Predicting the costs of managing patients with chronic obstructive pulmonary disease

SummaryThe economic consequences of chronic obstructive pulmonary disease (COPD) are considerable, although the factors that best predict costs are largely unknown. This study used a population-based cohort to identify the clinical factors during an index year that were most predictive of increased direct medical costs in the subsequent year, and to develop a predictive model that described the cost variations in COPD.The medical records of 2116 patients enrolled in one regional health system who had COPD and healthcare resource utilisation data for 1998 and 1999, were abstracted for information about symptoms, smoking history, chronic illnesses, and pulmonary function data. All inpatient, outpatient and pharmacy utilisation data for each subject for 1999 were extracted from the database. Total costs for each individual were transformed to a log scale. Potential causes of cost variability (predictor variables) were defined and classified into sets (or domains). Multiple linear regression models were fitted for each domain.The study demonstrated that severity of airflow obstruction, as assessed by FEV1% predicted, is a significant but weak predictor of future healthcare resource utilisation—prior hospitalisation and home oxygen use, the presence of comorbid conditions and symptoms of dyspnoea are better predictors of costs. Those interested in the economic benefits of new COPD treatments and disease management programs need to carefully account for these factors

An optical spectroscopic and polarimetric study of the microquasar binary system SS 433

Aims. Our aim is to study the mass transfer, accretion environment, and wind outflows in the SS 433 system, concentrating on the so-called stationary lines.Methods. We used archival high-resolution (X-shooter) and low-resolution (EMMI) optical spectra, new optical multi-filter polarimetry, and low-resolution optical spectra (Liverpool Telescope), spanning an interval of a decade and a broad range of precessional and orbital phases, to derive the dynamical properties of the system.Results. Using optical interstellar absorption lines and H I 21 cm profiles, we derive E(B-V) = 0.86 +/- 0.10, with an upper limit of E(B-V) = 1.8 +/- 0.1 based on optical Diffuse Interstellar Bands. We obtain revised values for the ultraviolet and U band polarizations and polarization angles (PA), based on a new calibrator star at nearly the same distance as SS 433 that corrects the published measurement and yields the same PA as the optical. The polarization wavelength dependence is consistent with optical-dominating electron scattering with a Rayleigh component in U and the UV filters. No significant phase modulation was found for PA while there is significant variability in the polarization level. We fortuitously caught a flare event; no polarization changes were observed but we confirm the previously reported associated emission line variations. Studying profile modulation of multiple lines of H I, He I, O I, Na I, Si II, Ca II, Fe II with precessional and orbital phase, we derive properties for the accretion disk and present evidence for a strong disk wind, extending published results. Using transition-dependent systemic velocities, we probe the velocity gradient of the wind, and demonstrate that it is also variable on timescales unrelated to the orbit. Using the rotational velocity, around 140 +/- 20 km s(-1), a redetermined mass ratio q=0.37 +/- 0.04, and masses M-X=4.2 +/- 0.4 M-circle dot, M-A=11.3 +/- 0.6 M-circle dot, the radius of the A star fills - or slightly overfills - its Roche surface. We devote particular attention to the O I 7772 angstrom and 8446 angstrom lines, finding that they show different but related orbital and precessional modulation and there is no evidence for a circumbinary component. The spectral line profile variability can, in general, be understood with an ionization stratified outflow predicted by thermal wind modeling, modulated by different lines of sight through the disk produced by its precession. The wind can also account for an extended equatorial structure detected at long wavelength.</div

An atlas of the knee joint proteins and their role in osteoarthritis defined by literature mining

