Genotypic variation in resource exchange, use, and production traits in the legume-rhizobia mutualism.

Mutualisms, reciprocally beneficial interactions between two or more species, are ubiquitous in nature. A common feature of mutualisms is extensive context-dependent variation in fitness outcomes. This context-dependency is hypothesized to stem from the environment's mediation of the relative costs and benefits associated with mutualisms. However, traits related to the exchange of goods and services in mutualisms have received little attention in comparison to net fitness outcomes. In this study, we quantified the contribution of host and symbiont genotypes to variation in resource exchange, use, and production traits measured in the host using the model mutualism between legumes and nitrogen-fixing rhizobia. We predicted that plant genotype × rhizobia genotype (G × G) effects would be common to resource exchange traits because resource exchange is hypothesized to be governed by both interacting partners through bargaining. On the other hand, we predicted that plant genotype effects would dominate host resource use and production traits because these traits are only indirectly related to the exchange of resources. Consistent with our prediction for resource exchange traits, but not our prediction for resource use and production traits, we found that rhizobia genotype and G × G effects were the most common sources of variation in the traits that we measured. The results of this study complement the commonly observed phenomenon of G × G effects for fitness by showing that numerous mutualism traits also exhibit G × G variation. Furthermore, our results highlight the possibility that the exchange of resources as well as how partners use and produce traded resources can influence the evolution of mutualistic interactions. Our study lays the groundwork for future work to explore the relationship between resource exchange, use and production traits and fitness (i.e., selection) to test the competing hypotheses proposed to explain the maintenance of fitness variation in mutualisms.

Optimized irrigation practices with fertilizer utilization strategies to improve photo-fluorescence efficiency, vascular bundles and maize production in semi-arid regions.

The mechanism of irrigation models combined with fertilizer utilization strategies under the biodegradable film mulching could greatly promote crop photosynthesis, vascular bundles structure; resource utilization and maize production are unclear in semi-arid areas. Unfortunately, this mechanism provides a scientific basis for improving irrigation and fertilizer utilization. A field study was carried out during 2021-2022 years. Seven treatments were established: two nitrogen levels: low-N (150 kg N ha-1) and high-N (300 kg N ha-1) combined with three different irrigation models: drip irrigation (DI), ridge irrigation (RI) and border irrigation (BI) under the biodegradable film mulching with (CK) treatment have no irrigation, fertilizer and mulching. Our results revealed that DIH treatment considerably increased soil water storage, enhanced photosynthesis rate (Pn) of maize by mainly to facilitate stomatal opening compared to the rest of all treatments. In addition, it also enhances the differentiation of the vascular bundle system and maintains its post silk function under better environmental conditions, greatly improving nitrogen storage in soil and plants, and enhancing maize productivity. DIH and RIH treatments significantly increased net photosynthesis rate (Pn), stomatal conductance (Gs), transpiration rate (Tr), maximum quantum yield of PSII photochemistry (Fv/Fm), and effective quantum yield of PSII photochemistry (ΦPSII), photochemical quenching (qP), non-photochemical quenching (NPQ), and yield were observed, but evapotranspiration (ET) decreased at different growth stages. The results showed that DIH treatment was an effective tillage strategy, which increased biomass yield by 32.6 %, grain yield by 46.0 %, water use efficiency (WUE) by 46.2 %, and nitrogen use efficiency (NUE) by 86.4 % compared to other treatments. Given these results, thus we recommend the drip irrigation combined with a high-N level under a biodegradable film mulching increase photo-fluorescence efficiency, maize production and resource utilization efficiency in semi-arid regions.

Carcass size, not source or taxon, dictates breeding performance and carcass use in a burying beetle.

Small vertebrate carcasses represent critical resources for many terrestrial organisms, including burying beetles, which rely on carcasses for survival and breeding. Carcass attributes can influence the reproduction of burying beetles, yet most studies on their breeding ecology have used laboratory-reared carcasses of limited sizes. We conducted breeding and feeding experiments using a wide size range of lab (laboratory mice) and wild carcasses (wild mammals, birds and reptiles) to investigate how carcass size, source and taxon affect various breeding outcomes (e.g. clutch size, brood size and brood mass) of the burying beetle Nicrophorus nepalensis. Our results reveal a hump-shaped relationship between carcass size and breeding performance, with optimal breeding outcomes occurring on medium-sized carcasses. Furthermore, despite the variation in carcass tissue nutritional composition, breeding outcomes and larval growth did not differ between the two carcass sources or among the three wild carcass taxa. Finally, we found a larval quality-quantity trade-off across the range of carcasses examined, with carcass size shaping the larval life-history traits. Overall, these results elucidate how carcass resources may influence the breeding performance of burying beetles. Importantly, our study provides solid evidence validating decades of research using lab carcasses to study the reproductive ecology of burying beetles.

