CEAC (oral semustine, etoposide, cytarabine and cyclophosphamide) vs BEAM (carmustine, etoposide, cytarabine, and melphalan) conditioning regimen of autologous stem cell transplantation for diffuse large B-cell lymphoma: a post-hoc, propensity score-matched, cohort study in Chinese patients.

Autologous stem cell transplantation (ASCT) is a salvage therapy for relapsed or refractory diffuse large B-cell lymphoma (DLBCL). We have developed a novel conditioning regimen called CEAC (oral semustine 250 mg/m2 d-6, etoposide 300 mg/m2 d-5 ~ d-2, cytarabine 500 mg/m2 d-5 ~ d-2, and cyclophosphamide 1200 mg/m2 d-5 ~ d-2) In lymphoma patients in China. Here, we conducted a study to compare the conventional BEAM regimen with the CEAC regimen in 110 DLBCL patients. Propensity-score matching was performed in a 1:4 ratio (22 patients received BEAM and 88 received CEAC). Our results showed no significant difference in the overall response rate (95% vs 97%, P = 1.000) and complete response rate (66% vs 73%, P = 0.580) between the two cohorts. The 5-year progression-free survival (PFS), 5-year overall survival (OS), and 5-year cumulative incidence of relapse (CIR) for all patients were 72% (95% CI 62%-82%), 92% (95% CI 86%-97%), and 29% (95% CI 17%-38%), respectively. There was no significant difference in the 5-year PFS (80% vs 70%, P = 0.637), 5-year OS (95% vs 91%, P = 0.496), and 5-year CIR (20% vs 30%, P = 0.733) between cohorts. In terms of safety, the CEAC cohort had a lower incidence rate of grade 1-2 gastrointestinal hemorrhage (P = 0.023) and severe nausea (P = 0.007) compared with the BEAM cohort. In conclusion, the CEAC regimen seems to be a suitable alternative to the BEAM regimen for ASCT in DLBCL patients.

Alcohol-involved sexual assault in the US military: a scoping review.

Background: Sexual assault and alcohol use are significant public health concerns, including for the United States (US) military. Although alcohol is a risk factor for military sexual assault (MSA), research on the extent of alcohol-involvement in MSAs has not been synthesised.Objective: Accordingly, this scoping review is a preliminary step in evaluating the existing literature on alcohol-involved MSAs among US service members and veterans, with the goals of quantifying the prevalence of alcohol-involved MSA, examining differences in victim versus perpetrator alcohol consumption, and identifying additional knowledge gaps.Method: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews, articles in this review were written in English, published in 1996 or later, reported statistics regarding alcohol-involved MSA, and included samples of US service members or veterans who experienced MSA during military service.Results: A total of 34 of 2436 articles identified met inclusion criteria. Studies often measured alcohol and drug use together. Rates of reported MSAs that involved the use of alcohol or alcohol/drugs ranged from 14% to 66.1% (M = 36.94%; Mdn = 37%) among servicemen and from 0% to 83% (M = 40.27%; Mdn = 41%) among servicewomen. Alcohol use was frequently reported in MSAs, and there is a dearth of information on critical event-level characteristics of alcohol-involved MSA. Additionally, studies used different definitions and measures of MSA and alcohol use, complicating comparisons across studies.Conclusion: The lack of event-level data, and inconsistencies in definitions, measures, and sexual assault timeframes across articles demonstrates that future research and data collection efforts require more event-level detail and consistent methodology to better understand the intersection of alcohol and MSA, which will ultimately inform MSA prevention and intervention efforts.

A total of 34 of 2436 articles identified met inclusion criteria. Studies often measured alcohol and drug use together. Rates of reported military sexual assaults that involved the use of alcohol or alcohol/drugs ranged from 14% to 66.1% (M = 36.94%; Mdn = 37%) among servicemen and from 0% to 83% (M = 40.27%; Mdn = 41%) among servicewomen.More precise prevalence estimates of the intersection between alcohol and military sexual assault were limited due to inconsistencies in the definitions of sexual assault and alcohol use, measures of sexual assault and alcohol use, and timeframe for reporting across studies.Future research should standardise the measures, definitions, and timeframes of sexual assault and alcohol-involvement to allow for a more precise estimation of alcohol-involved military sexual assault. Furthermore, event-level data is needed including amount and timeframe of alcohol consumption, relationship between victim and perpetrator, location of alcohol consumption and military sexual assault, and whether the assault was opportunistic or facilitated, to inform military sexual assault prevention and intervention efforts in the military.

Associations between trauma and substance use among healthcare workers and public safety personnel during the SARS-CoV-2 (COVID-19) pandemic: the mediating roles of dissociation and emotion dysregulation.

