Miracle-dz/UniFAR-FTUs huggingface dataset:
Implications of HCV RNA level at week 4 of direct antiviral treatments for hepatitis C

We aimed to determine whether the HCV viral load after four weeks of treatment (W4VL) with direct‐acting antiviral agents (DAAs) predicts sustained virologic response (SVR) in a real‐world clinical setting. We identified 21 095 patients who initiated DAA‐based antiviral treatment in the national Veterans Affairs (VA) healthcare system from 01/01/2014 to 06/30/2015. Week 4 viral load was categorized as undetectable, detectable below quantification (DBQ), detectable above quantification (DAQ) with viral load ≤42 IU/mL and DAQ with viral load >42 IU/mL. Week 4 viral load was undetectable in 36.1%, detectable below quantification in 45.6%, DAQ ≤42 in 9.3%, DAQ >42 in 9.1%. Detectable above quantification was much more common and undetectable week 4 viral load much less common when tested with the Abbott RealTime HCV assay vs the Roche COBAS AmpliPrep/COBAS TaqMan Version 2 assay. Compared to patients with undetectable week 4 viral load (SVR=93.5%), those with detectable below quantification (SVR=91.8%, adjusted odds ratio [AOR] 0.79, P‐value=.001), DAQ ≤42 (SVR=90.0%, AOR 0.63, P‐value<.001) and DAQ >42 (SVR=86.2%, AOR 0.52, P‐value<.001) had progressively lower likelihood of achieving SVR after adjusting for baseline characteristics and treatment duration. Among genotype 1‐infected patients who were potentially eligible for 8‐week sofosbuvir/ledipasvir monotherapy, we did not find evidence that treatment for 12 weeks instead of 8 weeks was associated with higher SVR, even among those with detectable above quantification. In summary, DBQ and DAQ W4VL are very common in real‐world practice, contrary to what was reported in clinical trials, and strongly predict reduced SVR across genotypes and clinically relevant patient subgroups. Whether and how week 4 viral load results should influence treatment decisions requires further study.
Hepatitis B surface antigen loss and sustained viral suppression in Asian chronic hepatitis B patients: A community‐based real‐world study

Community‐based real‐world outcomes on effectiveness of antiviral therapies for chronic hepatitis B virus (CHB) in Asians are limited. Whether hepatitis B surface antigen (HBsAg) loss correlates with undetectable virus and alanine aminotransferase (ALT) normalization on treatment or what predicts risk of seroreversion or detectable virus after stopping therapy is unclear. We aim to evaluate rates and predictors of HBsAg loss, seroconversion, ALT normalization and undetectable HBV DNA, including HBsAg seroreversion or re‐emergence of HBV DNA among Asian CHB patients. We retrospectively evaluated 1072 CHB adults on antiviral therapy at two community gastroenterology clinics from 1997 to 2015. Rates of HBsAg loss, ALT normalization, achieving undetectable HBV DNA and developing surface antibody (anti‐HBs) were stratified by HBeAg status. Following HBsAg loss, HBsAg seroreversion or re‐emergence of detectable HBV DNA was analysed. With median treatment of 76.7 months, the overall rate of HBsAg loss was 4.58%, with similar HBsAg loss rates between HBeAg‐positive and HBeAg‐negative patients (4.44% vs 4.71%, P=.85) in a predominantly Asian population (98.1%). Among HBsAg loss patients, 33.3% developed anti‐HBs, 95.8% achieved undetectable virus and 66.0% normalized ALT. No significant baseline or on‐treatment predictors of HBsAg loss were observed. While six patients who achieved HBsAg loss had seroreversion with re‐emergence of HBsAg positivity, viral load remained undetectable, demonstrating the sustainability of viral suppression. Among a large community‐based real‐world cohort of Asian CHB patients treated with antiviral therapy, rate of HBsAg loss was 4.58%. Despite only 33.3% of HBsAg loss patients achieving anti‐HBs, nearly all patients achieved sustained undetectable virus.
Development of joint engagement in young deaf and hearing children: effects of chronological age and language skills.

