Healthcare use and direct medical costs in a cleft lip and palate population:an analysis of observed and protocolized care and costs

This study was performed to describe observed healthcare utilization and medical costs for patients with a cleft, compare these costs to the expected costs based on the treatment protocol, and explore the additional costs of implementing the International Consortium for Health Outcomes Measurement (ICHOM) Standard Set for Cleft Lip and Palate (CL/P). Forty patients with unilateral CL/P between 0 and 24 years of age, treated between 2012 and 2019 at Erasmus University Medical Center, were included. Healthcare services (consultations, diagnostic and surgical procedures) were counted and costs were calculated. Expected costs based on the treatment protocol were calculated by multiplying healthcare products by the product prices. Correspondingly, the additional expected costs after implementing the ICHOM Standard Set (protocol + ICHOM) were calculated. Observed costs were compared with protocol costs, and the additional expected protocol + ICHOM costs were described. The total mean costs were highest in the first year after birth (€5596), mainly due to surgeries. The mean observed total costs (€40,859) for the complete treatment (0–24 years) were 1.6 times the expected protocol costs (€25,198) due to optional, non-protocolized procedures. Hospital admissions including surgery were the main cost drivers, accounting for 42% of observed costs and 70% of expected protocol costs. Implementing the ICHOM Standard Set increased protocol-based costs by 7%.</p

Extended Functionality in Verifiable Searchable Encryption

Abstract. When outsourcing the storage of sensitive data to an (un-trusted) remote server, a data owner may choose to encrypt the data beforehand to preserve confidentiality. However, it is then difficult to efficiently retrieve specific portions of the data as the server is unable to identify the relevant information. Searchable encryption has been well studied as a solution to this problem, allowing data owners and other au-thorised users to generate search queries which the server may execute over the encrypted data to identify relevant data portions. However, many current schemes lack two important properties: verifia-bility of search results, and expressive queries. We introduce Extended Verifiable Searchable Encryption (eVSE) that permits a user to verify that search results are correct and complete. We also permit verifiabl

Maliciously Secure Multi-Client ORAM

Oblivious RAM (ORAM) has emerged as an enabling technology to secure cloud-based storage services. The goal of this cryptographic primitive is to conceal not only the data but also the access patterns from the server. While the early constructions focused on a single client scenario, a few recent works have focused on a setting where multiple clients may access the same data, which is crucial to support data sharing applications. All these works, however, either do not consider malicious clients or they significantly constrain the definition of obliviousness and the system\u27s practicality. It is thus an open question whether a natural definition of obliviousness can be enforced in a malicious multi-client setting and, if so, what the communication and computational lower bounds are. In this work, we formalize the notion of maliciously secure multi-client ORAM, we prove that the server-side computational complexity of any secure realization has to be $\Omega(n)$, and we present a cryptographic instantiation of this primitive based on private information retrieval techniques, which achieves an $O(\sqrt{N})$ communication complexity. We further devise an efficient access control mechanism, built upon a novel and generally applicable realization of plaintext equivalence proofs for ciphertext vectors. Finally, we demonstrate how our lower bound can be bypassed by leveraging a trusted proxy, obtaining logarithmic communication and server-side computational complexity. We implemented our scheme and conducted an experimental evaluation, demonstrating the feasibility of our approach

Dynamic Electrowetting on Nanofilament Silicon for Matrix-Free Laser Desorption/Ionization Mass Spectrometry

