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An estimated 3% of the world's population is chronically infected with hepatitis C virus (HCV). Although HCV was discovered more than 20 y ago, its origin remains obscure largely because no closely related animal virus homolog has been identified; furthermore, efforts to understand HCV pathogenesis have been hampered by the absence of animal models other than chimpanzees for human disease. Here we report the identification in domestic dogs of a nonprimate hepacivirus. Comparative phylogenetic analysis of the canine hepacivirus (CHV) confirmed it to be the most genetically similar animal virus homolog of HCV. Bayesian Markov chains Monte Carlo and associated time to most recent common ancestor analyses suggest a mean recent divergence time of CHV and HCV clades within the past 500–1,000 y, well after the domestication of canines. The discovery of CHV may provide new insights into the origin and evolution of HCV and a tractable model system with which to probe the pathogenesis, prevention, and treatment of diseases caused by hepacivirus infection.

•V503-006 was a randomized safety and immunogenicity study in females 12–26 years of age.•V503-006 evaluated 9vHPV vaccine in those with previous qHPV vaccination.•9vHPV vaccine was generally well tolerated in prior qHPV vaccine recipients.•9vHPV vaccine was immunogenic for HPV 31/33/45/52/58 in prior qHPV vaccine recipients. To assess the safety and immunogenicity of the investigational 9-valent (6/11/16/18/31/33/45/52/58) HPV (9vHPV) vaccine in prior recipients of a 3-dose regimen of quadrivalent (6/11/16/18) HPV (qHPV) vaccine. V503-006 was a randomized, double-blinded, safety/tolerability and immunogenicity study of the 9vHPV vaccine in females 12–26 years of age who were previously vaccinated with qHPV vaccine. Subjects were randomized in a 2:1 ratio to receive 3 doses of 9vHPV vaccine (n=618) or saline placebo (n=306) at day 1, month 2, and month 6. Systemic, injection-site and serious adverse experiences (AEs) were monitored. Serum samples were collected at day 1, month 2, and month 7. Anti-HPV 6/11/16/18/31/33/45/52/58 titers were measured using the 9-valent HPV competitive Luminex Immunoassay (cLIA). The frequency of injection-site AEs (days 1–5 following any vaccination) was higher in the 9vHPV vaccine group than in the placebo group (91.1% and 43.9%, respectively). The frequencies of vaccine-related systemic AEs (days 1–15 following any vaccination) were generally comparable between the 2 groups (30.6% in the 9vHPV vaccine group, and 25.9% in the placebo group). One vaccine-related serious AE was reported in each of the 9vHPV vaccine and placebo groups. Few subjects (9vHPV=0.5%; placebo=0%) discontinued due to an AE. At 4 weeks post-dose 3, over 98% of subjects in the 9vHPV vaccine group were seropositive for HPV types 31/33/45/52/58, with marked elevations in cLIA geometric mean titers (GMTs) to these HPV types. Anti-HPV 31/33/45/52/58 GMTs were lower than in subjects administered 9vHPV vaccine who had not previously received qHPV vaccine (based on cross-study analyses); the clinical significance of this difference is unknown. Administration of a 3-dose regimen of 9vHPV vaccine to adolescent girls and young women 12–26 years of age who are prior qHPV vaccine recipients is highly immunogenic with respect to HPV types 31/33/45/52/58 and generally well tolerated.

Objectives To demonstrate the feasibility of partnering fire department personnel and home visiting nurses to increase the number of low-income homes protected by smoke alarms. Methods During a regularly scheduled home visit, nurses at the Nurse-Family Partnership of Maricopa County (NFP) informed their clients about an opportunity to have smoke alarms installed in their homes for free. For interested families, nurses sent a referral to the Phoenix Fire Department (PFD), scheduled an appointment, and accompanied the PFD volunteers during the installation. During the appointment, PFD personnel installed alarms and provided safety education. Clients completed a follow-up survey 1–3 months after the installation visit. In-depth interviews were completed with key informants from NFP and PFD to solicit feedback on the program. Results Fifty-two smoke alarm installation visits were completed. Before the fire department arrived, 55% of homes had no working smoke alarm. Almost all (94%) homes received at least one new smoke alarm, and every home had at least one working smoke alarm at the end of the fire department visit. At follow-up, all homes maintained at least one working smoke alarm. Members from both organizations were enthusiastic about, and supportive of the project. NFP nurses appreciated the skill and knowledge of the firefighters; PFD representatives noted that the nurses’ relationships with clients made it easier for them to gain access to families who are often described as “hard-to-reach”. Conclusions Partnering home visiting nurses and fire departments can be successful to increase the number of vulnerable homes with smoke alarms.

Alcohol use disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. We developed a multidisciplinary model to manage AUDs among TB patients in Tomsk, Russia. First, we assessed current standards of care through stakeholder meetings and ethnographic work. The Alcohol Use Disorders Identification Test (AUDIT) was incorporated into routine assessment of all patients starting TB treatment. We established treatment algorithms based on AUDIT scores. We then hired specialists and addressed licensing requirements to provide on-site addictions care. Our experience offers a successful model in the management of co-occurring AUDs among patients with chronic medical problems.

