BACKGROUND Patients with chronic infection with hepatitis C virus (HCV) genotype 1 often need 48 weeks of peginterferon–ribavirin treatment for a sustained virologic response. We designed a noninferiority trial (noninferiority margin, −10.5%) to compare rates of sustained virologic response among patients receiving two treatment durations. METHODS We enrolled patients with chronic infection with HCV genotype 1 who had not previously received treatment. All patients received telaprevir at a dose of 750 mg every 8 hours, peginterferon alfa-2a at a dose of 180 μg per week, and ribavirin at a dose of 1000 to 1200 mg per day, for 12 weeks (T12PR12), followed by peginterferon–ribavirin. Patients who had an extended rapid virologic response (undetectable HCV RNA levels at weeks 4 and 12) were randomly assigned after week 20 to receive the dual therapy for 4 more weeks (T12PR24) or 28 more weeks (T12PR48). Patients without an extended rapid virologic response were assigned to T12PR48. RESULTS Of the 540 patients, a total of 352 (65%) had an extended rapid virologic response. The overall rate of sustained virologic response was 72%. Among the 322 patients with an extended rapid virologic response who were randomly assigned to a study group, 149 (92%) in the T12PR24 group and 140 (88%) in the T12PR48 group had a sustained virologic response (absolute difference, 4 percentage points; 95% confidence interval, −2 to 11), establishing noninferiority. Adverse events included rash (in 37% of patients, severe in 5%) and anemia (in 39%, severe in 6%). Discontinuation of all the study drugs was based on adverse events in 18% of patients overall, as well as in 1% of patients (all of whom were randomly assigned) in the T12PR24 group and 12% of the patients randomly assigned to the T12PR48 group (P<0.001). CONCLUSIONS In this study, among patients with chronic HCV infection who had not received treatment previously, a regimen of peginterferon–ribavirin for 24 weeks, with telaprevir for the first 12 weeks, was noninferior to the same regimen for 48 weeks in patients with undetectable HCV RNA at weeks 4 and 12, with an extended rapid virologic response achieved in nearly two thirds of patients. (Funded by Vertex Pharmaceuticals and Tibotec; ILLUMINATE ClinicalTrials.gov number, NCT00758043.)
Overall, grade C evidence indicates that several methods of initial surgical drainage are equally effective, and the recurrence rate is low. The literature does not specifically address different treatments for children and adults.
Abstract. A pilot scale field test of non-aqueous phase liquid (NAPL) removal using high molecular weight alcohols was conducted at Operable Unit 1, Hill Air Force Base, Utah. Petroleum hydrocarbons and spent solvents were disposed of in chemical disposal pits at this site, and these materials are now present in the subsurface in the form of a light nonaqueous phase liquid (LNAPL). This LNAPL is a complex mixture of aromatic and aliphatic hydrocarbons, chlorinated solvents, and other compounds. The field experiment was performed in a 5 rn by 3 rn confined test cell, formed by driving interlocking sheet pile walls through the contaminated zone into an underlying clay. The test involved the injection and extraction of about four pore volumes (1 pore volume = 7000 L) of a mixture of 80% tert-butanol and 15% n-hexanol. The contaminants were removed by a combination of NAPL mobilization and enhanced dissolution, and the results of postflood soil coring indicate better than 90% removal of the more soluble contaminants (trichloroethane, toluene, ethylbenzene, xylenes, trimethylbenzene, naphthalene) and 70-80% removal of less soluble compounds (decane and undecane). The results of preflood and postflood NAPL partitioning tracer tests show nearly 80% removal of the total NAPL content from the test cell. The field data suggest that a somewhat higher level of removal could be achieved with a longer alcohol injection. IntroductionIt is now known that relatively small nonaqueous phase liquid (NAPL) source zones are capable of producing large contaminated groundwater plumes. While methods such as pumping and treating the contaminated water or funneling the water through reactive walls have been effective for plume control, they do not effectively address the source of the plume. Given that these source zones may continue to release contaminants for many decades or centuries, a large effort is now focused on the development of source zone removal methods. Often these techniques must be applied in situ, owing to the depth of contamination or to the presence of buildings and utilities which prevent excavation. The Rao et al. [1997] field test was performed in an isolated test cell, and it consisted of injecting about nine pore volumes of a 70% ethanol, 12% n-pentanol solution. They reported a bulk NAPL removal of -81%, with a higher removal efficiency for several individual compounds.
AUTOMATING OUTPUT SIZE AND SOFTWARE REUSE METRICS IN A REPOSITORY-BASED COMPUTER AIDED SOFTWARE ENGINEERING (CASE) ENVIRONMENT ABSTRACTMeasurement of software development productivity is needed in order to control software costs, but it is discouragingly labor-intensive and expensive. Computer aided software engineering (CASE) technologies --especially repository-based, integrated CASE --have the potential to support the automation of this measurement. In this paper, we discuss the development of automated analyzers for function point and software reuse measurement for object-based CASE. Both analyzers take advantage of the existence of a representation of the application system that is stored within an object repository, and that contains the necessary information about the application system. We also discuss metrics for software reuse measurement, including reuse leverage, reuse value and reuse classifcation, that are motivated by managerial requirements and the efforts, within industry and the IEEE, to standardize measurement. The functionality and the analytical capabilities of state-of-the-art automated software metrics analyzers are illustrated in the context of an investment banking industry application, that is similar to systems deployed at the New York City-based investment bank where these tools were developed and tested.
Neuropsychological testing of profoundly deaf children provides a detailed and accurate assessment of the child's cognitive, behavioral, and motor functions. The profoundly deaf child does not develop at the same rate as normal children in cognitive and behavioral domains. Neuropsychological testing is a useful tool for screening for cochlear implant candidacy and has the potential to track changes before and after implantation.
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