Factors associated with hepatitis C virus RNA levels in early chronic infection: the InC3 study.

Improved understanding of natural history of hepatitis C virus (HCV) RNA levels in chronic infection provides enhanced insights into immunopathogenesis of HCV and has implications for the clinical management of chronic HCV infection. This study assessed factors associated with HCV RNA levels during early chronic infection in a population with well-defined early chronic HCV infection. Data were from an international collaboration of nine prospective cohorts studying acute HCV infection (InC(3) study). Individuals with persistent HCV and detectable HCV RNA during early chronic infection (one year [±4 months] postinfection) were included. Distribution of HCV RNA levels during early chronic infection was compared by selected host and virological factors. A total of 308 individuals were included. Median HCV RNA levels were significantly higher among males (vs females; 5.15 vs 4.74 log IU/mL; P < 0.01) and among individuals with HIV co-infection (vs no HIV; 5.89 vs 4.86; P = 0.02). In adjusted logistic regression, male sex (vs female, adjusted odds ratio [AOR]: 1.93; 95%CI: 1.01, 3.69), interferon lambda 4 (IFNL4) rs12979860 CC genotype (vs TT/CT; AOR: 2.48; 95%CI: 1.42, 4.35), HIV co-infection (vs no HIV; AOR: 3.27; 95%CI: 1.35, 7.93) and HCV genotype G2 (vs G3; AOR: 5.40; 95%CI: 1.63, 17.84) were independently associated with high HCV RNA levels (>5.6 log IU/mL = 400 000 IU/mL). In conclusion, this study demonstrated that IFNL4 rs12979860 CC genotype, male sex, HIV co-infection and HCV genotype G2 are associated with high HCV RNA levels in early chronic infection. These factors exert their role as early as one year following infection.

Response to treatment following recently acquired hepatitis C virus infection in a multicentre collaborative cohort.

Pegylated interferon therapy is highly effective in recently acquired HCV. The optimal timing of treatment, regimen and influence of host factors remains unclear. We aimed to measure sustained virological response (SVR) during recent HCV infection and identify predictors of response. Data were from five prospective cohorts of high-risk individuals in Australia, Canada, Germany and the United States. Individuals with acute or early chronic HCV who commenced pegylated interferon therapy were included. The main outcome was SVR, and predictors were assessed using logistic regression. Among 516 with documented recent HCV infection, 237 were treated (pegylated interferon n = 161; pegylated interferon/ribavirin n = 76) (30% female, median age 35 years, 56% ever injected drugs, median duration of infection 6.2 months). Sixteen per cent (n = 38) were HIV/HCV co-infected. SVR among those with HCV mono-infection was 64% by intention to treat; SVR was 68% among HCV/HIV co-infection. Independent predictors of SVR in HCV mono-infection were duration of HCV infection (the odds of SVR declined by 8% per month of infection, aOR 0.92, 95% CI 0.85-0.99, P = 0.033), IFNL4 genotype (adjusted OR 2.27, 95% CI 1.13-4.56, P = 0.021), baseline HCV RNA <400 000 IU/mL (aOR 2.06, 95% CI 1.03-4.12, P = 0.041) and age ≥40 years (vs <30: aOR 2.92, 95% CI 1.31-6.49, P = 0.009), with no difference by drug regimen, HCV genotype, symptomatic infection or gender. The effect of infection duration on odds of SVR was greater among genotype-1 infection. Interferon-based HCV treatment is highly effective in recent HCV infection. Duration of infection, IFNL4 genotype and baseline HCV RNA levels can predict virological response and may inform clinical decision-making.

Competing states in the t-J model: uniform D-wave state versus stripe state.

Variational studies of the t-J model on the square lattice based on infinite projected-entangled pair states confirm an extremely close competition between a uniform d-wave superconducting state and different stripe states. The site-centered stripe with an in-phase d-wave order has an equal or only slightly lower energy than the stripe with antiphase d-wave order. The optimal stripe filling is not constant but increases with J/t. A nematic anisotropy reduces the pairing amplitude and the energies of stripe phases are lowered relative to the uniform state with increasing nematicity.

Spin density wave fluctuations and p-wave pairing in Sr2RuO4.

