Los Angeles - NAKASEC and Affiliates - HANA Center of greater Chicago, Korean Resource Center of southern California and NAKASEC VA of northern Virginia - celebrate the decision made today by U.S. District Judge Andrew Hanen of Texas to not block the Deferred Action for Childhood Arrivals (DACA) Program. What this ruling means is that for the time being, the federal government will continue to accept DACA renewal applications.
Texas and seven other states sought a nationwide injunction to stop DACA renewals and new applications. In his ruling today, Judge Hanen decided that the states had waited too long (six years) to challenge DACA and it did not require an emergency injunction. Youth with DACA should continue to submit renewal applications.
NAKASEC & Affiliates' young leaders have been at the forefront of organizing and advocating for undocumented immigrants since the threat to DACA first became public. Two NAKASEC DACAmented leaders, Jung Woo Kim and Esther Jeon, submitted testimony as part of a counter lawsuit led by the Mexican American Legal Defense and Education Fund (MALDEF).
Jung Woo and ten other young people have been riding bicycles from Seattle to San Diego to spread the word about the #Citizenship4All campaign. The Journey To Justice tour began near the northern border at Seattle on August 1st and will conclude near the southern border near San Diego on September 5th, the one-year anniversary of when the Trump administration cancelled DACA. Please learn more at www.godreamriders.org.


