The health and social care costs of a selection of health conditions and multi-morbidities

Background Multimorbidity (MM) is the presence of 2 or more long-term health conditions in a single individual. It impacts an individual’s quality of life, mental health and wellbeing, daily function, and often results in greater healthcare utilisation the more co-existing conditions they have (1-4). MM is a big challenge facing the NHS, especially given England’s ageing population, with an estimated two-thirds of individuals aged 65 and over having 2 or more long-term conditions (5-6). Yet, little is known about the resource use of these patients despite being the group with the largest impact on the NHS and with the worst health outcomes (7). Existing evidence focuses on specific health conditions and their interactions with other conditions using different methodologies, making comparisons across different conditions difficult. This work has empirically assessed the impact of multi-morbidity on NHS and social care costs. With the aim of answering the question: is the impact of developing a condition on health and social care costs greater for someone with no prior conditions, or for someone with an existing condition. If patients have multiple conditions, there may be some economies of scale involved with treatment, for example they may be able to discuss multiple queries during a single GP appointment, or in some cases the treatment provided will address multiple conditions. However, treating patients with multi-morbidities could theoretically also be more expensive than treating 2 conditions separately, as patients may be more likely to experience complications. Methodology This work considered the individual cost of 11 health conditions with high prevalence in the English population and their most common interactions. These were: chronic obstructive pulmonary disease (COPD), diabetes (types 1 and 2), lung cancer, breast cancer, coronary heart disease (CHD), stroke, hypertension, dementia, liver disease, depression and colorectal cancer. This project had 2 components: a literature review and an empirical estimation of the costs associated with MM. The literature review was used to inform and establish the methodology used in the empirical estimation. The empirical estimation used data on primary healthcare, secondary healthcare, and prescriptions usage from 2015 to estimate annual aggregated healthcare costs per patient. We assessed the cost impact of MM in a systematic way by applying advanced econometric methods to account for the specificities of the data distribution. Our methodology allowed us to attribute healthcare costs to specific conditions. For social care costs, we calculated the estimated costs using 2 different methodologies. For the first (preferred) methodology, we used Somerset Symphony data to calculate the 2014/15 social care costs of patients in South Somerset. This is a dataset that combines primary healthcare, secondary healthcare, and social care data. We thus applied the same methodology that was used to calculate primary and secondary healthcare costs. For the second methodology, we used the estimated health-related quality of life for patients with different conditions and combinations of conditions. We then used a regression (‘line of best fit’) to estimate their probability of requiring social care. Finally, we used unit cost estimates to arrive at estimated values for the costs of social care for individuals with different diseases. What this publication adds Average ‘cost per case’ estimates for individuals with single conditions or multimorbidities, each calculated based on the average age of patients with the condition or multi-morbidity of interest. These average ‘costs per case’ figures are always higher for individuals with multimorbidities than individuals with a single condition, as individuals with multi-morbidities tend to be older and additional conditions incur additional costs. We found that the cost of treating an individual with a multimorbidity is not statistically different than the additive cost of treating 2 individuals, each with one of the conditions, controlling for age and costs unrelated to the condition. As an illustrative example, if it costs £200 to treat a patient with depression and £200 to treat a patient with CHD, we did not find any evidence that it would cost more than £400 to treat a single patient with both depression and CHD (controlling for age and unrelated disease costs). In numerous cases, when considering healthcare costs, we have found that multimorbidity is associated with a reduction of the total individual cost compared to the sum of individual costs of patients. For example, a male patient with diabetes and CHD will cost between 77% and 78% (depending on the definition of sample prevalence) of the cost of treating 2 patients, one with diabetes and one with CHD, controlling for age and unrelated costs. Applying the same methodology for social care costs as for healthcare costs, we did not find any evidence that multi-morbidity is associated with either an increase or a reduction in total individual cost compared to the sum of individual costs of patient, for social care costs. This may be due to the relatively small sample size of the South Somerset data we used to estimate social care costs. Applying the alternative methodology for social care costs, which estimated social care need based on age and quality of life, we estimated higher social care costs than we found by analysing the South Somerset data. This implies that social care need may be greater than local authority social costs in South Somerset. This may be due to the relative affluence of South Somerset, which would limit the proportion of patients eligible for local authority-funded social care

Shower development of particles with momenta from 15 GeV to 150 GeV in the CALICE scintillator-tungsten hadronic calorimeter

We present a study of showers initiated by electrons, pions, kaons, and protons with momenta from 15 GeV to 150 GeV in the highly granular CALICE scintillator-tungsten analogue hadronic calorimeter. The data were recorded at the CERN Super Proton Synchrotron in 2011. The analysis includes measurements of the calorimeter response to each particle type as well as measurements of the energy resolution and studies of the longitudinal and radial shower development for selected particles. The results are compared to Geant4 simulations (version 9.6.p02). In the study of the energy resolution we include previously published data with beam momenta from 1 GeV to 10 GeV recorded at the CERN Proton Synchrotron in 2010.Comment: 35 pages, 21 figures, 8 table

