Determining initial and follow-up costs of cardiovascular events in a US managed care population

<p>Abstract</p> <p>Background</p> <p>Cardiovascular (CV) events are prevalent and expensive worldwide both in terms of direct medical costs at the time of the event and follow-up healthcare after the event. This study aims to determine initial and follow-up costs for cardiovascular (CV) events in US managed care enrollees and to compare to healthcare costs for matched patients without CV events.</p> <p>Methods</p> <p>A 5.5-year retrospective matched cohort analysis of claims records for adult enrollees in ~90 US health plans. Patients hospitalized for first CV event were identified from a database containing a representative sample of the commercially-insured US population. The CV-event group (n = 29,688) was matched to a control group with similar demographics but no claims for CV-related events. Endpoints were total direct medical costs for inpatient and outpatient services and pharmacy (paid insurance amount).</p> <p>Results</p> <p>Overall, mean initial inpatient costs were US dollars ($) 16,981 per case (standard deviation [SD] =$20,474), ranging from $6,699 for a transient ischemic attack (mean length of stay [LOS] = 3.7 days) to$56,024 for a coronary artery bypass graft (CABG) (mean LOS = 9.2 days). Overall mean health-care cost during 1-year follow-up was $16,582 (SD =$34,425), an excess of $13,792 over the mean cost of matched controls. This difference in average costs between CV-event and matched-control subjects was$20,862 and $26,014 after two and three years of follow-up. Mean overall inpatient costs for second events were similar to those for first events ($17,705/case; SD = $22,703). The multivariable regression model adjusting for demographic and clinical characteristics indicated that the presence of a CV event was positively associated with total follow-up costs (P < 0.0001).</p> <p>Conclusions</p> <p>Initial hospitalization and follow-up costs vary widely by type of CV event. The 1-year follow-up costs for CV events were almost as high as the initial hospitalization costs, but much higher for 2- and 3-year follow-up.</p

Review of properties of magnetic shape memory (MSM) alloys and MSM actuator designs

Magnetic shape memory alloys are a new group of "smart" materials that exhibit large strain of 6-12% when subjected to magnetic fields. This indicates their enormous potential to be used in different electromagnetic (EM) devices such as actuators, sensors, energy harvesters and dampers. Shape change in MSM materials is controlled by magnetic field and doesn't involve phase transformation, allowing it to overcome a number of disadvantages of conventional shape memory alloys (SMAs). MSM devices are capable of producing large force and stroke output in considerably small dimensions. At the same time they can have fast response and potentially very long lifetime. This paper discusses different modern designs and approaches to MSM actuator design with their advantages and disadvantages. An overview on characteristics of MSM alloys is also presented in order to highlight how different properties of the material influence the total output of a device

“We Used to Say Rats Fell from the Sky After a Flood:” Temporary Recovery of Muskrat Following Ice Jams in the Peace-Athabasca Delta

