Introduction
This analysis was conducted to assess the incidence of adverse clinical outcomes, healthcare resource use (HCRU), and the costs associated with systemic corticosteroid (SCS) use in ...adults with systemic lupus erythematosus (SLE) in the UK.
Methods
We identified incident SLE cases using the Clinical Practice Research Datalink GOLD, Hospital Episode Statistics-linked healthcare, and Office for National Statistics mortality databases from January 1, 2005, to June 30, 2019. Adverse clinical outcomes, HCRU, and costs were captured for patients with and without prescribed SCS.
Results
Of 715 patients, 301 (42%) had initiated SCS use (mean standard deviation (SD) 3.2 6.0 mg/day) and 414 (58%) had no recorded SCS use post-SLE diagnosis. Cumulative incidence of any adverse clinical outcome over 10-year follow-up was 50% (SCS group) and 22% (non-SCS group), with osteoporosis diagnosis/fracture most frequently reported. SCS exposure in the past 90 days was associated with an adjusted hazard ratio of 2.41 (95% confidence interval 1.77–3.26) for any adverse clinical outcome, with increased hazard for osteoporosis diagnosis/fracture (5.26, 3.61–7.65) and myocardial infarction (4.52, 1.16–17.71). Compared to low-dose SCS (< 7.5 mg/day), patients on high-dose SCS (≥ 7.5 mg/day) had increased hazard for myocardial infarction (14.93, 2.71–82.31), heart failure (9.32, 2.45–35.43), osteoporosis diagnosis/fracture (5.14, 2.82–9.37), and type 2 diabetes (4.02 1.13–14.27). Each additional year of SCS use was associated with increased hazard for any adverse clinical outcome (1.15, 1.05–1.27). HCRU and costs were greater for SCS users than non-SCS users.
Conclusions
Among patients with SLE, there is a higher burden of adverse clinical outcomes and greater HCRU in SCS versus non-SCS users.
Introduction
This analysis compared healthcare resource use (HCRU) and costs associated with incident organ damage in a cohort of adult patients with systemic lupus erythematosus (SLE).
Methods
...Incident SLE cases were identified (Clinical Practice Research Datalink CPRD and Hospital Episode Statistics-linked healthcare databases; January 1, 2005–June 30, 2019). Annual incidence of 13 organ damage domains was calculated from SLE diagnosis through follow-up. Annualized HCRU and costs were compared between organ damage and non-organ damage patient groups using generalized estimating equations.
Results
A total of 936 patients met the inclusion criteria for SLE. Mean age was 48.0 (standard deviation SD 15.7) years and 88% were female. Over a median follow-up period of 4.3 (interquartile range IQR 1.9–7.0) years, 59% (315/533) had evidence of post-SLE diagnosis incident organ damage (≥ 1 type), which was greatest for musculoskeletal (146/819 18%), cardiovascular (149/842 18%), and skin (148/856 17%) domains. Patients with organ damage had greater resource use for all organ systems, excluding gonadal, versus those without it. Overall, mean (SD) annualized all-cause HCRU was greater in patients with organ damage versus those without it (inpatient, 1.0 versus 0.2; outpatient, 7.3 versus 3.5; accident and emergency, 0.5 versus 0.2 days; primary care contacts, 28.7 versus 16.5; prescription medications, 62.3 versus 22.9). Adjusted mean annualized all-cause costs were significantly greater in both post- and pre-organ damage index periods for patients with organ damage versus those without it (all
P
< 0.05, excluding gonadal). Overall organ damage was associated with significantly increased adjusted mean annualized per-patient cost (£4442 greater
P
< 0.0001) ranging between £2709 and £7150 greater depending on the organ damage type.
Conclusion
Organ damage was associated with higher HCRU and healthcare costs, before and after SLE diagnosis. More effective SLE management may slow disease progression, prevent organ damage onset, improve clinical outcomes, and reduce healthcare costs.
Groundwater flow and contaminant migration tracing is a vital method of identifying and characterising pollutant source-pathway-receptor linkages in karst aquifers. Bacteriophages are an attractive ...alternative tracer to non-reactive fluorescent dye tracers, as high titres (>10
pfu mL
) can be safely released into the aquifer, offering improved tracer detectability. However, the interpretation of bacteriophage tracer breakthrough curves is complicated as their fate and transport are impacted by aquifer physicochemical conditions. A comparative tracer migration experiment was conducted in a peri-urban catchment in southeast England to characterise the behaviour of MS2 bacteriophage relative to sodium fluorescein dye in a karstic chalk aquifer. Tracers were released into a stream sink and detected at two abstraction boreholes located 3 km and 10 km away. At both sites, the loss of MS2 phage greatly exceeded that of the solute tracer. In contrast, the qualitative shape of the dye and phage breakthrough curves were visually very similar, suggesting that the bacteriophage arriving at each site was governed by comparable transport parameters to the non-reactive dye tracer. The colloid filtration theory was applied to explain the apparent contradiction of comparable tracer breakthrough patterns despite massive phage losses in the subsurface. One-dimensional transport models were also fitted to each breakthrough curve to facilitate a quantitative comparison of the transport parameter values. The model results suggest that the bacteriophage migrates through the conduit system slightly faster than the fluorescent dye, but that the former is significantly less dispersed. These results suggest that whilst the bacteriophage tracer cannot be used to predict receptor concentrations from transport via karstic flow paths, it can provide estimates for groundwater flow and solute contaminant transit times. This study also provides insight into the attenuation and transport of pathogenic viruses in karstic chalk aquifers.
The Nintendo Switch is a popular handheld gaming console that is used for a variety of purposes. The most common is that of gaming, however, there are supporting activities such as social networking, ...media consumption and internet connectivity. In this paper, we have detailed the processes that must be conducted in order to extract forensic evidence from Nintendo Switch devices. We extracted a number of different forensic artefacts from a NAND dump of several Nintendo Switch devices. We discovered several key artefacts, notably personally identifiable information, network connection history and displays that have been connected. We also assessed the forensic value of each artefact extracted from the device. We developed software to automate the process of dumping and extracting the content of the NAND memory. Additionally, we developed modules for the forensic software Autopsy and released these as open source software to automate the process of ingestion and analysis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP