Current and Future Incidence and Costs of Osteoporosis-Related Fractures in the Netherlands

This study aims to estimate the incidence and costs of osteoporosis-related fractures in The Netherlands in 2010 and project them to 2030. The incidence and costs of five different types of fractures (spine, hip, upper extremity, lower extremity, wrist/distal forearm, other) were derived from claims data of all Dutch healthcare insurers. Given that fracture-codes in claims data do not indicate whether fractures are related to osteoporosis, we used a large dataset with DXA measurements to attribute fractures to osteoporosis. Future projections used four scenarios: (1) demographic, (2) demographic ? annual trend in incidence rates, (3) demographic ? annual trend in incidence rates ? annual trend in costs, and (4) treatment. Of all registered fractures, 32 % was attributed to osteoporosis (36 % in women and 21 % in men). Over time (2010–2030) the increase in incidence of osteoporosis-related fractures was estimated to be 40 % (scenario 1); for the hip 60–79 % (scenario 1–2). In 2010, approximately €200 million was spent on treatment of osteoporosis-related fractures, most on fractures of the hip followed by wrist/distal forearm. In both men and women, the excess costs due to osteoporosis-related fractures were highest for hip fractures (€11,000–€13,000 per person), followed by spine fractures (€6000–€7000).The costs for osteoporosisrelated fractures were projected to increase with 50 % from 2010 to 2030 (scenario 1); for the hip 60–148 % (scenario 1–3). Pharmacotherapeutic prevention can lead to costsavings of €377 million in 2030 (scenario 1 and 4 combined). The projected increase in incidence and costs of osteoporosis-related fractures calls for a wider use of prevention and treatment

The Association of Oral Bisphosphonate Use With Mortality Risk Following a Major Osteoporotic Fracture in the United Kingdom:Population-Based Cohort Study

OBJECTIVES: Bisphosphonates (BPs) might have extra benefits in reducing mortality because of their anti-atherosclerotic effects, but studies reported conflicting results. We investigated the association between oral BP use and mortality risk following a major osteoporotic fracture (MOF) in the United Kingdom. DESIGN: This was a population-based cohort study. SETTING AND PARTICIPANTS: In total, 163,273 adults aged 50 years and older with an MOF between 2000 and 2018 from the Clinical Practice Research Datalink in the United Kingdom. METHODS: Cox proportional hazards models were used to estimate the risk of all-cause mortality in current (0‒6 months), recent (7‒12 months), and past (>1 year) exposures to oral BPs after nonhip MOF and hip fracture. In addition, stratification by sex, BP type, and duration of follow-up was performed. RESULTS: Compared with never users of oral BPs, current BP use was associated with a 7% higher all-cause mortality risk after nonhip MOF, whereas a 28% lower all-cause mortality risk was observed after hip fracture. Past BP exposure was associated with a 14% and 42% lower risk after nonhip MOF and hip fracture, respectively. When considering only the first 5 years of follow-up, mortality risk associated with current BP use was significantly lower for both fracture groups, and the greatest reduction in mortality risk was observed within the first year. Women had slightly lower risk compared with men. CONCLUSIONS AND IMPLICATIONS: We found a slight increased risk of all-cause mortality with current BP exposure after a nonhip MOF; however, a protective effect was observed following a hip fracture. Both the timing and the effect size of an association based on the anti-atherosclerotic hypothesis of BPs are not supported by our results. The decreasing trend of the mortality risk with shorter durations of follow-up suggests that the observed association is likely due to unknown distortion or unknown pleiotropic properties of BPs

Influence of biofilm lubricity on shear-induced transmission of staphylococcal biofilms from stainless steel to silicone rubber

In real-life situations, bacteria are often transmitted from biofilms growing on donor surfaces to receiver ones. Bacterial transmission is more complex than adhesion, involving bacterial detachment from donor and subsequent adhesion to receiver surfaces. Here, we describe a new device to study shear-induced bacterial transmission from a (stainless steel) pipe to a (silicone rubber) tube and compare transmission of EPS-producing and non-EPS-producing staphylococci. Transmission of an entire biofilm from the donor to the receiver tube did not occur, indicative of cohesive failure in the biofilm rather than of adhesive failure at the donor-biofilm interface. Biofilm was gradually transmitted over an increasing length of receiver tube, occurring mostly to the first 50cm of the receiver tube. Under high-shearing velocity, transmission of non-EPS-producing bacteria to the second half decreased non-linearly, likely due to rapid thinning of the lowly lubricious biofilm. Oppositely, transmission of EPS-producing strains to the second tube half was not affected by higher shearing velocity due to the high lubricity and stress relaxation of the EPS-rich biofilms, ensuring continued contact with the receiver. The non-linear decrease of ongoing bacterial transmission under high-shearing velocity is new and of relevance in for instance, high-speed food slicers and food packaging

