Urban environmental monitoring and health risk assessment introducing a fuzzy intelligent computing model.

Introduction: To enhance the precision of evaluating the impact of urban environments on resident health, this study introduces a novel fuzzy intelligent computing model designed to address health risk concerns using multi-media environmental monitoring data. Methods: Three cities were selected for the study: Beijing (B City), Kunming (K City), and Wuxi (W City), representing high, low, and moderate pollution levels, respectively. The study employs a Fuzzy Inference System (FIS) as the chosen fuzzy intelligent computing model, synthesizing multi-media environmental monitoring data for the purpose of urban health risk assessment. Results: (1) The model reliably estimates health risks across diverse cities and environmental conditions. (2) There is a positive correlation between PM2.5 concentrations and health risks, though the impact of noise levels varies by city. In cities B, K, and W, the respective correlation coefficients are 0.65, 0.55, and 0.7. (3) The Root Mean Square Error (RMSE) values for cities B, K, and W, are 0.0132, 0.0125, and 0.0118, respectively, indicating that the model has high accuracy. The R2 values for the three cities are 0.8963, 0.9127, and 0.9254, respectively, demonstrating the model's high explanatory power. The residual values for the three cities are 0.0087, 0.0075, and 0.0069, respectively, indicating small residuals and demonstrating robustness and adaptability. (4) The model's p-values for the Indoor Air Quality Index (IAQI), Thermal Comfort Index (TCI), and Noise Pollution Index (NPI) all satisfy p < 0.05 for the three cities, affirming the model's credibility in estimating health risks under varied urban environments. Discussion: These results showcase the model's ability to adapt to diverse geographical conditions and aid in the accurate assessment of existing risks in urban settings. This study significantly advances environmental health risk assessment by integrating multidimensional data, enhancing the formulation of comprehensive environmental protection and health management strategies, and providing scientific support for sustainable urban planning.

Utilizing support vector machines to foster sustainable development and innovation in the clean energy sector via green finance.

As the global demand for clean energy continues to grow, the sustainable development of clean energy projects has become an important topic of research. in order to optimize the performance and sustainability of clean energy projects, this work explores the environmental and economic benefits of the clean energy industry. through the use of Support Vector Machine (SVM) Multi-factor models and a bi-level multi-objective approach, this work conducts comprehensive assessment and optimization. with wind power base a as a case study, the work describes the material consumption of wind turbines, transportation energy consumption and carbon dioxide (CO2) emissions, and infrastructure material consumption through descriptive statistics. Moreover, this work analyzes the characteristics of different wind turbine models in depth. On one hand, the SVM multi-factor model is used to predict and assess the profitability of Wind Power Base A. On the other hand, a bi-level multi-objective approach is applied to optimize the number of units, internal rate of return within the project, and annual average equivalent utilization hours of the Wind Power Base A. The research results indicate that in March, the WilderHill New Energy Global Innovation Index (NEX) was 0.91053, while the predicted value of the SVM multi-factor model was 0.98596. The predicted value is slightly higher than the actual value, demonstrating the model's good grasp of future returns. The cumulative rate of return of Wind Power Base A is 18.83%, with an annualized return of 9.47%, exceeding the market performance by 1.68%. Under the optimization of the bi-level multi-objective approach, the number of units at Wind Power Base A decreases from the original 7004 to 5860, with total purchase and transportation costs remaining basically unchanged. The internal rate of return of the project increases from 8% to 9.3%, and the annual equivalent utilization hours increase to 2044 h, comprehensively improving the investment return and utilization efficiency of the wind power base. Through optimization, significant improvements are achieved in terAs the global demand for clean energy continues to grow, the sustainable development of clean energy projects has become an important topic of research. In order to optimize the performance and sustainability of clean energy projects, this work explores the environmental and economic benefits of the clean energy industry. Through the use of Support Vector Machine (SVM) multi-factor models and a bi-level multi-objective approach, this work conducts comprehensive assessment and optimization. With Wind Power Base A as a case study, the work describes the material consumption of wind turbines, transportation energy consumption and carbon dioxide (CO2) emissions, and infrastructure material consumption through descriptive statistics. Moreover, this work analyzes the characteristics of different wind turbine models in depth. On one hand, the SVM multi-factor model is used to predict and assess the profitability of Wind Power Base A. On the other hand, a bi-level multi-objective approach is applied to optimize the number of units, internal rate of return within the project, and annual average equivalent utilization hours of the Wind Power Base A. The research results indicate that in March, the WilderHill New Energy Global Innovation Index (NEX) was 0.91053, while the predicted value of the SVM multi-factor model was 0.98596. The predicted value is slightly higher than the actual value, demonstrating the model's good grasp of future returns. The cumulative rate of return of Wind Power Base A is 18.83%, with an annualized return of 9.47%, exceeding the market performance by 1.68%. Under the optimization of the bi-level multi-objective approach, the number of units at Wind Power Base A decreases from the original 7004 to 5860, with total purchase and transportation costs remaining basically unchanged. The internal rate of return of the project increases from 8% to 9.3%, and the annual equivalent utilization hours increase to 2044 h, comprehensively improving the investment return and utilization efficiency of the wind power base. Through optimization, significant improvements are achieved in terms of the number of units, internal rate of return within the project, and annual average equivalent utilization hours at Wind Power Base A. The number of units decreases to 5860, with total purchase and transportation costs remaining basically unchanged, the internal rate of return increases to 9.3%, and annual equivalent utilization hours increase to 2044 h. Energy consumption and CO2 emissions are significantly reduced, with energy consumption decreasing by 0.68 × 109 kgce and CO2 emissions decreasing by 1.29 × 109 kg. The optimization effects are mainly concentrated in the production and installation stages, with emission reductions achieved through the recycling and disposal of materials consumed in the early stages. In terms of investment benefits, environmental benefits are enhanced, with a 13.93% reduction in CO2 emissions. Moreover, there is improved energy efficiency, with the energy input-output ratio increasing from 7.73 to 9.31. This indicates that the Wind Power Base A project has significant environmental and energy efficiency advantages in the clean energy industry. This work innovatively provides a comprehensive assessment and optimization scheme for clean energy projects and predicts the profitability of Wind Power Base A using SVM multi-factor models. Besides, this work optimizes key parameters of the project using a bi-level multi-objective approach, thus comprehensively improving the investment return and utilization efficiency of the wind power base. This work provides innovative methods and strong data support for the development of the clean energy industry, which is of great significance for promoting sustainable development under the backdrop of green finance.

