The impact of adherence and disease control on resource use and charges in patients with mild asthma managed on inhaled corticosteroid agents

P Navaratnam1, HS Friedman2, E Urdaneta31Eympres Research, LLC, Hilliard, OH, USA; 2Analytic Solutions, LLC, New York, NY, USA; 3Schering-Plough Corporation, Kenilworth, NJ, USAObjective: Inadequate asthma control may affect asthma resource use and treatment charges, consequently contributing to the growing economic burden of asthma. The study objective was to determine the impact of medication adherence and asthma control on resource use and charges in mild asthmatic patients treated with inhaled corticosteroids (ICSs).Research design and methods: A claims database was analyzed retrospectively from October 2001–December 2007 to identify mild asthmatic patients aged 12–65 years who began ICS treatment. Demographics, drug utilization, and resource use for each patient were identified for the 365-day period before and after the index date (pre-index and post-index periods, respectively). Patients were designated as having high control high adherence (HCHA) or low control low adherence (LCLA) based on post-index exacerbations and the percentage of days covered; not all patients who qualified for study inclusion met adherence designation requirements. Differences between the HCHA and LCLA cohorts in resource use (eg, asthma treatment days) and asthma-related treatment charges were assessed.Results: Compared with the HCHA cohort (n = 483), the LCLA cohort (n = 258) had more asthma treatment days (2.9 vs 3.9, respectively; P < 0.0001) and higher overall asthma treatment charges ($2655 vs$3345, respectively; P < 0.0001) in the post-index period. An adjusted odds ratio suggested that patients receiving mometasone furoate (MF) were approximately 5 times more likely to belong to the HCHA cohort than patients receiving any other ICS (P < 0.0001).Conclusions: Better asthma control and adherence to prescribed ICSs are associated with lower asthma-related resource use and charges. Mild asthmatic patients receiving MF were more likely to be in the HCHA cohort than patients receiving other ICSs, perhaps due to the once-daily dosing of MF. Current NAEPP guidelines recommend low-dose ICS monotherapy for mild persistent asthma; thus, it is critical to optimize mild persistent asthma control and limit unnecessary resource use and charges.Keywords: adherence, asthma control, beclomethasone dipropionate, budesonide, fluticasone propionate, mometasone furoate, retrospective claims analysi

Transport protocols for multi hop wireless networks

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Report : "A Study Of The Misuse Of Drugs Among Secondary School Children In The State Of Penang And Selangor.

Drugs in a non-medical setting, used to alter mood, perception or consciousness are the topic of the present report: the report and the study upon which it is based reflect a widespread feeling in society that the use of such drugs is in itself a cause for concern, that the presumed increase in such use by young people heightens this concern~ but that response to drug usage which is ill informed is unlikely to achieve desirable ends

TAN: A Distributed Algorithm for Dynamic Task Assignment in WSNs

We consider the scenario of wireless sensor networks where a given application has to be deployed and each application task has to be assigned to each node in the best possible way. Approaches where decisions on task execution are taken by a single central node can avoid the exchange of data packets between task execution nodes but cannot adapt to dynamic network conditions, and suffer from computational complexity. To address this issue, in this paper, we propose an adaptive and decentralized task allocation negotiation algorithm (TAN) for cluster network topologies. It is based on noncooperative game theory, where neighboring nodes engage in negotiations to maximize their own utility functions to agree on which of them should execute single application tasks. Performance is evaluated in a city scenario, where the urban streets are equipped with different sensors and the application target is the detection of the fastest way to reach a destination, and in random WSN scenarios. Comparisons are made with three other algorithms: 1) baseline setting with no task assignment to multiple nodes; 2) centralized task assignment lifetime optimization; and 3) a dynamic distributed algorithm, DLMA. The result is that TAN outperforms these algorithms in terms of application completion time and average energy consumption. Published in

Cooperative task assignment for distributed deployment of applications in WSNs

Nodes in Wireless Sensor Networks (WSNs) are becoming more and more complex systems with the capabilities to run distributed structured applications. Which single task should be implemented by each WSN node needs to be decided by the application deployment strategy by taking into account both network lifetime and execution time requirements. In this paper, we propose an adaptive decentralised algorithm based on noncooperative game theory, where neighbouring nodes negotiate among each other to maximize their utility function. We then prove that an increment of the nodes utility corresponds to the same increment of the utility for the whole network. Simulation results show significant performance improvement with respect to existing algorithms

