Assessing health care resource use, outcomes, and costs among Medicaid beneficiaries receiving factor IX prophylaxis for hemophilia B.

BACKGROUND: Hemophilia B is characterized by a deficiency of clotting factor IX (FIX), leading to excessive bleeding. Hemophilia B is commonly treated using replacement FIX therapy, which may be administered prophylactically or on-demand following a bleeding episode. Previous research has found high health care resource use (HCRU) and costs among Medicare and commercially insured people with hemophilia B (PwHB), with FIX therapy being a primary driver of health care costs. OBJECTIVE: To assess HCRU, outcomes, and costs among US Medicaid beneficiaries receiving FIX prophylaxis for hemophilia B. METHODS: This study employed a retrospective comparative cohort design to assess HCRU, outcomes, and costs among adult male Medicaid beneficiaries receiving FIX prophylaxis for hemophilia B, relative to a matched comparator population of beneficiaries without bleeding disorders. Nationwide Medicaid claims and enrollment data from 2015 to 2020 were used for this analysis. Adult male PwHB who received FIX prophylaxis, defined as not having identified gaps in FIX therapy exceeding 60-days during a 1-year measurement period, and were continuously enrolled in Medicaid for at least 2 years, were matched 1:4 to comparator beneficiaries without bleeding disorders based on baseline demographic and clinical characteristics. Key measures of HCRU and outcomes included inpatient hospital admissions, outpatient hematologist visits, and bleeding events. Measures of health care costs were assessed among a subset of beneficiaries enrolled in fee-for-service Medicaid. RESULTS: PwHB receiving FIX prophylaxis were significantly more likely to have multiple inpatient hospital admissions and had a longer cumulative length of stay per person relative to comparator beneficiaries (30.2 vs 14.8 days, respectively; P = 0.0473). PwHB receiving FIX prophylaxis also had significantly higher rates of bleeding events relative to comparator beneficiaries (0.54 vs 0.02 per person, respectively; P < 0.0001) and outpatient hematologist visits (1.58 vs 0.20 per person, respectively; P < 0.0001). Annual costs among PwHB receiving FIX prophylaxis were significantly higher than costs among comparator beneficiaries ($928,370 vs $34,553 per person, respectively; P < 0.0001) and were overwhelmingly driven by costs associated with FIX therapy. CONCLUSIONS: This analysis found higher rates of HCRU and costs among Medicaid beneficiaries receiving FIX prophylaxis for hemophilia B relative to a matched comparator population of beneficiaries without bleeding disorders. Future research should examine hemophilia B costs and outcomes within the context of new treatments with innovative mechanisms of action, such as gene therapies, RNA interference therapies, and antitissue factor pathway inhibitor therapies.

Mean Apparent Propagator MRI: Quantitative Assessment of Tumor-Stroma Ratio in Invasive Ductal Breast Carcinoma.

Purpose To determine whether metrics from mean apparent propagator (MAP) MRI perform better than apparent diffusion coefficient (ADC) value in assessing the tumor-stroma ratio (TSR) status in breast carcinoma. Materials and Methods From August 2021 to October 2022, 271 participants were prospectively enrolled (ClinicalTrials.gov identifier: NCT05159323) and underwent breast diffusion spectral imaging and diffusion-weighted imaging. MAP MRI metrics and ADC were derived from the diffusion MRI data. All participants were divided into high-TSR (stromal component < 50%) and low-TSR (stromal component ≥ 50%) groups based on pathologic examination. Clinicopathologic characteristics were collected, and MRI findings were assessed. Logistic regression was used to determine the independent variables for distinguishing TSR status. The area under the receiver operating characteristic curve (AUC) and sensitivity, specificity, and accuracy were compared between the MAP MRI metrics, either alone or combined with clinicopathologic characteristics, and ADC, using the DeLong and McNemar test. Results A total of 181 female participants (mean age, 49 years ± 10 [SD]) were included. All diffusion MRI metrics differed between the high-TSR and low-TSR groups (P < .001 to P = .01). Radial non-Gaussianity from MAP MRI and lymphovascular invasion were significant independent variables for discriminating the two groups, with a higher AUC (0.81 [95% CI: 0.74, 0.87] vs 0.61 [95% CI: 0.53, 0.68], P < .001) and accuracy (138 of 181 [76%] vs 106 of 181 [59%], P < .001) than that of the ADC. Conclusion MAP MRI may serve as a better approach than conventional diffusion-weighted imaging in evaluating the TSR of breast carcinoma. Keywords: MR Diffusion-weighted Imaging, MR Imaging, Breast, Oncology ClinicalTrials.gov Identifier: NCT05159323 Supplemental material is available for this article. © RSNA, 2024.

