To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults.
A Markov model was used to ...evaluate the 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence and mortality, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The study incorporated updated evidence on screening test performance and adherence and was conducted from December 15, 2016, through November 6, 2019.
With perfect adherence, CRC incidence was reduced by 52% (95% CI, 46% to 56%) using colonoscopy, 61% (95% CI, 57% to 64%) using annual FIT, and 66% (95% CI, 63% to 68%) using MT-sDNA. Compared with no screening, perfect adherence screening extends life by 0.15, 0.17, and 0.19 QALYs per person with colonoscopy, FIT, and MT-sDNA, respectively. Colonoscopy is the most expensive strategy: approximately $110 million more than MT-sDNA and $127 million more than FIT. With imperfect adherence (best case), MT-sDNA resulted in 0.12 QALYs per person vs 0.05 and 0.06 QALYs per person by FIT and colonoscopy, respectively. Probabilistic sensitivity analyses supported the base-case analysis. Under varied adherence scenarios, MT-sDNA either dominates or is cost-effective (ICERs, $1740-$75,868 per QALY saved) compared with FIT and colonoscopy.
Each strategy reduced costs and increased QALYs compared with no screening. Screening by MT-sDNA results in the largest QALY savings. In Markov model analysis, screening by MT-sDNA in the Alaska Native population was cost-effective compared with screening by colonoscopy and FIT for a wide range of adherence scenarios.
Although inverse associations have been found between medication adherence and healthcare use and spending outcomes in many clinical settings, no studies to date have examined these relationships for ...patients with idiopathic pulmonary fibrosis (IPF) initiating nintedanib. We build on our prior study that used group-based trajectory modeling (GBTM) to compare inpatient hospitalization and medical care spending outcomes between groups of patients with different nintedanib adherence trajectories.
This analysis used 100% Medicare data and included beneficiaries with IPF who initiated nintedanib during 10/01/2014-12/31/2018. The sample consisted of community-dwelling older adults (≥ 66 years) with continuous coverage in Medicare Parts A (inpatient care), B (outpatient care) and D (prescription drugs) for one year before (baseline) and after (follow-up) initiating nintedanib. Patients were assigned to the GBTM-derived adherence trajectory group closest to their own nintedanib adherence experience. All-cause and IPF-related hospitalization events and total medical spending were measured during the follow-up period. Unadjusted and adjusted regression models were estimated to compare outcomes between patients in different nintedanib adherence trajectories.
Among the 1,798 patients initiating nintedanib, the mean age was 75.4 years, 61.1% were male, and 91.1% were non-Hispanic white. The best-fitting GBTM had five adherence trajectories: high adherence, moderate adherence, high-then-poor adherence, delayed-poor adherence, and early-poor adherence. All-cause hospitalizations and total all-cause medical spending were higher among patients in the high-then-poor, delayed-poor and early-poor adherence trajectories than those in the high adherence trajectory. For example, adjusted total all-cause medical spending was $4,876 (95% CI: $1,470 to $8,282) higher in the high-then-poor adherence trajectory, $3,639 (95% CI: $1,322 to $5,955) higher in the delayed-poor adherence trajectory and $3,907 (95% CI: $1,658 to $6,156) higher in the early-poor adherence trajectory compared with the high adherence trajectory. IPF-related hospitalizations and medical care spending were higher among those in the high-then-poor adherence trajectory compared with those in the high adherence trajectory.
Poor adherence to nintedanib was associated with all-cause hospitalizations and medical costs. Therefore, improved adherence programs, such as support programs, can be implemented to reduce economic burden.
A MWCNT/MnFe
2
O
4
nanocomposite was successfully synthesized by the hydrothermal method and its structural, optical, morphological and magnetic characterizations were done by XRD, FT-IR, TEM, SEM ...and VSM techniques. The nanocomposites have inverse spinel structure with a particle size of about 27–30 nm. Magnetic measurements reveal that all the MWCNTs/MnFe
2
O
4
nanocomposites display ferromagnetic behavior at room temperature. The nanocomposites exhibit superior photo catalytic activity of phenol degradation compared to pure MnFe
2
O
4
, owing to the reduction of photo-induced electron–hole pair recombination induced by the introduction of MWCNTs.
