Direct-acting antiviral (DAA) therapy is used in patients with HCV-related decompensated cirrhosis with the expectation of improving hepatic function. However, little is known about the long-term ...hepatic benefit of successful antiviral treatment.
Patients with advanced/decompensated cirrhosis (model for end-stage liver disease MELD ≥10), in whom NS5A-containing DAA therapy was initiated prior to September 2018, were included (from the HCV-TARGET cohort). Treatment outcomes and the impact of treatment on short-term and long-term hepatic function were examined.
A total of 642 patients were analyzed. The mean age was 60 years, 68% were male. The median baseline MELD was 12 (range 10–39) and 64% had prior decompensation. Among patients with available virologic outcomes, 90.5% achieved a sustained virologic response at 12 weeks (SVR12). Eighty (24%) patients achieved a clinically significant decrease in MELD by ≥3 points during short-term follow-up (9–26 weeks after the end of treatment). However, in long-term follow-up (median of 4 years after treatment), mean changes in MELD (−0.30 points), total bilirubin (+0.23 mg/dl) and albumin (+0.36 g/dl) were marginal. Fifty-one patients died and 22 underwent liver transplant. In long-term follow-up, a clinically meaningful decrease in MELD of ≥3 occurred in 29% and a final MELD score of <10 was achieved in 25%.
In a large real-world experience of patients with advanced/decompensated HCV-related cirrhosis treated with DAAs, there were only marginal improvements in MELD, total bilirubin, or albumin at long-term follow-up (after achieving SVR12). These patients may remain at high risk of decompensation and must continue to be closely monitored.
NCT01474811.
Hepatitis C virus infection can now be cured with medications, even in patients who have advanced scarring of the liver (cirrhosis). In this study, we evaluated whether liver function improves or deteriorates in the long-term, following successful treatment of hepatitis C in patients with cirrhosis. We found that overall liver function was relatively stable with only 29% of patients achieving a clinically meaningful improvement in liver function, and we therefore believe that these patients require ongoing monitoring.
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•SVR was achieved in 90.5% of patients with advanced/decompensated cirrhosis treated with direct-acting antivirals.•In long-term (>4 years) follow-up, overall mean changes in MELD, total bilirubin and albumin were marginal.•A clinically meaningful decrease in MELD of ≥3 occurred in 29% and a final MELD score of <10 was achieved in 25%.•Patients with advanced/decompensated liver disease should continue to be monitored following SVR.
We used psychological contract theory as a framework to meta-analytically review subjective and objective predictors of employees' perceived job insecurity. Seventy-six samples from 68 studies were ...included in our review. Results revealed that lower levels of job insecurity are associated with having an internal locus of control, lower amounts of role ambiguity and role conflict, greater amounts of organizational communication, less organizational change, younger employees, and white-collar and permanent work. Moderator analyses further revealed that relations between job insecurity and age, gender, education, and formal contracts are moderated by unemployment rates, countries of origin, and type of job insecurity measure. We discuss theoretical and practical implications for psychological contract theory and occupational health, and offer directions for future research.
Long-term observations of vegetation phenology can be used to monitor the response of terrestrial ecosystems to climate change. Satellite remote sensing provides the most efficient means to observe ...phenological events through time series analysis of vegetation indices such as the Normalized Difference Vegetation Index (NDVI). This study investigates the potential of a Photochemical Reflectance Index (PRI), which has been linked to vegetation light use efficiency, to improve the accuracy of MODIS-based estimates of phenology in an evergreen conifer forest. Timings of the start and end of the growing season (SGS and EGS) were derived from a 13-year-long time series of PRI and NDVI based on a MAIAC (multi-angle implementation of atmospheric correction) processed MODIS dataset and standard MODIS NDVI product data. The derived dates were validated with phenology estimates from ground-based flux tower measurements of ecosystem productivity. Significant correlations were found between the MAIAC time series and ground-estimated SGS (R (sup 2) equals 0.36-0.8), which is remarkable since previous studies have found it difficult to observe inter-annual phenological variations in evergreen vegetation from satellite data. The considerably noisier NDVI product could not accurately predict SGS, and EGS could not be derived successfully from any of the time series. While the strongest relationship overall was found between SGS derived from the ground data and PRI, MAIAC NDVI exhibited high correlations with SGS more consistently (R (sup 2) is greater than 0.6 in all cases). The results suggest that PRI can serve as an effective indicator of spring seasonal transitions, however, additional work is necessary to confirm the relationships observed and to further explore the usefulness of MODIS PRI for detecting phenology.
A meta‐analytic path analysis with k = 52 studies and sample size of roughly 17,000 showed that enhanced perceptions of organizational honesty is the primary mechanism by which realistic job previews ...(RJPs) influence voluntary turnover. This suggests revisions to RJP theory to incorporate social exchange and the way RJPs lead individuals to feel about the organization. Results assessing several new potential moderators of relationships between RJPs and turnover found that the most effective RJP design may be an oral or written RJP delivered posthire and designed to signal organizational honesty. We discuss several key theoretical and practical implications of the results based on a novel signaling theory perspective on RJPs.
To evaluate safety and efficacy of a custom-manufactured artificial iris device (CustomFlex Artificial Iris; HumanOptics AG) for the treatment of congenital and acquired iris defects.