[Abstract] Osteoarthritis (OA) is the most prevalent rheumatic pathology. However, OA is not simply a process of wear and tear affecting articular cartilage but rather a disease of the entire joint. One of the most common locations of OA is the knee. Knee tissues have been studied using molecular strategies, generating a large amount of complex data. As one of the goals of the Rheumatic and Autoimmune Diseases initiative of the Human Proteome Project, we applied a text-mining strategy to publicly available literature to collect relevant information and generate a systematically organized overview of the proteins most closely related to the different knee components. To this end, the PubPular literature-mining software was employed to identify protein-topic relationships and extract the most frequently cited proteins associated with the different knee joint components and OA. The text-mining approach searched over eight million articles in PubMed up to November 2022. Proteins associated with the six most representative knee components (articular cartilage, subchondral bone, synovial membrane, synovial fluid, meniscus, and cruciate ligament) were retrieved and ranked by their relevance to the tissue and OA. Gene ontology analyses showed the biological functions of these proteins. This study provided a systematic and prioritized description of knee-component proteins most frequently cited as associated with OA. The study also explored the relationship of these proteins to OA and identified the processes most relevant to proper knee function and OA pathophysiology.PI19/01206; Instituto de Salud Carlos IIIPI20/00793; Instituto de Salud Carlos IIIPI20/01409; Instituto de Salud Carlos IIIPI22/01155; Instituto de Salud Carlos IIIRICORS-REIRD21/0002/0009; Instituto de Salud Carlos IIIED431E2018/03; Xunta de GaliciaIN607A2021/07; Xunta de GaliciaIN607D2020/10; Xunta de Galici

A WIMP detector with two-phase xenon

Abstract We describe an important new technique to search for WIMPs. This technique employs a method of background discrimination using double phase xenon as detector target. We describe the construction of a two-phase, 1-kg xenon detector. The detector will be installed at the underground laboratory in the Mt. Blanc tunnel, which provides a low background rate. A comparison between the sensitivity curve of our detector and the theoretical events limit from SUSY calculations is presented

Low complexity soft demapping for non-binary LDPC codes

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Discovery of an autoantibody signature for the early diagnosis of knee osteoarthritis: data from the Osteoarthritis Initiative

[Abstract] Objective To find autoantibodies (AAbs) in serum that could be useful to predict incidence of radiographic knee osteoarthritis (KOA). Design A Nucleic-acid Programmable Protein Arrays (NAPPA) platform was used to screen AAbs against 2125 human proteins in sera at baseline from participants free of radiographic KOA belonging to the incidence and non-exposed subcohorts of the Osteoarthritis Initiative (OAI) who developed or not, radiographic KOA during a follow-up period of 96 months. NAPPA-ELISA were performed to analyse reactivity against methionine adenosyltransferase two beta (MAT2β) and verify the results in 327 participants from the same subcohorts. The association of MAT2β-AAb levels with KOA incidence was assessed by combining several robust biostatistics analysis (logistic regression, Receiver Operating Characteristic and Kaplan-Meier curves). The proposed prognostic model was replicated in samples from the progression subcohort of the OAI. Results In the screening phase, six AAbs were found significantly different at baseline in samples from incident compared with non-incident participants. In the verification phase, high levels of MAT2β-AAb were significantly associated with the future incidence of KOA and with an earlier development of the disease. The incorporation of this AAb in a clinical model for the prognosis of incident radiographic KOA significantly improved the identification/classification of patients who will develop the disorder. The usefulness of the model to predict radiographic KOA was confirmed on a different OAI subcohort. Conclusions The measurement of AAbs against MAT2β in serum might be highly useful to improve the prediction of OA development, and also to estimate the time to incidence.Instituto de Salud Carlos III; PT17/0019/0014Instituto de Salud Carlos III; PI14/01707Instituto de Salud Carlos III; PI16/02124Instituto de Salud Carlos III; PI17/00404Instituto de Salud Carlos III; DTS17/00200Instituto de Salud Carlos III; CIBER-BBN CB06/01/0040Insituto de Salud Carlos III; CIBER-ONC CB16/12/00400Instituto de Salud Carlos III; RETIC-RIER-RD12/0009/0018Xunta de Galicia; IN606A-2016/012Instituto de Salud Carlos III; CPII17/0026Insituto de Salud Carlos III; CPII15/0001

Precise 3D track reconstruction algorithm for the ICARUS T600 liquid argon time projection chamber detector

Liquid Argon Time Projection Chamber (LAr TPC) detectors offer charged particle imaging capability with remarkable spatial resolution. Precise event reconstruction procedures are critical in order to fully exploit the potential of this technology. In this paper we present a new, general approach of three-dimensional reconstruction for the LAr TPC with a practical application to track reconstruction. The efficiency of the method is evaluated on a sample of simulated tracks. We present also the application of the method to the analysis of real data tracks collected during the ICARUS T600 detector operation with the CNGS neutrino beam.Comment: Submitted to Advances in High Energy Physic

Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis

The field of inflammatory disease of the heart or "cardio-immunology " is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.Peer reviewe