Consolidation of Labor's enforcement responsibilities for the H-2A program could better protect U.S. agricultural workers.

"Report number: 08-98-004-03-321."

Cost-effectiveness of combination peginterferon alpha-2a and ribavirin compared with interferon alpha-2b and ribavirin in patients with chronic hepatitis C

BACKGROUND: Sustained virological response (SVR) is the primary objective in the treatment of chronic hepatitis C (CHC). Results from a recent clinical trial of patients with previously untreated CHC demonstrate that the combination of peginterferon alpha-2a and ribavirin produces a greater SVR than interferon alpha-2b and ribavirin combination therapy. However, the cost-effectiveness of peginterferon alpha-2a plus ribavirin in the U.S. setting has not been investigated. METHODS: A Markov model was developed to investigate cost-effectiveness in patients with CHC using genotype to guide treatment duration. SVR and disease progression parameters were derived from the clinical trials and epidemiologic studies. The impact of treatment on life expectancy and costs were projected for a lifetime. Patients who had an SVR were assumed to remain virus-free for the rest of their lives. In genotype 1 patients, the SVRs were 46% for peginterferon alpha-2a plus ribavirin and 36% for interferon alpha-2b plus ribavirin. In genotype 2/3 patients, the SVRs were 76% for peginterferon alpha-2a plus ribavirin and 61% for interferon alpha-2b plus ribavirin. Quality of life and costs were based on estimates from the literature. All costs were based on published U.S. medical care costs and were adjusted to 2003 U.S. dollars. Costs and benefits beyond the first year were discounted at 3%. RESULTS: In genotype 1, peginterferon alpha-2a plus ribavirin increases quality-adjusted life expectancy (QALY) by 0.70 yr compared to interferon alpha-2b plus ribavirin, producing a cost-effectiveness ratio of $2,600 per QALY gained. In genotype 2/3 patients, peginterferon alpha-2a plus ribavirin increases QALY by 1.05 yr in comparison to interferon alpha-2b plus ribavirin. Peginterferon alpha-2a combination therapy in patients with HCV genotype 2 or 3 is dominant (more effective and cost saving) compared to interferon alpha-2b plus ribavirin. Results weighted by genotype prevalence (75% genotype 1; 25% genotype 2 or 3) also show that peginterferon alpha-2a plus ribavirin is dominant. Peginterferon alpha-2a and ribavirin remained cost-effective (below $16,500 per QALY gained) under sensitivity analyses on key clinical and cost parameters. CONCLUSION: Peginterferon alpha-2a in combination with ribavirin with duration of therapy based on genotype, is cost-effective compared with conventional interferon alpha-2b in combination with ribavirin when given to treatment-naive adults with CHC.

The impact of peginterferon alfa-2a plus ribavirin combination therapy on health-related quality of life in chronic hepatitis C

Background/Aims: Peginterferon alfa-2a plus ribavirin improves sustained virological responses compared with interferon alfa-2b and ribavirin, or peginterferon alfa-2a alone in chronic hepatitis C. We examined the impact of these treatments on health related quality of life (HRQOL). Methods: Patients (n = 1121) were randomized to peginterferon alfa-2a weekly plus ribavirin or placebo, or interferon alfa-2b thrice weekly plus ribavirin. HRQOL was assessed with the SF-36 Health Survey and Fatigue Severity Scale (FSS). Results: Patients receiving peginterferon alfa-2a plus ribavirin reported better HRQOL than those receiving interferon alfa-2b plus ribavirin. These differences were statistically significant for three SF-36 domains and both FSS scores (p < = 0.05). Patients receiving peginterferon alfa-2a plus placebo had the least impairment; adding ribavirin significantly decreased five domains of the SF-36 and both FSS scores. Sustained virological response was associated with improvement at follow-up on all SF-36 and FSS scores. Conclusions: The effects of combination therapy on HRQOL and fatigue are less with peginterferon alfa-2a plus ribavirin than interferon alfa-2b plus ribavirin. Each medication in combination therapy with interferon and ribavirin, affects patients' quality of life differently. Understanding the relationship of specific therapeutic options to HRQOL may help physicians minimize the impact of therapy on HRQOL. (C) 2004 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Using psilocybin to investigate the relationship between attention, working memory, and the serotonin 1A and 2A receptors

