Relationship between the AGT M235T genetic variant and the characteristics and prognosis of coronary atherosclerosis in patients with acute myocardial infarction.

BACKGROUND: Along with environmental components, genetic factors play an essential role in the pathophysiology and progression of acute myocardial infarction (AMI). There is limited and conflicting data on the influence of the AGT M235T genetic variant on coronary atherosclerosis and death in AMI patients. METHODS: We carried out a prospective cohort study among 504 Vietnamese AMI patients selected between January 2020 and May 2021. All patients underwent invasive coronary angiography, had AGT M235T genetic variant genotyped using the polymerase chain reaction method, and were followed up for 12-month all-cause mortality. RESULTS: The proportions of the MM, MT, and TT genotypes were 0.4%, 20.8%, and 78.8%, respectively. There was no significant difference between the TT genotype and the MM + MT genotype groups regarding the position and number of stenosed coronary artery branches and the Gensini score. The AGT M235T genetic variant did not affect 12-month mortality (hazard ratio of TT vs. MM + MT: 1.185; 95% confidence interval: 0.596-2.354; P = 0.629). Subgroup analyses by age, sex, hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker therapy also did not reveal an association between the AGT M235T variant and all-cause mortality. CONCLUSION: In summary, the AGT M235T genetic variant was not found to be associated with coronary atherosclerosis characteristics and 12-month mortality in Vietnamese patients with AMI. Further multicenter studies with larger sample sizes and extended follow-up periods are needed to investigate this issue.

PRESERVING HUMAN LARGE-SCALE BRAIN CONNECTIVITY FINGERPRINT IDENTIFIABILITY WITH RANDOM PROJECTIONS.

The complex etiology of various neurodegenerative diseases and psychiatric disorders, especially at the individual level, has posed unmatched challenges to the advancement of personalized medicine. Recent technical advancements in functional magnetic resonance imaging has enabled researchers to map brain large-scale connectivity at an unprecedented level of subject precision. Nonetheless, along with the early dawn of promises in personalized medicine using various neuroimaging modalities rose the challenge of clinical utility of brain connectomics (e.g., functional connectomes). Besides many established challenges of functional connectome utility such as edge reliability, there exists an easily overlooked challenge that does not get the same level of attention: computationality of functional connectome. To improve clinical utility of functional connectomics, we propose a random projection method that would preserve a practically similar level of subject identifiability while sampling and retaining only a proportion of functional edges in subjects' functional connectome. Our work pave a way towards computational improvements, hence clinical utility, of functional connectomes while not compromising the integrity of biomarkers learnt from whole-brain large-scale functional connectivity imaging modality.

Pt Single Atom-Doped Triphasic VP-Ni3P-MoP Heterostructure: Unveiling a Breakthrough Electrocatalyst for Efficient Water Splitting.

Enhancement of an alkaline water splitting reaction in Pt-based single-atom catalysts (SACs) relies on effective metal-support interactions. A Pt single atom (PtSA)-immobilized three-phased PtSA@VP-Ni3P-MoP heterostructure on nickel foam is presented, demonstrating high catalytic performance. The existence of PtSA on triphasic metal phosphides gives an outstanding performance toward overall water splitting. The PtSA@VP-Ni3P-MoP performs a low overpotential of 28 and 261 mV for hydrogen evolution reaction (HER) and oxygen evolution reaction (OER) at a current density of 10 and 25 mA cm-2, respectively. The PtSA@VP-Ni3P-MoP (+,-) alkaline electrolyzer achieves a minimum cell voltage of 1.48 V at a current density of 10 mA cm-2 for overall water splitting. Additionally, the electrocatalyst exhibits a substantial Faradaic yield of ≈98.12% for H2 and 98.47% for O2 at a current density of 50 mA cm-2. Consequently, this study establishes a connection for understanding the active role of single metal atoms in substrate configuration for catalytic performance. It also facilitates the successful synthesis of SACs, with a substantial loading on transition metal phosphides and maximal atomic utilization, providing more active sites and, thereby enhancing electrocatalytic activity.