Design and rationale for an empirical investigation of the resource use and costs of investigator-initiated randomized trials in Switzerland, the UK, and Germany.

BACKGROUND: Conducting high-quality randomized clinical trials (RCTs) is challenging, time consuming, and resource intense. Academic investigators usually depend on scarce financial resources; however, current literature lacks systematically collected empirical data on the detailed resource use and costs of investigator-initiated RCTs. METHODS: The aim of this study is to generate a database of detailed empirical resource use and cost data from 100 investigator-initiated RCTs in Switzerland, Germany, and the UK. Investigators enter their empirical costs data into an online data collection form, which is followed by a short interview and a detailed cost report. We plan to investigate cost patterns and cost drivers and examine planned versus actual RCT costs as well as explore different strata of costs across the planning, conduct, and finalization phases, in drug and non-drug trials, and across medical fields and countries. DISCUSSION: This study will add detailed empirical data to the limited research on investigator-initiated RCT costs currently available. A study limitation will be that cost data will be retrospective and self-reported, which might be inaccurate depending on how costs were recorded. TRIAL REGISTRATION: Open Science Framework (OSF) https://doi.org/10.17605/OSF.IO/QY2GU . Registered on June 4, 2021.

Does Comorbid Food Allergy Affect Response to Omalizumab in Patients with Asthma?

Background: The intrinsic link between food allergy and asthma is well-established, and comorbidity can exacerbate both conditions. Omalizumab, an anti-immunoglobulin E (IgE) antibody, has the biological plausibility to manage both conditions, but only a few small studies have assessed omalizumab in patients with comorbid asthma and food allergy. Patients and Methods: We conducted a post hoc analysis of placebo-controlled, randomized clinical trials (IA05 in children and 008/009 in adolescents/adults) and real-world observational studies (EXCELS and PROSPERO). For each study, patients with asthma were stratified by whether they had physician-reported food allergy, as per baseline characteristics data. Results: For patients with comorbid food allergy, there was evidence for increased atopy at baseline (numerically higher total IgE levels and atopic comorbidities). The collective body of evidence found that omalizumab consistently improved general and asthma-specific patient-centered outcomes (food allergy-specific outcomes were not available). For patients with asthma, omalizumab improved healthcare resource use (emergency room visits, hospitalizations, unscheduled doctor visits), quality of life (asthma-specific Asthma Quality of Life Questionnaire), productivity (missed work/school days and the Work Productivity and Activity Impairment: Asthma), and asthma outcomes (asthma exacerbations and Asthma Control Test score) regardless of comorbid food allergy. Conclusion: There was no loss of omalizumab efficacy even though patients with both asthma and food allergy appeared to be generally more atopic. Omalizumab may be a viable management option for patients with these comorbidities. Clinical trial registration: NCT00079937; NCT01922037; NCT00252135.

Food allergy and asthma are linked and if you have both conditions then you can feel worse. There is a treatment available, called omalizumab, that helps people with asthma and helps people with food allergy, but it's not clear if it can help people with both conditions. Here, we look at whether omalizumab can help people with bad to very bad asthma (also called moderate to severe asthma) who also have food allergy. We found that omalizumab improved many aspects of a person's life, including whether they visited the emergency room, were admitted to hospital, their quality of life, whether they missed school or work, and whether their asthma improved. These improvements occurred in all people with moderate to severe asthma, whether they had food allergy or did not have food allergy. This suggests that omalizumab can help people with both conditions.

Health Care Resource Use and Total Mortality After Hospital Admission for Severe COVID-19 Infections During the Initial Pandemic Wave in France: Descriptive Study.