Research on the sustainable development of tourism coupled with economic and environment data--a case study of Hangzhou.

The scale of tourism has continued to expand in recent years, and many associated activities cause damage to the natural environment. The tourism, economy and natural environment constitute a system: destruction of the natural environment reduces the value of tourism and a lack of tourism affects the development of the economy. To explore the relationship between the tourism, economy and natural environment, and to explore possibilities for sustainable development, this paper takes Hangzhou, a tourist city in China, as a research object. An analysis of time series data is carried out. First, the tourism, economy and natural environment subsystems are constructed by extracting time series data acquired between 2010 and 2020. Second, a tourism evaluation model with coupled economic and natural environment data is constructed and the coupling degree and coupling coordination level in Hangzhou are evaluated. Third, the time series of each subsystem and the coupling coordination level of the whole system are analyzed. Finally, an optimization strategy is proposed for the coupled coordinated development of the tourism, economy and natural environment in Hangzhou. A key result is that the tertiary industry represented by tourism has become the main source of local income. Hangzhou's tourism coupling coordination level has changed from slight disorder in 2010 to good in 2020. It is also found that the COVID-19 pandemic has become a major factor restricting the development of tourism. Before the outbreak of COVID-19, Hangzhou's tourism industry and economy were synchronized. After the outbreak of COVID-19, both the number of tourists and tourism revenue in Hangzhou fell by nearly 15%.

Cost-Effective 2D Ultrathin Metal-Organic Layers with Bis-Metallic Catalytic Sites for Visible Light-Driven Photocatalytic CO2 Reduction.

Invited for the cover of this issue is the group of Liang-Nian He at Nankai University. The image depicts that 2D ultrathin metal organic layers (MOLs) with bis-metallic catalytic sites make an efficient photocatalyst resulting in efficient and selective visible-light-driven CO2 reduction. Read the full text of the article at 10.1002/chem.202201767.

Cost-Effective 2D Ultrathin Metal-Organic Layers with Bis-Metallic Catalytic Sites for Visible Light-Driven Photocatalytic CO2 Reduction.

