47 research outputs found
Efficacy and Safety of Sofosbuvir and Ribavirin in an Italian Cohort of HCV Genotype 2 Elderly Cirrhotic Patients
No full textObjective: Sofosbuvir and ribavirin represented until recently the standard of care in hepatitis C virus genotype 2 cirrhotic patients. In registration trials, 12-16 week durations were associated with 90% sus- tained virological responses, although not confirmed by real-life studies. In Italy, various durations (12,16, 20, and 24 weeks) represent lawfully reimbursable healthcare practice. The aim is, therefore, to study the behavior of Italian clinicians and the possible impact of therapy durations on sustained virological responses and patient safety.
Materials and methods: Data of all consecutive genotype 2 cirrhotic patients who started sofosbuvir plus ribavirin therapy between January 2015 and March 2017 in 7 Italian liver clinics were collected retrospectively.
Results: Overall, 147 patients (138 Child-Pugh A, mean age: 71 years) were treated. The median treatment duration was 16 weeks, but marked differences were found among the clinicians; however, the 12-week duration was not considered by the vast majority of them. Rates of intention-to-treat and per-protocol sus- tained virological responses were 95.9% and 97.1%, respectively, and neither showed differences between the various durations. No independent, sustained virological response predictors could be found, but the median baselines for Child-Pugh and Model For End-Stage Liver Disease scores were higher in non-respond- ers. Anemia was not associated with treatment duration. One case of acute kidney injury attributed to the possible sofosbuvir effect was reported.
Conclusion: In genotype 2 cirrhotic patients, sofosbuvir plus ribavirin was associated with real-life-sustained virological response rates of almost 96%, without a significant impact on treatment duration provided it was longer than 12 weeks
Fibrosis progression in HCV carriers with mild hepatitis who possess the high-repetition variant of the DRD4 gene, a genetic marker for binge-drinking and risk-seeking behavior: a longitudinal study
No full textAlcohol is a major determinant of the outcome of chronic hepatitis C virus (HCV) infection, but self-reported drinking habits lack reliability. We hypothesized that carriage of high-repetition variants (HRV) of the variable number of tandem repeats (VNTR) in exon III of the dopamine receptor D4 gene, linked to binge-drinking and risk-seeking behavior, might be a proxy measure of alcohol consumption, and aimed to verify whether it may affect histologic outcome
Apolipoprotein E genotypes modulate fibrosis progression in patients with chronic hepatitis C and persistently normal transaminases
No full textCarriage of the apolipoprotein E (Apo E) variants, E2, E3 and E4, affects cholesterol metabolism and may be involved in the persistence of hepatitis C virus (HCV) infection. Our aim was to verify whether carriage of specific Apo E variants modulates the course of hepatitis C
The interleukin 28B rs12979860 C/T polymorphism and serum cholesterol as predictors of fibrosis progression in patients with chronic hepatitis C and persistently normal transaminases
No full textThe interleukin 28B (IL-28B) rs12979860 C/T polymorphism is a predictor of spontaneous and treatment-induced hepatitis C virus (HCV) clearance. The C/C genotype is associated with higher serum cholesterol, predictor of a favorable outcome in chronic hepatitis C. Whether IL-28B polymorphism and serum cholesterol play a role in modulating the history of mild hepatitis C is unknown. To clarify this issue, 93 untreated patients infected with HCV with normal or near-normal transaminases and an initial Ishak staging score ≤1 were investigated retrospectively in the longitudinal study (median histological follow-up of 10 years). An additional confirmatory cohort of 143 patients with chronic HCV infection and abnormal levels of transaminases was evaluated in the cross-sectional study. In the longitudinal study, at the end of follow-up, Ishak staging scores progressed more frequently among carriers of a T/* allele who had a baseline serum cholesterol ≤175 mg/dl than in remaining patients: 6/36 (change ≤0), 15/45 (change 1-2), 6/12 (change ≥3), improvement chi-square P < 0.02, OR 3.1, 95% C.I. 1.3-7.7. In the cross-sectional study, the frequency of patients carrying the T/T genotype or serum cholesterol values ≤175 mg/dl increased starting from those with a staging score ≤2 (36/76, 47.4%), to those with a staging score of 3-4 (26/41, 63.4%) and to those with a staging score of 5-6 (20/26, 76.9%, P < 0.01 for linear trend). In conclusion, the interaction between IL-28B rs12979860 T/T genotype and low serum cholesterol concentration is an independent predictor of a worse disease course among patients infected with HCV with normal or near-normal transaminases
Structural changes in metals consumption
No full textFor 15 years the metals market has been characterized by slow growth - in some cases, even decline - in consumption. To test the proposition that structural changes in demand were the main cause of the slowdown, the author - drawing on U.S. data - uses an extended metals demand model that recognizes energy, labor, capital, and other materials as major inputs. The traditional model explains metals consumption in terms only of output and the prices of metal and its substitutes. It is inadequate to address the issue of structural change because it ignores other factors of production, such as energy, which have experienced dramatic changes. With the extended model, the null hypothesis of no structural change cannot be rejected for most metals. With the conventional model, the null hypothesis of no structural change is strongly rejected. Results with the extended model show that the downturn can be explained mostly by changes in the input variables, particularly such nonmetal inputs as capital and energy, which are much more important cost items than metals and have undergone drastic cost changes over the period.Environmental Economics&Policies,Economic Theory&Research,Montreal Protocol,Mining&Extractive Industry (Non-Energy),Primary Metals
Strengthening Uganda's policy environment for investing in university development
