Oral Prostacyclin Pathway Agents Used in PAH: A Targeted Literature Review.

Purpose: Pulmonary arterial hypertension (PAH) is a rare and progressive pulmonary vascular disease that can result in right heart failure and death. Oral prostacyclins play an important role in the management of intermediate-low risk PAH. This targeted literature review (TLR) aimed to identify and compare evidence supporting use of oral prostacyclin pathway agents (PPAs: selexipag and oral treprostinil) in intermediate-low risk PAH. Methods: A targeted literature review was conducted. Literature databases (MEDLINE, Embase, and Cochrane reviews) were searched for studies describing clinical practice and treatment outcomes for oral treprostinil and selexipag globally, published in English (2012 to 2022). Electronic searches were supplemented by manual-searches of targeted conferences (2020 to 2022), and reference lists of identified publications were reviewed. One reviewer assessed studies for eligibility. Results: In total, 95 publications met inclusion criteria: 47 full-text articles (selexipag n = 22; oral treprostinil n = 16; selexipag and oral treprostinil n = 9) and 48 conference materials. Selexipag and oral treprostinil target the prostacyclin pathway differently; their label-supporting trials had different primary endpoints (disease progression and hospitalization vs exercise capacity and disease progression), differing baseline therapy (0, 1 or 2 vs 0 or 1 baseline treatments), titration duration and dosing (personalized dose capped at 1600 ug twice daily (BID) vs increasing doses over time with no maximum dose), respectively. While both oral PPAs have demonstrated reduced risk of disease progression, only selexipag showed reduction in hospitalization rates. Oral PPAs have been shown to reduce healthcare costs in real-world clinical practice. This difference is reflected in labeled indications. Conclusion: Given differences in trial- and real-world outcomes, number of prior therapies, and dosing, personalizing the choice of oral PPA is critical to maximizing the benefit for individual patients.

PAH is a condition that causes heart failure. It is important to take medicines to slow down this process. For people with early disease, there are some medicines that can be taken as a tablet rather than as an injection to slow down disease progression. The differences between two of the tablet options ­ selexipag and oral treprostinil, are unclear. We reviewed publications describing how, when and why these medicines are used and how well they work, to improve our understanding of the value of these medicines to people with PAH.

Oxygen Vacancies Trigger Rapid Charge Transport Channels at the Engineered Interface of S-scheme Heterojunction for Boosting Photocatalytic Performance.

Although oxygen vacancies (Ovs) have been intensively studied in single semiconductor photocatalysts, exploration of intrinsic mechanisms and in-depth understanding of Ovs in S-scheme heterojunction photocatalysts are still limited. Herein, a novel S-scheme photocatalyst made from WO3-Ov/In2S3 with Ovs at the heterointerface is rationally designed. The microscopic environment and local electronic structure of the S-scheme heterointerface are well optimized by Ovs. Femtosecond transient absorption spectroscopy (fs-TAS) reveals that Ovs trigger additional charge movement routes and therefore increase charge separation efficiency. In addition, Ovs have a synergistic effect on the thermodynamic and kinetic parameters of S-scheme photocatalysts. As a result, the optimal photocatalytic performance is significantly improved, surpassing that of single component WO3-Ov and In2S3 (by 35.5 and 3.9 times, respectively), as well as WO3/In2S3 heterojunction. This work provides new insight into regulating the photogenerated carrier dynamics at the heterointerface and also helps design highly efficient S-scheme photocatalysts.

Efficient Solar-Driven Interfacial Water Evaporator using Hydrogel Modified Carbon-Based Biomass with Abundant Microchannels.

The conventional sea water desalination technologies are not yet adopted worldwide, especially in the third world countries due to their high capital cost as well as large energy requirement. To solve this issue in a sustainable way an interfacial solar water evaporation device is designed and proposed in this article using the branches of Prunus serrulata (PB). The PB has abundant microchannels and shows excellent photothermal conversion capability after carbonization. Moreover, the easy access to raw materials and the facile fabrication process makes the solar water evaporating device very cost effective for seawater desalination application. Experiments show that in the presence of the fabricated evaporator the evaporation rate of water can reach 3.5 kg m-2  h-1 under 1 sun, which is superior to many similar experimental devices. In addition, its advantages, such as effective sewage purification capability, low cost, and environmental friendliness, make this evaporator highly competitive in the extensive promotion of this technology and can be considered as a new sustainable solution for seawater desalination with great application potential and prospects.

