The safety of stopping nucleos(t)ide analogue treatment in patients with HBeAg-negative chronic hepatitis B.

BACKGROUND: The rates of hepatitis B surface antigen (HBsAg) seroclearance after stopping nucleos(t)ide analogues (NA) in European (19% in 2 years) and Asian (13% in 6 years) patients with chronic hepatitis B (CHB) vary dramatically. We evaluated the incidence of hepatitis flare and HBsAg seroclearance in hepatitis B e antigen (HBeAg)-negative Chinese CHB patients who had stopped NA. METHODS: This was a territory-wide retrospective study in Hong Kong. We identified HBeAg-negative CHB patients from January 2000 to December 2017 who had stopped NA treatment for more than 3 months. Hepatitis flare was defined as ALT >2×ULN. RESULTS: The 1076 patients were predominantly middle-aged men (mean age 52 years, male 74.8%) when starting NA; they stopped NA after 82 ± 35 months of treatment. At 44.3 ± 24.6 months after stopping NA, 147 (13.6%) patients had hepatitis flare, which led to resumption of NA; whereas 77 (7.2%) patients had flare but did not resume NA. Decompensation occurred in 7/914 (0.8%) patients. A total of 695 (64.6%) patients remained on NA treatment at the last visit. Eleven patients had achieved HBsAg seroclearance (6 of them had hepatitis flare and 1 of these 6 patients achieved HBsAg seroclearance after NA was restarted). Hepatic events developed in 75/695 (10.8%) patients who had NA resumed vs 43/381 (11.3%) patients who did not resume NA (P = .677). CONCLUSIONS: Hepatitis flare and retreatment were common in HBeAg-negative CHB patients who stopped NA treatment; whereas HBsAg seroclearance rarely occurred. Stopping NA to achieve functional cure should not be recommended at this moment.

Body Inversion Effects With Photographic Images of Body Postures: Is It About Faces?

As with faces, participants are better at discriminating upright bodies than inverted bodies. This inversion effect is reliable for whole figures, namely, bodies with heads, but it is less reliable for headless bodies. This suggests that removal of the head disrupts typical processing of human figures, and raises questions about the role of faces in efficient body discrimination. In most studies, faces are occluded, but the aim here was to exclude faces in a more ecologically valid way by presenting photographic images of human figures from behind (about-facing), as well as measuring gaze to different parts of the figures. Participants determined whether pairs of sequentially presented body postures were the same or different for whole and headless figures. Presenting about-facing figures (heads seen from behind) and forward-facing figures with faces enabled a comparison of the effect of the presence or absence of faces. Replicating previous findings, there were inversion effects for forward-facing whole figures, but less reliable effects for headless images. There were also inversion effects for about-facing whole figures, but not about-facing headless figures. Accuracy was higher in the forward- compared to the about-facing conditions, but proportional dwell time was greater to bodies in about-facing images. Likewise, despite better discrimination of forward-facing upright compared to inverted whole figures, participants focused more on the heads and less on the bodies in upright compared to inverted images. However, there was no clear relationship between performance and dwell time proportions to heads. Body inversion effects (BIEs) were found with about-facing whole figures and headless forward-facing figures, despite the absence of faces. With inverted whole figures, there was a significant relationship between performance and greater looking at bodies, and less at heads suggesting that in more difficult conditions a focus on bodies is associated with better discrimination. Overall, the findings suggest that the visual system has greater sensitivity to bodies in their most experienced form, which is typically upright and with a head. Otherwise, the more a face is implied by the context, as in whole figures or forward- rather than about-facing headless bodies, the better the performance as holistic/configural processing is likely stronger.

Who said dialogue conversations are easy? The communication between communication vulnerable people and health-care professionals: A qualitative study.

OBJECTIVE: To gain insight into how communication vulnerable people and health-care professionals experience the communication in dialogue conversations, and how they adjust their conversation using augmentative and alternative communication (AAC) or other communication strategies. METHODS: Communication vulnerable clients and health-care professionals in a long-term care institution were observed during a dialogue conversation (n = 11) and subsequently interviewed (n = 22) about their experiences with the conversation. The clients had various communication difficulties due to different underlying aetiologies, such as acquired brain injury or learning disorder. Results from the observations and interviews were analysed using conventional content analysis. RESULTS: Seven key themes emerged regarding the experiences of clients and professionals: clients blame themselves for miscommunications; the relevance of both parties preparing the conversation; a quiet and familiar environment benefitting communication; giving clients enough time; the importance and complexity of nonverbal communication; the need to tailor communication to the client; prejudices and inexperience regarding AAC. The observations showed that some professionals had difficulties using appropriate communication strategies and all professionals relied mostly on verbal or nonverbal communication strategies. CONCLUSION: Professionals were aware of the importance of preparation, sufficient time, a suitable environment and considering nonverbal communication in dialogue conversations. However, they struggled with adequate use of communication strategies, such as verbal communication and AAC. There is a lack of knowledge about AAC, and professionals and clients need to be informed about the potential of AAC and how this can help them achieve equal participation in dialogue conversations in addition to other communication strategies.