As novel generated 2D materials, metal-organic layers (MOLs) have recently emerged as a potential platform for photocatalytic CO2 reduction reaction (PCO2 RR). Such 2D structures negate the blemish of low-density catalytic sites and low electron transmission efficiency on the surface of metal organic frameworks (MOFs), while retaining the advantage of low expenditure when using earth-abundant metal nodes and meritorious applicability in the PCO2 RR. Herein, it is reported that the 2D ultrathin layer material with bis-metallic catalytic sites (Ni-O metal node and the Ni-N metal site) from bidentate ligand 2,2'-bipyridine-5,5'-dicarboxylate (H2 bpydc) and nickel(II) remarkably boosts the visible light-driven PCO2 RR performance with a CO yield of 2400 mmol g-1 for 18 h and a selectivity up to 99 %. Consequently, the effects of morphology, catalytic sites and intrinsic properties on PCO2 RR efficiency have been investigated in detail. In this context, the ultrathin layer structure has been elucidated as the key point to facilitate electron transfer efficiency. Notably, the bis-metallic catalytic sites with reasonable distance between two adjacent metals presumably induce synergistic effect and offer a guiding ideology for further designing high performance photocatalysts.

Prevalence of Frailty and Associations with Oral Anticoagulant Prescribing in Atrial Fibrillation.

BACKGROUND: Frailty is often cited as a factor influencing oral anticoagulation (OAC) prescription in patients with non-valvular atrial fibrillation (NVAF). We sought to determine the prevalence of frailty and its association with OAC prescription in older veterans with NVAF. METHODS: We used ICD-9 codes in Veterans Affairs (VA) records and Medicare claims data to identify patients with NVAF and CHA2DS2VASC ≥2 receiving care between February 2010 and September 2015. We examined rates of OAC prescription, further stratified by direct oral anticoagulant (DOAC) or vitamin K antagonist (VKA). Participants were characterized into 3 categories: non-frail, pre-frail, and frail based on a validated 30-item EHR-derived frailty index. We examined relations between frailty and OAC receipt; and frailty and type of OAC prescribed in regression models adjusted for factors related to OAC prescription. RESULTS: Of 308,664 veterans with NVAF and a CHA2DS2VASC score ≥2, 121,839 (39%) were prescribed OAC (73% VKA). The mean age was 77.7 (9.6) years; CHA2DS2VASC and ATRIA scores were 4.6 (1.6) and 5.0 (2.9) respectively. Approximately a third (38%) were frail, another third (32%) were pre-frail, and the remainder were not frail. Veterans prescribed OAC were younger, had higher bleeding risk, and were less likely to be frail than participants not receiving OAC (all p's<0.001). After adjustment for factors associated with OAC use, pre-frail (OR: 0.89, 95% CI: 0.87-0.91) and frail (OR: 0.66, 95% CI: 0.64-0.68) veterans were significantly less likely to be prescribed OAC than non-frail veterans. Of those prescribed OAC, pre-frail (OR:1.27, 95% CI: 1.22-1.31) and frail (OR: 1.75, 95% CI: 1.67-1.83) veterans were significantly more likely than non-frail veterans to be prescribed a DOAC than a VKA. CONCLUSIONS: There are high rates of frailty among older veterans with NVAF. Frailty using an EHR-derived index is associated with decreased OAC prescription.

Economic Analysis on Adoption of Biosimilar Granulocyte Colony-Stimulating Factors in Patients With Nonmyeloid Cancer at Risk of Febrile Neutropenia Within the Oncology Care Model Framework.