BACKGROUND: Little is known about post-hospital health care resource use (HRU) of patients admitted for severe COVID-19, specifically for the care of patients with postacute COVID-19 syndrome (PACS). OBJECTIVE: A list of HRU domains and items potentially related to PACS was defined, and potential PACS-related HRU (PPRH) was compared between the pre- and post-COVID-19 periods, to identify new outpatient care likely related to PACS. METHODS: A retrospective cohort study was conducted with the French National Health System claims data (SNDS). All patients hospitalized for COVID-19 between February 1, 2020, and June 30, 2020 were described and investigated for 6 months, using discharge date as index date. Patients who died during index stay or within 30 days after discharge were excluded. PPRH was assessed over the 5 months from day 31 after index date to end of follow-up, that is, for the post-COVID-19 period. For each patient, a pre-COVID-19 period was defined that covered the same calendar time in 2019, and pre-COVID-19 PPRH was assessed. Post- or pre- ratios (PP ratios) of the percentage of users were computed with their 95% CIs, and PP ratios>1.2 were considered as "major HRU change." RESULTS: The final study population included 68,822 patients (median age 64.8 years, 47% women, median follow-up duration 179.3 days). Altogether, 23% of the patients admitted due to severe COVID-19 died during the hospital stay or within the 6 months following discharge. A total of 8 HRU domains were selected to study PPRH: medical visits, technical procedures, dispensed medications, biological analyses, oxygen therapy, rehabilitation, rehospitalizations, and nurse visits. PPRs showed novel outpatient care in all domains and in most items, without specificity, with the highest ratios observed for the care of thoracic conditions. CONCLUSIONS: Patients hospitalized for severe COVID-19 during the initial pandemic wave had high morbi-mortality. The analysis of HRU domains and items most likely to be related to PACS showed that new care was commonly initiated after discharge but with no specificity, potentially suggesting that any impact of PACS was part of the overall high HRU of this population after hospital discharge. These purely descriptive results need to be completed with methods for controlling for confusion bias through subgroup analyses. TRIAL REGISTRATION: ClinicalTrials.gov NCT05073328; https://clinicaltrials.gov/ct2/show/NCT05073328.

Health Care Utilisation in a Cohort of Patients with Primary and Secondary Antibody Deficiency in the United Kingdom.

INTRODUCTION: This study investigates the frequency of hospital attendances, emergency care attendances and geographical influences on service interaction in cohorts of patients with primary and secondary antibody deficiency, to inform future service planning and delivery. METHODS: The COVID-19 in Antibody Deficiency (COV-AD) study was a United Kingdom study that enrolled 525 participants between April 2021 and September 2022. Data on health care utilisation was extracted from a screening cohort of participants at one participating site (Birmingham, UK). Hospital attendance (i.e. all outpatient and inpatient care episodes, including hospital-based IVIG treatment) and emergency care attendance patterns were analysed. Geographical differences in travel times to hospitals and associated costs were considered for all participants at all recruiting sites. RESULTS: Individuals with antibody deficiency had a median of 7 hospital attendances per year. A diagnosis of secondary antibody deficiency, and antibody deficiency severe enough to require treatment with immunoglobulin replacement were associated with an increased frequency of hospital attendance. 12.7% of the cohort attended the Emergency Department at least once in the preceding twelve months. Individuals with secondary antibody deficiency were at greater risk of requiring emergency care over the preceding one-year and five-year periods. Individuals receiving subcutaneous immunoglobulin lived further from their local immunology centre and were more likely to engage with the COV-AD research study remotely, via dried blood spots sampling. CONCLUSION: This study highlights the utilisation of emergency and secondary care usage amongst patient with immunodeficiency and may inform service adaptation and development to better accommodate patient needs and circumstances.

Inpatient burden of respiratory syncytial virus (RSV) in Switzerland, 2003 to 2021: an analysis of administrative data.

BackgroundRespiratory syncytial virus (RSV) is a leading cause of acute respiratory infections and hospitalisations in infants (age < 1 year) and young children. Little is known on RSV epidemiology and related inpatient healthcare resource use (HCRU) in Switzerland.AimTo explore RSV-related hospitalisations, inpatient HCRU and medical costs in all age groups, and risk factors for infant hospitalisations in Switzerland.MethodsWe used national hospital registry data from 2003 to 2021 identifying RSV cases with ICD-10-GM codes, and described demographic characteristics, HCRU and associated medical costs of RSV inpatients. The effect of risk factors on infant hospitalisation was estimated with logistic regression.ResultsWe observed a general increase and biannual pattern in RSV hospitalisations between 2003/04 and 2018/19, with 3,575 hospitalisations in 2018/19 and 2,487 in 2019/20 before numbers declined in 2020/21 (n = 902). Around two thirds of all hospitalisations occurred in infants. Mean (median) age was 118 (85) days in hospitalised infants and 74 (77) years in hospitalised adult patients (> 18 years); 7.2% of cases required intensive care unit stay. Mean inpatient medical costs were estimated at EUR 8,046. Most (90.8%) hospitalised infants with RSV were born after 35 weeks of gestation without bronchopulmonary dysplasia or congenital heart disease. Low birth weight, gestational age and congenital disorders were associated with a higher risk for hospitalisation.ConclusionsRSV leads to a substantial number of hospitalisations and peaks in hospital capacity utilisation. Measures to protect all infants from an RSV hospitalisation are essential in addressing this public health challenge.