2D Semi-Metallic Hafnium Ditelluride: A Novel Nonlinear Optical Material for Ultrafast and Ultranarrow Photonics Applications.

2D semi-metallic hafnium ditelluride material is used in several applications such as solar steam generation, gas sensing, and catalysis owing to its strong near-infrared absorbance, high sensitivity, and distinctive electronic structure. The zero-bandgap characteristics, along with the thermal and dynamic stability of 2D-HfTe2, make it a desirable choice for developing long-wavelength-range photonics devices. Herein, the HfTe2 -nanosheets are prepared using the liquid-phase exfoliation method, and their superior nonlinear optical properties are demonstrated by the obtained modulation depth of 11.9% (800 nm) and 6.35% (1560 nm), respectively. In addition, the observed transition from saturable to reverse saturable absorption indicates adaptability of the prepared material in nonlinear optics. By utilizing a side polished fiber-based HfTe2 -saturable absorber (SA) inside an Er-doped fiber laser cavity, a mode-locked laser with 724 fs pulse width and 56.63 dB signal-to-noise ratio (SNR) is realized for the first time. The generated laser with this SA has the second lowest mode-locking pump threshold (18.35 mW), among the other 2D material based-SAs, thus paving the way for future laser development with improved efficiency and reduced thermal impact. Finally, employing this HfTe2 -SA, a highly stable single-frequency fiber laser (SNR ≈ 74.56 dB; linewidth ≈ 1.268 kHz) is generated for the first time, indicating its promising ultranarrow photonic application.

Hospitalization-related costs associated with oral agents targeting the prostacyclin pathway for pulmonary arterial hypertension.

AIMS: Pulmonary arterial hypertension (PAH) is a rare, progressive, and ultimately fatal form of the broader condition pulmonary hypertension. ESC/ERS guidelines recommend therapy targeting the prostacyclin pathway for patients not achieving low-risk mortality status. Currently, only oral selexipag (OS) and oral treprostinil (OT) have this mechanism of action and are available in the United States (US). A recent database analysis has shown significantly lower hospitalization risk for patients treated with OS versus OT. Nevertheless, differences in hospitalization and treatment costs among PAH patients taking oral prostacyclin pathway agents (PPAs) in the US healthcare system remain unclear. This study aims to estimate the difference in costs for patients who achieve a stable maintenance dose from a US payer perspective. MATERIALS AND METHODS: We developed a cost calculator including direct medical costs from the US third-party payer perspective to estimate PAH-related hospitalizations and costs associated with oral PPA use over 2 years, in a hypothetical US payer plan with 1 million members. The treatment-eligible population was estimated from real-world epidemiological data. Treatment-specific hospitalizations were estimated from a study using the Optum Clinformatics administrative claims database. Influence of each model parameter was tested in one-way sensitivity analyses (OWSA), while scenario analysis tested the impact of key assumptions. RESULTS: For 78 PAH patients included in the model, the base case scenario estimated total costs of $46,736,768 with 98 PAH-related admissions for OS, and total costs of $60,113,620 and 161 PAH-related admissions over 2 years for OT. Using OS was associated with 22.3% cost reduction and 39.1% hospitalizations averted; the number of patients needed treated with selexipag to avoid one hospital admission was 1.23. OWSA indicated medication cost was the most sensitive parameter, followed by population parameters. LIMITATIONS AND CONCLUSIONS: OS use over 2 years would result in lower total, drug, and hospitalization-related costs compared with OT, thus providing financial savings for payers.

Impact of selexipag use within 12 months of pulmonary arterial hypertension diagnosis on hospitalizations and medical costs: A retrospective cohort study.

