Lifetime economic burden of prostate cancer

<p>Abstract</p> <p>Background</p> <p>Prostate cancer (PCa) is the most common cancer affecting men in the United States. The initial treatment and subsequent monitoring of PCa patients places a large burden on U.S. health care systems. The objectives of this study were to estimate the total and disease-related per-patient lifetime costs using a phase-based model of cancer care for PCa patients enrolled in Medicare.</p> <p>Methods</p> <p>A model was developed to estimate life-time costs for patients diagnosed with PCa. Patients ≥ 65 years old and diagnosed with PCa between calendar years 1991-2002 were selected from the SEER database. Using SEER, we estimated survival times for PCa patients from diagnosis until death. The period of time patients contributed to treatment phases was determined using an algorithm designed to model the natural history of PCa. Costs were obtained from the US SEER-Medicare database and estimated during specific phases of care. Cost estimates were then combined with survival data to yield total and PCa-related life-time costs.</p> <p>Results</p> <p>Overall, the model estimated life-time costs of $110,520 (95$34,432).</p> <p>Conclusions</p> <p>Prostate cancer places a significant burden on U.S. health-care systems with average life-time PCa-related costs in excess of $30,000.</p

Outcomes of thromboprophylaxis with enoxaparin vs. unfractionated heparin in medical inpatients

BACKGROUND: Clinical trials have shown low-molecular weight heparin (LMWH) to be at least as safe and efficacious as unfractionated heparin (UFH) for preventing venous thromboembolism (VTE) in acutely-ill medical inpatients. OBJECTIVE: To compare clinical and economic outcomes among acutely-ill medical inpatients receiving the LMWH enoxaparin versus UFH prophylaxis in clinical practice. METHODS: Using a large, multi-hospital, US database, we identified persons aged ≥40 years hospitalized for ≥6 days for an acute medical condition (including circulatory disorders, respiratory disorders, infectious diseases, or neoplasms) from Q4 1999 to Q1 2002. From these patients, those who received thromboprophylaxis with either enoxaparin or UFH were identified. Surgical patients and those requiring or ineligible for anticoagulation were excluded. We compared the incidence of deep-vein thrombosis (DVT), pulmonary embolism (PE), and all VTE (i.e., DVT and/or PE). Secondary outcomes were occurrence of side-effects, length of hospital stay and total costs. RESULTS: 479 patients received enoxaparin prophylaxis and 2,837 received UFH. The incidence of VTE was 1.7% with enoxaparin prophylaxis versus 6.3% with UFH (RR = 0.26; p < 0.001). Occurrence of side effects, length of stay (10.00 days with enoxaparin vs. 10.26 days with UFH; p = 0.348) and total costs ($18,777 vs.$17,602; p = 0.463) were similar in the 2 groups. CONCLUSION: We observed a 74% lower risk of VTE among patients receiving enoxaparin prophylaxis versus UFH prophylaxis. There was no significant difference in side effects or economic outcomes. These results provide evidence that the LMWH enoxaparin is more effective than UFH in reducing the risk of VTE in current clinical practice

Revealing hidden states in visual working memory using electroencephalography

It is often assumed that information in visual working memory (vWM) is maintained via persistent activity. However, recent evidence indicates that information in vWM could be maintained in an effectively "activity-silent" neural state. Silent vWM is consistent with recent cognitive and neural models, but poses an important experimental problem: how can we study these silent states using conventional measures of brain activity? We propose a novel approach that is analogous to echolocation: using a high-contrast visual stimulus, it may be possible to drive brain activity during vWM maintenance and measure the vWM-dependent impulse response. We recorded electroencephalography (EEG) while participants performed a vWM task in which a randomly oriented grating was remembered. Crucially, a high-contrast, task-irrelevant stimulus was shown in the maintenance period in half of the trials. The electrophysiological response from posterior channels was used to decode the orientations of the gratings. While orientations could be decoded during and shortly after stimulus presentation, decoding accuracy dropped back close to baseline in the delay. However, the visual evoked response from the task-irrelevant stimulus resulted in a clear re-emergence in decodability. This result provides important proof-of-concept for a promising and relatively simple approach to decode "activity-silent" vWM content using non-invasive EEG

The role of saliva in oral processing: Reconsidering the breakdown path paradigm

We discuss food oral processing research over the last two decades and consider strategies for quantifying the food breakdown model, originally conceptualised by Hutchings and Lillford . The key innovation in their seminal 1988 paper was shifting the focus from intact food properties, measured in the lab, towards strategies to capture the dynamic nature of eating. This has stimulated great progress in the field, but a key aspect missing in oral processing research is the conversion of the Hutchings and Lillford breakdown path conceptual model into quantifiable parameters considered in the context of physiological factors such as saliva and oral movements. To address these short comings, we propose the following analysis: Hutchings’s and Lillford’s definitions of “Structure” and “Lubrication” are incomplete and they comprise many and varied physicochemical properties. We offer, here, a deeper analysis of each parameter, and propose strategies for researchers to consider in their quantification as an update of the Hutchings and Lillford Breakdown path

