Tailoring Properties of Polypropylene through Crystallization in the Presence of Polymeric Nucleating Agents.

In this communication, we present a strategy for the addition of polymeric nucleating agents for the crystallization of isotactic polypropylene (iPP) that guarantees a perfect fine dispersion of nucleating particles within the entire mass of the polymer, with consequent their high efficiency even at very low concentrations. The Ziegler-Natta catalyst particles are coated by a thin skin of poly(trimethylallylsilane) (PTMAS) or poly(vinylcyclohexane) (PVCH) that will act as nucleating agents, by prepolymerization of the corresponding monomers. PVCH shows higher nucleation efficiency than PTMAS with greater increase of crystallization temperature by standard cooling from the melt. Both polymeric nucleating agents affect the crystal morphology greatly reducing the size of shperulites. This in turn affects the mechanical properties improving ductility and flexibility. The presence of the nucleating agent accelerates the crystallization of iPP and affords crystallization of the α form even upon fast crystallization by quenching the melt, condition that generally produces crystallization of the mesomorphic form of iPP. Crystals of α form so obtained show a nodular morphology and absence of spherulitic superstructure. This novel iPP material is characterized by outstanding and unexpected properties of high mechanical strength and modulus and contemporarily high ductility, flexibility and good transparency due to the nodular morphology of α form

Resource utilization and cost of treatment with anidulafungin or fluconazole for candidaemia and other forms of invasive candidiasis: focus on critically ill patients

Candidaemia and other forms of invasive candidiasis (C/IC) are serious and costly events for hospitalized patients, particularly those in the ICU. Both fluconazole and the echinocandins are recommended as first-line therapy for C/IC. Resource use and cost considerations are important in selecting appropriate treatment but little information is available on the economic implications of using echinocandins in this setting. To compare resource utilization and treatment costs (in $US) associated with the echinocandin anidulafungin (200 mg intravenously on day 1, then 100 mg intravenously daily) versus those of fluconazole (800 mg intravenously on day 1, then 400 mg intravenously daily) as first-line treatment for C/IC. Available charts from patients enrolled in a recent clinical trial comparing anidulafungin and fluconazole for C/IC were reviewed. Patients who were in the ICU at study entry were identified, and the following data, collected during the 13-week study period, were compared between treatment groups: global response at end of study treatment, number of days patients survived after hospital discharge ('hospital-free' days), hospital resource use, and C/IC-related costs (year 2008 values) to a US hospital payer. These comparisons were also conducted for all non-ICU hospitalized patients, and for survivors in both study populations. Sensitivity analyses explored the cost impact of variability in the hospitalization costs between ICUs and non-ICU wards and of reduced duration intravenous therapy. Statistical comparisons between the two treatment groups were conducted for clinical outcomes, resource use and cost measures, using regression models. All statistical comparisons were adjusted for baseline co-variates (Acute Physiology and Chronic Health Evaluation [APACHE] II score, absolute neutrophil count and catheter removal status). For ICU patients with C/IC (n = 63), global response was significantly higher for anidulafungin than fluconazole (68.6$US2680 (p = 0.73). For hospitalized patients who survived (anidulafungin 81.9%, fluconazole 69.7%), anidulafungin treatment was associated with an incremental cost of $US231 (p = 0.98). Anidulafungin as first-line treatment of C/IC appears to be of particular benefit to ICU patients, improving clinical outcomes and possibly decreasing costs, driven by reduced ICU and hospital stay, when compared with fluconazole. Anidulafungin also yielded significantly improved treatment outcomes in the general inpatient population, with total costs similar to fluconazole

Aspergillosis in Intensive Care Unit (ICU) patients: epidemiology and economic outcomes

<p>Abstract</p> <p>Background</p> <p>Few data are available regarding the epidemiology of invasive aspergillosis (IA) in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs) among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection.</p> <p>Methods</p> <p>Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008). Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6) who received initial antifungal therapy (AF) in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS) were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models.</p> <p>Results</p> <p>From 6,424 aspergillosis patients in the database, 412 (6.4%) ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%), acute respiratory failure (76%) and acute renal failure (41%). In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once). Mean length of stay (LOS) was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p < 0.0001 for both).</p> <p>Conclusions</p> <p>Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of <it>Aspergillus</it> as a potential etiology in ICU patients.</p