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Hidden beneath the escalating crisis of opioid-overdose deaths in the United States lies another danger: the increasing spread of hepatitis C virus associated with injection-opioid use. The social and economic costs of this epidemic could be staggering.

Covalent organic frameworks (COFs) are typically synthesized using solvothermal conditions (>120 °C, >72 hours) in harmful organic solvents. Here we report a strategy to rapidly (<60 minutes) synthesize imine-linked COFs in aqueous acetic acid using sonochemistry and thus avoid most of the disadvantages of solvothermal methods. Using the sonochemical method, we synthesized to our knowledge previously unreported COFs. The crystallinity and porosity of these COFs is comparable to or better than those of the same materials made by established solvothermal routes. The sonochemical method even works in sustainable solvents, such as food-grade vinegar. The generality of the method is shown in the preparation of a 2D COF with pendant functionalization and of a COF with 3D connectivity. Finally, a COF synthesized sonochemically acts as an excellent photocatalyst for the sacrificial hydrogen evolution from water, showing a more sustained catalytic performance compared with that of its solvothermal analogue. The speed, ease and generality of this sonochemical method together with improved material quality makes the use of sound an enabling methodology for the rapid discovery of functional COFs.A sonochemical route rapidly synthesizes covalent organic frameworks (COFs) in aqueous solutions of acetic acid. This method has operational advantages compared with conventional solvothermal routes and yields COFs of higher crystallinity and porosity, and hence improved materials properties.

The ribosome builds proteins by joining together amino acids in an order determined by messenger RNA. Here, we report on the design, synthesis, and operation of an artificial small-molecule machine that travels along a molecular strand, picking up amino acids that block its path, to synthesize a peptide in a sequence-specific manner. The chemical structure is based on a rotaxane, a molecular ring threaded onto a molecular axle. The ring carries a thiolate group that iteratively removes amino acids in order from the strand and transfers them to a peptide-elongation site through native chemical ligation. The synthesis is demonstrated with ∼10 18 molecular machines acting in parallel; this process generates milligram quantities of a peptide with a single sequence confirmed by tandem mass spectrometry.

Liver-related diseases, including liver cirrhosis and hepatocellular carcinoma (HCC), are significant causes of mortality globally. Specific causes and predictors of liver-related mortality in low resource settings require assessment to help inform clinical decision making and develop strategies for improved survival. The objectives of this study were to determine the proportion of liver-related deaths associated with liver cirrhosis, HCC, and their known risk factors, and secondly to determine predictors of in-hospital mortality among cirrhosis and HCC patients in Ghana. We first performed a cross-sectional review of death register entries from 11 referral hospitals in Ghana to determine the proportion of liver-related deaths and the proportion of risk factors associated with these deaths. Secondly, we conducted a retrospective cohort review of 172 in-patient liver cirrhosis and HCC cases admitted to a tertiary referral centre and determined predictors of in-hospital mortality using binary logistic regression and Kaplan-Meier survival analysis. In total, 8.8% of deaths in Ghanaian adults were due to liver-related causes. The proportion of liver-related deaths attributed to HBV infection was 48.8% (95% CI: 45.95–51.76), HCV infection was 7.0% (95% CI: 5.58–8.45), HBV-HCV co-infection 0.5% (95% CI: 0.1–0.9) and alcohol was 10.0% (95% CI: 8.30–11.67). Of 172 cases of HCC and liver cirrhosis, the in-patient mortality rate was 54.1%. Predictors of in-patient mortality in cirrhotic patients were increasing WBC (OR = 1.14 95% CI: 1.00–1.30) and the revised model for end-stage liver disease with sodium (MELD-Na) score (OR = 1.24 95% CI: 1.01–1.54). For HCC patients, female sex (OR = 3.74 95% CI: 1.09–12.81) and hepatic encephalopathy (grade 1) were associated with higher mortality (OR = 5.66 95% CI: 1.10–29.2). In conclusion, HBV is linked to a high proportion of HCC-related deaths in Ghana, with high in-hospital mortality rates that require targeted policies to improve survival.