No full textThe authors examine the policy environment for investment in university development in Uganda, with special attention to the needs of Makerere University. They present data on the structure and financing of higher education, which gets a high priority in government educational spending. A second public university and new private universities have been established since 1986, but Makerere accounts for most university enrollment and government spending on higher education and it trains most of the country's high-level professional and technical manpower. Its revitalization after many years of neglect is central to government and donor plans for investment in human resource development. The authors emphasize how continuing austerity affects staff retention and staff engagement in academic work, as well as the quality of programs Makerere offers. They present a strategy for university development that involves establishing policy structures to: guide and coordinate investments in higher education as a whole; facilitate the expansion of higher education and the development of diploma-granting institutions to accommodate increasing social demand; and promote cost-saving and revenue-generating activities in the public universities - which would require giving them more autonomy in matters affecting their cost structure and budgeting. Among specific actions they recommend: making better use of public university assets by developing night courses, part-time degree and non-degree programs, and contract training and other income-generating activities; investigating possibilities for better use of university farms and other properties; making more use of existing capacity in public institutions and increasing the capacity of the newly established private universities; strengthening secondary education in science subjects and encouraging more women to study science and technology; coordinating future donor investments so they address the broad needs of Makerere and other universities; and raising incomes of academic and nonacademic university staff members.Teaching and Learning,Curriculum&Instruction,Gender and Education,Tertiary Education,Primary Education
Pollution control in a decentralized economy : which level of government should subsidize what in Brazil
No full textSubsidies in Brazil essentially serve three purposes: (i) if assigned to the right level of government, they could reinforce the effectiveness of pollution taxes in reducing pollution; (ii) they offer an opportunity foradditional combinations of instruments and hence more flexibility in dealing with specific institutional characteristics of every state; and (iii) they can serve a purely"public relations"affect by showing that the federal government does not always rely on"sticks"but can also provide"carrots."The authors have four main messages of relevance to the Brazilian economy. First, carrots will not work without a stick. Subsidies of any type will not work without a coexisting pollution tax. Second, some carrots are better than others at achieving the government's objectives. In general, a state abatement subsidy is the more effective instrument to combine with a pollution tax. But when federal or state inspection capabilities are limited, monitoring subsidies may be an effective substitute. Third, increasing abatement subsidy rates can be counterproductive - tending to increase firm investment more than necessary and hence reduce the pollution tax base, while increasing subsidy costs. This can worsen the monitoring and inspection efforts and fiscal revenue. Finally, it is more effective to keep subsidy rates low if they are to be effective and sustainable and at the same time get the endorsement needed from state and federal fiscal administrations.Environmental Economics&Policies,Water and Industry,Pollution Management&Control,Public Sector Economics&Finance,Taxation&Subsidies
The \u27Truthiness\u27 of the \u27Daily Show Effect\u27: A Presidency Study
No full textNews-gathering for the American public changed in the past decade with a decline in trust for journalists and news media (Jones 2009), technology advancement (Haynes and Pitts 2009), and entertainment becoming a priority (Jones 2009; Haynes and Pitts 2009; Baumgartner and Morris 2006; Colletta 2009). Television, radio, and newspapers (the traditional media) are still used today with broadcast and cable television being the dominate news source (Colletta 2009; Haynes and Pitts 2009), however, an increased amount of Americans utilize the internet for their news information through what is known as new media, referring to Web blogs and social networks. Haynes and Pitts (2009) found that 55% of the public went online during the 2008 Presidential Elections to get their political news and information on candidates. Those who like political information will have greater ease in finding it [online], while those who prefer entertainment and the like will as well (Haynes and Pitts 2009, 53). People, however, are finding that entertainment aspect in news-gathering within traditional media. Soft news, in particularly political satire television, is becoming increasingly popular as news-gathering sources. Colletta defined satire as a form that holds up human vices and follies to ridicule, a criticism of any stupidity or vice in the form of scathing humor, and a critique of what an author sees as dangerous religious, political, moral, or social standards. Comedy and satire differ in that comedy evokes laughter, while satire uses laughter as a weapon (859). Parody, seen in sketch comedy in Saturday Night Live, is therefore satiric
Credit rationing, tenancy, productivity, and the dynamics of inequality
No full textWhy, when given the same resources, might productivity be lower on farms operated through sharecropping than on owner-run farms? The reason is that sharecropping, much less wage contracts, cannot overcome the divergence of interests between those who till the land and those who own it. Only land redistribution can do that. This paper presents notes toward a general equilibrium theory of land tenancy that suggest how changes in technology and publicly provided infrastructure can affect the equilibrium distribution of land in countries where credit is rationed. When credit to famers is rationed, changes in technology can increase the inequality in landholdings - with a long term increase in share tenancy. This is turn might reduce productivity, at least partially offsetting the initial improvements. The paper suggests that the development of effective rural financial institutions would reduce the likelihood of these negative effects on equality and productivity. It further cautions though that past attempts in creating such institutions have failed because of a lack of accountability and of enforcement procedures.Environmental Economics&Policies,Economic Theory&Research,Banks&Banking Reform,Economic Growth,Municipal Financial Management