Epidemiology and burden of chronic insomnia disorder in Europe: an analysis of the 2020 National Health and Wellness Survey.

INTRODUCTION: Chronic insomnia disorder (CID) is considered a significant worldwide public health concern; however, its exact burden is unknown. We estimate its prevalence across France, Germany, Italy, Spain, and the United Kingdom, and assess the economic and humanistic burden for a broader insomnia population. METHODS: This retrospective, cross-sectional, observational study used 2020 National Health and Wellness Survey (NHWS) data. Patients reporting insomnia were characterized to define CID. Health-related quality of life (HRQoL), work productivity, and healthcare resource use (HCRU) outcomes were assessed in four cohorts according to insomnia diagnosis and treatment status and examined using multivariable analyses according to Insomnia Severity Index categories. RESULTS: Among 62,319 respondents, 9,035 (21.2%) reported experiencing insomnia over the previous 12 months. CID prevalence rates were 5.5% to 6.7% across the five countries and 6.0% overall. HRQoL outcomes were persistently poorer in cohorts of patients diagnosed with insomnia than those with undiagnosed insomnia. Undiagnosed and treated insomnia patients reported the highest work presenteeism and total work productivity impairment and the highest number of emergency room and hospitalization visits than patients with insomnia (either treated or untreated). After adjusting for covariates, patients with severe insomnia reported significantly worse EQ-5D-5L utility scores, higher absenteeism and presenteeism rates, and more healthcare provider visits over the past 6 months than patients without insomnia (all p < 0.01). CONCLUSIONS: Our prevalence rates for CID align with published literature. A diagnosis of insomnia, use of sleep medications, and severity of insomnia are associated with poor quality of life, loss of work productivity, and higher HCRU, confirming the high unmet need and substantial humanistic and economic burden of CID.

Many people experience poor quality of sleep, also known as insomnia, due to difficulties falling asleep, staying asleep, or problems waking up too early. While this may be short-lived for some people, others may experience long-term issues with their sleep quality. However, our understanding of the number of people affected by long-term sleep issues, and the burden that this can cause, is poorly known. The aim of this study was to update estimates of the percentage of adults across France, Germany, Italy, Spain, and the United Kingdom who experience chronic insomnia. The burden of chronic insomnia was also assessed. Our results show that 5.5% to 6.7% of adults across the five countries experience chronic insomnia. Diagnosed and treated insomnia patients reported the poorest quality of life, decreased work productivity, and higher healthcare resource use. It was also apparent that people experiencing moderate to severe insomnia had poor outcomes on an ongoing basis, despite receiving treatment for their sleep problems. Consequently, the burden of insomnia is substantial and comparable in size to other notoriously debilitating conditions. We conclude that ongoing poor sleep quality is costly for patients, healthcare systems, employers, and society.

Resource use and costs of investigator-sponsored randomized clinical trials in Switzerland, Germany, and the United Kingdom: a metaresearch study.

BACKGROUND AND OBJECTIVES: Conducting high-quality randomized clinical trials (RCTs) is challenging and resource intensive. Funders and academic investigators depend on limited financial resources and, therefore, need empirical data for optimal budget planning. However, current literature lacks detailed empirical data on resource use and costs of investigator-sponsored RCTs. The aim of this study is to systematically collect cost data from investigator-sponsored RCTs from Switzerland, Germany, and the United Kingdom (UK). METHODS: Principal investigators were asked to share their RCT cost and resource use data and enter it into an online case report form. We assessed cost patterns, cost drivers, and specific cost items, examined costs by study phase (planning-, conduct-, and finalization phase), compared planned with actual RCT costs, and explored differences in cost patterns across countries, medical fields, and intervention types. RESULTS: We included 93 RCTs which were initiated in Switzerland (n = 53; including eight conducted in low- and lower middle-income countries), Germany (n = 22), and the UK (n = 18). The median total trial cost in our RCT sample was $645,824 [interquartile range (IQR), $269,846-$1,577,924]. The median proportion of the total costs spent for planning phase was 27.5% [IQR, 20.6%-39.7%], for conduct phase 57.3% [IQR, 44.4%-66.3%], and for finalization phase 12.7% [IQR, 8.5%-19.3%] with little variation across countries. The items that contributed most to the total costs were protocol writing (7.2%; IQR 3.8%-10.6%), data management (5.0%; IQR 2.2%-8.1%) and follow-up (4.5%; IQR 2.3%-8.4%). Of the 66 RCTs with an available original budget, 46 (69.7%) exceeded the budget by over 50%. Use of routinely collected data to assess primary outcomes was independently associated with lower per patient- and lower total trial costs. CONCLUSION: Over a quarter of total trial costs were incurred in the planning phase, which is typically not fully funded. Two-thirds of RCTs exceeded their budget by more than 50%. Investigators and funders should consider empirical cost data to improve budgeting and funding practices.

