The cost of moderate and severe COPD exacerbations to the Canadian healthcare system

SummaryBackgroundThe cost of exacerbations in chronic obstructive pulmonary disease (COPD) has not been well studied. The aim of this study was to identify and quantify the (average) cost of moderate and severe exacerbations (ME and SE, respectively) from a Canadian perspective.MethodsResources used during ME and SE were identified in a year long prospective, observational study (Resource Utilization Study In COPD (RUSIC)). The units of analysis were ME and SE. Unit costs (2006$CAN), based on provincial, hospital and published sources, were applied to resources. The overall cost per ME and SE were calculated. The population burden of exacerbations was also calculated.ResultsAmong study participants (N=609, aged 68.6±9.4 years, 58.3$126 (N=574) and $515 (N=105), respectively. The average overall cost of a ME was$641. For SEs, the average hospital stay was 10.0 days. The overall mean costs of outpatient, ED and hospitalization services for SE were $114 (N=44),$774 (N=140) and $8669 (N=151), respectively. The average overall cost of a SE was$9557.ConclusionThe economic burden associated with MEs and especially SEs, in Canada, is considerable and likely has a substantial impact on healthcare costs. The overall burden of exacerbations has been estimated in the range of $646 million to$736 million per annum

Minimizing energy demand and environmental impact for sustainable NH3 and H2O2 production—A perspective on contributions from thermal, electro-, and photo-catalysis

There is an urgent need to provide adequate and sustainable supplies of water and food to satisfy the demand of an increasing population. Catalysis plays important roles in meeting these needs by facilitating the synthesis of hydrogen peroxide that is used in water decontamination and chemicals production, and ammonia that is used as fertilizer. However, these chemicals are currently produced with processes that are either very energy-intensive or environmentally unfriendly. This article offers the perspectives of the challenges and opportunities in the production of these chemicals, focusing on the roles of catalysis in more sustainable, alternative production methods that minimize energy consumption and environmental impact. While not intended to be a comprehensive review, the article provides a critical review of selected literature relevant to its objectives, discusses areas needed for further research, and potential new directions inspired by new developments in related fields. For each chemical, production by thermal, electro-, and photo-excited processes are discussed. Problems that are common to these approaches and their differences are identified and possible solutions suggested

Sudakov Resummation for Subleading SCET Currents and Heavy-to-Light Form Factors

The hard-scattering contributions to heavy-to-light form factors at large recoil are studied systematically in soft-collinear effective theory (SCET). Large logarithms arising from multiple energy scales are resummed by matching QCD onto SCET in two stages via an intermediate effective theory. Anomalous dimensions in the intermediate theory are computed, and their form is shown to be constrained by conformal symmetry. Renormalization-group evolution equations are solved to give a complete leading-order analysis of the hard-scattering contributions, in which all single and double logarithms are resummed. In two cases, spin-symmetry relations for the soft-overlap contributions to form factors are shown not to be broken at any order in perturbation theory by hard-scattering corrections. One-loop matching calculations in the two effective theories are performed in sample cases, for which the relative importance of renormalization-group evolution and matching corrections is investigated. The asymptotic behavior of Sudakov logarithms appearing in the coefficient functions of the soft-overlap and hard-scattering contributions to form factors is analyzed.Comment: 50 pages, 10 figures; minor corrections, version to appear in JHE

Polyhedral vesicles

Polyhedral vesicles with a large bending modulus of the membrane such as the gel phase lipid membrane were studied using a Brownian dynamics simulation. The vesicles exhibit various polyhedral morphologies such as tetrahedron and cube shapes. We clarified two types of line defects on the edges of the polyhedrons: cracks of both monolayers at the spontaneous curvature of monolayer $C_{\text {0}}<0$, and a crack of the inner monolayer at $C_{\text {0}}\ge0$. Around the latter defect, the inner monolayer curves positively. Our results suggested that the polyhedral morphology is controlled by $C_{\text {0}}$.Comment: 4 pages, 5 figure

Prediction of major depressive disorder following beta-blocker therapy in patients with cardiovascular diseases