Using QALYs as an Outcome for Assessing Global Prediction Accuracy in Diabetes Simulation Models.

OBJECTIVES: (1) To demonstrate the use of quality-adjusted life-years (QALYs) as an outcome measure for comparing performance between simulation models and identifying the most accurate model for economic evaluation and health technology assessment. QALYs relate directly to decision making and combine mortality and diverse clinical events into a single measure using evidence-based weights that reflect population preferences. (2) To explore the usefulness of Q2, the proportional reduction in error, as a model performance metric and compare it with other metrics: mean squared error (MSE), mean absolute error, bias (mean residual), and R2. METHODS: We simulated all EXSCEL trial participants (N = 14,729) using the UK Prospective Diabetes Study Outcomes Model software versions 1 (UKPDS-OM1) and 2 (UKPDS-OM2). The EXSCEL trial compared once-weekly exenatide with placebo (median 3.2-y follow-up). Default UKPDS-OM2 utilities were used to estimate undiscounted QALYs over the trial period based on the observed events and survival. These were compared with the QALYs predicted by UKPDS-OM1/2 for the same period. RESULTS: UKPDS-OM2 predicted patients' QALYs more accurately than UKPDS-OM1 did (MSE: 0.210 v. 0.253; Q2: 0.822 v. 0.786). UKPDS-OM2 underestimated QALYs by an average of 0.127 versus 0.150 for UKPDS-OM1. UKPDS-OM2 predictions were more accurate for mortality, myocardial infarction, and stroke, whereas UKPDS-OM1 better predicted blindness and heart disease. Q2 facilitated comparisons between subgroups and (unlike R2) was lower for biased predictors. CONCLUSIONS: Q2 for QALYs was useful for comparing global prediction accuracy (across all clinical events) of diabetes models. It could be used for model registries, choosing between simulation models for economic evaluation and evaluating the impact of recalibration. Similar methods could be used in other disease areas. HIGHLIGHTS: Diabetes simulation models are currently validated by examining their ability to predict the incidence of individual events (e.g., myocardial infarction, stroke, amputation) or composite events (e.g., first major adverse cardiovascular event).We introduce Q2, the proportional reduction in error, as a measure that may be useful for evaluating and comparing the prediction accuracy of econometric or simulation models.We propose using the Q2 or mean squared error for QALYs as global measures of model prediction accuracy when comparing diabetes models' performance for health technology assessment; these can be used to select the most accurate simulation model for economic evaluation and to evaluate the impact of model recalibration in diabetes or other conditions.

Chewing gum to treat postoperative nausea and vomiting in female patients: a multicenter randomized trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) is common after general anesthesia, with consequences for patient outcomes, satisfaction with care and healthcare costs. Our aim was to compare a new treatment, chewing gum, with a widely-used intravenous agent, ondansetron, to treat PONV in female patients in the post anesthesia care unit (PACU). METHODS: We conducted a multicenter, randomized, controlled non-inferiority trial in 17 hospitals in Australia and New Zealand. Female patients aged ≥12 years undergoing volatile anesthetic-based general anesthesia for laparoscopic or breast surgery were enrolled. Protocolized anti-emetic prophylaxis was administered. Patients who developed PONV in the PACU were randomized to either 15 min of chewing gum or 4 mg of intravenous ondansetron. The primary outcome was cessation of nausea, retching or vomiting, with no recurrence nor rescue medication for 2 h after administration of the randomized intervention (i.e., complete response). RESULTS: Of 865 enrolled patients, 218 were randomized. In a per-protocol analysis, 50 of 105 (47.6%) ondansetron-treated patients compared with 31 of 103 (30.1%) chewing gum-treated patients achieved the primary outcome (absolute risk difference [95% confidence interval (CI)] -17.3 [-30.4 to -4.3] %), not reaching our prespecified non-inferiority limit. Time to complete response was longer for patients randomized to chewing gum (hazard ratio [95% CI] 0.53 [0.34, 0.83]), and they were more likely to receive antiemetics in the 24 h after surgery (absolute risk difference [95% CI] 14.07 [1.65, 26.49]). CONCLUSIONS: Chewing gum cannot be recommended as an alternative to ondansetron for treatment of PONV in female patients administered antiemetic prophylaxis.