PURPOSE To evaluate joint engagement (JE) in age-matched children with and without hearing and its relationship to oral language skills. METHOD Participants were 180 children with severe-to-profound hearing loss prior to cochlear implant surgery, and 96 age-matched children with normal hearing; all parents were hearing. JE was evaluated in a 10-minute videotaped free play task with parents. Engagement states ranged from the lowest (unengaged) to the highest level (symbol-infused coordinated). Standardized language measures were administered. RESULTS Multivariate analyses were conducted between the groups, stratified by chronological and language age. Children who were deaf (Deaf) spent less time in total symbol-infused JE than children with normal hearing (NH) across all ages. The majority of the Deaf group (83%) fell in the lowest language age group, in comparison to 35% of the NH group, and spent significantly less time in symbol-infused JE than hearing children. These delays were also observed in the Deaf group, who fell into the 18-36 month language age. No children in the Deaf group had achieved a language age of > 36 months. CONCLUSIONS Young children with and without hearing had different developmental trajectories of JE, which were related to oral language skills.
Face-viewing patterns in young children with autism spectrum disorders: speaking up for the role of language comprehension.

PURPOSE The aim was to examine whether viewing patterns toward the mouth, eyes, and nonmouth-noneyes areas differed between young children with autism spectrum disorder (ASD) and typically developing (TD) children when viewing a person speaking. The role of language comprehension in such viewing patterns was also examined. METHOD Eleven children with ASD (approximately 4.5 years old) and 29 TD toddlers (approximately 2.5 years old) participated. The groups were matched on language comprehension raw scores from the Reynell Developmental Language Scales III. All children viewed short films of a woman speaking while their eye movements were recorded with eye-tracking equipment. RESULTS Children with ASD spent proportionally less time viewing the mouth and more time viewing the nonmouth-noneyes areas. Time viewing the eyes did not differ between groups. Increased mouth viewing was associated with lower language comprehension in the group with ASD. CONCLUSION Variability in language comprehension is an important factor to monitor when interpreting face-viewing patterns in young children with ASD, particularly with regard to mouth viewing. The results may help explain divergent findings in this field of research.
Fast Track Head and Neck Referrals Audit

Objective: The National Institute for Clinical Excellence (NICE) outlines 10 key urgent referral guidelines. The Department of Health in the UK requires all cancer referrals to be seen within 2 weeks. The audit’s aim was to assess the appropriateness of referrals to the Head and Neck Cancer Clinic. Method: A retrospective analysis of all “2-week-wait” fast track referrals to the department over a 1-year period (starting August 2010). The referring diagnosis, time of consult, and initial management were recorded. A database of all referrals, the picture archiving and communications system (PACS), and computer and paper records were consulted. Results: For the period of the study a total of 446 referrals were received, 425 or 95% were seen within 14 days. The average wait was 9 days. The most common reasons for referral included neck lumps, dysphagia, and voice change. Referrals for inappropriate symptoms were not uncommon, however the main issue was duration of symptoms prior to referral, which averaged over 6 months. The diagnostic yield for malignancy was 6%, significantly lower when compared with a number of comparative studies. Although 59.5% of referrals were females, 70.4% of cancer diagnoses were in men. Conclusion: The use of the NICE guidelines by primary care physicians is far from common practice. A greater awareness of the guidelines would have several beneficial outcomes. The number of inappropriate referrals would be reduced and those with cancer should be picked up earlier, thus improving prognosis.
Rare clinically significant hepatic events and hepatitis B reactivation occur more frequently following rather than during direct‐acting antiviral therapy for chronic hepatitis C: Data from a national US cohort

