Sustained virologic response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis

BACKGROUND: Clinical outcomes of chronic hepatitis C infection in patients with advanced fibrosis include liver failure, hepatocellular carcinoma, and death. OBJECTIVE: To investigate whether sustained virologic response to treatment for hepatitis C is associated with improved clinical outcomes. DESIGN: Retrospective cohort study. SETTING: 5 hepatology units of tertiary care centers in Europe and Canada caring for patients with chronic hepatitis C treated between 1990 and 2003. PATIENTS: Consecutively treated patients with chronic hepatitis C who had biopsy-proven advanced fibrosis or cirrhosis (Ishak score, 4 to 6). MEASUREMENTS: Sustained virologic response, defined as absence of detectable hepatitis C virus RNA at 24 weeks after the end of treatment, and clinical outcomes, defined as death (liver-related or non-liver-related), liver failure, and hepatocellular carcinoma. RESULTS: Of 479 patients, 29.6% had sustained virologic response and 70.3% did not. Median follow-up was 2.1 years (interquartile range, 0.8 to 4.9 years). Four patients with and 83 without sustained virologic response had at least 1 outcome event. Sustained virologic response was associated with a statistically significant reduction in the hazard of events (adjusted hazard ratio, 0.21 [95% CI, 0.07 to 0.58]; P = 0.003). The effect was largely attributable to a reduction in liver failure, which developed in no patients with and 42 patients without sustained virologic response (5-year occurrence, 0% vs. 13.3% [CI, 8.4% to 18.2%]; unadjusted hazard ratio, 0.03 [CI, 0.00 to 0.91]). LIMITATIONS: Because few events occurred in the sustained virologic response group, the study had limited ability to detect differences between groups in individual outcomes. In addition, the study was retrospective; selection and survival biases may therefore influence estimates of effect. CONCLUSION: Sustained virologic response to treatment is associated with improved clinical outcomes, mainly prevention of liver failure, in patients with chronic hepatitis C and advanced fibrosis.

Radiolarian biostratigraphy of ODP Site 111-677

Well-preserved late Miocene through Pleistocene age radiolarian assemblages were recovered during ODP Leg 111 at Site 677, on the southern flank of the Costa Rica Rift in the eastern equatorial Pacific. Radiolarian "event" biostratigraphy (first and last morphotypic appearances) was established for Holes 677A and 677B using 21 species yielding 24 reliable datum levels. The cold upwelling waters above this site have prevented many typical tropical Pacific stratigraphic radiolarians from being useful age indicators. Biostratigraphic datum levels were assigned absolute ages based on previous work and were used to date the cores. Sedimentation rates varied from 3.7 cm/1000 yr in the late Pleistocene to 6.0 cm/1000 yr in the late Miocene. The age of the oldest sediments at this site is estimated as 5.89-6.37 Ma, which indicates that Site 677 is between magnetic anomalies 3A and 4. A total of 67 taxa were assessed for stratigraphic relevance at this site and are listed in the Appendix. One previously unknown Pliocene radiolarian stratigraphic indicator, Botryostrobus euporus (Ehrenberg), is identified.

Stable carbon and oxygen isotope record of planktonic and benthic foraminifera at ODP Site 111-677 in the Panama Basin

Oxygen and carbon isotope ratio measurements are presented for Globigerinoides ruber and for benthic species (mainly Uvigerina spp.) in the Pleistocene and uppermost Pliocene section of ODP Hole 677A in the Panama Basin. This provides the best available continuous Pleistocene stable isotope records from any location, fully justifying the recoring of DSDP Site 504. Oxygen isotope stage 22 (age about 0.85 Ma) was of similar magnitude to the most extensive glacials of the Brunhes and constitutes a logical base for the middle Pleistocene. Oxygen isotope stages as defined by Ruddiman et al. (1986, doi:10.1016/0012-821X(86)90024-5) and by Raymo et al. (1989, doi:10.1029/PA004i004p00413) back to stage 104 are recognized. Although the internationally agreed base of the Quaternary at or near stage 62 (about 1.6 Ma) is not marked by a major isotopic event, it does approximate the base of a regime characterized by highly regular 41,000-yr climate cycles. The records at Site 677 are ideal for time-series analyses and will permit a new attempt to develop a chronology for the early Pleistocene based on tuning to the orbital frequencies. The carbon isotope records also appear to contain considerable variance at orbital frequencies throughout the sequence analyzed.