Stability of the antimalarial drug dihydroartemisinin in under physiologically-relevant conditions : implications for clinical treatment, pharmacokinetic and in vitro assays

Artemisinins are peroxidic antimalarial drugs known to be very potent but chemically highly unstable; they degrade in the presence of ferrous iron, Fe(II)-heme or biological reductants. Less documented is how this translates into chemical stability and antimalarial activity across a range of conditions applying to in vitro testing and clinical situations. Dihydroartemisinin (DHA) is studied here because it is both an antimalarial drug on its own and the main metabolite of other artemisinins. The behavior of DHA in PBS, plasma or erythrocytes lysate at different temperatures and pH ranges was examined. The antimalarial activity of the residual drug was evaluated using the chemosensitivity assay on P. falciparum, and the extent of decomposition of DHA was established through use of HPLC-ECD analysis. The role of the Fe(II)-heme was investigated by blocking its reactivity using carbon monoxide. A significant reduction in the antimalarial activity of DHA was seen after incubation in plasma and to a lesser extent in erythrocytes lysate: activity was reduced by half after 3 hours and almost completely abolished after 24 hours. Serum-enriched media also affected DHA activity. Effects were temperature and pH-dependent and paralleled the increased rate of decomposition of DHA from pH 7 upwards and in plasma. These results suggest that particular care should be taken in conducting and interpreting in vitro studies, prone as they are to experimental and drug storage conditions. Disorders such as fever, hemolysis or acidosis associated with malaria severity may contribute to artemisinins instability and reduce their clinical efficacy

A novel technique to repair orbital roof defects: irradiated homologous cadaveric rib (Tutoplast ®) graft in a recurrent frontal sinus ossifying fibroma

Ossifying fibroma in the fronto-ethmoidal sinuses is a rare, benign condition. In symptomatic cases, surgical excision is often undertaken and bony defects may be repaired using alloplastic grafts. We present a novel method of repairing an orbital roof defect using irradiated homologous cadaveric rib (Tutoplast ®) graft, overlaid with a pericranial flap. The patient made an excellent recovery, concluding that it is a viable and safe option with lower morbidity

On the triplet state of poly(N-vinylcarbazole)

Triplet state properties including transient triplet absorption spectrum, intersystem crossing yields in solution at room temperature and phosphorescence spectra, quantum yields and lifetimes at low temperature as well as singlet oxygen yields were obtained for poly(N-vinylcarbazole) (PVK) in 2-methyl-tetrahydrofuran (2-MeTHF), cyclohexane or benzene. The results allow the determination of the energy value for the lowest lying triplet state and also show that triplet formation and deactivation is a minor route for relaxation of the lowest excited singlet state of PVK. In addition, they show the triplet state is at higher energy than reported heavy metal dopants used for electrophosphorescent devices, such that if this is used as a host it will not quench their luminescence.http://www.sciencedirect.com/science/article/B6TFN-4DTTJJC-7/1/b605edb9859b607f1a9b1c1348af029

Posterior Uterine Rupture Causing Fetal Expulsion into the Abdominal Cavity: A Rare Case of Neonatal Survival

Introduction. Uterine rupture is a potentially catastrophic complication of vaginal birth after caesarean section. We describe the sixth case of posterior uterine rupture, with intact lower segment scar, and the first neonatal survival after expulsion into the abdominal cavity with posterior rupture. Case Presentation. A multiparous woman underwent prostaglandin induction of labour for postmaturity, after one previous caesarean section. Emergency caesarean section for bradycardia revealed a complete posterior uterine rupture, with fetal and placental expulsion. Upon delivery, the baby required inflation breaths only. The patient required a subtotal hysterectomy but returned home on day 5 postnatally with her healthy baby. Discussion. Vaginal birth after caesarean section constitutes a trial of labour, and the obstetrician must be reactive to labour events. Posterior uterine rupture is extremely rare and may occur without conventional signs. Good maternal and fetal outcome is possible with a prompt, coordinated team response