Provider Attitudes and Practice Patterns for Direct-Acting Antiviral Therapy for Patients With Hepatocellular Carcinoma

Background & Aims: Direct-acting antivirals (DAAs) are effective against hepatitis C virus and sustained virologic response is associated with reduced incidence of hepatocellular carcinoma (HCC). However, there is controversy over the use of DAAs in patients with active or treated HCC and uncertainty about optimal management of these patients. We aimed to characterize attitudes and practice patterns of hepatology practitioners in the United States regarding the use of DAAs in patients with HCC. Methods: We conducted a survey of hepatology providers at 47 tertiary care centers in 25 states. Surveys were sent to 476 providers and we received 279 responses (58.6%). Results: Provider beliefs about risk of HCC recurrence after DAA therapy varied: 48% responded that DAAs reduce risk, 36% responded that DAAs do not change risk, and 16% responded that DAAs increase risk of HCC recurrence. However, most providers believed DAAs to be beneficial to and reduce mortality of patients with complete response to HCC treatment. Accordingly, nearly all providers (94.9%) reported recommending DAA therapy to patients with early-stage HCC who received curative treatment. However, fewer providers recommended DAA therapy for patients with intermediate (72.9%) or advanced (57.5%) HCC undergoing palliative therapies. Timing of DAA initiation varied among providers based on HCC treatment modality: 49.1% of providers reported they would initiate DAA therapy within 3 months of surgical resection whereas 45.9% and 5.0% would delay DAA initiation for 3–12 months and >1 year post-surgery, respectively. For patients undergoing transarterial chemoembolization (TACE), 42.0% of providers would provide DAAs within 3 months of the procedure, 46.7% would delay DAAs until 3–12 months afterward, and 11.3% would delay DAAs more than 1 year after TACE. Conclusions: Based on a survey sent to hepatology providers, there is variation in provider attitudes and practice patterns regarding use and timing of DAAs for patients with HCC. Further studies are needed to characterize the risks and benefits of DAA therapy in this patient population

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Review of augmentation of energy needs using renewable energy sources in India

Sustainable and equitable development is the most important challenge before mankind. After food, most pressing concern is energy for a decent living. The energy consumption has been recognized world wide as a parameter of development in a society. In the present paper an attempt has been made to review the demand of energy, the potential of renewable energy sources in India and its prospects for development in cost effective and sustainable manner.Renewable energy Installed capacity Electricity Cost

Study of friction characteristics of a diesel engine running on different viscosity grade engine oils using conventional and acoustic emissions technique

Experimental studies were conducted on an off highway heavy duty diesel engine running on different viscosity grade engine oil, for determining the friction power in a firing engine by measuring the indicated mean effective pressure (IMEP) by in–cylinder pressure sensor and calculating the Indicated power and Brake power. It is known fact that hydrodynamic friction is related to the viscosity of engine oil and it has been shown that this friction can be reduced by using low viscosity grade engine oil [1]. Experimental results of friction power are compared with the novel use of non-intrusive acoustic emission (AE) technique to provide information pertaining to engine friction. Conventional method of friction assessment revealed that there is some improvement in reducing engine friction power when lower viscosity grade engine oil is used in place of recommended grade viscosity oil. These findings were corroborated with the modern AE technique which also indicated the benefits of using lower viscosity grade engine oil in reducing the friction. This paper will extend the scope of AE technique for analyzing friction of an engine and may provide an opportunity for inservice monitoring of efficient engine operation

Small hydropower for sustainable energy development in India

Adequate amount of energy generation in a sustainable manner is a major challenge in the present energy scenario. Fast depleting fossils fuels and their environmental effects forces to look towards renewable sources for sustainable development. Among all renewable sources, small hydropower (SHP) is one of the promising sources for sustainable water and energy development. The geography of India supports the development of small hydro projects to enhance the energy generation. Small hydropower development is also necessary for proper utilization of available water resources. Present study has been carried out to highlight the water resource and small hydropower potential in India. Utilization of small hydropower sources for sustainable development has also been presented.Small hydropower Renewable Energy Water resources

PERFORMANCE EVALUATION OF A PASSENGER CAR FUELLEDWITH BLENDSOF JATROPAMETHYL ESTER/ETHYL ESTERWITH DIESEL

Recent concerns over the environment, increasing fuel prices and scarcity of its supply have promoted the interest in the development of the alternative sources for petroleum fuels. Many researchers have reported the use of vegetable oil ester as a fuel in diesel engine, thereby achieving reduction in harmful exhaust emissions as well as a comparable engine performance as that with diesel. However, study on chassis dynamometer and in the field related to fuel economy, acceleration was undertaken in order to understand the impact of blending vegetable oil esters with the diesel in vehicles. This paper presents the result of the investigation carried out on a diesel passenger car on chassis dynamometer using diesel, 10%, 20% and 30% blend of bio-diesel (JME) and (JEE) fuels. The vehicle performance study have been carried out with the aim of obtaining comparative measures of the constant speed fuel consumption, driving cycle fuel economy, WOT Power, fuel consumption. The emission of the CO2 was also computed using the fuel economy data on the above-mentioned fuels. The vehicle acceleration tests were also carried out on actual road condition using global positioning systems (GPS) and the results for maximum speed, time elapsed for a distance of the 1km and also the acceleration time for reaching speeds of 0-60 km/hr and 0-90 km/hr are reported in the paper