•Fe3O4/ZnS nanocomposite exhibit both improved optical and magnetic characteristics.•Magnetic anisotropy controls the self heating efficiency.•Heating efficiency of Fe3O4/ZnS nanocomposite is higher ...than Fe3O4 nanoparticle.•Fe3O4/ZnS nanocomposite is a decent candidate for magnetic hyperthermia applications.
Opto-magnetic Fe3O4/ZnS nanocomposite was synthesized by the co-precipitation method. The structural, morphological, optical and magnetic characterizations were performed by XRD, HRTEM, FTIR, PL, UV–Vis and VSM techniques. The existence of both the spinal cubic phase of Fe3O4 and the zinc blende phase of ZnS in the prepared nanocomposite was confirmed by XRD. HRTEM image depicts the formation of the ZnS shell around the Fe3O4 core. FTIR spectra revealed the incorporation of ZnS nanoparticles on the surface of Fe3O4 nanoparticles. UV–Vis spectra illustrate the decreasing band gap of the ZnS nanoparticles with the trend of increasing the size of ZnS nanoparticles due to the quantum size effect. PL spectra manifest the red shift in the nanocomposite due to a higher dielectric environment compared to the ZnS nanoparticle. The VSM study signifies the higher coercivity but lower saturation magnetization of the nanocomposite compared to the nanoparticle. The increasing heating efficiency of Fe3O4/ZnS nanocomposite than Fe3O4 nanoparticles was quantified by their respective SAR values which are found to increase in the ranges from 24–52 (w/g) (Fe3O4) to 31–79 (w/g) (Fe3O4/ZnS.) with respective concentrations. The above results speculate that the prepared nanocomposite is a decent candidate for magnetic hyperthermia applications to destroy the tumor and cancer cells.
Proton beam therapy is a commonly accepted treatment for intraocular melanomas, but the literature is lacking in descriptions of patient preferences of clinical outcomes and economic impact. In ...addition, no economic evaluations have been published regarding the incremental cost-effectiveness of proton beam therapy compared with enucleation or plaque brachytherapy, typical alternative treatments. We, therefore, conducted a cost-utility analysis of these three approaches for the treatment of intraocular melanomas.
A Markov model was constructed. Model parameters were identified from the published literature and publicly available data sources. Cost-effectiveness of each treatment was calculated in 2011 US Dollars per quality-adjusted life-year. Incremental cost-effectiveness ratios were calculated assuming enucleation as reference. One-way sensitivity analyses were conducted on all model parameters. A decision threshold of $50,000/quality-adjusted life-year was used to determine cost-effectiveness.
Enucleation had the lowest costs and quality-adjusted life-years, and plaque brachytherapy had the highest costs and quality-adjusted life-years. Compared with enucleation, the base-case incremental cost-effectiveness ratios for plaque brachytherapy and proton beam therapy were $77,500/quality-adjusted life-year and $106,100/quality-adjusted life-year, respectively. Results were highly sensitive to multiple parameters. All three treatments were considered optimal, and even dominant, depending on the values used for sensitive parameters.
Base-case analysis results suggest enucleation to be optimal. However, the optimal choice was not robust to sensitivity analyses and, depending on the assumption, both plaque brachytherapy and proton beam therapy could be considered cost-effective. Future clinical studies should focus on generating further evidence with the greatest parameter uncertainty to inform future cost-effectiveness analyses.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Literature is limited comparing adverse effects (AEs) of the proliferation signal inhibitors (PSIs) sirolimus (SRL) and everolimus (EVL) in pediatric heart transplant (HTx) recipients.
...Methods
Single‐center, observational cohort analysis assessing first use of SRL or EVL in pediatric HTx recipients <21 years of age with up to 2 years follow‐up between 2009 and 2020.
Results
Eighty‐seven patients were included, with 52 (59.8%) receiving EVL and 35 (40.2%) receiving SRL. Tacrolimus with PSI was the most common regimen. Intergroup comparison revealed lower baseline estimated glomerular filtration rate (eGFR) and greater increase in eGFR from baseline to 6 months and latest follow‐up in SRL cohort compared to EVL cohort. There was greater increase in HDL cholesterol in SRL cohort compared to EVL cohort. Intragroup analysis revealed eGFR and HDL cholesterol increased significantly within SRL cohort, triglycerides and glycosylated hemoglobin increased in EVL cohort, and LDL cholesterol and total cholesterol increased in both cohorts (all p < .05). There were no differences in hematological indices or rates of aphthous ulcers, effusions, or infections between cohorts. Incidence of proteinuria was not significantly different among those screened within cohorts. Of those included in our analysis, one patient in SRL cohort (2.9%) and two in EVL cohort (3.8%) had PSI withdrawn due to AE.
