The Separate Development of Children’s Listener and Speaker Behavior and the Intercept as Behavioral Metamorphosis

The study of verbal behavior focuses on communicative functions of the speakers/producers as they affect the behavior of listeners/observers. Effects on the listener reinforce the speaker and the listener/observer benefits (i.e., is reinforced) from the behavior of the speaker/producer. The interlocking of, and exchange of, the speaker and listener behavior between individuals and within one’s own skin constitute bidirectional operants. These bidirectional operants are instances of social interactions and measures of social behavior. Evidence suggests that the act of listening, among other observing responses, is initially developmentally independent from speaker behavior. How they become joined parallels the biological phenomenon of metamorphosis. The succession of changes has been empirically identified as a succession of verbal behavior development cusps, which are described in their sequence biologically as a manifestation of functional metamorphosis. The onset of a cusp constitutes first instances of behavior and accompanying stimulus control that allows infants and children to contact parts of the environment for the first time resulting in their learning things impossible to learn before or learning faster. Cusps for the intercept of the speaker and listener lead to bidirectional operants and provide explanations for how children incidentally learn the names of things, become increasingly social, and make subsequent complex behavior possible. Many of the cusps identified in our research resulted from the missing behavior and stimulus control of children with autism. Once cusps were established, these children learned things they could not learn before, learned faster, and learned by contacting parts of the social environment they could not contact before. These findings led to a theory of verbal behavior development that point to the selection of bidirectional operants as behavioral phenotypes during functional metamorphosis, which has enhanced the survival of Homo sapiens through emergent symbolic skills for more effective collaboration between two or more individuals.

Use of the IRT Model to Validate Test Items from a Technology Assisted Health Coaching Program

Item Response Theory (IRT) models have been extensively used in the field of education to identify link between a response to a test item and underlying latent capability of the test taker. We demonstrate the benefit of using IRT model to analyze health data using data from M. chat program such that statisticians can use the method in lieu of traditional methods including Cronbach’s alpha, discriminant analysis and factor analysis. M. chat is a technology based health coaching program and the baseline survey from the participants in the program includes response in different but correlated domains of diet, social habits, leisure practices, mental health, substance abuse, self-sufficiency and medication adherence. We analyzed baseline data from 416 subjects using IRT models. Our results indicated that responses pertaining to alcohol and substance abuse were the most discriminating items with an average discrimination estimate of approximately 4.99 whereas the least discriminating items were the diet habits, with an average estimate of -0.476.

Family Health History and Behavioral Change among Undergraduate Students: A Mixed Methods Study

Background: We examined family health history (FHH) as a public health intervention tool in undergraduate students. We hypothesized that the FHH assignment would positively relate to students’ FHH knowledge and health and healthcare-seeking behavioral change. Methods: Health professional students’ (n = 103) pre/post-test surveys and research papers were collected in 2011-2012, from a mid-western and southern university in the United States of America, using mixed methods research. Results: The majority of students were aged 18 - 30, women, White, had healthcare access and health insurance, and awareness of the term FHH. Significant logistic regression relationships existed between: 1) helping students understand important strengths and weaknesses in their health and quality of life and outcomes of talking with family and doctors about FHH;and 2) improving students’ understanding of what they needed to do to maintain their health and the outcome statement “FHH tells you about inherited genes.” Key themes from the research papers included actions and FHH and proposed behavioral changes. Conclusions: Quantitative findings supported the relationship between students’ assignment evaluation and knowledge change, while qualitative findings supported relationships between assignment evaluation and knowledge and behavioral change. This study highlights regional differences in students’ FHH and the need to address family support barriers to behavioral change.

