The impact of diagnosing provider type on longitudinal care for patients with newly diagnosed Huntington's Disease.

AIMS: This study evaluated the association between provider types for patients with newly diagnosed Huntington's disease (HD) and healthcare resource utilization (HCRU), costs, and treatment patterns. MATERIALS AND METHODS: This retrospective analysis used MarketScan® databases (1/1/2017-12/31/21) to identify provider type who diagnosed and managed US adult patients with HD. Patients with continuous enrollment 6 months pre- and 12 months post-diagnosis were included. Outcomes evaluated over 12 months post-diagnosis included hospitalizations, outpatient visits, antipsychotic or vesicular monoamine transporter 2 (VMAT2) inhibitor use, and total healthcare costs. RESULTS: 340 eligible patients had a mean age at diagnosis of 49 years. 56.5% were female; 71.5% had a Charlson Comorbidity Index of 0. Patients were diagnosed by neurologists (48.5%), primary care providers (PCP) (35.6%), psychiatrists (3.5%), or other providers (12.4%). Patients diagnosed by PCPs or neurologists received significantly more follow-ups by the same diagnosing provider type (P < 0.05).All-cause and HD-related outpatient visits at 12-month follow-up had more patients diagnosed by PCPs (23.9, 5.1) than neurologists (18.0, 2.4), psychiatrists (16.7, 1.67), or others (15.3, 2.4). HD-related mean costs totaled $2,489 ($1,179 inpatient and $1,310 outpatient). Patients diagnosed by neurologists had significantly lower HD-related total non-medication costs vs those diagnosed by PCPs (-$2,256; P < 0.05).Among patients diagnosed by neurologists vs PCPs, similar proportions received antipsychotics within the first year (55% vs 52%, respectively); more patients managed by neurologists received VMAT2 inhibitors (12% vs 7%, respectively). LIMITATIONS: Our study includes limitations inherent to retrospective claims studies. CONCLUSIONS: Patients with HD are most often diagnosed by neurologists or PCPs; the same diagnosing provider type typically manages follow-up. Patients diagnosed by neurologists had significantly fewer HD-related outpatient visits, lower HD-related non-drug costs, and more frequently received VMAT2 inhibitors vs those diagnosed by PCPs. Our findings show an integrated care team may provide evidence-based, personalized care for patients with HD.

Huntington's disease is a rare disease that is caused by changes in genes. Symptoms of Huntington's disease are irritability, depression, loss of memory, and issues with movement. The symptoms are different for each person and can happen at different times during the disease. A team of doctors that can help with all the symptoms is important for treating Huntington's disease. In our study we looked at which type of doctor was diagnosing Huntington's disease and if the patient continued to see the same type of doctor. We also looked at whether the costs of the disease were related to the type of doctor that diagnosed the disease. We found that most patients were diagnosed by a primary care doctor or a neurologist (brain doctor), and they continued to see the same doctor. Patients who saw a neurologist had less doctor visits for their HD and also less costs for their HD. These results show having a team of doctors that can help with all symptoms of HD may make it easier for patients to receive the best care for their symptoms.

Evaluating cost-effectiveness of PFO management strategies: closure with cardioform vs. amplatzer, and treatment with medical therapy alone, for secondary stroke prevention.

AIM: The aim of this study was to evaluate the cost-effectiveness of patent foramen ovale (PFO) closure using CARDIOFORM Septal Occluders versus AMPLATZER Septal Occluders, as well as compared to Medical Therapy Alone, from a payor perspective in the United States. METHODS: An economic evaluation compared the value of CARDIOFORM, AMPLATZER, and Medical Therapy Alone. A Markov model simulated a cohort of 1,000 individuals with PFO and a history of cryptogenic stroke, with baseline demographic and clinical characteristics reflecting individuals enrolled in the REDUCE and RESPECT trials over a five-year time horizon. The costs and health consequences associated with complications and adverse events, including recurrent stroke, were compared over a time horizon of 5 years. RESULTS: PFO closure using CARDIOFORM was economically dominant, providing both cost-savings and improved effectiveness compared to closure with AMPLATZER. It resulted in an estimated savings of over $1.3 million, an additional 24.8 quality-adjusted life-years (QALYs) gained, and 26 strokes avoided in a cohort of 1,000 patients. When compared to Medical Therapy Alone, closure with CARDIOFORM was found to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of $36,697 per QALY gained. Sensitivity and scenario analysis showed the model findings to be highly robust across reasonable changes to baseline input values and assumptions. CONCLUSIONS: The results of this analysis suggest that PFO closure using the CARDIOFORM Septal Occluder is the most cost-effective treatment strategy for patients with a PFO-associated stroke, particularly compared to AMPLATZER where it resulted in both cost-saving and improved patient outcomes.