Incident depression has been reported to be associated with poor prognosis in patients with cardiovascular disease (CVD), which might be associated with beta-blocker therapy. Because early detection and intervention can alleviate the severity of depression, we aimed to develop a machine learning (ML) model predicting the onset of major depressive disorder (MDD). A model based on L1 regularized logistic regression was trained against the South Korean nationwide administrative claims database to identify risk factors for the incident MDD after beta-blocker therapy in patients with CVD. We identified 50,397 patients initiating beta-blockers for CVD, with 774 patients developing MDD within 365 days after initiating beta-blocker therapy. An area under the receiver operating characteristic curve (AUC) of 0.74 was achieved. A history of non-selective beta-blockers and factors related to anxiety disorder, sleeping problems, and other chronic diseases were the most strong predictors. AUCs of 0.62–0.71 were achieved in the external validation conducted on six independent electronic health records and claims databases in the USA and South Korea. In conclusion, an ML model that identifies patients at high-risk for incident MDD was developed. Application of ML to identify susceptible patients for adverse events of treatment may serve as an important approach for personalized medicine

Retrospective Cohort Study of Unresectable Stage III Non-Small-Cell Lung Cancer in Canada

Background: The management of unresectable stage iii non-small-cell lung cancer (NSCLC) is complex and best determined through multidisciplinary consultation. A longitudinal, population-level study was carried out to describe the management approach and outcomes of treatment in the real-world setting in Ontario. Methods: Individuals diagnosed with nsclc between 1 April 2010 and 31 March 2015 were identified in the Ontario Cancer Registry. Unresectable disease was defined as no surgery reported within 3 months of diagnosis. Initial treatments included radiotherapy (RT, curative or palliative), chemotherapy, targeted therapy, and chemoradiation [CRT, concurrent (cCRT) or sequential (sCRT)]. Survival was calculated from diagnosis with stage III disease to death or last follow-up. Results: Of the 24,729 individuals diagnosed with nsclc, 5243 (21.2%) had stage iii disease, with most of the latter group (4542, 86.6%) having unresectable disease. Median age was 70 years, and 54.2% were men. The frequency of first-line treatment was cCRT, 22.1%; palliative rt, 21.0%; curative rt, 19.6%; no treatment, 19.6%; chemotherapy alone, 11.6%; sCRT, 5.4%; and targeted therapy, 0.7%. Median overall survival (mOS) was 14.2 months [95% confidence interval (CI): 13.6 months to 14.7 months], with the longest survival observed in patients who received targeted therapy (mOS: 34.7 months; 95% CI: 21.4 months to 51.2 months), and the poorest, in those receiving no cancer treatment (mOS: 5.9 months; 95% CI: 5.0 months to 6.4 months). The mOS in patients receiving cCRT was 23.6 months (95% CI: 21.4 months to 25.6 months). Conclusions: Guideline-recommended cCRT is undertaken in only a small proportion of patients with unresectable NSCLC in Ontario. The reasons for low uptake of that recommendation are only partly understood

Real-World Treatment Patterns and Survival in Stage IV Non-Small-Cell Lung Cancer in Canada

Background: Almost half of all patients with non-small-cell lung cancer (nsclc) present with stage iv disease. The objective of the present study was to characterize treatment patterns and survival outcomes in patients with advanced nsclc. Methods: We conducted a longitudinal population-level study in patients diagnosed with stage iv nsclc in Ontario between 1 April 2010 and 31 March 2015, with follow-up to 31 March 2017 for overall survival and treatment sequence. Patients were stratified as nonsquamous or squamous histology. A sub-analysis was conducted for patients with nonsquamous histology who received targeted therapies, on the assumption that their tumours were EGFR mutation–positive (EGFRm+). Treatment patterns were determined, and survival was calculated from date of diagnosis to death or censoring. Results: Of 24,729 nsclc cases identified, stage iv disease was diagnosed in 49.2%, histology was nonsquamous in 10,103, and EGFRm+ was assumed in 508. Median patient age ranged from 69 to 72 years for the three cohorts. For patients with nonsquamous histology, palliative radiotherapy was the most frequently used first-line treatment (44.4%), followed by no treatment (26.7%) and chemotherapy (14.9%). In the EGFRm+ cohort, 75.6% received gefitinib as first- or second-line therapy, and almost half (47.4%) the 473 patients with squamous histology treated with first-line chemotherapy received cisplatin or carboplatin with gemcitabine. Median overall survival in the nonsquamous and squamous cohorts was 4.9 and 4.6 months respectively; it was 17.6 months for patients who were EGFRm+. Conclusions: Survival of patients with stage iv nsclc remains poor, with the exception of patients who are EGFRm+. Only 14.9% of patients received first-line chemotherapy; the mainstay of treatment was palliative radiotherapy