Factors related to the functionality of community-based rural water supply and sanitation program in Indonesia

This study used multinomial logistic regression and Bayesian belief networks(BBN)to analyze factors influenc-ing the functionality of the community-based rural drinking water supply and sanitation program(PAMSIMAS)in Indonesia.28,936 PAMSIMAS projects in 33 provinces in Indonesia were analyzed.The data indicates that 85.4%of the water supply systems were fully functioning,9.1%were partially functioning,and 5.5%were not functioning.In the regression analysis,good management is positively associated with functionality and a high investment per capita is negatively associated with the functionality.The latter suggests the need for comprehen-sive economic analysis in the feasibility study in scattered housing sites and remote-undeveloped areas.We also found that high community participation at the beginning of the project was associated with the not functioning system,while women’s participation was positively associated with the functionality.Furthermore,the household connection is more likely to be functioning than communal connection.BBN analysis shows if the beneficiaries do not pay for water,the probability of not functioning systems is 20 times higher than systems with fee collec-tion.Moreover,the combination of strong management,strong financial status,and household connection rather than communal connection increases the probability of fully functioning to 98%.Improvement of data collection is also necessary to monitor the current conditions of all PAMSIMAS systems in Indonesia.This study offers a country-level perspective for better implementation of the community-based rural water supply and sanitation program in developing countries.

Analysis of YouTube^(TM) videos related to bowel preparation for colonoscopy

AIM: To examine YouTubeTM videos about bowel preparation procedure to better understand the quality of this information on the Internet. METHODS: YouTubeTM videos related to colonoscopy preparation were identified during the winter of 2014; only those with ≥ 5000 views were selected for analysis(n = 280). Creator of the video, length, date posted, whether the video was based upon personal experience, and theme was recorded. Bivariate analysis was conducted to examine differences between consumers vs healthcare professionals-created videos. RESULTS: Most videos were based on personal experience. Half were created by consumers and 34% were ≥ 4.5 min long. Healthcare professional videos were viewed more often(> 19400, 59.4% vs 40.8%,P = 0.037, for healthcare professional and consumer, respectively) and more often focused on the purgative type and completing the preparation. Consumer videos received more comments(> 10 comments, 62.2% vs 42.7%, P = 0.001) and more often emphasized the palatability of the purgative, disgust, and hunger during the procedure. Content of colonoscopy bowel preparation YouTube? videos is influenced by who creates the video and may affect views on colon cancer screening. CONCLUSION: The impact of perspectives on the quality of health-related information found on the Internet requires further examination.

Non-Operative Management of Hip Osteoarthritis

This paper reviews several non-operative and non-pharmacologic management strategies advocated for alleviating the pain and disability experienced by people with hip osteoarthritis. It analyzes whether painful debilitating hip osteoarthritis, which has no effective cure and is often progressive, may be affected positively by non-operative interventions designed to control osteoarthritis pain. Finally, it provides an integrated plan of management for ameliorating hip osteoarthritis pain and disability in light of this knowledge.

Use of sport-related concussion information sources among parents of United States middle school children

Objective:Parents may use various information sources to obtain information about sport-related concussions(SRC).This study examined SRCrelated information sources used by parents of United States middle school children(age:10-15 years).Methods:A panel of 1083 randomly selected U.S.residents,aged≥18 years and identifying as parents of middle school children,completed an online questionnaire capturing parental and child characteristics,and utilization and perceived trustworthiness of various sources of SRC-related information.Multivariable logistic regression models identified factors associated with utilizing each source.Adjusted odds ratios(OR)with 95%confidence intervals(95%CIs)excluding 1.00 were deemed significant.Results:Doctors/healthcare providers(49.9%)and other healthcare-related resources(e.g.,Centers for Disease Control and Prevention,WebMD)(37.8%)were common SRC-related information sources;64.0%of parents utilized≥1 of these sources.Both sources were considered“very”or“extremely”trustworthy for SRC-related information among parents using these sources(doctors/healthcare providers:89.8%;other healthcare-related resources:70.9%).A 10-year increase in parental age was associated with higher odds of utilizing doctors/healthcare providers(adjusted odd ratio(OR_(adjusted))=1.09,95%CI:1.02-1.16)and other healthcare-related resources(OR_(adjusted)=1.11,95%CI:1.03-1.19).The odds of utilizing doctors/healthcare providers(OR_(adjusted)=0.58,95%CI:0.40-0.84)and other healthcare-related resources(OR_(adjusted)=0.64,95%CI:0.44-0.93)were lower among parents whose middle school children had concussion histories versus the parents of children who did not have concussion histories.Conclusion:One-third of parents did not report using doctors/healthcare providers or other healthcare-related resources for SRC-related information.Factors associated with underutilization of these sources may be targets for future intervention.Continuing education for healthcare providers and educational opportunities for parents should highlight accurate and up-to-date SRC-related information.

