Estimating the Lifetime Treatment Burden of Patients With Follicular Lymphoma: A Retrospective Study Using Real-World Multicenter Data

PURPOSE Although follicular lymphoma is characterized by long natural history and frequent relapses, data on the number of patients receiving subsequent therapy lines are scarce. To perform reliable health economical calculations for various treatment options, data regarding the lifetime number of therapy courses are needed. The purpose of this study was to use real-world data to create a model that could estimate the treatment burden over a 20-year period. MATERIALS AND METHODS We performed a 20-year simulation on the basis of retrospectively obtained multicenter data of 743 patients with follicular lymphoma. The simulation was carried out in two steps: First, a competing risk model on the basis of Weibull distribution was used to simulate the state transitions from diagnosis onward and from first-line therapy onward. Then, the data were completed by imputing on the basis of the existing data. Completion of data was repeated for 1,000 times to estimate reliability. RESULTS In 20 years, 97% (2.5-97.5 percentile range: 96%-98%), 66% (61%-70%), 34% (30%-41%), and 15% (9%-18%) of the patients received first-line, second-line, third-line, and fourth-line therapies, respectively. The median number of therapy lines received by each patient was two. CONCLUSION Despite long remissions, approximately two thirds of the patients receive at least two lines and one-third at least three lines of therapy during their lifetime

Properties and DEFC tests of Nafion Functionalized titanate nanotubes composite membranes prepared by melt extrusion

Nafion based composites are promising materials to improve the performance of direct ethanol fuel cells. In this work, composite membranes of Nafion and titanate nanotubes functionalized with sulfonic acid groups were prepared by melt extrusion and tested in a direct ethanol fuel cell. Far and mid infrared spectroscopies evidenced the formation of ionic bridges between the sulfonic acid groups of both functionalized nanoparticles and the ionomer. Small angle X ray scattering measurements revealed that the melt extrusion method leads to an uniform distribution of the inorganic phase in the ionomer matrix. Such structural analysis indicated that the improved the proton conduction properties of the composites, even with the addition of a high concentration of functionalized nanoparticles, are an outcome of the synergistic ionic network due to the hydrid organic inorganic proton conducting phases. However, an improvement of the fuel cell performance is observed for 2.5 wt of functionalized titanate nanotubes, which is a result of the lower ethanol crossover and the plasticizing effect of the aliphatic segments of the organic moieties grafted at the surface of the titanate nanoparticle

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Development of new systems of nano-disperse Pt-(2%Pt-Ce0.9W0.1O2)/C electrocatalysts tolerant to carbon monoxide (CO) for PEMFC anodes

The nanophase material (powder) of Ce0.9W0.1O2 was synthesized via coprecipitation of oxalates of cerium (IV) and tungsten cations. Pt-Ce0.9W0.1O2 (2 wt% Pt) was prepared by an alcohol-reduction process using H2PtCl6.6H2O as source of Pt, Ce0.9W0.1O2 as support and ethylene glycol as solvent and reducing agent. Pt-Ce0.9W0.1O2 was physically mixed with commercial Pt/C E-TEK (20 w% Pt) to produce the Pt-(2%Pt-Ce0.9W0.1O2)/C electrocatalyst. The prepared electrocatalysts were characterized by energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD) and CO stripping. The performances of Pt/C E-TEK and Pt-(2%Pt-Ce0.9W0.1O2)/C electrocatalysts were tested in single fuel cell fed with a mixture H2/CO (100 ppm of CO). The results showed that the mixture of 2%Pt-Ce0.9W0.1O2 and Pt/C E-TEK increases the CO tolerance in a single fuel cell operating at 85 ºC compared with Pt/C E-TEK

Development Of New Systems Of Nano-disperse Pt-(2%pt-ce0.9w 0.1o2)/c Electrocatalysts Tolerant To Carbon Monoxide (co) For Pemfc Anodes

The nanophase material (powder) of Ce0.9W0.1O 2 was synthesized via coprecipitation of oxalates of cerium (IV) and tungsten cations. Pt-Ce0.9W0.1O2 (2 wt% Pt) was prepared by an alcohol-reduction process using H2PtCl 6.6H2O as source of Pt, Ce0.9W 0.1O2 as support and ethylene glycol as solvent and reducing agent. Pt-Ce0.9W0.1O2 was physically mixed with commercial Pt/C E-TEK (20 w% Pt) to produce the Pt-(2%Pt-Ce 0.9W0.1O2)/C electrocatalyst. The prepared electrocatalysts were characterized by energy dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD) and CO stripping. The performances of Pt/C E-TEK and Pt-(2%Pt-Ce0.9W0.1O2)/C electrocatalysts were tested in single fuel cell fed with a mixture H2/CO (100 ppm of CO). The results showed that the mixture of 2%Pt-Ce0.9W 0.1O2 and Pt/C E-TEK increases the CO tolerance in a single fuel cell operating at 85°C compared with Pt/C E-TEK. ©The Electrochemical Society.431185189Du Melle, F., The global and urban environment: The need for clean power systems (1998) Journal of Power Sources, 71 (1-2), pp. 7-11Oliveira Neto, A., Farias, A.L., Dias, R.R., Brandalise, M., Linardi, M., Spinacé, E.V., Enhanced electro-oxidation of ethanol using PtSn/CeO2-C electrocatalyst prepared by an alcohol-reduction process (2008) Electrochemistry Communications, 10 (9), pp. 1315-1317Pamqvist, A.E.C., Wirde, M., Gelius, U., Muhammed, M., Surfaces of Doped Nanophase Cerium Oxide Catalysts (1999) NanoStructured Materials, 11 (8), pp. 995-1007Rothenberg, G., De Graaf, E.A., Bliek, A., Solvent-Free Synthesis of Rechargeable Solid Oxygen Reservoirs for Clean Hydrogen Oxidation (2003) Angew. Chem. Int. Ed., (42), pp. 3366-3368. , BartGu, D.M., Chu, Y.Y., Wang, Z.B., Jiang, Z.Z., Yin, G.P., Liu, Y., Methanol oxidation on Pt/CeO2-C electrocatalyst prepared by microwave-assisted ethylene glycol process (2010) Applied Catalysis B: Environmental, 102 (1-2), pp. 9-18Hou, Z., Yi, B., Lin, Z., Zhang, H., CO tolerance of PtRu-HxMeO3/C (Me = W, Mo) made by composite support method (2003) Journal of Power Sources, 123 (2), pp. 116-125Santiago, E.I., Batista, M.S., Assaf, M.E., Ticianelli, E.A., Mechanism of CO tolerance on Molybdenum-Based Electrocatalysts for PEMFC (2004) Journal of the Electrochemical Society, 151 (7), pp. A944-A94

Link between disease status at 24 months and mortality in follicular lymphoma

acceptedVersionNon peer reviewe