Elders and Indigenous land users in the Peace-Athabasca Delta (PAD) have observed a dramatic decline in the relative abundance of muskrat in recent decades (~1935–2014). The main explanation for the decline has been reduction in suitable habitat as a result of decades with reduced frequency of ice-jam flooding on the Peace River. Under favourable conditions, ice jams can cause flooding of perched basins within the PAD that would otherwise receive no recharge from floodwaters. To examine whether abundance of muskrat in the PAD is driven by flooding, we tested the predictions that the density of muskrat (estimated by winter counts of houses) (1) was inversely related to the number of years since major ice jam floods and (2) increased with water depth. An ongoing collaborative monitoring program initiated in 2011, combined with analysis of data from past surveys (1973–2015), allowed Indigenous land users and scientists to document a 10 to 100-fold increase in the density of muskrat houses in 24 basins, over the two years following ice-jam flood events in the PAD. During 1973–2015, in the periods between major floods, density of houses dropped by approximately 79% for every year after a significant flood. In 27 basins surveyed from 2011 to 2015, density of muskrat houses increased by two orders of magnitude in the two years following a flood in the spring of 2014. Density of muskrat houses had a non-linear relationship with estimated depth of water at the time of fall freeze-up; the highest densities of muskrat houses were in basins with about 60 – 250 cm of water at the time of freeze-up. The depth of snow at the time of surveys did not have a strong relationship with the density of muskrat houses. However, few houses were counted in basins with more than 20 cm of snow, likely because deeper snow made it more difficult to conduct surveys and spot houses. Factors other than an increase in the depth of water at fall freeze-up may provide the mechanisms by which flooding affects muskrat. Density of muskrat houses is clearly tied to ice-jam flooding in the PAD. However, the local mechanisms by which floods affect muskrat are best understood by Indigenous land users and remain poorly understood by Western science. Indigenous peoples continue to regard muskrat as an indicator of ecological and cultural health of the PAD. This study highlights the value of consistent ecological monitoring that includes Indigenous knowledge.Les aînés et les utilisateurs des terres autochtones du delta des rivières de la Paix et Athabasca ont observé une baisse draconienne de l’abondance du rat musqué au cours des dernières décennies (~1935-2014). La principale explication du déclin est la diminution d’abris convenables, et ce, en raison de plusieurs décennies marquées par la fréquence réduite d’inondations causées par des embâcles dans la rivière de la Paix. Dans des conditions favorables, les embâcles peuvent causer l’inondation des bassins perchés au sein du delta des rivières de la Paix et Athabasca qui autrement ne recevraient pas de recharge des eaux de crue. Afin d’examiner si l’abondance du rat musqué dans le delta des rivières de la Paix et Athabasca est favorisée par les inondations, nous avons testé des prévisions selon lesquelles la densité du rat musqué (estimée par le nombre d’abris en hiver) 1) était inversement liée au nombre d’années depuis les dernières importantes inondations causées par des embâcles et 2) augmentait avec la profondeur de l’eau. Un programme collaboratif de suivi continu lancé en 2011, combiné à l’analyse de données des relevés antérieurs (1973-2015), a permis aux utilisateurs des terres autochtones et aux scientifiques de multiplier de 10 à 100 fois la densité d’abris du rat musqué dans 24 bassins, au cours des deux années suivant des événementsd’inondation causés par des embâcles dans le delta des rivières de la Paix et Athabasca. Entre 1973 et 2015, durant les périodes se situant entre les inondations importantes, la densité d’abris a diminué d’environ 79 % chaque année suivant une inondation importante. Dans 27 bassins sondés entre 2011 et 2015, la densité d’abris du rat musqué a augmenté de deux ordres de grandeur au cours des deux années ayant suivi une inondation survenue au printemps de 2014. La densité d’abris du rat musqué avait une relation non linéaire avec la profondeur de l’eau estimée au moment de la prise des glaces en automne; les plus fortes densités d’abris du rat musqué se trouvaient dans les bassins ayant de 60 à 250 cm d’eau au moment de la prise des glaces. La profondeur de la neige au moment des relevés n’avait pas de relation solide avec la densité d’abris du rat musqué. Cependant, nous avons compté peu d’abris dans les bassins comptant plus de 20 cm de neige, probablement parce qu’il était plus difficile d’effectuer des relevés et de trouver les abris dans la neige plus épaisse. Des facteurs autres que l’augmentation de la profondeur de l’eau au moment de la prise des glaces en automne pourraient fournir les mécanismes par lesquels les inondations se répercutent sur les rats musqués. La densité d’abris du rat musqué est manifestement liée aux inondations causées par des embâcles dans le delta des rivières de la Paix et Athabasca. Toutefois, les utilisateurs des terres autochtones comprennent mieux les mécanismes locaux par lesquels les inondations se répercutent sur les rats musqués, tandis qu’ils demeurent mal compris par la science occidentale. Les peuples autochtones continuent de considérer le rat musqué comme un indicateur de la santé écologique et culturelle du delta des rivières de la Paix et Athabasca. Cette étude fait ressortir la valeur d’un suivi écologique constant qui tient compte des connaissances autochtones

