Budget Impact of Introducing Fixed-Duration Mosunetuzumab for the Treatment of Relapsed or Refractory Follicular Lymphoma After Two or More Lines of Systemic Therapy in the USA.

OBJECTIVE: This study aimed to assess the budget impact of introducing fixed-duration mosunetuzumab as a treatment option for adult patients with relapsed or refractory follicular lymphoma after at least two prior systemic therapies and to estimate the total cumulative costs per patient in the USA. METHODS: A 3-year budget impact model was developed for a hypothetical 1-million-member cohort enrolled in a mixed commercial/Medicare health plan. Comparators were: axicabtagene ciloleucel, tisagenlecleucel, tazemetostat, rituximab plus lenalidomide, copanlisib, and older therapies (rituximab or obinutuzumab ± chemotherapy). Costs per patient comprised treatment-associated costs including the drug, its administration, adverse events, and routine care. Dosing and safety data were ascertained from respective package inserts and clinical trial data. Drug costs (March 2023) were estimated based on the average wholesale acquisition cost reported in AnalySource®, and all other costs were based on published sources and inflated to 2022 US dollars. Market shares were obtained from Genentech internal projections and expert opinion. Budget impact outcomes were presented on a per-member per-month basis. RESULTS: Compared with a scenario without mosunetuzumab, its introduction over 3 years resulted in a budget increase of $69,812 (1% increase) and an average per-member per-month budget impact of $0.0019. Among the newer therapies, mosunetuzumab had the second-lowest cumulative per patient cost (mosunetuzumab = $202,039; axicabtagene ciloleucel = $505,845; tisagenlecleucel = $476,293; rituximab plus lenalidomide = $263,520; tazemetostat = $250,665; copanlisib = $127,293) and drug costs, and its introduction only increased total drug costs by 0.1%. By year 3, the cumulative difference in the per patient cost with mosunetuzumab was -$303,805 versus axicabtagene ciloleucel, -$274,254 versus tisagenlecleucel, -$61,481 versus rituximab plus lenalidomide, -$48,625 versus tazemetostat, and $74,747 versus copanlisib. Older therapies were less costly with 3-year cumulative costs that ranged from $36,512 to $147,885. CONCLUSIONS: Over 3 years, the estimated cumulative per patient cost of mosunetuzumab is lower than most available newer therapies, resulting in a small increase in the budget after its formulary adoption for the treatment of relapsed or refractory follicular lymphoma.

Immunotherapy-associated symptoms, distress, financial toxicity and unmet supportive care needs of patients with cancer.

PURPOSE: To examine the unmet care needs (i.e., overall needs and need subdomains [physical and daily living needs, psychological and emotional needs, care and support needs, and health-system and informational needs]) of patients with cancer undergoing immunotherapy alone or in combination with other anticancer therapies, as well as related influencing factors. METHODS: A cross-sectional design was adopted. Cancer patients who received immunotherapy completed consent and questionnaires. Unmet care needs were evaluated with the Chinese version of the Supportive Care Needs Survey Screening Tool, symptom severity with the Symptom Severity Scale, distress severity with the Distress Thermometer Scale, and financial toxicity using the Financial Toxicity - Functional Assessment of Chronic Illness Therapy Questionnaire. RESULTS: In total, 105 patients were surveyed. The most frequently reported unmet needs were psychological and emotional needs (56.2%) followed by health-system and informational needs (36.2%). The major factors associated with unmet care needs and their subdomains were years of education, symptoms, distress, and financial toxicity. Years of education predicted overall unmet care needs, psychological and emotional needs, and care and support needs; symptoms predicted overall unmet care needs and all four subdomains; distress predicted psychological and emotional needs and health-system and informational needs; and financial toxicity predicted overall needs and psychological and emotional needs. CONCLUSIONS: Patients with higher education, severe symptoms, distress, and financial toxicity reported more unmet care needs. The findings of this study could be incorporated into immunotherapy-related clinical practice guidelines and future interventions to improve the quality of cancer care.

Improved effects of the b-value for 2000 sec/mm2 DWI on an accurate qualitative and quantitative assessment of rectal cancer.