BACKGROUND: Given the highly stressful environment surrounding the SARS-CoV-2 pandemic, healthcare workers (HCW) and public safety personnel (PSP) are at an elevated risk for adverse psychological outcomes, including posttraumatic stress disorder (PTSD) and alcohol/substance use problems. As such, the study aimed to identify associations between PTSD severity, related dissociation and emotion dysregulation symptoms, and alcohol/substance use problems among HCWs and PSP. METHODS: A subset of data (N = 498; HCWs = 299; PSP = 199) was extracted from a larger study examining psychological variables among Canadian HCWs and PSP during the pandemic. Structural equation modelling assessed associations between PTSD symptoms and alcohol/substance use-related problems with dissociation and emotion dysregulation as mediators. RESULTS: Among HCWs, dissociation fully mediated the relation between PTSD and alcohol-related problems (indirect effect ß = .133, p = .03) and emotion dysregulation partially mediated the relation between PTSD and substance-related problems (indirect effect ß = .151, p = .046). In PSP, emotion dysregulation fully mediated the relation between PTSD and alcohol-related problems (indirect effects ß = .184, p = .005). For substance-related problems among PSP, neither emotion dysregulation nor dissociation (ps >.05) had any effects. CONCLUSION: To our knowledge, this is the first study examining associations between PTSD severity and alcohol/substance use-related problems via mediating impacts of emotion dysregulation and dissociation among HCWs and PSP during the SARS-CoV-2 pandemic. These findings highlight dissociation and emotion dysregulation as important therapeutic targets for structured interventions aimed at reducing the burden of PTSD and/or SUD among Canadian HCWs or PSP suffering from the adverse mental health impacts of the SARS-CoV-2 pandemic.

Among healthcare workers, dissociation mediated relation between posttraumatic stress disorder (PTSD) severity and alcohol-related problems and emotion dysregulation mediated relation between PTSD severity and substance-related problems.Among public safety personnel, emotion dysregulation mediated relation between PTSD severity and alcohol-related problems. Neither dissociation nor emotion dysregulation mediated relation between PTSD severity and substance-related problems.Results underscore dissociation and emotion dysregulation as potential key therapeutic targets for intervention for healthcare workers and public safety personnel struggling with PTSD and comorbid alcohol/substance use-related problems.

A systematic review of snake translocations to identify potential tactics for reducing postrelease effects.

Advancements in the field of reintroduction biology are needed, but understanding of how to effectively conduct translocations, particularly with snakes, is lacking. We conducted a systematic review of snake translocation studies to identify potential tactics for reducing postrelease effects. We included studies on intentional, human-mediated, wild-wild, or captive-wild translocations to any location, regardless of motive or number of snakes translocated. Only studies that presented results for at least 1 of 4 outcomes (movement behavior, site fidelity, survival, or population establishment) were included. We systematically searched 4 databases for published studies and used 5 methods to search the gray literature. Our search and screening criteria yielded 121 data sources, representing 130 translocation cases. We quantified the association between 15 translocation tactics and short-term translocation outcomes by calculating odds ratios and used forest plots to display results. Snake translocations involved 47 species (from mainly 2 families), and most were motivated by research, were monitored for at least 6 months, occurred in North America, and took place from the 1990s onward. The odds of a positive snake translocation outcome were highest with release of captive reared or juvenile snakes, release of social groups together, delayed release, provision of environmental enrichment or social housing before release, or minimization of distance translocated. The odds of a positive outcome were lowest when snakes were released early in their active season. Our results do not demonstrate causation, but outcomes of snake translocation were associated with 8 tactics (4 of which were strongly correlated). In addition to targeted comparative studies, we recommend practitioners consider the possible influence of these tactics when planning snake translocations.

La biología de la reintroducción requiere de avances; sin embargo, hay muy poco conocimiento sobre cómo realizar efectivamente las reubicaciones, particularmente las de las serpientes. Revisamos sistemáticamente los estudios sobre reubicación de serpientes para identificar las potenciales maniobras de reducción del estrés postliberación. Incluimos estudios sobre las reubicaciones a cualquier localidad que hayan sido intencionales, mediadas por humanos, de ambiente silvestre a ambiente silvestre o de cautiverio a ambiente silvestre sin importar el motivo o el número de serpientes reubicadas. Sólo incluimos estudios que presentaran resultados para al menos 1 de los cuatro resultados posibles: conducta de movimiento, fidelidad al sitio, supervivencia o establecimiento poblacional. Buscamos sistemáticamente en cuatro bases de datos de estudios publicados y usamos cinco métodos para buscar en la literatura gris. Nuestros criterios de búsqueda y revisión resultaron en 121 fuentes de datos, las cuales representaron 130 casos de reubicación. Cuantificamos la asociación entre 15 maniobras de reubicación y los resultados a corto plazo de las reubicaciones mediante el cálculo de la razón de probabilidades y usamos diagramas de efecto para mostrar los resultados. La reubicación de serpientes incluyó a 47 especies (principalmente de dos familias) y la mayoría estuvo motivada por la investigación, fue monitoreada durante seis meses (al menos), se ubicó en América del Norte y ocurrieron a partir de la década de 1990. La probabilidad de que la reubicación de serpientes tuviera un resultado positivo fueron mayores con la liberación de serpientes criadas o juveniles, la liberación de grupos sociales en conjunto, la liberación retardada, el suministro de enriquecimiento ambiental o alojamiento previo a la liberación o la reducción de la distancia de reubicación. Esta misma probabilidad fue menor cuando las serpientes fueron liberadas tempranamente durante su temporada activa. Nuestros resultados no demuestran causalidad, pero los resultados de la reubicación de serpientes estuvieron asociados con ocho maniobras (cuatro de las cuales contaban con una correlación sólida). Además de los estudios comparativos focalizados, recomendamos que los practicantes consideren la posible influencia de estas maniobras cuando se planifiquen la reubicación de serpientes.