Increasing evidence suggests a link between attention, working memory, serotonin (5-HT), and prefrontal cortex activity. In an attempt to tease out the relationship between these elements, this study tested the effects of the hallucinogenic mixed 5-HT1A/2A receptor agonist psilocybin alone and after pretreatment with the 5-HT2A antagonist ketanserin. Eight healthy human volunteers were rested on a multiple-object tracking task and spatial working memory task under the four conditions: placebo, psilocybin (215 mu g/kg), ketanserin (50 mg), and psilocybin and ketanserin. Psilocybin significantly reduced attentional tracking ability, but had no significant effect on spatial working memory, suggesting a functional dissociation between the two tasks. Pretreatment with ketanserin did not attenuate the effect of psilocybin on attentional performance, suggestinga primary involvement of the 5-HT1A receptor in the observed defecit. Based on physiological and pharmacological data,we speculate that this impaired attentional performance may reflect a reduced ability to suppress or ignore distracting stimuli rather than reduced attentional capacity. The clinical relevance of these results is also discussed.

Re-treatment of chronic hepatitis C patients after relapse: efficacy of peginterferon-alpha-2a (40 kDa) and ribavirin

SUMMARY. We conducted a randomized multinational study to determine whether 48 weeks of re-treatment with peginterferon- alpha-2a (40 kDa) plus ribavirin would induce a sustained virological response (SVR) in relapsed chronic hepatitis C patients. Patients who had previously relapsed during 24 weeks of untreated follow-up, after having achieved an end-of-treatment virological response with 24 weeks of peginterferon-alpha-2a (40 kDa)/ribavirin combination therapy, within a phase III trial, were studied. Although the recommended dosage was the same as that used at the end of the initial trial, adjustments were permitted. Data on serious adverse events, or adverse events that resulted in dose reductions or discontinuations, were collected. Following re-treatment, the overall SVR rate in the 64 patients was 55%. The SVR rates in patients infected with hepatitis C virus (HCV) genotype 1 and non-1 genotypes were 51% and 63%, respectively. Early (week 12) virological responses were seen in 39 patients (61%) and were predictive of an SVR. Re-treatment was well tolerated. The most frequent adverse events recorded were fatigue (5%) and abdominal pain (3%). Dosages of peginterferon-alpha-2a (40 kDa) and/or ribavirin were modified because of adverse events in 3% and 13% of patients, and because of laboratory abnormalities in 23% and 5% of patients, respectively. Thus, a 48-week course of peginterferon-alpha-2a (40 kDa) plus ribavirin induces an SVR in 55% of patients who relapsed during follow-up after 24 weeks of combination therapy. Physicians should not hesitate to offer re-treatment to patients who relapse after an initial, 24-week course of combination therapy, or who have prematurely stopped treatment because, for example, of laboratory abnormalities.

SCOTROC 2A: Carboplatin followed by docetaxel or docetaxel gemcitabine as first-line chemotherapy for ovarian cancer

The feasibility of sequential carboplatin followed by docetaxel-based therapy for untreated ovarian cancer was determined. Patients received four q3w cycles of carboplatin AUC 7, then four q3w cycles of either docetaxel 100 mg m(-2) (day 1) (arm A); docetaxel 75 mg m(-2) (day 8) and gemcitabine 1250 mg m(-2) (days 1,8) (arm B) or docetaxel 25 mg m(-2) and gemcitabine 800 mg m(-2) (both given weekly (days 1,8,15)) (arm C). A total of 44 patients were randomised to each treatment arm. None of the arms demonstrated an eight cycle completion rate (70.5/72.7/45.5% in arms A/B/C, respectively), which was statistically greater than 60% (P = 0.102, P = 0.056, P = 0.982) which was our formal feasibility criteria, although only the completion rate in arm C was clearly worse than this level. The overall response rate (ORR) after carboplatin was 65.7% in 70 evaluable patients. In evaluable patients, ORRs after docetaxel-based cycles were: arm A 84.0% (21 out of 25); arm B 77.3% (17 out of 22); arm C 69.6% (16 out of 23). At follow-up (median 30 months), median progression-free survival times were: arm A 15.5 months (95% Cl: 10.5 - 20.6); arm B 18.1 months (95% Cl: 15.9 - 20.3); arm C, 13.7 months (95% Cl: 12.8 - 14.6). Neutropenia was the predominant grade 3 - 4 haematological toxicity: 77.8/85.7/54.4% in arms A/B/C, respectively. Dyspnoea was markedly increased in both gemcitabine-containing arms (P = 0.001) but was worse in arm C. Although just failing to rule out eight cycle completion rates less than 60%, within the statistical limitations of these small cohorts, the overall results for arms A and B are encouraging. Larger phase III studies are required to test these combinations.

