Cost-utility of adjuvant zoledronic acid in patients with breast cancer and low estrogen levels

BACKGROUND: Adjuvant zoledronic acid (za) appears to improve disease-free survival (dfs) in women with early-stage breast cancer and low levels of estrogen (lle) because of induced or natural menopause. Characterizing the cost-utility (cu) of this therapy could help to determine its role in clinical practice. METHODS: Using the perspective of the Canadian health care system, we examined the cu of adjuvant endocrine therapy with or without za in women with early-stage endocrine-sensitive breast cancer and lle. A Markov model was used to compute the cumulative costs in Canadian dollars and the quality-adjusted life-years (qalys) gained from each adjuvant strategy, discounted at a rate of 5% annually. The model incorporated the dfs and fracture benefits of adjuvant za. Probabilistic and one-way sensitivity analyses were conducted to examine key model parameters. RESULTS: Compared with a no-za strategy, adjuvant za in the induced and natural menopause groups was associated with, respectively, $7,825 and$7,789 in incremental costs and 0.46 and 0.34 in qaly gains for cu ratios of $17,007 and$23,093 per qaly gained. In one-way sensitivity analyses, the results were most sensitive to changes in the za dfs benefit. Probabilistic sensitivity analysis suggested a 100% probability of adjuvant za being a cost-effective strategy at a threshold of $100,000 per qaly gained. CONCLUSIONS: Based on available data, adjuvant za appears to be a cost-effective strategy in women with endocrine-sensitive breast cancer and lle, having cu ratios well below accepted thresholds

Analysis of Nonsequential Double Ionization Using Virtual Detector Theory with Path Summation

We apply the virtual detector method, which is based on non-destructive numerical quantum detections and the propagation of Bohmian-like classical particles, to study in an ab initio way the nonsequential ionization dynamics of a model two-electron atom with helium character. Single- and double-ionization events are characterized and displayed using detector signals measured at different points in the two-electron two-dimensional position-space. The double photoelectron momentum distribution is calculated via coherent path-summation over virtual particle trajectories. Insights into different ionization and electron recollision pathways are gained from detailed virtual particle tracking and energy-time readouts. This study demonstrates a new extension of our application of virtual detector theory to strong-field multi-electron quantum dynamics.Comment: 6 pages, 6 figures, 1 tabl

Sudden Death of Genuine Tripartite Entanglement

Entanglement sudden death (ESD) is a dynamical physical process [Yu and Eberly, Science 323, 598 (2009)]. It occurs when entanglement is able to vanish abruptly, i.e., with a discontinuous slope as a function of time, even though the entangled qubits themselves evolve steadily and analytically. Two-qubit ESD has been well-described and multiply observed, but it remains a mystery. That is, it has not been possible to identify any initial condition under which a state's dynamics can be confidently predicted to evolve to ESD. This challenge has been frustrated by the lack of a quantitative measure of genuine entanglement even for pure-state systems as small as three qubits. Now, with the help of a newly discovered three-qubit measure [Xie and Eberly, Phys. Rev. Lett 127, 040403 (2021)], and by bringing convex-roof construction and Legendre transforms into play, we are able to describe the mixed-state ESD dynamics of a three-qubit system. An unexpected bonus of this advance is the identification of a condition under which ESD can reliably be anticipated.Comment: 5 pages, 3 figure

Linking Gas-Phase and Solution-Phase Protein Unfolding via Mobile Proton Simulations

Native mass spectrometry coupled to ion mobility (IM-MS) combined with collisional activation (CA) of ions in the gas phase (in vacuo) is an important method for the study of protein unfolding. It has advantages over classical biophysical and structural techniques as it can be used to analyze small volumes of low-concentration heterogeneous mixtures while maintaining solution-like behavior and does not require labeling with fluorescent or other probes. It is unclear, however, whether the unfolding observed during collision activation experiments mirrors solution-phase unfolding. To bridge the gap between in vacuo and in-solution behavior, we use unbiased molecular dynamics (MD) to create in silico models of in vacuo unfolding of a well-studied protein, the N-terminal domain of ribosomal L9 (NTL9) protein. We utilize a mobile proton algorithm (MPA) to create 100 thermally unfolded and coulombically unfolded in silico models for observed charge states of NTL9. The unfolding behavior in silico replicates the behavior in-solution and is in line with the in vacuo observations; however, the theoretical collision cross section (CCS) of the in silico models was lower compared to that of the in vacuo data, which may reflect reduced sampling