Assessment of resting energy expenditure in patients with cirrhosis

BACKGROUND Malnutrition affects 20%to 50%of patients with cirrhosis.It may be associated with serious complications and has a direct impact on prognosis.Resting energy expenditure(REE)is an important parameter to guide the optimization of therapy and recovery of nutritional status in patients with cirrhosis.However,the REE of patients with cirrhosis is still unclear,casting doubt upon the optimal nutritional management approach.AIM To identify the best method that predicts the REE of cirrhotic patients,using indirect calorimetry(IC)as the gold standard.METHODS An observational study was performed on 90 patients with cirrhosis.REE was assessed by IC,bioelectrical impedance analysis(BIA),and predictive formulas,which were compared using Bland-Altman plots and the Student’s t-test.RESULTS REE values measured by IC(1607.72±257.4 kcal)differed significantly from those determined by all other methods(BIA:1790.48±352.1 kcal;Harris&Benedict equation:2373.54±254.9 kcal;IOM equation:1648.95±185.6 kcal;Cunningham equation:1764.29±246.2 kcal),except the Food and Agriculture Organization of the United Nations,World Health Organization,and United Nations University(FAO/WHO/UNU)(1616.07±214.6 kcal)and McArdle(1611.30±241.8 kcal)equations.We found no significant association when comparing IC and 24-h dietary recall among different Child-Pugh classes of cirrhosis.CONCLUSION The IOM and FAO/WHO/UNU equations have the best agreement with the CI.These results indicate a possibility of different tools for the clinical practice on cirrhotic patients.

Clinician Misperceptions about the Importance of Adolescent HPV Vaccination

Introduction: Adolescent HPV vaccination rates remain suboptimal. The purpose of the study was to investigate attitudes about HPV vaccine relative to other adolescent vaccines among clinical staff from primary care offices and school based clinics. Methods: We interviewed clinicians in primary care offices and school-based clinics regarding their attitudes about HPV vaccine relative to Tdap and MCV4. Results: Respondents (n = 36) included clinical staff in family medicine (47%), pediatrics (25%), obstetrics/gynecology (19%) and school-based health clinics (8%). Only 3% strongly agreed and 17% agreed that completion of HPV vaccine was more important than completion of pertussis vaccine (Tdap), while 6% strongly agreed and 33% agreed that completion of HPV vaccine was more important than completion of meningitis vaccine (MCV4). Discussion: Providing clinicians with additional information about the cancer prevention benefits of the HPV vaccine and the greater risk for HPV infection/disease relative to other vaccine preventable adolescent diseases may help to increase HPV vaccination rates among adolescents.

Factors and expectations influencing concussion disclosure within NCAA DivisionⅠathletes:A mixed methodological approach

Background:Participation in sports is associated with many benefits to all aspects of health;however,it also comes with the risk of injury,particularly concussions.Self-disclosure and care seeking following a concussion are especially important because of the lack of outwardly visible signs and/or symptoms.Although recent research has explored factors affecting concussion disclosure,use of isolated methodologies limits the ability to contextualize how disclosure or nondisclosure occurs.Therefore,the purpose of this study was to describe the factors and expectations of National Collegiate Athletic Association(NCAA)athletes that may influence concussion disclosure.Methods:This mixed-methods convergent parallel research study included 25 NCAA Division I athletes representing 13 sports,all of whom completed a concussion-education session with pre-/post-test surveys and a semistructured interview.Eligible athletes were at least 18 years old and on an NCAA roster.The surveys focused on previous concussion-related disclosure behaviors,knowledge,attitudes,beliefs,norms,and intentions about disclosing concussion.Interviews focused on the athletes’experiences related to concussion disclosure.Survey data were analyzed using descriptive statistics and Mann-Whitney U tests.Interviews were analyzed using a Consensual Qualitative Research tradition.Results:Participants had good concussion knowledge(median=46.0),positive attitudes(median=38.0),strong beliefs(median=13.0),and strong intentions to disclose concussion symptoms(median=7.0).None of the constructs differed by participants’gender.Although quantitative findings were mostly positive,interview data highlighted factors that may explain why some participants are successful in disclosing concussions and why others may find disclosure difficult.Educational efforts,sport culture,and medical professional presence were the primary facilitators discussed by participants.Stigma,pressure,and a lack of team support were perceived as disclosure barriers.Conclusion:The context in which concussion disclosure occurs or does not occur is vital to the success of educational interventions.Interventions must prioritize stakeholder-and team-based perspectives on concussion to establish a network supportive to disclosure.

