Pelagic larval dispersal is thought to be the main mechanism connecting many marine populations and is an important determinant both of an individual’s success and a population’s distribution and ...spatial structure. Thus, quantitative estimates of the retention or dispersion of larvae from spawning grounds is important for the determination of recruitment success in fisheries. Models can be used to study connectivity through a dispersal curve or dispersal kernel: the probability that a larva will settle at a given distance from its release location. We applied a 3-dimensional circulation model and a Lagrangian particle tracking model to the southeast US continental shelf to describe dispersal kernels in 2 dimensions. We used a fully orthogonal design to assess the importance of factors that influence the dispersal kernel, including spawning time, spawning location, larval behavior (vertical position in the water column), larval duration, and turbulent dispersal. Our results indicate that adult behavior, in the form of spawning time and location, may be more important than larval behavior in determining larval dispersal on the inner- and mid-shelves in this region.
Abstract Objective The aim of this study was to elicit the individual willingness to pay (WTP) for a quality-adjusted life-year (QALY). Methods In a Web-based questionnaire containing contingent ...valuation exercises, respondents valued health changes in five scenarios. In each scenario, the respondents first valued two health states on a visual analog scale (VAS) and expressed their WTP for avoiding a decline in health from the better health state to the worse, using a payment scale followed by a bounded open contingent valuation question. Analysis WTP per QALY was calculated for QALY gains calculated using VAS valuations, as well as the Dutch EQ-5D tariffs, the two steps in the WTP estimations and each scenario. Heterogeneity in WTP per QALY ratios was examined from the perspective of: 1) household income; and 2) the level of certainty in WTP indicated by respondents. Theoretical validity was analyzed using clustered multivariate regressions. Results A total of 1091 respondents, representative of the Dutch population, participated in the survey. Mean WTP per QALY was €12,900 based on VAS valuations, and €24,500 based on the Dutch EuroQoL tariffs. WTP per QALY was strongly associated with income, varying from €5000 in the lowest to €75,400 in the highest income group. Respondents indicating higher certainty exhibited marginally higher WTP. Regression analyses confirmed expected relations between WTP per QALY, income, and other personal characteristics. Conclusion Individual WTP per QALY values elicited in this study are similar to those found in comparable studies. The use of individual valuations in social decision-making deserves attention, however.
Purpose: To describe subjective caregiver burden of parents of adults with Duchenne muscular dystrophy (DMD) and to identify factors associated with the level of subjective burden. Methods: In a ...cross-sectional study in 80 parents of 57 adult, severely disabled DMD patients' level of subjective caregiver burden was measured with the Caregiver Strain Index (CSI) and the Self Rated Burden Scale. A visual analogue scale was used to measure happiness. The expanded CSI version, the CarerQoL and open questions were used to analyse caregiving in more depth. In uni and multivariate analyses, associations of objective care characteristics, patient characteristics and caregiver characteristics with burden were explored. Results: Parents indicated substantial burden, but valued giving care as being important and rewarding. Subjective burden was associated with received support, tracheotomy, active coping by the patient and anxiety in patient and parents, together explaining 34%-36% of variance. Living situation was not associated with experienced burden. Conclusions: Caring for an adult son with DMD is burdensome, but rewarding. Subjective caregiver burden of parents may be alleviated by adequate support and respite care, by avoiding tracheotomy and by intervention programs targeting anxiety and promoting active coping by the patient from childhood.
Implications for Rehabilitation
Parents of adult patients with Duchenne Muscular Dystrophy experience substantial subjective caregiver burden, but they also value caregiving as important and rewarding.
Level of subjective caregiver burden in parents is associated with support, tracheotomy, active coping by the patient and anxiety both in patients and parents.
Subjective caregiver burden might be alleviated by adequate support and respite care, by avoiding tracheotomy and by intervention programs targeting anxiety and promoting active coping.
Healthcare Costs and Obesity Prevention Rappange, David R.; Brouwer, Werner B. F.; Hoogenveen, Rudolf T. ...
PharmacoEconomics,
01/2009, Letnik:
27, Številka:
12
Journal Article
Recenzirano
Background:
Obesity is a major contributor to the overall burden of disease (also reducing life expectancy) and associated with high medical costs due to obesity-related diseases. However, obesity ...prevention, while reducing obesity-related morbidity and mortality, may not result in overall healthcare cost savings because of additional costs in life-years gained. Sector-specific financial consequences of preventing obesity are less well documented, for pharmaceutical spending as well as for other healthcare segments.
