1,814 research outputs found
Female patients in fertile age with chronic hepatitis C, easy genotype, and persistently normal transaminases have a 100% chance to reach a sustained virological response.
No full textBackground: Patients with chronic hepatitis C and persistently normal alanine transaminase levels have recently been included in the guidelines for antiviral treatment.
Aim: To evaluate the efficacy of PEG-interferon α-2a and weight-based ribavirin doses in patients with these characteristics in a single Italian centre.
Materials and Methods: Patients with chronic hepatitis C and at least three normal alanine transaminase values over a 12-month period were offered a treatment with PEG-interferon α-2a 180 mg/week and ribavirin (800 mg/day for weight 60 and 75 kg) for 24 weeks (according to genotype 2 or 3) or for 48 weeks (according to genotype 1 or 4). Each patient at baseline underwent liver stiffness (LS) examination using Fibroscan. Data were analysed according to the intention-to-treat criteria.
Results: A total of 227 patients (55 men, 172 women) were enrolled into the study: 65 (28.6%) had genotype 1, 144 (63.4%) genotype 2, nine (4.0%) genotype 3 and nine (4.0%) genotype 4. Patients with genotype 2 or 3 (N=153 with easy genotypes) were allocated in group 1 and those with genotype 1 or 4 (N=74 with difficult genotypes) in group 2. According to the LS measurement, patients were classified as follows: 159 (70.0%) presented absent or mild fibrosis (LS=2.5–7.0 kPa), 61 (26.9%) patients had significant fibrosis (LS=7.1–9.5) and seven (3.1%) patients had severe fibrosis (LS >9.6). Twelve patients (5.3%) dropped out within 4 months because of side-effects, whereas 215 patients completed the study. Overall, 13 patients were considered nonresponders (5.7%) and six patients (2.6%) were relapsers to the therapy. The sustained virological response (SVR) rate was 85.4% and it was higher in ‘easy’ genotypes (2 or 3) compared with ‘difficult’ genotypes (1 or 4) (92.2 vs. 74.3%, P<0.001). No statistical difference was found in the SVR rate between patients presenting absent or mild fibrosis as against those with significant fibrosis. Multivariate analysis, including factors correlated with SVR, showed that easy genotype and female sex are significantly associated with a SVR.
Conclusion: Patients with chronic hepatitis C and persistently normal transaminases have an 85.4% chance to clear the virus with conventional antiviral treatment. Female patients in fertile age with easy genotypes have a 100% chance to reach a SVR
Tackling inequalities: are secondary prevention therapies for reducing post-infarction mortality used without disparities?
No full textBackground: Mortality due to coronary heart disease has been declining as a result of better clinical patient management, including secondary prevention with the aid of effective drugs. The clinical challenge remains how to improve adherence to evidence-based cardiac care for all patients who can benefit from it. The present study aimed to assess the effectiveness of drug use after acute myocardial infarction (AMI) in reducing total medium-term mortality and to establish whether there are disparities in prescribing all therapies of demonstrated effectiveness.Design: We conducted a retrospective cohort study between 2002 and 2009 using a record linkage database, considering 1327 patients discharged after AMI.Methods: Cox's regression models were used for the survival analysis with time-dependent variables. Logistic regression analyses were performed to investigate the inequalities in the actual use of therapies found significantly associated with a lower mortality in the survival analyses.Results: Therapies independently associated with a lower all-cause mortality risk were antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. Gender-related differences in prescriptions were seen for statins and antiplatelet drugs; age-related differences emerged for all drugs. Associated chronic obstructive pulmonary disease reduced the likelihood of patients taking the effective treatments.Conclusion: The present study revealed disparities in the use of treatments for the secondary prevention of coronary heart disease unjustifiable on the strength of clinical evidence
Trattamento antivirale in pazienti portatoricronici di epatite C e transaminasemianormale a lungo termine: risultati preliminaridi uno studio pilota
No full textOBIETTIVI: valutare l’efficacia del PEG-IFNa-2a + ribavirina in una coorte
di pazienti HCV positivi con livelli di ALT persistentemente normali in
accordo con le nuove linee guida internazionali.MATERIALI: sono stati inclusi nello studio un gruppo di soggetti con almeno
3 determinazioni di ALT normali in un periodo superiore a 12 mesi. Tali
soggetti sono stati trattati con PEG-IFNa-2a 180mg/settimana + ribavirina
800 mg/die per 24 settimane se appartenenti ai genotipi 2 e 3, oppure per
48 settimane se appartenenti ai genotipi 1 e 4.