BACKGROUND AND STUDY OBJECTIVES: A higher b-value Diffusion-weighted imaging (DWI) would improve the contrast between cancerous and noncancerous tissue. Apparent diffusion coefficient (ADC)-histogram analysis is a method that can provide statistical data and quantitative information on tumor heterogeneity. This study aimed to compare two high b-values (1000 and 2000 sec/mm2) DWI in tumor detection and diagnostic performance in identifying early-stage tumor rectal cancer. PATIENTS AND METHODS: This blinded and blinded retrospective study involved 56 patients with rectal cancer and 45 patients. Two radiologists evaluated the qualitative detection parameters and quantitative parameters of the ADC evaluated histogram and compared them between two DWI sequences (b-value for 1000 sec/mm2 and 2000 sec/mm2). The characteristic curves were used to assess diagnostic administration for the ADC histogram in discriminating early-stage tumors. RESULTS: The b-value for 2000 sec/mm2 DWI significantly improved AUCs, sensitivity, specificity, and precision and decreased false-positive rate for detection compared to the b-value for 1000 sec/mm2 (p < 0.05). The mean and fifth percentile ADC value for stage I using the b-value for 1000 sec/mm2 DWI was significantly higher than stage ≥ II (p = 0.036II and 0.016 respectively), as the well as fifth, 10th, mean ADC of the fifth, 10th, and 25th ADC percentile at b-value for 2000 sec/mm2 (p = 0.031, 0.014, 0.035 and 0.025 respectively). The AUCs of the fifth percentile ADC at b-value for 2000 sec/mm2 DWI in both readers in differentiating the stage Ⅰ tumor were the highest (0.732 and 0.751). CONCLUSION: The b-value for 2000 sec/mm2 DWI could improve the accurate detection of rectal cancer. The fifth percentile ADC at b-value for 2000 sec/mm2 sec/mm2 DWI was more useful for discriminating early stage than the b-value for 1000 sec/mm2 DWI.

Assessment of rehabilitation following subarachnoid haemorrhage in China: findings from the Chinese Stroke Center Alliance.

BACKGROUND: Rehabilitation improves functional recovery in subarachnoid hemorrhage (SAH) patients, and assessing patients for rehabilitation is the first step in this process. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation for patients with SAH. METHODS: To identify patients hospitalized with SAH and to analyze rehabilitation assessment rates, we used data for 11,234 SAH patients admitted to 861 hospitals from the China Stroke Center Alliance from August 2015 to July 2019. We examined factors for rehabilitation assessment and analyzed the relationship between rehabilitation assessment and outcomes in these patients. RESULTS: Among 11,234 patients with SAH, 6,513 (58.0%) were assessed for rehabilitation. Assessed patients had an increased length of stay (mean ± SD days: 17.3 ± 12.5 versus 11.6 ± 10.5, P = 49.4), a higher Glasgow Coma Scale (GCS) score on admission (mean ± SD GCS score: 12.3 ± 3.8 versus 11.8 ± 4.4, P = 12.2), and were more likely to be admitted to the stroke unit (19.6% versus 13.8%, P = 15.6). In multivariable analysis, factors associated with an increased likelihood of a rehabilitation assessment (p < 0.05) included a longer length of stay (odds ratio [OR], 1.04; 95% confidence interval (CI), 1.04 to 1.05) and care such as dysphagia screening (OR, 1.88; 95% CI, 1.73 to 2.04), DVT prophylaxis (OR, 1.56; 95% CI, 1.41 to 1.72) and vessel evaluation (OR, 1.80; 95% CI, 1.63 to 1.98). For the multivariate analysis of outcomes, patients undergoing rehabilitation assessment had a longer length of stay (OR, 1.96; 95% CI, 1.81 to 2.12), a higher modified Rankin Scale (mRS) score at discharge (OR, 1.49; 95% CI, 1.36 to 1.64), and higher rates of discharge to a rehabilitation center (OR, 3.23; 95% CI, 1.81-5.75). CONCLUSION: More than two-fifths of SAH patients were not assessed for rehabilitation. Rates vary considerably among hospital grades, and there is a need to improve adherence to recommended care for SAH patients.

Quantitative assessment of articular cartilage degeneration using 3D ultrashort echo time cones adiabatic T1ρ (3D UTE-Cones-AdiabT1ρ) imaging.