Objective:
To estimate the effect of obesity prevention on annual and lifetime drug spending as well as other sector-specific expenditures, i.e. the hospital segment, long-term care segment and primary healthcare.
Methods:
The RIVM (Dutch National Institute for Public Health and the Environment) Chronic Disease Model and Dutch cost of illness data were used to simulate, using a Markov-type model approach, the lifetime expenditures in the pharmaceutical segment and three other healthcare segments for a hypothetical cohort of obese (body mass index BMI ≥30 kg/m
2
), non-smoking people with a starting age of 20 years. In order to assess the sector-specific consequences of obesity prevention, these costs were compared with the costs of two other similar cohorts, i.e. a ‘healthy-living’ cohort (non-smoking and a BMI ≥18.5 and <25 kg/m
2
) and a smoking cohort. To assert whether preventing obesity results in cost savings in any of the segments, net present values were estimated using different discount rates. Sensitivity analyses were conducted across key input values and using a broader definition of healthcare.
Results:
Lifetime drug expenditures are higher for obese people than for ‘healthy-living’ people, despite shorter life expectancy for the obese. Obesity prevention results in savings on drugs for obesity-related diseases until the age of 74 years, which outweigh additional drug costs for diseases unrelated to obesity in life-years gained. Furthermore, obesity prevention will increase long-term care expenditures substantially, while savings in the other healthcare segments are small or non-existent. Discounting costs more heavily or using lower relative mortality risks for obesity would make obesity prevention a relatively more attractive strategy in terms of healthcare costs, especially for the long-term care segment. Application of a broader definition of healthcare costs has the opposite effect.
Conclusions:
Obesity prevention will likely result in savings in the pharmaceutical segment, but substantial additional costs for long-term care. These are important considerations for policy makers concerned with the future sustainability of the healthcare system.
OBJECTIVE:To compare neonatal outcomes by method of delivery in preterm (34 weeks of gestation or prior), small-for-gestational-age (SGA) newborns in a large diverse cohort.
METHODS:Birth data for ...1995–2003 from New York City were linked to hospital discharge data. Data were limited to singleton, liveborn, vertex neonates delivered between 25 and 34 weeks of gestation. Births complicated by known congenital anomalies and birth weight less than 500 g were excluded. Small for gestational age was used as a surrogate for intrauterine growth restriction. Associations between method of delivery and neonatal morbidities were estimated using logistic regression.
RESULTS:Two thousand eight hundred eighty-five SGA neonates meeting study criteria were identified; 42.1% were delivered vaginally, and 57.9% were delivered by cesarean. There was no significant difference in intraventricular hemorrhage, subdural hemorrhage, seizure, or sepsis between the cesarean delivery and vaginal delivery groups. Cesarean delivery compared with vaginal delivery was associated with increased odds of respiratory distress syndrome. The increased odds persisted after controlling for maternal age, parity, ethnicity, education, primary payer, prepregnancy weight, gestational age at delivery, diabetes, and hypertension.
CONCLUSION:Cesarean delivery was not associated with improved neonatal outcomes in preterm SGA newborns and was associated with an increased risk of respiratory distress syndrome.
LEVEL OF EVIDENCE:II
Separating the causal impact of early delivery on neonatal health outcomes from the antecedents of early delivery is challenging given the range of pathologies that are typically involved. Isolating ...preterm births resulting from trauma offers an opportunity to assess the impact of preterm birth independent of the usual causes, and it appears that such births are at substantially increased risk of adverse health outcomes (Am J Epidemiol. 2015;182(9):750-758). Trauma-related preterm births may offer insight into what happens when presumably normally developing fetuses are delivered early. Whereas pathology-related preterm births are preceded by a stressful uterine environment, including multiple contributing factors, and allow for interventions to prepare the newborn for extrauterine life, none of these applies to trauma-related preterm births. However, the trauma itself presumably causes acute problems that lead to the decision to deliver. Generalizing from the findings for trauma-related preterm births suggests that the pathology typically causing preterm birth does not have a strong independent effect and that a longer period leading up to the preterm birth is beneficial whether due to maturation or the opportunity for intervention.
