Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis

<p>Abstract</p> <p>Background</p> <p>Analyses of utilization trends (cost drivers) allow us to understand changes in colorectal cancer (CRC) costs over time, better predict future costs, identify changes in the use of specific types of care (eg, hospice), and provide inputs for cost-effectiveness models. This retrospective cohort study evaluated healthcare resource use among US Medicare beneficiaries diagnosed with CRC between 1992 and 2002.</p> <p>Methods</p> <p>Cohorts included patients aged 66+ newly diagnosed with adenocarcinoma of the colon (n = 52,371) or rectum (n = 18,619) between 1992 and 2002 and matched patients from the general Medicare population, followed until death or December 31, 2005. Demographic and clinical characteristics were evaluated by cancer subsite. Resource use, including the percentage that used each type of resource, number of hospitalizations, and number of hospital and skilled nursing facility days, was evaluated by stage and subsite. The number of office, outpatient, and inpatient visits per person-year was calculated for each cohort, and was described by year of service, subsite, and treatment phase. Hospice use rates in the last year of life were calculated by year of service, stage, and subsite for CRC patients who died of CRC.</p> <p>Results</p> <p>CRC patients (mean age: 77.3 years; 44.9% male) used more resources than controls in every category (<it>P </it>< .001), with the largest differences seen in hospital days and home health use. Most resource use (except hospice) remained relatively steady over time. The initial phase was the most resource intense in terms of office and outpatient visits. Hospice use among patients who died of CRC increased from 20.0% in 1992 to 70.5% in 2004, and age-related differences appear to have evened out in later years.</p> <p>Conclusion</p> <p>Use of hospice care among CRC decedents increased substantially over the study period, while other resource use remained generally steady. Our findings may be useful for understanding CRC cost drivers, tracking trends, and forecasting resource needs for CRC patients in the future.</p

A case of acute necrotizing encephalopathy associated with parainfluenza virus infection

Acute necrotizing encephalopathy (ANE) may be suspected when a young child presents with abrupt onset of altered mental status, seizures, or both. Definitive clinical diagnosis is based on magnetic resonance imaging (MRI) results. ANE is associated with influenza virus infections. Preliminary data suggests that up to 25% of ANE patients die, and up to 25% of ANE survivors develop substantial neurologic sequelae. Here, we describe a case of a comatose 22-month-old girl who was admitted to our hospital because of febrile illness and seizures. On day 13 of her illness, she died from ANE associated with infection from parainfluenza virus. Brain MRI results indicated diffuse bilateral symmetric signal changes in both basal ganglia, thalami, periventricular white matter, pons, and cerebral white matter, as well as generalized swelling of the brain

The role of nutrient loading and eutrophication in estuarine ecology.

Eutrophication is a process that can be defined as an increase in the rate of supply of organic matter (OM) to an ecosystem. We provide a general overview of the major features driving estuarine eutrophication and outline some of the consequences of that process. The main chemical constituent of OM is carbon (C), and therefore rates of eutrophication are expressed in units of C per area per unit time. OM occurs in both particulate and dissolved forms. Allochthonous OM originates outside the estuary, whereas autochthonous OM is generated within the system, mostly by primary producers or by benthic regeneration of OM. The supply rates of limiting nutrients regulate phytoplankton productivity that contributes to inputs of autochthonous OM. The trophic status of an estuary is often based on eutrophication rates and can be categorized as oligotrophic (<100 g C m(-2) y(-1), mesotrophic (100-300 g C m(-2) y(-1), eutrophic (300-500 g C m(-2) y(-1), or hypertrophic (>500 g C m(-2) y(-1). Ecosystem responses to eutrophication depend on both export rates (flushing, microbially mediated losses through respiration, and denitrification) and recycling/regeneration rates within the estuary. The mitigation of the effects of eutrophication involves the regulation of inorganic nutrient (primarily N and P) inputs into receiving waters. Appropriately scaled and parameterized nutrient and hydrologic controls are the only realistic options for controlling phytoplankton blooms, algal toxicity, and other symptoms of eutrophication in estuarine ecosystems