NGO开展VCT预防静脉吸毒人群HIV／AIDS效果的研究

目的研究非政府组织(NGO)开展自愿咨询检测(VCT)预防静脉吸毒人群艾滋病病毒/艾滋病(HIV/ AIDS)的效果。方法由妇女联合会承担VCT工作。疾病预防控制中心进行指导和培训,建立"家庭健康教育站",发动同伴招募社区静脉吸毒人员;提供检测前后咨询和快速检测服务;提供美沙酮替代治疗(MMT)和HIV/AIDS诊治转诊服务。结果建立了NGO开展VCT预防社区静脉吸毒人群HIV/AIDS的工作模式。吸毒人员HIV抗体阳性率为57.5%,他们的艾滋病传播及预防知识的知晓率从VCT前的49.3%～86.2%提高到VCT后的81.1%～99.1%;共用针头、棉花、药液的百分率从45.296～56.7%降到30.096-33.6%;用漂白粉清洗针头/注射器的百分事从零提高到17%;吸毒者发生性行为时从不使用安全套的百分比从约82%减少到32.5%～38.4%,小于一半时间至每次使用安全套的百分比从0～9.896提高到7.1%～24.4%。吸毒人员、HIV感染者获得了MMT和HIV/AIDS诊治转诊服务和心理支持。不歧视吸毒人员及HIV感染者的社区环境初步形成。结论由NGO开展VCT预防静脉吸毒人群艾滋病可行、有效。

VCT预防静脉吸毒人群HIV感染效果的研究

目的 评价VCT预防社区静脉吸毒人群HIV感染的效果.方法 在社区建立VCT工作站,采用同伴方法招募社区静脉吸毒人员,为他们提供检测前、检测后咨询和快速检测服务、美沙酮替代治疗和HIV抗体确认、治疗转诊服务,3个月后随访评估.结果 共招募到226名社区静脉吸毒人员,以男性青年为主,小学文化程度占54%,随访率为96%.HIV抗体阳性率为57.4%.吸毒人员参加VCT前艾滋病传播途径及预防知识的知晓率为49.3%～86.2%,共用针头、注射用品(棉花,药液)百分率为45.1%～56.6%;82%的吸毒者发生性行为时从不使用避孕套,少于一半时间至每次使用避孕套的百分比为0%～9.8%.参加VCT后艾滋病传播途径及预防知识的知晓率提高到81.1%～99.1%.针具、注射用品(棉花,药液)共用率降到29.9%～33.6%;从不使用避孕套的百分比减少到32.5%,少于一半时间至每次使用避孕套的百分比提高到8%～24.4%.吸毒人员、HIV感染者获得了美沙酮替代疗法和HIV抗体确认检测的转诊服务、心理支持.不歧视吸毒人员及HIV感染者的社区环境正在逐步形成.结论 VCT可以降低社区吸毒人员HIV感染的危险行为和危害,有效地预防和控制艾滋病的蔓延.

