Objective
Cerebrospinal fluid (CSF) biomarkers are shown to facilitate a risk identification of patients with mild cognitive impairment (MCI) into different risk levels of progression to Alzheimer’s ...disease (AD). Knowing a patient’s risk level provides an opportunity for earlier interventions, which could result in potential greater benefits. We assessed the cost effectiveness of the use of CSF biomarkers in MCI patients where the treatment decision was based on patients’ risk level.
Methods
We developed a state-transition model to project lifetime quality-adjusted life-years (QALYs) and costs for a cohort of 65-year-old MCI patients from a US societal perspective. We compared four test-and-treat strategies where the decision to treat was based on a patient’s risk level (low, intermediate, high) of progressing to AD with two strategies without testing, one where no patients were treated during the MCI phase and in the other all patients were treated. We performed deterministic and probabilistic sensitivity analyses to evaluate parameter uncertainty.
Results
Testing and treating low-risk MCI patients was the most cost-effective strategy with an incremental cost-effectiveness ratio (ICER) of US$37,700 per QALY. Our results were most sensitive to the level of treatment effectiveness for patients with mild AD and for MCI patients. Moreover, the ICERs for this strategy at the 2.5th and 97.5th percentiles were US$18,900 and US$50,100 per QALY, respectively.
Conclusion
Based on the best available evidence regarding the treatment effectiveness for MCI, this study suggests the potential value of performing CSF biomarker testing for early targeted treatments among MCI patients with a narrow range for the ICER.
Selection of tools for monitoring epigeal arthropods may be limited by site characteristics and the need to reduce risk of vertebrate bycatch. We designed a ramp trap for sampling surface-active ...arthropod diversity and compared its effectiveness with pitfall traps. Paired transects of ten ramp and ten pitfall traps were laid out in five sites at the Hopland Research and Extension Center in California. We identified and enumerated the ground-dwelling arthropods in the samples, with an emphasis on beetles and spiders, and compared trap types using t-tests and NMDS. There was no significant difference in abundance and diversity between ramp and pitfall traps for beetles or spiders; however, there were significantly more millipedes caught by pitfall traps. The NMDS analysis of beetle assemblages distinguished between trap types; however, differences were not significant for spider assemblages. The ramp traps were more difficult to fabricate and transport because of their complexity and bulk, but they were easier and faster to setup, more resistant to disturbance, and resulted in less vertebrate bycatch. Ramp traps are a useful tool to be used alongside or as an alternative to pitfall traps.
Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of ...continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections.
All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of the aorta and false lumen.
A total of 129 patients treated for type B dissections between 1994 and December 2005 were identified. Median radiological follow-up was 14 months. Fourteen patients died perioperatively leaving 115 patients available for analysis. Seventy-four of these had CT imaging of sufficient quality for morphological analysis. The vast majority of acute patients were treated for rupture or end-organ ischemia whereas most chronic patients were treated for asymptomatic aneurysms. In 80% of patients, the false lumen thrombosed along the stent graft but it remained perfused distal to the stent graft fixation in 50% of patients. Only 5% of patients presented with aortic enlargement of the stent grafted area when adequate proximal sealing was achieved. The distal, uncovered aorta displayed expansion in 16% of patients.
The stent grafted thoracic aorta after type B dissection appears to be stabilized by covering the primary entry site with a stent graft in the majority of both acute and chronic dissections. The uncovered portion of the aorta distal to the stent graft, however, remains at risk of continuous dilatation. Stent grafting for complicated type B thoracic dissections seems to be a treatment option with reasonable morbidity and mortality even though the incidence of severe complications is still significant.