Methods for Communicating the Impact of Parameter Uncertainty in a Multiple-Strategies Cost-Effectiveness Comparison.

PURPOSE: Analyzing and communicating uncertainty is essential in medical decision making. To judge whether risks are acceptable, policy makers require information on the expected outcomes but also on the uncertainty and potential losses related to the chosen strategy. We aimed to compare methods used to represent the impact of uncertainty in decision problems involving many strategies, enhance existing methods, and provide an open-source and easy-to-use tool. METHODS: We conducted a systematic literature search to identify methods used to represent the impact of uncertainty in cost-effectiveness analyses comparing multiple strategies. We applied the identified methods to probabilistic sensitivity analysis outputs of 3 published decision-analytic models comparing multiple strategies. Subsequently, we compared the following characteristics: type of information conveyed, use of a fixed or flexible willingness-to-pay threshold, output interpretability, and the graphical discriminatory ability. We further proposed adjustments and integration of methods to overcome identified limitations of existing methods. RESULTS: The literature search resulted in the selection of 9 methods. The 3 methods with the most favorable characteristics to compare many strategies were 1) the cost-effectiveness acceptability curve (CEAC) and cost-effectiveness acceptability frontier (CEAF), 2) the expected loss curve (ELC), and 3) the incremental benefit curve (IBC). The information required to assess confidence in a decision often includes the average loss and the probability of cost-effectiveness associated with each strategy. Therefore, we proposed the integration of information presented in an ELC and CEAC into a single heat map. CONCLUSIONS: This article presents an overview of methods presenting uncertainty in multiple-strategy cost-effectiveness analyses, with their strengths and shortcomings. We proposed a heat map as an alternative method that integrates all relevant information required for health policy and medical decision making. HIGHLIGHTS: To assess confidence in a chosen course of action, decision makers require information on both the probability and the consequences of making a wrong decision.This article contains an overview of methods for presenting uncertainty in multiple-strategy cost-effectiveness analyses.We propose a heat map that combines the probability of cost-effectiveness from the cost-effectiveness acceptability curve (CEAC) with the consequences of a wrong decision from the expected loss curve.Collapsing of the CEAC can be reduced by relaxing the CEAC, as proposed in this article.Code in Microsoft Excel and R is provided to easily analyze data using the methods discussed in this article.

Intervention effects on self-control decrease speed of biological aging mediated by changes in substance use: A longitudinal study of African American youth.

Biological aging is a common root for multiple diseases causing morbidity and mortality, and trajectories of aging may start early in life. This study was designed to examine whether a universal family-based substance use preventive intervention to enhance self-control and reduce substance use would also result in reductions in biological aging among Black youth from the rural South. The Adults in the Making (AIM) program is a randomized controlled trial with six 2-h sessions for Black youth. The 216 youths agreeing to provide blood at age 22 included 114 who had received the AIM intervention and 102 who assigned to the control group. We examined accelerated DNA methylation (DNAm)-based aging using a recently developed measure, "GrimAge," that has been shown to predict the risk of early mortality and that is known to be more strongly affected by substance use than other DNAm-based aging indices. Relative to those randomly assigned to the control group, those receiving the intervention demonstrated significantly enhanced self-control, slower increases in substance use, and reduced Grim aging at age 22. Using a bootstrapping method with 1000 replications, we found a significant indirect effect of AIM on reduced Grim aging through its effect on self-control and substance use. Sensitivity analyses examined effects using other indices of DNAm-based aging. These findings suggest that a family-based program designed to enhance rural Black youth's self-control can have beneficial effects on self-control, enhancing young adult health and health behavior, and ultimately decreased mortality risk.