基于大五人格理论应用潜在剖面分析探究2型糖尿病患者的用药依从性

目的:探究2型糖尿病(type 2 diabetes mellitus,T2DM)患者的人格画像,探讨其与用药依从性的关系及用药依从性的影响因素。方法:选取北京市通州区、顺义区中4个社区卫生服务中心所属的22个社区卫生服务站的T2DM患者作为研究对象,采用自行设计的问卷收集人口学信息,采用大五人格量表简式版收集人格信息,运用潜在剖面分析探究人格画像。采用用药依从性量表评估用药依从性,运用方差分析探究不同人格画像的用药依从性是否有差异,应用有序多分类Logistic回归探究用药依从性的影响因素。结果:751例T2DM患者被纳入研究,潜在剖面分析结果显示,本研究中的T2DM患者可分为4类人格画像,包括内敛稳定型(42.7%)、消极型(12.7%)、焦虑型(15.3%)和活泼负责型(29.3%),其中75例患者表示自己不用药也不打胰岛素,5例患者数据缺失,最终671例患者被纳入用药依从性的相关分析。方差分析结果显示,人格画像为焦虑型的患者其用药依从性得分(5.55±1.65)与消极型患者得分(5.94±1.53)差异无统计学意义(P=0.089),但显著低于内敛稳定型(6.17±1.46,P=0.001)和活泼负责型(6.09±1.65,P=0.004)。将人格画像为焦虑型和消极型的患者合并为焦虑消极型纳入有序多分类Logistic回归,结果显示,相比焦虑消极型患者,人格画像为活泼负责型、内敛稳定型是用药依从性好的保护因素(OR=1.567,95%CI:1.096~2.237;OR=1.774,95%CI:1.214~2.591),且受教育程度也影响患者的用药依从性。结论:基于大五人格理论,T2DM患者可分为4类人格画像,将焦虑型和消极型合并后的焦虑消极型是患者用药依从性差的独立危险因素;此外,受教育程度也是用药依从性的影响因素。

北京市通州区和顺义区747例2型糖尿病患者生存质量影响因素

目的:探讨北京市通州区和顺义区747例2型糖尿病患者的生存质量现状及影响因素。方法:对纳入研究的747例2型糖尿病患者进行问卷调查和抽血实验室血生化检查。以糖化血红蛋白(hemoglobin A1c,HbA1c)作为血糖控制指标,以糖尿病患者特异性生存质量量表(diabetes specific quality of life scale,DSQL)评分为患者生存质量指标,采用多元线性回归和结构方程模型(structural equation modeling,SEM)分析生存质量的影响因素。结果:调查747例患者,HbA1c平均水平(7.1±1.2)%,血糖控制达标率为35.1%(262/747)。血糖控制好和血糖控制差两组患者的病程、服药和使用胰岛素、吸烟情况及体重指数(body mass index,BMI)差异有统计学意义(P<0.05)。DSQL总分为(44.92±13.32)分,生理维度条目平均分最高,其次是心理维度。多元线性回归结果显示,家庭月收入、并发症、抑郁、病程时间、胰岛素、住院及自我效能是DSQL总分的影响因素(P<0.05)。SEM结果显示,血糖对于生存质量的生理维度(标准化效应值为0.166)、心理维度(0.076)及社会维度(0.124)存在影响,抑郁对于生存质量的生理维度(0.342)、心理维度(0.217)及治疗维度(0.050)存在影响,差异有统计学意义(P<0.05)。结论:北京市通州区和顺义区2型糖尿病患者HbA1c控制水平欠佳,生存质量尚可,仍有非常大的提升空间。应提高对男性、病程长、处于不服药状态、不使用胰岛素、吸烟、处于抑郁状态、糖尿病技能得分水平低的患者的关注和管理,同时应在临床治疗中提高对患者心理需求的重视,加强对患者及其家属的心理健康教育,采取相应的心理干预措施,以达到有效控制血糖的目的,从而提高患者的生活质量。

Hip Joint Osteoarthritis Pain Sources and Control

Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.

Opportunities and challenges of using big data for global health

The past two decades have witnessed the burgeoning of enormous digital technologies and data collected via countless channels.They are combined in numerous ways in different fields,including epidemiology,mHealth and modeling of health systems,with the intention to improve human health(e.g.,clinical decision support,electronic medical record management)[1-6].However,this is a new interdisciplinary area where no single scientific discipline knows how to take full advantage of these data and technologies to solve health problems[1].

Bipolar and Schizophrenia Disorders Diagnosis Using Artificial Neural Network

Motivation: Bipolar disorder (BD) and schizophrenia (SZ) has a difficult diagnosis, so the main objective of this article is to propose the use of Artificial Neural Networks (ANNs) to classify (diagnose) groups of patients with BD or SZ from a control group using sociodemographic and biochemical variables. Methods: Artificial neural networks are used as classifying tool. The data from this study were obtained from the array collection from Stanley Neuropathology Consortium databank. Inflammatory markers and characteristics of the sampled population were the inputs variables. Results: Our findings suggest that an artificial neural network could be trained with more than 90% accuracy, aiming the classification and diagnosis of bipolar, schizophrenia and control healthy group. Conclusion: Trained ANNs could be used to improve diagnosis in Schizophrenia and Bipolar disorders.