BACKGROUND: Oral selexipag, a prostacyclin pathway agent (PPA), is effective in patients with pulmonary arterial hypertension (PAH). The objective of this study is to assess the impact of initiating oral selexipag within 12 months of diagnosis on health outcomes. METHODS: This retrospective cohort study used data from Optum's de-identified Clinformatics® Data Mart Database. PAH patients between 1 October 2015 and 30 September 2019 were included. Patients were also required to have received PAH medication within 12 months of their initial diagnosis. Study groups included patients who initiated selexipag within 12 months of PAH diagnosis (SEL ≤ 12) and those who did not initiate any PPA within 12 months of PAH diagnosis (No PPA ≤ 12). Inverse probability of treatment weighting was used to remove potential confounding between groups. Cox and Poisson regression models were used to compare hospitalization and disease progression. Generalized linear model with gamma distribution and log link was used to compare costs. RESULTS: SEL ≤ 12 had lower rate of all-cause hospitalizations (rate ratio: 0.76, 95% confidence interval [CI]: 0.60, 0.96) versus no PPA ≤ 12, but no differences in PAH-related hospitalization rate (rate ratio: 1.03, 95% CI: 0.79, 1.33) or risk of disease progression (hazard ratio: 1.01, 95% CI: 0.71, 1.44). SEL ≤ 12 incurred lower all-cause (mean difference: -$23 623; 95% CI: -35 537, -8512) and PAH-related total medical costs (mean difference: -$12 927; 95% CI: -19 559, -5679) versus no PPA ≤ 12. CONCLUSION: Selexipag initiation within 12 months of PAH diagnosis demonstrated reductions in all-cause hospitalization rate and medical costs.

Real-World Treatment Patterns Among Patients with Connective Tissue Disorder-Related Pulmonary Arterial Hypertension in the United States: A Retrospective Claims-Based Analysis.

INTRODUCTION: Connective tissue disorders (CTDs) are the most frequent diseases associated with pulmonary arterial hypertension (PAH). Despite advances in treatment, the prognosis of CTD-related PAH remains poor. To help identify areas for improvement in the management of CTD-related PAH, this study assessed real-world PAH treatment patterns in this population in the US. METHODS: Eligible adult patients with PAH initiated on a PAH treatment (index date: 1st initiation date) were identified from Optum's de-identified Clinformatics® Data Mart Database (10/01/2015-09/30/2021) and categorized into mutually exclusive cohorts (CTD + PAH; PAH) based on the presence of CTD diagnosis claims. Treatment patterns were assessed from the index date to the earliest of death or end of continuous insurance eligibility, or data availability. Treatment persistence was assessed using Kaplan-Meier analysis. RESULTS: A total of 4751 patients were included (CTD + PAH: n = 728, mean follow-up of 18.8 months; PAH: n = 4023, mean follow-up of 19.6 months). For both cohorts, the most common first treatment regimens were sildenafil (CTD + PAH: 38.7%; PAH: 51.5%), tadalafil (10.0%; 9.4%), and macitentan (8.1%; 5.4%) monotherapy; these were also the most frequent agents included in any of the first 3 treatment regimens. Combination therapy was more frequent in the CTD + PAH versus PAH cohort (any regimen: 40.9% vs. 27.2%; 1st treatment regimen: 26.9% vs. 18.5%; 2nd: 52.8% vs. 42.0%; 3rd: 55.2% vs. 48.5%). Treatment persistence was similar across cohorts and the first three treatment regimens, with persistence rates ranging from 42.6 to 49.7% at 12 months. CONCLUSIONS: Treatment patterns were generally similar between the CTD + PAH and PAH cohorts, although combination therapy was more frequent in the CTD + PAH cohort. Both cohorts may benefit from broader use of all available PAH treatment classes, including combination therapy. Considering the life-threatening nature of PAH, our findings also highlight the need to address the low persistence rates with PAH therapies regardless of etiology.

Uncooled Mid-Infrared Sensing Enabled by Chip-Integrated Low-Temperature-Grown 2D PdTe2 Dirac Semimetal.

