AIMTo study impact of baseline mental health disease on hepatitis C virus (HCV) treatment; and Beck’s Depression Inventory (BDI) changes with sofosbuvir- and interferon-based therapy. METHODSThis is a retros...AIMTo study impact of baseline mental health disease on hepatitis C virus (HCV) treatment; and Beck’s Depression Inventory (BDI) changes with sofosbuvir- and interferon-based therapy. METHODSThis is a retrospective cohort study of participants from 5 studies enrolled from single center trials conducted at the Clinical Research Center of the National Institutes of Health, Bethesda, MD, United States. All participants were adults with chronic HCV genotype 1 infection and naïve to HCV therapy. Two of the studies included HCV mono-infected participants only (SPARE, SYNERGY-A), and 3 included human immunodeficiency virus (HIV)/HCV co-infected participants only (ERADICATE, PFINPK, and ALBIN). Patients were treated for HCV with 3 different regimens: Sofosbuvir and ribavirin in the SPARE trial, ledipasvir and sofosbuvir in SYNERGY-A and ERADICATE trials, and pegylated interferon (IFN) and ribavirin for 48 wk in the PIFNPK and ALBIN trials. Participants with baseline mental health disease (MHD) were identified (defined as either a DSM IV diagnosis of major depression, bipolar disorder, schizophrenia, generalized anxiety, and post-traumatic stress disorder or requiring anti-depressants, antipsychotics, mood stabilizers or psychotropics prescribed by a psychiatrist). For our first aim, we compared sustained virologic response (SVR) and adherence (pill counts, study visits, and in 25 patients, blood levels of the sofosbuvir metabolite, GS-331007) within each study. For our second aim, only patients with HIV coinfection were evaluated. BDI scores were obtained pre-treatment, during treatment, and post-treatment among participants treated with sofosbuvir-based therapy, and compared to scores from participants treated with interferon-based therapy. Statistical differences for both aims were analyzed by Fisher’s Exact, and t-test with significance defined as a P value less than 0.05. RESULTSBaseline characteristics did not differ significantly between all participants with and without MHD groups treated with sofosbuvir-based therapy. Among patients treated with sofosbuvir-based therapy, the percentage of patients with MHD who achieved SVR was the same as those without (SPARE: 60.9% of those MHD compared to 67.6% in those without, P = 0.78; SYNERGY-A: 100% of both groups; ERADICATE: 100% compared to 97.1%). There was no statistically significant difference in pill counts, adherence to study visits between groups, nor mean serum concentrations of GS-331007 for each group at week 2 of treatment (P = 0.72). Among patients with HIV co-infection, pre-treatment BDI scores were similar among patients treated with sofosbuvir, and those treated with interferon (sofosbuvir-based 5.24, IFN-based 6.96; P = 0.14); however, a dichotomous effect on was observed during treatment. Among participants treated with directly acting antiviral (DAA)-based therapy, mean BDI scores decreased from 5.24 (pre-treatment) to 3.28 during treatment (1.96 decrease, P = 0.0034) and 2.82 post-treatment. The decrease in mean score from pre- to post-treatment was statistically significant (-2.42, P = 0.0012). Among participants treated with IFN-based therapy, mean BDI score increased from 6.96 at pre-treatment to 9.19 during treatment (an increase of 2.46 points, P = 0.1), and then decreased back to baseline post-treatment (mean BDI score 6.3, P = 0.54). Overall change in mean BDI scores from pre-treatment to during treatment among participants treated with DAA-based and IFN-therapy was statistically significant (-1.96 and +2.23, respectively; P = 0.0032). This change remained statistically significant when analysis was restricted to participants who achieved SVR (-2.0 and +4.36, respectively; P = 0.0004). CONCLUSIONSofosbuvir-based therapy is safe and well tolerated in patients with MHD. A decline in BDI associated with sofosbuvir-based HCV treatment suggests additional MHD benefits, although the duration of these effects is unknown.展开更多
NEWTON’s laws of motion predicted that light would travel faster from a moving source—it doesn’t.Einstein was convinced that unruly electrons had no place in an orderly,understandable universe.Both assumed that hum...NEWTON’s laws of motion predicted that light would travel faster from a moving source—it doesn’t.Einstein was convinced that unruly electrons had no place in an orderly,understandable universe.Both assumed that human knowledge could be perfected,mathematically,and that a coherent scientific account of the world we find ourselves in,not only exists,but is available and open to dedicated human enquiry.This paper argues that Hume,Kant and recent work on Hubble’s Constant render this idealistic position untenable.The remedy proposed is not to tighten scientific definitions ever further,but to reposition Science so as to prioritise the biosphere.This entails placing the process of living organisms centre stage,since they defy the Second Law of Thermodynamics,thereby reducing Uncertainty for all—an approach best exemplified in clinical medicine,where despite unbridgeable gaps in medical knowledge,healing can and does take place.Using Quaker insights developed in the 1650s,a non-theological pathway is offered which emphasises human creativity and social cohesion.Unhappily psychiatry today,under the guise of being 100%scientific in the Einstein way,discards three counts of millennial medical wisdom,with catastrophic consequences,as shown by scientifically valid data.A healthier approach to mental and social health,emphasising trust and consent,is described.展开更多
