Mg.Comment: Physics Letters B, Volume 779, 10 April 2018, Pages 124-12

Cross-shell states in 15^{15}C: a test for p-sd interactions

The low-lying structure of $^{15}$C has been investigated via the neutron-removal $^{16}$C$(d,t)$ reaction. Along with bound neutron sd-shell hole states, unbound p-shell hole states have been firmly confirmed. The excitation energies and the deduced spectroscopic factors of the cross-shell states are an important measure of the $[(p)^{-1}(sd)^{2}]$ neutron configurations in $^{15}$C. Our results show a very good agreement with shell-model calculations using the SFO-tls interaction for $^{15}$C. However, a modification of the $p$-$sd$ and $sd$-$sd$ monopole terms was applied in order to reproduce the $N=9$ isotone $^{17}$O. In addition, the excitation energies and spectroscopic factors have been compared to the first calculations of $^{15}$C with the $ab~ initio$ self-consistent Green's function method employing the NNLO$_{sat}$ interaction. The results show the sensitivity to the size of the $N=8$ shell gap and highlight the need of going beyond the current truncation scheme in the theory

Coulomb breakup of 17 Ne from the view point of nuclear astrophysics

6 pags., 5 figs. -- XII International Symposium on Nuclei in the Cosmos, August 5-12, 2012, Cairns, AustraliaBy the Coulomb breakup of 17Ne, the time-reversed reaction 15O(2p, γ) 17Ne has been studied. This reaction might play an important role in the rp process, as a break-out reaction of the hot CNO cycle. The secondary 17Ne ion beam with an energy of 500 MeV/nucleon has been dissociated in a Pb target. The reaction products have been detected with the LAND-R3B experimental setup at GSI. The preliminary differential and integral Coulomb dissociation cross section σCoul has been determined, which then will be converted into a photo-absorption cross section σphoto, and a two-proton radiative capture cross section σcap. Additionally, information about the structure of the 17Ne, a potential two-proton halo nucleus, will be received. The analysis is in progress.This project was supported by the German Federal Ministry for Education and Research (BMBF), EU(EURONS), EMMI-GSI, and HIC for FAI