PURPOSE: Value-based programs, such as the Oncology Care Model (OCM), seek to improve care for patients undergoing chemotherapy, while reducing total costs. The purpose of this study is to quantify the impact of adopting biosimilar granulocyte colony-stimulating factors (G-CSFs) for febrile neutropenia (FN) primary prophylaxis (PP) from a US practice perspective. METHODS: A 1-year economic analysis on real-world direct drug costs and health care resource utilization was conducted in a hypothetical cohort of 500 patients with nonmyeloid cancer receiving chemotherapy. The first model simulated total cost savings of biosimilar versus reference G-CSFs over six cycles of chemotherapy. The second model evaluated cost and outcome implications of expanding the use of biosimilar G-CSFs to an additional 10% of patients at intermediate FN risk. RESULTS: Based on real-world evidence over 1 year, a total of 121 of 500 patients received G-CSF prophylaxis resulting in cost savings that ranged from $0.54M US dollars (USD) (short-acting, eg, filgrastim) to $1.68M USD (long-acting, eg, pegfilgrastim) when switching from reference to biosimilar G-CSFs. Expanding the use of biosimilar G-CSFs allowed an additional 24 patients to receive prophylaxis of FN, leading to cost savings of $0.03M USD or $1.19M USD, with a reduction of $0.08M USD in FN-related resource utilization cost. The per-patient per-year cost saving for long-acting G-CSFs was about $3,000 USD. CONCLUSION: The implementation of biosimilar versus reference G-CSFs to OCM-participating practices results in a reduction of costs and facilitates achieving OCM metrics by improving patients' outcomes while expanding biosimilar G-CSFs access to patients at intermediate risk of chemotherapy-induced FN.

Economic and clinical outcomes of pegfilgrastim via prefilled syringe vs on-body injector: a real-world data analysis.

BACKGROUND: Pegfilgrastim is available as a prefilled syringe (PFS) and an on-body injector (OBI). Whether the administration method of pegfilgrastim affects the effectiveness and health care resources has not been evaluated in the setting of routine care. OBJECTIVE: To compare real-world clinical and economic outcomes between PFS and OBI methods of administration. METHODS: This was a retrospective observational study in patients diagnosed with breast cancer or non-Hodgkin lymphoma who received myelosuppressive chemotherapy and prophylactic use of pegfilgrastim via PFS or OBI between January 1, 2017, and May 31, 2018, according to MarketScan research databases. A propensity score was used to match the PFS cohort 1:1 to the OBI cohort. Outcomes were compared among the matched cohorts using a generalized linear model and generalized estimating equations with log-link function. RESULTS: 3,152 patients were identified. After matching, the final sample included 2,170 patients, representing 1,085 in each cohort. The incidence of febrile neutropenia (FN) in the first chemotherapy cycle was 1.01% for OBI (95% CI = 0.56-1.82) vs 1.48% for PFS (95% CI = 0.91-2.39; P = 0.336). In all chemotherapy cycles (total cycles = 7,467), the FN incidence was 0.91% for OBI (95% CI = 0.64-1.30) vs 1.22% for PFS (95% CI = 0.90-1.64; P = 0.214). There was no statistically significant difference in adjusted per-member per-month all-cause total cost health care resource utilization (HCRU) for hospitalizations, emergency department visits, and pharmacy claims. CONCLUSIONS: In a matched cohort of patients representing real-world utilization, there was no statistically or clinically meaningful difference in FN incidence between OBI and PFS methods of pegfilgrastim administration. There was no difference in total HCRU or total costs. OBI and PFS methods of administration are both indicated for patients requiring prophylactic pegfilgrastim, which is important considering that biosimilar PFS options are now available. DISCLOSURES: This study was funded by Sandoz, Inc. Wang, Li, and K. Campbell are employees of Sandoz, Inc. Schroader and D. Campbell are employees of Xcenda, which was contracted by Sandoz, Inc., to provide study and manuscript development. McBride reports receiving payment from Sandoz, Inc., as a consultant, unrelated to this study; Coherus for advisory board and speaker engagements; and Pfizer for advisory board participation during the time of this study.

Economic modeling of reSET-O, a prescription digital therapeutic for patients with opioid use disorder.

