Understanding the Economic Burden of Nonsevere Nocturnal Hypoglycemic Events: Impact on Work Productivity, Disease Management, and Resource Utilization

AbstractObjectiveNonsevere hypoglycemic events are common and may occur in one-third of persons with diabetes as often as several times a week. This study’s objective was to examine the economic burden of nonsevere nocturnal hypoglycemic events (NSNHEs).MethodsA 20-minute Web-based survey, with items derived from the literature, expert input, and patient interviews, assessing the impact of NSNHEs was administered in nine countries to 18 years and older patients with self-reported diabetes having an NSNHE in the past month.ResultsA total of 20,212 persons were screened, with 2,108 respondents meeting criteria and included in the analysis sample. The cost of lost work productivity per NSNHE was estimated to be between $10.21 (Germany) and$28.13 (the United Kingdom), representing 3.3 to 7.5 hours of lost work time per event. A reduction in work productivity (presenteeism) was also reported. Compared with respondents’ usual blood sugar monitoring practice, on average, 3.6 ± 6.6 extra tests were conducted in the week following the event at a cost of approximately $87.1 per year. Additional costs were also incurred for doctor visits as well as medical care required because of falls or injuries incurred during the NSNHE for an annual cost of$2,111.3 per person per year. When taking into consideration the multiple impacts of NSNHEs for the total sample and the frequency that these events occur, the resulting total annual economic burden was $288,000 or$127 per person per event.ConclusionsNSNHEs have serious consequences for patients. Greater attention to treatments that reduce NSNHEs can have a major impact on reducing the economic burden of diabetes

A comparison of health-related quality of life (health utility) between insulin degludec and insulin glargine: a meta-analysis of phase 3 trials

Aim: To evaluate health-related quality of life (health utility) scores in patients with diabetes receiving insulin degludec (IDeg) or insulin glargine (IGlar). Methods: Patient-level data from six, randomized, controlled, open-label, multicentre, confirmatory, treat-to-target trials of 26- or 52 weeks' duration were pooled in this analysis. The Short Form 36 (SF-36) version-2 health questionnaire was completed by patients at baseline and end-of-trial. SF-36 scores for 4001 individual patients were then mapped onto the EuroQol-5D health utility scale, which has a range from −0.59 (a state worse than death) to 1.00 (perfect health). Results: IDeg treatment exhibited a significant improvement in health status of 0.005 (CI: 0.0006; 0.009) points compared with IGlar (p < 0.024). Gender, region, trial and age also had a significant influence on estimated utility scores as did baseline utility scores, p < 0.05. Prior to the removal of interaction variables a difference of 0.008 points was observed, p < 0.045. Previous insulin treatment did not have an impact on the final outcome. Conclusion: This study shows that IDeg is associated with a modest, but statistically significant, improvement in health utility compared with IGlar in patients with diabetes

Structural and chemical characterization of the back contact region in high efficiency CdTe solar cells

Cadmium telluride (CdTe) is the leading commercialized thin-film photovoltaic technology. Copper is commonly used in back contacts to obtain high efficiency, but has also been implicated as a harmful factor for device stability. T hus it is critical to understand its composition and distribution within complete devices. In this work the composition and structure of the back contact region was examined in high efficiency devices (-16%) contacted using a ZnTe:Cu buffer layer followed by gold metallization. T he microstructure was examined in the asdeposited state and after rapid thermal processing (RTP) using high resolution transmission electron microscopy and EDX chemical mapping. After RTP the ZnTe exhibits a bilayer structure with polycrystalline, twinned grains adjacent to Au and an amorphous region adjacent to CdTe characterized by extensive Cd-Zn interdiffusion. T he copper that is co-deposited uniformly within ZnTe is found to segregate dramatically after RTP activation, either collecting near the ZnTe/Au interface or forming CUxTe clusters in CdTe at defects or grain boundaries near the interface with ZnTe. Chlorine, present throughout CdTe and concentrated at grain boundaries, does not penetrate significantly into the back contact region during RTP activation

Development of ZnTe as a back contact material for thin film cadmium telluride solar cells

