Endovascular Repair of Splenic Vein Aneurysm with Balloon Expandable Stent Placement.

Given the rarity of splenic vein aneurysms, it is no surprise that there are little data to help guide clinicians regarding indications and techniques for repair. Traditionally associated with hepatobiliary pathology including portal hypertension and pancreatitis, management typically involved open splenectomy. We describe the case of a patient with an incidentally found enlarging splenic vein aneurysm in the absence of significant past medical history. The patient underwent successful repair of the aneurysm utilizing a transhepatic endovascular approach with a balloon expandable stent. We offer this as minimally invasive solution allowing splenic salvage.

AidData's Geospatial Global Chinese Development Finance Dataset.

AidData's Global Chinese Development Finance Dataset (Version 3.0) provides detailed information about more than 20,000 development projects across 165 low- and middle-income countries financed by 791 official sector Chinese donors and lenders from 2000 to 2021. In this study, we introduce a methodology for identifying the geospatial features of these projects. Our application of the methodology has resulted in the Geospatial Global Chinese Development Finance Dataset (Version 3.0), which captures the geospatial features of 9,405 projects across 148 low- and middle-income countries supported by Chinese grant and loan commitments worth more than USD 830 billion. The dataset provides details for 6,266 projects containing spatial definitions of roads, railways, power plants, transmission lines, buildings, and other precisely geocoded features. It identifies approximate and administrative-level locations for 3,139 additional projects. The methodology, dataset, and the code used to construct the dataset have been made publicly available to facilitate replication and future applications.

Irrigation strengthens climate resilience: Long-term evidence from Mali using satellites and surveys.

Agriculture in the Sahel and much of sub-Saharan Africa remains to a large extent rainfed. At the same time, climate change is already causing less predictable rainfall patterns in the region, even as rising temperatures increase the amount of water needed for agricultural production. We assess to what extent irrigation can strengthen the climate resilience of farming communities. Our study sample consists of nearly 1,000 distinct locations in Mali in which small-scale, river-based irrigation was introduced over the past two decades, as weather conditions worsened and political upheaval erupted. Using the staggered roll-out of the irrigation and repeated observations over 20 years allows us to compare the pre- and postirrigation outcomes of locations while adjusting for confounding factors. We geospatially link data on irrigation interventions with agricultural conditions measured using satellite imagery and surveys, as well as child nutrition and health outcomes and conflict event data. Using a two-way fixed effects model to quasi-experimentally estimate counterfactual outcomes, we find that the introduction of irrigation led to substantial increases in agricultural production on supported fields, with these gains persisting even a decade later. Children in nearby communities are less likely to be stunted or wasted due to the irrigation, and conflict risks decrease in the closest communities. Some of these gains are offset by worsening conditions farther away from the newly installed irrigation. These findings suggest that, even with political conflicts in semi-arid areas already increasing, sustainable irrigation may offer a valuable tool to improve communities' long-term well-being and social cohesion.

geoBoundaries: A global database of political administrative boundaries.

We present the geoBoundaries Global Administrative Database (geoBoundaries): an online, open license resource of the geographic boundaries of political administrative divisions (i.e., state, county). Contrasted to other resources geoBoundaries (1) provides detailed information on the legal open license for every boundary in the repository, and (2) focuses on provisioning highly precise boundary data to support accurate, replicable scientific inquiry. Further, all data is released in a structured form, allowing for the integration of geoBoundaries with large-scale computational workflows. Our database has records for every country around the world, with up to 5 levels of administrative hierarchy. The database is accessible at http://www.geoboundaries.org, and a static version is archived on the Harvard Dataverse.

Herpes zoster in children.

Herpes zoster (HZ) in immunocompetent children is quite uncommon. Initial exposure to the varicella-zoster virus (VZV) may be from a wild-type or vaccine-related strain. Either strain may cause a latent infection and subsequent eruption of HZ. We present a case of HZ in a 15-month-old boy after receiving the varicella vaccination at 12 months of age. A review of the literature regarding the incidence, clinical characteristics, and diagnosis of HZ in children also is provided.

Treatment patterns following discontinuation of adalimumab, etanercept, and infliximab in a US managed care sample.