Dynamic electrowetting on nanostructured silicon surfaces is demonstrated as an effective method for improving detection sensitivity in matrix-free laser desorption/ ionization mass spectrometry. Without electrowetting, silicon surfaces comprising dense fields of oriented nanofilaments are shown to provide efficient ion generation and high spectral peak intensities for deposited peptides bound to the nanofilaments through hydrophobic interactions. By applying an electrical bias to the silicon substrate, the surface energy of the oxidized nanofilaments can be dynamically controlled by electrowetting, thereby allowing aqueous buffer to penetrate deep into the nanofilament matrix. The use of electrowetting is shown to result in enhanced interactions between deposited peptides and the nanofilament silicon surface, with improved signal-to-noise ratio for detected spectral peaks. An essential feature contributing to the observed performance enhancement is the open-cell nature of the nanofilament surfaces, which prevents air from becoming trapped within the pores and limiting solvent penetration during electrowetting. The combination of nanofilament silicon and dynamic electrowetting is shown to provide routine detection limits on the order of several attomoles for a panel of model peptides. Following its introduction in the late 1980s, 1 matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS) has emerged as a leading method for soft ionization of analyte molecules prior to mass determination, typically by time-of-flight (TOF) MS. The technique has been widely used for a range of biopolymers, which are typically cocrystallized with a UV-absorbing organic matrix to enhance their ionization efficiency. However, MALDI-MS is well-known to suffer from excessive matrix background signal for low molecular weight analytes, and thus its application has been limited to the study of relatively large biopolymers. Furthermore, MALDI-MS sensitivity is generally lower than that of electrospray ionization (ESI)-MS, with typical detection limits around 1 fmol, 2 although limits on the order of 10-100 amol can achieved using microstructured targets and optimized target preparation methods. [3][4][5] In 1999, Wei et al. reported the desorption/ionization on porous silicon (DIOS) technique, 6 in which an electrochemically etched porous silicon (pSi) surface serves to efficiently absorb UV laser energy during LDI-MS analysis, allowing effective biomolecular measurements in the absence of organic matrix. As a result, matrix interference typically encountered below ca. 500 m/z in MALDI-MS is eliminated, allowing biomolecules within this range to be accessed by the DIOS-MS technology. 1 In addition to smallmolecule analysis, 7 the technology has been applied to protein characterization. [8][9][10] Because the pSi targets can be readily functionalized, preferential binding of analytes based on affinity 11,12 or hydrophobic 13 interactions has been demonstrated. The high sensitivity combined with good tolerance to contaminants also makes DIOS-MS an attractive platform for forensics applications. 14 Detailed reviews of the DIOS-MS technique, including background and applications, have been presented in recent review papers. 15,16 Nanostructured pSi surfaces developed for DIOS-MS are prepared by galvanostatic etching of silicon, 6,17,18 resulting in a surface consisting of nanoscale pores which exhibit a closed-cell morphology. For the analysis of biopolymers containing hydrophobic domains, such as peptides, silylation of the pSi surface

Simultaneous Imaging of Small Metabolites and Lipids in Rat Brain Tissues at Atmospheric Pressure by Laser Ablation Electrospray Ionization Mass Spectrometry

Atmospheric pressure imaging mass spectrometry is a rapidly expanding field that offers advantages in the ability to study biological systems in their native condition, simplified sample preparation, and high-throughput experiments. In laser ablation electrospray ionization (LAE-SI), the native water molecules in biological tissues facilitate sampling by a focused mid-infrared laser beam. The ionization of the ablated material is accomplished by electrospray postionization. In this work, we demonstrate that the imaging variant of LAESI simultaneously provides lateral distributions for small metabolites and lipids directly in rat brain sections. To cope with the fragile nature and potential dehydration of the brain tissue due to drying in the ambient environment as well as to minimize analyte redistribution, a Peltier cooling stage is integrated into the LAESI imaging system. We demonstrate the utility of high-resolution (m/∆m &gt; 6000) timeof-flight mass spectrometry with LAESI to deconvolute spatial distributions of different chemical species with identical nominal mass. To help with the evaluation of the massive data sets, Pearson colocalization maps are calculated for selected small metabolites and lipids. We show that this approach reveals biologically meaningful correlations between these two classes of biomolecules. Continued developments in imaging mass spectrometry (MS) have provided a variety of techniques to report on the distribution of endogenous molecules and xenobiotics in biological tissues. The biological sciences and drug discovery have benefited from imaging MS methods, 1 such as matrix-assisted laser desorption ionization (MALDI) and secondary ion mass spectrometry (SIMS), and most recently, nanostructure initiator mass spectrometry (NIMS). These techniques have demonstrated exceptional capabilities in molecular imaging of animal tissue and whole-body sections under vacuum conditions. 2-9 To probe biochemical processes under native conditions, similar imaging capabilities are needed for the atmospheric pressure environment. Molecular imaging with MS under atmospheric pressure conditions is based on emerging techniques that offer simplified sample preparation and a capability for high-throughput analysis. [10][11][12] Although the imaging time for a ∼1 cm 2 area can be measured in hours, the acquired data set contains information on the distribution of hundreds of chemical species. This compares favorably with the time requirement for, e.g., optical methods that require separate tagging or staining for every species of interest. Among the direct ionization MS techniques, the spatial organization of small biomolecules and xenobiotics in biological tissues has been studied with the imaging variant of desorption electrospray ionization (DESI), 13-16 atmospheric pressure infrared matrix-assisted laser desorption ionization (AP * To whom correspondence should be addressed. E-mail: [email protected]. Phone: 202-994-2717. Fax: 202-994-587