In recent years, the Russian Federation has seen a dramatic rise in morbidity and mortality from tuberculosis (TB), attributed in part to an increase in alcohol use disorders (AUDs), which are associated with worse TB treatment outcomes. This study describes the knowledge, attitudes and practices of physicians who treat TB patients in Tomsk, Russia. We conducted semistructured interviews with 16 TB physicians and 1 addiction specialist. Interviews were audiorecorded, transcribed, translated and systematically analyzed. We identified four key domains: definitions of alcohol use and abuse and physicians’ knowledge, attitudes and practices regarding these problems. Physicians described patients as largely precontemplative and reluctant to seek treatment. Physicians recognized their limited knowledge in diagnosing and treating AUDs but expressed interest in acquiring these skills. Few options are currently available for treatment of AUDs in TB patients in Tomsk. These findings suggest that Tomsk physicians are aware of the need to engage AUDs in TB patients but identify a knowledge gap that restricts their ability to do so. Training TB physicians to use simple screening instruments and deliver evidence-based alcohol interventions improves TB outcomes among patients with co-occurring AUDs.

\"The expedient ratification of CSO's impasse reflects positively on management, indicating that they have a constructive relationship with musicians,\" Moody's added. The strike marked the orchestra's first in more than two decades. \"Expediently ratifying the labor contracts is a credit positive for both organizations and reflects favorably on the sector,\" Moody's wrote in its credit outlook. \"Though some concessions were made by the organizations, the settlements include expense savings and limitations on salary increases that will help the finances of the organizations as they struggle amidst falling ticket sales, declining endowments, and waning philanthropic support.\" Musicians also will begin paying towards their health care benefit plans but will begin receiving a 22% share of any operating surplus. \"It's unlikely that this particular benefit will be realized in the near-term given the organization's budget situation,\" Moody's said.

\"If you are talking full repeal, it would have a significant impact, because Verity benefited from Medicare expansion and from the increase in people insured, it lowered the amount of bad debt from charity care,\" said Stephen Forney, chief financial officer of Verity, a non-profit California chain of six hospitals serving lower-income neighborhoods in the San Francisco Bay Area and Los Angeles. The healthcare segment of the municipal bond markets has already experienced a widening of spreads relative to the rest of the market since Donald Trump's election as president, according to Grant Goodman, a financial advisor in the Los Angeles office of Lancaster Pollard, an investment banking firm. The spreads between a 30-year AAA general obligation bond subject to alternative minimum tax and BBB healthcare bonds grew by 26 basis points from Nov. 10 to Dec. 9, according to the Municipal Market Data Triple A scale. The costs of serving uninsured patients often results in bad debt for hospitals and weighs heavier on regional and stand-alone hospitals, which have experienced a greater widening of spreads on their bonds then larger hospital systems, Goodman said. Moving forward without legislative agreement on a replacement plan is a risky strategy \"that could lead to dysfunctional individual insurance market conditions, higher uninsured levels and tougher operating conditions for hospitals,\" wrote George Huang, a Wells Fargo municipal research group senior analyst in a Dec. 15 report. \"Since the launch of CountyCare in 2013, the health system has begun to see more insured patients...

In Connecticut, which has seen a series of downgrades amid ongoing budget troubles, the previously tied state Senate went over to the Democrats, giving the party control of both houses and the governor's office, after Democrat Ned Lamont won the race against Republican Bob Stafanowski to succeed Democrat Dannel Malloy. Evers has said he wants to funnel more state dollars to education and transportation, cut middle class taxes, reverse the state's controversial Act 10 legislation that limited local collective bargaining rights and renegotiate state tax breaks offered to Foxconn Technology Group for its new plant. In New Mexico, U.S. Rep. Michelle Lujan Grisham returned the governor's mansion to Democratic control after eight years under Republican Gov. Susana Martinez, In Colorado, Democratic U.S. Rep. Jared Polis defeated Republican Walker Stapleton for the governor's seat being vacated by two-term Democrat John Hickenlooper, and his fellow Democrats control the General Assembly after taking control of the Senate.

All agreed that Lehman's bankruptcy demanded more immediate attention than Merrill's acquisition. \"These are very different situations,\" said Kenneth Kaufman of Kaufman, Hall & Associates Inc., an Illinois-based advisory firm that specializes in health care. \"The Lehman situation is much more immediate. Bankruptcy is an event for termination, so a lot of people are scrambling on that right now. This is really complicated stuff. Everybody is involving bankruptcy counsel and seeing where to go forward from here.\" \"Another banker has to be found and in some cases there are other complications, so it's going to be a lot of work to get that fixed up, especially as we're not exactly working in the most stable of markets right now,\" Kaufman said. \"This is a pretty big day.\" He said his firm was already working with bankruptcy attorneys to assess the full impact of Lehman's move, as was another Midwestern financial advisor. \"With Merrill, we've been assuming it will be like JPMorgan and Bear Sterns, where Bank of America will assume all of the responsibility and no one should get too excited at the present time,\" he said. \"It's another matter with Lehman. Some of our clients with Lehman as a dealer and remarketing agent are trying to work through what to do with that.\" He added that as of yesterday it was still too early for the firm to be making any formal recommendations to clients.