RIASSUNTO: sono stati arruolati 206 pazienti (48 M, 158 F). I soggetti
maschi, rispetto alle femmine, presentavano una differenza significativa
con valori più alti di BMI, ALT, GGT, carica virale e grading/staging della
fibrosi alla biopsia epatica. Il genotipo 2 è risultato il più rappresentato,
rispettivamente, nel 65,5% delle femmine e nel 55,2% dei maschi, mentre
i genotipi 1 e 4 erano presenti nel 34,5% dei soggetti. Il trattamento è stato
completato dal 95,7% (188/206) dei pazienti, mentre 18 (8,7%) hanno
interrotto il trial per le seguenti motivazioni: 3 hanno autosospeso il
trattamento, 4 sono risultati non responder, i rimanenti 11, a causa della
comparsa di effetti collaterali. I 188 pazienti che hanno concluso la terapia
sono stati seguiti con un follow-up minimo di 6 mesi in cui veniva monitorata
la carica virale con dosaggi mensili. Sono risultati non responders 11
(5,8%) pazienti, mentre 171 (90,9%) hanno risposto e mantenuto la risposta
a distanza di 6 mesi dopo la fine della terapia con una percentuale di
ricaduta, alla sospensione, del 2,9%.
CONCLUSIONI: da una preliminare analisi dei dati, emerge l’indicazione di
offrire il trattamento antivirale anche a pazienti con epatite cronica da HCV
e valori di ALT persistentemente normali
Sopravvivenza nei soggetti con IMAin trattamento con statine nell’AULSS 18della Regione Veneto
No full textOBIETTIVI: Valutare la sopravvivenza di diverse coorti di soggetti infartuati
in relazione all’assunzione di statine.MATERIALI: Nell’AULSS 18 di Rovigo è stato implementato un Sistema
Epidemiologico Integrato (SEI) con analisi dei dati a partire dal 2002.
Mediante l’algoritmo SISMEC-AIE applicato agli archivi informatizzati
contenenti le cause di morte (CM), le schede di dimissione ospedaliera
(SDO) e le prescrizioni farmaceutiche (PF), è stato possibile identificare i
casi di IMA incidenti nel periodo 2002-2008. I soggetti sono stati suddivisi
in trattati, non trattati e con somministrazione non continuativa. I soggetti
trattati sono stati identificati mediante la ricerca di una prescrizione di
statine in un periodo inferiore ai 30 giorni dalla dimissione ospedaliera e con
assunzione continuativa della terapia fino al termine del follow-up.
Nell’archivio di mortalità è stato ricercato il decesso.
RIASSUNTO: Complessivamente, sono stati identificati 2091 soggetti
ricoverati per IMA, con una letalità intraospedaliera del 13,4%. Dei 1810
soggetti inclusi nello studio, con un follow-up complessivo di 5031 anni,
482 hanno iniziato il trattamento con statine, di questi, il 33,4% ha sospeso
la terapia. Nei primi 30 giorni dopo la dimissione, 1328 soggetti non hanno
assunto alcuna terapia con statine, fra i quali il 17,4% ha successivamente
iniziato il trattamento per poi sospenderlo nel 2,1% dei casi. La
sopravvivenza a 6,8 anni risulta del 95,0% e del 51,2% rispettivamente nei
soggetti trattati continuativamente e non trattati. Nei soggetti con trattamento
“non continuativo” la sopravvivenza a fine follow-up varia tra il 73,0% e
l’80,0%.
CONCLUSIONI: La sopravvivenza risulta essere significativamente
superiore nei soggetti trattati con statine rispetto ai non trattati,
sottolineando l’importanza di una terapia appropriata e protratta nel tempo.