Hadron shower decomposition in the highly granular CALICE analogue hadron calorimeter

The spatial development of hadronic showers in the CALICE scintillator-steel analogue hadron calorimeter is studied using test beam data collected at CERN and FNAL for single positive pions and protons with initial momenta in the range from 10 to 80 GeV/c. Both longitudinal and radial development of hadron showers are parametrised with two-component functions. The parametrisation is fit to test beam data and simulations using the QGSP_BERT and FTFP_BERT physics lists from Geant4 version 9.6. The parameters extracted from data and simulated samples are compared for the two types of hadrons. The response to pions and the ratio of the non-electromagnetic to the electromagnetic calorimeter response, h/e, are estimated using the extrapolation and decomposition of the longitudinal profiles.Comment: 38 pages, 19 figures, 5 tables; author list changed; submitted to JINS

Angioimmunoblastic T-cell lymphoma is the most common T-cell lymphoma in two distinct French information data sets.

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Mould Routine Identification in the Clinical Laboratory by Matrix-Assisted Laser Desorption Ionization Time-Of-Flight Mass Spectrometry

BACKGROUND: MALDI-TOF MS recently emerged as a valuable identification tool for bacteria and yeasts and revolutionized the daily clinical laboratory routine. But it has not been established for routine mould identification. This study aimed to validate a standardized procedure for MALDI-TOF MS-based mould identification in clinical laboratory. MATERIALS AND METHODS: First, pre-extraction and extraction procedures were optimized. With this standardized procedure, a 143 mould strains reference spectra library was built. Then, the mould isolates cultured from sequential clinical samples were prospectively subjected to this MALDI-TOF MS based-identification assay. MALDI-TOF MS-based identification was considered correct if it was concordant with the phenotypic identification; otherwise, the gold standard was DNA sequence comparison-based identification. RESULTS: The optimized procedure comprised a culture on sabouraud-gentamicin-chloramphenicol agar followed by a chemical extraction of the fungal colonies with formic acid and acetonitril. The identification was done using a reference database built with references from at least four culture replicates. For five months, 197 clinical isolates were analyzed; 20 were excluded because they were not identified at the species level. MALDI-TOF MS-based approach correctly identified 87% (154/177) of the isolates analyzed in a routine clinical laboratory activity. It failed in 12% (21/177), whose species were not represented in the reference library. MALDI-TOF MS-based identification was correct in 154 out of the remaining 156 isolates. One Beauveria bassiana was not identified and one Rhizopus oryzae was misidentified as Mucor circinelloides. CONCLUSIONS: This work's seminal finding is that a standardized procedure can also be used for MALDI-TOF MS-based identification of a wide array of clinically relevant mould species. It thus makes it possible to identify moulds in the routine clinical laboratory setting and opens new avenues for the development of an integrated MALDI-TOF MS-based solution for the identification of any clinically relevant microorganism

Design, construction and commissioning of a technological prototype of a highly granular SiPM-on-tile scintillator-steel hadronic calorimeter

The CALICE collaboration is developing highly granular electromagnetic and hadronic calorimeters for detectors at future energy frontier electron-positron colliders. After successful tests of a physics prototype, a technological prototype of the Analog Hadron Calorimeter has been built, based on a design and construction techniques scalable to a collider detector. The prototype consists of a steel absorber structure and active layers of small scintillator tiles that are individually read out by directly coupled SiPMs. Each layer has an active area of 72 × 72 cm^2 and a tile size of 3 × 3 cm^2. With 38 active layers, the prototype has nearly 22,000 readout channels, and its total thickness amounts to 4.4 nuclear interaction lengths. The dedicated readout electronics provide time stamping of each hit with an expected resolution of about 1 ns. The prototype was constructed in 2017 and commissioned in beam tests at DESY. It recorded muons, hadron showers and electron showers at different energies in test beams at CERN in 2018. In this paper, the design of the prototype, its construction and commissioning are described. The methods used to calibrate the detector are detailed, and the performance achieved in terms of uniformity and stability is presented

Path segmentation for beginners: an overview of current methods for detecting changes in animal movement patterns

Increased availability of high-resolution movement data has led to the development of numerous methods for studying changes in animal movement behavior. Path segmentation methods provide basics for detecting movement changes and the behavioral mechanisms driving them. However, available path segmentation methods differ vastly with respect to underlying statistical assumptions and output produced. Consequently, it is currently difficult for researchers new to path segmentation to gain an overview of the different methods, and choose one that is appropriate for their data and research questions. Here, we provide an overview of different methods for segmenting movement paths according to potential changes in underlying behavior. To structure our overview, we outline three broad types of research questions that are commonly addressed through path segmentation: 1) the quantitative description of movement patterns, 2) the detection of significant change-points, and 3) the identification of underlying processes or ‘hidden states’. We discuss advantages and limitations of different approaches for addressing these research questions using path-level movement data, and present general guidelines for choosing methods based on data characteristics and questions. Our overview illustrates the large diversity of available path segmentation approaches, highlights the need for studies that compare the utility of different methods, and identifies opportunities for future developments in path-level data analysis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s40462-016-0086-5) contains supplementary material, which is available to authorized users

