Direct costs of chronic obstructive pulmonary disease among managed care patients

Anand A Dalal1, Laura Christensen2, Fang Liu3, Aylin A Riedel31US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 2Health Economics Outcomes Research, i3 Innovus, Ann Arbor, MI, USA; 3Health Economics Outcomes Research, i3 Innovus, Eden Prairie, MN, USAPurpose: To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD) among commercially insured patients in the US.Methods: In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days), emergency department (ED), standard inpatient admission, and intensive care unit (ICU) cohorts. Patient-level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated.Results: Of the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD) annual COPD-related health care costs (2008 US) increased across the cohorts (P < 0.001), ranging from 2003 ($3238) to$43,461 ($76,159) per patient. Medical costs comprised 96$305 ($310) for an outpatient visit,$274 ($336) for an urgent outpatient visit,$327 ($65) for an ED visit,$9745 ($2968) for a standard admission, and$33,440 for an ICU stay.Conclusion: Direct costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs.Keywords: health care cost, health expenditure, lung diseases, managed car

Development and Evaluation of an Undergraduate Science Communication Module

This paper describes the design and evaluation of an undergraduate final year science communication module for the Science Faculty at the University of East Anglia. The module focuses specifically on science communication and aims to bring an understanding of how science is disseminated to the public. Students on the module are made aware of the models surrounding science communication and investigate how the science culture interfaces with the public. During the module they learn how to adapt science concepts for different audiences and how to talk confidently about science to a lay-audience. Student motivation for module choice centres on the acquisition of transferable skills and students develop these skills through designing, running and evaluating a public outreach event at a school or in a public area. These transferable skills acquired include communication, interaction with different organisations such as museums and science centres, developing understanding of both the needs of different audiences and the importance of time management. They also develop skills relating to self-reflection and how to use this as a tool for future self development. The majority of students completing the module go on to further study, either a PhD, MSc or teacher training. The module can be sustained in its present formed if capped at 40 students, however it is recognised that to increase cohort size, further investment of faculty time and resources would be required

A Spatially Resolved Study of the Synchrotron Emission and Titanium in Tycho's Supernova Remnant with NuSTAR

We report results from deep observations (~750 ks) of Tycho's supernova remnant (SNR) with NuSTAR. Using these data, we produce narrow-band images over several energy bands to identify the regions producing the hardest X-rays and to search for radioactive decay line emission from 44Ti. We find that the hardest (>10 keV) X-rays are concentrated in the southwest of Tycho, where recent Chandra observations have revealed high emissivity "stripes" associated with particles accelerated to the knee of the cosmic-ray spectrum. We do not find evidence of 44Ti, and we set limits on its presence and distribution within the SNR. These limits correspond to a upper-limit 44Ti mass of M44 < 2.4x10^-4 M_sun for a distance of 2.3 kpc. We perform spatially resolved spectroscopic analysis of sixty-six regions across Tycho. We map the best-fit rolloff frequency of the hard X-ray spectra, and we compare these results to measurements of the shock expansion and ambient density. We find that the highest energy electrons are accelerated at the lowest densities and in the fastest shocks, with a steep dependence of the roll-off frequency with shock velocity. Such a dependence is predicted by models where the maximum energy of accelerated electrons is limited by the age of the SNR rather than by synchrotron losses, but this scenario requires far lower magnetic field strengths than those derived from observations in Tycho. One way to reconcile these discrepant findings is through shock obliquity effects, and future observational work is necessary to explore the role of obliquity in the particle acceleration process.Comment: 12 pages, 12 figures, ApJ in pres

Wolbachia Endosymbionts Modify Drosophila Ovary Protein Levels in a Context-Dependent Manner

ABSTRACT Endosymbiosis is a unique form of interaction between organisms, with one organism dwelling inside the other. One of the most widespread endosymbionts is Wolbachia pipientis, a maternally transmitted bacterium carried by insects, crustaceans, mites, and filarial nematodes. Although candidate proteins that contribute to maternal transmission have been identified, the molecular basis for maternal Wolbachia transmission remains largely unknown. To investigate transmission-related processes in response to Wolbachia infection, ovarian proteomes were analyzed from Wolbachia-infected Drosophila melanogaster and D. simulans. Endogenous and variant host-strain combinations were investigated. Significant and differentially abundant ovarian proteins were detected, indicating substantial regulatory changes in response to Wolbachia. Variant Wolbachia strains were associated with a broader impact on the ovary proteome than endogenous Wolbachia strains. The D. melanogaster ovarian environment also exhibited a higher level of diversity of proteomic responses to Wolbachia than D. simulans. Overall, many Wolbachia-responsive ovarian proteins detected in this study were consistent with expectations from the experimental literature. This suggests that context-specific changes in protein abundance contribute to Wolbachia manipulation of transmission-related mechanisms in oogenesis. IMPORTANCE Millions of insect species naturally carry bacterial endosymbionts called Wolbachia. Wolbachia bacteria are transmitted by females to their offspring through a robust egg-loading mechanism. The molecular basis for Wolbachia transmission remains poorly understood at this time, however. This proteomic study identified specific fruit fly ovarian proteins as being upregulated or downregulated in response to Wolbachia infection. The majority of these protein responses correlated specifically with the type of host and Wolbachia strain involved. This work corroborates previously identified factors and mechanisms while also framing the broader context of ovarian manipulation by Wolbachia