Implications of Brexit on EU Financial Services

This study, which is prepared by Policy Department A at the request of the ECON Committee, addresses the implications and economic impact of several scenarios of the UK leaving the EU in relation to financial services, ranging from a ‘hard Brexit’ without any arrangements concerning financial services to the current state of affairs under the terms of a full EU membership. Special focus is put on a peculiar variation of ‘hard Brexit’, which are the third-country regimes in the current EU secondary legal framework that allow partial access to the EU single market based on ‘equivalence’ on the basis of decisions by the European Commission or national authorities. The study presents these regimes and the extent to which they were already used in the past. The economic analysis looks at three variations of ‘hard Brexit’ (one, in which the access to the single market is closed, one with partial access based on equivalence and one, in which the City of London is transformed into an ‘offshore financial centre’) and at the scenario, in which the UK joins the EEA. The economic assessment is based on the current state of affairs in relation to the interwovenness of financial services in the EU28 including a closer look at the importance of UK-based clearing of Euro denominated trades

Influence of wear and overwear on surface properties of etafilcon A contact lenses and adhesion of Pseudomonas aeruginosa

PURPOSE. To determine changes in physicochemical surface properties of contact tenses (CLs) during daily wear and effects of lens wear on adhesion of a Pseudomonas aeruginosa strain from a patient with CL-related keratitis.METHODS. Ten new CL wearers used ionic, etafilcon A lenses with 58% water on both eyes for approximately 10 hours each day during 10 and 50 days. All lenses were treated daily with an appropriate lens care solution. After the CLs were worn for 10 days (first pair of lenses) and 50 days (second pair, representing overwear), hydrophobicity by water contact angles, surface roughness by atomic force microscope, elemental surface composition by x-ray photoelectron spectroscopy (XPS), and adsorbed proteins by SDS-PAGE were determined on one lens. The lens from the contralateral eye was placed in a parallel plate flow chamber for bacterial adhesion after each time interval.RESULTS. Water contact angles on lenses changed from 45degrees on unused lenses to 61degrees +/- 25degrees after 10 days of wear and changed significantly (P &lt;0.05) to 27degrees +/- 14degrees after 50 days of wear. Surface roughness increased significantly (P &lt;0.05) from 4 +/- 2 nm (unused) to 10 +/- 7 nm after 50 days of wear. These changes were accompanied by adsorption of proteinaceous material, as evidenced by XPS and SDS-PAGE, demonstrating adsorption of lysozyme, tear lipocalin, and a 30-kDa protein. Initial bacterial adhesion to worn CLs was lower than to unworn CLs. Furthermore, detachment of adhering bacteria from worn lenses was easier than from unworn lenses. The changes observed in the physicochemical surface properties of the lenses after the CLs were worn for 50 days were accompanied by reports of discomfort by 6 of the 10 new CL wearers. Multiple regression analysis revealed that the most predictive variables for an effect on initial deposition after 10 days of wear were hydrophobicity, roughness, the presence of nitrogen-rich material, including the presence of a 30-kDa protein, and the presence of oxygen-rich material-that is, the type of oxygen adsorbed (O==C or O-C). After 50 days of wear, roughness and the presence of tear lipocalin were most predictive.CONCLUSIONS. This study demonstrates that the physicochemical surface properties changed after wear and overwear, whereas overwear of the lenses decreased initial adhesion of P. aeruginosa #3 under the present experimental conditions.</p

Force analysis of bacterial transmission from contact lens cases to corneas, with the contact lens as the intermediary

PURPOSE. To determine the probability of transmission of a Staphylococcus aureus strain from a contact lens case, to the contact lens (CL) surfaces, to the cornea, on the basis of bacterial adhesion forces measured by using atomic force microscopy (AFM). METHODS. Adhesion forces between S. aureus strain 835 probes with rigid and soft CLs, storage cases, and porcine corneas were measured with AFM and used to calculate Weibull distributions, from which the transmission probability from one surface to another was derived. Bacterial transmission probabilities from force analyses were compared with experimentally obtained transmission data. RESULTS. After bond-strengthening, S. aureus adhered to the surface of a lens case with a median force of 10.8 nN. Adhesion forces were different on the soft and rigid CLs (7.7 and 13.6 nN, respectively). Adhesion forces on porcine corneas amounted to 11.8 nN. Data variations were used to calculate the Weibull distribution, from which the probability of transmission from the lens case to a CL and from the CL to the cornea can be directly read. Final transmission probabilities from lens case to the cornea were slightly higher for the rigid (24%) than for the soft (19%) CL. Bacterial transmission determined experimentally increased with increasing contact times, but were within the range of the probabilities derived from Weibull analyses. CONCLUSIONS. Probabilities of bacterial transmission from contaminated lens cases to corneas can be derived from Weibull analyses of measured forces of adhesion to the surfaces involved. (Invest Ophthalmol Vis Sci. 2011;52:2565-2570) DOI:10.1167/iovs.10-639