Why was this study done? Patent foramen ovale (PFO) is a small opening in the heart that can allow blood clots to pass from one side to the other, increasing the risk of strokes, particularly those without a clear cause, known as cryptogenic strokes. Closing the PFO can help prevent these strokes. This study aimed to determine which treatment option is the best value for money and most effective for preventing secondary strokes in patients with PFO: using the CARDIOFORM Septal Occluder, the AMPLATZER Septal Occluder, or using only medications.What did the researchers do? We used a computer model to simulate the health outcomes and costs for 1,000 patients with PFO who had experienced a cryptogenic stroke. The model followed these patients over five years and compared three treatment strategies: closing the PFO with the CARDIOFORM device, closing it with the AMPLATZER device, and using medications alone (Medical Therapy Alone).What did the researchers find? Our findings showed that:The CARDIOFORM device was more cost-effective and provided better health outcomes than the AMPLATZER device.Using the CARDIOFORM device saved over $1.3 million, added nearly 25 more years of good-quality life (measured as quality-adjusted life years or QALYs), and prevented 26 strokes in a group of 1,000 patients.Compared to using medications alone, the CARDIOFORM device was cost-effective, with a cost of about $36,700 for each year of good-quality life gained. What do the results mean? These results suggest that using the CARDIOFORM device to close a PFO is the best strategy for preventing secondary strokes when compared to AMPLATZER and Medical Therapy Alone. This approach not only saves money but also improves patient outcomes compared to the AMPLATZER device and using medications alone.How could this study help patients? This study provides clear and well-grounded information that helps patients, healthcare providers, and policymakers make informed decisions about the best treatment strategies for preventing secondary strokes in patients with PFO. Using the CARDIOFORM device can lead to better health outcomes and cost savings, ultimately improving the quality of life for patients.

You are What Your Parents Expect: Height and Local Reference Points.

Recent estimates are that about 150 million children under five years of age are stunted, with substantial negative consequences for their schooling, cognitive skills, health, and economic productivity. Therefore, understanding what determines such growth retardation is significant for designing public policies that aim to address this issue. We build a model for nutritional choices and health with reference-dependent preferences. Parents care about the health of their children relative to some reference population. In our empirical model, we use height as the health outcome that parents target. Reference height is an equilibrium object determined by earlier cohorts' parents' nutritional choices in the same village. We explore the exogenous variation in reference height produced by a protein-supplementation experiment in Guatemala to estimate our model's parameters. We use our model to decompose the impact of the protein intervention on height into price and reference-point effects. We find that the changes in reference points account for 65% of the height difference between two-year-old children in experimental and control villages in the sixth annual cohort born after the initiation of the intervention.

Differential response of heavy metal accumulation in freshwater aquatic organisms to organic matter pathway (δ13C) and trophic level (δ15N).