text:
British American Tobacco - Half-Year Report to 30 June 2021
Half-Year Report to 30 June 2021
STRONG BRANDS DRIVE NEW CATEGORY ACCELERATION
Jack Bowles, Chief Executive:
"This has been an exciting period of growth in New Categories, with New Category constant currency revenue up by 50% in the first half. We added 2.6m consumers, our highest ever increase, to our non-combustible product consumer base, to reach 16.1m. This demonstrates our accelerating transformation driven by our multi-category portfolio, with continued key market share gains in all three New Categories.
"We are building strong, global brands of the future with Vuse, Velo and glo. These are underpinned by industry leading multi-category consumer insights and science, with increasing digitalisation. We have invested a further incremental £346m in the first half, funded by continued value growth from combustibles and expect to reach our £1bn Quantum savings target 12 months early. We have now increased our savings target to £1.5bn by 2022.
"Our rapid growth in New Categories is driving significant scale benefits and 2021 is shaping up to be a pivotal year in our journey towards A Better Tomorrow.
"Our focus on New Categories growth and business sustainability puts ESG at the core of our strategy. There is great momentum across the business and we are well on track to meet our targets of £5bn of New Category revenue by 2025 and 50m non-combustible product consumers by 2030.
"We are committed to reducing the health impact of our business. Our ambition remains a sustainable, high growth, multi-category, consumer products business. I am excited about the future for BAT."
Performance highlights
ADJUSTED
(constant)
Cigarette and THP volume share
+20 bps
Cigarette and THP value share
Consumers of non-combustible products1
16.1m +2.6m
Revenue (£m)
£12,175m -0.8% £12,175m +8.1%
Revenue from New Categories (£m)
£883m +40.4% £883m +50.0%
Profit from operations (£m)
£4,907m -3.7% £5,235m +5.4%
Operating margin (%)
40.3% -120 bps 43.0% -70 bps2
Diluted EPS (pence)
141.6p -6.0% 154.2p +6.1%
Net cash generated from operating activities (£m)
£2,254m -35.3%
Free cash flow after dividends (£m)
(£1,163)m Not meaningful
Cash conversion (%)2
45.9% -22.5 ppts 66.7% -13.5 ppts
Borrowings3 (£m)
£45,010m -10.8%
Adjusted Net Debt (£m)
£40,490m -7.6%
The use of non-GAAP measures, including adjusting items and constant currencies, are further discussed on pages 54 to 58 of the full announcement, with reconciliations from the most comparable IFRS measure provided.
Internal estimate.
Movement in adjusted operating margin and operating cash conversion are provided at current rates.
Borrowings includes lease liabilities.
Accelerating our Transformation
New Categories revenue up 50% to £942m*
Our highest ever non-combustible product consumer acquisition +2.6m to 16.1m in H1, with 11.8% of Group revenue delivered by non-combustible products
Vapour revenue up 59%*, Vuse approaching global category value share leadership
glo revenue up 38%*, with glo Hyper volume share gains in ENA and Japan
Velo revenue up 63%*, with our T5 volume share of the Modern Oral category at 39.5% up 280 bps
Further incremental increase of £346m investment in H1, capitalising on strong momentum in all three New Categories
Full Year New Category losses expected to reduce
Strong H1 Results
Revenue up 8.1%* led by New Category growth and a partial recovery from prior-year COVID-19 impacts
Combustible revenue up 5.8%* with price/mix of 4.3%, reflecting Emerging Market (EM) recovery
Cigarette value share up 10 bps, and volume share up 10 bps reflecting strong EM performance
Further £256m cost savings, driven by Quantum, target increased to £1.5bn (previously £1bn) by 2022
Adjusted profit from operations up 5.4%* includes a transactional FX impact of 2%
Adjusted operating margin down 70 bps, driven by increased New Category investment, geographic mix and transactional FX
Adjusted diluted EPS up 6.1%*
Operating cashflow conversion of 67%, reflecting phasing of excise payments in the US in 2020
* at constant rates of exchange
On track for FULL YEAR 2021 guidance:
Global tobacco industry volume now expected to be down c.-1.5% (from c.-3%), driven by strong EM recovery.
US industry volume expected to be down c.-5.5%, given continuing macro-economic uncertainties and a strong comparator.
Constant currency revenue growth above 5% and continued strong progress towards £5bn New Categories revenue in 2025.
Mid-single figure constant currency adjusted EPS growth, including continued expectation of c.2% transactional FX headwind.
Expected translational FX headwind of c.7% on full year adjusted diluted EPS growth.
Operating cashflow conversion in excess of 90%, Adjusted Net debt/Adjusted EBITDA around three times.
Commitment to 65% dividend pay-out ratio and growth in sterling terms.
Half-Year Report to 30 June 2021 (1.4 mb)
Forward looking statements and other matters
This announcement contains certain forward-looking statements, including "forward-looking" statements made within the meaning of the U.S. Private Securities Litigation Reform Act of 1995.
In particular, these forward-looking statements include, among other statements, statements regarding the Group's future financial performance, planned product launches and future regulatory developments, as well as: (i) certain statements in the Strong Brands Drive New Category Acceleration section and in the Chief Executive commentary (pages 1 to 2 of the full announcement); (ii) certain statements in the Finance and Transformation Director's Statement (page 2 of the full announcement); (iii) certain statements in the Category Performance Review (pages 4 to 8 of the full announcement); (iv) certain statements in the Regional Review section (pages 9 to 13 of the full announcement); (v) certain statements in the Other Financial Information section (pages 14 to 17 of the full announcement); (vi) certain statements in the Other Information section (pages 18 to 23 of the full announcement); (vii) certain statements in the Notes to the Unaudited Interim Financial Statements section (pages 32 to 49 of the full announcement), including the Liquidity and Contingent Liabilities and Financial Commitments sections; and (viii) certain statements in the Other Information section (pages 50 to 62 of the full announcement), including the Non-GAAP Measures sections and under the heading "Dividends".
These statements are often, but not always, made through the use of words or phrases such as "believe," "anticipate," "could," "may," "would," "should," "intend," "plan," "potential," "predict," "will," "expect," "estimate," "project," "positioned," "strategy," "outlook", "target" and similar expressions. These include statements regarding our intentions, beliefs or current expectations concerning, amongst other things, our results of operations, financial condition, liquidity, prospects, growth, strategies and the economic and business circumstances occurring from time to time in the countries and markets in which the British American Tobacco Group (the "Group") operates, including the projected future financial and operating impacts of the COVID-19 pandemic.
All such forward-looking statements involve estimates and assumptions that are subject to risks, uncertainties and other factors. It is believed that the expectations reflected in this announcement are reasonable, but they may be affected by a wide range of variables that could cause actual results to differ materially from those currently anticipated. Among the key factors that could cause actual results to differ materially from those projected in the forward-looking statements are uncertainties related to the following: the impact of competition from illicit trade; the impact of adverse domestic or international legislation and regulation; the inability to develop, commercialise and deliver the Group's New Categories strategy; adverse litigation and dispute outcomes and the effect of such outcomes on the Group's financial condition; the impact of significant increases or structural changes in tobacco, nicotine and New Categories related taxes; translational and transactional foreign exchange rate exposure; changes or differences in domestic or international economic or political conditions; the ability to maintain credit ratings and to fund the business under the current capital structure; the impact of serious injury, illness or death in the workplace; adverse decisions by domestic or international regulatory bodies; and changes in the market position, businesses, financial condition, results of operations or prospects of the Group.
A review of the reasons why actual results and developments may differ materially from the expectations disclosed or implied within forward-looking statements can be found by referring to the information contained under the headings "Cautionary statement", "Group Principal Risks" and "Group Risk Factors" in the 2020 Annual Report and Form 20-F of British American Tobacco p.l.c. (BAT). Additional information concerning these and other factors can be found in BAT's filings with the U.S. Securities and Exchange Commission ("SEC"), including the Annual Report on Form 20-F and Current Reports on Form 6-K, which may be obtained free of charge at the SEC's website, http://www.sec.gov and BAT's Annual Reports, which may be obtained free of charge from the British American Tobacco website www.bat.com.
No statement in this announcement is intended to be a profit forecast and no statement in this communication should be interpreted to mean that earnings per share of BAT for the current or future financial years would necessarily match or exceed the historical published earnings per share of BAT. Past performance is no guide to future performance and persons needing advice should consult an independent financial adviser. The forward-looking statements reflect knowledge and information available at the date of preparation of this announcement and BAT undertakes no obligation to update or revise these forward-looking statements, whether as a result of new information, future events or otherwise. Readers are cautioned not to place undue reliance on such forward-looking statements.
All financial statements and financial information provided by or with respect to the U.S. or Reynolds American Inc. (Reynolds American) are initially prepared on the basis of U.S. GAAP and constitute the primary financial statements or financial records of the U.S. / Reynolds American. This financial information is then converted to International Financial Reporting Standards as issued by the IASB and as adopted for use in the UK ("IFRS") for the purpose of consolidation within the results of the Group. To the extent any such financial information provided in this announcement relates to the U.S. or Reynolds American it is provided as an explanation of, or supplement to, Reynolds American's primary U.S. GAAP based financial statements and information.
Our vapour product Vuse (including Alto, Solo, Ciro and Vibe), and certain products including Velo, Grizzly, Kodiak, Camel Snus and Granit, which are sold in the U.S., are subject to FDA regulation and no reduced-risk claims will be made as to these products without Agency clearance.
Anna Vickerstaff
+44 (0) 20 7845 2888 (24 hours) | @BATplc
Mike Nightingale: +44 (0)20 7845 1180
Victoria Buxton: +44 (0)20 7845 2012
William Houston: +44 (0)20 7845 1138
John Harney: +44 (0)20 7845 1263

