Excess mortality in patients with advanced chronic hepatitis C treated with long-term peginterferon

Chronic hepatitis C virus infection can cause chronic liver disease, cirrhosis and liver cancer. The Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) Trial was a prospective, randomized controlled study of long-term, low-dose peginterferon therapy in patients with advanced chronic hepatitis C who failed to respond to a previous course of optimal antiviral therapy. The aim of this follow-up analysis is to describe the frequency and causes of death among this cohort of patients. Deaths occurring during and after the HALT-C Trial were reviewed by a committee of investigators to determine the cause of death and to categorize each death as liver- or nonliver-related and as related or not to complications of peginterferon. Rates of liver transplantation were also assessed. Over a median of 5.7 years, 122 deaths occurred among 1,050 randomized patients (12%), of which 76 were considered liver-related (62%) and 46 nonliver-related (38%); 74 patients (7%) underwent liver transplantation. At 7 years the cumulative mortality rate was higher in the treatment compared to the control group (20% versus 15%, P = 0.049); the primary difference in mortality was in patients in the fibrosis compared to the cirrhosis stratum (14% versus 7%, P = 0.01); comparable differences were observed when liver transplantation was included. Excess mortality, emerging after 3 years of treatment, was related largely to nonliver-related death; liver-related mortality was similar in the treatment and control groups. No specific cause of death accounted for the excess mortality and only one death was suspected to be a direct complication of peginterferon. Conclusion: Long-term maintenance peginterferon in patients with advanced chronic hepatitis C is associated with an excess overall mortality, which was primarily due to nonliver-related causes among patients with bridging fibrosis. (H EPATOLOGY 2011;)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83750/1/24169_ftp.pd

Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study.

The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes. We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis. Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts

The medical student

The Medical Student was published from 1888-1921 by the students of Boston University School of Medicine

Trends and patterns in surface water chemistry in Europe and North America between 1990 and 2016, with particular focus on changes in land use as a confounding factor for recovery

The report presents trends in sulphate, nitrate, chloride, base cations, ANC (acid neutralising capacity), pH and DOC at circa 500 ICP Waters sites in Europe and North America for the period 1990-2016. Time series were analysed for trends in annual median values, annual extreme values and change points, that indicate years with sudden changes in trend or level. Also provided is a brief overview of possible implications of land use change for recovery of acidified surface waters

The lacuna of capital, the state and war? The lost global history and theory of Eastern agency

In this article I seek to constructively engage Alex Anievas’s seminal book that is deservedly the subject of this forum. For Anievas has become a key figure in the revival of Trotskyism in IR and his is one of the first book-length treatments of the New Trotskyist theory of the international. My critique is meant merely as a constructive effort to push his excellent scholarship further in terms of developing his non-Eurocentric approach. In the first section I argue that his book represents a giant leap forward for the New Trotskyist IR. However, in the following sections I argue that although undeniably a brave attempt nevertheless, in the last instance, Anievas falls a few steps short in realising a genuinely non-Eurocentric account of world politics. This is because while he certainly restores or brings in ‘the lost theory and history of IR’ that elevates class forces to a central role in shaping world politics, nevertheless he fails to bring in ‘the lost global theory and history of Eastern agency’ that constitutes, in my view, the key ingredient of a non-Eurocentric approach to world politics. I also argue that while his anti-reductionist ontological credentials are for the most part extremely impressive, nevertheless, I argue that these are compromised in his analysis of Hitler’s racism. Finally, in the conclusion I ask whether the theoretical architecture of the New Trotskyism in IR is capable of developing a non-Eurocentric approach before concluding in the affirmative with respect to its modern revisionist incarnation of which Anievas is in the vanguard

Synthesis

Human activity in the last century has led to a substantial increase in nitrogen (N) emissions and deposition. This N deposition has reached a level that has caused or is likely to cause alterations to the structure and function of many ecosystems across the United States. One approach for quantifying the level of pollution that would be harmful to ecosystems is the critical loads approach. The critical load is dei ned as the level of a pollutant below which no detrimental ecological effect occurs over the long term according to present knowledge. The objective of this project was to synthesize current research relating atmospheric N deposition to effects on terrestrial and aquatic ecosystems in the United States and to identify empirical critical loads for atmospheric N deposition. The receptors that we evaluated included freshwater diatoms, mycorrhizal fungi and other soil microbes, lichens, herbaceous plants, shrubs, and trees. The main responses reported fell into two categories: (1) biogeochemical, and (2) individual species, population, and community responses. This report synthesizes current research relating atmospheric nitrogen (N) deposition to effects on terrestrial and aquatic ecosystems in the United States and to identify empirical critical loads for atmospheric N deposition. The report evaluates the following receptors: freshwater diatoms, mycorrhizal fungi and other soil microbes, lichens, herbaceous plants, shrubs, and trees. The main responses reported fell into two categories: (1) biogeochemical; and (2) individual species, population, and community responses. The range of critical loads for nutrient N reported for U.S. ecoregions, inland surface waters, and freshwater wetlands is 1 to 39 kg N ha-1 y-1. This range spans the range of N deposition observed over most of the country. The empirical critical loads for N tend to increase in the following sequence for different life forms: diatoms, lichens and bryophytes, mycorrhizal fungi, herbaceous plants and shrubs, trees