Down-Regulation of Neogenin Accelerated Glioma Progression through Promoter Methylation and Its Overexpression in SHG-44 Induced Apoptosis

Dependence receptors have been proved to act as tumor suppressors in tumorigenesis. Neogenin, a DCC homologue, well known for its fundamental role in axon guidance and cellular differentiation, is also a dependence receptor functioning to control apoptosis. However, loss of neogenin has been reported in several kinds of cancers, but its role in glioma remains to be further investigated.Western blot analysis showed that neogenin level was lower in glioma tissues than in their matching surrounding non-neoplastic tissues (n = 13, p<0.01). By immunohistochemical analysis of 69 primary and 16 paired initial and recurrent glioma sections, we found that the loss of neogenin did not only correlate negatively with glioma malignancy (n = 69, p<0.01), but also glioma recurrence (n = 16, p<0.05). Kaplan-Meier plot and Cox proportional hazards modelling showed that over-expressive neogenin could prolong the tumor latency (n = 69, p<0.001, 1187.6 ± 162.6 days versus 687.4 ± 254.2 days) and restrain high-grade glioma development (n = 69, p<0.01, HR: 0.264, 95% CI: 0.102 to 0.687). By Methylation specific polymerase chain reaction (MSP), we reported that neogenin promoter was methylated in 31.0% (9/29) gliomas, but absent in 3 kinds of glioma cell lines. Interestingly, the prevalence of methylation in high-grade gliomas was higher than low-grade gliomas and non-neoplastic brain tissues (n = 33, p<0.05) and overall methylation rate increased as glioma malignancy advanced. Furthermore, when cells were over-expressed by neogenin, the apoptotic rate in SHG-44 was increased to 39.7% compared with 8.1% in the blank control (p<0.01) and 9.3% in the negative control (p<0.01).These observations recapitulated the proposed role of neogenin as a tumor suppressor in gliomas and we suggest its down-regulation owing to promoter methylation is a selective advantage for glioma genesis, progression and recurrence. Furthermore, the induction of apoptosis in SHG-44 cells after overexpression of neogenin, indicated that neogenin could be a novel target for glioma therapy

Immature gannets follow adults in commuting flocks providing a potential mechanism for social learning

Group travel is a familiar phenomenon among birds but the causes of this mode of movement are often unclear. For example, flocking flight may reduce flight costs, enhance predator avoidance or increase foraging efficiency. In addition, naive individuals may also follow older, more experienced conspecifics as a learning strategy. However, younger birds may be slower than adults so biomechanical and social effects on flock structure may be difficult to separate. Gannets are wide‐ranging (100s–1000s km) colonial seabirds that often travel in V or echelon‐shaped flocks. Tracking suggests that breeding gannets use memory to return repeatedly to prey patches 10s–100s km wide but it is unclear how these are initially discovered. Public information gained at the colony or by following conspecifics has been hypothesised to play a role, especially during early life. Here, we address two hypotheses: 1) flocking reduces flight costs and 2) young gannets follow older ones in order to locate prey. To do so, we recorded flocks of northern gannets commuting to and from a large colony and passing locations offshore and used a biomechanical model to test for age differences in flight speeds. Consistent with the aerodynamic hypothesis, returning flocks were significantly larger than departing flocks, while, consistent with the information gathering hypothesis, immatures travelled in flocks more frequently than adults and these flocks were more likely to be led by adults than expected by chance. Immatures did not systematically occupy the last position in flocks and had similar theoretical airspeeds to adults, making it unlikely that they follow, rather than lead, for biomechanical reasons. We therefore conclude that while gannets are likely to travel in flocks in part to reduce flight costs, the positions of immatures in those flocks may result in a flow of information from adults to immatures, potentially leading to social learning

Performance of the CMS High Granularity Calorimeter prototype to charged pion beams of 20−-300 GeV/c

The upgrade of the CMS experiment for the high luminosity operation of the LHC comprises the replacement of the current endcap calorimeter by a high granularity sampling calorimeter (HGCAL). The electromagnetic section of the HGCAL is based on silicon sensors interspersed between lead and copper (or copper tungsten) absorbers. The hadronic section uses layers of stainless steel as an absorbing medium and silicon sensors as an active medium in the regions of high radiation exposure, and scintillator tiles directly readout by silicon photomultipliers in the remaining regions. As part of the development of the detector and its readout electronic components, a section of a silicon-based HGCAL prototype detector along with a section of the CALICE AHCAL prototype was exposed to muons, electrons and charged pions in beam test experiments at the H2 beamline at the CERN SPS in October 2018. The AHCAL uses the same technology as foreseen for the HGCAL but with much finer longitudinal segmentation. The performance of the calorimeters in terms of energy response and resolution, longitudinal and transverse shower profiles is studied using negatively charged pions, and is compared to GEANT4 predictions. This is the first report summarizing results of hadronic showers measured by the HGCAL prototype using beam test data.Comment: To be submitted to JINS