AIMS: reSET-O is a Food and Drug Administration-cleared prescription digital therapeutic (PDT) indicated to improve outpatient-treatment retention of patients with opioid use disorder (OUD). This study examined the cost-effectiveness and budget impact of reSET-O in conjunction with treatment as usual (reSET-O + TAU) relative to TAU. MATERIALS AND METHODS: Adult patients with ≥1 OUD diagnosis, treated with buprenorphine from 1 January 2015 to 30 March 2018, were identified from Truven Health MarketScan Commercial and Medicare Supplemental Research Databases. Twelve-week healthcare resource utilization (HCRU) costs for patients categorized as adherent and nonadherent to buprenorphine treatment were estimated. Total 12-week costs included OUD treatment and other HCRU costs. The cost-effectiveness of reSET-O + TAU was modeled in accordance with prior clinical trial outcomes. The 12-week budget impact of reSET-O was modeled for a 1 million-member healthcare plan. RESULTS: Higher buprenorphine adherence was associated with lower HCRU costs in claims data. Twelve-week per-patient total costs were $305 more for those receiving reSET-O + TAU than those receiving TAU. The incremental cost-effectiveness ratio was $18.70 per 1 percentage-point increase in the treatment retention rate. The probability that reSET-O + TAU would be considered cost-effective was over 92% for willingness-to-pay thresholds of $6,000 or more. The 12-week budget impact of reSET-O was $8,908, translating to $0.003 per member per month. LIMITATIONS: The findings of the cost-effectiveness and budget impact modeling are limited by the assumptions of the models due to uncertainty around some inputs. While no model is free of bias, the inputs for this model were carefully selected to reflect contemporary treatment patterns. CONCLUSIONS: Depending on the payer's willingness to pay, reSET-O may be cost-effective in increasing buprenorphine treatment retention rates. reSET-O results in an approximate budget impact of $0.003 per member per month, depending on market share and the prevalence of the population receiving treatment for OUD.

Wearable Bracelet Monitoring the Solar Ultraviolet Radiation for Skin Health Based on Hybrid IPN Hydrogels.

The risk of extensive exposure of the human epidermis to solar ultraviolet radiation is significantly increased nowadays. It not only induces skin aging and solar erythema but also increases the possibility of skin cancer. Therefore, a simply prepared, highly sensitive, and optically readable device for monitoring the solar ultraviolet radiation is highly desired for the skin health management. Because of the photoinitiated polymerization triggered by graphene-carbon nitride (g-C3N4) under ultraviolet radiation, g-C3N4 is homogeneously distributed in the hybrid hydrogels containing N-isopropylacrymide (NIPAM), poly(ethylene glycol) methyl ether methacrylate (OEGMA300), and sodium alginate (SA). By further immersing the hybrid hydrogels into calcium chloride solution, hybrid alginate-Ca2+/P(NIPAM-co-OEGMA300)/g-C3N4 interpenetrating polymeric network (IPN) hydrogels are obtained. Due to the homogeneous distribution of g-C3N4 and the existence of thermoresponsive polymers, the hybrid IPN hydrogels present good adsorption capability and high degradation efficiency for methylene blue (MB) especially at high temperature under ultraviolet radiation. Based on this unique property, the bracelet monitoring skin health is prepared by simply immersing the hybrid IPN hydrogels into the MB solution and then wrapping it with PET foil. Because the immersion time for the top, middle, and bottom parts of the hybrid IPN hydrogels is gradually increased, their colors vary from light to dark blue. A longer time is required for the discoloration of the darker part under solar ultraviolet radiation. Thus, the bracelet can be used to conveniently monitor the dose of solar ultraviolet radiation by simply checking the discoloration in the bracelet under sunshine. Due to the facile preparation and low cost of the bracelet, it is a promising candidate for wearable devices for skin health management.

Economic modeling for the US of the cost-efficiency and associated expanded treatment access of conversion to biosimilar pegfilgrastim-bmez from reference pegfilgrastim.

Aims: For this economic analysis, we aimed to model: (1) the cost-efficiency of prophylaxis with biosimilar pegfilgrastim-bmez for chemotherapy-induced (febrile) neutropenia (CIN/FN) compared to reference pegfilgrastim, and (2) the expanded access to CIN/FN prophylaxis and anti-neoplastic treatment that could be achieved with biosimilar cost-savings on a budget-neutral basis.Methods: In a hypothetical panel of 20,000 cancer patients receiving CIN/FN prophylaxis and using the average sales price (ASP) for the second quarter of 2019 for reference pegfilgrastim, we: conducted an ex ante simulation from the payer perspective of the cost-savings of 10-100% conversion from reference to biosimilar pegfilgrastim-bmez using drug price discounting ranging from 10-35%; estimated the budget-neutral expanded access to biosimilar pegfilgrastim-bmez enabled by these cost-savings; and estimated the budget-neutral expanded access to anti-neoplastic treatment with pembrolizumab. The simulations were replicated using fourth quarter 2019 wholesale acquisition cost (WAC) for reference pegfilgrastim and biosimilar pegfilgrastim-bmez in a post facto analysis.Results: In ASP simulations, cost-savings of using pegfilgrastim-bmez over reference pegfilgrastim in a 20,000 patient panel range from $1.3 M (at 15% price discount) to $3 M (35%) at 10% conversion rate and from $6.4 M to $14.9 M, respectively, at 50% conversion. These savings could provide prophylaxis with pegfilgrastim-bmez to an additional 352 (15% discount) to 1,076 patients (35%) at 10% conversion or 1,764-5,384, respectively, at 50% conversion. Alternatively, savings could be reallocated for anti-neoplastic treatment with pembrolizumab to 3 (15% discount) to 9 (35%) patients at 10% conversion or 19-45, respectively, at 50% conversion. When utilizing WAC, cost-savings range from $4.6 M (10% conversion) to $23.1 M (50%) which could provide pegfilgrastim-bmez to an additional 1,174 (10% conversion) to 5,873 patients (50%).Conclusions: Prophylaxis with biosimilar pegfilgrastim-bmez increases the value of cancer care by generating significant cost-savings that could be reallocated to provide expanded access to CIN/FN prevention and anti-neoplastic therapy on a budget-neutral basis.

