The Irish paradigm on the natural progression of hepatitis C virus infection: an investigation in a homogeneous patient population infected with HCV 1b (Review)

The aetiological agent of chronic hepatitis C is the hepatitis C virus. The hepatitis C virus is spread by parenteral transmission of body fluids, primarily blood or blood products. In 1989, after more than a decade of research, HCV was isolated and characterised. The hepatitis C viral genome is a positive-sense, single-stranded RNA molecule approximately 9.4 kb in length, which encodes a polyprotein of about 3100 amino acids. There are 6 main genotypes of HCV, each further stratified by subtype. In 1994, a cohort of women was identified in Ireland as having been iatrogenically exposed to the hepatitis C virus. The women were all young and exposed as a consequence of the receipt of HCV 1b contaminated anti-D immunoglobulin. The source of the infection was identified as an acutely infected female. As part of a voluntary serological screening programme involving 62,667 people, 704 individuals were identified as seropositive for exposure to the hepatitis C virus; 55.4% were found to be positive for the viral genome 17 years after exposure. Of these women 98% had evidence of inflammation, but suprisingly, a remarkable 49% showed no evidence of fibrosis. Clinicopathology and virological analysis has identified associations between viral load and the histological activity index for inflammation, and, between inflammation and levels of the liver enzyme alanine aminotransferase. Infection at a younger age appears to protect individuals from progression to advanced liver disease. Molecular analyses of host immunogenetic elements shows that particular class II human leukocyte associated antigen alleles are associated with clearance of the hepatitis C virus. Additional class II alleles have been identified that are associated with stable viraemia over an extended period of patient follow-up. Although, investigation of large untreated homogeneous cohorts is likely to become more difficult, as the efficacy of anti-viral therapy improves, further investigation of host and viral factors that influence disease progression will help provide an evidence based approach were realistic expectations regarding patient prognosis can be ascertained.

Perpetuating sales: enabling incumbent survival of radical technological shifts

This paper examines an industry whose incumbents’ specialised complimentary assets were their operations management and distribution channels. This advantage was seriously undermined by the advent of digital distribution. Radical technological change theories dictate that if incumbents in an industry without specialised complimentary assets will be replaced by entrants. This did not happen, and extant theories of incumbent survival do not explain why the incumbents remained dominant in the industry. We propose that survival is due to the unique industry characteristic of perpetuating sales. This paper will explain what is a perpetuating sales model and why does it enable incumbent survival?

Salutogenesis: a new paradigm for pervasive computing in healthcare environments?

Salutogenesis is now accepted as a part of the contemporary model of disease: an individual is not only affected by pathogenic factors in the environment, but those that promote well-being or salutogenesis. Given that "environment" extends to include the built environment, promotion of salutogenesis has become part of the architectural brief for contemporary healthcare facilities, drawing on an increasing evidence-base. Salutogenesis is inextricably linked with the notion of person-environment "fit". MyRoom is a proposal for an integrated architectural and pervasive computing model, which enhances psychosocial congruence by using real-time data indicative of the individual's physical status to enable the environment of his/her room (colour, light, temperature) to adapt on an on-going basis in response to bio-signals. This work is part of the PRTLI-IV funded programme NEMBES, investigating the use of embedded technologies in the built environment. Different care contexts require variations in the model, and iterative prototyping investigating use in different contexts will progressively lead to the development of a fully-integrated adaptive salutogenic single-room prototype.

Potential Arctic tundra vegetation shifts in response to changing temperature, precipitation and permafrost thaw

Over the past decades, vegetation and climate have changed significantly in the Arctic. Deciduous shrub cover is often assumed to expand in tundra landscapes, but more frequent abrupt permafrost thaw resulting in formation of thaw ponds could lead to vegetation shifts towards graminoid-dominated wetland. Which factors drive vegetation changes in the tundra ecosystem are still not sufficiently clear. In this study, the dynamic tundra vegetation model, NUCOM-tundra (NUtrient and COMpetition), was used to evaluate the consequences of climate change scenarios of warming and increasing precipitation for future tundra vegetation change. The model includes three plant functional types (moss, graminoids and shrubs), carbon and nitrogen cycling, water and permafrost dynamics and a simple thaw pond module. Climate scenario simulations were performed for 16 combinations of temperature and precipitation increases in five vegetation types representing a gradient from dry shrub-dominated to moist mixed and wet graminoid-dominated sites. Vegetation composition dynamics in currently mixed vegetation sites were dependent on both temperature and precipitation changes, with warming favouring shrub dominance and increased precipitation favouring graminoid abundance. Climate change simulations based on greenhouse gas emission scenarios in which temperature and precipitation increases were combined showed increases in biomass of both graminoids and shrubs, with graminoids increasing in abundance. The simulations suggest that shrub growth can be limited by very wet soil conditions and low nutrient supply, whereas graminoids have the advantage of being able to grow in a wide range of soil moisture conditions and have access to nutrients in deeper soil layers. Abrupt permafrost thaw initiating thaw pond formation led to complete domination of graminoids. However, due to increased drainage, shrubs could profit from such changes in adjacent areas. Both climate and thaw pond formation simulations suggest that a wetter tundra can be responsible for local shrub decline instead of shrub expansion.