Cadmium telluride (CdTe) is high-efficiency commercialised thin film photovoltaic technology. However, developing a stable low-resistivity back contact to the CdTe solar cells is still an issue. High work function and low level of doping of this material don't allow to create an ohmic contact with metals directly. Copper is commonly used to lower the back contact barrier in CdTe solar cells, but an excessive amount of copper diffusing through the cell is harmful for the device performance and stability. In this work a copper-doped ZnTe (ZnTe:Cu) buffer layer was incorporated in between CdTe and gold metal contact by high-rate pulsed DC magnetron sputtering. The back contact was then activated by rapid thermal processing (RTP) resulting in spectacular improvement in key device performance indicators, open circuit voltage (VOC) and fill factor (FF)

Thermochromic Metal Halide Perovskite Windows with Ideal Transition Temperatures

Urban centers across the globe are responsible for a significant fraction of energy consumption and CO2 emission. As urban centers continue to grow, the popularity of glass as cladding material in urban buildings is an alarming trend. Dynamic windows reduce heating and cooling loads in buildings by passive heating in cold seasons and mitigating solar heat gain in hot seasons. In this work, we develop a mesoscopic building energy model that demonstrates reduced building energy consumption when thermochromic windows are employed. Savings are realized across eight disparate climate zones of the United States. We use the model to determine the ideal critical transition temperature of 20 to 27.5 {\deg}C for thermochromic windows based on metal halide perovskite materials. Ideal transition temperatures are realized experimentally in composite metal halide perovskite film composed of perovskite crystals and an adjacent reservoir phase. The transition temperature is controlled by co-intercalating methanol, instead of water, with methylammonium iodide and tailoring the hydrogen-bonding chemistry of the reservoir phase. Thermochromic windows based on metal halide perovskites represent a clear opportunity to mitigate the effects of energy-hungry buildings

Intensity-modulated radiotherapy of nasopharyngeal carcinoma: a comparative treatment planning study of photons and protons

<p>Abstract</p> <p>Background</p> <p>The aim of this treatment planning study was to investigate the potential advantages of intensity-modulated (IM) proton therapy (IMPT) compared with IM photon therapy (IMRT) in nasopharyngeal carcinoma (NPC).</p> <p>Methods</p> <p>Eight NPC patients were chosen. The dose prescriptions in cobalt Gray equivalent (Gy_E) for gross tumor volumes of the primary tumor (GTV-T), planning target volumes of GTV-T and metastatic (PTV-TN) and elective (PTV-N) lymph node stations were 72.6 Gy_E, 66 Gy_E, and 52.8 Gy_E, respectively. For each patient, nine coplanar fields IMRT with step-and-shoot technique and 3D spot-scanned three coplanar fields IMPT plans were prepared. Both modalities were planned in 33 fractions to be delivered with a simultaneous integrated boost technique. All plans were prepared and optimized by using the research version of the inverse treatment planning system KonRad (DKFZ, Heidelberg).</p> <p>Results</p> <p>Both treatment techniques were equal in terms of averaged mean dose to target volumes. IMPT plans significantly improved the tumor coverage and conformation (<it>P </it>< 0.05) and they reduced the averaged mean dose to several organs at risk (OARs) by a factor of 2–3. The low-to-medium dose volumes (0.33–13.2 Gy_E) were more than doubled by IMRT plans.</p> <p>Conclusion</p> <p>In radiotherapy of NPC patients, three-field IMPT has greater potential than nine-field IMRT with respect to tumor coverage and reduction of the integral dose to OARs and non-specific normal tissues. The practicality of IMPT in NPC deserves further exploration when this technique becomes available on wider clinical scale.</p

Family history of cancer as a risk factor for second malignancies after Hodgkin's lymphoma

This study estimated the risk of second primary malignancies after Hodgkin's lymphoma (HL) in relation to family history of cancer, age at diagnosis and latency, among 6946 patients treated for HL in Sweden in 1965–1995 identified through the Swedish Cancer Register (SCR). First-degree relatives (FDRs) to the HL patients and their malignancies were then ascertained together with their malignancies through the Multi-Generation Registry and SCR. The HL patient cohort was stratified on the number of FDRs with cancer, and standardised incidence ratios (SIRs) of developing SM were analysed. In the HL cohort, 781 SM were observed 1 year or longer after HL diagnosis. The risk for developing SM increased with the number of FDRs with cancer, SIRs being 2.26, 3.01, and 3.45 with 0, 1, or ⩾2 FDRs with cancer, respectively. Hodgkin's lymphoma long-term survivors treated at a young age with a family history of cancer carry an increased risk for developing SM and may represent a subgroup where standardised screening for the most common cancer sites could be offered in a stringent surveillance programme