El envejecimiento biológico es una causa común de varias enfermedades que causan morbilidad y mortalidad, y las trayectorias del envejecimiento pueden comenzar en las primeras etapas de la vida. Este estudio se diseñó para analizar si una intervención preventiva familiar y universal en el abuso de sustancias orientada a mejorar el autocontrol y a reducir el consumo de sustancias también tendría como resultado disminuciones del envejecimiento biológico entre jóvenes negros del sur rural. El programa Adults in the Making (AIM) es un ensayo controlado aleatorizado con seis sesiones de dos horas para jóvenes negros. Entre los 216 jóvenes que aceptaron dar sangre a los 22 años se encontraban 114 que habían recibido la intervención del AIM y 102 asignados al grupo de referencia. Analizamos el envejecimiento basado en la metilación acelerada del ADN (ADNm) usando un método de medición desarrollado recientemente que se llama "GrimAge", el cual, según se ha demostrado, predice el riesgo de mortalidad temprana y está más marcadamente afectado por el consumo de sustancias que otros índices de envejecimiento basados en el ADNm. En relación con las personas asignadas aleatoriamente al grupo de referencia, las que recibieron la intervención demostraron un autocontrol considerablemente mayor, aumentos más lentos de consumo de sustancias y un menor envejecimiento Grim a los 22 años. Utilizando un método de muestreo con reemplazamiento con 1000 reproducciones, hallamos un efecto indirecto significativo del AIM en un menor envejecimiento Grim mediante su efecto en el autocontrol y el consumo de sustancias. Los análisis de sensibilidad examinaron los efectos utilizando otros índices de envejecimiento basados en el ADNm. Estos resultados indican que un programa familiar diseñado para aumentar el autocontrol de los jóvenes negros de zonas rurales puede tener efectos beneficiosos en el autocontrol, mejorar la salud de los adultos jóvenes y su conducta con respecto a la salud y, finalmente, disminuir el riesgo de mortalidad.

The perils of flawed science in wildlife trade literature.

Despite broad scientific consensus that sustainable use of wildlife can enhance conservation efforts, ethical concerns have led some community groups to oppose use of wild animals. Voicing those concerns is legitimate, but underlying philosophical bias should not influence science-based analysis and interpretation. We argue that philosophical biases are common in the scientific literature on trade in wildlife. The critically important case of bias surrounding the use of reptile leathers for luxury fashion illustrates the problem. Based on analysis of official seizures of fashion products made from wildlife, a recent study inferred that criminal activity (as inferred by noncompliance with regulations) was common and increasing and, hence, that authorities needed to adopt more stringent restrictions on the trade. In fact, the conclusions of that study are artifacts of pseudoreplication (e.g., multiple counts of single violations) and biased sampling (e.g., focus on companies with high rates of error) and run directly opposite to actual patterns in the data. As a proportion of overall trade, rates of noncompliance are exceptionally low (<0.4%), are declining, and result primarily from paper-work errors rather than criminal intent (e.g., such errors are more frequent for goods shipped by government authorities than by the commercial fashion industry). The recommendation by the study authors to prohibit the international trade in wildlife-based fashion products is imperiling a sustainable trade that can benefit biodiversity and people's livelihoods by providing financial incentives for conservation of species and habitats. This example offers a warning of the dangers of basing research on the wildlife trade on ethical or philosophical positions rather than objective evaluations of evidence.

Los Peligros de la Ciencia Errada en la Literatura sobre el Comercio de Fauna Resumen A pesar del amplio consenso científico de que el uso sustentable de la fauna puede mejorar los esfuerzos de conservación, las preocupaciones éticas han llevado a algunos grupos comunitarios a oponerse al uso de fauna silvestre. Es legítimo otorgarles una voz a estas preocupaciones, pero el sesgo filosófico subyacente no debería influenciar el análisis basado en la ciencia y su interpretación. Discutimos que los sesgos filosóficos son comunes en la literatura científica sobre la fauna. El caso críticamente importante del sesgo alrededor del uso de pieles de reptiles para artículos lujosos de moda ilustra este problema. Con base en el análisis de incautaciones oficiales de productos de moda hechos de fauna, Sosnowski y Petrossian (2020) infirieron que la actividad criminal (deducida como el no cumplimiento de las regulaciones) era común y se encontraba en crecimiento y por lo tanto, que las autoridades necesitaban adoptar restricciones más estrictas para el mercado. De hecho, las conclusiones de Sosnowski y Petrossian (2020) son artefactos de pseudoreplicación (es decir, conteos múltiples de violaciones únicas) y un muestreo sesgado (es decir, enfocado en compañías con tasas altas de error) y van directamente en contra de los patrones actuales en los datos. Como una proporción del mercado en general, las tasas de no cumplimiento son excepcionalmente bajas (<0.4%), están declinando y son el resultado principal de los errores cometidos en el papeleo y no de la intención criminal (es decir, dichos errores son más frecuentes para los bienes enviados por las autoridades del gobierno que para los envíos realizados por la industria de la moda comercial). La recomendación hecha por Sosnowski y Petrossian (2020) de prohibir el mercado internacional de productos de moda hechos con productos animales está poniendo en peligro al mercado sustentable que puede beneficiar a la biodiversidad y al sustento de las personas al proporcionar incentivos financieros para la conservación de especies y hábitats. Este ejemplo ofrece una advertencia sobre los peligros de basar la investigación del mercado de fauna en posiciones éticas o filosóficas en lugar de evaluaciones objetivas de la evidencia.