The migration of heavy metals into aquatic ecosystems is a concern for the safety of aquatic organisms and human health. However, the migration of heavy metals from habitats to the food chain in freshwater ecosystems requires extensive exploration. We extensively investigated the levels of heavy metals in multiple media of freshwater ecosystems and explored their migration from freshwater habitats to the food chain. The results showed that the concentrations of Cr, Cu, Cd, Zn, Sb, and Pb in sediments, Cr in mollusks, and Cd in clams exceeded their standard limit values. Feeding habits, species, and body length considerably affected heavy metal levels in fish, whereas regional differences, body length, and weight considerably affected heavy metal levels in mollusks. The bioconcentration capacity (improved biotawater (sediment) accumulation factors) of the muscles was higher than that of the gills and visceral mass. Mollusks were strongly enriched in Cu, Cd, Zn, and Mn in their habitats, whereas fish were more favourable for the accumulation of Cu, Zn, and Cr. Heavy metals in sediments pose a higher risk to aquatic organisms than those in the overlying water. Trophic level (TL) (δ15N) considerably diluted levels of most metals, whereas Cu and Zn levels increased along the organic matter pathway (δ13C) in the entire aquatic food chain. The levels of typical pollutants, such as Cu, Zn, As, Cd, Pb, and Cr changed considerably along the organic matter pathway in mollusks. The levels of heavy metals in fish were not affected by TL or organic matter pathway, except for Cu. The potential risk of consuming aquatic organisms from Poyang Lake was ranked as clams > snails > fish for adults and children and As in aquatic organisms was the primary contributor to health risk.

Comparison of healthcare resource use and cost between influenza and COVID-19 vaccine coadministration and influenza vaccination only.

OBJECTIVE: To compare healthcare resource utilization (HCRU) and all-cause medical costs among individuals aged ≥50 years who received influenza and COVID-19 vaccines on the same day and those who received influenza vaccine only. METHODS: We conducted a retrospective cohort study leveraging Optum's de-identified Clinformatics DataMart from 8/31/2021 to 7/31/2023. Individuals aged ≥50 years continuously enrolled in health plans for 1 year prior and until 7/31/2023 were included. Two cohorts were formed based on vaccination status between 8/31/2022 and 1/31/2023: co-administered influenza and COVID-19 vaccines (co-admin cohort) and influenza vaccine only (influenza cohort). Associations between vaccination status and all-cause, influenza-related, COVID-related, pneumonia-related, and cardiorespiratory-related hospitalization, outpatient or emergency room visits and all-cause medical costs were estimated by weighted generalized linear models, adjusting for confounding by stabilized inverse probability of treatment weighting. RESULTS: 613,156 (mean age: 71) and 1,340,011 (mean age: 72) individuals were included in the co-admin and influenza cohorts, respectively. After weighting, the baseline characteristics were balanced between cohorts. The co-admin cohort was at statistically significant lower risk of all-cause (RR: 0.95, 95% CI: 0.93-0.96), COVID-19-related (RR: 0.59, 95% CI: 0.56-0.63), cardiorespiratory-related (RR: 0.94, 95% CI: 0.93-0.96) and pneumonia-related (RR: 0.86, 95% CI: 0.83-0.90) hospitalization but not influenza-related hospitalizations (RR: 0.91, 95% CI: 0.81, 1.04) compared with the influenza cohort. Co-administration was associated with 3% lower all-cause medical cost (cost ratio: 0.974, 95% CI: 0.968, 0.979) during the follow-up period compared to receiving influenza vaccine only. LIMITATIONS: Limitations include the potential residual confounding bias in observational data, measurement errors from claims data, and that the cohort was followed for a single season. CONCLUSION: Receiving co-administered COVID-19 and influenza vaccines versus only receiving influenza vaccination reduced the risk of HCRU, especially COVID-19-related hospitalization and all-cause medical costs. Increasing vaccine coverage, particularly for COVID-19, might have public health and economic benefits.

Improving the measurement of nitrogen stable isotopes in organic materials containing high C:N ratios using a 5A molecular sieve column.

The nitrogen stable isotope composition (δ15N) of plant materials has numerous applications. Plant materials like bark can have a very high C:N ratio. Incomplete C combustion in such samples interferes with the δ15N measurement due to CO production. We modified the standard setup for δ15N measurement using an elemental analyzer (EA) coupled to an isotope ratio mass spectrometer (IRMS) by incorporating a 5A molecular sieve column, which better separates N2 from CO. We compared this new modified setup and the standard one for the measurement of bark samples. Precision and accuracy for δ15N in standards with low C:N ratio were equivalent for the two methods. However, for bark the results obtained with the new method had better precision and accuracy than the standard method. Replicates are nevertheless recommended with the new method to ensure confidence in the results.•During elemental analysis, incomplete combustion of material with high C:N ratio can lead to CO formation, which interferes with δ15N IRMS measurements.•Here we use a 5A molsieve column to remove the CO interference in δ15N measurements Precision and accuracy on δ15N measurements of samples with high C content are significantly improved.