OBJECTIVES: To evaluate articular cartilage degeneration using quantitative three-dimensional ultrashort-echo-time cones adiabatic-T1ρ (3D UTE-Cones-AdiabT1ρ) imaging. METHODS: Sixty-six human subjects were recruited for this study. Kellgren-Lawrence (KL) grade and Whole-Organ Magnetic-Resonance-Imaging Score (WORMS) were evaluated by two musculoskeletal radiologists. The human subjects were categorized into three groups, namely normal controls (KL0), doubtful-minimal osteoarthritis (OA) (KL1-2), and moderate-severe OA (KL3-4). WORMS were regrouped to encompass the extent of lesions and the depth of lesions. The UTE-Cones-AdiabT1ρ values were obtained using 3D UTE-Cones data acquisitions preceded by seven paired adiabatic full passage pulses that corresponded to seven spin-locking times (TSLs) of 0, 12, 24, 36, 48, 72, and 96 ms. The performance of the UTE-Cones-AdiabT1ρ technique in evaluating the degeneration of knee cartilage was assessed via the ANOVA comparisons with subregional analysis and Spearman's correlation coefficient as well as the receiver-operating-characteristic (ROC) curve. RESULTS: UTE-Cones-AdiabT1ρ showed significant positive correlations with KL grade (r = 0.15, p < 0.05) and WORMS (r = 0.57, p < 0.05). Higher UTE-Cones-AdiabT1ρ values were observed in both larger and deeper lesions in the cartilage. The differences in UTE-Cones-AdiabT1ρ values among different extent and depth groups of cartilage lesions were all statistically significant (p < 0.05). Subregional analyses showed that the correlations between UTE-Cones-AdiabT1ρ and WORMS varied with the location of cartilage. The AUC value of UTE-Cones-AdiabT1ρ for mild cartilage degeneration (WORMS=1) was 0.8. The diagnostic threshold value of UTE-Cones-AdiabT1ρ for mild cartilage degeneration was 39.4 ms with 80.8% sensitivity. CONCLUSIONS: The 3D UTE-Cones-AdiabT1ρ sequence can be useful in quantitative evaluation of articular cartilage degeneration. KEY POINTS: • The 3D UTE-Cones-AdiabT1ρ sequence can distinguish mild cartilage degeneration from normal cartilage with a diagnostic threshold value of 39.4 ms for mild cartilage degeneration with 80.8% sensitivity. • Higher UTE-Cones-AdiabT1ρ values were observed in both larger and deeper lesions in the articular cartilage. • UTE-Cones-AdiabT1ρ is a promising biomarker for quantitative evaluation of early cartilage degeneration.

Assessment of heavy metals should be performed before the development of the selenium-rich soil: A case study in China.

The use of selenium (Se)-rich soils in China is an effective method for rural revitalization, but assessment of heavy metals is essential prior to the development of Se-rich soils. This study was focused on the Jiangjin district, a typical Se-rich area located in Sichuan Basin of China, to investigate contamination, influencing factors, and sources of As, Cr, Cu, Cd, Ni, Pb, Sb, and Zn based on 156 topsoil samples. This study analyzed and compared the enrichment factor (EF), Nemerow index (PN), geographical information system (GIS), and positive matrix factorization (PMF). Results demonstrate that the average values of As, Cu, Cd, Sb, and Zn in topsoil were higher than the soil background values of western Chongqing by approximately 1.75, 1.11, 1.27, 1.71, and 2.58 times, respectively, indicating that some heavy metals have been enriched in the soils. The polluted areas of As, Cu, Cd, and Zn in topsoil were mainly distributed in the northern and central Jiangjin district, whereas high-Sb soils were located in the southeast. The Cr, Cu, Cd, Pb, and Sb were concentrated in Se-rich soils, indicating that heavy metals pollution should be carefully considered for the utilization of Se-rich soils. Four potential sources of heavy metals were found in this study area: 1) the parent materials (Cr, Ni, Cu); 2) industrial activities with high coal consumption (As); 3) mechanical and chemical industrial activities (Zn, Sb); and 4) transportation and agricultural activities (Pb, Cd). These observations provide a scientific basis for the development, utilization, and protection of Se-rich soil resources.

Bedaquiline Drug Resistance Emergence Assessment in Multidrug-Resistant Tuberculosis (MDR-TB): a 5-Year Prospective In Vitro Surveillance Study of Bedaquiline and Other Second-Line Drug Susceptibility Testing in MDR-TB Isolates.

