Prevalence and determinants of hepatitis B co-infection among a United States Veterans Administration cohort with hepatitis C

Background and aim. Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection is associated with increased risk of cirrhosis, decompensation, hepatocellular carcinoma, and death. Yet, there is sparse epidemiologic data on co-infection in the United States. Therefore, the aim of this study was to determine the prevalence and determinants of HBV co-infection in a large United States population of HCV patients. ^ Methods. The National Veterans Affairs HCV Clinical Case Registry was used to identify patients tested for HCV during 1997–2005. HCV exposure was defined as two positive HCV tests (antibody, RNA or genotype) or one positive test combined with an ICD-9 code for HCV. HCV infection was defined as only a positive HCV RNA or genotype. HBV exposure was defined as a positive test for hepatitis B core antibodies, hepatitis B surface antigen, HBV DNA, hepatitis Be antigen, or hepatitis Be antibody. HBV infection was defined as only a positive test for hepatitis B surface antigen, HBV DNA, or hepatitis Be antigen within one year before or after the HCV index date. The prevalence of exposure to HBV in patients with HCV exposure and the prevalence of HBV infection in patients with HCV infection were determined. Multivariable logistic regression was used to identify demographic and clinical determinants of co-infection. ^ Results. Among 168,239 patients with HCV exposure, 58,415 patients had HBV exposure for a prevalence of 34.7% (95% CI 34.5–35.0). Among 102,971 patients with HCV infection, 1,431 patients had HBV co-infection for a prevalence of 1.4% (95% CI 1.3–1.5). The independent determinants for an increased risk of HBV co-infection were male sex, positive HIV status, a history of hemophilia, sickle cell anemia or thalassemia, history of blood transfusion, cocaine and other drug use. Age >50 years and Hispanic ethnicity were associated with a decreased risk of HBV co-infection. ^ Conclusions. This is the largest cohort study in the United States on the prevalence of HBV co-infection. Among veterans with HCV, exposure to HBV is common (∼35%), but HBV co-infection is relatively low (1.4%). There is an increased risk of co-infection with younger age, male sex, HIV, and drug use, with decreased risk in Hispanics.^

Predictors of benzodiazepine self -administration behavior in anxious patients

The purpose of this study was to examine factors that may be associated with benzodiazepine (BZ) self-administration and risks of dependence in anxious patients. Preliminary work included examination of psychosocial characteristics and subjective drug response as potential predictors of medication use. Fifty-five M, F patients with generalized anxiety or panic disorder participated in a 3-week outpatient Choice Procedure in which they self-medicated “as needed” with alprazolam (Alz) and placebo. Findings showed that a large amount of variance in alprazolam preference, frequency, and quantity of use could be predicted by measures of anxiety, drug liking, and certain personality characteristics. The primary study extended this work by examining whether individual differences in Alz sensitivity also predict patterns of use. Twenty anxious patients participated in the study, which required 11 weekly clinic visits. Ten of these also participated in a baseline assessment of HPA-axis function that involved 24-hour monitoring of cortisol and ACTH levels and a CRH Stimulation Test. This assessment was conducted on the basis of prior evidence that steroid metabolites exert neuromodulatory effects on the GABA A receptor and that HPA-axis function may be related to BZ sensitivity and long-term disability in anxious patients. Patients were classified as either HIGH or LOW users based on their p.r.n. patterns of Alz use during the first 3 weeks of the study. They then participated in a 4-week dose response trial in which they received prescribed doses of medication (placebo, 0.25, 0.5, and 1.0mg Alz), each taken TID for 1 week. The dose response trial was followed by a second 3-week Choice Procedure. Findings were not indicative of biological differences in Alz sensitivity between the HIGH and LOW users. However, the HIGH users had higher baseline anxiety and greater anxiolytic response to Alz than the LOW users. Anxiolytic benefits of p.r.n. and prescribed dosing were shown to be comparable, and patients' conservative patterns of p.r.n. medication use were not affected by the period of prescribed dosing. Although there was not strong evidence to suggest relationships between HPA-axis function and Alz use or sensitivity, interesting findings emerged about the relationship between HPA-axis function and anxiety. ^

Considerations on the trade and finances of this Kingdom, and on the measures of Administration with respect to those great national objects since the conclusion of the peace [Texto impreso]

Autor tomado de la Britsh Library

Library outreach: addressing Utah's “Digital Divide”

A “Digital Divide” in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine—Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

A catalogue of books [donated by Jasper Mauduit] in the library of Harvard College [at]: Cambridge in New England, 1765

This leatherbound volume lists books donated to the Harvard College Library by Jasper Mauduit, who served as an agent in London on behalf of the Province of the Massachusetts Bay. Entries are arranged alphabetically and by format; i.e. the first page lists all folios whose author, title, or keyword begin with "A," the next page lists all quartos beginning with "A," and the following page lists all "octavo &ca" volumes beginning with "A." The volume continues in a similar manner for each letter of the alphabet. Following a devastating fire in 1764 which destroyed most of the books in the Harvard College Library, Mauduit donated books, as well as money for the purchase of books, to the College. He also acted as an agent of the Society for Propagating the Gospel in New England and Parts Adjacent, using the £300 they donated for the rebuilding of the College library to select and purchase a large number of books. It is not known if the books listed in this catalog are those donated by Mauduit himself, or if they are the donations he purchased on behalf of the Society. The creator of this volume is unknown; although all entries are made in the same hand, the identity of the writer has not been determined. The label attached to the front cover, which refers to the Lime Street address of Mauduit's business in London, suggests that the list might have been prepared by Mauduit himself.

First Account of Administration on C. Gannett's Estate & Papers relating to the same, [1818]

Long paper notebook with a handwritten inventory of Gannett's estate arranged by house location with price estimates. The inventory appears to correspond with the "Sales at auction" document. The verso of the last page contains the note: "Inventory of Personal Estate (copy)."

Scene in front of Bus. Ad. Bldg. [Business Administration Building]

Lee Black & Kenneth Black, architects.

Business Administration from Lorch Hall

Lee Black & Kenneth Black, architects.

Fountain. In the center of the circular driveway between the Michigan Union and the Administration Bldg.

Gift of Clas of 1956

Undergraduate Library

Albert Kahn Associates, architects. Built 1957. On verso: University of Michigan, News Service, 3528 Administration Bldg., Ann Arbor, Michigan 48104

Administration Building

Harley, Ellington & Day, architects. Occupied in December 1948 by business, administrative, and public service departments, the building was designated as the Administrative Building. Exterior features Marshall Frederick's sculpture. In 1967, upon completion of the Fleming Administration Building, this building became the LS&A Building.

Administration Building Rear

Harley, Ellington & Day, architects. Occupied in December 1948 by business, administrative, and public service departments, the building was designated as the Administrative Building. Exterior features Marshall Frederick's sculpture. In 1967, upon completion of the Fleming Administration Building, this building became the LS&A Building.

Administration Building Rear

Harley, Ellington & Day, architects. Occupied in December 1948 by business, administrative, and public service departments, the building was designated as the Administrative Building. Exterior features Marshall Frederick's sculpture. In 1967, upon completion of the Fleming Administration Building, this building became the LS&A Building. Person in image.