Laparoscopic transabdominal preperitoneal technique versus open surgery with the ULTRAPRO Hernia System for the repair of female primary femoral hernias-an observational retrospective study.

Femoral hernias (FHs), predominantly seen in females, require surgery for cure. To date, surgical repair of primary FHs in female patients with either open surgery or laparoscopic operation has been poorly documented. We retrospectively investigated the treatment of female primary FHs with open surgery using the ULTRAPRO Hernia System (UHS procedure) or the laparoscopic procedure, namely, the transabdominal preperitoneal (TAPP) technique. A total of 41 female patients with primary FHs who had undergone UHS or TAPP were included in this study. The procedural parameters, post-surgical complications, treatment expense, and follow-up results were analyzed. The vast majority of patients (39/41) underwent elective operations: 15 received UHS (including 2 emergency cases) and 26 had TAPP (P = .08). The UHS group had a greater average age, due to the fact that FHs occur often in people with advanced age who tend to have systemic disease, limiting the use of general anesthesia required for TAPP. Compared with UHS, TAPP took a significantly shorter time to complete and patients undergoing TAPP had a dramatically shorter hospital stay. While no recurrence was observed in both groups, post-procedure pain and foreign body sensation were reported by significantly more patients in UHS group. The cost was greater with TAPP. Taken together, we concluded that both UHS and TAPP are effective in the management of female FHs. In view of the advantages and disadvantages between the open and the laparoscopic operation, surgeons can select a procedure according to their skills and patients' situation.

The cost of cardiovascular-disease-related death in patients with type 2 diabetes mellitus.

OBJECTIVES: To assess the magnitude of difference in all-cause healthcare resource utilization (HCRU) and costs between patients with type 2 diabetes mellitus (T2DM) who died from a cardiovascular disease (CVD)-related cause in the year preceding death vs. those who did not die during this same period. METHODS: A large US administrative claims database was used to identify patients with T2DM who died of a CVD-related cause from July 2012 to April 2015. These patients were matched 1:1 to patients with T2DM who did not die, using direct matching methods. HCRU and costs were assessed in each of the four quarters (Q4: 12-10 months; Q3: 9-7 months; Q2: 6-4 months; and Q1: 3-0 months) prior to death and compared between patient cohorts using paired t-tests and McNemar's tests. RESULTS: A final matched cohort of 7648 patients who died and 7648 patients who did not die were identified. A significantly higher proportion of patients who died utilized inpatient services vs. those who did not die (Q4: 12.6% vs. 4.6%, p < .001; Q3: 14.6% vs. 4.6%, p < .001; Q2: 17.6% vs. 5.5%, p < .001; and Q1: 65.0% vs. 10.1%, p < .001). In addition, patients who died incurred significantly higher all-cause costs (Q4: $8882 vs. $3970, p < .001; Q3: $10,462 vs. $3661, p < .001; Q2: $12,564 vs. $4169, p < .001; and Q1: $36,076 vs. $6319, p < .001). CONCLUSIONS: T2DM patients with a CVD-related death had significantly greater HCRU and costs in the year including and preceding death compared to those who did not die.

Incremental burden of type 2 diabetes in patients experiencing cardiovascular hospitalizations.