Bedaquiline Drug Resistance Emergence Assessment in Multidrug-resistant tuberculosis (MDR-TB) (DREAM) was a 5-year (2015 to 2019) phenotypic drug resistance surveillance study across 11 countries. DREAM assessed the susceptibility of 5,036 MDR-TB isolates of bedaquiline treatment-naive patients to bedaquiline and other antituberculosis drugs by the 7H9 broth microdilution (BMD) and 7H10/7H11 agar dilution (AD) MIC methods. Bedaquiline AD MIC quality control (QC) range for the H37Rv reference strain was unchanged, but the BMD MIC QC range (0.015 to 0.12 µg/ml) was adjusted compared with ranges from a multilaboratory, multicountry reproducibility study conforming to Clinical and Laboratory Standards Institute Tier-2 criteria. Epidemiological cutoff values of 0.12 µg/ml by BMD and 0.25 µg/ml by AD were consistent with previous bedaquiline breakpoints. An area of technical uncertainty or intermediate category was set at 0.25 µg/ml and 0.5 µg/ml for BMD and AD, respectively. When applied to the 5,036 MDR-TB isolates, bedaquiline-susceptible, -intermediate, and -resistant rates were 97.9%, 1.5%, and 0.6%, respectively, for BMD and 98.8%, 0.8%, and 0.4% for AD. Resistance rates were the following: 35.1% ofloxacin, 34.2% levofloxacin, 33.3% moxifloxacin, 1.5% linezolid, and 2% clofazimine. Phenotypic cross-resistance between bedaquiline and clofazimine was 0.4% in MDR-TB and 1% in pre-extensively drug-resistant (pre-XDR-TB)/XDR-TB populations. Coresistance to bedaquiline and linezolid and clofazimine and linezolid were 0.1% and 0.3%, respectively, in MDR-TB and 0.2% and 0.4%, respectively, in pre-XDR-TB/XDR-TB populations. Resistance rates to bedaquiline appear to be low in the bedaquiline-treatment-naive population. No treatment-limiting patterns for cross-resistance and coresistance have been identified with key TB drugs to date.

Genotoxicity assessment of triclocarban by comet and micronucleus assays and Ames test.

The widespread usage and ubiquitous distribution of triclocarban (3,4,4'-trichlorocarbanilide, TCC) have raised public concerns about its health effects. At present, there is little information about the genotoxicity of TCC. In this study, we used a battery of genotoxicity testing methods including salmonella reverse mutation test (Ames test), comet assay and micronucleus assay to detect the effects of TCC on gene mutation, DNA breakage, and chromosome damage. The results of Ames test showed that TCC at 0.1-1000 µg/plate did not significantly increase the number of revertant colonies in the four standard Salmonella typhimurium strains, i.e., TA97, TA98, TA100, and TA102, when compared to the vehicle control. The results from comet assay demonstrated that exposure to 5, 10, or 15 µM TCC for 24 h did not significantly increase the percentage of comet cells, tail length (TL), DNA in tail (T DNA%), or olive tail moment (OTM) in keratinocyte HaCaT and hepatic L02 cells. Moreover, TCC did not markedly enhance the frequency of micronucleated cells or micronuclei in HaCaT and L02 cells in the micronucleus assay. Taken together, the results indicated that TCC did not exhibit any genotoxic effects. Our study provides additional information for the safety profile of TCC.

Postablation assessment of hepatocellular carcinoma using dual-energy CT: Comparison of half versus standard iodine contrast medium.

This retrospective study was aimed to evaluate the reduced iodine load on image quality and diagnostic performance in multiphasic hepatic CT using a novel monoenergetic reconstruction algorithm (nMERA) in assessment of local tumor progression after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC). Ninety patients who underwent CT 1 month after RFA of HCC. Forty-five patients had multiphasic hepatic dual-energy CT with a half-reduced contrast medium (HRCM) of 277.5 mg I/kg. The nMERA (40-70-keV) images were reconstructed in each phase. Another 45 patients received a standard contrast medium (SCM) of 555 mg I/kg, and the images were reconstructed as a simulated 120-kVp images. Primary outcome was accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) in assessment of local tumor progression. Additional advanced assessments included the image noise, attenuation value, contrast-to-noise ratio (CNR), and subjective image quality between the groups. The accuracy, sensitivity and specificity of nMERA HRCM images were 95.7%, 100% and 93.9% for 40 keV, 95.7%, 85.7% and 100% for 50 keV, 83.0%, 42.8% and 100% for 60 keV, and 83.0%, 42.9% and 100% for 70 keV. The AUROC was 0.99, 0.99, 0.94, and 0.93 for 40-70 keV nMERA HRCM images, respectively. Compared with simulated 120-kVp SCM images, nMERA HRCM images demonstrated comparable noise at 70-keV (P < 0.05), and comparable CNR at 40- and 50-keV (P < 0.05). nMERA DECT enables the contrast medium to be reduced to up to 50% in multiphasic hepatic CT while preserving diagnostic accuracy.