Effects of bioenergy on biodiversity arising from land-use change and crop type.

Understanding how the world's flora and fauna will respond to bioenergy expansion is critical. This issue is particularly pronounced considering bioenergy's potential role as a driver of land-use change, the variety of production crops being considered and currently used for biomass, and the diversity of ecosystems that can potentially supply land for bioenergy across the planet. We conducted 2 global meta-analyses to determine how 8 of the most commonly used bioenergy crops may affect site-level biodiversity. One search was directed at finding data on biodiversity in different production land uses and the other at extracting energy-yield estimates of potential bioenergy crops. We used linear mixed-effect models to test whether effects on biodiversity varied with different individual bioenergy crop species, estimated energy yield, first- or second-generation crops, type of reference ecosystem considered, and magnitude of vertical change in habitat structure between any given crop and the reference ecosystem. Species diversity and abundance were generally lower in crops considered for bioenergy relative to the natural ecosystems they may replace. First-generation crops, derived from oils, sugars, and starches, tended to have greater effects than second-generation crops, derived from lignocellulose, woody crops, or residues. Crop yield had nonlinear effects on abundance and, to a lesser extent, overall biodiversity; biodiversity effects were driven by negative yield effects for birds but not other taxa. Our results emphasize that replacing natural ecosystems with bioenergy crops across the planet will largely be detrimental for biodiversity, with first generation and high-yield crops having the strongest negative effects. We argue that meeting energy goals with bioenergy using existing marginal lands or biomass extraction within existing production landscapes may provide more biodiversity-friendly alternatives than conversion of natural ecosystems for biofuel production.

RESUMEN: Es de suma importancia entender cómo responderán la flora y la fauna mundial ante la expansión de la bioenergía. Este tema es acentuado particularmente si consideramos el papel potencial que tiene la bioenergía como causante del cambio en el uso de suelo, la variedad de producción de cultivos que se está considerando y que se usa actualmente para la biomasa y la diversidad de ecosistemas que potencialmente pueden proporcionar tierras para la bioenergía en todo el planeta. Realizamos dos meta-análisis mundiales para determinar cómo ocho de los cultivos que se usan con mayor frecuencia para la bioenergía podrían afectar a la biodiversidad a nivel de sitio. Una búsqueda estuvo dirigida al hallazgo de datos sobre la biodiversidad en diferentes usos de suelo para producción y la otra hacia la extracción de estimaciones de producción de energía de los cultivos potenciales para la bioenergía. Usamos modelos de efectos lineales mixtos para probar si los efectos sobre la biodiversidad variaron con diferentes especies individuales de cultivos para bioenergía, la producción de energía estimada, los cultivos de primera o segunda generación, el tipo de ecosistema de referencia considerado y la magnitud del cambio vertical en la estructura del hábitat entre cualquier cultivo dado y el ecosistema de referencia. La diversidad y la abundancia de especies fueron generalmente más bajas para los cultivos considerados para la bioenergía en relación con el ecosistema natural que podrían reemplazar. Los cultivos de primera generación, derivados de aceites, azúcares y almidones, tendieron a tener efectos más grandes que los cultivos de segunda generación, derivados de la lignocelulosa, cultivos leñosos o residuos. La producción de cultivos tuvo efectos no lineales sobre la abundancia y, a una menor extensión, sobre la biodiversidad en general; los efectos de la biodiversidad fueron causados por los efectos negativos de producción para las aves pero no para otros taxones. Nuestros resultados enfatizan que el reemplazo de ecosistemas naturales por cultivos para la bioenergía en todo el planeta será considerablemente perjudicial para la biodiversidad, con los efectos negativos más fuertes ocasionados por los cultivos de primera generación o de alta producción. Argumentamos que lograr los objetivos de energía por medio de bioenergía usando las tierras marginales existentes o la extracción de biomasa dentro de paisajes existentes de producción puede proporcionar alternativas más amigables para la biodiversidad que la conversión de los ecosistemas naturales para la producción de biocombustibles.

Vocational Rehabilitation for Patients with Chronic Musculoskeletal Pain With or Without a Work Module: An Economic Evaluation.