该文对B/S模式下心理预警系统的构建过程进行了分析。系统基于B/S模式,集在线测评、学习、宣传、管理于一体,实现了无纸化的心理学问卷调查,并能准确地计算测试结果。该系统运用了ASP.NET、SQL Server 2005数据库、网页设计等计算机技术...该文对B/S模式下心理预警系统的构建过程进行了分析。系统基于B/S模式,集在线测评、学习、宣传、管理于一体,实现了无纸化的心理学问卷调查,并能准确地计算测试结果。该系统运用了ASP.NET、SQL Server 2005数据库、网页设计等计算机技术,将心理学研究成果赋予实体,具有较强的先进性和可扩展性。展开更多
文摘AIMTo study impact of baseline mental health disease on hepatitis C virus (HCV) treatment; and Beck’s Depression Inventory (BDI) changes with sofosbuvir- and interferon-based therapy. METHODSThis is a retrospective cohort study of participants from 5 studies enrolled from single center trials conducted at the Clinical Research Center of the National Institutes of Health, Bethesda, MD, United States. All participants were adults with chronic HCV genotype 1 infection and naïve to HCV therapy. Two of the studies included HCV mono-infected participants only (SPARE, SYNERGY-A), and 3 included human immunodeficiency virus (HIV)/HCV co-infected participants only (ERADICATE, PFINPK, and ALBIN). Patients were treated for HCV with 3 different regimens: Sofosbuvir and ribavirin in the SPARE trial, ledipasvir and sofosbuvir in SYNERGY-A and ERADICATE trials, and pegylated interferon (IFN) and ribavirin for 48 wk in the PIFNPK and ALBIN trials. Participants with baseline mental health disease (MHD) were identified (defined as either a DSM IV diagnosis of major depression, bipolar disorder, schizophrenia, generalized anxiety, and post-traumatic stress disorder or requiring anti-depressants, antipsychotics, mood stabilizers or psychotropics prescribed by a psychiatrist). For our first aim, we compared sustained virologic response (SVR) and adherence (pill counts, study visits, and in 25 patients, blood levels of the sofosbuvir metabolite, GS-331007) within each study. For our second aim, only patients with HIV coinfection were evaluated. BDI scores were obtained pre-treatment, during treatment, and post-treatment among participants treated with sofosbuvir-based therapy, and compared to scores from participants treated with interferon-based therapy. Statistical differences for both aims were analyzed by Fisher’s Exact, and t-test with significance defined as a P value less than 0.05. RESULTSBaseline characteristics did not differ significantly between all participants with and without MHD groups treated with sofosbuvir-based therapy. Among patients treated with sofosbuvir-based therapy, the percentage of patients with MHD who achieved SVR was the same as those without (SPARE: 60.9% of those MHD compared to 67.6% in those without, P = 0.78; SYNERGY-A: 100% of both groups; ERADICATE: 100% compared to 97.1%). There was no statistically significant difference in pill counts, adherence to study visits between groups, nor mean serum concentrations of GS-331007 for each group at week 2 of treatment (P = 0.72). Among patients with HIV co-infection, pre-treatment BDI scores were similar among patients treated with sofosbuvir, and those treated with interferon (sofosbuvir-based 5.24, IFN-based 6.96; P = 0.14); however, a dichotomous effect on was observed during treatment. Among participants treated with directly acting antiviral (DAA)-based therapy, mean BDI scores decreased from 5.24 (pre-treatment) to 3.28 during treatment (1.96 decrease, P = 0.0034) and 2.82 post-treatment. The decrease in mean score from pre- to post-treatment was statistically significant (-2.42, P = 0.0012). Among participants treated with IFN-based therapy, mean BDI score increased from 6.96 at pre-treatment to 9.19 during treatment (an increase of 2.46 points, P = 0.1), and then decreased back to baseline post-treatment (mean BDI score 6.3, P = 0.54). Overall change in mean BDI scores from pre-treatment to during treatment among participants treated with DAA-based and IFN-therapy was statistically significant (-1.96 and +2.23, respectively; P = 0.0032). This change remained statistically significant when analysis was restricted to participants who achieved SVR (-2.0 and +4.36, respectively; P = 0.0004). CONCLUSIONSofosbuvir-based therapy is safe and well tolerated in patients with MHD. A decline in BDI associated with sofosbuvir-based HCV treatment suggests additional MHD benefits, although the duration of these effects is unknown.
文摘NEWTON’s laws of motion predicted that light would travel faster from a moving source—it doesn’t.Einstein was convinced that unruly electrons had no place in an orderly,understandable universe.Both assumed that human knowledge could be perfected,mathematically,and that a coherent scientific account of the world we find ourselves in,not only exists,but is available and open to dedicated human enquiry.This paper argues that Hume,Kant and recent work on Hubble’s Constant render this idealistic position untenable.The remedy proposed is not to tighten scientific definitions ever further,but to reposition Science so as to prioritise the biosphere.This entails placing the process of living organisms centre stage,since they defy the Second Law of Thermodynamics,thereby reducing Uncertainty for all—an approach best exemplified in clinical medicine,where despite unbridgeable gaps in medical knowledge,healing can and does take place.Using Quaker insights developed in the 1650s,a non-theological pathway is offered which emphasises human creativity and social cohesion.Unhappily psychiatry today,under the guise of being 100%scientific in the Einstein way,discards three counts of millennial medical wisdom,with catastrophic consequences,as shown by scientifically valid data.A healthier approach to mental and social health,emphasising trust and consent,is described.
文摘该文对B/S模式下心理预警系统的构建过程进行了分析。系统基于B/S模式,集在线测评、学习、宣传、管理于一体,实现了无纸化的心理学问卷调查,并能准确地计算测试结果。该系统运用了ASP.NET、SQL Server 2005数据库、网页设计等计算机技术,将心理学研究成果赋予实体,具有较强的先进性和可扩展性。