Locating the most energetic electrons in Cassiopeia A

We present deep ($>$2.4 Ms) observations of the Cassiopeia A supernova remnant with {\it NuSTAR}, which operates in the 3--79 keV bandpass and is the first instrument capable of spatially resolving the remnant above 15 keV. We find that the emission is not entirely dominated by the forward shock nor by a smooth "bright ring" at the reverse shock. Instead we find that the $>$15 keV emission is dominated by knots near the center of the remnant and dimmer filaments near the remnant's outer rim. These regions are fit with unbroken power-laws in the 15--50 keV bandpass, though the central knots have a steeper ($\Gamma \sim -3.35$) spectrum than the outer filaments ($\Gamma \sim -3.06$). We argue this difference implies that the central knots are located in the 3-D interior of the remnant rather than at the outer rim of the remnant and seen in the center due to projection effects. The morphology of $>$15 keV emission does not follow that of the radio emission nor that of the low energy ($<$12 keV) X-rays, leaving the origin of the $>$15 keV emission as an open mystery. Even at the forward shock front we find less steepening of the spectrum than expected from an exponentially cut off electron distribution with a single cutoff energy. Finally, we find that the GeV emission is not associated with the bright features in the {\it NuSTAR} band while the TeV emission may be, suggesting that both hadronic and leptonic emission mechanisms may be at work.Comment: 12 pages, 11 figures, accepted for publication in Ap

Lab-on-a-chip workshop activities for secondary school students

The ability to engage and inspire younger generations in novel areas of science is important for bringing new researchers into a burgeoning field, such as lab-on-a-chip. We recently held a lab-on-a-chip workshop for secondary school students, for which we developed a number of hands-on activities that explained various aspects of microfluidic technology, including fabrication (milling and moulding of microfluidic devices, and wax printing of microfluidic paper-based analytical devices, so-called μPADs), flow regimes (gradient formation via diffusive mixing), and applications (tissue analysis and μPADs). Questionnaires completed by the students indicated that they found the workshop both interesting and informative, with all activities proving successful, while providing feedback that could be incorporated into later iterations of the event

‘Just Google It?’: Pupils’ Perceptions and Experience of Research in the Secondary Classroom

While numerous studies examine perceptions of research held by university researchers, studies examining perceptions held by school pupils are rare. To address this gap and following analysis of questionnaire data (N = 2634, KS3/4/5 pupils), we conducted 11 group interviews with 100 pupils in England to investigate their experiences of research during schooling and their perceptions of how research is conceived, conducted and where its utility and significance lie. Thematic analysis of the interview data – informed by Angela Brew’s 4-tier descriptor of perceptions of research (domino, trading, layer, journey), Jenni Stubb's and colleagues' elaboration of this descriptor, Jan Meyer's and colleagues' conceptions of research inventory (CoRI) and Diane Bills’ distinction between Research and research – led to seven themes. Here we elaborate the most significant of these themes: fact finding as research; who formulates and owns a research question; and the friction between uninformed opinion and informed view. We conclude that secondary pupils’ experiences and perceptions of research, while overall relatively rich, vary across different disciplines. We also conclude that pupils would benefit substantially from more comprehensive engagement with research processes, and we observe the role that qualifications such as the Extended Project Qualification can play in fostering said engagement

Determinants of Discard of Expanded Criteria Donor Kidneys: Impact of Biopsy and Machine Perfusion

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73820/1/j.1600-6143.2008.02157.x.pd

Autism Spectrum Disorder Among US Children (2002–2010): Socioeconomic, Racial, and Ethnic Disparities

Objectives. To describe the association between indicators of socioeconomic status (SES) and the prevalence of autism spectrum disorder (ASD) in the United States during the period 2002 to 2010, when overall ASD prevalence among children more than doubled, and to determine whether SES disparities account for ongoing racial and ethnic disparities in ASD prevalence