Factors Affecting on Environmental Strategy in SMEs manufacturing Firms of a developing country: Mediating role of Green Employee Behavior.

Background: Sustainability in small and medium-sized enterprises (SMEs) which engage heavily in manufacturing provides them with an essential platform for implementing environmental strategy, which is aimed at reducing environmental damage and promoting environmental protection. This study aims to examine the impact of the reduction in resource use, the greening of processes and products on environmental strategy and the mediating role of green employee behaviour. Methods: Primary data gathered with the help of questionnaires from employees of SMEs manufacturing in developing countries, Pakistan. The research gathered data from 211 participants by applying a pre-tested instrumental questionnaire and structural equation modelling (SEM) for data analysis. Results: The results confirmed all direct effects, including a reduction in resource use, the greening of processes and products and green employee behaviour of environmental strategies in small and medium manufacturing firms. Also, confirmed partial mediation effect of green employee behavior between greening of processes and products and environmental strategy. Conclusion: The current study clearly showed the need for programs and infrastructures that support resource reduction and greening businesses in SMEs. Companies' implementation of green processes and technologies allows SMEs to take an environmentally responsible stand and become part of the movement toward sustainability. The research stresses the importance of green employee conduct as a mediator, the central point being the individual employee being engaged and aware of the subject and willing to participate in environmentally friendly practices. Therefore, small and medium enterprises should enlighten their staff to practice green behaviour, give them what they need and empower them to be change drivers that will trigger sustainability throughout the organisations.

A Comprehensive Accounting of Construction Materials in Belt and Road Initiative Projects.

The Belt and Road Initiative (BRI) stands as the most ambitious infrastructure project in history, marked by its scale of investment, extensive geographical reach across continents and countries, and a diverse array of projects from roads to digital networks. While the BRI's environmental sustainability has raised concerns, the impacts of construction materials used in these projects have been overlooked, especially in developing countries. Here, we map and account for the materials embodied in the BRI by integrating, for the first time, official governmental project reports, geographical information, and material flow analysis. We pinpoint and analyze the BRI material stocks in each individual project by material types, countries, regions, and sectors. Between 2008 and 2023, 328 million tons of construction materials have accumulated in 540 BRI projects around the world, mostly in Asia and Africa. Aggregates (sand and gravel) constitute the largest share (82%), followed by cement, steel, and other materials. Most of the materials are used in transportation infrastructure. Our work further highlights some limitations in terms of data quality for such sustainability assessments. By shedding light on the significant impact of BRI projects on raw material usage across the globe, this study sets the stage for further investigations into environmental impacts of BRI and material stock-flow-nexus from perspective of an initiative.

Reproductive resilience of growth and nitrogen uptake underpins yield improvement in winter wheat with forced delay of sowing.

Winter wheat production is influenced by climate extremes worldwide. Heavy precipitation induced delay of sowing generates limited photothermal resources for wheat early growth. However, how wheat build resilience from stunted seedling growth has not been fully explored. Here, a twelve-year farmers' survey of wheat yield was recorded and four-year field experiments of wheat grown in normal and late-sowing were performed under zero nitrogen (N0) and optimum nitrogen (Opt.N) supply. Wheat growth and N uptake were measured at both vegetative and reproductive stages alongside photothermal resource-use efficiency. Farmers' survey showed 10.4 % yield losses due to delayed sowing compared to the normal. However, four-year field trials revealed that the combination of increasing seeding rates and Opt.N application recovered grain yield of sowing-delayed wheat and even increased by 13.2 % compared to plants in the normal seasons. Although delayed sowing substantially suppressed seedling growth and tillering before winter dormancy, the Opt.N application increased spring tillers by 2.4-fold which were productive at maturity. Further, plant growth and N uptake from jointing to anthesis of sowing-delayed wheat were accelerated by Opt.N, but not by N0 treatment. Delayed sowing significantly shortened the duration of lag phase of grain filling by 3.5 days and by 183 growing degree days compared with the normal, which initiated the linear and fast filling earlier. Increased leaf photosynthesis by 27.4 % during grain filling further supported the fast recovery of grain filling in the sowing-delayed wheat. Concomitantly, the physiological N-use efficiency increased by 46.7 % during grain filling and by 41.5 % at maturity by enhancing N availability and seeding rates, and photothermal resource-use efficiency increased by 1.3- to 1.7-fold for wheat with delayed vs. normal sowing. Overall, these findings highlight the integrated management of nutrient and cultivation to mitigate the impacts of climate extremes on crop productivity through building plant reproductive resilience.