redpajama_set_name: RedPajamaCommonCrawl


Take your statement to the next level with this stunning necklace. Bold in design, refined in details. This necklace features a intricate floral design in vibrant colors. Pair this necklace with a statement top for a fashionable look.


text:
Василий Константинович Глотов (4 сентября 1997, Барнаул) — российский хоккеист, нападающий.

Начал заниматься хоккеем в 4 года в клубе «Рубин» барнаульского посёлка Южный. Затем стал тренироваться в спортивной школе клуба «Мотор» (позже — СШОР «Алтай»), тренер Прохор Доловых. С 10−11 лет — в хоккейной школе «Сибирь» Новосибирск, с сезона 2009/20 играл в московских клубах «Динамо», «Серебряные акулы», «Северная звезда». Сезоны 2014/15 — 2015/16 провёл в команде МХЛ «СКА-Серебряные Львы».

На драфте НХЛ 2016 года был выбран под № 190 в 7 раунде клубом «Баффало Сейбрз». В сезонах 2016/17 — 2018/19 играл в низших североамериканских лигах за команды , «Шавиниган Катарактс», , «Рочестер Американс».

Перед сезоном 2019/20 был заявлен за команду ВХЛ «СКА-Нева», в сентябре подписал контракт со СКА. Первый матч в КХЛ сыграл 3 января 2020 в гостях с «Йокеритом» (0:6). 5 января в игре с «Динамо» Минск (4:1) забросил первую шайбу. В октябре 2020 года был обменян в «Сочи». 25 сентября 2022 года был обменян обратно в СКА на Артёма Фёдорова.

Примечания

Ссылки
 http://forchecking.ru/player.php?id=12328
 https://r-hockey.ru/people/player/583-001-0041664-6

Хоккеисты России
Хоккеисты КХЛ
Хоккейные нападающие
Игроки ХК «СКА-Серебряные Львы»
Игроки «Кейп-Бретон Иглз»
Игроки «Шавиниган Катарактс»
Игроки «Цинциннати Сайклонс»
Игроки «Рочестер Американс»
Игроки ХК «СКА-Нева»
Игроки ХК СКА Санкт-Петербург
Игроки ХК «Сочи»

redpajama_set_name: RedPajamaWikipedia


Thiess has secured a A$140 million increase to its contract with Glencore for coal mining services at Mt Owen in the Hunter Valley, Australia.
Under the variation, Thiess will mine additional volumes following a new Development Consent obtained by Glencore.
Thiess will continue to provide mine planning, design and execution, drill and blast, overburden removal and coal mining services until June 2021 under the amended contract.