3D human pose data augmentation using Generative Adversarial Networks for robotic-assisted movement quality assessment.

In the realm of human motion recognition systems, the augmentation of 3D human pose data plays a pivotal role in enriching and enhancing the quality of original datasets through the generation of synthetic data. This augmentation is vital for addressing the current research gaps in diversity and complexity, particularly when dealing with rare or complex human movements. Our study introduces a groundbreaking approach employing Generative Adversarial Networks (GANs), coupled with Support Vector Machine (SVM) and DenseNet, further enhanced by robot-assisted technology to improve the precision and efficiency of data collection. The GANs in our model are responsible for generating highly realistic and diverse 3D human motion data, while SVM aids in the effective classification of this data. DenseNet is utilized for the extraction of key features, facilitating a comprehensive and integrated approach that significantly elevates both the data augmentation process and the model's ability to process and analyze complex human movements. The experimental outcomes underscore our model's exceptional performance in motion quality assessment, showcasing a substantial improvement over traditional methods in terms of classification accuracy and data processing efficiency. These results validate the effectiveness of our integrated network model, setting a solid foundation for future advancements in the field. Our research not only introduces innovative methodologies for 3D human pose data enhancement but also provides substantial technical support for practical applications across various domains, including sports science, rehabilitation medicine, and virtual reality. By combining advanced algorithmic strategies with robotic technologies, our work addresses key challenges in data augmentation and motion quality assessment, paving the way for new research and development opportunities in these critical areas.

Assessment of ADRB1 polymorphism in patients with acute coronary syndrome treated with ticagrelor and aspirin.

Background: This study investigated the influence of ADRB1 gene rs1801253 polymorphism on the treatment response of ticagrelor and aspirin in patients with acute coronary syndrome (ACS). Methods: Genetic typing was detected by Sanger sequencing. Platelet inhibition was assessed using thromboelastography. Kaplan-Meier and Cox regression were applied for prognosis analysis. Results: Out of 200 participants, 94 cases with rs1801253-CC genotype and 106 cases with CG+GG genotype were found. There was no significant difference between the rs1801253-CC and CG+GG groups in the number of ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction and unstable angina patients. There was no statistical difference in the basic data of patients in the two groups in terms of age, sex, medical history and medicine use in the dominant model. The rs1801253-CC genotype was a risk prognostic factor for ACS patients based on the Cox regression analysis results. Conclusion: Detecting ADRB1 polymorphism is crucial for ACS patients undergoing treatment with ticagrelor and aspirin.

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Simplified S1 Vertebral Bone Quality Score in the Assessment of Patients with Vertebral Fragility Fractures.

OBJECTIVE: To evaluate the effectiveness of the S1 vertebral bone quality (VBQ) score in assessing bone quality among patients with vertebral fragility fractures (VFF). Additionally, whether the combination of S1 VBQ and Hounsfield unit (HU) values improves the predictive accuracy of VFF. METHODS: Using lumbar noncontrast computed tomography and T1-weighted magnetic resonance imaging, we measured L1 HU values, S1 VBQ, and L1-L4 VBQ. To assess their predictive performance for VFF, we constructed receiver operating characteristic curves. We also compared the diagnostic efficacy of HU values with that of S1 VBQ and L1--L4 VBQ values for the joint diagnosis of VFF. The Delong test was used to compare the value of individual or combined predictions of VFF. RESULTS: In comparison to the nonfracture group, all patients exhibited markedly elevated S1 VBQ and L1--L4 VBQ and notably reduced HU values (P < 0.001). Multivariate analysis revealed that elevated S1 VBQ, increased L1--L4 VBQ, and decreased HU values independently correlated with VFF development. The areas under the curve for VFF prediction were 0.806 for S1 VBQ, 0.799 for L1--L4 VBQ, and 0.820 for HU values. According to the Delong test, the combination of HU values with S1 VBQ/L1--L4 VBQ significantly improved the diagnostic accuracy. CONCLUSIONS: The simplified S1 VBQ is a valuable tool for predicting the occurrence of VFF and can be used as an alternative to the L1--L4 VBQ. In addition, the combination of S1 VBQ and HU values can significantly improve the predictive value of VFF.

Environmental regulation and carbon emission efficiency: Evidence from pollution levy standards adjustment in China.

