Telaprevir or boceprevir based therapy for chronic hepatitis C infection: Development of resistance-associated variants in treatment failure

The use of triple-therapy, pegylated-interferon, ribavirin and either of the first generation hepatitis C virus (HCV) protease inhibitors telaprevir or boceprevir, is the new standard of care for treating genotype 1 chronic HCV. Clinical trials have shown response rates of around 70–80%, but there is limited data from the use of this combination outside this setting. Through an expanded access programme, we treated 59 patients, treatment naïve and experienced, with triple therapy. Baseline factors predicting treatment response or failure during triple therapy phase were identified in 58 patients. Thirty seven (63.8%) of 58 patients had undetectable HCV RNA 12 weeks after the end of treatment. Genotype 1a (p = 0.053), null-response to previous treatment (p = 0.034), the rate of viral load decline after 12 weeks of previous interferon-based treatment (p = 0.033) were all associated with triple-therapy failure. The most common cause of on-treatment failure for telaprevir-based regimens was the development of resistance-associated variants (RAVs) at amino acids 36 and/or 155 of HCV protease (p = 0.027) whereas in boceprevir-based regimens mutations at amino acid 54 were significant (p = 0.015). SVR12 rates approaching 64% were achieved using triple therapy outside the clinical trial setting, in a patient cohort that included cirrhotics.

Interaction Rituals and Jumbled Emotions Among “Relative Strangers”: Simulated Patient Work on a Trainee Complementary Therapy Practitioner Program

Learning games such as role-play (which we refer to as “simulated interaction rituals”) are commonly used as social tools to develop trainee health practitioners. However, the effect of such rituals on individual and group participant emotions has not been carefully studied. Using a heuristic approach, we explore the experiences of complementary therapy practitioner trainees (and their trainers) participating in a personal development course. Ten trainees and two tutors were interviewed, observational notes taken, and a secondary qualitative analysis undertaken. Participants and tutors described a medley of disparate emotional and moral responses to group rituals, conceptualized in this article as “jumbled emotions.” Such emotions required disentangling, and both trainees and staff perceived participating in unfamiliar rituals “with relative strangers” as challenging. Front of stage effects are frequently processed “backstage,” as rituals threaten social embarrassment and confusion. Concerns around emotional triggers, authenticity, and outcomes of rituals arise at the time, yet trainees can find ways to work through these issues in time.

The Edinburgh Critical Edition of the Selected Writing of Andrew Lang, volume 2

This is the first critical edition of the works of Andrew Lang (1844-1912), the Scottish writer whose enormous output spanned the whole range of late nineteenth-century intellectual culture. Neglected since his death, partly because of the diversity of his interests and the volume of his writing, his cultural centrality and the interdisciplinary nature of his work make him a vital figure for contemporary scholars. This volume covers his work on literary criticism, history and biography.

Discipline-specific writing for business students: Research, practice and pedagogy

In the past few years strong arguments have been made for locating academic writing in higher education within the students’ disciplinary contexts in the belief that a full understanding of the role and dynamic of writing can only be achieved if it is examined as a social practice in its context of production. This chapter reports on a study that examined the conceptualisations of writing for business by a group of undergraduate and postgraduate lecturers and students at the business school of a British university. Based on a critical analysis of the literature reviewed for the study, and the data collected, the chapter contributes to existing writing pedagogy with a number of research-informed transformative pedagogical applications for teaching discipline-specific writing for business. Such applications which combine context-oriented practices (e.g. raising awareness of the role of disciplinary values in shaping writing) and text-oriented activities (e.g. discipline-specific referencing) aim at influencing the pedagogic agenda for teaching writing in higher education. The chapter concludes with questions for reflection and discussion that provide an opportunity for readers to reflect upon their own teaching environment.