Medical informatics education by medical professors within their discipline

A system for medical informatics education for medical students has been developed in the medical school. This paper describes the concept underlying the development of this system and its progressive outcomes over 8 years. In order to stimulate students to acquire computer-related knowledge and skills, this subject has been integrated into the course works of various medical subjects such as physiology. In addition, acquired knowledge and skills are evaluated within each subject by the production of reports for example, using computers. This provides a concrete example for students of the relevance of the information sciences to the solving of medical problems. A well equipped computer facility for the study of medicine also plays a significant role in inspiring student incentive. A computer room equipped with Macintosh computers was opened adjacent to the main medical library and is used in the same manner as the library, with books replaced by computers. In addition, all new students acquire their own Macintosh PowerBook. These various initiations have facilitated concept that the computer may be applied to medical problem solving at any time or place and may become as commonplace as a pen in daily medical practice.     

Clonal composition and persistence of antigen-specific circulating T follicular helper cells

T follicular helper (T_FH) cells play an essential role in promoting B cell responses and antibody affinity maturation in germinal centers (GC). A subset of memory CD4⁺ T cells expressing the chemokine receptor CXCR5 has been described in human blood as phenotypically and clonally related to GC T_FH cells. However, the antigen specificity and relationship of these circulating T_FH (cT_FH) cells with other memory CD4⁺ T cells remain poorly defined. Combining antigenic stimulation and T cell receptor (TCR) Vβ sequencing, we found T cells specific to tetanus toxoid (TT), influenza vaccine (Flu), or Candida albicans (C.alb) in both cT_FH and non-cT_FH subsets, although with different frequencies and effector functions. Interestingly, cT_FH and non-cT_FH cells specific for C.alb or TT had a largely overlapping TCR Vβ repertoire while the repertoire of Flu-specific cT_FH and non-cT_FH cells was distinct. Furthermore, Flu-specific but not C.alb-specific PD-1⁺ cT_FH cells had a “GC T_FH-like” phenotype, with overexpression of IL21, CXCL13, and BCL6. Longitudinal analysis of serial blood donations showed that Flu-specific cT_FH and non-cT_FH cells persisted as stable repertoires for years. Collectively, our study provides insights on the relationship of cT_FH with non-cT_FH cells and on the heterogeneity and persistence of antigen-specific human cT_FH cells.     

Sofosbuvir plus ribavirin in Japanese patients with chronic genotype 2 HCV infection: an open‐label,phase 3 trial

Genotype 2 hepatitis C virus (HCV) accounts for up to 30% of chronic HCV infections in Japan. The standard of care for patients with genotype 2 HCV – peginterferon and ribavirin for 24 weeks – is poorly tolerated, especially among older patients and those with advanced liver disease. We conducted a phase 3, open‐label study to assess the efficacy and safety of an all‐oral combination of the NS5B polymerase inhibitor sofosbuvir and ribavirin in patients with chronic genotype 2 HCV infection in Japan. We enrolled 90 treatment‐naïve and 63 previously treated patients at 20 sites in Japan. All patients received sofosbuvir 400 mg plus ribavirin (weight‐based dosing) for 12 weeks. The primary endpoint was sustained virologic response at 12 weeks after therapy (SVR12). Of the 153 patients enrolled and treated, 60% had HCV genotype 2a, 11% had cirrhosis, and 22% were over the aged 65 or older. Overall, 148 patients (97%) achieved SVR12. Of the 90 treatment‐naïve patients, 88 (98%) achieved SVR12, and of the 63 previously treated patients, 60 (95%) achieved SVR12. The rate of SVR12 was 94% in patients with cirrhosis and in those aged 65 and older. No patients discontinued study treatment due to adverse events. The most common adverse events were nasopharyngitis, anaemia and headache. Twelve weeks of sofosbuvir and ribavirin resulted in high rates of SVR12 in treatment‐naïve and previously treated patients with chronic genotype 2 HCV infection. The treatment was safe and well tolerated by patients, including the elderly and those with cirrhosis.     

Household food insecurity and future orientation of Ghanaian youth and their parents

Food insecurity heightens risk for poor mental health and psychosocial functioning. Higher levels of future orientation influence numerous desirable behaviors. However, limited evidence exists on the association between food insecurity and future orientation, particularly in low-resource settings. The objective of this study was to examine the association between food insecurity and future orientation of Ghanaian youth and their parents. The study included a cross-sectional sample of 2656 youth and 2656 parents from 8 of Ghana’s 10 regions. Food insecurity was measured using the Household Food Insecurity Access Scale. Future orientation in the Ghanaian context was measured using three distinct factors adapted from the School Success Profile and the Consideration of Future Consequences scale. We analyzed our data using hierarchical linear modeling, with a three-level linear random-intercept model with covariates. Results suggest an inverse relationship between food insecurity and future orientation of youth and their parents. Food insecurity was consistently and significantly associated with lower orientation toward success (β = ?0.18, 95% confidence interval [CI] = ?0.22, ?0.14) and higher uncertainty of the future (β = 0.22, 95% CI = 0.17, 0.28) among youth, as well as lower consideration of future consequences (β = ?0.15, 95% CI = ?0.23, ?0.06) among parents. Additionally, severe food insecurity was associated with the lowest future orientation scores for youth and their parents. Our findings indicate that, under conditions of food insecurity, youth and their parents lose sight of the future, which may come at a great cost. Encouraging individuals to engage in thinking about the future or to create future images of their selves may not be meaningful if their basic needs, including access to food, are not met. Programs that provide opportunities to generate income and accumulate assets may have a twofold effect of increasing access to food and improving future orientation.