Purpose Vocational rehabilitation (VR) is a widely used intervention aimed to optimize work participation for patients on sick leave due to chronic musculoskeletal pain (CMP). Economic evaluations of care as usual VR are scarce, and may provide relevant information to guide clinical, reimbursement and policy decisions. The aim of this study was to evaluate the short-term cost-effectiveness and return on investment (ROI) of VR for patients on sick leave due to CMP with an additional work module (VR+) compared to VR without work module, from a societal and employers' perspective. Methods A retrospective longitudinal cohort study within a Dutch care as usual context was applied. Participants with CMP and decreased work participation originating from seven Dutch rehabilitation centers were included in this study. Participants underwent VR or VR+. Main data sources at baseline and discharge: Quality-adjusted life year (QALY) based on EQ-5D, intervention costs, self-reported productivity and health care utilization. Main analyses cost-effectiveness, including incremental cost-effectiveness ratio (ICER) and a cost-effectiveness acceptability curve (CEAC); and ROI analyses with use of the human capital method. Results N = 324 participants were analyzed. The results show that VR+ was cost-effective compared to VR: mean cost savings of €820 per 0.012 QALY gained. CEAC suggests probability of VR+ being cost-effective is > 0.91 for thresholds of €20.000 and higher. The mean ROI of VR+ for employers was 38%. Conclusion It was concluded that at discharge, VR+ was cost-effective compared to VR. ROI was positive for employers.

Insight into the effect of SO2 on the Hg0 removal performance over a 1V-8Ce/AC sorbent at low temperatures.

The influences of SO2 on Hg° removal over the 1V-8Ce/AC sorbent were systematically investigated at low temperatures. The experimental results showed that SO2 has a dual effect on Hg° removal, that is, SO2 has both a promoting effect and an inhibiting effect on Hg° removal. The SO2 transient response experiment indicated that SO2 could not only react with Hg° to promote the removal of Hg° but also react with the active components and poison the sorbent. O2 is indispensable for the removal of Hg°, which can offset the adverse effects caused by SO2 and H2O. HCl exhibited an obvious promoting effect on Hg° removal in the presence of SO2. The 1V-8Ce/AC sorbent exhibited good sulfur resistance and excellent stability (EHg = 90.04 %) after a 24 h reaction performed under the 1000 ppm SO2 condition at 150 °C. In addition, the Hg-TPD and XPS methods were used to assist in studying the effect of SO2 on Hg° removal over the 1V-8Ce/AC sorbent. Finally, the mechanism of Hg° removal in an SO2 atmosphere was also explored, which showed that Hg° was removed by two possible pathways over the 1V-8Ce/AC sorbent.

[IEAC versus CEAC high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation for lymphoma: analysis of efficacy and safety in 106 cases].

ObjectiveTo evaluate the efficacy and safety of IEAC (idarubici, etoposide, cytosine arabinoside, and cyclophosphamide) and CEAC (lomustine, etoposide, cytosine arabinoside, and cyclophosphamide) high-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (ASCT) in the treatment of lymphoma.MethodWe retrospectively analyzed the data of 106 lymphoma patients undergoing ASCT from 2013 to 2018 using IEAC (n=43) or CEAC (n=63) regimens. The time of hematopoietic reconstruction, adverse events and the patients' survival outcomes in the two groups were compared to evaluate the efficacy and safety of the two regimens. Univariate and multivariate analyses were performed to identify the factors potentially affecting the patients' survival.ResultsIn the total of 106 patients, successful hematopoietic reconstruction was achieved in 104 patients and treatment-related deaths occurred in 2 patients. No significant differences were observed in the time to hematopoietic recovery, adverse events or survival outcomes between the patients receiving IEAC and CEAC regimens. In the 104 patients with successful hematopoietic reconstruction who were followed for a median of 27.4 months (range 4.3 to 74.3 months), the 5-year progress-free survival (PFS) and overall survival (OS) rates were 72.9% and 81.9%, respectively. The main adverse events (beyond grade 2 based on CTCAE v5.0) included infection, oral mucositis, nausea and vomiting, liver damage, cardiotoxicity, hypokalemia, and diarrhea. No significant difference was found in the survival outcomes or adverse events between the 2 regimens. T cell lymphoma and failure to achieve complete remission (CR) before ASCT were the risk factors of PFS (P=0.015 and P=0.007, respectively) and OS (P=0.038 and 0.031, respectively). The patients who achieved CR 3 months after the transplantation had higher rates of PFS (P=0.007) and OS (P=0.003).ConclusionIEAC and CEAC regimens prior to by ASCT are both safe and effective in the treatment of lymphoma and can be used as alternative conditioning regimens for lymphoma patients undergoing ASCT.

Protocol for a longitudinal study of melatonin therapy and cost effectiveness analysis in stimulant-treated children with ADHD and insomnia: An N-of-1 trial.

BACKGROUND: Children with ADHD and sleep problems have more caregiver deficits and decreased school attendance than children with ADHD but without a sleep problem. We conducted an N-of-1 trial of melatonin for children with ADHD on stimulants. As a follow-up study, we aim to conduct a cost effectiveness analysis (CEA) of melatonin therapy by comparing costs of this condition (of using melatonin) to costs of the baseline condition (usual care with no N-of-1 trial). METHODS: The CEA will compare participants who remained on melatonin vs those who chose to cease melatonin. Costs will be determined by medication cost to the caregiver(s), school/work absences, other sleep remedy costs, and health service utilization costs, including incidentals like parking. These costs will be determined at baseline, end of 6-week trial, and 6 months post-trial. We will also calculate Quality-Adjusted Life-Years (QALY) based on responses to PedsQL or SF-12v2 for patients and caregiver(s) and assess differences between remaining on melatonin or not; and assess the intermediate-term effectiveness and adverse effects of melatonin at 6 months. DISCUSSION: We hypothesize that shorter sleep-onset-latency will be associated with improved QALYs for patients and caregivers. We also expect that targeting melatonin to positive responders will be cost effective both for individuals and society. Cost per QALY for positive responders to melatonin is useful for doctors when creating treatment plans since melatonin is not an over-the-counter pharmaceutical in Australia. TRIAL REGISTRATION NUMBER: ACTRN12614000542695.