Di rilievo risulta il numero di soggetti in trattamento “non continuativo”. Tali
conclusioni devono essere ulteriormente approfondite sia per eliminare gli
eventuali effetti confondenti, sia per valutare la corretta applicazione della
terapia in accordo con le linee guida regionali
Discontinuous Galerkin Methods for Numerical Weather Prediction: DG in a large-eddy simulation
No full textThe coarse grid of numerical weather prediction and climate models requires parametrization models to resolve atmospheric processes that are smaller than the grid size. For parametrization development, these processes are simulated by a high resolution model. At the Royal Netherlands MeteorologicalInstitute, the Dutch Atmospheric Large-Eddy Simulation (DALES) is used. This three-dimensional high resolution model uses advection schemes that are too diffusive when steep gradients are present. In this thesis, an advection scheme based on the Discontinuous Galerkin (DG) method is implementedfor DALES.The DG method is known to be dispersive. To remove those non-physical oscillations, the moment limiter of Krivodonova is used. Krivodonova constructed the limiter for one- and two-dimensions. In this thesis the moment limiter and limiting order are derived for three-dimensions. DALES is a model based on the finite difference method and uses operational splitting. Therefore, the DG advection scheme needs a mapping from each cell average to all nodal values that are needed for one DG cell, and a mapping back, which we called mapping a and b respectively. Mappings a that are discussed are taking the cell average as value for all nodal points of the DG cell (cell average a), and taking the L -projection of the cell average to the continuous finite element space (L -projection). This thesis describes mappings b that calculate cell averages of nodal DG values (cell average b)and calculate the cell averages of the tendencies of DG values (cell average of tendency). Using cell average a combined with cell average of tendency, made the DG method as diffusive as the first order upwind scheme. Substituting the cell average a method with the L -projection, the DG method becamevery dispersive, meaning that there was not enough diffusion. At last, cell average b was tested with the L -projection. Its numerical results showed that the speed of the advection was slower than the theoretical velocity. Therefore, a method is suggested which does not need mappings. An option couldbe a supergrid that takes multiple DALES cells as a DG cell.Applied Mathematic
Increasing Distributed Generation Penetration using Soft Normally-Open Points
No full textThis paper considers the effects of various voltage control solutions on facilitating an increase in allowable levels of distributed generation installation before voltage violations occur. In particular, the voltage control solution that is focused on is the implementation of `soft' normally-open points (SNOPs), a term which refers to power electronic devices installed in place of a normally-open point in a medium-voltage distribution network which allows for control of real and reactive power flows between each end point of its installation sites. While other benefits of SNOP installation are discussed, the intent of this paper is to determine whether SNOPs are a viable alternative to other voltage control strategies for this particular application. As such, the SNOPs ability to affect the voltage profile along feeders within a distribution system is focused on with other voltage control options used for comparative purposes. Results from studies on multiple network models with varying topologies are presented and a case study which considers economic benefits of increasing feasible DG penetration is also given
Dg algebras with enough idempotents, their dg modules and their derived categories
No full textWe develop the theory dg algebras with enough idempotents and their dg modules and show their equivalence with that of small dg categories and their dg modules. We introduce the concept of dg adjunction and show that the classical covariant tensor-Hom and contravariant Hom-Hom adjunctions of modules over associative unital algebras are extended as dg adjunctions between categories of dg bimodules. The corresponding adjunctions of the associated triangulated functors are studied, and we investigate when they are one-sided parts of bifunctors which are triangulated on both variables. We finally show that, for a dg algebra with enough idempotents, the perfect left and right derived categories are dual to each other.The author is highly indebted to Alexander Zimmermann for the careful reading of these notes, for his comments and for his help in improving the presentation. This work is backed by reseach projects from the Ministerio de Economía y Competitividad of Spain(MTM201346837-P and MTM201677445-P) and the Fundación ’Séneca’ of Murcia(19880/GERM/15), both with a part of FEDER funds. We thank these institutions for their support
A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments
No full textBackground: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication.
Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years.
Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge.
Results: A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common
among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units.
Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. Thepotential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes
Life cycle comparison of petroleum- and bio-based paper binder from distillers grains (DG)
No full textAbstractThis study presents a comparative cradle-to-gate life cycle assessment (LCA) of distillers grain (DG) gum, a bio-based paper coating binder, and polyvinyl alcohol (PVA). Non-renewable energy use, greenhouse gas (GHG) emissions, and eutrophication potential were assessed for each binder. Economic, mass, and energy allocation were used to allocate the impacts of DG gum production with co-products (ethanol and livestock feed). DG production non-renewable energy use (269 to 183MJ) surpassed that associated with PVA production (168MJ). GHG emissions from DG gum production under mass and energy allocations were 28% and 37% lower than PVA production emissions, respectively. Corn cultivation is responsible for 55% to 78% of the eutrophication impacts of DG gum production under energy and economic allocation, respectively. Changes to natural gas consumption and fertilizer runoff had the largest influence on total energy use, GHG emissions, and eutrophication potential of DG gum production
The DG-category of secondary cohomology operations
No full textWe study track categories (i.e., groupoid-enriched categories) endowed with additive structure similar to that of a 1-truncated DG-category, except that composition is not assumed right linear. We show that if such a track category is right linear up to suitably coherent correction tracks, then it is weakly equivalent to a 1-truncated DG-category. This generalizes work of the first author on the strictification of secondary cohomology operations. As an application, we show that the secondary integral Steenrod algebra is strictifiable
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