Recently, a debate has arisen over which of the two distinct parts of the Fermi surface of Sr(2)RuO(4) is the active part for the chiral p-wave superconductivity exhibited. Early theories proposed p-wave pairing on the two-dimensional γ band, whereas a recent proposal focuses on the one-dimensional (α, ß) bands whose nesting pockets are the source of the strong incommensurate spin density wave (SDW) fluctuations. We apply a renormalization group theory to study quasi-one-dimensional repulsive Hubbard chains and explain the form of SDW fluctuations, reconciling the absence of long-range order with their nesting Fermi surface. The mutual exclusion of p-wave pairing and SDW fluctuations in repulsive Hubbard chains favors the assignment of the two-dimensional γ band as the source of p-wave pairing.

A phenomenological theory of the anomalous pseudogap phase in underdoped cuprates.

The theoretical description of the anomalous properties of the pseudogap phase in the underdoped region of the cuprate phase diagram lags behind the progress in spectroscopic and other experiments. A phenomenological ansatz, based on analogies to the approach to Mott localization at weak coupling in lower dimensional systems, has been proposed by Yang et al (2006 Phys. Rev. B 73 174501). This ansatz has had success in describing a range of experiments. The motivation underlying this ansatz is described and the comparisons with experiment are reviewed. Implications for a more microscopic theory are discussed together with the relation to theories that start directly from microscopic strongly coupled Hamiltonians.

Andreev and single-particle tunneling spectra of underdoped cuprate superconductors.

We study tunneling spectroscopy between a normal metal and an underdoped cuprate superconductor modeled by a phenomenological theory in which the pseudogap is a precursor to the undoped Mott insulator. In the low barrier tunneling limit, the spectra are enhanced by Andreev reflection only within a voltage region of the small superconducting energy gap. In the high barrier tunneling limit, the spectra show a large energy pseudogap associated with single particle tunneling. Our theory semiquantitatively describes the two gap behavior observed in tunneling experiments.

The association between booster seat use and risk of death among motor vehicle occupants aged 4-8: a matched cohort study.

OBJECTIVE: To estimate the effectiveness of booster seats and of seatbelts in reducing the risk of child death during traffic collisions and to examine possible effect modification by various collision and vehicle characteristics. METHODS: A matched cohort study was conducted using data from the Fatality Analysis Reporting System. Death risk ratios were estimated with conditional Poisson regression, bootstrapped coefficient standard errors, and multiply imputed missing values using chained equations. RESULTS: Estimated death risk ratios for booster seats used with seatbelts were 0.33 (95% CI 0.28 to 0.40) for children age 4-5 years and 0.45 (0.31 to 0.63) for children aged 6-8 years (Wald test of homogeneity p<0.005). The estimated risk ratios for seatbelt used alone were similar for the two age groups, 0.37 (0.32 to 0.43) and 0.39 (0.34 to 0.44) for ages 4-5 and 6-8, respectively (Wald p = 0.61). Estimated booster seat effectiveness was significantly greater for inbound seating positions (Wald p = 0.05) and during rollovers collisions (Wald p = 0.01). Significant variability in risk ratio estimates was not observed across levels of calendar year, vehicle model year, vehicle type, or land use. CONCLUSIONS: Seatbelts, used with or without booster seats, are highly effective in preventing death among motor vehicle occupants aged 4-8 years. Booster seats do not appear to improve the performance of seatbelts with respect to preventing death (risk ratio 0.92, 95% CI 0.79 to 1.08, comparing seatbelts with boosters to seatbelts alone), but because several studies have found that booster seats reduce non-fatal injury severity, clinicians and injury prevention specialists should continue to recommend the use of boosters to parents of young children.

Differential toxicity to Cd, Pb, and Cu in dragonfly larvae (Insecta: Odonata).