Pore-water chemistry of ODP sites 111-677 and 111-678

Sites 677 and 678 were drilled on ODP Leg 111 to test hypotheses about the nature and pattern of hydrothermal circulation on a mid-ocean ridge flank. Together with earlier results from DSDP Site 501/504 and several heatflow and piston coring surveys covering a 100-km**2 area surrounding the three drill sites, they confirm that hydrothermal circulation persists in this 5.9-m.y.-old crust, both in basement and through the overlying sediments (Langseth et al., 1988, doi:10.2973/odp.proc.ir.111.102.1988). Profiles of sediment pore-water composition with depth at the three drill sites show both vertical and horizontal gradients. The shapes of the profiles and their variation from one site to another result from a combination of vertical and horizontal diffusion, convection, and reaction in the sediments and basement. Chemical species that are highly reactive in the siliceous-calcareous biogenic sediments include bicarbonate (alkalinity), ammonium, sulfate, manganese, calcium, strontium, lithium, silica, and possibly potassium. Reactions include bacterial sulfate reduction, mobilization of Mn2+, precipitation of CaCO3, and recrystallization of calcareous and siliceous oozes to chalk, limestone, and chert. Species with profiles more affected by reaction in basaltic basement than in the sediments include Mg, Ca, Na, K, and oxygen isotopes. Reaction in basement at 60?C and at higher temperatures has produced a highly altered basement formation water that is uniform in composition over distances of several kilometers. As inferred from the composition of the basal sediment pore water at the three sites, this uniformity extends from up flow zone to downflow zone in basement and the sediments. It exists in spite of large variations in heat flow and depth to basement, apparently as a result of homogenization by hydrothermal circulation in basement. Profiles for chlorinity, Na, Mg, and other species in the sediment pore waters confirm that Site 678, drilled on a localized heatflow high identified by Langseth et al. (1988), is a site of long-lived upwelling of warm water from basement through the sediments at velocities of 1 to 2 mm/yr. The upflow through the anomalously thin sediments is apparently localized above an uplifted fault block in basement. This site and other similar sites in the survey area give rise to lateral diffusion and possibly flow through the sediments, which produces lateral gradients in sediment pore-water composition at sites such as 501/504. The complementary pore-water profiles at the low-heatflow Site 677 2 km to the south indicate that downflow is occurring through the sediments there, at comparable rates of 1 to 2 mm/yr.

Operator's and organizational maintenance manual : control, radio set C-6709/G, (NSN 5820-00-930-3597).

"August 1979."

Identifying programs to reduce road trauma to A.C.T. motorcyclists

A broad range of motorcycle safety programs and systems exist in Australia and New Zealand. These vary from statewide licensing and training systems run by government licensing and transport agencies to safety programs run in small communities and by individual rider groups. While the effectiveness of licensing and training has been reviewed and recommendations for improvement have been developed (e.g. Haworth & Mulvihill, 2005), little is known about many smaller or innovative programs, and their potential to improve motorcycle safety in the ACT.

Impacts of periodic tillage on soil C stocks : a synthesis

Long-term loss of soil C stocks under conventional tillage and accrual of soil C following adoption of no-tillage have been well documented. No-tillage use is spreading, but it is common to occasionally till within a no-till regime or to regularly alternate between till and no-till practices within a rotation of different crops. Short-term studies indicate that substantial amounts of C can be lost from the soil immediately following a tillage event, but there are few field studies that have investigated the impact of infrequent tillage on soil C stocks. How much of the C sequestered under no-tillage is likely to be lost if the soil is tilled? What are the longer-term impacts of continued infrequent no-tillage? If producers are to be compensated for sequestering C in soil following adoption of conservation tillage practices, the impacts of infrequent tillage need to be quantified. A few studies have examined the short-term impacts of tillage on soil C and several have investigated the impacts of adoption of continuous no-tillage. We present: (1) results from a modeling study carried out to address these questions more broadly than the published literature allows, (2) a review of the literature examining the short-term impacts of tillage on soil C, (3) a review of published studies on the physical impacts of tillage and (4) a synthesis of these components to assess how infrequent tillage impacts soil C stocks and how changes in tillage frequency could impact soil C stocks and C sequestration. Results indicate that soil C declines significantly following even one tillage event (1-11 % of soil C lost). Longer-term losses increase as frequency of tillage increases. Model analyses indicate that cultivating and ripping are less disruptive than moldboard plowing, and soil C for those treatments average just 6% less than continuous NT compared to 27% less for CT. Most (80%) of the soil C gains of NT can be realized with NT coupled with biannual cultivating or ripping. (C) 2007 Elsevier B.V. All rights reserved.