Next-generation mid-infrared (MIR) imaging chips demand free-cooling capability and high-level integration. The rising two-dimensional (2D) semimetals with excellent infrared (IR) photoresponses are compliant with these requirements. However, challenges remain in scalable growth and substrate-dependence for on-chip integration. Here, we demonstrate the inch-level 2D palladium ditelluride (PdTe2) Dirac semimetal using a low-temperature self-stitched epitaxy (SSE) approach. The low formation energy between two precursors facilitates low-temperature multiple-point nucleation (∼300 °C), growing up, and merging, resulting in self-stitching of PdTe2 domains into a continuous film, which is highly compatible with back-end-of-line (BEOL) technology. The uncooled on-chip PdTe2/Si Schottky junction-based photodetector exhibits an ultrabroadband photoresponse of up to 10.6 µm with a large specific detectivity. Furthermore, the highly integrated device array demonstrates high-resolution room-temperature imaging capability, and the device can serve as an optical data receiver for IR optical communication. This study paves the way toward low-temperature growth of 2D semimetals for uncooled MIR sensing.

Characteristics of patients with pulmonary arterial hypertension from an innovative, comprehensive real-world patient data repository.

Pulmonary arterial hypertension (PAH) is a rare, life-limiting disease. PAH registries provide real-world data that complement clinical trial data and inform treatment decisions. The TRIO comprehensive, integrated patient data repository (TRIO CIPDR), is an innovative US repository capturing data on contemporary patients diagnosed with pulmonary hypertension and receiving US Food and Drug Administration-approved PAH therapies. This repository uniquely combines clinical data from electronic medical records with the ability to track drug-prescription and drug-dispensing characteristics, and includes 946 adult patients with PAH (data collected January 2019 to December 2020) enrolled from nine representative US specialist tertiary care centers. Potentially eligible patients were identified based on dispensing data from specialty pharmacies. Hemodynamic and clinical data, as well as dispensing information on prescribed PAH medications, were provided by tertiary centers. At enrollment, 75% of patients were female, 67% were White, median age at PAH diagnosis was 53 years (median time from diagnosis to enrollment was 5 years), and 37% were obese. Comorbidity profiles were as expected for a PAH population, although the proportion with atrial fibrillation (34%) was higher than expected. Overall, 38% of patients had idiopathic PAH and 30% had connective tissue disease-related PAH. Among 917 patients receiving PAH-specific therapy, 40% were on monotherapy, 43% on dual therapy, and 17% on triple therapy. Longitudinal data from this repository will allow tracking of the PAH treatment journey in relation to clinical characteristics and outcomes.

Economic burden of illness among patients with pulmonary arterial hypertension (PAH) associated with connective tissue disorders (CTD).

Pulmonary arterial hypertension (PAH) is commonly associated with connective tissue disorders (CTDs). This study provides a contemporary assessment of the economic burden of CTD + PAH and PAH in the United States. Eligible adult patients identified from Optum's deidentified Clinformatics® Data Mart Database (10/01/2015-09/30/2021) were classified into mutually exclusive cohorts based on recorded diagnoses: (1) CTD + PAH, (2) PAH, (3) CTD, (4) control without CTD/PAH. The index date was a randomly selected diagnosis date for PAH (CTD + PAH, PAH cohorts) or CTD (CTD cohort), or a random date (control cohort). Entropy balancing was used to balance characteristics across cohorts. Healthcare costs and healthcare resource utilization (HRU) per patient per month (PPPM) were assessed for ≤12 months postindex and compared among balanced cohorts. A total of 552,900 patients were included (CTD + PAH: n = 1876; PAH: n = 8177; CTD: n = 209,156; control: n = 333,691). Average total all-cause costs were higher for CTD + PAH than PAH cohort ($16,854 vs. $15,686 PPPM; p = 0.02); both cohorts incurred higher costs than CTD and control cohorts ($4476 and $2170 PPPM; all p < 0.001). Average HRU PPPM was similar between CTD + PAH and PAH cohorts (inpatient stay: 0.15 vs. 0.15, outpatient visits: 4.23 vs. 4.11; all p > 0.05), while CTD and control cohorts incurred less HRU (inpatient stay: 0.07 and 0.03, outpatient visits: 2.67 and 1.69; all p < 0.001). CTD + PAH and PAH are associated with a substantial economic burden. The incremental burden attributable to PAH versus the general population and patients with CTD without PAH highlights significant unmet needs among PAH patients.