Mourneabbey have had their fill of losing these finals, leaving three behind them in the space of four years before this one. They weren't about to let it happen again. They put Foxrock-Cabinteely through the rinser here and lifted their first All-Ireland title with a blow-out win in Parnell Park.
You can only be denied so many times. Mourneabbey leathered into this final like they wanted to leave no room for doubt. They had the wind in the first half and made full use of it, playing the game in Fox-Cab's half of the pitch and giving the Dublin champions no peace in it. They demolished Aisling Tarpey's kick-out, forcing her to kick into the teeth of the gale and the whoosh of the rain and turning her into the loneliest woman in Donnycarney.
With that foothold established, it was the Mourneabbey big guns who ran the game. Bríd O'Sullivan was relentless, gunning through the middle of the Fox-Cab defence at will. Ciara O'Sullivan schemed away at centre-forward, showing-and-going and keeping going.
And at the point of the spear, Doireann O'Sullivan and Laura Fitzgerald were unplayable at times, with Ellie Jack throwing into the pot as well when the chances arose. Between them, the Mourneabbey full-forward line had 1-10 scored by half-time, 1-7 of it from play.
Overall, indeed, Mourneabbey's shooting in that first half was pretty exceptional. Given the conditions, 13 scores from 15 shots was a phenomenal return. Doireann O'Sullivan in particular was dangerous any time she got on the ball. Flawless from frees, she scored three cracking points from play, all from around 40 metres out on an angle. She was instrumental in their goal as well, laying it on a plate for Fitzgerald to palm home.
The goal pretty much finished the game as a contest, making it 1-11 to 0-3 with 25 minutes gone. Fox-Cab hadn't been able to get to the pitch of the game at all, overwhelmed and outplayed from the start. Even when they replied with an instantaneous goal of their own through Fiona Claffey, it was only a speedbump for the Cork champions.
Mourneabbey went to the break nine ahead, 1-12 to 1-3. If Fox-Cab were going to make any dent in that margin, they were going to have to come out blazing after the restart. In fairness to Sinead Goldrick, their one leader all evening, she stuck the first point on the board within a couple of minutes. But that was as good as it got.
If anything, it was Mourneabbey who were the more dangerous for the rest of the game. They hit the crossbar twice in the space of 30 seconds through Eimear Harrington and Ciara O'Sullivan before Harrington missed a penalty on 44 minutes. Even with all their second-half wastefulness though, this never became a close contest.


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How to Load and Open 4K MXF videos on TCL TV with highest quality?
How to Simple Play MXF movies on Samsung TV without any issue?
How to Convert Canon XF305 MXF Footage to VOB Format for Playing on TV ?
How to transfer MXF to Apple ProRes MOV for Editing and Convert to MP4 for Playback?


Prince Robert, cousin of Grand Duke Henri, was among the mourners at the funeral of Baroness Philippine de Rothschild yesterday. Attended by around 1,200 people, the ceremony took place at the Château Mouton-Rothschild near Bordeaux. Baroness Philippine was survived by her husband, Jean-Pierre de Beaumarchais, her three children, Camille Ögren, Philippe Sereys de Rothschild and Julien de Beaumarchais, and ten grandchildren.


