The economic benefit of timely, adequate, and adherence to Parkinson's disease treatment: the Value of Treatment Project 2

Background: Parkinson's disease (PD) is a chronic progressive neurological disorder with a high psychosocial and economic burden. As part of the European Brain Council (EBC)-led Value of Treatment project, this study aimed to capture the economic benefit of timely, adequate, and adherence to PD treatment. Methods: The EBC Value of Treatment Initiative combined different stakeholders to identify unmet needs in the patients’ journey according to Rotterdam methodology. The economic evaluation focused on three major topics identified as major gaps: start of treatment; best treatment for advanced disease; and adherence to treatment. Two separate healthcare systems (Germany and the UK) were chosen. Cost-effectiveness was determined by using decision-analytical modelling approaches. Effectiveness was expressed as quality-adjusted life-years (QALYs) gained and incremental cost-effectiveness ratio (ICER). Results: Treatment intervention in PD was found to be cost-effective regardless of the initial health state of the patient receiving the treatment. Cost savings were between -€1000 and −€5400 with 0.10 QALY gain and -€1800 and -€7600 with 0.10 QALY gain for Germany and the UK, respectively. Treatment remains cost-effective within the National Institute for Health and Care Excellence thresholds. Availability of adequate treatment to more patients was also found to be cost-effective, with an ICER of €15,000–€32,600 across country settings. Achieving the target adherence to treatment would generate cost-savings of €239,000–€576,000 (Germany) and €917,000–€2,980.000 (UK) for every 1,000 patients treated adequately. Conclusions: The analyses confirmed that timely, adequate, and adherence to PD treatment will not only improve care of the patients but is also cost-effective across healthcare systems. Further studies with a distinct identification of gaps in care are necessary to develop better and affordable care

TEM study of the martensitic phases in the ductile DyCu and YCu intermetallic compounds

DyCu and YCu are representatives of the family of CsCI-type B2 rare earth intermetallic compounds that exhibit high room temperature ductility. Structure, orientation relationship, and morphology of the martensites in the equiatomic compounds DyCu and YCu are examined using transmission electron microscopy (TEM). TEM studies show that the martensite structures in DyCu and YCu alloys are virtually identical. The martensite is of orthorhombic CrB-type B33 structure with lattice parameters a = 0.38 nm, b = 1.22 nm, and c = 0.40 nm. (02 (1) over bar) twins were observed in the B33 DyCu and YCu martensites. The orientation relationship of B33 and B2 phases is (11 (1) over bar)[112]B33 parallel to (110)[001]B2. The simulated electron diffraction patterns of the B33 phase are consistent with those of experimental observations. TEM investigations also reveal that a dominant orthorhombic FeB-type B27 martensite with lattice parameters a = 0.71 nm, b = 0.45 nm, and c = 0.54 nm exists in YCu alloy. (I (1) over barI) twins were observed in the B27 YCu martensite. The formation mechanism of B2 to B33 and B2 to B27 phase transformation is discussed

Catechol-O-methyltransferase inhibition with tolcapone reduces the "wearing off" phenomenon and levodopa requirements in fluctuating parkinsonian patients.

