Fracture liaison services (FLS), implemented in different ways and countries, are reported to be a cost-effective or even a cost-saving secondary fracture prevention strategy. This presumed favorable ...cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards. This study summarizes the economic impact and cost-effectiveness of FLS implemented to reduce subsequent fractures in individuals with osteoporosis. This systematic review identified studies reporting economic outcomes for FLS in osteoporotic patients aged 50 and older through a comprehensive search of MEDLINE, EMBASE, Cochrane Central, and PubMed of studies published January, 2000 to December, 2016. Grey literature (e.g., Google scholar, conference abstracts/posters) were also hand searched through February 2017. Two independent reviewers screened titles and abstracts and conducted full-text review on qualified articles. All disagreements were resolved by discussion between reviewers to reach consensus or by a third reviewer. In total, 23 qualified studies that evaluated the economic aspects of FLS were included: 16 cost-effectiveness studies, 2 cost-benefit analyses, and 5 studies of cost savings. Patient populations varied (prior fragility fracture, non-vertebral fracture, hip fracture, wrist fracture), and FLS strategies ranged from mail-based interventions to comprehensive nurse/physician-coordinated programs. Cost-effectiveness studies were conducted in Canada, Australia, USA, UK, Japan, Taiwan, and Sweden. FLS was cost-effective in comparisons with usual care or no treatment, regardless of the program intensity or the country in which the FLS was implemented (cost/QALY from $3023–$28,800 US dollars (USD) in Japan to $14,513–$112,877 USD in USA. Several studies documented cost savings. FLS, implemented in different ways and countries, are reported to be cost-effective or even cost-saving. This presumed favorable cost-benefit relationship is encouraging and lends support to expanded implementation of FLS per International Osteoporosis Foundation Best Practice Standards.
A new open source multi-GPU 2D flood model called TRITON is presented in this work. The model solves the 2D shallow water equations with source terms using a time-explicit first order upwind scheme ...based on an Augmented Roe's solver that incorporates a careful estimation of bed strengths and a local implicit formulation of friction terms. The scheme is demonstrated to be first order accurate, robust and able to solve for flows under various conditions. TRITON is implemented such that the model effectively utilizes heterogeneous architectures, from single to multiple CPUs and GPUs. Different test cases are shown to illustrate the capabilities and performance of the model, showing promising runtimes for large spatial and temporal scales when leveraging the computer power of GPUs. Under this hardware configuration, communication and input/output subroutines may impact the scalability. The code is developed under an open source license and can be freely downloaded in https://code.ornl.gov/hydro/triton.
•TRITON is released as a multi-GPU open source 2D hydrodynamic flood code.•It solves the 2D shallow water equations using a first order time-explicit scheme.•It runs efficiently for realistic configurations using heterogeneous architectures.•The runoff capability is demonstrated to be convenient for flood modeling.•Communication and I/O times may represent a bottleneck for operational purposes.
Summary
Background
Hepatitis C virus (HCV) infection has been linked to an increased risk of insulin resistance and carotid atherosclerosis.
Aim
To investigate the association between HCV infection ...and stroke, and the effect of interferon‐based therapy (IBT) on stroke risk in chronic hepatitis C (CHC) patients.
Methods
We conducted a retrospective cohort study that followed up 3113 subjects with a newly detected HCV infection and 12 452 age‐ and gender‐matched subjects without HCV infection selected from a random sample of 106 beneficiaries from the Taiwan National Health Insurance Program up to 5 years. Use of IBT was defined as treatment with interferon alpha, pegylated interferon alpha‐2a or pegylated interferon alpha‐2b for at least 3 months. The hazard ratio (HR) for newly detected stroke was calculated for subjects with HCV compared to those without HCV, and for IBT‐treated HCV patients compared to non‐IBT‐treated HCV patients while adjusting for possible confounding factors.