New era: Prophylactic surgery for patients with multiple endocrine neoplasia-2A

Background: The surgical management of patients with multiple endocrine neoplasia-2A (MEN-2A) continues to evolve with specific genotype-phenotype correlations allowing for a more tailored approach. In this study, we report the surgical management of one of the largest MEN-2A families with a rearranged during transfection (RET) codon 804 mutation. Method: This is a cohort study comprising all at-risk kindred within a single known MEN-2A family. Prophylactic total thyroidectomy with lymph node dissection was recommended to all mutation carriers aged 5 years and older. Results: There were a total of 48 at-risk individuals in the MEN-2A kindred, with 22 patients undergoing thyroidectomy after appropriate preoperative evaluation. A total of 9 patients had medullary thyroid cancer including 5 with a normal preoperative calcitonin level. A total of 11 patients had C-cell hyperplasia and 7 showed histological evidence of parathyroid disease. Only the index case had a phaeochromocytoma. Conclusion: Genetic testing for germline mutations in the RET proto-oncogene has allowed precise identification of affected RET carriers and provided the opportunity for prophylactic or 'preclinical' surgery to treat and in fact to prevent medullary thyroid cancer. This concept of prophylactic surgery based on a genetic test is likely to be applied more widely as the tools of molecular biology advance.

Novel characteristics of the biological properties of the yeast Saccharomyces cerevisiae eukaryotic initiation factor 2A

Eukaryotic initiation factor 2A (eIF2A) has been shown to direct binding of the initiator methionyl-tRNA (Met-tRNA(i)) to 40 S ribosomal subunits in a codon-dependent manner, in contrast to eIF2, which requires GTP but not the AUG codon to bind initiator tRNA to 40 S subunits. We show here that yeast eIF2A genetically interacts with initiation factor eIF4E, suggesting that both proteins function in the same pathway. The double eIF2A/eIF4E-ts mutant strain displays a severe slow growth phenotype, which correlated with the accumulation of 85% of the double mutant cells arrested at the G(2)/M border. These cells also exhibited a disorganized actin cytoskeleton and elevated actin levels, suggesting that eIF2A might be involved in controlling the expression of genes involved in morphogenic processes. Further insights into eIF2A function were gained from the studies of eIF2A distribution in ribosomal fractions obtained from either an eIF5BDelta (fun12Delta) strain or a eIF3b-ts (prt1-1) strain. It was found that the binding of eIF2A to 40 and 80 S ribosomes was not impaired in either strain. We also found that eIF2A functions as a suppressor of Ure2p internal ribosome entry site-mediated translation in yeast cells. The regulation of expression from the URE2 internal ribosome entry site appears to be through the levels of eIF2A protein, which has been found to be inherently unstable with a half-life of approximately 17 min. It was hypothesized that this instability allows for translational control through the level of eIF2A protein in yeast cells.

(Supplement) Concentration in palynomorphs per gram of dry sediment in ANDRILL core AND-2A

An exceptional triple palynological signal (unusually high abundance of marine, freshwater, and terrestrial palynomorphs) recovered from a core collected during the 2007 ANDRILL (Antarctic geologic drilling program) campaign in the Ross Sea, Antarctica, provides constraints for the Middle Miocene Climatic Optimum. Compared to elsewhere in the core, this signal comprises a 2000-fold increase in two species of dinoflagellate cysts, a synchronous five-fold increase in freshwater algae, and up to an 80-fold increase in terrestrial pollen, including a proliferation of woody plants. Together, these shifts in the palynological assemblages ca. 15.7 Ma ago represent a relatively short period of time during which Antarctica became abruptly much warmer. Land temperatures reached 10 °C (January mean), estimated annual sea-surface temperatures ranged from 0 to 11.5 °C, and increased freshwater input lowered the salinity during a short period of sea-ice reduction.