Interaction Between Convection and Pulsation

This article reviews our current understanding of modelling convection dynamics in stars. Several semi-analytical time-dependent convection models have been proposed for pulsating one-dimensional stellar structures with different formulations for how the convective turbulent velocity field couples with the global stellar oscillations. In this review we put emphasis on two, widely used, time-dependent convection formulations for estimating pulsation properties in one-dimensional stellar models. Applications to pulsating stars are presented with results for oscillation properties, such as the effects of convection dynamics on the oscillation frequencies, or the stability of pulsation modes, in classical pulsators and in stars supporting solar-type oscillations.Comment: Invited review article for Living Reviews in Solar Physics. 88 pages, 14 figure

Profiling Circulating and Urinary Bile Acids in Patients with Biliary Obstruction before and after Biliary Stenting

Bile acids are considered as extremely toxic at the high concentrations reached during bile duct obstruction, but each acid displays variable cytotoxic properties. This study investigates how biliary obstruction and restoration of bile flow interferes with urinary and circulating levels of 17 common bile acids. Bile acids (conjugated and unconjugated) were quantified by liquid chromatography coupled with tandem mass spectrometry in serum and urine samples from 17 patients (8 men and 9 women) with biliary obstruction, before and after biliary stenting. Results were compared with serum concentrations measured in 40 age- and sex-paired control donors (20 men and 20 women). The total circulating bile acid concentration increases from 2.7 µM in control donors to 156.9 µM in untreated patients with biliary stenosis. Serum taurocholic and glycocholic acids exhibit 304- and 241-fold accumulations in patients with biliary obstruction compared to controls. The enrichment in chenodeoxycholic acid species reached a maximum of only 39-fold, while all secondary and 6α-hydroxylated species –except taurolithocholic acids – were either unchanged or significantly reduced. Stenting was efficient in restoring an almost normal circulating profile and in reducing urinary bile acids

Clinical emergence of neurometastatic merkel cell carcinoma: a surgical case series and literature review

Merkel cell carcinoma (MCC) is a rare cutaneous neuroendocrine neoplasm of possible viral origin and is known for its aggressive behavior. The incidence of MCC has increased in the last 15 years. Merkel cell carcinoma has the potential to metastasize, but rarely involves the central nervous system. Herein, we report three consecutive surgical cases of MCC presenting at a single institution within 1 year. We used intracavitary BCNU wafers (Gliadel®) in two cases. Pathological features, including CK20 positivity, consistent with MCC, were present in all cases. We found 33 published cases of MCC with CNS involvement. We suggest that the incidence of neurometastatic MCC may be increasing, parallel to the increasing incidence of primary MCC. We propose a role for intracavitary BCNU wafers in the treatment of intra-axial neurometastatic MCC

National records of 3000 European bee and hoverfly species: A contribution to pollinator conservation

Pollinators play a crucial role in ecosystems globally, ensuring the seed production of most flowering plants. They are threatened by global changes and knowledge of their distribution at the national and continental levels is needed to implement efficient conservation actions, but this knowledge is still fragmented and/or difficult to access. As a step forward, we provide an updated list of around 3000 European bee and hoverfly species, reflecting their current distributional status at the national level (in the form of present, absent, regionally extinct, possibly extinct or non-native). This work was attainable by incorporating both published and unpublished data, as well as knowledge from a large set of taxonomists and ecologists in both groups. After providing the first National species lists for bees and hoverflies for many countries, we examine the current distributional patterns of these species and designate the countries with highest levels of species richness. We also show that many species are recorded in a single European country, highlighting the importance of articulating European and national conservation strategies. Finally, we discuss how the data provided here can be combined with future trait and Red List data to implement research that will further advance pollinator conservation