Predicting Risk of 1-Year Hospitalization Among Patients with Pulmonary Arterial Hypertension.

INTRODUCTION: US claims-based analyses emphasize the substantial hospitalization burden of patients with pulmonary arterial hypertension (PAH) and the significant need for improved monitoring and more timely interventions. A claims-based predictive model may be useful to assist healthcare providers and payers in identifying patients with PAH at increased hospitalization risk. To address this aim, we constructed statistical models using baseline patient variables available in administrative healthcare claims to predict patients' risk for all-cause and PH-related hospitalization within 1 year of initiating ≥ 1 PAH indicated medication. METHODS: Adult patients with PAH who newly initiated ≥ 1 PAH indicated medication were selected from the MarketScan Commercial and Medicare Supplemental databases (January 1, 2009-January 31, 2019). Cox regression models were built with a randomly selected training set and evaluated using a validation set of remaining patients. Predictive variables for the models were selected in three steps: clinical knowledge, univariate analysis, and backward stepwise selection. RESULTS: Within 1 year of initiating ≥ 1 PAH indicated medication, 1502/3872 (38.8%) had an all-cause hospitalization and 950/3872 (24.5%) had a pulmonary hypertension (PH)-related hospitalization. Predictive risk factors for all-cause hospitalization were Quan-Charlson Comorbidity Index (CCI) score 2-3 [hazard ratio (HR) 1.229; P = 0.038] and ≥ 4 (HR 1.531; P < 0.001), claims-based frailty index (CFI) score > 1 (highest frailty level; HR 1.301; P = 0.018), hemoptysis (HR 1.254; P = 0.016), malaise/fatigue (HR 1.150; P = 0.037), history of PH-related hospitalization (HR 1.171; P = 0.011), non-PH-related ER visit (HR 1.713; P = 0.014), and higher non-PH-related outpatient visit cost (HR 1.069; P < 0.001). Predictive risk factors for PH-related hospitalization were female sex (HR 1.264; P = 0.004), Quan-CCI score ≥ 4 (HR 1.408; P = 0.008), portal hypertension (HR 1.565; P = 0.019), CFI score > 1 (HR 1.522; P = 0.002), dyspnea (HR 1.259; P = 0.023), and history of PH-related hospitalization (HR 1.273; P = 0.002). CONCLUSIONS: The US claims-based predictive models showed acceptable performance to predict 1-year hospitalization among patients with PAH.

Comparative evaluation of costs and healthcare resource utilization of oral selexipag versus inhaled treprostinil or oral treprostinil in patients with pulmonary arterial hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH), a rare vasculopathy progressively leading to right heart failure and death, is associated with considerable economic burden. Oral prostacyclin pathway agents (PPAs) like selexipag and treprostinil address an underlying PAH pathway, yet are often under-utilized. Data on head-to-head cost comparison of various PPAs is lacking. METHODS: In this retrospective study using a large health claims database, we compared the per-patient-per-year (PPPY) costs and healthcare resource utilization (HRU) among PAH patients taking either oral selexipag, inhaled treprostinil or oral treprostinil in the United States between July 2015 and March 2020. Patients with ≥1 prescription for one of the drugs of interest, ≥1 in-patient pulmonary hypertension (PH) diagnosis, or ≥ 2 outpatient PH diagnoses were included in this study. Baseline differences between the three groups were adjusted using an inverse probability of treatment weighting approach. 411 patients were selected for the final study cohorts. RESULTS: All-cause hospitalization costs were highest for oral treprostinil ($39,983) compared to oral selexipag ($20,635) and inhaled treprostinil ($16,548; p = .037). Total PAH-related medical costs were 40% lower for patients on oral selexipag compared to patients on oral and inhaled treprostinil ($24,351 vs. $40,398 and $40,339, respectively; p = .006). PAH-related outpatient visits were lowest for patients on oral selexipag (14 PPPY visits) compared to oral treprostinil (16 PPPY visits) and inhaled treprostinil (22 PPPY visits; p = .001). CONCLUSIONS: Compared to oral and inhaled treprostinil, oral selexipag may incur lower medical costs and reduce PAH related outpatient visits for patients with PAH.