OBJECTIVE: To evaluate the incremental economic burden of type 2 diabetes in patients experiencing cardiovascular (CV) hospitalizations. RESEARCH DESIGN AND METHODS: Adults with ≥1 CV hospitalization were identified using a US-based healthcare claims database from 1 July 2011 to 30 June 2014. Outcomes for patients surviving the index hospitalization were compared between patients with vs. without type 2 diabetes (cohorts were identified in the pre-index period). Subsequent CV hospitalizations were evaluated using Cox proportional hazards models. All-cause and CV-related healthcare resource utilization (HCRU) and costs captured on a per-patient per-month (PPPM) basis during a variable follow-up period were evaluated using appropriate multivariable regression models. RESULTS: Of 316,207 patients with ≥1 CV hospitalization, 23% had comorbid type 2 diabetes. The mean age ± SD was 62.6 ± 12.3 years and 64.4% were male. During follow-up, the type 2 diabetes cohort had a 19% higher risk of subsequent CV hospitalizations compared to the non-type-2-diabetes cohort (p < .001). This difference in risk was highest in patients aged 35-44 years. Subsequent all-cause hospitalizations for the type 2 diabetes cohort were longer (mean length of stay, 6.7 vs. 6.3 days; p < .001), with higher total bed-days PPPM (mean, 0.52 vs. 0.43; p < .001), compared to the non-type-2-diabetes cohort. The type 2 diabetes cohort had a significantly higher incremental cost for both the index CV hospitalization (mean cost difference, $1046; p < .001) and all-cause costs PPPM following discharge (mean cost difference, $749; p < .001). CONCLUSIONS: Comorbid type 2 diabetes was associated with an increased risk of subsequent CV hospitalizations and higher costs and HCRU during the follow-up period.

Inhaled Corticosteroid-Containing Treatment Escalation and Outcomes for Patients with Asthma in a U.S. Health Care Organization.

BACKGROUND: Asthma is a common disorder that affects approximately 8% of the U.S. POPULATION: Treatment guidelines indicate inhaled corticosteroids (ICS) as the mainstay treatment, yet poor asthma control is common among ICS-treated patients. Treatment escalation (ICS dose increase and other controller therapy add-ons) is used to manage symptoms. Real-world studies of postescalation outcomes may inform treatment decisions. OBJECTIVES: To (a) describe characteristics and treatment patterns among asthma patients who escalated treatment and (b) assess outcomes (exacerbations, uncontrolled asthma, and health care resource utilization [HCRU]) after escalation. METHODS: The study cohort was identified from a large U.S. administrative claims database via ICD-9-CM codes for asthma (493.xx on ≥ 2 dates) and initiation (defining index date) of long-term (> 1 fill) ICS-containing treatment between January 1, 2009, and September 30, 2014. One year of continuous enrollment was required before and after the index date. Escalation was defined as ≥ 1 of the following: ICS dose increase; a switch between ICS, long-acting beta-2 agonists (LABA), or leukotriene modifiers (LTRM) to a different ICS, LABA, or LTRM; or add-on of controller medications (e.g., antibody biologic). Escalation patterns were examined. Rates of exacerbation (defined by inpatient admission, emergency department [ED] visit, or office visit with a pharmacy claim for an oral corticosteroid [OCS] within 7 days) and occurrence of uncontrolled asthma (defined by > 4 fills for a short-acting beta agonist [SABA] in a 1-year period, ≥ 1 OCS fill, or ≥ 1 asthma-related ED visit or inpatient admission) were calculated. Per-patient-per-year (PPPY) HCRU was estimated. RESULTS: Among 35,126 patients (mean [SD] age 38 [16] years) who initiated long-term ICS-containing treatment, 5,044 (14%) patients escalated their index regimens at 136 (105) days post-index (i.e., pre-escalation period). The most frequent changes, alone or in combination, included ICS dose increase (68%) or LABA (27%) or LTRM (25%) add-ons. Before escalation, the exacerbation rate was 1.60 (5.10) PPPY, and 1,108 (22%) patients experienced exacerbation. During the postescalation period of 251.6 (138.9) days, the exacerbation rate was 0.75 (2.9) PPPY, and 1,038 (21%) patients experienced exacerbation. A majority (> 85%) of exacerbations in the periods before and after escalation were associated with an office visit plus an OCS pharmacy claim within 7 days. Uncontrolled asthma was experienced by 41.5% and 41.0% of patients before and after escalation, respectively. Ambulatory care visits were common before (mean [SD] 24.0 [26.7] all-cause and 8.5 [13.4] asthma-related PPPY) and after escalation (19.3 [21.3] all-cause and 4.6 [8.1] asthma-related PPPY). CONCLUSIONS: Among asthma patients who initiated a long-term ICS-containing regimen, approximately 14% escalated therapy within a year of initiation. Yet, 21% of those patients had ≥ 1 exacerbation, and 41% of patients had uncontrolled asthma within 1 year after treatment escalation. The results demonstrate an unmet need among asthma patients who escalated their ICS-containing treatment. DISCLOSURES: This study was sponsored and funded by Boehringer-Ingelheim, which contracted with Optum to conduct the research. The sponsor collaborated with Optum on the preparation, writing, revision, and approval of the manuscript. Bengston, Cao, Hulbert, Wolbeck, Elliott, and Buikema are employees of Optum. Yu and Wang are employed by Boehringer-Ingelheim. Study concept and design were contributed by Bengston, Yu, and Wang. Cao, Hulbert, and Wolbeck collected the data, and data analysis was performed by Bengston, Yu, and Wang. The manuscript was written by Bengston, along with Yu and Wang, and revised by Bengston, Yu, and Wang, along with the other authors.