BACKGROUND: More than 50% of patients with Parkinson's disease develop motor response fluctuations (the "wearing off" phenomenon) after more than five years of levodopa therapy. Inhibition of catechol-O-methyltransferase by tolcapone has been shown to increase levodopa bioavailability and plasma elimination half life, thereby prolonging the efficacy of levodopa. OBJECTIVES: The primary objective was to evaluate the efficacy of tolcapone in reducing "wearing off" in levodopa treated, fluctuating parkinsonian patients. Secondary objectives included assessment of reduction in levodopa requirements, improvement in patients' clinical status, duration of improvements, and tolerability of tolcapone. METHODS: In this multicentre, randomised, double blind, placebo controlled trial, 58 patients received placebo, 60 received 100 mg tolcapone three times daily (tid), and 59 received 200 mg tolcapone tid, in addition to levodopa/benserazide. RESULTS: After three months with 200 mg tolcapone tid, "off" time decreased by 26.2% of the baseline value, "on" time increased by 20.6% (P<O.01 v placebo), and the mean total daily levodopa dose decreased by 122 mg from the baseline dose of 676 mg (P<0.01). These responses were maintained up to nine months. With 100 mg tolcapone tid, "off" time decreased by 31.5% (P<0.05), "on" time increased by 21.3% (P<0.01), and the mean total daily levodopa dose decreased by 109 mg from the baseline dose of 668 mg (P<0.05). With 200 mg tolcapone tid, unified Parkinson's disease rating scale motor and total scores were significantly reduced, and quality of life (sickness impact profile) scores were significantly improved. Both dosages were well tolerated. Dyskinesia was the most often reported levodopa induced adverse event. Diarrhea was the most often reported non-dopaminergic adverse event and the most frequent reason for withdrawal from the study: four patients in the 100 mg tolcapone tid group and six in the 200 mg tid group withdrew because of diarrhea. CONCLUSION: Tolcapone prolongs "on" time in fluctuating parkinsonian patients while allowing a reduction in daily levodopa dosage, thereby improving the efficacy of long term levodopa therapy

Anisotropic admixture in color-superconducting quark matter

The analysis of color-superconducting two-flavor deconfined quark matter at moderate densities is extended to include a particular spin-1 Cooper pairing of those quarks which do not participate in the standard spin-0 diquark condensate. (i) The relativistic spin-1 gap Delta' implies spontaneous breakdown of rotation invariance manifested in the form of the quasi-fermion dispersion law. (ii) The critical temperature of the anisotropic component is approximately given by the relation T_c'~ Delta'(T=0)/3. (iii) For massless fermions the gas of anisotropic Bogolyubov-Valatin quasiquarks becomes effectively gapless and two-dimensional. Consequently, its specific heat depends quadratically on temperature. (iv) All collective Nambu-Goldstone excitations of the anisotropic phase have a linear dispersion law and the whole system remains a superfluid. (v) The system exhibits an electromagnetic Meissner effect.Comment: v2: references added, angular dependence of the gap clarified, v3: extended discussion, typo in eq. (5) corrected, version accepted for publication in PR

Socioeconomic impact of restless legs syndrome and inadequate restless legs syndrome management across European settings

Restless legs syndrome (RLS) is one of the most common neurological disorders. It describes an irresistible urge to move the legs, mostly manifested in the evening and at night, which can lead to severe sleep disturbance. As part of the European Brain Council (EBC)-led Value-of-Treatment project, this study aimed at capturing the socioeconomic impact of RLS related to the inadequate diagnosis and treatment across different European healthcare settings. The economic burden of RLS was estimated using the published EBC framework of analysis in three separate European Union healthcare systems (France, Germany, and Italy). The RLS care pathway was mapped to identify the unmet needs of patients. Based on specific patient stories, the economic impact of correctly diagnosing RLS and changing between inadequate and target treatment was calculated using appropriate scenario analysis. RLS proved to be a significant personal and social burden, when epidemiological data, high prevalence of RLS, and its need for treatment are combined. By looking at the savings emerging from the provision of optimal care management (timely and correct diagnosis, evidence-based therapy, avoidance of therapy-related complications such as augmentation), the authors foresee substantial economic savings with the achievement of adequate diagnosis and treatment of RLS. Education about RLS is urgently needed for all subspecialties involved in RLS patient care as well as the general public. Equally important, the search for new causal treatment strategies should be intensified to reduce suffering and substantial societal cost