Results
The overall person‐years of follow‐up were 8624.11 in patients with HCV, 54 533.69 in patients without HCV, 666.65 in IBT‐treated patients, and 7886.49 in nontreated patients. The multivariable‐adjusted hazard ratio (HR) for newly detected stroke was 1.23 for subjects with HCV compared to the age‐ and sex‐matched subjects without HCV (adjusted HR = 1.23, 95% CI = 1.06–1.42, P = 0.008). Moreover, use of IBT significantly reduced the risk of stroke in HCV patients (adjusted HR = 0.39, 95% CI = 0.16–0.95, P = 0.039) after adjusting for known prognostic factors.
Conclusions
Interferon‐based therapy may reduce the long‐term risk of stroke in patients with chronic HCV infection.
Aim
To investigate the influence of mineral trioxide aggregate (MTA) on angiogenesis of primary human dental pulp cells (hDPCs) via the MAPK pathway, in particular p38.
Methodology
Human dental pulp ...cells were cultured with MTA to angiogenesis, after which cell viability, ion concentration, osmolality, NO secretion, the von Willebrand factor (vWF) and angiopoietin‐1 (Ang‐1) protein expression were examined. PrestoBlue® was used for evaluating the proliferation of hDPCs. An enzyme‐linked immunosorbent assay was employed to determine vWF and Ang‐1 protein secretion in hDPCs cultured on MTA and the control. Cells cultured on the tissue culture plate without the cement were used as the control. The t‐test was used to evaluate the significance of the differences between the mean values.
Results
Mineral trioxide aggregate elicited a significant (P < 0.05) increased viability compared with the control (15%, 16% and 13% on days 1, 3 and 5 of cell seeding, respectively). MTA consumed calcium and phosphate ions, and released more Si ions in the medium. MTA significantly (P < 0.05) increased the osmolality of the medium to 313, 328 and 341 mOsm kg−1 after 1, 3 and 5 days, respectively. P38 was activated through phosphorylation, and the phosphorylation kinase was investigated in the cell system after being cultured with MTA. Expression levels for Ang‐1 and vWF in hDPCs on MTA were higher than those of the MTA + p38 inhibitor (SB203580) group (P < 0.05) at all of the time‐points.
Conclusions
Mineral trioxide aggregate was able to activate the p38 pathway in hDPCs cultured in vitro. Moreover, Si increased the osmolality required to facilitate the angiogenic differentiation of hDPCs via the p38 signalling pathway. When the p38 pathway was blocked by SB203580, the angiogenic‐dependent protein secretion decreased. These findings verify that the p38 pathway plays a key role in regulating the angiogenic behaviour of hDPCs cultured on MTA.
Micromechanisms of fracture from acoustic emission Kao, C.-S.; Carvalho, F.C.S.; Labuz, J.F.
International journal of rock mechanics and mining sciences (Oxford, England : 1997),
06/2011, Letnik:
48, Številka:
4
Journal Article
Recenzirano
Acoustic emission (AE) events were located and characterized from a mode I fracture test on Charcoal granite. An AE source was modeled as a displacement discontinuity, a microcrack, with a ...displacement vector
b, normal
n, and area Δ
A. For convenience, the source parameters were recovered through a moment tensor representation, the components of which were estimated by minimizing the error between theoretical and measured displacements at sensor positions, with an appropriate constraint on the moment tensor for the microcrack model. Amplitude sensitivity was obtained through a calibration method with a step-unloading point source, providing the linkage between the AE signal and the measured displacement. The source mechanisms of some 400 events were identified as mixed-mode but shear dominant, with both opening and closing normal displacements. Decomposition of the microcrack volumes
b
i
Δ
A into the global coordinate system of the specimen revealed a positive accumulation of opening volume compatible with the mode I fracture mechanism, while the change in the vertical component agreed with the trend of beam deflection, even during a snap-back response. An out-of-plane, mode III microcrack volume component was also detected, which reflects the nature of the local deviation of the fracture path due to heterogeneity on the grain scale. Microcrack orientations, defined by horizontal and vertical angles called tortuosity and inclination angles, respectively, provided the explanation for the shear-dominant mechanisms on the local scale but opening on the structural level. Thus, shear-type AE events can be consistent with tensile fracture, as microcracks are locally based at various orientations.
