Hepatitis C infection: eligibility for antiviral therapies

peer reviewedBackground Current treatments of chronic hepatitis C virus (HCV) are effective, but expensive and susceptible to induce significant side effects. Objectives To evaluate the proportion of HCV patients who are eligible for a treatment. Methods In a database comprising 1726 viraemic HCV patients, the files of 299 patients who presented to the same hepatologist for an initial appointment between 1996 and 2003 were reviewed. Results Patients' characteristics were age 43.1 +/- 15.6 years, 53% male and 92% Caucasian. The main risk factors were transfusion (43%) and drug use (22%). Genotypes were mostly genotype 1 (66%), genotype 3 (12%) and genotype 2 (10%). These characteristics were not different from those of the whole series of 1726 patients. A total of 176 patients (59%) were not treated, the reasons for non-treatment being medical contraindications (34%), non-compliance (25%) and normal transaminases (24%). In addition, 17% of patients declined therapy despite being considered as eligible, mainly due to fear of adverse events. Medical contraindications were psychiatric (27%), age (22%), end-stage liver disease (15%), willingness for pregnancy (13%), cardiac contraindication (7%) and others (16%). Only 123 patients (41%) were treated. A sustained viral response was observed in 41%. The treatment was interrupted in 16% for adverse events. Conclusions The majority of HCV patients are not eligible for treatment. This implies that, with current therapies, only 17% of patients referred for chronic HCV become sustained responders. Some modifications of guidelines could extend the rate of treatment (patients with normal transaminases), but an important barrier remains the patients' and the doctors' fear of adverse events

Temperature, Biogenesis,

this reported TMAX is now being challenged (Stetter 2003). Other recent support for a hyperthermophilic LCA comes from expanded sequence and secondary structure data of rRNA (Shepard et al. 2003), the tRNA sequence tree (Tong et al. 2003) and experimental tests using modified enzyme residues (Miyazaki et al. 2001; Yamagishi et al. 2003). If future phylogenetic trees based on greater sampling and better understood genomes confirm the apparent near universal absence of hyperthermophiles with mesophilic ancestors (Fig. 16.1), the asymmetric evolution of hyperthermophiles to mesophiles would be confirmed. This asymmetry is supported for example, by the absence of any living eucaryote with a TMAX exceeding a few degrees above 60 # C, in spite of at least 2 billion years of opportunity to adapt to hyperthermophil

Operational prediction of ash concentrations in the distal volcanic cloud from the 2010 Eyjafjallajökull eruption

During the 2010 eruption of Eyjafjallajökull, improvements were made to the modeling procedure at the Met Office, UK, enabling peak ash concentrations within the volcanic cloud to be estimated. In this paper we describe the ash concentration forecasting method, its rationale and how it evolved over time in response to new information and user requirements. The change from solely forecasting regions of ash to also estimating peak ash concentrations required consideration of volcanic ash emission rates, the fraction of ash surviving near-source fall-out, and the relationship between predicted mean and local peak ash concentrations unresolved by the model. To validate the modeling procedure, predicted peak ash concentrations are compared against observations obtained by ground-based and research aircraft instrumentation. This comparison between modeled and observed peak concentrations highlights the many sources of error and the uncertainties involved. Despite the challenges of predicting ash concentrations, the ash forecasting method employed here is found to give useful guidance on likely ash concentrations. Predicted peak ash concentrations lie within about one and a half orders of magnitude of the observed peak concentrations. A significant improvement in the agreement between modeled and observed values is seen if a buffer zone, accounting for positional errors in the predicted ash cloud, is used. Sensitivity of the predicted ash concentrations to the source properties (e.g., the plume height and the vertical distribution of ash at the source) is assessed and in some cases, seemingly minor uncertainties in the source specification have a large effect on predicted ash concentrations

Reducing Health Disparity in People with Intellectual Disabilities: A Report from Health Issues Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities1

Disparities in the health status and care experienced by people with intellectual disabilities are increasingly being recognized. This special report presents the results of an international expert consensus workshop held under the auspices of the Health Issues Special Interest Research Group of the International Association for the Scientific Study of Intellectual Disabilities. The workshop's presentations were designed to identify domains of health disparity and identify examples of evidence-based or good practice and from them define statements and recommendations that would form the basis of an agenda for change. The report recognizes the breadth of domains that impact on disparity in health among people with intellectual disabilities by highlighting the importance of classification and the direct recognition of the increased morbidity and reduced life expectancy that these people experience. The report also considers population-based causes of disparity relating to social circumstances and inequalities in the provision of health and social services. Individual predispositions attributable to sex or genetic factors and potential solutions actualized through self-determination are discusse