OBJECTIVES: Because clinical guidelines do not offer clear recommendations for treatment options after discontinuing a tumor necrosis factor (TNF) blocker, this study evaluated treatment patterns within 360 days after discontinuation of TNF-blocker treatment. METHODS: The IMS LifeLink Health Plan Claims database was used to identify patients diagnosed with rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis who received etanercept, adalimumab, or infliximab between January 1, 2005 and March 31, 2009. Discontinuation from index (first) TNF blocker was defined as switching to a different TNF blocker or a >45-day gap in therapy. Patients were categorized into mutually exclusive groups in descending order: (a) restart of index TNF blocker; (b) switch to another TNF blocker; (c) switch to a different biologic; (d) switch to nonbiologic therapy; or (e) no new treatment. RESULTS: Among 27,704 patients who initiated TNF-blocker therapy, 14,707 (53%) patients discontinued treatment over 1-3 years of follow-up. Within 360 days of discontinuing index TNF blocker, 53.4% of patients restarted index therapy: etanercept 59.9%, adalimumab 46.5%, and infliximab 43.1% (P < 0.001 for etanercept vs. adalimumab and infliximab). The majority of therapy restarts occurred within the first 3 months after discontinuation. Other patients switched to another TNF blocker: etanercept 17.1%, adalimumab 19.1% (P = 0.010 vs. etanercept), and infliximab 15.0% (P = 0.009 vs. etanercept). Switches from index TNF blocker to non-TNF-blocker biologic therapy were low: etanercept 1.9%, adalimumab 4.1%, and infliximab 10.7% (P < 0.001 for etanercept vs. adalimumab and infliximab). Switches from index TNF blocker to nonbiologic treatments were 5.4% for etanercept, 6.5% for adalimumab, and 6.9% for infliximab. CONCLUSIONS: Restarting of index TNF-blocker therapy occurs frequently after discontinuation, suggesting that long gaps in TNF-blocker therapy may be common. A significantly higher proportion of etanercept patients restarted their index TNF blocker within 3 months of discontinuation, compared with adalimumab and infliximab patients.

Annual costs of tumor necrosis factor inhibitors using real-world data in a commercially insured population in the United States.

OBJECTIVE: To calculate annual cost per treated patient of tumor necrosis factor (TNF) inhibitors etanercept, adalimumab, and infliximab for common approved indications, based on actual TNF-inhibitor use in clinical practice. METHODS: Adults with ≥1 claim for etanercept, adalimumab, or infliximab between January 2005 and March 2009 were identified from the IMS LifeLink™ Health Plan Claims Database. Patients new to therapy or continuing therapy (i.e., a prior claim for a TNF-inhibitor) were analyzed separately. Included patients had been enrolled from 180 days before the first TNF-inhibitor claim (index date) through 360 days after the index date and had a diagnosis during the pre-index period for rheumatoid arthritis, psoriasis, psoriatic arthritis, or ankylosing spondylitis. Patients with Crohn's disease, ulcerative colitis, or juvenile idiopathic arthritis were excluded. Annual costs were calculated using wholesale acquisition costs for the TNF-inhibitor and Medicare Physician Fee Schedule for drug administration. Costs from restarting or switching TNF-inhibitor therapy during the first year were included. RESULTS: A total of 27,704 patients (11,528 new, 16,176 continuing) had claims for etanercept, adalimumab, or infliximab, most commonly (65%) for treatment of rheumatoid arthritis. The most commonly used agent was etanercept (14,777 patients; 53%), followed by adalimumab (6862 patients; 25%) and infliximab (6065 patients; 22%). Annual cost per treated patient was etanercept $14,873, adalimumab $17,766, and infliximab $21,256 across all indications. Annual cost per treated patient by disease was (etanercept/adalimumab/infliximab): rheumatoid arthritis ($14,314/$17,700/$20,390), psoriasis ($17,182/$17,682/$23,935), psoriatic arthritis ($15,030/$18,483/$24,974), and ankylosing spondylitis ($14,254/$16,925/$23,056). New and continuing patients showed similar results, with etanercept having the lowest costs. LIMITATIONS: This analysis is limited to three TNF-inhibitors and a US managed-care population. CONCLUSIONS: Based on this analysis of real-world use of TNF-inhibitors among patients in nationwide clinical practice settings, the annual TNF-inhibitor cost per treated patient was lowest for etanercept across all indications.

Comparison of cobinamide to hydroxocobalamin in reversing cyanide physiologic effects in rabbits using diffuse optical spectroscopy monitoring.

Our purpose is to compare cobinamide to hydroxocobalamin in reversing cyanide (CN)-induced physiologic effects in an animal model using diffuse optical spectroscopy (DOS). Cyanide poisoning is a major threat worldwide. Cobinamide is a novel molecule that can bind two molecules of cyanide, has a much higher binding affinity than hydroxocobalamin, and is more water soluble. We investigated the ability of equimolar doses of cobinamide and hydroxocobalamin to reverse the effects of cyanide exposure in an animal model monitored continuously by DOS. Cyanide toxicity was induced in 16 New Zealand white rabbits by intravenous infusion. Animals were divided into three groups: controls (n=5) received saline following cyanide, hydroxocobalamin (N=6) following cyanide, and cobinamide (N=5) following cyanide. Cobinamide caused significantly faster and more complete recovery of oxy- and deoxyhemoglobin concentrations in cyanide-exposed animals than hydroxocobalamin- or saline-treated animals, with a recovery time constant of 13.8+/-7.1 min compared to 75.4+/-25.1 and 76.4+/-42.7 min, for hydroxocobalamin- and saline-treated animals, respectively (p<0.0001). This study indicates that cobinamide more rapidly and completely reverses the physiologic effects of cyanide than equimolar doses of cobalamin at the dose used in this study, and CN effects and response can be followed noninvasively using DOS.