Recently, cases of hepatitis B virus reactivation (HBVr) with direct‐acting antiviral therapy (DAAs) for HCV have been reported. However, few data exist from large, Western cohorts. The study objectives were to evaluate the incidence of alanine aminotransferase (ALT) flares, clinically significant hepatic events, and HBVr among a national cohort of US veterans with prior exposure to HBV (anti‐HBc+) treated with DAAs. We used a national administrative database to identify patients treated with DAAs from January 2014 through November 2016 and obtained clinical and demographic as well as HBV and HCV treatment data. HBVr was defined as an at least 1‐log increase in HBV DNA titre. Among 17 779 anti‐HBc+ patients, 17 400 were HIV− and 379 were HIV+. Among the HIV− patients, 17 266 (99%) were HBsAg− prior to DAA therapy and 134 were HBsAg+. Among HIV‐, HBsAg− patients, ALT elevations greater than 10 times the upper limit of normal (ULN; ≥300 IU/mL) were rare and occurred more frequently after treatment completion: 31 cases (<0.1%) during vs 85 (0.6%) following treatment. Clinically significant hepatic events defined as ALT increases >100 IU/L with total bilirubin >2.5 mg/dL occurred in 39 cases (0.3%), most often following DAA completion (n = 35 cases, 3/35 in setting of HCV relapse). Among 31 patients with post‐DAA hepatic events without HCV relapse, 10 (32%) were confirmed unrelated to HBVr by HBsAg and/or HBV DNA testing, 1 (3%) confirmed due to HBVr, and 20 (65%) did not have documented HBV‐related testing. One additional case of HBsAg− to + seroreversion was identified. Among HBsAg+ DAA recipients, 2/97 (2%), both with cirrhosis, experienced ALT elevations ≥300 IU/mL in the setting of HBVr. In conclusion, clinically significant hepatic events and HBVr were rare and much more likely among HBsAg‐positive individuals. Anti‐HBc + patients should be monitored for ALT flares and HBVr during and possibly for up to 6 months post‐DAA therapy.
Test-retest reliability of respiratory resistance measured with the airflow perturbation device.

PURPOSE In this study, the authors aimed to determine reliability of the airflow perturbation device (APD) to measure respiratory resistance within and across sessions during resting tidal (RTB) and postexercise breathing in healthy athletes, and during RTB across trials within a session in athletes with paradoxical vocal fold motion (PVFM) disorder. METHOD Prospective, repeated-measures design. The APD measured respiratory resistance during 3 baseline assessments in 24 teenage female athletes, 12 with and 12 without PVFM. Control athletes provided data at rest and following a customized exercise challenge during each of 3 sessions. Intraclass correlation coefficient (ICC) analysis assessed strength of relationships, and repeated-measures analysis of variance assessed differences across trials and sessions. RESULTS ICC analyses confirmed strong correlations across RTB trials for inspiratory, expiratory, and mean respiratory resistance in both groups. Inspiratory resistance decreased ~5% between sessions for control participants; expiratory and mean respiratory resistances were stable. Data from control athletes across sessions and following rigorous exercise were strongly correlated when taken at comparable intervals. CONCLUSIONS APD-measured respiratory resistance, including separate assessments for the inspiratory and expiratory phases, has strong test-retest reliability during RTB and after exercising. This suggests that the APD is a useful measurement tool for the assessment of airway function in patients suspected of having PVFM.
A psychometric review of norm-referenced tests used to assess phonological error patterns.

PURPOSE The authors provide a review of the psychometric properties of 6 norm-referenced tests designed to measure children's phonological error patterns. Three aspects of the tests' psychometric adequacy were evaluated: the normative sample, reliability, and validity. METHOD The specific criteria used for determining the psychometric adequacy of these tests were based on current recommendations in the literature. Test manuals and response forms were reviewed for psychometric adequacy according to these criteria. RESULTS The tests included in this review failed to exhibit many of the psychometric properties required of well-designed norm-referenced tests. Of particular concern was lack of adequate sample size, poor evidence of construct validity, and lack of information about diagnostic accuracy. CONCLUSIONS To ensure that clinicians have access to valid and reliable tests, test developers must make a greater effort to establish that the tests they design have adequate psychometric properties. The authors hope that this review will help clinicians and other professionals to be more aware of some of the limitations of using these tests to make educational decisions.
Speech abilities in preschool children with speech sound disorder with and without co-occurring language impairment.