Water-land-energy efficiency and nexus within global agricultural trade during 1995-2019.

Agricultural product demand driven by population and economic growth poses challenges to water, land, and energy utilization, and this increasing local demand is largely met through trade. However, the efficiency and nexus pattern of the water, land, and energy embodied in agricultural trade are not well understood. This study uses the multi-regional input-output framework to analyze agricultural water, land, and energy utilization efficiency of resource footprints per unit economic output as well as their transfer and nexus pattern in global agricultural trade for 1995-2019. The results show that many international agricultural trade paths are inefficient in the water, land, and energy resource use because the agricultural products in these paths are exported from relatively low- to high-efficiency economies/regions. However, these inefficient transfer paths show an increasing trend over the study period. Regarding the water-land-energy nexus, conflicts are prevalent in land-energy and water-energy couplings. Most trade paths are conducted to alleviate the pressure on a specific resource, inadvertently increasing the pressure on other resources. Although agricultural trade is important for meeting global food demands, it is not consistently beneficial to the local environment when considering agricultural resources use efficiency. This study is expected to improve our understanding of agricultural trade impacts to the agricultural resources and support the sustainable development of global agriculture.

Potential healthcare resource use and associated costs of every 2 month injectable cabotegravir plus rilpivirine long-acting regimen implementation in the Spanish National Healthcare System compared to daily oral HIV treatments.

INTRODUCTION: HIV treatment currently consists of daily oral antiretroviral therapy (ART). Cabotegravir + rilpivirine long-acting (CAB + RPV LA) is the first ART available in Spain administered every 2 months through intramuscular injection by a healthcare professional (HCP). The objective of this analysis was to assess potential healthcare resource use (HRU) and cost impact of implementing CAB + RPV LA vs. daily oral ART at National Health System (NHS) hospitals. METHODS: Online quantitative interviews and cost analysis were performed. Infectious disease specialists (IDS), hospital pharmacists (HP) and nurses were asked about their perception of potential differences in HRU between CAB + RPV LA vs. daily oral ART, among other concepts of interest. Spanish official tariffs were applied as unit costs to the HRU estimates (€2022). RESULTS: 120 responders (n = 40 IDS, n = 40 HP, n = 40 nurses) estimated an average number of annual visits per patient by speciality (IDS, HP, and nurse, respectively) of 3.3 vs. 3.7; 4.4 vs. 6.2; 6.1 vs. 3.9, for CAB + RPV LA vs. daily oral ART, and 3.0 vs. 3.2; 4.8 vs. 5.8; 6.9 vs. 4.9, respectively when adjusting by corresponding specialist responses. Estimation by the total sample led to an annual total cost per patient of €2,076 vs. €2,473, being €2,032 vs. €2,237 after adjusting by corresponding HCP, for CAB + RPV LA vs. daily oral ART. CONCLUSIONS: These results suggest that the implementation of CAB + RPV LA in NHS hospitals would not incur in increased HRU-related costs compared to current daily oral ARTs, being potentially neutral or even cost-saving.

Acceptability, feasibility, equity and resource use for prenatal screening for chlamydia and gonorrhea: A systematic review.

Background: A systematic review on acceptability, feasibility, equity and resource use was conducted as part of updating recommendations from the Public Health Agency of Canada on prenatal screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). Methods: Information sources, including MEDLINE® All, Embase and Cochrane CENTRAL (January 2003-January 2021) electronic databases were searched for studies that assessed acceptability, feasibility, equity and resource use of screening for CT or NG in pregnant persons aged ≥12 years. The Risk of Bias Assessment Tool for Non-Randomized Studies was used for quality assessment and a narrative synthesis was prepared. Results: Of the 1,386 records identified, nine observational studies (approximately 5,000 participants) and three economic evaluations met the inclusion criteria. In general, pregnant persons and healthcare providers accepted screening. Most pregnant persons and partners supported universal testing for CT. Pregnant persons preferred non-invasive sampling methods. Inequities in feasibility (accessibility to screening) exist in certain populations. Studies have shown that targeted screening can miss cases. Screening all pregnant persons for CT has net cost savings compared to no screening. Limitations include not identifying eligible literature on acceptability of prenatal screening for NG among partners of pregnant persons and some studies with increased risk populations that restrict the generalizability of the findings highlighting areas for future research. Conclusion: Prenatal screening for CT and NG is generally acceptable among pregnant persons and healthcare providers. Evidence has shown that targeted screening can miss cases. The findings were included when updating PHAC's recommendations on prenatal screening for CT and NG. This work was presented at the Society of Obstetricians and Gynaecologists of Canada's 2024 Annual Clinical and Scientific Conference in Edmonton, Alberta.