Levels of trace elements in the blood of chick gulls from the English Channel: Spatial and trophic implications.

Anthropogenic activity has disturbed the natural distribution and circulation of trace elements in the environment. This has led to increased background levels of numerous elements, causing global pollution. In this context, seabirds are relevant bioindicators of environmental contamination. This study focuses on the ecological factors that influence the concentrations of 14 trace elements in the blood of the chicks of three sympatric gull species from the French coast of the English Channel. Between 2015 and 2017, 174 birds were sampled in the industrialised Seine Estuary (in the city of Le Havre and on Ratier Island) and in the remote Chausey Islands, 200 km to the west. We also considered the Se:Hg molar ratio using Hg concentrations in those birds. Ag and V concentrations were below the quantification limit in all cases, while the fraction of non-quantified samples was higher than 30 % for Cd, Cr and Ni. Among the elements quantified in the samples, the lowest concentrations were noted for Co and the highest for Fe, building the following order: Co < Cd < Ni < Mn ≤ Pb < Cr < Hg < Cu < Se < As < Zn < Fe. No unanimous scheme of concentrations among elements, species and sites existed. Similarly, different models were fitted and different factors were significant for different species and elements. We observed the biomagnification of As and the biodilution of Pb. Pb concentrations were also highest in the industrial site in the city of Le Havre. Despite the high proportion of non-quantified samples for Cd, Cr and Ni, we continued to notice higher concentrations in the marine environment of the Chausey Islands. Concentrations of some elements clearly revealed habitat dependence. In some cases the Se:Hg molar ratio was lower than 4, a threshold for diminishing Hg toxicity by Se.

Divergent ornamentation within a single population of the barn swallow.

Differential migration strategies favour different sets of characteristics, including sexually selected ornamentation. Such phenotypic variation is particularly evident in a population with partial migration, where migrants and non-migrants co-exist. Partial migration provides insights into the link between migration, local environment and ornamentation, although empirical studies remain scarce. Here, we studied the plumage traits of barn swallows (Hirundo rustica) in southern Japan, where both winterings and migrants breed sympatrically. We further examined this relationship with multiple isotopes (δ2H, δ13C, δ15N and δ34S), which provides insight into their moulting habitat. Among males, winterings and migrants differed in their morphological traits: wintering males had shorter wings, which suggests the high demand for flight apparatus in migratory birds. Moreover, wintering males had larger white tail spots and less colourful throat patches than migratory males, indicating ornament divergence between them. Wintering males had a significantly smaller isotopic space when examining the combinations of δ34S with the other isotopes compared to migratory males, which indicates a differential geographic range between them, perhaps because of the limited variation in the distance to the sea in wintering males. As in males, wintering females had a significantly smaller isotopic space than migrant females, but there were few morphological differences between migratory and wintering females. Instead, some morphological traits were related to isotope values in females. These results indicate sex-specific linkage between migration, local environment, and ornamentation.

Genetic Evaluation of Water Use Efficiency and Nutrient Use Efficiency in Populus deltoides Bartr. ex Marsh. Seedlings in China.

Populus deltoides Bartr. ex Marsh. represents a valuable genetic resource for fast-growing plantations in temperate regions. It holds significant cultivation and breeding potential in northern China. To establish an efficient breeding population of poplar, we studied the genetic variation of P. deltoides from different provenances. Our focus was on genotypes exhibiting high growth rates and efficient water and nutrient use efficiency (WUE and NUE). We evaluated 256 one-year-old seedlings from six provenances, measuring height, ground diameter, total biomass, and leaf carbon and nitrogen isotope abundance (δ13C and δ15N). Our analytical methods included variance analysis, multiple comparisons, mixed linear models, correlation analysis, and principal component analysis. The results showed that the coefficient of variation was highest for δ15N and lowest for δ13C among all traits. Except for δ15N, the effects of intra- and inter-provenance were highly significant (p < 0.01). The rates of variation for all traits ranged from 78.36% to 99.49% for intra-provenance and from 0.51% to 21.64% for inter-provenance. The heritability of all traits in AQ provenance was over 0.65, and all exhibited the highest level except for seedling height. All traits were significantly positively correlated with each other (p < 0.05), while ground diameter, total biomass, and WUE were highly significantly negatively correlated with latitude (p < 0.01). After a comprehensive evaluation, two provenances and eight genotypes were selected. The genetic gains for seedling height, ground diameter, total biomass, WUE, and NUE were 27.46 cm (178-2-106), 3.85 mm (178-2-141), 16.40 g (178-2-141), 0.852‱ (LA05-N15), and 3.145‱ (174-1-2), respectively. Overall, we revealed that the abundant genetic variation in P. deltoides populations mainly comes from intra-provenance differences and evaluated provenances and genotypes. The results of this study will contribute to optimizing and enhancing the breeding process of Chinese poplar and improving the productivity of fast-growing plantations.