Epidemiology and economic burden of brain metastases among patients with primary breast cancer: results from a US claims data analysis.

OBJECTIVE: To estimate the incidence, prevalence, and economic burden of secondary breast cancer brain metastases (BCBM) among a US-based population of patients with primary breast cancer. METHODS: Female patients diagnosed with secondary BCBM between 1/2002 and 12/2004 and with a brain or head diagnostic test within 30 days of the BCBM diagnosis were identified in a US commercial insurance claims database. A 12-month look-back period was used to identify patients with a breast cancer diagnosis and those with and without a history of BCBM. Patients were required to be continuously enrolled in their health plan for the duration of the study. Incident BCBM patients were matched to a control group of breast cancer patients with no evidence of BCBM. Patient characteristics at baseline, incidence and prevalence rates, and resource utilization and health care costs were determined. RESULTS: From 2002 to 2004, 779 incident and 995 prevalent BCBM patients and 8,518 primary breast cancer patients were identified. The incidence of BCBM during this time period was 9.1% (95% CI=8.5%, 9.8%); the prevalence of BCBM was 11.7% (95% CI=11.0%, 12.4%), with rates increasing from 2002 to 2004. About 22% of incident patients died (based on a proxy measure) during the follow-up period, an average of 158 days (95% CI=131.1, 183.9) from the index BCBM diagnosis. A 1:1 match of incident BCBM patients to controls resulted in 775 patients in each group. At 6 months follow-up (N=398), incident BCBM patients had significantly more hospital stays (mean 1.1 vs. 0.5, P<0.001) and remained hospitalized for a longer period (mean 8.0 days vs. 2.5 days, P<0.001) compared to controls. Incident BCBM patients also averaged more physician office visits (32.8 vs. 24.3, P<0.001) as well as pharmacy claims (56.0 vs. 39.1, P<0.001). Similar differences were found at 12 months (N=230). Average total costs for incident BCBM patients at 6 months were $60,045 compared to $28,193 for controls (P<0.001); this difference was driven by higher mean inpatient ($17,462 vs. $5,362, P<0.001) and outpatient ($26,209 vs. $11,652, P<0.001) costs among incident BCBM patients. At 12 months, higher mean total costs persisted in incident BCBM patients ($99,899 vs. $47,719, P<0.001). After adjusting for key variables, mean costs for these patients were 123% higher than those for control group patients. CONCLUSIONS: Secondary BCBM is a common occurrence among breast cancer patients, with rates increasing over time. Breast cancer patients with secondary BCBM incurred significantly more health care resources following diagnosis compared to those with breast cancer but no BCBM. Mean total costs for BCBM patients were more than double those of patients without BCBM at 6 and 12 months. The increasing prevalence and economic burden associated with BCBM suggests an unmet need that could be filled with newer treatments that improve breast cancer outcomes, including the prevention or delay of BCBM.

Therapy switching in patients receiving long-acting opioids.

BACKGROUND: Patterns of therapy switching in patients receiving long-acting opioids have not been well documented. OBJECTIVE: To compare therapy switching among patients beginning treatment with controlled-release (CR) oxycodone, transdermal fentanyl, or CR morphine sulfate. METHODS: Using a US healthcare claims database, we identified patients beginning treatment with CR oxycodone, transdermal fentanyl, or CR morphine sulfate between July 1, 1998, and December 31, 1999. We compiled claims for each patient for 6 months following therapy initiation and compared the incidence of therapy switching among the 3 groups. We also estimated total healthcare charges for patients who switched therapy versus those who did not. RESULTS: We identified 1931, 668, and 449 patients beginning therapy with CR oxycodone, transdermal fentanyl, and CR morphine sulfate, respectively; 16.7%, 25.0%, and 35.9%, respectively, had cancer. For patients without cancer, rates of therapy switching at 6 months were 10.6% (CR oxycodone), 19.0% (transdermal fentanyl), and 26.0% (CR morphine sulfate); for those with cancer, rates were 23.8%, 24.6%, and 29.8%, respectively. Multivariate hazard ratios (vs CR morphine sulfate) for therapy switching in patients without cancer were 0.36 (95% CI, 0.27 to 0.47) for CR oxycodone and 0.69 (0.51 to 0.94) for transdermal fentanyl; for those with cancer, corresponding hazard ratios were 0.72 (0.50 to 1.03) and 0.76 (0.50 to 1.16). Total healthcare charges were significantly (p < 0.01) higher for patients who switched therapy than those who did not (23,965 US dollars vs 14,299 US dollars in pts. without cancer; 58,259 US dollars vs 39,618 US dollars for those with cancer). CONCLUSIONS: Patients without cancer who receive CR oxycodone or transdermal fentanyl are less likely to switch therapy than those receiving CR morphine sulfate. Total healthcare charges are higher for patients who switch therapy.