An Exploration of Mothers' Successful Completion of Family-Centered Residential Substance Use Treatment.

Behavioral health and substance use centers have started focusing efforts on creating, adopting, and implementing evidence-based practices and programs that effectively address the needs of women and, particularly, mothers entering treatment with children. However, women with substance use disorders (SUDs) remain an underserved and understudied population; even less studied are the complexities and unique SUD treatment needs of women who have children. Family therapists' systemic training is a valued approach in conceptualizing and implementing treatment for mothers with SUDs and their families. This study explored the construct of mothering children during family-centered substance use treatment using a transcendental phenomenological approach. Analysis revealed themes related to motherhood, parenting, and support for mothers and children. Two themes emerged from the data: (a) grappling with motherhood and addiction leading to the decision for treatment and (b) specific aspects of the treatment program conducive to motherhood. Results indicated the positive impact of mothers' experiences in family-centered substance use treatment, aligning with previous literature that suggests mothers are more engaged in treatment when their children remain in their care. The insights gleaned from the participants in this study provide suggestions for further improving programming that supports mothers and their children during the recovery process. Treatment considerations are offered for family therapists working with mothers with SUDs and their families.

Los centros para la salud conductual y el consumo de sustancias han comenzado a centrar sus esfuerzos en la creación, la adopción y la implementación de prácticas y programas factuales que aborden eficazmente las necesidades de las mujeres y, particularmente, de las madres que ingresan en un tratamiento con hijos. Sin embargo, las mujeres con trastorno por consumo de sustancias siguen siendo una población marginada y poco estudiada; y aun menos estudiadas son las complejidades y las necesidades exclusivas de tratamiento para los trastornos por consumo de sustancias de las mujeres que tienen hijos. La capacitación sistémica de los terapeutas familiares es un enfoque valioso a la hora de conceptualizar e implementar el tratamiento para las madres con trastornos por consumo de sustancias y sus familias. Este estudio analizó el constructo de la maternidad durante el tratamiento para el consumo de sustancias centrado en la familia utilizando un enfoque fenomenológico trascendental. El análisis reveló temas relacionados con la maternidad, la paternidad y el apoyo para las madres y los hijos. De los datos surgieron dos temas: (a) la lucha con la maternidad y la adicción conducente a la decisión de recibir tratamiento y (b) aspectos específicos del programa de tratamiento favorables para la maternidad. Los resultados indicaron el efecto positivo de las experiencias de las madres en el tratamiento para el consumo de sustancias centrado en la familia en consonancia con bibliografía anterior que sugiere que las madres se comprometen más con el tratamiento cuando sus hijos quedan a su cuidado. Las apreciaciones recogidas de los participantes de este estudio ofrecen sugerencias para mejorar más las programaciones que apoyen a las madres y a sus hijos durante el proceso de recuperación. Se ofrecen consideraciones sobre el tratamiento para los terapeutas familiares que trabajan con madres con trastornos por abuso de sustancias y sus familias.

A cost-utility analysis of phosphodiesterase type 5 inhibitors in the treatment of erectile dysfunction.

INTRODUCTION: Patent expiration for erectile dysfunction (ED) treatments like sildenafil means loss of exclusivity (LOE), and other manufacturers may bring generics to the market. This has resulted in price reductions, which influences the cost-effectiveness. In Norway, this development has led to a discussion on whether reimbursement should be granted. Cost-effectiveness analysis in this treatment area is scarce and more research is demanded. OBJECTIVE: The objective of this study was to assess the cost-effectiveness of three separate phosphodiesterase type 5 (PDE5) inhibitors in ED therapy in a Norwegian setting. METHODS: The cost-effectiveness was analyzed using two patient populations: (1) 55-year-old patients diagnosed with ED and with no specific underlying illness, and (2) 55-year-old patients diagnosed with ED and with diabetes as an underlying illness. Using a state-transition Markov model with a 10-year time horizon, a "no-treatment" option was compared with three treatment strategies: (1) treatment using 50/100 mg sildenafil; (2) treatment using 10/20 mg tadalafil; (3) treatment using 10 mg vardenafil. A societal perspective was applied. RESULTS: All PDE5 inhibitor treatment strategies were cost-effective compared to a "no-treatment" option, with cost per additional quality-adjusted life-year of less than €15,000. With a willingness-to-pay threshold greater than €13,500, sildenafil was estimated as the dominant treatment strategy. The probabilistic sensitivity analysis indicated robust results. However, as the expected value of information was considerable, the cost-effectiveness of conducting further research to reduce uncertainty should be considered. Treating a diabetic population was less cost-effective for all PDE5 inhibitors and was associated with greater uncertainty with regard to choosing the optimal strategy. CONCLUSIONS: Sildenafil treatment of erectile dysfunction was a cost-effective alternative compared to tadalafil and vardenafil, as well as compared to a "no-treatment" option. Treating a diabetic population is less cost-effective for all PDE5 inhibitors and was associated with greater uncertainty.