The current burden of Hepatitis C virus infection and the availability of HCV-related services in Ghana are not well described. Previous estimates on HCV seroprevalence in the country are outdated. This study investigated the HCV seroprevalence and testing and treatment capacity in Ghana. A multi-centre cross-sectional study was conducted in which laboratory and blood bank registers from 17 public healthcare institutions in Ghana were reviewed. A survey on cost and availability of HCV-related testing and treatment was also performed. Crude and pooled estimates of HCV seroprevalence, frequency and median cost of available diagnostic tests and medicines were described. The crude HCV seroprevalence was 2.62% (95% CI 2.53–2.72) and the pooled estimate was 4.58% (95% CI 4.06–5.11) among 103,609 persons tested in laboratories. Age (OR 1.02 95% CI 1.01–1.02) and male sex (OR 1.26 95% CI 1.08–1.48) were predictors of a positive anti-HCV RDT test. Northern administrative regions in Ghana had the highest HCV seroprevalence ranging from 8.3–14.4%. Among 55, 458 potential blood donors, crude HCV seroprevalence was 3.57% (95% CI 3.42–3.72). Testing was through Rapid Diagnostic Test (RDT) kits in most facilities, and only 2 of 17 centres were performing HCV RNA testing. The median cost of an anti-HCV RDT test was$0.97 (0–1.61) and $ 3.23 (1.61–7.58) for persons with and without government health insurance respectively. The median cost of a 12-week course of the pan-genotypic direct-acting antiviral therapy sofosbuvir-daclatasvir was $887.70. In conclusion, there are significant regional differences in HCV burden across Ghana. Limited access to and cost of HCV RNA and DAA therapy hinders testing and treatment capability, and consequently HCV elimination efforts. A national HCV program supported with a sustainable financing plan is required to accelerate HCV elimination in Ghana.

Background and aims Refugees are at higher risk for hepatitis B (HBV) and hepatitis C (HCV), but often face unique healthcare barriers to vaccination, testing, and treatment. This scoping review aimed to identify and characterize HBV and HCV prevention and care services serving refugee populations globally. Methods A literature search was conducted on Embase, Cochrane, and PubMed databases. Research studies published in English between January 2010 to July 2022 describing an HBV or HCV prevention, testing, or treatment intervention for refugees were included. Results There were a total of 69 articles reporting viral hepatitis prevalence, implementation of services, or economic modelling. Of the 38 implementation studies, 14 were stand-alone HBV and/or HCV interventions, while 24 studies included HBV and/or HCV in an intervention targeting multiple infectious diseases and/or parasitic infections. Interventions commonly included a testing ( n  = 30) or referral ( n  = 24) component. Frequently reported features to promote program accessibility included bilingual services ( n  = 25), community partnerships ( n  = 21), and multidisciplinary staff members ( n  = 18), such as cultural and/or linguistic mediators, community health workers, community health leaders, lay health workers, local health staff, members of the refugee community, and social workers. The most commonly reported challenge was the transience of refugees ( n  = 5). Twenty studies noted funding sources, of which twelve reported governmental funding (not including national health insurance) and eight reported that refugees received national health insurance. Conclusions This is the first scoping review to characterize the types of hepatitis prevention, screening, and treatment interventions serving refugee populations globally. Published experiences of HBV and HCV services for refugee populations remain limited. Additional efforts are needed to disseminate models of hepatitis interventions for refugees to ensure access to care for this key population. To achieve hepatitis elimination globally, best practices must be identified and shared to expand access to hepatitis services for refugee populations.

Background and aims Data are needed to inform hepatitis B virus (HBV) testing and treatment policies in Ghana to make progress towards achieving the 2030 WHO elimination targets. This study investigated testing patterns for HBV and described the age, sex, and region-specific prevalence of HBV infection in Ghana using hospital data. Methods A nationwide multi-centre cross-sectional study was performed where hospital-based registers were reviewed. These included review of 139,966 laboratory, 169,048 blood bank, and 83,920 delivery register entries from 22 healthcare institutions in Ghana. Frequencies and proportions, and crude and pooled estimates reported. Chi squared test was used for tests of independence. Logistic regression was used to identify factors associated with a positive test result. Results The crude HBsAg seroprevalence was 8.48% (95%CI 8.25–8.57%) with pooled estimate of 11.40% (95%CI 10.44–12.35). HBsAg seroprevalence among children under 5 years was 1.87% (95%CI 1.07-3.27) and highest age-specific seroprevalence was in those 40-49 years. The highest region-specific seroprevalences was in the Savannah (22.7%). Predictors of a positive HBsAg RDT test included female sex (OR 0.81 95% CI 0.74–0.88), and age (OR 1.005 95%CI 1.002–1.007). The proportion of parturient women receiving HBsAg testing increased between 2017 (87.2%) and 2020 (94.3%) ( p  < 0.001). The crude HBsAg seroprevalence in parturient women was 6.14% (95% CI 5.97-6.31). Among blood donors the crude HBsAg seroprevalence was 5.69% (95%CI 5.58–5.80). Data from 2 teaching hospitals indicated that in 2020, although 1500 HBsAg positive tests were recorded only 746 serological profile and 804 HBV DNA tests were performed. HBV e antigen seroprevalence was 6.28% (95%CI 4.73–7.84). Conclusion and recommendations Ghana remains a country with high HBV burden. There is an unequal distribution, with higher HBsAg seroprevalence in the north of the country. Furthermore, PCR testing is not widely available outside of large teaching hospitals, which limits diagnostic work-up. Hepatitis reporting systems and registers should be improved to facilitate data capture of indicators and standardised across the country to allow for comparability. Furthermore, where gains have been made in testing among pregnant women, there is a need for linkage to appropriate care.