Nitrogen isotope characteristics and importance of NOx from biomass burning in China.

Biomass burning is a primary source of atmospheric nitrogen oxide (NOx), however, the lack of isotopic fingerprints from biomass burning limits their use in tracing atmospheric nitrate (NO3-) and NOx. A total of 25 biomass fuels from 10 provinces and regions in China were collected, and the δ15N values of biomass fuels (δ15N-biomass) and δ15N-NOx values of biomass burning (δ15N-NOx values of BB, open burning, and rural cooking stove burning) were determined. The δ15N-NOx values of open burning and rural cooking stove burning ranged from -0.8 ‰ to 11.6 ‰ and 0.8 ‰ to 9.5 ‰, respectively, indicating a significant linear relation with δ15N-biomass. Based on the measured δ15N-NOx values of BB and biomass burning emission inventory data, the δ15N-NOx values of BB in different provinces and regions of China were calculated using the δ15N-NOx model, with a mean value of 5.0 ± 1.8 ‰. The spatial variations in the estimated δ15N-NOx values of BB in China were mainly controlled by the differences in the δ15N-NOx values and the proportions of NOx emissions from various straw burning activities in provinces and regions of China. Furthermore, by using the combined local emissions of biomass burning with regional transportations of NOx based on air-mass backward trajectories, we established an improved δ15N-NOx model and obtained more accurate δ15N-NOx values of BB in regions (2.3 ‰ to 8.4 ‰). By utilising the reported δ15N-NOx values of precipitation and particulate matter from 21 cities in China and the more accurate δ15N-NOx values of BB, the NOx contributions from four sources (mobile sources, coal combustion, biomass burning, and microbial N cycle) at the national scale were estimated using a Bayesian model. The significant contributions of biomass burning (20.9 % to 44.3 %) to NOx emissions were revealed, which is vital for controlling NOx emissions in China.

Nutrient responses of vascular plants to N2-fixing tree Alnus hirsuta encroachment in a boreal peatland.

The N2-fixing trees Alnus spp. have been widely encroaching into boreal peatlands, but the nutrient responses of native vascular plants remain unclear. Here, we compared nutrient concentrations and isotope signal of six common plants (Betula fruticosa, Salix rosmarinifolia, Vaccinium uliginosum, Rhododendron tomentosum, Chamaedaphne calyculata, and Eriophorum vaginatum) between Alnus hirsuta island and open peatland and assessed plant nutrient responses to A. hirsuta encroachment in boreal peatlands. Alnus hirsuta encroachment increased nitrogen (N) concentration of leaf, branch, and stem. Despite no significant interspecific difference in branch and stem, the increment magnitude of leaf N concentration varied among species, with greatest magnitude for R. tomentosum (55.1% ± 40.7%) and lowest for E. vaginatum (9.80% ± 4.40%) and B. fruticosa (18.4% ± 10.7%). Except for E. vaginatum, the significant increase in δ15N occurred for all organs of shrubs, with interspecific differences in change of leaf δ15N. According to the mass balance equation involving leaf δ15N, R. tomentosum and E. vaginatum, respectively, obtained highest (40.5% ± 19.8%) and lowest proportions (-14.0% ± 30.5%) of N from A. hirsuta. Moreover, the increment magnitudes of leaf N concentration showed a positive linear relationship with the proportion of N from A. hirsuta. In addition, A. hirsuta encroachment reduced leaf phosphorus (P) concentration of deciduous shrubs (i.e., B. fruticosa, S. rosmarinifolia, and V. uliginosum), thus increasing N:P ratio. These findings indicate that Alnus encroachment improves native plant N status and selectively intensifies P limitation of native deciduous shrubs, and highlight that the N acquisition from the symbiotic N2-fixing system regulates plant N responses in boreal peatlands.