Burden of respiratory syncytial virus (RSV) infection in Germany: a systematic review.

BACKGROUND: Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory infection and hospitalizations among infants, young children, and the elderly. This systematic literature review aimed to summarize the epidemiological and economic burden estimates of RSV infection at any age in Germany. METHODS: We conducted a systematic literature search to identify full-text articles published from 2003 to 2023 and reporting data on the epidemiological or economic burden of RSV in Germany. Based on pre-specified eligibility criteria, data on incidence, rates of hospital and intensive care unit (ICU) admission, clinical manifestation, underlying conditions, seasonality, health care resource use and costs were extracted. RESULTS: After screening 315 full-text articles, we included 42 articles in the review. The characteristics of the included studies were heterogenous regarding study population, setting, age groups and RSV-related outcome measures. The most frequently reported epidemiological outcome measures were RSV detection rate (n = 33), followed by clinical manifestation (n = 19), seasonality (n = 18), and underlying conditions of RSV infection (n = 13). RSV detection rates were reported across heterogenous study populations, ranging from 5.2 to 55.4% in pediatric inpatient cases and from 2.9 to 14% in adult inpatient cases. All articles that reported RSV detection rates across several age groups demonstrated the highest burden in infants and young children. Few articles reported RSV-related outcome measures distinctively for the outpatient setting. Health care resource use, such as hospital length of stay, ICU admission rate and treatment of patients with RSV infection were described in 23 articles, of which only one study quantified associated costs from 1999 to 2003 for children ≤ 3 years. In-hospital ICU admission rates varied between 3.6 and 45%, depending on population characteristics as age and underlying conditions. CONCLUSIONS: This systematic review revealed that RSV imposes substantial disease burden in infants, young children, and the elderly in Germany, whereby infants are particularly affected. To date, there has been limited exploration of the impact of RSV infection on healthy children or the elderly in Germany. Given their notably high reported burden in studies, the medical and economic RSV burden in these groups should move more into focus.

Health care resource use and costs in patients with food allergies: a United States insurance claims database analysis.

AIMS: Food allergies impose a large clinical and financial burden on patients and the health care system. However, little is known about the factors associated with health care resource use and costs. The aim of this study was to investigate health care resource use and costs in individuals with food allergies utilizing health care in the United States. METHODS: We conducted a retrospective analysis of insurance claims data from the Merative MarketScan Research Databases (indexed from 1 January 2015 to 30 June 2022). All-cause and food allergy-related health care resource use, direct medical, and out-of-pocket costs for medical services were estimated for 12 months post-index using International Classification of Diseases [ICD] codes. RESULTS: Of 355,520 individuals with food allergies continuously enrolled in a health insurance plan for ≥12 months pre- and post-index, 17% had a food allergy-related emergency department visit and 0.9% were hospitalized. The top patient characteristic associated with all-cause and food allergy-related hospitalizations, all-cause costs, and food allergy-related outpatient visit costs was a Charlson Comorbidity Index score of ≥2. Food allergy-related direct medical and out-of-pocket costs were high among patients with a food allergy-related visit. Out-of-pocket cost per patient per year for outpatient visits, emergency department visits, and hospitalizations had an estimated mean of $1631 for patients with food allergy-related visits, which is ∼11% of the total costs for these services ($14,395 per patient per year). LIMITATIONS: Study limitations are primarily related to the nature of claims databases, including generalizability and reliance on ICD codes. Nevertheless, MarketScan databases provide robust patient-level insights into health care resource use and costs from a large, commercially insured patient population. CONCLUSION: The health care resource use of patients with food allergies imposes a burden on both the health care system and on patients and their families, especially if patients had comorbidities.

Some people with food allergies might need extra visits to the doctor or hospital to manage allergic reactions to food, and these visits add to the cost of medical services for both families and for health care providers. Using records of health insurance claims, we looked into the factors affecting medical visits and costs in people with food allergies in the United States. For people with food allergies, having additional medical conditions (measured using the Charleson Comorbidity Index) were linked with extra medical visits and costs. Out-of-pocket costs were high for people who visited a doctor or hospital for their food allergies (costing each person more than $1,600 per year). The total medical cost of food allergy-related care was $14,395 per person per year, paid for by families and health care providers. Our findings might help to better manage and treat people with food allergies and reduce medical costs.

Impact of moderate-to-high-suicide-intent in major depressive disorder: a retrospective cohort study on patient characteristics and healthcare resource utilisation in England.