Odonate larvae are important organisms in aquatic ecosystems but have been rarely studied in laboratory toxicity tests. Only a few previous studies have been conducted on odonates and their responses to heavy metals. We exposed two species of libellulid larvae (Anisoptera: Libellulidae) to equimolar concentrations of cadmium, lead, or copper in 7-day survival tests. Larvae were tolerant of high concentrations of cadmium and lead, as no significant decrease in survival was observed at exposures as high as 0.893 and 2.232 mM, respectively. In contrast, larvae were more sensitive to copper exposure, demonstrating significantly decreased survival to exposures as low as 2.360 microM. In whole animal samples, larvae accumulated very high concentrations (>1000 microg/g dry weight) of all three metals in an exposure-related manner. Much of this accumulation could probably be attributed to adsorption or accumulation of metal within the exoskeleton, because odonate larvae are known to sequester metals into this material. Our results were generally consistent with previous observations indicating that odonates are tolerant to metal exposures, even in comparison with other aquatic invertebrates. However, there are few studies that have used odonates in toxicity tests and compared these organisms to other aquatic life. Based on their abundance and their simple requirements in the laboratory, we believe that odonate larvae can be useful toxicological model organisms.

Giant phonon anomaly associated with superconducting fluctuations in the pseudogap phase of cuprates.

The pseudogap in underdoped cuprates leads to significant changes in the electronic structure, and was later found to be accompanied by anomalous fluctuations of superconductivity and certain lattice phonons. Here we propose that the Fermi surface breakup due to the pseudogap, leads to a breakup of the pairing order into two weakly coupled sub-band amplitudes, and a concomitant low energy Leggett mode due to phase fluctuations between them. This increases the temperature range of superconducting fluctuations containing an overdamped Leggett mode. In this range inter-sub-band phonons show strong damping due to resonant scattering into an intermediate state with a pair of overdamped Leggett modes. In the ordered state, the Leggett mode develops a finite energy, changing the anomalous phonon damping into an anomaly in the dispersion. This proposal explains the intrinsic connection between the anomalous pseudogap phase, enhanced superconducting fluctuations and giant anomalies in the phonon spectra.

Compensating for provider nonresponse using response propensities to form adjustment cells: the National Immunization Survey.

OBJECTIVES: The National Immunization Survey (NIS) uses two phases of data collection to obtain vaccination information from a sample of young children: a random-digit-dialing (RDD) survey for identifying households with children 19-35 months of age, followed by a mail survey for obtaining provider-reported vaccination histories about these children. Provider-reported vaccination histories are used to estimate vaccination coverage rates. In 1998, provider-reported vaccination histories were not obtained for 32.9% of children with a completed RDD interview. This report describes the statistical methods adopted in 1998 to reduce the bias in vaccination coverage estimates that could result from "vaccination history nonresponse," that is, differences between children for whom provider data was obtained and those for whom it was not obtained. METHODS: In the methods adopted in 1998, children with completed NIS RDD interviews are grouped into adjustment cells defined by their propensity to have adequate provider data. Sampling weights of children with adequate provider data are divided by the cell-specific weighted response rate to allow these children to represent all children in the cell. RESULTS: Using an "optimal" number of cells, the overall extent of bias reduction was 0.5%, suggesting that provider nonresponse bias was small. Authoritative literature suggests using five cells. No statistically significant differences were observed in vaccination coverage estimates when comparing estimates based on the "optimal" number of cells with five cells. Thus, five adjustment cells are used to reduce provider nonresponse bias in the NIS vaccination coverage estimates. No substantively important differences were observed between estimates based on the methodology used prior to 1998 and the methodology adopted in 1998.

The seroepidemiology of human immunodeficiency virus in the United States household population: NHANES III, 1988-1991.

To provide an estimate of the seroprevalence of human immunodeficiency virus (HIV) in a representative sample of the U.S. household population, serum samples from participants in the third National Health and Nutrition Examination Survey (NHANES III) were tested for HIV antibody. The testing was performed anonymously on 5,430 individuals 18-59 years old from phase 1 of NHANES III conducted from 1988 to 1991. Twenty-nine individuals were HIV positive. The total weighted prevalence was 0.39%. The population estimate of infected individuals was 547,000, with a 95% confidence interval of 299,000-1,020,000 infected persons. Black participants were four times more likely to be HIV positive than white/other individuals and three times more likely than Mexican Americans. Men were three times more likely to be infected than women. Higher nonresponse to the survey and to phlebotomy was observed in young white men; therefore these data provide a conservative estimate of HIV infection in the general household population. This estimate does not include individuals who do not live in households and who may be at higher risk of infection, such as persons in penal institutions, the homeless, or certain hospitalized patients.