To Eat or Not to Eat: Novel Stable Isotope Models Reveal a Shift in Carnivory with Nutrient Availability for Aquatic Utricularia spp.

BACKGROUND AND AIMS: Freshwater nitrogen inputs are increasing globally, altering the structure and function of wetland ecosystems adapted to low nutrient conditions. Carnivorous wetland plants, Utricularia spp., are hypothesised to reduce their reliance on carnivory and increase their assimilation of environmental nutrients when the supply of ambient nutrients increases. Despite success in using stable isotope approaches to quantify carnivory of terrestrial carnivorous plants, quantifying carnivory of aquatic Utricularia requires improvement. METHODS: We developed stable isotope mixing models to quantify aquatic plant carnivory and used these models to measure dietary changes of three Utricularia species: Utricularia australis, U. gibba, and U. uliginosa in 11 wetlands across a 794 km gradient in eastern Australia. Diet was assessed using multiple models that compared variations in the natural abundance nitrogen isotope composition (δ15N) of Utricularia spp. with that of non-carnivorous plants, and environmental and carnivorous nitrogen sources. KEY RESULTS: Carnivory supplied 40 - 100 % of plant nitrogen. The lowest carnivory rates coincided with the highest availability of ammonium and dissolved organic carbon. CONCLUSIONS: Our findings suggest that Utricularia populations may adapt to high nutrient environments by shifting away from energetically costly carnivory. This has implications for species conservation as anthropogenic impacts continue to affect global wetland ecosystems.

Trophic plasticity of a tropical seabird revealed through DNA metabarcoding and stable isotope analyses.

DNA metabarcoding and stable isotope analysis have significantly advanced our understanding of marine trophic ecology, aiding systematic research on foraging habits and species conservation. In this study, we employed these methods to analyse faecal and blood samples, respectively, to compare the trophic ecology of two Red-billed Tropicbird (Phaethonaethereus; Linnaeus, 1758) colonies on Mexican islands in the Pacific. Trophic patterns among different breeding stages were also examined at both colonies. Dietary analysis reveals a preference for epipelagic fish, cephalopods, and small crustaceans, with variations between colonies and breeding stages. Isotopic values (δ15N and δ13C) align with DNA metabarcoding results, with wider niches during incubation stages. Differences in diet are linked to environmental conditions and trophic plasticity among breeding stages, influenced by changing physiological requirements and prey availability. Variations in dietary profiles reflect contrasting environmental conditions affecting local prey availability.

Opportunistic omnivory impairs the use of the Atlantic blue crab Callinectes sapidus as a trace metal biomonitor in invaded Mediterranean coastal waters.

The contribution of non-indigenous species to the transfer of contaminants in invaded food webs represents an active research area. Here we measured trace metals and CN stable isotopes in five populations of the invasive Atlantic blue crab Callinectes sapidus and in baseline bivalve species from Spain, Italy and Greece. They were used to estimate trophic transfer effects and the trophic position and isotopic niche of C. sapidus. Maximum trophic transfer effects occurred where the crab showed the largest isotopic niches and highest trophic positions; furthermore, the consistency of trace metal profiles between bivalves and crabs co-varied with the trophic position of the latters. Omnivory may influence the success of an invasive species, but also limit its effectiveness for biomonitoring. However, our results indicated that stable isotopes analysis provides a clarifying background where to cast patterns of contamination of the blue crab as well as of other omnivorous biomonitor species.

Well supplied in life, set aside in death: A multi-isotope study of Justinian plague victims from Saint-Doulchard (France, 7th-8th centuries AD).