BACKGROUND: Major depressive disorder (MDD) is a disabling mental illness that can affect all aspects of daily life and is a leading cause of healthcare resource utilisation (HCRU). AIMS: We aimed to characterise patients with MDD with moderate-to-high-suicide-intent, compare their HCRU to patients with MDD without moderate-to-high-suicide-intent, and better understand their patient pathways. METHODS: This retrospective cohort study used data collected from primary care electronic health records from Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics, Mental Health Services Data Set, and Office for National Statistics in England. Adults diagnosed with ≥ 1 MDD diagnosis between 04/2007 and 11/2015 were categorised by suicide intent. RESULTS: 307,476 patients with MDD were included (294,259 patients without moderate-to-high-suicide-intent and 13,217 with moderate-to-high-suicide-intent). Patients with MDD with moderate-to-high-suicide-intent were younger on average (39.0 vs. 44.8 years) and included a lower percentage of females (58% vs. 65%) compared to patients without moderate-to-high-suicide-intent. HCRU was greater among patients with moderate-to-high-suicide-intent than patients without moderate-to-high-suicide-intent during the first follow-up year for general practitioner consultations (38.5 vs. 29.4), psychiatric outpatient visits (1.5 vs. 0.1), psychiatrist visits (3.6 vs. 0.3), emergency visits (1.5 vs. 0.3), and hospitalisations (86% vs. 26%). Overall, 56% of patients with moderate-to-high-suicide-intent had an antidepressant prescription within 30 days from the initial moderate-to-high-suicide-intent. CONCLUSIONS: Patients with MDD and moderate-to-high-suicide-intent were younger, included more males and incurred greater HCRU than those without moderate-to-high-suicide-intent. These results suggest a greater need for effective medical care and appropriate treatments for patients with moderate-to-high-suicide-intent, which could help reduce associated symptoms, mortality, and HCRU.

Healthcare resource use and costs associated with the misdiagnosis of migraine.

OBJECTIVE: To compare healthcare resource utilization and healthcare costs in patients with migraine with or without a history of misdiagnosis. BACKGROUND: Despite the high prevalence of migraine, migraine is commonly misdiagnosed. The healthcare resource use and cost burden of a misdiagnosis is unknown. METHODS: This retrospective cohort study identified adults with an incident migraine diagnosis from the Merative™ Marketscan® Commercial and Medicare Supplemental Databases between June 2018 and 2019. Patients with a diagnosis of commonly considered misdiagnoses (headache, sinusitis, or cervical pain) before their migraine diagnosis were classified as the "misdiagnosed cohort." Patients in the misdiagnosed cohort were potentially misdiagnosed, then eventually received a correct diagnosis. Patients without a history of commonly considered misdiagnoses prior to their migraine diagnosis were classified as the "correctly diagnosed cohort." Healthcare resource utilization and healthcare costs were assessed in the period before migraine diagnosis and compared between the cohorts. Outcomes were reported as per patient per month and compared with incidence rate ratios. RESULTS: A total of 29,147 patients comprised the correctly diagnosed cohort and 3841 patients comprised the misdiagnosed cohort and met the inclusion criteria. Patients in the misdiagnosed cohort had statistically significantly higher rates of inpatient admissions (0.02 vs. 0.01, incidence rate ratio [IRR] 1.61, 95% confidence interval [CI] 1.47-1.74), emergency department visits (0.10 vs. 0.05; IRR 1.89, 95% CI 1.79-1.99), neurologist visits (0.12 vs. 0.02; IRR 5.95, 95% CI 5.40-6.57), non-neurologist outpatient visits (2.64 vs. 1.58; IRR 1.67, 95% CI 1.62-1.72) and prescription fills (2.82 vs. 1.84; IRR 1.53, 95% CI 1.48-1.58) compared to correctly diagnosed patients. Misdiagnosed patients had statistically significantly higher rates of healthcare cost accrual for inpatient admissions ($1362 vs. $518; IRR 2.62, 95% CI 2.50-2.75), emergency department visits ($222 vs. $98; IRR 2.27, 95% CI 2.18-2.36), neurologist visits ($42 vs. $9; IRR 4.39, 95% CI 4.00-4.79), non-neurologist outpatient visits ($1327 vs. $641; IRR 2.07, 95% CI 1.91-2.24), and prescription fills ($305 vs. $215; IRR 1.41, 95% CI 1.18-1.70) compared to correctly diagnosed patients. CONCLUSION: Patients with migraine who have a history of misdiagnoses have higher rates of healthcare resource utilization and cost accrual versus those without such history.