Multicenter, ...prospective, unmasked, nonrandomized, interventional clinical trial.
Patients with photophobia, sensitivity secondary to partial or complete congenital or acquired iris defects, or both.
Eyes were implanted from November 26, 2013, to December 1, 2017, with a custom, foldable artificial iris by 1 of 4 different surgical techniques. Patients were evaluated 1 day, 1 week, and 1, 3, 6, and 12 months after surgery. At each examination, slit-lamp findings, intraocular pressure, implant position, subjective visual symptoms, and complications were recorded. Corrected distance visual acuity (CDVA) and endothelial cell density (ECD) were measured at 3, 6, or 12 months as additional safety evaluations. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was used to assess health-related quality of life affected by vision. The Global Aesthetic Improvement Scale was used to assess cosmetic results.
Photosensitivity, glare, visual symptoms, NEI VFQ-25 score, Global Aesthetic Improvement Scale rating, prosthesis-related adverse events, intraocular lens (IOL)-related adverse events, and surgery-related adverse events 12 months after surgery.
At the 12-month postoperative examination, a 59.7% reduction in marked to severe daytime light sensitivity (P < 0.0001), a 41.5% reduction in marked to severe nighttime light sensitivity (P < 0.0001), a 53.1% reduction in marked to severe daytime glare (P < 0.0001), and a 48.5% reduction in severe nighttime glare (P < 0.0001) were found. A 15.4-point improvement (P < 0.0001) in the NEI VFQ-25 total score was found, and 93.8% of patients reported an improvement in cosmesis as measured by the Global Aesthetic Improvement Scale 12 months after surgery. No loss of CDVA of > 2 lines related to the device was found. Median ECD loss was 5.3% at 6 months after surgery and 7.2% at 12 months after surgery.
The artificial iris surpassed all key safety end points for adverse events related to the device, IOL, or implant surgery and met all key efficacy end points, including decreased light and glare sensitivity, improved health-related quality of life, and satisfaction with cosmesis. The device is safe and effective for the treatment of symptoms and an unacceptable cosmetic appearance created by congenital or acquired iris defects.
Ecosystems across the United States are changing in complex and unpredictable ways and analysis of these changes requires coordinated, long‐term research. This paper is a product of a synthesis ...effort of the U.S. National Science Foundation funded Long‐Term Ecological Research (LTER) network addressing the LTER core research area of “populations and communities.” This analysis revealed that each LTER site had at least one compelling “story” about what their site would look like in 50–100 yr. As the stories were prepared, themes emerged, and the stories were group into papers along five themes: state change, connectivity, resilience, time lags, and cascading effects. This paper addresses the cascading effects theme and includes stories from the Bonanza Creek (boreal), Kellogg Biological Station (agricultural and freshwater), Palmer (Antarctica), and Harvard Forest (temperate forest) LTER sites. We define cascading effects very broadly to include a wide array of unforeseen chains of events that result from a variety of actions or changes in a system. While climate change is having important direct effects on boreal forests, indirect effects mediated by fire activity—severity, size, and return interval—have large cascading effects over the long term. In northeastern temperate forests, legacies of human management and disturbance affect the composition of current forests, which creates a cascade of effects that interact with the climate‐facilitated invasion of an exotic pest. In Antarctica, declining sea ice creates a cascade of effects including declines in Adèlie and increases in Gentoo penguins, changes in phytoplankton, and consequent changes in zooplankton populations. An invasion of an exotic species of lady beetle is likely to have important future effects on pest control and conservation of native species in agricultural landscapes. New studies of zebra mussels, a well‐studied invader, have established links between climate, the heat tolerance of the mussels, and harmful algal blooms. Collectively, these stories highlight the need for long‐term studies to sort out the complexities of different types of ecological cascades. The diversity of sites within the LTER network facilitates the emergence of overarching concepts about trophic interactions as an important driver of ecosystem structure, function, services, and futures.
C3 and C4 photosynthesis pathways represent fundamental differences in vegetation characteristics and physiology. Spectral reflectance collected on the ground and from satellite successfully ...described the fraction of C4 species coverage in the Konza Prairie Long-Term Ecological Reserve (LTER) which supports a grassland made up of mixtures of C3 and C4 plants. Plant species area coverage was measured within the LTER and also at study sites of the First International Land Surface Climatology Project Field Experiment (FIFE) in 1987. Ground-measured visible-near infrared (VNIR) spectral reflectances were collected in FIFE and from a 2015 Hyperion spectrometer image from the Earth Observing 1 (EO-1) satellite.
Partial least squares regression (PLSR) successfully described C4 cover fraction from the FIFE ground VNIR reflectances (R
2
= 0.75). Convolving the bands to 10-nm Hyperion spectral bands decreased the accuracy of the retrievals (R
2
= 0.43). PLSR applied to Hyperion reflectances extracted for the LTER watersheds was also successful describing C4 cover fraction for the VNIR Hyperion bands (R
2
= 0.89), but showed little improvement when the shortwave infrared bands were included (R
2
= 0.92). The coefficients from the FIFE data convolved to VNIR Hyperion bands are similar to the coefficients derived from the Hyperion data, suggesting this approach works over a range of conditions and spatial scales.
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