Synthesis

Human activity in the last century has led to a substantial increase in nitrogen (N) emissions and deposition. This N deposition has reached a level that has caused or is likely to cause alterations to the structure and function of many ecosystems across the United States. One approach for quantifying the level of pollution that would be harmful to ecosystems is the critical loads approach. The critical load is dei ned as the level of a pollutant below which no detrimental ecological effect occurs over the long term according to present knowledge. The objective of this project was to synthesize current research relating atmospheric N deposition to effects on terrestrial and aquatic ecosystems in the United States and to identify empirical critical loads for atmospheric N deposition. The receptors that we evaluated included freshwater diatoms, mycorrhizal fungi and other soil microbes, lichens, herbaceous plants, shrubs, and trees. The main responses reported fell into two categories: (1) biogeochemical, and (2) individual species, population, and community responses. This report synthesizes current research relating atmospheric nitrogen (N) deposition to effects on terrestrial and aquatic ecosystems in the United States and to identify empirical critical loads for atmospheric N deposition. The report evaluates the following receptors: freshwater diatoms, mycorrhizal fungi and other soil microbes, lichens, herbaceous plants, shrubs, and trees. The main responses reported fell into two categories: (1) biogeochemical; and (2) individual species, population, and community responses. The range of critical loads for nutrient N reported for U.S. ecoregions, inland surface waters, and freshwater wetlands is 1 to 39 kg N ha-1 y-1. This range spans the range of N deposition observed over most of the country. The empirical critical loads for N tend to increase in the following sequence for different life forms: diatoms, lichens and bryophytes, mycorrhizal fungi, herbaceous plants and shrubs, trees

Comment on Bachmann et al. (2013): A nonrepresentative sample cannot describe the extent of cultural eutrophication of natural lakes in the United States

In their recent paper, Bachmann et al. (2013) evaluate the extent to which natural lakes in the contiguous United States have been affected by cultural eutrophication since Europe-an settlement, using paleolimnological data collected during the 2007 National Lakes Assessment (NLA; U.S. Environ-mental Protection Agency [USEPA] 2009). The NLA sites were selected using a statistically valid sampling design that allows for the overall ecological condition of the nation’s lakes to be accurately characterized (USEPA 2009). Given the current consensus among limnologists regarding the prevalence of culturally eutrophic lakes (Finlayson and D’Cruz 2005; Carpenter et al. 2011), the conclusion of Bachmann et al. that ‘‘in the United States of America, the extent that natural lakes have been changed by cultural eutrophication does not seem to be large’’ (Bachmann et al. 2013, p. 950) is surprising. The findings of Bachmann et al. supporting this statement are not based on the entire NLA sample of natural lakes but rather on a subset of them. We demonstrate below that not only is this subset not representative of the entire population of natural lakes in the United States, but that it is biased toward lakes in regions with less anthropogenic activity and substantially lower nutrient concentrations. Consequently, we argue that the conclusions drawn by Bachmann et al. (2013) at the national scale are based upon a statistically flawed analysis

Long-term rise in riverine dissolved organic carbon concentration is predicted by electrolyte solubility theory

The riverine dissolved organic carbon (DOC) flux is of similar magnitude to the terrestrial sink for atmospheric CO2, but the factors controlling it remain poorly determined and are largely absent from Earth system models (ESMs). Here, we show, for a range of European headwater catchments, that electrolyte solubility theory explains how declining precipitation ionic strength (IS) has increased the dissolution of thermally moderated pools of soluble soil organic matter (OM), while hydrological conditions govern the proportion of this OM entering the aquatic system. Solubility will continue to rise exponentially with declining IS until pollutant ion deposition fully flattens out under clean air policies. Future DOC export will increasingly depend on rates of warming and any directional changes to the intensity and seasonality of precipitation and marine ion deposition. Our findings provide a firm foundation for incorporating the processes dominating change in this component of the global carbon cycle in ESMs