Outcomes and costs of single-step hepatitis C testing in primary care, Birmingham, United Kingdom

OBJECTIVES

In UK laboratories, the diagnostic algorithm for chronic hepatitis C (HCV) infection commonly requires two serological assays to confirm anti-HCV-antibody positivity in a serum sample followed by HCV RNA detection in a second whole-blood sample (two-step testing algorithm). A single-step algorithm (both anti-HCV antibodies and RNA tested on an initial serum specimen) has been advocated to reduce attrition rates from the care pathway.

STUDY DESIGN

To investigate the feasibility, clinical impact and relative costs of switching from a two-step to single-step testing algorithm in the laboratory, a pilot study on unselected primary care requests was undertaken.

METHODS

All primary care patients tested for HCV infection from December 2013 to April 2016 were included. The single-step testing algorithm was introduced in March 2015. Before this, the two-step algorithm was used. Patients were followed up until August 2016.

RESULTS

RNA quantitation in plasma was within one log of serum values for 21 paired samples. Although all patients in the single-step algorithm received an RNA test, only 70% completed the two-step testing algorithm; differences in referral rates to specialist care was due to 30% of HCV antibody-positive patients in the two-step algorithm not having follow-up whole-blood sampling for HCV RNA testing. Costs per new diagnosis and new diagnosis referred to specialist care were lower in single-step testing by £94.32 and £144.25, respectively.

CONCLUSION

This study provides further evidence that a single-step testing algorithm, as recommended in the UK Standards for Microbiology Investigation, works in practice and should be the standard of care for screening for chronic HCV.

Stationary and nonstationary fluid flow of a bose-einstein condensate through a penetrable barrier

We experimentally study the fluid flow induced by a broad, penetrable barrier moving through an elongated dilute gaseous Bose-Einstein condensate. The barrier is created by a laser beam swept through the condensate, and the resulting dipole potential can be either attractive or repulsive. We examine both cases and find regimes of stable and unstable fluid flow: At slow speeds of the barrier, the fluid flow is steady due to the superfluidity of the condensate. At intermediate speeds, we observe an unsteady regime in which the condensate gets filled with dark solitons. At faster speeds, soliton formation completely ceases, and a remarkable absence of excitation in the condensate is seen again.

Observation of faraday waves in a Bose-Einstein condensate

Faraday waves in a cigar-shaped Bose-Einstein condensate are created. It is shown that periodically modulating the transverse confinement, and thus the nonlinear interactions in the BEC, excites small amplitude longitudinal oscillations through a parametric resonance. It is also demonstrated that even without the presence of a continuous drive, an initial transverse breathing mode excitation of the condensate leads to spontaneous pattern formation in the longitudinal direction. Finally, the effects of strongly driving the transverse breathing mode with large amplitude are investigated. In this case, impact-oscillator behavior and intriguing nonlinear dynamics, including the gradual emergence of multiple longitudinal modes, are observed.

The global atmospheric environment for the next generation

Air quality, ecosystem exposure to nitrogen deposition, and climate change are intimately coupled problems: we assess changes in the global atmospheric environment between 2000 and 2030 using 26 state-of-the-art global atmospheric chemistry models and three different emissions scenarios. The first (CLE) scenario reflects implementation of current air quality legislation around the world, while the second (MFR) represents a more optimistic case in which all currently feasible technologies are applied to achieve maximum emission reductions. We contrast these scenarios with the more pessimistic IPCC SRES A2 scenario. Ensemble simulations for the year 2000 are consistent among models and show a reasonable agreement with surface ozone, wet deposition, and NO2 satellite observations. Large parts of the world are currently exposed to high ozone concentrations and high deposition of nitrogen to ecosystems. By 2030, global surface ozone is calculated to increase globally by 1.5 +/- 1.2 ppb (CLE) and 4.3 +/- 2.2 ppb (A2), using the ensemble mean model results and associated +/-1 sigma standard deviations. Only the progressive MFR scenario will reduce ozone, by -2.3 +/- 1.1 ppb. Climate change is expected to modify surface ozone by -0.8 +/- 0.6 ppb, with larger decreases over sea than over land. Radiative forcing by ozone increases by 63 +/- 15 and 155 +/- 37 mW m(-2) for CLE and A2, respectively, and decreases by -45 +/- 15 mW m(-2) for MFR. We compute that at present 10.1% of the global natural terrestrial ecosystems are exposed to nitrogen deposition above a critical load of 1 g N m(-2) yr(-1). These percentages increase by 2030 to 15.8% (CLE), 10.5% (MFR), and 25% (A2). This study shows the importance of enforcing current worldwide air quality legislation and the major benefits of going further. Nonattainment of these air quality policy objectives, such as expressed by the SRES-A2 scenario, would further degrade the global atmospheric environment.