Lithostratigraphy determined from downhole logs in the AND-2A borehole

During the 2007-2008 austral spring season, the ANDRILL (Antarctic Drilling project) Southern McMurdo Sound Project recovered an 1138-m-long core, representing the last 20 m.y. of glacial history. An extensive downhole logging program was successfully carried out. Due to drill hole conditions, logs were collected in several passes from the total depth at 1138.54 m below seafloor (mbsf) to 230 mbsf. After data correction, several statistical methods, such as factor analysis, cluster analysis, box-and-whisker diagrams, and cross-plots, were applied. The aim of these analyses was to use detailed interpretation of the downhole logs to obtain a description of the lithologies and their specific physical properties that is independent of the core descriptions. The sediments were grouped into the three main facies, diamictite, mudstone and/or siltstone, and sandstone, and the physical properties of each were determined. Notable findings include the high natural radioactivity values in sandstone and the high and low magnetic susceptibility values in mudstone and/or siltstone and in sandstone. A modified lithology cluster column was produced on the basis of the downhole logs and statistical analyses. It was possible to use the uranium content in the downhole logs to determine hiatuses and thus more accurately place the estimated hiatuses. Using analyses from current literature (geochemistry, clasts, and clay minerals) in combination with the downhole logs (cluster analysis), the depths 225 mbsf, 650 mbsf, 775 mbsf, and 900 mbsf were identified as boundaries of change in sediment composition, provenance, and/or environmental conditions. The main use of log interpretation is the exact definition of lithological boundaries and the modification of the paleoenvironmental interpretation.

Downhole logging of the AND-2A borehole, Victoria Land Basin, McMurdo Sound, Antarctica

Under the framework of the ANDRILL Southern McMurdo Sound (SMS) Project successful downhole experiments were conducted in the 1138.54 metre (m)-deep AND-2A borehole. Wireline logs successfully recorded were: magnetic susceptibility, spectral gamma ray, sonic velocity, borehole televiewer, neutron porosity, density, calliper, geochemistry, temperature and dipmeter. A resistivity tool and its backup both failed to operate, thus resistivity data were not collected. Due to hole conditions, logs were collected in several passes from the total depth at ~1138 metres below sea floor (mbsf) to ~230 mbsf, except for some intervals that were either inaccessible due to bridging or were shielded by the drill string. Furthermore, a Vertical Seismic Profile (VSP) was created from ~1000 mbsf up to the sea floor. The first hydraulic fracturing stress measurements in Antarctica were conducted in the interval 1000-1138 mbsf. This extensive data set will allow the SMS Science Team to reach some of the ambitious objectives of the SMS Project. Valuable contributions can be expected for the following topics: cyclicity and climate change, heat flux and fluid flow, seismic stratigraphy in the Victoria Land Basin, and structure and state of the modern crustal stress field.

Clay mineral distribution in sediment core AND-2A

Clay mineral assemblages in sediments from ANDRILL drill core AND-2A were used to reconstruct the Neogene palaeoenvironment. For the first time a clay mineral data set can be presented for southern McMurdo Sound, Ross Sea, Antarctica, that covers an expanded and fairly continuous Lower and Middle Miocene section. Although the occurrence of some authigenic smectites, zeolites and opal-CT documents diagenetic processes, the clay mineral assemblages allow a subdivision of the core into three intervals that reflect changes in provenance and volcanic activity. Interval I (1000-440 mbsf, 20.0-16.5 Ma) is characterised by a dominant sediment source in the Transantarctic Mountains. Frequent and short-term changes in the illite and smectite concentrations were caused by the influx of volcanic sediment components from southern McMurdo Sound and by diagenesis. Interval II (440-225 mbsf, 16.5-15.0 Ma) has much more uniform illite and smectite contents. The assemblage is derived from the Transantarctic Mountains. Interval III (225-0 mbsf, 15.0-0 Ma, containing major hiatuses) shows a distinctly enhanced volcanic influence and sediment components that come from the south of McMurdo Sound. The AND-2A clay mineral assemblages indicate persistent physical weathering conditions and do not mirror the Mid-Miocene Climatic Optimum. They indicate that the climatic changes were probably not strong enough to cause a modification in the weathering regime on the Antarctic continent.