Resource utilization and costs of managing patients with advanced melanoma: a Canadian population-based study.

BACKGROUND: The use and detailed costs of services provided for people with advanced melanoma (amel) are not well known. We conducted an analysis to determine the use of health care services and the associated costs delineated by relevant attributable costs, which we defined for subjects in the province of Ontario. METHODS: Through the Ontario Cancer Data Linkage Project, a cohort of amel patients with diagnoses between 31 August 2005 and 2012 (follow-up to 2013) and with valid International Classification of Diseases (9th revision, Clinical Modification) 172 codes and histology codes was identified. A cohort of individuals with amel having a combination of at least 1 palliative, 1 medical oncology, and 1 hospitalization code was generated. The health system services used by this population were clustered into hospitalization, palliation, physician medical visits, medication, homecare, laboratory, diagnostics, and other resources. Overall rates of use and disaggregated costs were determined by phase of care for the entire cohort. RESULTS: The mean age for the 2748 individuals in the cohort was 67 years. The greater proportion of the patients were men (65.6%) and were more than 65 years of age (>50%). In this advanced cohort, fewer than 45% of patients were alive 3 years after the malignant melanoma diagnosis. The average annual cost per patient over the time horizon was $6,551. At $15,830, year 1 after diagnosis was the most expensive, followed by year 2, at $8,166. CONCLUSIONS: Our data provide a baseline for the costs associated with amel treatment. Future studies will include newer agents and comparative effectiveness research for personalized therapies.

Burden of illness for metastatic melanoma in Canada, 2011-2013.

BACKGROUND: Detailed epidemiology for patients with advanced metastatic melanoma in Canada is not well characterized. We conducted an analysis of patients with this disease in the province of Ontario, with the aim being to study the presentation, disease characteristics and course, and treatment patterns for malignant melanoma. METHODS: In this Canadian observational prospective and retrospective study of patients with malignant melanoma, we used data collected in the Canadian Melanoma Research Network (cmrn) Patient Registry. We identified patients who were seen at 1 of 3 cancer treatment centres between April 2011 and 30 April 2013. Patient data from 2011 and 2012 were collected retrospectively using chart records and existing registry data. Starting January 2013, data were collected prospectively. Variables investigated included age, sex, initial stage, histology, mutation type, time to recurrence, sites of metastases, resectability, and previous therapies. RESULTS: A cohort of 810 patients with melanoma was identified from the cmrn registry. Mean age was 58.7 years, and most patients were men (60% vs. 40%). Factors affecting survival included unresectable or metastatic melanoma, initial stage at diagnosis, presence of brain metastasis, and BRAF mutation status. The proportion of surviving patients decreased with higher initial disease stages. CONCLUSIONS: Using registry data, we were able to determine the detailed epidemiology of patients with melanoma in the Canadian province of Ontario, validating the comprehensive and detailed information that can be obtained from registry data.

Physicochemical characterization of sewage sludge and green waste for agricultural utilization.

In order to valorize the organic wastes, a mixture composed of 60 kg of thick sewage sludge from a wastewater treatment plant, 30 kg of green wastes (made of 10 kg straw of wheat, 10 kg manure farm wastes, and 10 kg of dead leaves), and 10 kg of wood chips was prepared. The organic wastes were mixed and put into a wooden cubic composter having a volume of 1.5 m3. Physicochemical analyses were made every 30 days for five months. The results of the analyses showed that the obtained compost had good physicochemical quality and can be used as an organic fertilizer. The main characteristics of this compost were distinguished by its pH from 7.4 to 7.8, with a ratio of organic matter of 40-42%. During composting, the humification process led to an increase in humic acids from 29.5 to 39.1 mg g(-1), a decrease in fulvic acids from 32.1 to 10.9 mg g(-1), and a global decomposition of hemicellulose, cellulose, and lignin. The obtained results show that a period of 150 days of composting gave a C/N ratio of 15.4. The total metal content in the final compost was much lower than the standard toxic levels for composts to be used as good soil fertilizers. The germination index for the two plants Cicer arietinum and Hordeum vulgare was 93% after the same period of composting, showing that the final compost was not phytotoxic. The study showed the possibility of valorization of the compost and its possible use in the domain of agriculture.

Association of transcription factor 7-like 2 gene (TCF7L2) polymorphisms with stress-related hyperglycaemia (SRH) in intensive care and resulting outcomes: The READIAB study.

OBJECTIVE: The study aimed to evaluate the impact of the single nucleotide polymorphism (SNP) rs7903146 on the transcription factor 7-like 2 (TCF7L2) gene in stress-related hyperglycaemia (SRH), defined as blood glucose≥11mmol/L in at least two blood samples during the first 3 days in the intensive care unit (ICU), and on 28-day and 1-year mortality, and incidence of type 2 diabetes (T2D) at 6 months and 1 year in patients hospitalized in the ICU. METHODS: This prospective observational (non-interventional) multicentre READIAB study, carried out during 2012-2016 in six French ICUs, involved adult patients admitted to ICUs for at least two organ failures; patients admitted for<48h were excluded. During the 3-day ICU observational period, genetic testing, blood glucose values and insulin treatment were recorded. MAIN RESULTS: The association of rs7903146 with SRH was assessed using logistic regression models. Cox proportional hazards regression models assessed the associations between rs7903146 and mortality and between SRH and mortality, both at 28 days and 1 year. A total of 991 of the 1000 enrolled patients were included in the READIAB-G4 cohort, but 242 (24.4%) had preexisting diabetes and were excluded from the analyses. SRH occurred within the first 3 days in the ICU for one-third of the non-diabetes patients. The association between the rs7903146 polymorphism and SRH did not reach significance (P=0.078): OR(peroneTcopy): 1.24, 95% CI: 0.98-1.58. A significant association was found between rs7903146 and 28-day mortality after adjusting for severity scores (P=0.026), but was no longer significant at 1 year (P=0.61). At 28 days, mortality was increased in patients with SRH (HR: 2.09, 95% CI: 1.43-3.06; P<0.001), and remained significant at 1 year after adjusting for severity scores (HR: 1.73, 95% CI: 1.32-2.28; P<0.001). On admission, non-diabetes patients with SRH had a higher incidence of T2D at 6 months vs. those without SRH (16.0% vs. 7.6%, RR: 2.11, 95% CI: 1.07-4.20; P=0.030). At 1 year, these figures were 13.4% vs. 9.2%, RR: 1.45, 95% CI: 0.71-2.96; P=0.31). Moreover, the rs7903146 polymorphism was not significantly associated with T2D development at either 6 months (P=0.72) or 1 year (P=0.64). CONCLUSION: This study failed to demonstrate any significant association between rs7903146 and SRH. Nevertheless, the issue remains an important challenge, as SRH may be associated with increased rates of both mortality and T2D development.