Meson loop effects in the NJL model at zero and non-zero temperature

We compare two different possibilities to include meson-loop corrections in the Nambu-Jona-Lasinio model: a strict 1/N_c-expansion in next-to-leading order and a non-perturbative scheme corresponding to a one-meson-loop approximation to the effective action. Both schemes are consistent with chiral symmetry, in particular with the Goldstone theorem and the Gell-Mann-Oakes-Renner relation. The numerical part at zero temperature focuses on the pion and the rho-meson sector. For the latter the meson-loop-corrections are crucial in order to include the dominant rho -> pipi-decay channel, while the standard Hartree + RPA approximation only contains unphysical qqbar-decay channels. We find that m_\pi, f_\pi, and quantities related to the rho-meson self-energy can be described reasonably with one parameter set in the 1/N_c-expansion scheme, whereas we did not succeed to obtain such a fit in the non-perturbative scheme. We also investigate the temperature dependence of the quark condensate. Here we find consistency with chiral perturbation theory to lowest order. Similarities and differences of both schemes are discussed.Comment: 51 pages, 18 figures, to be published in Physics of Atomic Nuclei, the volume dedicated to the 90th birthday of A.B. Migdal, error in Eq. 4.22 correcte

The Computational Complexity of Knot and Link Problems

We consider the problem of deciding whether a polygonal knot in 3-dimensional Euclidean space is unknotted, capable of being continuously deformed without self-intersection so that it lies in a plane. We show that this problem, {\sc unknotting problem} is in {\bf NP}. We also consider the problem, {\sc unknotting problem} of determining whether two or more such polygons can be split, or continuously deformed without self-intersection so that they occupy both sides of a plane without intersecting it. We show that it also is in NP. Finally, we show that the problem of determining the genus of a polygonal knot (a generalization of the problem of determining whether it is unknotted) is in {\bf PSPACE}. We also give exponential worst-case running time bounds for deterministic algorithms to solve each of these problems. These algorithms are based on the use of normal surfaces and decision procedures due to W. Haken, with recent extensions by W. Jaco and J. L. Tollefson.Comment: 32 pages, 1 figur

Ti-Al composite wires with high specific strength

An alternative deformation technique was applied to a composite made of titanium and an aluminium alloy in order to achieve severe plastic deformation. This involves accumulative swaging and bundling. Furthermore, it allows uniform deformation of a composite material while producing a wire which can be further used easily. Detailed analysis concerning the control of the deformation process, mesostructural and microstructural features and tensile testing was carried out on the as produced wires. A strong grain refinement to a grain size of 250–500 nm accompanied by a decrease in h111i fibre texture component and a change from low angle to high angle grain boundary characteristics is observed in the Al alloy. A strong increase in the mechanical properties in terms of ultimate tensile strength ranging from 600 to 930 MPa being equivalent to a specific strength of up to 223 MPa/g/cm3 was achieved

Malignancy risk analysis in patients with inadequate fine needle aspiration cytology (FNAC) of the thyroid

Background Thyroid fine needle aspiration cytology (FNAC) is the standard diagnostic modality for thyroid nodules. However, it has limitations among which is the incidence of non-diagnostic results (Thy1). Management of cases with repeatedly non-diagnostic FNAC ranges from simple observation to surgical intervention. We aim to evaluate the incidence of malignancy in non-diagnostic FNAC, and the success rate of repeated FNAC. We also aim to evaluate risk factors for malignancy in patients with non-diagnostic FNAC. Materials and Methods Retrospective analyses of consecutive cases with thyroid non diagnostic FNAC results were included. Results Out of total 1657 thyroid FNAC done during the study period, there were 264 (15.9%) non-diagnostic FNAC on the first attempt. On repeating those, the rate of a non-diagnostic result on second FNAC was 61.8% and on third FNAC was 47.2%. The overall malignancy rate in Thy1 FNAC was 4.5% (42% papillary, 42% follicular and 8% anaplastic), and the yield of malignancy decreased considerably with successive non-diagnostic FNAC. Ultrasound guidance by an experienced head neck radiologist produced the lowest non-diagnostic rate (38%) on repetition compared to US guidance by a generalist radiologist (65%) and by non US guidance (90%). Conclusions There is a low risk of malignancy in patients with a non-diagnostic FNAC result, commensurate to the risk of any nodule. The yield of malignancy decreased considerably with successive non-diagnostic FNAC