Vitamin D and bone fracture healing

AIM: To examine whether vitamin D is of potential relevance in the healing process of fractures. METHODS: The present narrative review examined the bulk of the evidence based literature on the topic of vitamin D and bone healing in key electronic data bases from 1980 onwards using the terms vitamin D and bone healing, callus, fracture healing. All data were examined carefully and categorized according to type of study. A summary of the diverse terms and approaches employed in the research, as well as the rationale for hypothesizing vitamin D has a role in fracture healing was detailed.RESULTS: The results show very few human studies have been conducted to examine if vitamin D is effective at promoting post fracture healing, and the different animal models that have been studied provide no consensus on this topic. The terms used in the related literature, as well as the methods used to arrive at conclusions on this clinical issue are highly diverse, there is no standardization of either of these important terms and methodologies, hence no conclusive statements or clinical guidelines can be forthcoming. There is a strong rational for continuing to examine if vitamin D supplements should be administered post-fracture, and ample evidence vitamin D is an essential hormone for functioning in general, as well as bone health and muscle as this relates to bone density.CONCLUSION: Whether those with low vitamin D levels can benefit from supplements if their nutritional practices do not cover recommended daily amounts, remains in question.

Preoperative virtual video visits only:a convenient option that should be offered to caregivers beyond the pandemic

Objective During the COVID-19 pandemic,our group implemented preoperative video visits(VVs)to limit physical contact.The aim of this study was to determine caregivers’and providers’perceptions of this practice and to determine feasibility for continuation.Methods All patients who had only a preoperative VV prior to an elective surgery were identified from March-October 2020.Caregivers,surgeons,and clinic staff were surveyed about their experiences.Results Thirty-four preoperative VVs were followed by an elective surgery without a preceding in-person visit.Of the 31 caregiver surveys completed,the majority strongly agreed that the VV was more convenient(87%,n=27).Eighty-one percent(n=25)strongly agreed or agreed that the VV saved them money.Ninety-four percent(n=29)strongly agreed or agreed that they would choose the VV option again.Caregivers saved an average travel distance of 60.3 miles one way(range 6.1-480).Of the 13/17 providers who responded,77%(n=10)expressed that the practice should continue.Conclusions Virtual health became a necessity during the pandemic,and caregivers were overwhelmingly satisfied.Continuing VVs as an option beyond the pandemic may be a reasonable and effective way to help eliminate some of the hurdles that impede healthcare-seeking behavior and should be offered.

Effect of Hepatitis C Treatment on Renal Function in Liver Transplant Patients

Background andAims:Hepatitis C Virus(HCV)is uniformly recurrent after liver transplant(LT)and recurrence is associated with an increased risk of mortality.Immunosuppressive medications increase the risk of chronic kidney disease,and the presence of chronic kidney disease presents a challenge for HCV treatment in LT recipients.The aim of this study was to assess changes in glomerular filtration rates(GFRs)of LT recipients receiving HCV treatment.Methods:This is a retrospective study of LT patients who received HCV treatment between 2015 and 2016(n=60).The outcomes of interest were differences in serum creatinine levels and in GFR,measured at treatment initiation and at 24 weeks after treatment.The average age of the patients was 59 years-old,and 17%were cirrhotic and 67%were treatment-experienced.All patients received sofosbuvir/ledipasvir without ribavirin.Results:All patients achieved sustained virologic response at 12 weeks after treatment(SVR12).At baseline,55%of patients had GFR<60 mL/min per 1.73 m2.Among those patients,GFR did not change in 18%,33%had improved GFR,and 48%had worsened GFR.Up to 45%of the patients had a GFR>60 mL/min per 1.73 m2.Among those patients,GFR did not change in 81%,and 19%had worsened GFR.In the entire cohort,65%of patients had improved or stable GFR and 35%had worsened GFR.The average change in serum creatinine between baseline and 24 weeks was 0.10(p=0.18).Conclusions:This study showed improved or unchanged GFR in 65%and worsened GFR in 35%of LT recipients who achieved SVR12.Worsening of GFR was more frequently encountered in those with impaired renal function at baseline.Caution should be used when treating HCV in LT recipients,especially those with baseline status of renal impairment.