text:
Tuberculosis (TB) Related Stigma: A Conceptual Framework and Workplace Implications
People living with Tuberculosis (TB) are stigmatized socially. Tuberculosis is an infectious disease transmitted through the air and can affect any part of the body, majority people do not know much about its mode of transmission and treatment protocols. Despite being curable, Tuberculosis is still a stigmatized disease, not only because of its clinical manifestations but also due to psychosocial behaviors. TB affected individuals are consider devalued in society and in an organizational context they get reduced opportunities of selection, promotion and income. Stigma is often explained as a discrediting attribute leading to an impairment of social status and position, rejection and/or exclusion.
Likewise, stigmatized identities are devalued social identities or attributes given to an affected individual due to infectious diseases. This study examines the relatively new phenomenon of (deviant workplace behavior, turnover intention and social isolation) as an outcome of tuberculosis stigmatized identities at workplace. The current study empirically and theoretically investigates self-esteem as an interlinking mechanism in the relationship between valence content (internal, enacted, anticipated and disclosure) tuberculosis stigmatized identities and workplace outcomes (deviant workplace behavior, turnover intention and social isolation). In addition, magnitude (centrality and salience) Tb induced stigma used as a potential moderating variable between valence content of TB induced stigmatized identities and self-esteem. Also, moderating role of perceived organizational support is also a salient feature of the study in the relationship between self-esteem and workplace outcomes.
Data were collected through self-administrated questionnaire that is translated into native language. Population of current study was middle and low level employees working in public and private Tuberculosis hospitals of Pakistan. Author used convenience/purposive sampling to obtain the data. The data of current study collected into three time lags. The total number of questionnaire was 550. The same number of questionnaires was distributed in all three time intervals and the response rate was 321 only.
The result of current study indicates that valence content (internalized and anticipated) TB stigmatized identities positively related with self-esteem. IV Accordingly, enacted TB stigma has negative impact on self-esteem and disclosure TB stigma has positive impact on self-esteem.
The moderating role of centrality TB stigma only established in the relationship between enacted TB induces stigma and self-esteem. The role of centrality tuberculosis stigma as moderator is not established with (internal, anticipated, disclosure) TB stigmatized individuals and self-esteem. Similarly, the role of salience tuberculosis stigma as moderating variable also not established in current study. Furthermore, self-esteem as interlinking mechanism in the relationship between valence content and workplace outcome i.e. turnover intention not established in current study. Accordingly, self-esteem mediates in the relationship between valence content of TB stigmatized identities workplace outcomes (deviant workplace behavior and social isolation).In addition, self-esteem not act as a mediating variable in the relationship between (enacted, disclosure) tuberculosis stigmatized identities and social isolation. In the current research POS not act as a moderating variable between self-esteem and workplace outcome (Deviant workplace behaviors and social isolation).In addition, perceived organizational support act as facilitating moderating variable in the relationship between self-esteem and social isolation. Social identity theory has been used as an overarching theory for current theoretical model. Theoretical and practical implications along with future recommendations have been discussed.


Animal figures may depict the spirit helpers of the shaman, which often took animal form. The most common were the bighorn sheep and the rattlesnake.
The bighorn is definately the most prominent of the animals shapes found in petroglyphs. A variation I find interesting is what I believe to be an antelope figure. Typically, with horns shorter and less curved, these may be mistaken for bighorn sheep. After these two, then it seems the snake is most numerous. Many of what could be birds in flight are also observed.