Prdm1 Regulates Thymic Epithelial Function To Prevent Autoimmunity

Autoimmunity is largely prevented by medullary thymic epithelial cells (TECs) through their expression and presentation of tissue-specific Ags to developing thymocytes, resulting in deletion of self-reactive T cells and supporting regulatory T cell development. The transcription factor Prdm1 has been implicated in autoimmune diseases in humans through genome-wide association studies and in mice using cell type–specific deletion of Prdm1 in T and dendritic cells. In this article, we demonstrate that Prdm1 functions in TECs to prevent autoimmunity in mice. Prdm1 is expressed by a subset of mouse TECs, and conditional deletion of Prdm1 in either Keratin 14– or Foxn1-expressing cells in mice resulted in multisymptom autoimmune pathology. Notably, the development of Foxp3+ regulatory T cells occurs normally in the absence of Blimp1. Importantly, nude mice developed anti-nuclear Abs when transplanted with Prdm1 null TECs, but not wild-type TECs, indicating that Prdm1 functions in TECs to regulate autoantibody production. We show that Prdm1 acts independently of Aire, a crucial transcription factor implicated in medullary TEC function. Collectively, our data highlight a previously unrecognized role for Prdm1 in regulating thymic epithelial function

Structural and dielectric properties of Sr2_{2}TiO4_{4} from first principles

We have investigated the structural and dielectric properties of Sr$_{2}$TiO$_{4}$,the first member of the Sr$_{n+1}$Ti$_{n}$O$_{3n+1}$ Ruddlesden-Popper series, within density functional theory. Motivated by recent work in which thin films of Sr$_{2}$TiO$_{4}$ were grown by molecular beam epitaxy (MBE) on SrTiO$_{3}$ substrates, the in-plane lattice parameter was fixed to the theoretically optimized lattice constant of cubic SrTiO$_{3}$ (n=$\infty$), while the out-of-plane lattice parameter and the internal structural parameters were relaxed. The fully relaxed structure was also investigated. Density functional perturbation theory was used to calculate the zone-center phonon frequencies, Born effective charges, and the electronic dielectric permittivity tensor. A detailed study of the contribution of individual infrared-active modes to the static dielectric permittivity tensor was performed. The calculated Raman and infrared phonon frequencies were found to be in agreement with experiment where available. Comparisons of the calculated static dielectric permittivity with experiments on both ceramic powders and epitaxial thin films are discussed.Comment: 11 pages, 1 figure, 8 tables, submitted to Phys. Rev.

Solution modification of PEDOT:PSS inks for ultrasonic spray coating

PEDOT:PSS is a high-conductivity hole-transporting polymer that is widely used in polymer and perovskite photovoltaic devices, as well as in a host of other antistatic applications. Here we show that modification of PEDOT:PSS inks using ternary solvents and by the addition of small amounts of a high molecular weight polymer make it possible to deposit highly uniform thin films via ultrasonic spray coating. Such films can be deposited using a single pass in the wet phase without the use of surfactants; a process that greatly simplifies their deposition. Using this technique we create films having thickness and roughness comparable to that of spin coated films, whilst properties such as the conductivity and stability can be improved

Seasonal variations of Saanen goat milk composition and the impact of climatic conditions

The aim of this research was to investigate the effect of climatic conditions and their impact on seasonal variations of physico-chemical characteristics of Saanen goat milk produced over a period of 4 years. Lactation period (early, mid and late) and year were considered as factors that influence physico-chemical composition of milk. Pearson's coefficient of correlation was calculated between the physico-chemical characteristics of milk (fat, proteins, lactose, non-fat dry matter, density, freezing point, pH, titrable acidity) and climatic condition parameters (air temperature, temperature humidity index-THI, solar radiation duration, relative humidity). Results showed that all physico-chemical characteristics of Saanen goat milk varied significantly throughout the lactation period and years. The decrease of fat, protein, non-fat dry matter and lactose content in goat milk during the mid-lactation period was more pronounced than was previously reported in the literature. The highest values for these characteristics were recorded in the late lactation period. Observed variations were explained by negative correlation between THI and the physico-chemical characteristics of Saanen goat milk. This indicated that Saanen goats were very prone to heat stress, which implied the decrease of physico-chemical characteristics during hot summers