Hospitalization Among Pulmonary Arterial Hypertension Patients With and Without Connective Tissue Disease Comorbidities Prescribed Oral Selexipag.

INTRODUCTION: Patients with connective tissue disorders (CTD) and pulmonary arterial hypertension (PAH) have a poorer prognosis than those with other PAH etiologies. This study assessed the impact of CTD on healthcare outcomes among PAH patients with and without CTD comorbidities that were treated with oral selexipag. METHODS: The study utilized Optum's de-identified Clinformatics® Data Mart Database (2007-2021) from January 1, 2014 to June 30, 2019, and identified patients with PAH without CTD and PAH with CTD treated with oral selexipag. Patients had ≥ 12-month baseline period with no requirement for a minimum follow-up period. Patients were followed until any of the following events: discontinuation of oral selexipag, or health plan disenrollment, or death, or presence of a diagnosis claim for CTEPH, or study end date, whichever occurred first. PAH-related hospitalizations, PAH disease progression, and healthcare utilizations and costs were assessed in the follow-up period. The Cox proportional hazards model was used to evaluate the time to hospitalization and generalized linear models were used to examine healthcare costs and utilization between the two cohorts. RESULTS: In the analysis, 237 PAH without CTD, and 80 PAH patients with CTD comorbidities prescribed oral selexipag were included. The PAH without CTD comorbidities cohort was older (65 vs. 63 years old), had proportionately less females (72 vs. 83%), and higher comorbidity burden than PAH with CTD comorbidities (mean CCI index 3 vs. 2). After adjusting for potential confounders, the risk for PAH-related hospitalization (hazard ratio (HR) 1.13, p value 0.641), all-cause hospitalization (HR 1.09, p value: 0.765), and PAH disease progression (HR 1.14, p value 0.522) between the two cohorts were similar. After adjusting for baseline demographic and clinical characteristics, PAH with CTD comorbidities incurred higher total mean all-cause PAH-related medical care costs compared to PAH without CTD comorbidities. CONCLUSIONS: In this real-world study, the risk of hospitalization and PAH disease progression were similar between the two cohorts who received oral selexipag. The results from this study corroborate findings of the GRIPHON post hoc analysis of PAH-associated CTD patients and support oral selexipag use in PAH-CTD patients.

Bio-Derived Photothermal Materials and Evaporators for Sustainable Solar Energy-Driven Water Process.

Interfacial solar steam generation (ISSG) is considered as an excellent seawater desalination technology because of its electricity-independent nature, low cost, and portability. However, improving the water evaporation efficiency, simplifying the fabrication process, and reducing the overall cost of the evaporator are still challenging. Here, an efficient and sustainable solar water evaporator is fabricated with carbonized ginkgo biloba leaves as the structural basis of photothermal materials. The combination of the abundant capillary channels in ginkgo leaves paired with polyacrylamide (PAM) hydrogel accelerates water transportation and solar-driven evaporation. The fabricated evaporator shows excellent photothermal conversion capability and evaporates water at 2.39 kg m-2 h-1 under 1 sun irradiation. In addition, the device exhibits remarkable stability in simulated seawater and can effectively realize seawater desalination or sewage treatment. As a result, the system is promising for future highly efficient solar evaporation due to its environmental protection and low cost.

Multiwalled Carbon Nanotube-Based On-Body Patch Antenna for Detecting COVID-19-Affected Lungs.

A novel rectangular patch antenna based on multiwall carbon nanotubes has been designed and developed for assisting the initial detection of COVID-19-affected lungs. Due to their highly conductive nature, each nanotube echoes electromagnetic waves in a unique manner, influencing the increase in bandwidth. The proposed antenna operates at 6.63, 7.291, 7.29, and 7.22 GHz with a higher bandwidth classified as an ultrawide band and can be used on a human body phantom model because of its flexibility and decreased radiation qualities. Flame retardant 4 is chosen as a substrate with a uniform thickness of 1.62 mm due to its inexpensive cost and excellent electrical properties. The maximum specific absorption rate of the proposed antenna is obtained as 1.77 W/kg for 10 g of tissues. For testing purposes, a model including all the known features of COVID-19-affected lungs is developed. The designed antenna exhibits excellent performance in free space, normal lungs, and affected lung environments. It might be utilized as a first screening device for COVID-19 patients, especially in resource-constrained areas where traditional medical equipment such as X-ray and computerized tomography scans are scarce.