PURPOSE The authors compared preschool children with co-occurring speech sound disorder (SSD) and language impairment (LI) to children with SSD only in their numbers and types of speech sound errors. METHOD In this post hoc quasi-experimental study, independent samples t tests were used to compare the groups in the standard score from different tests of articulation/phonology, percent consonants correct, and the number of omission, substitution, distortion, typical, and atypical error patterns used in the production of different wordlists that had similar levels of phonetic and structural complexity. RESULTS In comparison with children with SSD only, children with SSD and LI used similar numbers but different types of errors, including more omission patterns ( p < .001, d = 1.55) and fewer distortion patterns ( p = .022, d = 1.03). There were no significant differences in substitution, typical, and atypical error pattern use. CONCLUSIONS Frequent omission error pattern use may reflect a more compromised linguistic system characterized by absent phonological representations for target sounds (see Shriberg et al., 2005). Research is required to examine the diagnostic potential of early frequent omission error pattern use in predicting later diagnoses of co-occurring SSD and LI and/or reading problems.
Aiming for elimination: Outcomes of a consultation pathway supporting regional general practitioners to prescribe direct‐acting antiviral therapy for hepatitis C

To increase access to treatment, the Australian government enabled general practitioners (GPs) to prescribe direct‐acting antivirals (DAAs) to treat hepatitis C virus (HCV)—in consultation with a specialist if inexperienced in HCV management. This study describes the establishment and outcomes of a remote consultation pathway supporting GPs to treat HCV. Key stakeholders from primary and tertiary healthcare services in the Barwon South Western region developed and implemented an HCV remote consultation pathway. Pharmaceutical Benefits Schedule prescription data were used to evaluate GP DAA prescription 12 months pre‐and post‐ pathway implementation. A retrospective review of patients referred for remote consultation for 12 months post‐ pathway inception was undertaken to determine the care cascade. HCV treatment initiation by GPs increased after implementation of the remote consultation pathway. In the 12‐month study period, 74 GPs referred 169 people for remote consultation; 114 (67%) were approved for GP DAA treatment; 48 (28%) were referred for specialist assessment. In total, 119 (71%) patients commenced DAA; 69 were eligible for SVR12 assessment. Post‐treatment HCV RNA data were available for 52 (75%) people; 37 achieved SVR12; 15 achieved SVR ranging from week 5 to 11 post‐treatment. No treatment failure was detected. Collaborative development and implementation of a remote consultation pathway has engaged regional GPs in managing HCV. Follow‐up post‐treatment could be improved; however, no treatment failure has been documented. To eliminate HCV as a public health threat, it is vital that specialists support GPs to prescribe DAA.
Vermicompost and farmyard manure improves food quality, antioxidant and antibacterial potential of Cajanus cajan (L. Mill sp.) leaves.

BACKGROUND Pigeon pea (Cajanus cajan) leaves are a good source of nutrition and health benefitting phenolic compounds. However, its importance has not yet been effectively addressed. Recently, a 2-year field experiment was attempted in an alluvial soil to understand the role of various organic and inorganic fertilisers and their combinations not only on soil quality, but also on production of foremost phenolic compounds and imparting antioxidant and antibacterial properties in C. cajan under vermicompost treatments. RESULTS Notable enhancements in crude protein, soluble carbohydrate, ash content and total flavonoid content were recorded in Cajanus leaves under vermicompost treatments. We detected a significant rise in carlinoside content in C. cajan leaves, which is known to reduce bilirubin concentration in hepatitis affected human blood. Farmyard manure treatments resulted in a high crude fibre content coupled with a substantially high concentration of total phenols, and chlorophyll. In addition, incorporation of vermicompost with or without inorganic fertiliser in the soil had a significant impact on antioxidant and antibacterial properties of C. cajan leaves. Above and beyond, farmyard manure and vermicompost positively influenced the physico-chemical health of the soil. CONCLUSION The present nutrient management scheme based on organic input not only induced a higher yield of C. cajan endowed with improved antioxidant and antibacterial properties, but also enhanced the production of various phenolic compounds. © 2016 Society of Chemical Industry.
Bimodal Programming: A Survey of Current Clinical Practice.