Chitosan-thioglycolic acid composite cross-linked with glutaraldehyde for selective recovery of Au(III) ions from e-waste leachate via reduction-coupled adsorption and incineration.

The recovery of gold (Au) from electronic waste (e-waste) has gained significant attention due to its high Au content and economic feasibility compared to natural ores. This study presents a facile, single-step approach to prepare the chitosan-thioglycolic acid composite crosslinked with glutaraldehyde (CS-TGA-GA) and demonstrates its unique capability for precious metal management, which is a less investigated application area for thiolated chitosan materials. The novel cost-effective biosorbent CS-TGA-GA demonstrated a very high adsorption capacity of 1351.9 ± 96 mg/g and selectivity for Au(III) from an acidic e-waste solution at pH 1 and 298 K. The high adsorption capacity and selectivity of the sorbent can be attributed to the abundance of -NH2, -OH, and -SH groups present on its surface. Various characterizations, such as scanning electron microscopy, energy-dispersive X-ray spectroscopy, X-ray diffractometry, Fourier-transform infrared spectroscopy, and X-ray photoelectron spectroscopy, as well as sorption experiments, including pH, kinetic, and isotherm studies, were performed. The kinetic data align with a pseudo-second-order model and the isotherm data can be well expressed by the Freundlich model. The CS-TGA-GA composite effectively facilitated the conversion of Au(III) to Au(0), leading to the formation of Au nanoparticles that aggregated in the reaction vessel over time. Subsequently, the Au-loaded CS-TGA-GA underwent an incineration procedure, yielding recovered Au with a purity of 99.6%, as measured by X-ray fluorescence. In addition to its large uptake capacity, acid stability, and recyclability, the prepared sorbent showed a highly selective uptake of Au(III) ions in a solution containing various metal ions leached from waste printed circuit boards. These results highlight the potential of CS-TGA-GA as an adsorbent for the recovery of Au from e-waste leachate, thereby contributing to sustainable resource management.

The Impact of Unrelated Future Medical Costs on Economic Evaluation Outcomes for Different Models of Diabetes.

OBJECTIVE: This study leveraged data from 11 independent international diabetes models to evaluate the impact of unrelated future medical costs on the outcomes of health economic evaluations in diabetes mellitus. METHODS: Eleven models simulated the progression of diabetes and occurrence of its complications in hypothetical cohorts of individuals with type 1 (T1D) or type 2 (T2D) diabetes over the remaining lifetime of the patients to evaluate the cost effectiveness of three hypothetical glucose improvement interventions versus a hypothetical control intervention. All models used the same set of costs associated with diabetes complications and interventions, using a United Kingdom healthcare system perspective. Standard utility/disutility values associated with diabetes-related complications were used. Unrelated future medical costs were assumed equal for all interventions and control arms. The statistical significance of changes on the total lifetime costs, incremental costs and incremental cost-effectiveness ratios (ICERs) before and after adding the unrelated future medical costs were analysed using t-test and summarized in incremental cost-effectiveness diagrams by type of diabetes. RESULTS: The inclusion of unrelated costs increased mean total lifetime costs substantially. However, there were no significant differences between the mean incremental costs and ICERs before and after adding unrelated future medical costs. Unrelated future medical cost inclusion did not alter the original conclusions of the diabetes modelling evaluations. CONCLUSIONS: For diabetes, with many costly noncommunicable diseases already explicitly modelled as complications, and with many interventions having predominantly an effect on the improvement of quality of life, unrelated future medical costs have a small impact on the outcomes of health economic evaluations.

Volume-optimal persistence homological scaffolds of hemodynamic networks covary with MEG theta-alpha aperiodic dynamics.