Nonlinear Optical Activities in Two-Dimensional Gallium Sulfide: A Comprehensive Study.

The nonlinear optical (NLO) properties of two-dimensional (2D) materials are fascinating for fundamental physics and optoelectronic device development. However, relatively few investigations have been conducted to establish the combined NLO activities of a 2D material. Herein, a study of numerous NLO properties of 2D gallium sulfide (GaS), including second-harmonic generation (SHG), two-photon excited fluorescence (TPEF), and NLO absorption are presented. The layer-dependent SHG response of 2D GaS identifies the noncentrosymmetric nature of the odd layers, and the second-order susceptibility (χ2) value of 47.98 pm/V (three-layers of GaS) indicates the superior efficiency of the SHG signal. In addition, structural deformation induces the symmetry breaking and facilitates the SHG in the bulk samples, whereas a possible efficient symmetry breaking in the liquid-phase exfoliated samples results in an enhancement of the SHG signal, providing prospective fields of investigation for researchers. The generation of TPEF from 800 to 860 nm depicts the two-photon absorption characteristics of 2D GaS material. Moreover, the saturable absorption characteristics of 2D GaS are realized from the largest nonlinear absorption coefficient (ß) of -9.3 × 103, -91.0 × 103, and -6.05 × 103 cm/GW and giant modulation depths (Ts) of 24.4%, 35.3%, and 29.1% at three different wavelengths of 800, 1066, and 1560 nm, respectively. Hence, such NLO activities indicate that 2D GaS material can facilitate in the technical advancements of future nonlinear optoelectronic devices.

The direct and indirect health care costs associated with pulmonary arterial hypertension among commercially insured patients in the United States.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare, progressive, and fatal disease associated with considerable overall clinical and economic burden. Although the direct health care costs of PAH have been well described, there are few data regarding indirect costs and productivity loss associated with PAH. Patient data were assessed until the earliest of death, end of full-time employment, end of continuous enrollment, or end of study period. OBJECTIVES: To update data on the direct burden and address the knowledge gap regarding the indirect burden associated with PAH. METHODS: This is a retrospective case-control study with prevalent and incident patients with PAH aged 18-64 years identified from the MarketScan Commercial and Health and Productivity management datasets during the identification period (January 1, 2016, to November 30, 2018). Patients were required to have continuous enrollment for 12 months or longer from the baseline period and 1 month or longer from the follow-up (post-index) period. Among patients with PAH (cases), the first observed PAH diagnosis claim date during the identification period was the index date. Patients without PAH (controls) were selected and assigned a random index date during the same period. Controls were matched 1:1 by age, sex, and region to prevalent and incident PAH cases. Per patient per month (PPPM), all-cause health care resource utilization, costs, and short-term disability (STD) were examined for cases and controls during the follow-up period. Multivariable analysis was performed using the generalized linear model to determine the adjusted direct and indirect health care utilization and costs. RESULTS: A total of 1,293 prevalent and 455 incident patients with PAH were identified. During the follow-up period, prevalent patients with PAH had significantly higher total mean all-cause health care costs ($9,915 vs $359, P < 0.0001) and inpatient length of stay (0.63 vs 0.02 days, P < 0.0001) PPPM as compared with controls. Prevalent patients with PAH had significantly longer STD (6.0 vs 1.5 days, P < 0.0001) and higher STD-related costs ($1,226 vs $277, P < 0.0001) PPPM as compared with controls. Incident patients with PAH had significantly higher total mean all-cause health care costs ($9,353 vs $336, P < 0.0001) and inpatient length of stay (0.92 vs 0.01 days, P < 0.0001) PPPM as compared with controls. Incident patients with PAH also had longer STD (8.1 vs 1.5 days, P < 0.0001) and higher STD-related costs ($1,706 vs $263, P < 0.0001), as compared with controls. CONCLUSIONS: This study showed that incident and prevalent patients with PAH had significantly higher direct and indirect health care resource utilization and costs as well as productivity loss compared with patients without PAH. DISCLOSURES: Ms Ogbomo and Mr Mallampati were paid employees of STATinMED Research at the time of study completion; STATinMED Research is a paid consultant to Janssen Scientific Affairs, LLC. Drs Tsang and Panjabi are employees of Janssen Scientific Affairs LLC, a subsidiary of Johnson and Johnson, the study sponsor.