OBJECTIVES: Justinian plague and its subsequent outbreaks were major events influencing Early Medieval Europe. One of the affected communities was the population of Saint-Doulchard in France, where plague victim burials were concentrated in a cemetery enclosure ditch. This study aimed to obtain more information about their life-histories using the tools of isotope analysis. MATERIALS AND METHODS: Dietary analysis using carbon and nitrogen isotopes was conducted on 97 individuals buried at Le Pressoir in Saint-Doulchard, with 36 of those originating from the enclosure ditch. This sample set includes all individuals analyzed for plague DNA in a previous study. Mobility analysis using strontium isotope analysis supplements the dietary study, with 47 analyzed humans. The results are supported by a reference sample set of 31 animal specimens for dietary analysis and 9 for mobility analysis. RESULTS: The dietary analysis results showed significantly different dietary behavior in individuals from the ditch burials, with better access to higher quality foods richer in animal protein. 87Sr/86Sr ratios are similar for both studied groups and indicate a shared or similar area of origin. DISCUSSION: The results suggest that the ditch burials contain an urban population from the nearby city of Bourges, which overall had a better diet than the rural population from Saint-Doulchard. It is implied that city's population might have been subjected to high mortality rates during the plague outbreak(s), which led to their interment in nearby rural cemeteries.

Mandibular bone mass density in a medieval population and its relationship with stable isotopes δ13C and δ15N.

The aim of this study was to compare the level of bone mass in digital orthopantomograms in two populations (medieval and current) using two radiomorphometric indexes, and to correlate the mandibular bone mass value, in the medieval mandible population, with stable isotope data δ13C and δ15N. An observational, cross-sectional, and analytical study on mandibles from two diachronic groups, 15 mandibles from the medieval settlement of La Torrecilla (Granada, Spain) and 15 mandibles from current patients at the Faculty of Dentistry of the University of Granada (Spain), matched by age and sex was conducted. The bone mass density was determined using the Mandibular Cortical Width Index (MCW) and the Mandibular Panoramic Index (PMI) in digital panoramic radiographs. In the medieval group, the values of bone mass density were correlated with those of two stable isotopes (δ13C and δ15N). The mean value of MCW in mm in the medieval group was 3.96 ± 0.60 (mean ± standard deviation) and in the current group was 4.02 ± 1.01. The PMI was 0.33 ± 0.06 and 0.35 ± 0.08 in the medieval and current groups respectively, with similar results in both groups (p = 0.820 and p = 0.575). A negative correlation was found between both morphometric indices and the δ15N isotope (rs = 0.56, p = 0.030 and rs = 0.61, p = 0.016, respectively). The bone mass density in mandibles belonging to the two compared populations, determined by two quantitative radiomorphometric indices, is similar. Within the medieval population, there is an inverse correlation between the δ15N value and bone mass density.

A cost-consequence analysis comparing three cardiac ablation strategies for the treatment of paroxysmal atrial fibrillation.

BACKGROUND AND AIMS: Cardiac ablation is a well-established method for treating atrial fibrillation (AF). Pulsed field ablation (PFA) is a non-thermal therapeutic alternative to radiofrequency ablation (RFA) and cryoballoon ablation (CRYO). PFA uses high-voltage electric pulses to target cells. The present analysis aims to quantify the costs, outcomes, and resources associated with these three ablation strategies for paroxysmal AF. METHODS: Real-world clinical data were prospectively collected during index hospitalization by three European medical centers (Belgium, Germany, the Netherlands) specialized in cardiac ablation. These data included procedure times (pre-procedural, skin-to-skin and post-procedural), resource use, and staff burden. Data regarding complications associated with each of the three treatment options and redo procedures were extracted from the literature. Costs were collected from hospital economic formularies and published cost databases. A cost-consequence model from the hospital perspective was built to estimate the impact of the three treatment options in terms of effectiveness and costs. RESULTS: Across the three centers, N = 91 patients were included over a period of 12 months. A significant difference was seen in pre-procedural time (mean ± SD, PFA: 13.6 ± 3.7 min, CRYO: 18.8 ± 6.6 min, RFA: 20.4 ± 6.4 min; p < .001). Procedural time (skin-to-skin) was also different across alternatives (PFA: 50.9 ± 22.4 min, CRYO: 74.5 ± 24.5 min, RFA: 140.2 ± 82.4 min; p < .0001). The model reported an overall cost of €216,535 per 100 patients treated with PFA, €301,510 per 100 patients treated with CRYO and €346,594 per 100 patients treated with RFA. Overall, the cumulative savings associated with PFA (excluding kit costs) were €850 and €1,301 per patient compared to CRYO and RFA, respectively. CONCLUSION: PFA demonstrated shorter procedure time compared to CRYO and RFA. Model estimates indicate that these time savings result in cost savings for hospitals and reduce outlay on redo procedures. Clinical practice in individual hospitals varies and may impact the ability to transfer the results of this analysis to other settings.