The role of the physical environment in conversations between people who are communication vulnerable and health-care professionals: a scoping review.

PURPOSE: The role of the physical environment in communication between health-care professionals and persons with communication problems is a neglected area. This study provides an overview of factors in the physical environment that play a role in communication during conversations between people who are communication vulnerable and health-care professionals. METHOD: A scoping review was conducted using the methodological framework of Arksey and O'Malley. The PubMed, PsycINFO, CINAHL and Cochrane Library databases were screened, and a descriptive and thematic analysis was completed. RESULTS: Sixteen publications were included. Six factors in the physical environment play a role in conversations between people who are communication vulnerable and health-care professionals: (1) lighting, (2) acoustic environment, (3) humidity and temperature, (4) setting and furniture placement, (5) written information, and (6) availability of augmentative and alternative communication (AAC) tools. These factors indicated barriers and strategies related to the quality of these conversations. CONCLUSIONS: Relatively small and simple strategies to adjust the physical environment (such as adequate lighting, quiet environment, providing pen and paper) can support people who are communication vulnerable to be more involved in conversations. It is recommended that health-care professionals have an overall awareness of the potential influence of environmental elements on conversations. Implications for rehabilitation The physical environment is an important feature in the success or disturbance of communication. Small adjustments to the physical environment in rehabilitation can contribute to a communication-friendly environment for conversations with people who are communication vulnerable. Professionals should consider adjustments with regard to the following factors in the physical environment during conversations with people who are communication vulnerable: lighting, acoustic environment, humidity and temperature, setting and furniture placement, written information, and availability of AAC (augmentative and alternative communication tools).

Graduate survey of the South Carolina Area Health Education Consortium family practice residency programs.

The results of this study demonstrate several interesting characteristics of the graduates of the SC AHEC associated family medicine residency programs: 45 percent practice in South Carolina, 63 percent live further than 120 miles from their residency program, 96 percent are satisfied with their specialty choice, and 56 percent are involved in teaching medical students and residents. Furthermore, these graduates have the following tendencies: to practice in the traditional solo or group practice; to practice in a suburban community, town or rural community and a setting size less than a population of 100,000 persons; to care for the aging adult and geriatric population; to provide nursing home care; and to utilize house calls to provide patient care). As the current health care system continues to be redesigned, this information will be essential for assessment and planning purposes.

Prohormone atrial natriuretic peptides 1-30, 31-67, and 99-126 increase in proportion to right ventricular pacing rate.

To determine whether heart rate contributes to release of three new peptide hormones synthesized in the heart, right ventricular pacing at rates of 100, 125, 150, and 180 bpm was performed in six dogs with measurement of the plasma concentration of these peptides at each pacing rate while right atrial and systemic blood pressures were simultaneously monitored. These three peptides of the 126-amino-acid prohormone of atrial natriuretic factor (ANF), consisting of amino acids 1-30 (pro ANF 1-30), 31-67 (pro ANF 31-67), and 99-126 (ANF), increased incrementally at paced heart rates of 125, 150, and 180 bpm (r = 0.8, p less than 0.001). Right atrial pressure decreased with increasing heart rate but systemic blood pressure did not decrease until the heart rate was 180 bpm, at which time these peptides had obtained their maximal circulating concentrations. After pacing, mean right atrial pressure and levels of ANF returned to prepacing values within 30 minutes. Mean arterial blood pressure, on the other hand, increased throughout the 120-minute period after pacing. At 2 hours after pacing, levels of pro ANFs 1-30 and 31-67 were elevated compared with prepacing values. These data demonstrate that, at heart rates of 125 bpm and above, pro ANF 1-30, pro ANF 31-67, and ANF (99-126) are simultaneously and incrementally released in direct proportion to heart rate. The sustained elevation in pro ANFs 1-30 and 31-67 seen 2 hours after pacing suggests that they may contribute to the prolonged diuresis seen after cardiac pacing or tachycardia.

Influence of alkaline pH on the effectiveness of sodium fluoride dentifrices.

Two similar sodium fluoride dentifrices, one neutral and one alkaline, were compared to a placebo for clinical effectiveness in reducing caries. The neutral dentifrice contained 35% less soluble fluoride than the alkaline dentifrice. Both fluoride dentifrices were significantly effective but were not different from each other.