Assessment of forest restoration with multitemporal remote sensing imagery.

Climate variability and man-made impacts have severely damaged forests around the world in recent years, which calls for an urgent need of restoration aiming toward long-term sustainability for the forest environment. This paper proposes a new three-level decision tree (TLDT) approach to map forest, shadowy, bare and low-vegetated lands sequentially by integrating three spectral indices. TLDT requires neither image normalization nor atmospheric correction, and improves on the other methods by introducing more levels of decision tree classification with inputs from the same multispectral imagery. This approach is validated by comparing the results obtained from aerial orthophotos (25 cm) that were acquired at approximately the same time in which the Formosa-2 images (8 m) were being taken. The overall accuracy is as high as 96.8% after excluding the deviations near the boundary of each class caused by the different resolutions. With TLDT, the effectiveness of forest restoration at 30 sites are assessed using all available multispectral Formosat-2 images acquired between 2005 and 2016. The distinction between natural regeneration and regrowth enhanced by restoration efforts were also made by using the existing dataset and TLDT developed in this research. This work supports the use of multitemporal remote sensing imagery as a reliable source of data for assessing the effectiveness of forest restoration on a regular basis. This work also serves as the basis for studying the global trend of forest restoration in the future.

Treatment with normobaric or hyperbaric oxygen and its effect on neuropsychometric dysfunction after carbon monoxide poisoning: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Carbon monoxide (CO) poisoning may result in acute neurological sequelae, cognitive sequelae, and delay neurological sequelae. The administration of hyperbaric oxygen (HBO) to prevent the development of delayed neurological sequelae in CO poisoning have extensively investigated but conflicting results have been reported. We performed a systematic literature review and meta-analysis of randomized controlled trials (RCTs) evaluating HBO treatment and its effect on neuropsychometric dysfunction after CO poisoning. METHODS: We searched Medline, Embase, Pubmed, and the Cochrane Register of Controlled Trials from inception to December 2017. Eligible studies compared HBO therapy with normobaric oxygen (NBO) in patients with CO poisoning. RESULTS: Six studies compared HBO with NBO in CO poisoning patients. Compared with patients treated with NBO, a lower percentage of patients treated with HBO reported headache (16.2% vs 16.5%, relative risk [RR] = 0.83, 95% CI = 0.38-1.80), memory impairment (18.2% vs 23.8%, RR = 0.80, 95% CI = 0.43-1.49), difficulty concentrating (15.0% vs 18.4%, RR = 0.86, 95% CI = 0.55-1.34), and disturbed sleep (14.7% vs 16.2%, RR = 0.91, 95% CI = 0.59-1.39). Two sessions of HBO treatment exhibited no advantage over one session. CONCLUSIONS: The meta-analysis indicated that compared with CO poisoning patients treated with NBO, HBO treated patients have a lower incidence of neuropsychological sequelae, including headache, memory impairment, difficulty concentrating, disturbed sleep, and delayed neurological sequelae. Taking into consideration the cost-effectiveness of one session of HBO, one session of HBO treatment could be an economical option for patients with CO poisoning with high severity.

Assessment of Different Cetirizine Dosing Strategies on Seasonal Allergic Rhinitis Symptoms: Findings of Two Randomized Trials.