Enabling the Rational Design of Low-Fat Snack Foods: Insights from In Vitro Oral Processing

Texture perception can be conceptualized as an emergent cognitive response to several of the physical and chemical properties of a food. Contemporary oral processing research is focused on revealing the relationships between the sensory perceptions and the food properties, with the goal of enabling rational product design. One major challenge is the complexity of molecular and biocolloid interactions, underpinning even simple texture properties. Here, we will introduce the in vitro oral processing approach, which divides oral processing into discrete units of operation (first bite, comminution, granulation, bolus formation, and tribology) and then systematically investigates the material properties that govern each specific oral processing unit operation without the added complexity inherent to biological systems. We will describe how we used the approach to rationally design a low-fat potato chip by investigating the impact from adding back, to a low fat potato chip, a small amount of oil mixed with the surface active agent polyglycerol polyricinoleate (PGPR). The relevance of instrumental measures was validated by sensory assessment wherein panelists ranked the perceived oiliness of three different types of potato chips. The sensory results indicated that perceived oiliness was higher when the low- fat potato chip was supplemented with a 0.5% by weight topical coating (0.5% by weight 15% by weight PGPR in oil mixture) compared to the unaltered low-fat potato chip. The perceived difference in oiliness was found to correspond to in vitro transient friction of saliva in the presence and absence of PGPR. These results illustrate how dividing oral processing into distinct phases allows one to more readily align sensory and in vitro measures, allowing for integration of the two disciplines and more rational design when modifying macronutrients

Responsive polysaccharide-grafted surfaces for biotribological applications

The elucidation of biolubrication mechanisms and the design of artificial biotribological contacts requires the development of model surfaces that can help to tease out the cues that govern friction in biological systems. Polysaccharides provide an interesting option as a biotribological mimic due to their similarity with the glycosylated molecules present at biointerfaces. Here, pectin was successfully covalently grafted at its reducing end to a polydimethylsiloxane (PDMS) surface via a reductive amination reaction. This method enabled the formation of a wear resistant pectin layer that provided enhanced boundary lubrication compared to adsorbed pectin. Pectins with different degrees of methylesterification and blockiness were exposed to salt solutions of varying ionic strength and displayed responsiveness to solvent conditions. Exposure of the grafted pectin layers to solutions of between 1 and 200 mM NaCl resulted in a decrease in boundary friction and an increase in the hydration and swelling of the pectin layer to varying degrees depending on the charge density of the pectin, showing the potential to tune the conformation and friction of the layer using the pectin architecture and environmental cues. The robust and responsive nature of these new pectin grafted surfaces makes them an effective mimic of biotribological interfaces and provides a powerful tool to study the intricate mechanisms involved in the biolubrication phenomenon

Rofecoxib and cardiovascular adverse events in adjuvant treatment of colorectal cancer

Background Selective cyclooxygenase inhibitors may retard the progression of cancer, but they have enhanced thrombotic potential. We report on cardiovascular adverse events in patients receiving rofecoxib to reduce rates of recurrence of colorectal cancer. Methods All serious adverse events that were cardiovascular thrombotic events were reviewed in 2434 patients with stage II or III colorectal cancer participating in a randomized, placebo-controlled trial of rofecoxib, 25 mg daily, started after potentially curative tumor resection and chemotherapy or radiotherapy as indicated. The trial was terminated prematurely owing to worldwide withdrawal of rofecoxib. To examine possible persistent risks, we examined cardiovascular thrombotic events reported up to 24 months after the trial was closed. Results The median duration of active treatment was 7.4 months. The 1167 patients receiving rofecoxib and the 1160 patients receiving placebo were well matched, with a median follow-up period of 33.0 months (interquartile range, 27.6 to 40.1) and 33.4 months (27.7 to 40.4), respectively. Of the 23 confirmed cardiovascular thrombotic events, 16 occurred in the rofecoxib group during or within 14 days after the treatment period, with an estimated relative risk of 2.66 (from the Cox proportional-hazards model; 95% confidence interval [CI], 1.03 to 6.86; P = 0.04). Analysis of the Antiplatelet Trialists’ Collaboration end point (the combined incidence of death from cardiovascular, hemorrhagic, and unknown causes; of nonfatal myocardial infarction; and of nonfatal ischemic and hemorrhagic stroke) gave an unadjusted relative risk of 1.60 (95% CI, 0.57 to 4.51; P = 0.37). Fourteen more cardiovascular thrombotic events, six in the rofecoxib group, were reported within the 2 years after trial closure, with an overall unadjusted relative risk of 1.50 (95% CI, 0.76 to 2.94; P = 0.24). Four patients in the rofecoxib group and two in the placebo group died from thrombotic causes during or within 14 days after the treatment period, and during the follow-up period, one patient in the rofecoxib group and five patients in the placebo group died from cardiovascular causes. Conclusions Rofecoxib therapy was associated with an increased frequency of adverse cardiovascular events among patients with a median study treatment of 7.4 months’ duration. (Current Controlled Trials number, ISRCTN98278138.