Malaria from hyperendemicity to elimination in Hekou County on China-Vietnam border: an ecological study.

BACKGROUND: Malaria control and elimination are challenged by diversity and complexity of the determinants on the international border in the Great Mekong Sub-region. Hekou, a Chinese county on the China-Vietnam border, was used to document Chinese experiences and lessons for malaria control and elimination. METHODS: The design was an ecological study. Malaria burden before 1951 and procedures of 64 years (1952-2015) from malaria hyperendemicity to elimination are described. Single and bilinear regression analysis was utilized to analyse the relationship between the annual malaria incidence (AMI) and gross domestic product (GDP), urbanization rate, and banana planting area (BPA). RESULTS: There was a huge malaria burden before 1951. AMI was reduced from 358.62 per 1000 person-years in 1953 to 5.69 per 1000 person-years in 1960. A system of primary health services, comprising three levels of county township hospitals and village health stations maintained malaria control and surveillance activities in changing political and social-economic settings. However, potential under-reported of malaria and market-oriented healthcare led to a malaria epidemic in 1987. Strong political commitment reoriented malaria from a control to an elimination programme. High coverage of malaria intervention and population access to intervention was crucial for malaria control and elimination; meanwhile, AMI was closely associated with socio-economic development, correlation coefficients (R) -0.6845 (95% CI -0.7978, -0.6845) for national GDP, -0.7014 (-0.8093, -0.7014) for national urbanization rate and -0.5563 (-0.7147, -0.3437) for BPA. CONCLUSIONS: Multifactor, including political commitment, effective interventions, social and economic development and changing ecological environment, and the complicated interactions between these factors contribute to malaria elimination in Hekou County.

Sulfhydryl-Modified Fe3O4@SiO2 Core/Shell Nanocomposite: Synthesis and Toxicity Assessment in Vitro.

The objectives of this study are to prepare sulfhydryl-modified Fe3O4@SiO2 core/shell magnetic nanocomposites, assess their toxicity in vitro, and explore their potential application in the biomedical fields. Fe3O4 nanoparticles synthesized by facile solvothermal method were coated with SiO2 via the Stöber method and further modified by the meso-2,3-dimercaptosuccinic acid (DMSA) to prepare Fe3O4@SiO2@DMSA nanoparticles. The morphology, structure, functional groups, surface charge, and magnetic susceptibility of the nanoparticles were characterized by transmission electron microscopy, X-ray diffraction, Fourier transform infrared spectrometry, X-ray photoelectron spectroscopy, zeta potential analysis, dynamic laser scattering, and vibrating sample magnetometer. Cytotoxicity tests and hemolysis assay were also carried out. Experimental results show that the toxicity of sulfhydryl-modified Fe3O4@SiO2 core/shell nanoparticles in mouse fibroblast (L-929) cell lines is between grade 0 and grade 1, and the material lacks hemolytic activity, indicating good biocompatibility of this Fe3O4@SiO2@DMSA nanocomposite, which is suitable for further application in biochemical fields.