Excited states have been identified in the heaviest known even-ZN=84 isotone 158W, which lies in a region of one-proton emitters and the two-proton drip line. The observation of γ-ray transitions ...feeding the ground state establishes the excitation energy of the yrast 6+ state confirming the spin-gap nature of the α-decaying 8+ isomer. The 8+ isomer is also expected to be unbound to two-proton emission but no evidence for this decay mode was observed. An upper limit for the two-proton decay branch has been deduced as b2p≤ 0.17% at the 90% confidence level. The possibility of observing two-proton emission from multiparticle isomers in nearby nuclides is considered.
ABSTRACT Since the introduction of e-cigarettes into the U.S. market, the number and variety of vaping products have proliferated. E-hookahs are long, pen-like vaping devices that debuted in U.S. ...markets in 2014. By applying the Host, Agent, Vector, Environment (HAVE) model, the objective of this exploratory study was to assess differences between e-cigarettes and e-hookahs to help inform tobacco regulatory science and practice. In June–August 2014, a total of 54 unique manufactured e-cigarette and e-hookah products were identified at point of sales (POS) around three college campuses in Southeast U.S. Documented characteristics included brand name, disposable, rechargeable, nicotine containing, packaging, and flavor type. Descriptive analyses were conducted October to November 2014 to assess frequency and percent of product type across POS and specific characteristics. Among 54 products, 70.4% was e-cigarettes and 29.6% was e-hookahs. Across POS, drug stores and grocery stores carried e-cigarettes exclusively, while gas stations carried the greatest proportion of e-hookahs. Compared to e-hookahs, a greater proportion of e-cigarettes were non-disposable and contained nicotine; a greater proportion of e-hookahs came in fruit and other types of flavors compared to e-cigarettes. The present study suggests that e-cigarettes and e-hookahs differ by specific product characteristics and by places where they are sold. Despite these differences, the products are used for similar purposes warranting careful monitoring of industry manufacturing and marketing, because the safety of both products is still undetermined. Additional research is needed to understand the uptake and continued use of these products.
New experimental data for dissociation of relativistic 17Ne projectiles incident on targets of lead, carbon, and polyethylene targets at GSI are presented. Special attention is paid to the excitation ...and decay of narrow resonant states in 17Ne. Distributions of internal energy in the O15+p+p three-body system have been determined together with angular and partial-energy correlations between the decay products in different energy regions. The analysis was done using existing experimental data on 17Ne and its mirror nucleus 17N. The isobaric multiplet mass equation is used for assignment of observed resonances and their spins and parities. A combination of data from the heavy and light targets yielded cross sections and transition probabilities for the Coulomb excitations of the narrow resonant states. The resulting transition probabilities provide information relevant for a better understanding of the 17Ne structure.
The Boomerang Nebula is the coldest known object in the Universe, and an extreme member of the class of Pre-Planetary Nebulae, objects which represent a short-lived transitional phase between the AGB ...and Planetary Nebula evolutionary stages. Previous single-dish CO (J=1-0) observations (with a 45 arcsec beam) showed that the high-speed outflow in this object has cooled to a temperature significantly below the temperature of the cosmic background radiation. Here we report the first observations of the Boomerang with ALMA in the CO J=2-1 and J=1-0 lines to resolve the structure of this ultra-cold nebula. We find a central hourglass-shaped nebula surrounded by a patchy, but roughly round, cold high-velocity outflow. We compare the ALMA data with visible-light images obtained with HST and confirm that the limb-brightened bipolar lobes seen in these data represent hollow cavities with dense walls of molecular gas and dust producing both the molecular-emission-line and scattered-light structures seen at millimeter and visible wavelengths. The large diffuse biconical shape of the nebula seen in the visible is likely due to preferential illumination of the cold high-velocity outflow. We find a compact source of millimeter-wave continuum in the nebular waist -- these data, together with sensitive upper limits on the radio continuum using observations with ATCA, indicate the presence of a substantial mass of very large (mm-sized) grains in the waist of the nebula. Another unanticipated result is the detection of CO emission regions beyond the ultracold region which indicate the re-warming of the cold gas, most likely due to photoelectric grain heating.
PDF