The Torino team has good football and good players that can make a difference they are a team that operates in Serie A and are in 6th position. They are having a good season. They are candidates to fight for a European place and at this stage they are in a good moment.
They come from a win over Genoa 2-1 for Serie A.
They were playing with one more player but they still lost and in the first half of the equalizer, they scored twice and they used the comeback.
This competition have already won in five times and are a team to take into account. In this Glass of Italy came to beat Cosenza by expressive 4-0.
Sudtirol, This team is active in Lega Pro in Italy and are a team that is in the middle of the league table. The squad is virtually composed of only Italians and are a team with little history.
They reach this stage in the Italian Cup with a lot of surprise. It's been three rounds to get here. They started with Albalonga and won 2-1 at home.
Then they beat Venezia 1-0 away from home and finally a good surprise, 2-0 away from home in Frosinone.
Results that feed the dream of a new surprise, but this time in the house of a team much superior with other types of players and arguments.
Torino faces this competition with great seriousness and is alert to the danger that South-West represents. This team from Lega Pro have already dropped two teams from another level and Torino is aware that can not devalue the opponent.
I like the way Torino plays, always very dynamic and organized in search of victory.
It is quite expected that we have some changes compared to the last 11 of the team, it is normal that some substitutes enter the starting 11, but I see this Torino motivated and looking for the victory from the 1st minute. South Tyrol will refer more to the defense and sooner or later I believe Torino will score and win the first half of the match.
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text:
Dolores "Dee" Werdermann
Dolores "Dee" Werdermann Dolores "Dee" Werdermann nee Facciani of Palm Coast, FL was born on October 21, 1928 in South Fork, PA. She was the only child of the late Benjamin Facciani and Matilda "Terry" Facciani Leshay nee Cignetto. She passed away peacefully on Wednesday, July 17, 2013 in Palm Coast, FL at the age of 84 years. She relocated to Palm Coast, FL in 1996 from Harrisburg, PA. Dee was a very active member of St. Elizabeth Ann Seton Catholic Church, serving as lector and Eucharistic Minister both at church and Florida Hospital Flagler. She was a professed member of the Secular Franciscan Order. In her retirement Dee kept very busy, she was the founder of the Flagler Chapter of Project Linus and a founding member of the Blanketeers. Dee was a companion spirit at Christian Healing Ministries and also gave her time to the Retired and Senior Volunteer Ministries. She was involved in stage productions by the Little Theater and was an Opera Club member. Dee enjoyed all arts and theater, traveling, knitting, scrap-booking, stamping, and poker. She was also a Humperdinck-L-Ette and was crazy about Johnny Depp. She had a love for new endeavors, a great sense of humor and her awesome laugh will never be forgotten. She is survived by her children; Derek, Maxine, and Karen, three grandchildren, and two great grandchildren. A Memorial Mass will be held Monday, July 29, 2013 at 11:00 am from the St. Elizabeth Ann Seton Catholic Church, 4600 Belle Terre Pkwy., Palm Coast, FL 32164. Family may receive friends from 10:00 am at the church until the time of Mass. In lieu of flowers, donations may be made in Dee's name to Florida Hospital Hospice Care, 770 W. Granada Blvd. Ste. 304, Ormond Beach, FL 32174. All services are under the direction of Heritage Funeral & Cremation Service, Port Orange, FL
  Dolores "Dee" Werdermann Dolores "Dee" Werdermann nee Facciani of Palm Coast, FL was born on October 21, 1928 in South Fork, PA.  She was the only child of the late Benjamin Facciani and Matilda "Terry"... View Obituary & Service Information
The family of Dolores "Dee" Werdermann created this Life Tributes page to make it easy to share your memories.
Dolores "Dee" Werdermann nee Facciani...
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text:
Home Notifiable infections Hepatitis B
Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) that primarily affects the liver. HBV is mainly spread through direct contact with infected blood and blood products but can be sexually transmitted.
Acute hepatitis B virus (HBV) infection may be asymptomatic or may present with the following symptoms:
lethargy,
anorexia for a few days then jaundice,
pale stools and dark urine.
The incubation period is 45-180 days (mean: 60 days)
In some cases of HBV infection, the virus will not be eliminated and the person will become chronically infected (i.e.HBsAg or HBV DNA (PCR) has been detected on two occasions at least 6 months apart). Chronic HBV infection is commonly asymptomatic. However, there is no such thing as a healthy carrier. Even if they appear to be healthy, people with chronic HBV should be monitored regularly (every 6-12 months) by their GP for signs and symptoms of liver disease
Chronic HBV (CHB) infection is usually asymptomatic until the patient has progressed to cirrhosis (liver damage and scarring). Symptoms of cirrhosis include:
ankle swelling,
ascites,
GI bleeding,
There are four phases of CHB:
Immune tolerance
Immune clearance
Immune control
Immune escape
The patient's immune response in each phase determines the outcome of infection and the severity of cirrhosis which is caused by the immune response rather than the hepatitis B virus (HBV) itself. Progression to cirrhosis is most likely during the immune clearance and immune escape phases; treatment should be considered for patients in these phases, see Treatment
People with cirrhosis due to chronic HBV are at increased risk of developing hepatocellular carcinoma.
People with chronic HBV may transmit infection vertically (from mother to baby), or through sexual or percutaneous exposure.