Higher-order properties of functional magnetic resonance imaging (fMRI) induced connectivity have been shown to unravel many exclusive topological and dynamical insights beyond pairwise interactions. Nonetheless, whether these fMRI-induced higher-order properties play a role in disentangling other neuroimaging modalities' insights remains largely unexplored and poorly understood. In this work, by analyzing fMRI data from the Human Connectome Project Young Adult dataset using persistent homology, we discovered that the volume-optimal persistence homological scaffolds of fMRI-based functional connectomes exhibited conservative topological reconfigurations from the resting state to attentional task-positive state. Specifically, while reflecting the extent to which each cortical region contributed to functional cycles following different cognitive demands, these reconfigurations were constrained such that the spatial distribution of cavities in the connectome is relatively conserved. Most importantly, such level of contributions covaried with powers of aperiodic activities mostly within the theta-alpha (4-12 Hz) band measured by magnetoencephalography (MEG). This comprehensive result suggests that fMRI-induced hemodynamics and MEG theta-alpha aperiodic activities are governed by the same functional constraints specific to each cortical morpho-structure. Methodologically, our work paves the way toward an innovative computing paradigm in multimodal neuroimaging topological learning. The code for our analyses is provided in https://github.com/ngcaonghi/scaffold_noise.

Health-related quality of life assessment in health economic analyses involving type 2 diabetes.

AIM: Incorporating health-related quality of life (HRQoL) measures into health economic analyses can help to provide evidence to inform decisions about how to improve patient outcomes in the most cost-effective manner. The aim of this narrative review was to assess which HRQoL instruments have been used in economic evaluations of type 2 diabetes management including in Indigenous communities. METHOD: MEDLINE (Ovid), Embase (Ovid) and Cochrane were searched from inception to June 2022. Studies included patients with type 2 diabetes; economic evaluations, derived scores from direct questioning of individuals; and were in English. Records were assessed for bias using the JBI critical appraisal tools. RESULTS: A total of 3737 records were identified, with 22 publications meeting the criteria for inclusion. Across those 22 articles, nine HRQoL instruments had been utilised. Generic tools were most frequently used to measure HRQoL, including EQ-5D (-3 L and -5 L) (n = 10, 38%); SF-12 (n = 5, 19%); and SF-36 (n = 4, 15%). Two tools addressing the specific stressors faced by people with type 2 diabetes were utilised: Problem Areas In Diabetes tool (n = 1, 4%) and Diabetes Distress Scale (n = 1, 4%). Two publications reported whether the study population included Indigenous peoples. CONCLUSION: A wide range of HRQoL instruments are used in economic evaluations of type 2 diabetes management, with the most frequent being varying forms of the EQ-5D. Few economic evaluations noted whether Indigenous peoples were featured in the study population. More research into HRQoL in people living with type 2 diabetes is urgently needed to improve evidence on effectiveness and cost-effectiveness of interventions.

Comprehensive drought risk assessment and mapping in Taiwan: An ANP-ANN ensemble approach.

This study aims to comprehensively evaluate and map the risk of drought in Taiwan by employing a combination of two powerful models, the Analytic Network Process (ANP) and Artificial Neural Network (ANN). This innovative approach utilizes an ensemble learning method, where ANP constructs a logical network and assigns weights to various indicators. Subsequently, ANN leverages these weights to train the model effectively. A total of twenty indicators were incorporated into the analysis to create a holistic drought risk map for Taiwan. These indicators are thoughtfully categorized into three essential components: hazard, exposure, and vulnerability, providing a well-defined representation of drought risk. The trained ANN model showcases remarkable accuracy and performance, boasting values of 0.940 for accuracy, 0.946 for precision, 0.938 for recall, 0.942 for the F1 score, and 0.923 for the Kappa Index. These results unequivocally affirm the model's effectiveness in predicting drought risk. Furthermore, the final drought risk map underwent rigorous validation through fieldwork and statistical data. The validation process yielded high accuracies, ranging from 0.717 to 0.851, for assessing damage to crops, converted damaged areas, and estimated value product loss. This validation, conducted against multiple reference data sources, underscores the map's reliability and its alignment with various goodness-of-fit criteria. In summary, this study underscores the potency of the ANP-ANN ensemble approach, with the trained ANN model proving its robustness in swiftly predicting drought risk across diverse ecological and socioeconomic scenarios.

Coordination of force-generating actin-based modules stabilizes and remodels membranes in vivo.