Cardiometabolic assessment of lamin A/C gene mutation carriers: a phenotype-genotype correlation.

AIMS: Mutations of the LMNA gene encoding lamin A/C induce heterogeneous phenotypes ranging from cardiopathies and myopathies to lipodystrophies. The aim of this study was to compare cardiometabolic complications in patients with heterozygous LMNA mutations at the 482nd codon, the 'hotspot' for partial lipodystrophy, with carriers of other, non-R482 LMNA mutations. METHODS AND RESULTS: This study included 29 patients with R482 LMNA mutations, 29 carriers of non-R482 LMNA mutation and 19 control subjects. Cardiac and metabolic phenotypes were compared between groups. A family history of either cardiac implantable electronic devices (CIEDs; P < 0.001) or sudden death (P < 0.01) was more frequent in non-R482 than R482 carriers. The non-R482 carriers also had more abnormalities on electrocardiography and received CIEDs more often than R482 carriers (P < 0.001). On cardiac ultrasound, non-R482 patients had greater frequencies of left atrial enlargement (P < 0.05) and lower left ventricular ejection fractions (P < 0.01) than R482 carriers. In contrast, R482 carriers had lower BMI (P < 0.05), leptin (P < 0.01) and fat mass (P < 0.001), but higher intra-/total abdominal fat-mass ratios (P < 0.001) and prevalences of diabetes (P < 0.01) and hypertriglyceridaemia (P < 0.05) than non-R482 carriers, with a trend towards more coronary artery disease. However, non-R482 carriers had higher intra-/total abdominal fat-mass ratios (P < 0.02) and prevalences of diabetes (P < 0.001) and hypertriglyceridaemia (P < 0.05) than the controls. CONCLUSION: Non-R482 carriers present more frequently with arrhythmias than R482 carriers, who twice as often have diabetes, suggesting that follow-up for laminopathies could be adjusted for genotype. Non-R482 mutations require ultra-specialized cardiac follow-up, and coronary artery disease should not be overlooked. Although overlapping phenotypes are found, LMNA mutations essentially lead to tissue-specific diseases, favouring genotype-specific pathophysiological mechanisms.

Transmission line matrix modelling of thermal injuries to skin.

A numerical model based on the transmission line matrix method is presented for the quantitative prediction of skin burn resulting from exposure of a specific region of human skin surface to a high temperature heat source. Transient temperatures were numerically estimated by Pennes' bioheat equation, and the damage function denoting the extent of burn was calculated using the Arrhenius assumptions for protein damage rate. A two-dimensional transmission line matrix model was used to predict the effects of exposure time and structure thicknesses on the transient temperature distribution and damage extent. Compared with other numerical sources the transmission line matrix results revealed good agreement, suggesting that this method may be an effective tool for the thermal diagnostic of burns.

Artificial neural network models for prediction of daily fine particulate matter concentrations in Algiers.

Neural network (NN) models were evaluated for the prediction of suspended particulates with aerodynamic diameter less than 10-µm (PM10) concentrations. The model evaluation work considered the sequential hourly concentration time series of PM10, which were measured at El Hamma station in Algiers. Artificial neural network models were developed using a combination of meteorological and time-scale as input variables. The results were rather satisfactory, with values of the coefficient of correlation (R (2)) for independent test sets ranging between 0.60 and 0.85 and values of the index of agreement (IA) between 0.87 and 0.96. In addition, the root mean square error (RMSE), the mean absolute error (MAE), the normalized mean squared error (NMSE), the absolute relative percentage error (ARPE), the fractional bias (FB), and the fractional variance (FS) were calculated to assess the performance of the model. It was seen that the overall performance of model 3 was better than models 1 and 2.

Impact of urban and industrial effluents on the coastal marine environment in Oran, Algeria.

In Algeria most of the urban waste water is dumped without treatment into the Sea. It is tremendously important to assess the consequences of organic matter rich sewage on marine ecosystem. In this study we investigated the effects of industrial and urban sewage on the dissolved oxygen (O2), chemical oxygen demand (COD), biochemical oxygen demands (BOD5), pH, salinity, electrical conductivity (EC), Metal element (Hg, Pb, Cu, Ni, Cr, Cd), petroleum hydrocarbons (HC), oil and grease (OG) in Bay of Oran, Algeria. A ten-year follow-up research showed that the concentrations of oil and grease released into the bionetwork are of higher ecological impact and this needs to be given the desired consideration. Information on bathing water quality revealed that the most beaches in Oran are under the national environmental standard limit.