China's economy experienced great growth, which also induces large carbon emission. Facing the target of "Carbon peak, Carbon neutrality" in China, it is vital to improve the carbon emission efficiency. Employing the spatial Difference-in-Differences model, this paper investigates the impact of environmental regulation on carbon emission efficiency with a quasi-natural experiment of Pollution Levy Standards Adjustment in China. Our empirical results show that the environmental regulation can significantly improve the carbon emission efficiency. moreover, two impact channels are explored: green innovation and industrial upgrading. More specifically, the green innovation increases with environmental regulation, and the increased green innovation improves carbon emission efficiency. The industry upgrading increases with environmental regulation, and the increased industry upgrading improves carbon emission efficiency. Finally, in terms of city heterogeneity, we find that the impact of environmental regulation will be more pronounced for larger cities and resource-based cities. Our findings suggest that the environmental regulation must be enhanced for both smaller cities and non-resource-based cities. Moreover, to promote the green innovation of firms, since green innovation is risky and costly, governments should provide more subsidies or grants on corporate green technologies, thus firms will be motivated to invest in green technologies to reduce carbon emission.

Clinical and Economic Burden Associated With Acute Graft-Versus-Host Disease After Allogeneic Hematopoietic Cell Transplantation in Germany.

BACKGROUND: Acute graft-vs-host disease (aGVHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), yet there are limited data on the clinical and economic burden of aGVHD in Germany. This real-world study aimed to evaluate clinical and economic outcomes among patients in Germany with or without aGVHD after allo-HSCT. METHODS: This retrospective cohort study used administrative claims extracted from the German statutory health insurance database. Eligible adult patients underwent allo-HSCT between 1 January 2009 and 31 December 2017 for any hematological malignancy. Clinical (severe infections and mortality) and economic (health care resource use [HCRU] and costs) outcomes were compared in "aGVHD" patients and "no GVHD" patients. Propensity score matching (1:1) was used to balance covariates between the aGVHD and no GVHD groups. RESULTS: After propensity score matching, 95 aGVHD and 95 no GVHD patients were included in the analysis. The aGVHD group had significantly higher odds of mortality than the no GVHD group (odds ratio [OR] 2.2; 95% CI 1.2-4.0). Odds of severe infection were similar between the 2 groups (OR 1.7; 95% CI 0.9-3.3). Patients in the aGVHD group had significantly more overnight hospitalizations per patient-year (mean [SD]: 3.7 [3.0] and 2.7 [2.5], P = .029), and total direct costs were 1.6-fold higher than those in the no GVHD group. CONCLUSION: Among patients who underwent allo-HSCT, aGVHD was associated with significantly higher mortality, HCRU, and costs, highlighting the need for effective prophylaxis and treatment options to prevent or reduce the incidence of aGVHD.

A simulation and risk assessment framework for water-energy-environment nexus: A case study in the city cluster along the middle reach of the Yangtze River, China.

In the Anthropocene, there is a strong interlinkage among water, energy, and the environment. The water-energy-environment nexus (WEEN) has been vigorously advocated as an emerging development paradigm and a global research agenda. Based on the nexus concept, a framework for the WEEN complex system simulation and risk assessment is developed. The three metropolitan areas of the city cluster along the middle reaches of the Yangtze River (CCMRYR) are taken as the objects. Regional policies are combined with generic shared socio-economic pathways (SSPs) to form a localized SSPs suitable for the research region. The dynamic simulation of the WEEN complex system and the risk analysis are carried out with the combination of system dynamics models and copula functions. Results show that: There are obvious differences in water utilization, energy consumption, air pollutant emissions, and water pollutant emissions among the three metropolitan areas. The issue of high carbon intensity in the Wuhan Metropolitan Coordinating Region needs to be emphasized and solved from the perspective of optimizing the industrial structure. Adhering to current development patterns, there will be successive peaks in water utilization, energy consumption, and carbon emissions in Wuhan, Dongting Lake, and Poyang Lake Metropolitan Coordinating Region by 2030, leading to high synergy risks at the systemic level, with maximum values of 0.84, 0.85, 0.62, respectively. A development path based on conservation priorities indicates that future policymaking needs to prioritize a resource-saving and pollution-control development pattern directed by technological upgrading against the backdrop of scarce natural resource endowments. The localized SSPs are a beneficial extension that enriches the narrative of regional-scale SSPs. The evolutionary trajectories and risk assessments of WEEN complex systems under different localized SSPs provide a sweeping insight into the consequences of policy decisions, thus enabling policymakers to appraise policy rationality and implement appropriate corrective measures.