Membrane remodeling drives a broad spectrum of cellular functions, and it is regulated through mechanical forces exerted on the membrane by cytoplasmic complexes. Here, we investigate how actin filaments dynamically tune their structure to control the active transfer of membranes between cellular compartments with distinct compositions and biophysical properties. Using intravital subcellular microscopy in live rodents we show that a lattice composed of linear filaments stabilizes the granule membrane after fusion with the plasma membrane and a network of branched filaments linked to the membranes by Ezrin, a regulator of membrane tension, initiates and drives to completion the integration step. Our results highlight how the actin cytoskeleton tunes its structure to adapt to dynamic changes in the biophysical properties of membranes.

Effective removal of perfluorooctanoic acid from water using PVA@UiO-66-NH2/GO composite materials via adsorption.

This study introduces an innovative approach using highly efficient nanocomposite materials to effectively remove PFAS from water, demonstrating remarkable adsorption capabilities. The nanocomposite was synthesized by integrating a zirconium-based metal-organic framework (MOF) called UiO-66 with graphene oxide (GO) within a polyvinyl alcohol (PVA) matrix. The resulting PVA@UiO-66/GO material features flower-like UiO-66 MOF crystals embedded in the PVA and GO matrix. Various kinetic models were applied to determine the rate constants and adsorption capacities, with the Langmuir isotherm indicating an adsorption capacity of 9.904 mg/g. Thermodynamic analysis confirmed the process's spontaneity and exothermic nature. The UiO-66-NH2/GO/PVA composite also demonstrated high reusability, maintaining substantial PFOA removal efficiency across multiple cycles, with optimal reduction occurring at approximately pH 5. Overall, the PVA@UiO-66/GO composites offer an effective, sustainable, and environmentally friendly solution for PFAS removal in water purification.

Adverse effect of smoking on surgical site infection following ankle and calcaneal fracture fixation: a meta-analysis.

Purpose: Studies have reported conflicting findings on the relationship between smoking and surgical site infection (SSI) post fixation for ankle and calcaneal fractures. This meta-analysis explored the effect of smoking on SSI incidence following open reduction and internal fixation (ORIF) of these fractures. Methods: Full-text studies on smoking's influence on post-ORIF SSI rates for closed ankle and calcaneal fractures were sourced from the PubMed, Embase, and Cochrane databases, with no consideration given to language or publication date. Study quality was appraised using the Newcastle-Ottawa Scale. Odds ratios (OR) and the corresponding 95% CIs were determined using random-effects models. This meta-analysis adhered to the PRISMA guidelines and was registered with PROSPERO (CRD42023429372). Results: The analysis incorporated data from 16 cohort and case-control studies, totaling 41 944 subjects, 9984 of whom were smokers, with 956 SSI cases. Results indicated smokers faced a higher SSI risk (OR: 1.62; 95% CI: 1.32-1.97, P < 0.0001) post ORIF, with low heterogeneity (I 2 = 26%). Smoking was identified as a significant deep SSI risk factor (OR: 2.09; 95% CI: 1.42-3.09; P = 0.0002; I 2 = 31%). However, the subgroup analysis revealed no association between smoking and superficial SSI (OR: 1.05; 95% CI: 0.82-1.33; P = 0.70; I 2 = 0%). Conclusion: Smoking is associated with increased SSI risk after ORIF for closed ankle and calcaneus fractures. Although no clear link was found between superficial SSI and smoking, the data underscore the negative influence of smoking on deep SSI incidence.

Drosophila models of the anti-inflammatory and anti-obesity mechanisms of kombucha tea produced by Camellia sinensis leaf fermentation.