Laboratory investigations of HBV infection include:
tests to diagnose HBV infection
tests for pre-treatment assessment of people with chronic hepatitis B infection. See Follow up.
follow up tests to monitor liver function +/- response to treatment. See Follow up
Tests for diagnosing HBV infection
Patients of unknown HBV status should always have three initial tests performed (HBsAg, Anti-HBs and Anti-HBc) to determine infection status and the need for vaccination. Specify the above tests on the request form rather than 'hepatitis B serology'
Those at high-risk of HBV who should be offered testing include:
people who frequently change their sexual partners, including sex workers
people diagnosed with any STI, test for hepatitis B when testing for STIs and at the 3 month follow-up appointment
partners and household contacts of people with acute or chronic hepatitis B
people born in intermediate and high prevalence countries
Aboriginal and Torres Strait Islander peoples.
HBsAg testing is recommended for all pregnant women in the first trimester of each pregnancy to allow appropriate measures to be implemented to prevent newborn infants developing chronic HBV infection.
The tests detects antibodies to and antigen of the virus. There is a period after infection, when the test will not detect antibody or antigen because they are yet to be produced or are present at a level that cannot be detected. This is called the window period which may last up to 3 months.
Interpreting serology
HBsAg
anti-HBc
anti-HBs positive
negative Chronic HBV infection
IgM anti-HBc*
anti-HBs
negative Acute HBV infection
*(high titre)
anti-HBs negative
negative Susceptible to infection (vaccination
should be recommended)
positive Immune due to Hepatitis B vaccination
negative Various possibilities including: distant
resolved infection, recovering from acute HBV, false positive,
'occult' HBV
Source: Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine - Decision making in hepatitis B (external site)
See Follow up section below for details of further investigations required prior to referral of patients with chronic HBV infection.
Treatment of chronic hepatitis B (external site) can significantly reduce progressive liver damage and loss of liver function. It will generally consist of oral antiviral therapy which needs to be taken on a long-term basis. Less commonly, pegylated interferon may be used
GPs can be authorised to prescribe hepatitis B medicines.
Patients with chronic HBV should be offered hepatitis A vaccination unless they are known to be already immune because the case fatality rate is high if they develop hepatitis A infection.
Informing your patient
Provide contact details of support services and relevant material.
Use a professional interpreter if required. Call Translating and Interpreting Service (TIS) 13 14 50.
Fact sheets for patients (Healthy WA)
Reduce transmission
Avoid behaviours that risk re-infection/super-infection and transmission to others.
Advise care with blood and personal grooming items.
Counsel patients with chronic HBV about safe sex practices.
Refer to alcohol and drug services for opioid substitution treatment as necessary, e.g. Mental Health Commission (external site)
If your patient is continuing to engage in injecting drug use refer to the Peer Based Harm Reduction WA (formerly WA Substance Users' Association) (external site)
Offer hepatitis B vaccination to non-immune household and sexual contacts of patients with chronic HBV - contact your Public Health Unit for further information.
People with chronic HBV who are health care workers may perform exposure prone procedures (EPPs) if they comply with the Australian National Guidelines for the Management of Healthcare Workers Living with Blood Borne Viruses and Healthcare Workers who Perform Exposure Prone Procedures at Risk of Exposure to Blood Borne Viruses (external site).
Alcohol - a modifiable risk factor for disease progression
Status Advise
Early disease with no risk factors for progression,
consistently normal ALT and normal clinical
examination Alcohol advice as per general population, NHMRC
Australian guidelines to reduce health risks from
drinking alcohol (external site)
Significant fibrosis At most one standard drink/day and no binging
Cirrhosis Aim for total abstinence
Refer to alcohol and drug services as necessary
People with hepatitis B should be offered HAV vaccination, if not immune. See Guidelines for the Provision of Hepatitis A and B Vaccine to Adults in Western Australia at Risk of Acquiring these Infections by Sexual Transmission (PDF 248KB).
Psychological support and counselling
For parents and their family/partners, telephone support, education and support groups are available through Hepatitis WA (external site)
The National Health and Medical Research Council's (NHMRC) Immunisation Handbook (external site) recommends that the following groups are among those who should receive hepatitis B vaccine:
household or other close (household like) contacts of people with hepatitis B
sexual contacts of people with hepatitis B
sex industry workers
individuals with chronic liver disease and/or hepatitis C
haemodialysis patients
HIV positive people and other immunocompromised people
inmates of correctional facilities
people at occupational risk e.g. healthcare workers, ambulance personnel, dentists, police, staff of correctional facilities, embalmers, tattooists and body-piercers
migrants from hepatitis B endemic countries
Aboriginal and Torres Strait Islander people.
Serological testing for evidence of past (or current) hepatitis B infection prior to vaccination may be warranted for certain older children, adolescents and adults, especially those at increased risk of acquiring hepatitis B infection, e.g. people who inject drugs, sex industry workers, immunocompromised people, and those living in communities with higher prevalence of HBV, including migrant communities and Aboriginal and Torres Strait Islander people. Serological testing allows people with HBV infection to be identified which facilitates clinical and public health management to prevent liver damage and onward transmission, respectively
