Determining initial and follow-up costs of cardiovascular events in a US managed care population

<p>Abstract</p> <p>Background</p> <p>Cardiovascular (CV) events are prevalent and expensive worldwide both in terms of direct medical costs at the time of the event and follow-up healthcare after the event. This study aims to determine initial and follow-up costs for cardiovascular (CV) events in US managed care enrollees and to compare to healthcare costs for matched patients without CV events.</p> <p>Methods</p> <p>A 5.5-year retrospective matched cohort analysis of claims records for adult enrollees in ~90 US health plans. Patients hospitalized for first CV event were identified from a database containing a representative sample of the commercially-insured US population. The CV-event group (n = 29,688) was matched to a control group with similar demographics but no claims for CV-related events. Endpoints were total direct medical costs for inpatient and outpatient services and pharmacy (paid insurance amount).</p> <p>Results</p> <p>Overall, mean initial inpatient costs were US dollars ($) 16,981 per case (standard deviation [SD] =$20,474), ranging from $6,699 for a transient ischemic attack (mean length of stay [LOS] = 3.7 days) to$56,024 for a coronary artery bypass graft (CABG) (mean LOS = 9.2 days). Overall mean health-care cost during 1-year follow-up was $16,582 (SD =$34,425), an excess of $13,792 over the mean cost of matched controls. This difference in average costs between CV-event and matched-control subjects was$20,862 and $26,014 after two and three years of follow-up. Mean overall inpatient costs for second events were similar to those for first events ($17,705/case; SD = $22,703). The multivariable regression model adjusting for demographic and clinical characteristics indicated that the presence of a CV event was positively associated with total follow-up costs (P < 0.0001).</p> <p>Conclusions</p> <p>Initial hospitalization and follow-up costs vary widely by type of CV event. The 1-year follow-up costs for CV events were almost as high as the initial hospitalization costs, but much higher for 2- and 3-year follow-up.</p

Role of Insect Pollinators in Crop Production and Ecosystem

Pollinators, particularly insects, play an indispensable role in ensuring the health of terrestrial ecosystems and in bolstering agricultural productivity. Their symbiotic relationship with plants has evolved over millennia, resulting in co-adaptations that facilitate the reproductive success of many plant species. This review sheds light on the multifaceted interactions between insect pollinators and plants, emphasizing their contributions not only in crop production but also in maintaining broader ecosystem services. The importance of insect pollinators, such as bees, butterflies, beetles, and flies, among others, is highlighted by their direct influence on the yield and quality of many crops. Notably, global agricultural sectors like fruits (e.g., apples and berries) and nuts (e.g., almonds) heavily depend on these insects for pollination. In economic terms, pollinators contribute substantially, with their decline potentially resulting in significant economic losses globally. Beyond agriculture, insect pollinators play a role in numerous ecosystem services. They aid in seed dispersal, ensuring gene flow and maintaining genetic diversity within plant populations. They act as crucial nodes in the food web, serving as prey for a plethora of species. They also indirectly support soil health by promoting the decomposition of plant matter, which enriches soil fertility and structure. Despite their importance, pollinators are under threat from various anthropogenic factors. Pesticides, habitat destruction, and climate change have been identified as primary drivers behind the decline of many pollinator species. Disease outbreaks and the proliferation of parasites further compound these challenges. Addressing these threats requires integrated conservation strategies. Practices like integrated pest management can minimize pesticide impact, while creating and maintaining pollinator habitats in agricultural and urban landscapes can provide refuges for these insects. Breeding programs targeting disease and parasite resistance and global collaborative efforts can further bolster pollinator populations. Investing in their conservation is not just an ecological imperative but also a socioeconomic one, ensuring food security for the growing global population. Emerging research avenues, such as genomic studies on pollinators, offer potential solutions and deeper insights into their resilience and adaptability. As the world grapples with escalating environmental challenges, understanding and supporting insect pollinators is paramount for a sustainable future.Insect pollinator

Enzymatic functionalization of cork surface with antimicrobial hybrid biopolymer/silver nanoparticles

Laccase-assisted assembling of hybrid biopolymer-silver nanoparticles and cork matrices into an antimicrobial material with potential for water remediation is herein described. Amino-functional biopolymers were first used as doping agents to stabilize concentrated colloidal dispersions of silver nanoparticles (AgNP), additionally providing the particles with functionalities for covalent immobilization onto cork to impart a durable antibacterial effect. The solvent-free AgNP synthesis by chemical reduction was carried out in the presence of chitosan (CS) or 6-deoxy-6-(omega-aminoethyl) aminocellulose (AC), leading to simultaneous AgNP biofunctionalization. This approach resulted in concentrated hybrid NP dispersion stable to aggregation and with hydrodynamic radius of particles of about 250 nm. Moreover, laccase enabled coupling between the phenolic groups in cork and amino moieties in the biopolymer-doped AgNP for permanent modification of the material. The antibacterial efficiency of the functionalized cork matrices, aimed as adsorbents for wastewater treatment, was evaluated against Escherichia coli and Staphylococcus aureus during 5 days in conditions mimicking those in constructed wetlands. Both intrinsically antimicrobial CS and AC contributed to the bactericidal effect of the enzymatically grafted on cork AgNP. In contrast, unmodified AgNP were easily washed off from the material, confirming that the biopolymers potentiated a durable antibacterial functionalization of the cork matrices.Peer Reviewe