Chronic hepatitis C virus (HCV) infection remains a major cause of liver disease worldwide and requires effective strategies to achieve elimination targets. Taiwan has a substantial HCV burden, with prevalence varying by region; in Changhua County, prevalence was 4.3% before large-scale intervention. In 2019, Changhua launched a county-wide micro-elimination program—the Changhua Integrated Program to Stop Hepatitis C Infection (CHIPS-C)—which combined existing population screening with targeted outreach to higher-risk groups and decentralized delivery of curative direct-acting antiviral (DAA) treatment. Using individual-level data from a population-based cohort, we compared care cascade performance before and after CHIPS-C implementation. The program was associated with increased screening coverage (53.7% to 90.2%) and fewer individuals screened to achieve similar numbers of diagnosed infections. Improvements were driven by streamlined confirmatory testing and coordinated care delivery. Here we show that CHIPS-C substantially increased the adjusted treatment completion rate (83.9% vs 38.7% before implementation). Model-based projections indicate that these gains could reduce HCV-related liver cancer and mortality to levels meeting World Health Organization elimination targets by 2030. These findings demonstrate that integrating risk-based targeting with existing health systems can markedly improve efficiency and outcomes, providing a scalable model for accelerating HCV elimination in diverse settings. Changhua County, Taiwan launched a hepatitis C elimination initiative which integrates population-based screening and targeted strategies for high-risk groups. Here, the authors evaluate its impacts on hepatitis C virus cascade care and treatment outcomes and compare to a counterfactual scenario without the program.

With a decade left to reach the ambitious goals for viral hepatitis elimination set out by the World Health Organization, many challenges remain. Despite the remarkable improvements in therapy for hepatitis C virus (HCV) infection, most people living with the infection remain undiagnosed, and only a fraction have received curative therapy. Accordingly, the 2020 HCV Special Interest Group symposium at the annual American Association for the Study of Liver Diseases Liver Meeting examined policies and strategies for the scale‐up of HCV testing and expanded access to HCV care and treatment outside the specialty setting, including primary care and drug treatment and settings for care of persons who inject drugs and other marginalized populations at risk for HCV infection. The importance of these paradigms in elimination efforts, including micro‐elimination strategies, was explored, and the session also included discussion of hepatitis C vaccine development and other strategies to reduce mortality through the use of organs from HCV‐infected organ donors for HCV‐negative recipients. In this review, the key concepts raised at this important symposium are summarized.

Patriarchy has long structured Christian life and practice. In many Baptist settings, even formal affirmations of women in leadership leave a gap between stated commitments and women’s lived experience. This study investigates how Baptist congregations cultivate empowering environments for women by tracing the interplay of beliefs, practices, and processes through which theology is enacted in congregational life. Drawing on feminist theology and lived-religion perspectives, and using constructivist grounded theory, we conducted nine semi-structured interviews with 15 women clergy across seven U.S. Baptist congregations. Analysis proceeded through iterative initial, focused, and theoretical coding with attention to reflexivity and trustworthiness. Findings highlight four interlocking dynamics: structural shifts in leadership and policy that institutionalize gender equity; cultural and theological intentionality in worship and congregational routines; relational practices of support and education; and the persistence of microaggressions and benevolent sexism that complicate progress. Synthesizing these themes, we adapt Cornwall’s cyclical account of empowerment and Carr’s feminist praxis into a Spiral of Congregational Empowerment for Women comprising six phases (see Discussion). This study contributes to feminist theology, congregational studies, and the sociology of religion and offers practical implications for congregations and ministerial formation to align worship, policy, culture and accountability for sustained gender equity.