BACKGROUND: Cetirizine has been shown to be effective for relief of seasonal allergic rhinitis (SAR) symptoms. Allergic rhinitis symptoms have been reported to have circadian variations, with symptoms tending to be most bothersome overnight and in the morning. OBJECTIVE: To evaluate the effects of different cetirizine dosing schedules in comparison to twice daily (BID) chlorpheniramine and placebo on SAR symptoms at 12 and 24 hours postdose. METHODS: Study 1 subjects received cetirizine 10-mg once daily in the morning (QAM), cetirizine 10-mg once daily at bedtime (QHS), cetirizine 5-mg twice daily, or placebo. Study 2 subjects received cetirizine 5-mg QAM, cetirizine 10-mg QHS, chlorpheniramine 8-mg BID, or placebo. The primary end point was total symptom severity complex (TSSC); TSSC was the sum of symptom severity ratings averaged over the 2-week study period. Post hoc analyses of reflective symptom severity assessed in the morning (TSSCAM) and in the evening (TSSCPM) were conducted to evaluate cetirizine's effects at 12 and 24 hours postdose. RESULTS: In study 1, subject- and investigator-assessed TSSC was significantly lower in all cetirizine groups versus placebo (P ≤ .003). In study 2, subject-assessed TSSC was significantly lower in all cetirizine groups versus placebo (P ≤ .04) and was numerically lower for investigator-assessed TSSC. Post hoc analyses demonstrated that cetirizine significantly improved TSSCAM at 12 and 24 hours postdose versus placebo in both studies regardless of dosing schedule. TSSCPM significantly improved at 12 and 24 hours postdose in all study 1 cetirizine groups versus placebo. In study 2, versus placebo, TSSCPM significantly improved at 12 hours postdose in cetirizine 5-mg QAM group and numerically improved at 24 hours postdose in cetirizine 10-mg QHS group. CONCLUSION: Regardless of dosing regimen, cetirizine demonstrates effective 24-hour relief of SAR symptoms, particularly on TSSCAM, which assesses overnight and early morning symptom control.

Comprehensive geriatric assessment prediction of postoperative complications in gastrointestinal cancer patients: a meta-analysis.

BACKGROUND: Gastrointestinal cancer is an age-associated disease, and geriatric patients are mostly likely to suffer from postoperative complications. Some studies indicated that comprehensive geriatric assessment (CGA) could predict postoperative complications in gastrointestinal cancer patients. However, the evidence is mixed. OBJECTIVE: This study aimed to conduct a meta-analysis to identify the effectiveness of CGA for predicting postoperative complications in gastrointestinal cancer patients. METHODS: The Joanna Briggs Institute Library, Cochrane Library, PubMed, Embase, Web of Science, CINAHL Complete and four Chinese databases were searched for studies published up to March 2017. Two reviewers independently screened literature, extracted data and assessed the quality of included studies. RevMan5.3 was used for meta-analysis or only descriptive analysis. RESULTS: Six studies were included, with 1,037 participants in total. In all, 13 components of CGA were identified, among which comorbidity (Charlson Comorbidity Index [CCI] ≥3; odds ratio [OR]=1.31, 95% CI [1.06, 1.63], P=0.01), polypharmacy (≥5 drugs/day; OR=1.30, 95% CI [1.04, 1.61], P=0.02) and activities of daily living (ADL) dependency (OR=1.69, 95% CI [1.20, 2.38], P=0.003) were proven relevant to the prediction of postoperative complications. No conclusive relationship was established between instrumental activities of daily living (IADL) dependency (OR=1.18, 95% CI [0.73, 1.91], P=0.51), Mini-Mental State Examination (MMSE; OR=1.13, 95% CI [0.91, 1.41], P=0.27), potential malnutrition (OR=1.07, 95% CI [0.87, 1.31], P=0.54), malnutrition (OR=1.26, 95% CI [0.80, 1.99], P=0.32), Geriatric Depression Scale (GDS; OR=1.18, 95% CI [0.90, 1.55], P=0.24) and postoperative complications. CONCLUSION: Comorbidity (CCI ≥3), polypharmacy (≥5 drugs/day) and ADL dependency were predictive factors for postoperative complications in gastrointestinal cancer patients; the results of other geriatric instruments were not conclusive, pointing to insufficient studies and requirement of more original investigations.

Economic Conditions May Contribute to Increased Violence toward Children: A Nationwide Population-Based Analysis of Pediatric Injuries in Taiwanese Emergency Departments.