The anatomic detail of the interosseous membrane was studied by dissection of 20 preserved cadaveric specimens. The interosseous membrane was found to be a complex structure consisting of a central ...band, accessory bands, a proximal interosseous band, and membranous portions. The central band, a stout ligamentous structure, was found in all specimens. Fibers of the central band originate on the radius and are oriented distal and ulnar an average of 21
0 to the longitudinal axis of the ulna. Accessory bands were of less substance than the central band but were present in all specimens. The number of accessory bands ranged from 1 to 5. The proximal interosseous band is located on the dorsal surface only, and its fibers run counter to the central band. It shares a point of origin with the central band on the radius. This structure was present in 17 of 20 specimens. Since the central band was the most dominant and consistent structure, we chose to analyze the strain in the central band in 6 preserved specimens. Maximum strain in the central band of the intact specimen occurs in neutral forearm rotation. Once the radial head is removed, the percent strain universally increases throughout the arc of forearm rotation and peak strain shifts to pronation.
ObjectiveInitial GH-induced catch up growth is highly variable in short children born small for gestational age (SGA) and mainly influenced by age at start of therapy and GH dose. This study compared ...the first year growth-promoting effect of an individually adjusted GH dose (IAD) versus a fixed high GH dose (FHD) in pre-pubertal children born SGA with severe short stature.DesignThis was a randomized, open-label, multi-center study.MethodsThe FHD group received 0.067 mg/kg per day GH throughout the 12-month study. The IAD group initially received 0.035 mg/kg per day GH; at 3 months the Cologne growth-prediction model for first year change in height SDS was applied; if predicted change was <0.75, GH was increased to 0.067 mg/kg per day for the remaining 9 months, otherwise the initial dose was continued.ResultsIn the IAD group, 38 out of the 80 patients required the higher GH dose from month 3. From an ANCOVA for non-inferiority, mean difference in change in height SDS between IAD and FHD groups was −0.24 (95% confidence interval (CI) −0.35: −0.12), the CI for height SDS being above the pre-defined non-inferiority margin of −0.5. GH dose reductions due to IGF-I SDS >0.5 and IGFBP-3 SDS <−0.5 were performed in 4/99 FHD patients, but none of the IAD group patients. Safety data were similar between groups.ConclusionWith a mean treatment group difference of 1 cm in 12-month growth response, although statistically significant, the IAD group was considered non-inferior compared with the FHD group. Early growth prediction can be used to tailor the dose to the individual patient's needs, resulting in lower overall GH dose.
We present a new catalog of TeV gamma-ray sources using 1523 days of data from the High-Altitude Water Cherenkov (HAWC) Observatory. The catalog represents the most sensitive survey of the northern ...gamma-ray sky at energies above several TeV, with three times the exposure compared to the previous HAWC catalog, 2HWC. We report 65 sources detected at ≥5 significance, along with the positions and spectral fits for each source. The catalog contains eight sources that have no counterpart in the 2HWC catalog, but are within 1° of previously detected TeV emitters, and 20 sources that are more than 1° away from any previously detected TeV source. Of these 20 new sources, 14 have a potential counterpart in the fourth Fermi Large Area Telescope catalog of gamma-ray sources. We also explore potential associations of 3HWC sources with pulsars in the Australia Telescope National Facility (ATNF) pulsar catalog and supernova remnants in the Galactic supernova remnant catalog.
Leaves of Arctium lappa contain several mono- and dicaffeoylquinic acids, as evaluated by liquid chromatography-mass spectrometry. In order to investigate the protection on gastric mucosa against ...ulcers, rats were treated with fractions from leaf extract prior to ethanol-induced ulcers. The original fraction obtained as ethanol soluble fraction from hot aqueous extract was able to protect de gastric mucosa, and this effect was retained in the ethyl acetate fraction, obtained from liquid/liquid fractionation. The main compound in this fraction was isolated and chemically characterized by nuclear magnetic resonance and mass spectrometry, assisted by isopropylidene derivatization which gave rise a mass increment of 40 units. Therefore, the underivatized compound that had m/z 515.119 M-H- was shifted to m/z 555.151, being confirmed as 1,3-O-dicaffeoylquinic acid, which presented an ED50 of 57µgkg−1 on gastric protection, lesser than the therapeutic concentration of omeprazole (40mgkg−1).
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•Leaf extract from Arctium lappa was active against ethanol-induced ulcers;•The active compound was isolated and characterized as 1,3-O-dicaffeoylquinc acid;•The isomer 1,5-O-dicaffeoylquinic acid was not effective;•NMR and MS fingerprints analysis of native and modified structure were developed.
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