Kombucha tea is a traditional beverage originating from China and has recently gained popularity worldwide. Kombucha tea is produced by the fermentation of tea leaves and is characterized by its beneficial properties and varied chemical content produced during the fermentation process, which includes organic acids, amino acids, vitamins, minerals, and other biologically active compounds. Kombucha tea is often consumed as a health drink to combat obesity and inflammation; however, the bioactive effects of kombucha tea have not been thoroughly researched. In this study, we reveal the underlying mechanisms of the beneficial properties of kombucha tea and how they protect against obesity and inflammation by studying Drosophila models. We established an inflammatory Drosophila model by knocking down the lipid storage droplet-1 gene, a human perilipin-1 ortholog. In this model, dysfunction of lipid storage droplet-1 induces inflammation by enhancing the infiltration of hemocytes into adipose tissues, increasing reactive oxygen species production, elevating levels of proinflammatory cytokines, and promoting the differentiation of hemocytes into macrophages. These processes are regulated by the c-Jun N-terminal Kinase (JNK) pathway. Using this unique Drosophila model that mimics mammalian inflammation, we verified the beneficial effects of kombucha tea on reducing tissue inflammation. Our data confirms that kombucha tea effectively improves inflammatory conditions by suppressing the expression of cytokines and proinflammatory responses induced by lipid storage droplet-1 dysfunction. It was found that kombucha tea consumption alleviated the production of reactive oxygen species and activated the JNK signaling pathway, signifying its potential as an anti-inflammatory agent against systemic inflammatory responses connected to the JNK pathway. Kombucha tea reduced triglyceride accumulation by increasing the activity of Brummer (a lipase), thereby promoting lipolysis in third-instar larvae. Therefore, kombucha tea could be developed as a novel, functional beverage to protect against obesity and inflammation. Our study also highlights the potential use of this innovative model to evaluate the effects of bioactive compounds derived from natural products.

Dengue Hemorrhagic Fever in Quang Nam Province (Vietnam) from 2020 to 2022-A Study on Serotypes Distribution and Immunology Factors.

Background: Dengue hemorrhagic fever (DHF) is the most prevalent and fastest-growing vector-borne disease globally, with symptoms ranging from mild to severe and, in some cases, fatal. Quang Nam province in Vietnam can serve as a model for dengue epidemiological study, as it is an endemic region for DHF with a tropical climate, which significantly constrains the health system. However, there are very few epidemiological and microbiological reports on Dengue virus (DENV) serotypes in this region due to the limited availability of advanced surveillance infrastructure. Aims of the study: This study aims to (1) assess the PCR positivity rates among hospitalized patients with clinical Dengue presentation; (2) identify the circulating DENV serotypes; and (3) assess the impact of secondary DENV infections on outbreak severity by detecting the presence of DENV-specific IgG antibodies in the plasma of DENV-infected patients. Materials and methods: Blood samples from patients clinically diagnosed with DHF and admitted to Quang Nam General Hospital (2020-2022) were analyzed. RNA extraction was performed using the NKDNA/RNAprep MAGBEAD kit, followed by Multiplex Reverse Transcription real-time Polymerase Chain Reaction (MLP RT-rPCR) for DENV detection and serotype identification. Positive samples were further tested for DENV-specific IgG antibodies using an enzyme-linked immunosorbent assay (ELISA). Results: The PCR positivity rate among hospitalized patients was approximately 68% throughout the study period. A significant shift in DENV serotypes was observed, with DENV-2 initially dominant and later giving way to DENV-1. IgG was detected in nearly half of the MPL RT-rPCR-positive samples, indicating secondary DENV infections. Conclusions: Our study highlights persistent dengue prevalence and dynamic shifts in DENV serotypes in Quang Nam province, emphasizing the need for improved diagnostic strategies and timely sample collection. The significant serotype shifts and the presence of IgG in hospitalized patients suggest potential severe outcomes from recurrent DENV infections, possibly linked to antibody-dependent enhancement (ADE) effect, underscoring the importance of advanced surveillance, vector control, vaccination campaigns, and public education to predict and prevent future DHF epidemics.

Liquid Metal Grid Patterned Thin Film Devices Toward Absorption-Dominant and Strain-Tunable Electromagnetic Interference Shielding.