Issues associated with the design of a national probability sample for human exposure assessment.

Data obtained from national probability sample surveys provide important information on the prevalence of various health conditions and distributions of physical and biochemical characteristics of the U.S. population. The sample design of a survey specifies how sampling from a designated population over a stated period is to be accomplished. A survey's analytical objectives and interests--in particular subpopulations--affect the sample design strategy. Selected subdomains of the population often must be oversampled so that estimates can be made with acceptable precision. This article addresses sample design considerations for a national probability sample for human tissue monitoring and specimen banking. Among the sampling issues addressed are the oversampling of special populations e.g., minority groups and at-risk groups such as low income or elderly persons; geographic coverage; and sample size considerations. The sample design for a major health survey, the Third National Health and Nutrition Examination Survey (NHANES III), is used to illustrate a complex, multistage probability sample design and to highlight some of the sampling issues discussed in this article.

Forty years and four surveys: how does our measuring measure up?

OBJECTIVE: This article reviews four surveys methodologies that have been used over the past 40 years to assess immunization rates in young children in the United States. These methods include three national surveys: (1) United States Immunization Survey (1959-1985), which was first a household and then a telephone survey; (2) National Health Interview Survey (1991-present), which interviews people in their homes; and (3) National Immunization Survey (1994-present), a random-digit-dialing telephone survey. In addition, a series of retrospective school record surveys that used standard sampling and assessment methodologies were conducted nationally during 4 school years September 1990-May 1991. METHODS: Federal publications, National Immunization Conference proceedings, and Centers for Disease Control and Prevention (CDC) internal reports regarding national immunization surveys were reviewed. The methodology used in each survey is presented, and selected examples of previously tabulated results are presented. CONCLUSIONS: The assessment of immunization coverage in American preschool children requires ongoing commitment and survey expertise. Over the past 40 years the CDC's efforts to determine vaccination coverage in young children has evolved from the comparatively simple United States Immunization Survey to the current National Immunization Survey that utilizes sophisticated statistical and survey techniques to obtain the most-accurate results yet available.

Comparison of NIS and NHIS/NIPRCS vaccination coverage estimates. National Immunization Survey. National Health Interview Survey/National Immunization Provider Record Check Study.

BACKGROUND: The National Immunization Survey (NIS) and the National Health Interview Survey (NHIS) produce national coverage estimates for children aged 19 months to 35 months. The NIS is a cost-effective, random-digit-dialing telephone survey that produces national and state-level vaccination coverage estimates. The National Immunization Provider Record Check Study (NIPRCS) is conducted in conjunction with the annual NHIS, which is a face-to-face household survey. As the NIS is a telephone survey, potential coverage bias exists as the survey excludes children living in nontelephone households. METHODS: To assess the validity of estimates of vaccine coverage from the NIS, we compared 1995 and 1996 NIS national estimates with results from the NHIS/NIPRCS for the same years. RESULTS: Both the NIS and the NHIS/NIPRCS produce similar results. CONCLUSION: The NHIS/NIPRCS supports the findings of the NIS.

Overview of the sampling design and statistical methods used in the National Immunization Survey.

Abstract: The National Immunization Survey (NIS) is a large federally funded survey designed to estimate vaccination coverage rates for children residing in the United States aged 19 to 35 months. In 1999, over 8 million telephone call attempts were made to obtain provider-reported vaccination histories on 22,521 children in the age range of interest.

National Immunization Survey: the methodology of a vaccination surveillance system.

The National Immunization Survey (NIS) was designed to measure vaccination coverage estimates for the US, the 50 states, and selected urban areas for children ages 19-35 months. The NIS includes a random-digit-dialed telephone survey and a provider record check study. Data are weighted to account for the sample design and to reduce nonresponse and non-coverage biases in order to improve vaccination coverage estimates. Adjustments are made for biases resulting from nonresponse and nontelephone households, and estimation procedures are used to reduce measurement bias. The NIS coverage estimates represent all US children, not just children living in households with telephones. NIS estimates are highly comparable to vaccination estimates derived from the National Health Interview Survey. The NIS allows comparisons between states and urban areas over time and is used to evaluate current and new vaccination strategies.