► Acoustic emission is modeled as a point source of displacement discontinuity, a microcrack, described by displacement vector
b, normal
n, and area Δ
A. ► From a moment tensor representation of a microcrack, the source mechanisms from a mode I fracture test are identified as shear dominant. ► Decomposition of
b
i
Δ
A reveals a positive accumulation of opening volume compatible with mode I fracture. ► Due to fracture tortuosity, shear-dominant mechanisms on the local scale can be consistent with opening on the global level.
Oxidative stress has been increasingly linked to the high incidence of cardiovascular events in patients with chronic kidney disease (CKD), especially as traditional cardiovascular risk factors seem ...to not be able to account for the huge cardiovascular morbidity and mortality in this population group. Oxidative stress is increased in patients with renal impairment as a result of increased oxidant activity and reduced antioxidant capacity, and this is increased in a graded manner with increasing renal dysfunction. Inflammation, which is also present in CKD, further amplifies the oxidant generation process. The two clinical sequelae of oxidative stress are endothelial dysfunction and left ventricular hypertrophy, which have adverse cardiovascular consequences. With our new understanding of oxidative stress, it is now important to assess treatment options that reduce it in the hope that they reverse endothelial dysfunction and left ventricular hypertrophy and the clinical sequelae of these abnormalities.
Periodontal disease encompasses gingivitis and periodontitis, which exerts systemic effects. We conducted a population-based study to evaluate the association between periodontal disease and the risk ...of cancer.
We used insurance claims data from 1997 to 2010, accessing a database of 1 million randomly selected insurants in Taiwan. All patients were older than 20 and newly diagnosed with periodontitis between 1 January 1997 and 31 December 2010. The comparison cohort comprised patients older than 20, who were newly diagnosed with gingivitis in the same period. Both cohorts were followed until a cancer diagnosis, lost to follow-up, death, termination of insurance, or the end of 2010.
The incidence rate of cancer was 1.14 times higher in the study cohort than in the comparison cohort confidence interval (CI) = 1.11-1.17. The adjusted hazard ratio (HR) was 1.05 (95% CI = 1.00-1.11). A multivariable analysis showed that the periodontitis patients exhibited an elevated risk of developing oral cancer (adjusted HR = 1.79, 95% CI = 1.42-2.25).
The findings indicated that patients in the periodontitis cohort exhibited a higher risk of developing oral cancer than those in the gingivitis cohort.
Both the Yangtze River Delta (YRD) and the Pearl River Delta (PRD), the two most rapidly developing areas in eastern China, have suffered from serious air pollution, and thus, numerous investigations ...were devoted to studying these problems. Other areas in eastern China have received less attention despite similar rapid development in their industries and economy. In this study, we analyzed air‐quality data from Kinmen Island (24°27′26″N, 118°19′36″E) located off Fujian Province and between the two above‐mentioned deltas. Our results clearly show that the study area is experiencing serious air quality deterioration. Particularly, high levels of suspended particulate matter (PM) were observed during winter, when the northeasterly monsoon prevails. For example, concentrations of wintertime PM10 (particles ≤ 10 μm in diameter) frequently exceeded 100 μg/m3 in the last three years. In addition to the air‐quality data analysis, aerosol samples were collected between 22 November 2007 and 6 March 2008 and subjected to chemical analyses of various species. Our findings show that the three principal PM components include organic, mineral, and sulfate species with moderate to minor fractions of nitrate, sea salt, elemental carbon, and trace metal oxides. The high PM levels observed over the island may be partly attributed to the transport from a mixed‐type industrial area located ∼40 km northeast of Kinmen. Our study could partially fill the air quality data gap between the YRD and PRD regions, and highlight the alarming fact that air pollution has gradually expanded along eastern China's coastal zone.
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