Childhood injuries are unfortunately common. Analysis procedures may assist professionals who work with children with developing preventive measures for protecting children's wellness. This study explores the causes of pediatric injuries presenting to an emergency department in Taiwan. This nationwide, population-based study was conducted using data from the National Health Insurance Research Database of Taiwan (NHIRD). Patients aged <18 years were identified from approximately one million individuals listed in the NHIRD. We followed up with these patients for nine years and analyzed the causes of injuries requiring presentation to an emergency department. Variables of interest were age, sex, injury mechanisms, and temporal trends. A total of 274,028 children were identified in our study. Between 2001 and 2009, the leading causes of pediatric injuries treated in emergency departments were motor vehicle injuries, falls, and homicide. The overall incidence of injuries declined over the course of the study because of reductions in motor vehicle accidents and falls. The incidence of homicide increased during the study period, particularly between 2007 and 2009. A moderately inverse correlation between homicide rate and economic growth was observed (correlation coefficient: -0.613, p = 0.041). There was a general decline in pediatric injuries between 2001 and 2009. Public policy changes, including motorcycle helmet laws and increases in alcohol taxes, may have contributed to this decline. Unfortunately, the incidence of homicide increased over the course of the study. Ongoing financial crises may have contributed to this increase. Multidisciplinary efforts are required to reduce homicide and reinforce the importance of measures that protect children against violence.

The evaluation of trustworthiness to identify health insurance fraud in dentistry.

OBJECTIVE: According to the investigations of the U.S. Government Accountability Office (GAO), health insurance fraud has caused an enormous pecuniary loss in the U.S. In Taiwan, in dentistry the problem is getting worse if dentists (authorized entities) file fraudulent claims. Several methods have been developed to solve health insurance fraud; however, these methods are like a rule-based mechanism. Without exploring the behavior patterns, these methods are time-consuming and ineffective; in addition, they are inadequate for managing the fraudulent dentists. METHODS: Based on social network theory, we develop an evaluation approach to solve the problem of cross-dentist fraud. The trustworthiness score of a dentist is calculated based upon the amount and type of dental operations performed on the same patient and the same tooth by that dentist and other dentists. RESULTS: The simulation provides the following evidence. (1) This specific type of fraud can be identified effectively using our evaluation approach. (2) A retrospective study for the claims is also performed. (3) The proposed method is effective in identifying the fraudulent dentists. CONCLUSIONS: We provide a new direction for investigating the genuineness of claims data. If the insurer can detect fraudulent dentists using the traditional method and the proposed method simultaneously, the detection will be more transparent and ultimately reduce the losses caused by fraudulent claims.

Risk of Respiratory Syncytial Virus Infection in Cyanotic Congenital Heart Disease in a Subtropical Area.

OBJECTIVE: To compare the risk of respiratory syncytial virus (RSV)-associated hospitalization and analyze the epidemiology of RSV infection in patients with cyanotic and acyanotic congenital heart disease (CHD), we analyzed the nationwide health insurance database from 2005-2010. STUDY DESIGN: This study included 1050 patients with cyanotic CHD and 7077 patients with acyanotic CHD. Patients with acyanotic CHD were further classified into hemodynamically significant (hs)-acyanotic and non-hs-acyanotic groups according to whether they underwent surgery or took at least 2 anticongestive medications. RESULTS: RSV-associated hospitalization was higher in the cyanotic group than in hs-acyanotic and non-hs-acyanotic groups both before 1 year of age (4.8% vs 2.1% vs 1.5%, P < .001) and between 1 and 2 years of age (0.9% vs 0.56% vs 0.14%, P = .003). The hospitalization duration, intensive care, ventilator support prevalence, hospitalization cost, and mortality rate were significantly higher in the cyanotic group than in the other 2 groups. Logistic regression revealed that cyanotic CHD was the most significant risk factor for the ventilator support and RSV-associated mortality. In both patients with cyanotic and acyanotic CHD, RSV-associated hospitalization rate was higher in patients aged younger than 1 year and in spring and autumn in Taiwan, a subtropical country. CONCLUSIONS: The results show that patients with cyanotic CHD have a higher risk of severe RSV infection than do those with acyanotic CHD. RSV prophylaxis is more important and may reduce costs more for patients with cyanotic CHD.

Feasibility of using the International Classification of Functioning, Disability and Health Core Set for evaluation of fall-related risk factors in acute rehabilitation settings.