The demand of high-performance thin-film-shaped deformable electromagnetic interference (EMI) shielding devices is increasing for the next generation of wearable and miniaturized soft electronics. Although highly reflective conductive materials can effectively shield EMI, they prevent deformation of the devices owing to rigidity and generate secondary electromagnetic pollution simultaneously. Herein, soft and stretchable EMI shielding thin film devices with absorption-dominant EMI shielding behavior is presented. The devices consist of liquid metal (LM) layer and LM grid-patterned layer separated by a thin elastomeric film, fabricated by leveraging superior adhesion of aerosol-deposited LM on elastomer. The devices demonstrate high electromagnetic shielding effectiveness (SE) (SET of up to 75 dB) with low reflectance (SER of 1.5 dB at the resonant frequency) owing to EMI absorption induced by multiple internal reflection generated in the LM grid architectures. Remarkably, the excellent stretchability of the LM-based devices facilitates tunable EMI shielding abilities through grid space adjustment upon strain (resonant frequency shift from 81.3 to 71.3 GHz @ 33% strain) and is also capable of retaining shielding effectiveness even after multiple strain cycles. This newly explored device presents an advanced paradigm for powerful EMI shielding performance for next-generation smart electronics.

Recovering from COVID-19 (ReCOV): Feasibility of an Allied-Health-Led Multidisciplinary Outpatient Rehabilitation Service for People with Long COVID.

BACKGROUND: A multidisciplinary approach is required for the management of long COVID. The aim of this study was to determine the feasibility (demand, implementation, practicality, acceptability, and limited efficacy) of an allied-health-led multidisciplinary symptom management service (ReCOV) for long COVID. METHODS: A single-group observational cohort feasibility study was conducted to determine demand (referrals), acceptability (survey), implementation (waitlist times, health professions seen), practicality (adverse events), and limited efficacy (admission and discharge scores from the World Health Organization Disability Assessment Scale, Brief Illness Perception Questionnaire (BIPQ), Patient Health Questionnaire, and EuroQol 5D-5L). Data are presented as median [interquartile range] or count (percentage). RESULTS: During the study, 143 participants (aged 42.00 [32.00-51.00] years, 68% women) participated in ReCOV. Participants were waitlisted for 3.86 [2.14-9.86] weeks and engaged with 5.00 [3.00-6.00] different health professionals. No adverse events occurred. The thematic analysis revealed that ReCOV was helpful but did not fully meet the needs of all participants. Limited efficacy testing indicated that participants had improved understanding and control (p < 0.001) of symptoms (BIPQ) and a small improvement in EQ VAS score (median difference 5.50 points [0.00-25.00], p = 0.004]). CONCLUSIONS: A multidisciplinary service was safe and mostly acceptable to participants for the management of long COVID. Further research should investigate the clinical and cost effectiveness of such a service, including optimal service duration and patient outcomes.

Examining the Impact of Structural Uncertainty Across 10 Type 2 Diabetes Models: Results From the 2022 Mount Hood Challenge.

OBJECTIVES: The Mount Hood Diabetes Challenge Network aimed to examine the impact of model structural uncertainty on the estimated cost-effectiveness of interventions for type 2 diabetes. METHODS: Ten independent modeling groups completed a blinded simulation exercise to estimate the cost-effectiveness of 3 interventions in 2 type 2 diabetes populations. Modeling groups were provided with a common baseline population, cost and utility values associated with different model health states, and instructions regarding time horizon and discounting. We collated the results to identify variation in predictions of net monetary benefit (NMB) and the drivers of those differences. RESULTS: Overall, modeling groups agreed which interventions had a positive NMB (ie, were cost-effective), Although estimates of NMB varied substantially-by up to £23 696 for 1 intervention. Variation was mainly driven through differences in risk equations for complications of diabetes and their implementation between models. The number of modeled health states was also a significant predictor of NMB. CONCLUSIONS: This exercise demonstrates that structural uncertainty between different health economic models affects cost-effectiveness estimates. Although it is reassuring that a decision maker would likely reach similar conclusions on which interventions were cost-effective using most models, the range in numerical estimates generated across different models would nevertheless be important for price-setting negotiations with intervention developers. Minimizing the impact of structural uncertainty on healthcare decision making therefore remains an important priority. Model registries, which record and compare the impact of structural assumptions, offer one potential avenue to improve confidence in the robustness of health economic modeling.