Conclusion
Low‐dose PSIs in calcineurin inhibitor minimization regimens appear well‐tolerated with low withdrawal rate secondary to AE in pediatric HTx recipients. While incidence of most AE was similar between PSI, our results suggest EVL may be associated with less favorable metabolic impact than SRL in this population.
A detailed experimental and theoretical investigations on the origin of room temperature ferromagnetism in Fe doped CdS diluted magnetic semiconductor is reported in the present study. X-ray ...diffraction results reveal the cubic zinc blende CdS structure with an average crystallite size of 2 nm–3 nm which is in concurrence with the Transmission electron microscopy results. UV–visible spectroscopy depict the enhancement of optical band gap of Fe doped CdS nanoparticles compared to the bulk CdS as a result of the quantum confinement effect. Photoluminescence spectra revealed the presence of Cd2+ and S2− defect states in the nanoparticles in addition to the fluorescence quenching effect. FTIR results demonstrate the stretching vibrations of CdS bond. Magnetic study confirms the existence of room temperature ferromagnetic ordering in the nanoparticles for the lower concentration of Fe, as a result of spin polarization induced by the Fe atoms to the nearest neighboring S atoms. At higher concentration of Fe, the enhanced antiferromagnetic interaction between short range Fe ions suppresses the ferromagnetic ordering. Theoretical calculations demonstrate the half metallic nature of Fe doped CdS system with strong p-d hybridization between the Fe-d states and the S-p states which results the room temperature ferromagnetism.
•DFT calculations are performed to investigate the ferromagnetic ordering in the Fe doped CdS nanoparticles.•Fe doped CdS system shows half metallic properties.•The ferromagnetic ordering is due to p-d exchange interaction between the localized d spins of the Fe ions and the free delocalized carriers.•p-d hybridization between the d states of Fe and the p states of S are observed in the Fe doped CdS system.
The copper ferrite fiber has been synthesized using the electrospinning technique by optimizing the electric voltage and viscosity of the polymer solution. Physical properties of copper ferrite fiber ...have been tuned with annealing at different temperatures (550, 750, and 950 °C for 2 h). The crystal structure has been confirmed by X-ray-diffraction pattern analysis and studied by using Rietveld refinement technique. The morphology of fibers was explored with the help of field emission scanning electron microscopy. The fibers annealed at 550 °C crystallize to cubic structure, and the tetragonal phase has been observed for 750 °C, and 950 °C annealed fibers. Sample annealed at 750 °C shows the highest magnetocrystalline anisotropy constant at 300 K (3 × 10
5
erg/cc). The SAR (Specific absorption rate) and ILP (intrinsic loss power parameter) of the 750 °C annealed fibers are 265 ± 5 W/g and 3.412 nHm
2
/Kg, respectively. The SAR value calculated by using non-adiabatic approach is 335 W/g.
This paper deals with the removal of methyl green, a cationic dye, and methyl blue, an anionic dye, from aqueous system by adsorption onto the montmorillonite clay. The effect of different ...experimental conditions such as time, adsorbate concentrations, pH, temperature, and presence of other ions has been investigated. In order to understand the adsorption behavior of the dye molecules onto montmorillonite, the kinetics of the adsorption data were analyzed using different models such as pseudo-first-order, pseudo-second-order, intraparticle diffusion, Boyd, Elovich, Richi, and Bajpai model. This study shows that the adsorption maximum reached at 60 min and follows the pseudo-second-order kinetics. The adsorption isotherm has been investigated in the pH range of 4-9 at 25 degree C and analyzed with different models namely Langmuir, Freundlich, Sips, Toth, Temkin, Scatchard, and Dubinin and Raduskevich (D-R) models. The thermodynamic parameters such as the Gibbs free energy ( Delta G degree ), enthalpy ( Delta H degree ), and entropy ( Delta S degree ) changes were calculated. The interaction of dye molecules onto montmorillonite has been investigated by X-ray diffraction analysis which indicates that adsorption takes place mainly into the interlayer region of the clay. Maximum removal of methyl green and methyl blue dye molecules up to 68.35 and 95.95%, respectively was achieved by adsorption of the dye molecules onto montmorillonite clay at pH 5 and 35 degree C.
PDF