Standard regimes for vaccination include:
0, 1 and 6 months
0, 1, 2 and 12 months
0, 7, 21 days and 12 months for rapid vaccination of those at highest risk.
Vaccination should be administered into the deltoid muscle.
If doses are missed the course does not need to be restarted, but all doses should be completed.
Serological testing following hepatitis B vaccination
Post-vaccination testing for Anti-HBs antibody and HBsAg levels is recommended:
3 to 12 months after completing the primary vaccine course in infants born to mothers with chronic hepatitis B infection.
4 to 8 weeks after completion of the primary course for
those at significant occupational risk (e.g. healthcare workers whose work involves frequent exposure to human tissue, blood or body fluids)
those at risk of severe or complicated HBV disease (e.g. persons who are immunocompromised, and persons with pre-existing liver disease not related to hepatitis B)
sexual partners and household, or other close household-like, contacts of persons who are infected with hepatitis B
those in whom a poor response to hepatitis B vaccination may occur (e.g. haemodialysis patients, persons with bleeding disorders vaccinated via the SC route).
Post-vaccination serology is NOT recommended for other groups
A single booster dose (4th dose) of vaccine can be given to confirm non-responder status. Those who are still non-responders after being given the booster/4th dose should have 2 further doses of hepatitis B vaccine at monthly intervals, and be re-tested for anti-HBs levels at least 4 weeks after the last dose.
On receipt of a notification of a hepatitis B case, the local public health nurse follows up with the reporting doctor and with the case to discuss household and sexual contacts. All household and sexual contacts of a person with chronic hepatitis B should be tested for hepatitis B infection. Non-immune household and sexual contacts should be offered free hepatitis B immunisation (and hepatitis B immunoglobulin if significant exposure has occurred).
WA Health Guideline for Accessing State Funded Vaccine for non-immune household and sexual contacts
The Australian Immunisation Handbook 10th Edition (external site)
Chronic hepatitis B
HBsAg or HBV DNA (PCR) has been detected on two occasions at least 6 months apart
Review your patient for evidence of decompensated liver disease - one or more of the clinical complications of chronic liver disease:
low albumin
high INR
variceal bleeding
encephalopathy.
High risk of progression:
>45yrs of age
heavy alcohol intake
family history of hepatocellular carcinoma (HCC)
co-infection with HIV/HCV/HDV
presence of cirrhosis
long duration of infection.
Initial Investigations (tests in bold are required prior to referral)
U&E
LFTs (AST, ALT, ALP, GGT, Albumin, Bilirubin)
HBeAg/HBeAb
HBV DNA (quantitative viral load)
Alpha-fetoprotein(AFP)
Liver/abdominal ultrasound
HCV serology
HAV serology
HIV serology
HDV serology
ANA/ASMA
Review every 6-12 months and monitor for signs and symptoms of liver disease e.g. signs: palmar erythema, spider naevi, jaundice, ascites, encephalopathy, hepato-splenomegaly.
Investigations (should be guided by HBeAg and LFT):
Previous result Investigation and frequency
HBeAg LFT LFT (ALT) HBV DNA HBeAg and HBeAb
+ve ALT<2xULN
6-12 monthly 12 monthly 6-12 monthly
+ve
ALT>2xULN
3-6 monthly 3-6 monthly 3-6 monthly
-ve normal
6-12 monthly 12 monthly -
-ve abnormal 3-6 monthly 3-6 monthly -
ULN = upper limit of normal level
Screening for hepatocellular carcinoma
Ultrasound and AFP every 6 months for those at high risk:
family history of HCC
Aboriginal and Torres Strait Islander people >50yrs
Asian men >40yrs
Asian women >50yrs
African people >20yrs
>40yrs with raised ALT +/- high HBV DNA (>2,000 IU/ml).
Control of fatigue: advise planning rest periods during the day and the addition of light to moderate exercise into their routines to reduce fatigue.
Psychological support and counselling available through Hepatitis WA (external site)
Urgent (seen <1 week): If evidence of decompensated liver disease discuss directly with Gastroenterology/General Physician at your local hospital and fax a completed referral directly to the relevant hospital.
Metropolitan Perth: Via Central Referral Service to Gastroenterology/Infectious Diseases (external site)
Regional Western Australia: Direct to your regional Physician/Hospital/Hepatology Nurse/Public Health Unit.
Refer those with:
raised AFP
HBsAg +ve and HBeAg +ve with ALT >2x ULN
HBsAg +ve and HBeAg –ve with HBV DNA >2000 IU/ml and raised LFT
HBsAg +ve and >40yrs of age with ALT 1-2x ULN
High risk of progression and/or are complex.
Information to include with referral:
likely date and mode of transmission
other drugs (include injecting drug use)
symptoms and signs of hepatitis (e.g. jaundice)
investigation results (those in bold in management section).
Note: Patients with HIV co-infection and who are asymptomatic with no signs of chronic liver disease can be managed by Infectious Diseases/Immunology
Notify WA Health of any cases of HBV
Contact tracing, testing and vaccination of non-immune sexual, family and household contacts are important to prevent further transmission of HBV.
Post-exposure prophylaxis
Percutaneous, ocular or mucous membrane contacts should be given hepatitis B immunoglobulin (HBIG) 400 IU intramuscularly (100IU, if body weight <30kg), as a single dose within 72 hours of exposure.
Individuals sexually exposed should be given HBIG within two weeks of sexual contact. Adults should be given HBIG 400 IU intramuscularly, as a single dose, and vaccination commenced within 7 days of exposure. Hepatitis B vaccination and immunoglobulin can be given at the same time, but at different sites.
Hepatitis B (Healthy WA)
Gastroenterological Society of Australia (GESA) Chronic Hepatitis B Patient Resources (external site)
Real time hepatitis B notification data