Cost-effectiveness of Sorafenib for Treatment of Advanced Hepatocellular Carcinoma in India.

BACKGROUND: Majority of patients of hepatocellular carcinoma (HCC) in India present in advanced stages, when curative treatment options are limited. We undertook this study to assess the cost-effectiveness of treating advanced HCC patients with sorafenib compared with best supportive care (BSC). METHODS: A Markov model was parameterized to model the lifetime costs and consequences of treating advanced HCC patients with sorafenib versus BSC using a societal perspective. Cost of routine care, diagnostics, management of complications in both the arms and management of adverse effects of sorafenib treatment were considered. A probabilistic sensitivity analysis was undertaken to assess the effect of parameter uncertainty. RESULTS: The incremental cost and benefit gained by treating HCC using sorafenib was Indian rupees 94,182 ($1459) and 0.19 quality adjusted life years (QALYs) per patient, implying an incremental cost of Indian rupees 507,520 ($7861) per QALY gained. CONCLUSIONS: Sorafenib is not cost-effective for use in advanced hepatocellular carcinoma treatment in India.

Cost-effectiveness of preoperative motor mapping with navigated transcranial magnetic brain stimulation in patients with high-grade glioma.

OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) is used to identify the motor cortex prior to surgery. Yet, there has, until now, been no published evidence on the economic impact of nTMS. This study aims to analyze the cost-effectiveness of nTMS, evaluating the incremental costs of nTMS motor mapping per additional quality-adjusted life year (QALY). By doing so, this study also provides a model allowing for future analysis of general cost-effectiveness of new neuro-oncological treatment options. METHODS The authors used a microsimulation model based on their cohort population sampled for 1000 patients over the time horizon of 2 years. A health care provider perspective was used to assemble direct costs of total treatment. Transition probabilities and health utilities were based on published literature. Effects were stated in QALYs and established for health state subgroups. RESULTS In all scenarios, preoperative mapping was considered cost-effective with a willingness-to-pay threshold < 3*per capita GDP (gross domestic product). The incremental cost-effectiveness ratio (ICER) of nTMS versus no nTMS was 45,086 Euros/QALY. Sensitivity analyses showed robust results with a high impact of total treatment costs and utility of progression-free survival. Comparing the incremental costs caused by nTMS implementation only, the ICER decreased to 1967 Euros/QALY. CONCLUSIONS Motor mapping prior to surgery provides a cost-effective tool to improve the clinical outcome and overall survival of high-grade glioma patients in a resource-limited setting. Moreover, the model used in this study can be used in the future to analyze new treatment options in neuro-oncology in terms of their general cost-effectiveness.

Cost-effectiveness analysis of a vaccination program for the prevention of herpes zoster and post-herpetic neuralgia in adults aged 50 and over in Germany.

Herpes zoster (HZ; shingles) is a common viral disease that affects the nerves and surrounding skin causing a painful dermatomal rash and leading to debilitating complications such as, mainly, post-herpetic neuralgia (PHN). Currently, there is no effective treatment for HZ and PHN. The objective of this study was to assess the cost-effectiveness of a HZ vaccination program in Germany. An existing Markov Model was adapted to the German healthcare setting to compare a vaccination policy to no vaccination on a lifetime time-horizon, considering 2 scenarios: vaccinating people starting at the age of 50 or at the age of 60 years, from the perspective of the statutory health insurance (SHI) and the societal perspective. According to the perspective, vaccinating 20% of the 60+ German population resulted in 162,713 to 186,732 HZ and 31,657 to 35,793 PHN cases avoided. Corresponding incremental cost-effectiveness ratios (ICER) were 39,306 €/QALY from the SHI perspective and 37,417 €/QALY from a societal perspective. Results for the 50+ German population ranged from 336,468 to 394,575 HZ and from 48,637 to 56,087 PHN cases avoided from the societal perspective. Corresponding ICER were 39,782 €/QALY from a SHI perspective and 32,848 €/QALY from a societal perspective. Sensitivity analyses showed that results are mainly impacted by discount rates, utility values and use of alternative epidemiological data.The model indicated that a HZ vaccination policy in Germany leads to significant public health benefits and could be a cost-effective intervention. The results were robust and consistent with local and international existing literature.