Fast Track Arthroplasty Using Local Infiltration Analgesia

Fast track arthroplasty is a holistic approach to patients who undergo total hip and knee arthroplasty, a journey or care that begins with setting patient’s expectation, optimising medical status, using intraoperative local anaesthetic infiltra-tion, decreasing narcotics usage either in spinal or post-operative medication, discouraging usage of patient controlled analgesia or urinary catheters, encouraging day of operation mobilisation and optimising post-operative physiotherapy protocols. The use of local infiltration analgesia (LIA) is a good alternative compared to other traditional pain management techniques. The purpose of adoption of LIA technique is to provide comfort from the trauma associated with hip and knee arthroplasty particularly for the first 36 h post-operatively, during the time of high post-operative pain, to facilitate increased post-operative mobilisation and function. LIA is safe and effective to achieve good outcomes, early mobilisation and decreasing length of stay without jeopardising clinical outcomes. This chapter discusses LIA and its multimodal approach to analgesia, regional anaesthesia and early mobilisation that improves overall patient experience and satisfaction. The chapter discusses LIA techniques, wound catheter placement, and postoperative protocol to achieve fast track hip and knee arthroplasty

The Coverage Problem in Video-Based Wireless Sensor Networks: A Survey

Wireless sensor networks typically consist of a great number of tiny low-cost electronic devices with limited sensing and computing capabilities which cooperatively communicate to collect some kind of information from an area of interest. When wireless nodes of such networks are equipped with a low-power camera, visual data can be retrieved, facilitating a new set of novel applications. The nature of video-based wireless sensor networks demands new algorithms and solutions, since traditional wireless sensor networks approaches are not feasible or even efficient for that specialized communication scenario. The coverage problem is a crucial issue of wireless sensor networks, requiring specific solutions when video-based sensors are employed. In this paper, it is surveyed the state of the art of this particular issue, regarding strategies, algorithms and general computational solutions. Open research areas are also discussed, envisaging promising investigation considering coverage in video-based wireless sensor networks

Superstaq: Deep Optimization of Quantum Programs

We describe Superstaq, a quantum software platform that optimizes the execution of quantum programs by tailoring to underlying hardware primitives. For benchmarks such as the Bernstein-Vazirani algorithm and the Qubit Coupled Cluster chemistry method, we find that deep optimization can improve program execution performance by at least 10x compared to prevailing state-of-the-art compilers. To highlight the versatility of our approach, we present results from several hardware platforms: superconducting qubits (AQT @ LBNL, IBM Quantum, Rigetti), trapped ions (QSCOUT), and neutral atoms (Infleqtion). Across all platforms, we demonstrate new levels of performance and new capabilities that are enabled by deeper integration between quantum programs and the device physics of hardware.Comment: Appearing in IEEE QCE 2023 (Quantum Week) conferenc

Banana as adjunct in beer production: applicability and performance of fermentative parameters

Traditionally, the raw materials for beer production are barley, hops, water, and yeast, but most brewers use also different adjuncts. During the alcoholic fermentation, the contribution of aroma compounds from other ingredients to the final beer flavor depends on the wort composition, on the yeast strain, and mainly on the process conditions. In this context, banana can also be a raw material favorable to alcoholic fermentation being rich in carbohydrates and minerals and providing low acidity. In this work, the objective was to evaluate the performance of wort adjusted with banana juice in different concentrations. For this, static fermentations were conducted at 15 °C at pilot scale (140 L of medium). The addition of banana that changed the concentration of all-malt wort from 10 °P to 12 and 15 °P were evaluated (°P is the weight of the extract or the sugar equivalent in 100 g solution, at 20 °C). The results showed an increase in ethanol production, with approximately 0.4 g/g ethanol yield and 0.6 g/L h volumetric productivity after 84 h of processing when concentrated wort was used. Thus, it was concluded that banana can be used as an adjunct in brewing methods, helping in the development of new products as well as in obtaining concentrated worts.Fundação para a Ciência e a Tecnologia (FCT)EMATER-MGJohnson-DiverseyFapesp (Fundação de Amparo à Pesquisa do Estado de São Paulo/Brasil)Wallerstein Industrial & CommercialNovozymesCAPES (Coordenação para Aperfeiçoamento do Ensino Superior/ Brasil)Malteria do ValeGRICES (Gabinete de Relações Internacionais da Ciência e do Ensino Superior/Portugal

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London