Development and evaluation of a predictive algorithm for unsatisfactory response among patients with pulmonary arterial hypertension using health insurance claims data.

OBJECTIVE: This study aimed to develop and validate a predictive algorithm for unsatisfactory response to initial pulmonary arterial hypertension (PAH) therapy using health insurance claims. METHODS: Adult patients with PAH initiated on a first PAH therapy (index date) were identified from Optum's de-identified Clinformatics Data Mart Database (1/1/2010-12/31/2019). A random survival forest algorithm was developed using patient-month data and predicted the "survival function" (i.e. risk of not having unsatisfactory response) over time. For each patient-month observation, risk factors were assessed in the 12 months prior. Unsatisfactory response was defined as the first instance of (1) new PAH therapy, (2) PAH-related hospitalization or emergency room visit, (3) lung transplant or atrial septostomy, (4) PAH-related death or (5) chronic oxygen therapy initiation. To facilitate use in clinical practice, a simplified risk score was also developed based on a linear combination of the most important risk factors identified in the algorithm. RESULTS: In total, 4781 patients were included (median age = 69.0 years; 58.6% female). Over a median follow-up of 14.0 months, 3169 (66.3%) had an unsatisfactory response. The most important risk factors included in the algorithm were healthcare resource use (i.e. PAH-related outpatient visits, pulmonologist visits, cardiologist visits, all-cause hospitalizations), time since first PAH diagnosis, time since index date, Charlson Comorbidity Index, dyspnea, and age. Predictive accuracy was good for the full algorithm (C-statistic: 0.732) but was slightly lower for the simplified risk score (C-statistic: 0.668). CONCLUSION: The present claims-based algorithm performed well in predicting time to unsatisfactory response following initial PAH therapy.

Waste Egg Tray and Toner-Derived Highly Efficient 3D Solar Evaporator for Freshwater Generation.

With the advancement of civilization, water purification, as well as management and disposal of ever-increasing municipal solid waste (MSW), and e-waste, have become global concerns. To address these issues in a sustainable way, a 3D solar evaporator has been proposed in this paper by repurposing recycled paper from MSW in the form of egg trays and waste dry toner (e-waste) using a facile fabrication method. The unique 3D porous structure, fibrous surface, superior water absorbing capability as well as low thermal conductivity of wastepaper-derived egg trays make them an excellent candidate for an efficient solar evaporator, while the waste toner powder coating significantly enhances the optical absorbance capacity. Under 1 sun illumination, the proposed solar evaporator demonstrates an excellent evaporation rate and efficiency of 1.3 kg/m2 h and 78.5%, respectively. Moreover, the competitive advantage of the 3D structure in collecting solar irradiance at various light incident angles in comparison to a 2D structure, excellent cycle stability, low processing temperature, and the use of low-cost waste materials enable its use for large-scale water purification systems.

Beyond Tristimulus Color Vision with Perovskite-Based Multispectral Sensors.

In this study, optical multispectral sensors based on perovskite semiconductors have been proposed, simulated, and characterized. The perovskite material system combined with the 3D vertical integration of the sensor channels allow for realizing sensors with high sensitivities and a high spectral resolution. The sensors can be applied in several emerging areas, including biomedical imaging, surveillance, complex motion planning of autonomous robots or vehicles, artificial intelligence, and agricultural applications. The sensor elements can be vertically integrated on a readout electronic to realize sensor arrays and multispectral digital cameras. In this study, three- and six-channel vertically stacked perovskite sensors are optically designed, electromagnetically simulated, and colorimetrically characterized to evaluate the color reproduction. The proposed sensors allow for the implementation of snapshot cameras with high sensitivity. The proposed sensor is compared to other sensor technologies in terms of sensitivity and selectivity.