BACKGROUND: Previously, we reported the use of an International Classification of Functioning (ICF) core set that can provide a holistic framework for evaluating the risk factors of falls; however, data on the feasibility of applying this core set are lacking. AIM: To investigate the feasibility of applying the fall-related ICF risk-factor core set in the case of patients in an acute-rehabilitation setting. DESIGN: A cross-sectional and descriptive correlational design. SETTING: Acute-rehabilitation ward. POPULATION: A total of 273 patients who experienced fall at acute-rehabilitation ward. METHODS: The data on falls were collected from the hospital's Nursing Information System (NIS) and the fall-reporting system (Adverse Event Reporting System, AERS) between 2010 and 2013. The relationship of both systems to the fall-related ICF core set was analyzed to assess the feasibility of their clinical application. We evaluated the feasibility of using the fall-related ICF risk-factor core set by using the frequency and the percentage of the fall patients in of the listed categories. RESULTS: The fall-related ICF risk-factor core set category b735 (muscle tone functions) exhibited a high feasibility (85.95%) for clinical application, and the category b730 (muscle power functions) covered 77.11% of the patients. The feasibility of application of the category d410 (change basic body position) was also high in the case of all fall patients (81.69%). CONCLUSIONS: In the acute-rehabilitation setting, the feasibility of application of the fall-related ICF risk-factor core set is high. CLINICAL REHABILITATION IMPACT: The fall-related ICF risk-factor core set can help multidisciplinary teams develop fall-prevention strategies in acute rehabilitation wards.

Assessment for water quality by artificial neural network in Daya Bay, South China Sea.

In this study, artificial neural network such as a self-organizing map (SOM) was used to assess for the effects caused by climate change and human activities on the water quality in Daya Bay, South China Sea. SOM has identified the anthropogenic effects and seasonal characters of water quality. SOM grouped the four seasons as four groups (winter, spring, summer and autumn). The Southeast Asian monsoons, northeasterly from October to the next April and southwesterly from May to September have also an important influence on the water quality in Daya Bay. Spatial pattern is mainly related to anthropogenic activities and hydrodynamics conditions. In spatial characteristics, the water quality in Daya Bay was divided into two groups by chemometrics. The monitoring stations (S3, S8, S10 and S11) were in these area (Dapeng Ao, Aotou Harbor) and northeast parts of Daya Bay, which are areas of human activity. The thermal pollution has been observed near water body in Daya Bay Nuclear Power Plant (S5). The rest of the monitoring sites were in the south, central and eastern parts of Daya Bay, which are areas that experience water exchanges from South China Sea. The results of this study may provide information on the spatial and temporal patterns in Daya Bay. Further research will be carry out more research concerning functional changes in the bay ecology with respect to changes in climatic factor, human activities and bay morphology in Daya Bay.

Arrhythmic burdens in patients with tetralogy of Fallot: a national database study.

BACKGROUND: Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease with increasingly recognized late morbidity. OBJECTIVE: The purpose of this study was to explore the long-term outcome by using a national database of Taiwan, a country with national health insurance and easily accessible medical care. METHODS: Data on TOF patients were retrieved from database records from 2000 to 2010. Complications and therapies were identified by their respective codes. RESULTS: We identified 4781 TOF patients (prevalence 0.63/1000 in pediatric patients and 0.06/1000 in adult patients). Arrhythmias were identified in 219 patients (8.3% for adult patients and 2.8% for pediatric patients): 160 tachycardia and 59 bradycardia (4 with tachy-bradycardia syndrome). The occurrence of arrhythmias was associated with higher mortality (excluding cardiac surgical death, 15.6% vs 8.6%, P = .001). Patients with atrial fibrillation were the oldest (median age 44.3 years), followed by those with tachy-bradycardia syndromes (32.4 years) and atrial flutter (31.5 years). The incidence of nonperioperative tachycardia increased with age (1.4%, 1.7%, 3.3%, 5.2%, 10.2%, and 16.9% in age group 0-9, 10-19, 20-29, 30-39, 40-49, and ≥50 years, respectively). Tachycardia therapy (ablation and implantable cardioverter-defibrillator) was administered in 20.4% (annually 2.4%) of patients with nonperioperative tachycardia. In the subgroup born 2000-2010 with complete postnatal data, mortality was 15.1% (296/1960), and 1-, 5-, and 10-year survival was 0.911, 0.826, and 0.788, respectively. Risk of atrioventricular block requiring a pacemaker was 0.6%. CONCLUSION: Arrhythmias are common in TOF patients and increase mortality risk. Medical needs because of tachycardia often appear late in adulthood.