Real-World Treatment of Patients Newly Diagnosed with Chronic Obstructive Pulmonary Disease: A Retrospective German Claims Data Analysis.

Purpose: This study aimed to describe the real-world treatment of German incident COPD patients, compare that treatment with clinical guidelines, and provide insight into disease development after incident diagnosis. In addition, the economic burden of the disease by assessing COPD-related healthcare costs was described. Patients and Methods: Based on a German claims dataset, continuously insured individuals (04/2014-03/2019) aged 40 years or older with at least two incident pulmonologist's diagnoses or one inpatient diagnosis of COPD (ICD-10-GM code J44.-; no respective diagnosis in a 12-month baseline period) were selected. Treatment patterns after incident diagnosis considering inhaled maintenance therapies identified by ATC codes (outpatient prescriptions) were analyzed. Prescription patterns were compared with recommendations of German COPD treatment guidelines. Severe exacerbations were assessed as hospitalizations with main diagnosis ICD-10-GM code J44.1. COPD-associated costs from the perspective of the health insurance fund AOK PLUS were calculated per patient-year (PY). Results: The sample comprised 17,464 incident COPD patients with a mean age of 71.5 years. 58.9% were male and the mean Charlson-Comorbidity-Index was 5.3. During follow-up (median: 2.0 years), 57.1% of the patients received at least one prescription of an inhaled maintenance therapy, whereas 42.9% did not. Among treated patients, 35.2% started their treatment with LABA/LAMA, 25.3% with LAMA monotherapy, 16.2% with LABA/ICS, and 7.8% with LABA/LAMA/ICS therapy. Within four weeks after initial diagnosis, ICS-containing therapies were prescribed in 14.1% of patients. Of all patients with a prescribed triple therapy, 68.9% had no corresponding exacerbation history documented. On average, 0.16 severe exacerbations and 0.19 COPD-related hospitalizations were observed per PY during available follow-up. Direct COPD-related costs were 3,693 €/PY, with COPD-related hospitalizations being responsible for about 79.2% of these costs. Conclusion: Long-acting bronchodilators are the mainstay of pharmacological treatment of incident COPD patients in Germany, in line with guideline recommendations. Yet, a considerable proportion of incident COPD patients did not receive any inhaled maintenance therapy.

Soil properties and earthworm populations associated with bauxite residue rehabilitation strategies.

It is recognised that the establishment and function of soil biota is critical for successful mine residue rehabilitation. Bauxite residues are alkaline, saline and sodic and, whilst methods for establishing vegetation are well studied, little is known about key soil fauna such as earthworms. At a bauxite residue disposal area in Ireland, a 12-year-old rehabilitated residue was examined for evidence of earthworm populations. Five species of earthworm, dominated by Allolobophora chlorotica, were recorded in the rehabilitated residue representing the endogeic, epigeic and epi-anecic ecological groups. To further understand the potential for rehabilitated residues to support earthworm communities, a series of exposure tests was conducted. Whilst unamended residues (pH 10.2, EC 0.629 mS cm-1, ESP 54) was hostile to A. chlorotica survival, 100% survival was observed after 90 days for gypsum and organic-amended residue at salinity of up to 2.9 mS cm-1, possibly due to calcium becoming the dominant cation. Survival of earthworms at salinities higher than anticipated tolerance levels suggests that specific ion dominance plays a role in earthworm survival in saline soils. Percent mass change was negatively correlated with pH, EC and sodium content of the residues. Residue from the 12-year-old site also supported the anecic species Aporrectodea longa over 100 days. Percent mass change in residue samples retrieved from the 12-year-old site was significantly greater (p < 0.05) to that observed for a control soil. Capability of the rehabilitated residue to support earthworm populations indicates the development of a functioning soil system in rehabilitated residues.

Bodily variability of zinc natural isotope abundances in sheep.

Evidence is growing that the range of zinc stable isotope compositions, represented by the deviation of (66)Zn in permil units relative to a standard and expressed as delta(66)Zn, is larger in organic matter than in inorganic material. This study reports the variations of delta(66)Zn in various organs of sheep raised on a controlled diet. Zinc was purified by anion-exchange chromatography. The Zn concentrations and Zn stable isotope compositions were determined by quadrupole inductively coupled plasma mass spectrometry and multi-collector inductively coupled plasma mass spectrometry, respectively. The data show that delta(66)Zn variability exceeds 1 per thousand, with bone, muscle, serum and urine enriched in the heavy isotopes, and feces, red blood cells, kidney and liver enriched in light isotopes, all relative to the diet value. The (66)Zn enrichment of the circulating serum reservoir is likely to take place in the digestive tract, probably through the preferential binding of lighter isotopes with phytic acid, which is known to control the uptake of metallic elements. Mass balance calculations suggest that the (66)Zn depletion between diet and feces, which is not balanced by any other outward flux, leads to a secular isotopic drift in serum. A simple time-dependent two-box model, involving the gastro-intestinal tract on the one hand and the muscle and bone on the other, predicts that the maximum (66)Zn enrichment, which equals the difference in delta(66)Zn between diet and bulk (approximately 0.25 per thousand), is reached after about ten years. Therefore, a better understanding of the variations of natural abundance of Zn isotopes in animals and humans will probably bring new perspectives for the assessment of their Zn status.