1,244 research outputs found
Economics of dialysis dependence following renal replacement therapy for critically ill acute kidney injury patients.
BACKGROUND: The obective of this study was to perform a cost-effectiveness analysis comparing intermittent with continuous renal replacement therapy (IRRT versus CRRT) as initial therapy for acute kidney injury (AKI) in the intensive care unit (ICU).
METHODS: Assuming some patients would potentially be eligible for either modality, we modeled life year gained, the quality-adjusted life years (QALYs) and healthcare costs for a cohort of 1000 IRRT patients and a cohort of 1000 CRRT patients. We used a 1-year, 5-year and a lifetime horizon. A Markov model with two health states for AKI survivors was designed: dialysis dependence and dialysis independence. We applied Weibull regression from published estimates to fit survival curves for CRRT and IRRT patients and to fit the proportion of dialysis dependence among CRRT and IRRT survivors. We then applied a risk ratio reported in a large retrospective cohort study to the fitted CRRT estimates in order to determine the proportion of dialysis dependence for IRRT survivors. We conducted sensitivity analyses based on a range of differences for daily implementation cost between CRRT and IRRT (base case: CRRT day 200 to 4046 for CRRT versus 37 780 for CRRT versus $39 448 for IRRT on average). The base case incremental cost-effectiveness analysis showed that CRRT dominated IRRT. This dominance was confirmed by extensive sensitivity analysis.
CONCLUSIONS: Initial CRRT is cost-effective compared with initial IRRT by reducing the rate of long-term dialysis dependence among critically ill AKI survivors
Fas ligand elicits a caspase-independent proinflammatory response in human keratinocytes: implications for dermatitis.
Fas ligand (FasL) causes apoptosis of epidermal keratinocytes and triggers the appearance of spongiosis in eczematous dermatitis. We demonstrate here that FasL also aggravates inflammation by triggering the expression of proinflammatory cytokines, chemokines, and adhesion molecules in keratinocytes. In HaCaT cells and in reconstructed human epidermis (RHE), FasL triggered a NF-kappaB-dependent mRNA accumulation of inflammatory cytokines (tumor necrosis factor-alpha, IL-6, and IL-1beta), chemokines (CCL2/MCP-1, CXCL1/GROalpha, CXCL3/GROgamma, and CXCL8/IL-8), and the adhesion molecule ICAM-1. Oligomerization of Fas was required both for apoptosis and for gene expression. Inhibition of caspase activity abolished FasL-dependent apoptosis; however, it failed to suppress the expression of FasL-induced genes. Additionally, in the presence of caspase inhibitors, but not in their absence, FasL triggered the accumulation of CCL5/RANTES (regulated on activation normal T cell expressed and secreted) mRNA. Our findings identify a novel proinflammatory role of FasL in keratinocytes that is independent of caspase activity and is separable from apoptosis. Thus, in addition to causing spongiosis, FasL may play a direct role in triggering and/or sustaining inflammation in eczemas
Anisotropic conductivity of Nd_{1.85}Ce_{0.15}CuO_{4-\delta} films at submillimeter wavelengths
The anisotropic conductivity of thin NdCeCuO
films was measured in the frequency range 8 cm 40 cm and
for temperatures 4 K K. A tilted sample geometry allowed to extract
both, in-plane and c-axis properties. The in-plane quasiparticle scattering
rate remains unchanged as the sample becomes superconducting. The temperature
dependence of the in-plane conductivity is reasonably well described using the
Born limit for a d-wave superconductor. Below T_{{\rm C}%} the c-axis
dielectric constant changes sign at the screened c-axis plasma
frequency. The temperature dependence of the c-axis conductivity closely
follows the linear in T behavior within the plane.Comment: 4 pages, 4 figure
Alignment of galaxy spins in the vicinity of voids
We provide limits on the alignment of galaxy orientations with the direction
to the void center for galaxies lying near the edges of voids. We locate
spherical voids in volume limited samples of galaxies from the Sloan Digital
Sky Survey using the HB inspired void finder and investigate the orientation of
(color selected) spiral galaxies that are nearly edge-on or face-on. In
contrast with previous literature, we find no statistical evidence for
departure from random orientations. Expressed in terms of the parameter c,
introduced by Lee & Pen to describe the strength of such an alignment, we find
that c<0.11(0.13) at 95% (99.7%) confidence limit within a context of a toy
model that assumes a perfectly spherical voids with sharp boundaries.Comment: 8 pages, 4 figures; v2 discussion expanded, references fixed, matches
version accepted by JCA
Carbon emission savings and short-term health care impacts from telemedicine: An evaluation in epilepsy
Objective: Health systems make a sizeable contribution to national emissions of greenhouse gases that contribute to global climate change. The UK National Health Service is committed to being a net zero emitter by 2040, and a potential contribution to this target could come from reductions in patient travel. Achieving this will require actions at many levels. We sought to determine potential savings and risks over the short term from telemedicine through virtual clinics.