PURPOSE The purpose of this study was to determine the current clinical practice in approaches to bimodal programming in the United States. To be specific, if clinicians are recommending bimodal stimulation, who programs the hearing aid in the bimodal condition, and what method is used for programming the hearing aid? METHOD An 11-question online survey was created and sent via email to a comprehensive list of cochlear implant programming centers in the United States. The survey was sent to 360 recipients. RESULTS Respondents in this study represented a diverse group of clinical settings (response rate: 26%). Results indicate little agreement about who programs the hearing aids, when they are programmed, and how they are programmed in the bimodal condition. Analysis of small versus large implant centers indicated small centers are less likely to add a device to the contralateral ear. CONCLUSIONS Although a growing number of cochlear implant recipients choose to wear a hearing aid on the contralateral ear, there is inconsistency in the current clinical approach to bimodal programming. These survey results provide evidence of large variability in the current bimodal programming practices and indicate a need for more structured clinical recommendations and programming approaches.
Real‐world outcomes of unrestricted direct‐acting antiviral treatment for hepatitis C in Australia: The South Australian statewide experience

In March 2016, the Australian government offered unrestricted access to direct‐acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) to the entire population. This included prescription by any medical practitioner in consultation with specialists until sufficient experience was attained. We sought to determine the outcomes and experience over the first twelve months for the entire state of South Australia. We performed a prospective, observational study following outcomes of all treatments associated with the state's four main tertiary centres. A total of 1909 subjects initiating DAA therapy were included, representing an estimated 90% of all treatments in the state. Overall, SVR12 was 80.4% in all subjects intended for treatment and 95.7% in those completing treatment and follow‐up. 14.2% were lost to follow‐up (LTFU) and did not complete SVR12 testing. LTFU was independently associated with community treatment via remote consultation (OR 1.50, 95% CI 1.04‐2.18, P = .03), prison‐based treatment (OR 2.02, 95% CI 1.08‐3.79, P = .03) and younger age (OR 0.98, 95% CI 0.97‐0.99, P = .05). Of the 1534 subjects completing treatment and follow‐up, decreased likelihood of SVR12 was associated with genotype 2 (OR 0.23, 95% CI 0.07‐0.74, P = .01) and genotype 3 (OR 0.23, 95% CI 0.12‐0.43, P ≤ .01). A significant decrease in treatment initiation was observed over the twelve‐month period in conjunction with a shift from hospital to community‐based treatment. Our findings support the high responses observed in clinical trials; however, a significant gap exists in SVR12 in our real‐world cohort due to LTFU. A declining treatment initiation rate and shift to community‐based treatment highlight the need to explore additional strategies to identify, treat and follow‐up remaining patients in order to achieve elimination targets.
"You Can Lead a Horse to Water …": Focus Group Perspectives on Initiating and Supporting Hearing Health Change in Older Adults.

PURPOSE The aim of this study was to use focus group discussions to (a) evaluate the use of an educational presentation as an impetus for hearing health change and (b) investigate hearing health from the perspective of older adults. METHOD Twenty-seven (4 men, 23 women) community-dwelling older adults attended 4 data collection events. Participants attended a presentation titled Hearing Health in Older Adults, which was delivered by a trained presenter in a peer-teaching-peer format. Following each presentation, a focus group discussion took place. Digital audio recordings, field notes, and memos of the discussions were used to create verbatim transcripts. Data were analyzed using qualitative description and thematic analysis techniques. RESULTS Five central themes emerged when older adult focus groups discussed the presentation and hearing health change: recognizing and admitting, understanding the options, sharing stories and experiences, barriers and facilitators, and the presentation. CONCLUSION Facilitators to hearing health change identified by participants include widespread education about hearing health; clarification about roles, professional motivation, and cost in hearing care; and opportunities to learn from and share personal stories with peers.
Hemiatrofia facial progressiva: registro de um caso

The authors report a case of Parry-Romberg disease with predominantly facial left atrophy, seizures, amnesic aphasia, mental retardation, right hemiplegia and hemianesthesia, and cerebellar syndrome. The rarity of cerebellar atrophy (only one case thus far reported in the literature surveyed) is emphasized, as well as the correlation between the clinical abnormalities and the computerized axial tomography of the skull.