Methods: During the severe acute respiratory syndrome coronavirus 2 (SARS-2-CoV) pandemic, scheduled face-to-face epilepsy clinics at a specialist site were replaced by remote teleclinics. We used a standard methodology applying conversion factors to calculate emissions based on the total saved travel distance. A further conversion factor was used to derive emissions associated with electricity consumption to deliver remote clinics from which net savings could be calculated. Patients’ records and clinicians were interrogated to identify any adverse clinical outcomes.
Results: We found that enforced telemedicine delivery for over 1200 patients resulted in the saving of ~224 000 km of travel with likely avoided emissions in the range of 35 000–40 000 kg carbon dioxide equivalent (CO2e) over a six and half month period. Emissions arising directly from remote delivery were calculated to be <200 kg CO2e (~0.5% of those for travel), representing a significant net reduction of greenhouse gas emissions. Only one direct adverse outcome was identified, with some additional benefits identified anecdotally.
Significance: The use of telemedicine can make a contribution toward reduced emissions in the health care sector and, in the delivery of specialized epilepsy services, had minimal adverse clinical outcomes over the short term. However, these outcomes will likely vary with clinic locations, medical specialties and conditions
Decoherence in trapped ions due to polarization of the residual background gas
We investigate the mechanism of damping and heating of trapped ions
associated with the polarization of the residual background gas induced by the
oscillating ions themselves. Reasoning by analogy with the physics of surface
electrons in liquid helium, we demonstrate that the decay of Rabi oscillations
observed in experiments on 9Be+ can be attributed to the polarization phenomena
investigated here. The measured sensitivity of the damping of Rabi oscillations
with respect to the vibrational quantum number of a trapped ion is also
predicted in our polarization model.Comment: 26 pdf pages with 5 figures, http://www.df.ufscar.br/~quantum
Experimental evidence for 56Ni-core breaking from the low-spin structure of the N=Z nucleus 58Cu
Low-spin states in the odd-odd N=Z nucleus 58Cu were investigated with the
58Ni(p,n gamma)58Cu fusion evaporation reaction at the FN-tandem accelerator in
Cologne. Seventeen low spin states below 3.6 MeV and 17 new transitions were
observed. Ten multipole mixing ratios and 17 gamma-branching ratios were
determined for the first time. New detailed spectroscopic information on the
2+,2 state, the Isobaric Analogue State (IAS) of the 2+,1,T=1 state of 58Ni,
makes 58Cu the heaviest odd-odd N=Z nucleus with known B(E2;2+,T=1 --> 0+,T=1)
value. The 4^+ state at 2.751 MeV, observed here for the first time, is
identified as the IAS of the 4+,1,T=1 state in 58Ni. The new data are compared
to full pf-shell model calculations with the novel GXPF1 residual interaction
and to calculations within a pf5/2 configurational space with a residual
surface delta interaction. The role of the 56Ni core excitations for the
low-spin structure in 58Cu is discussed.Comment: 15 pages, 7 figures, submitted to Phys. Rev.
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