Stable isotope analysis in soil prospection reveals the type of historic land-use under contemporary temperate forests in Europe.

The determination of δ13C and δ15N values is a common method in archaeological isotope analysis-in studying botanical and human remains, dietary practices, and less typically soils (to understand methods of agricultural cultivation, including fertilization). Stable isotope measurements are also commonly used in ecological studies to distinguish different ecosystems and to trace diachronic processes and biogeochemical mechanisms, however, the application of this method in geochemical prospection, for determining historic land-use impact, remains unexplored. The study at hand focuses on a deserted site of a Cistercian manor, dating from the thirteenth to fifteenth centuries. Isotopic measurements of anthropogenically influenced soils have been compared to approximately 400 archaeobotanical, soil, and sediment samples collected globally. The results reveal the potential of isotope measurements in soil to study the impact of past land use as isotope measurements identify specific types of agricultural activities, distinguishing crop production or grazing. δ13C and δ15N ratios also likely reflect fertilization practices and-in this case-the results indicate the presence of cereal cultivation (C3 cycle plants) and fertilization and that the site of the medieval manor was primarily used for grain production rather than animal husbandry.

Initiating immunoglobulin replacement therapy helps reduce severe infections and shifts healthcare resource utilization to outpatient services among US patients with inborn errors of immunity.

AIMS: Patients with inborn errors of immunity (IEI) are predisposed to severe recurrent/chronic infections, and often require hospitalization, resulting in substantial burden to patients/healthcare systems. While immunoglobulin replacement therapies (IgRTs) are the standard first-line treatment for most forms of IEI, limited real-world data exist regarding clinical characteristics and treatment costs for patients with IEI initiating such treatment. This retrospective analysis examined infection and treatment characteristics in US patients with IEI initiating IgRT with immune globulin infusion (human), 10% (IG10%). Healthcare resource utilization (HCRU) and associated costs before and after treatment initiation were compared. Additionally, the impact of COVID-19 on infection diagnoses was evaluated. METHODS: Patients with IEI initiating IG10% between July 2012 and August 2019 were selected from Merative MarketScan Databases using diagnosis/prescription codes. Patients were followed 6 months before and after first IG10% claim date. Demographic and clinical characteristics were described. Treatment characteristics and HCRU before and after IG10% initiation were compared. Infection diagnoses during 2020 and 2019 (March-December) were compared. RESULTS: The study included 1,497 patients with IEI diagnoses (mean age = 43.4 years) initiating IG10%, with frequently reported comorbidities like asthma (32.1%). Following IG10% initiation, fewer severe infection diagnoses (11.6% vs 19.9%), fewer infection-related inpatient (10.8% vs 19.5%) and outpatient services (71.6% vs 79.9%), and lower infection-related total healthcare costs ($7,849 vs $13,995; p < 0.001)-driven by lower inpatient costs ($2,746 vs $9,900)-were observed than before. Fewer patients had infection diagnoses during COVID-19 (22.8%) than the prior year (31.2%). CONCLUSION: Patients with IEI are susceptible to severe infections leading to high disease burden and treatment costs. Following IG10% initiation, we observed fewer infections, lower infection-related treatment costs, and shift in care (inpatient to outpatient) leading to significant cost savings. Among patients with IEI, 27% fewer infection diagnoses were observed during the early COVID-19 lockdown period than the prior year.

Some people are born with inborn errors of immunity, or IEI. This study included 1,497 people with IEI who recently started taking a drug called immunoglobulin therapy. Before taking this drug, the participants got infections easily, were hospitalized often, and had to take other costly medicines. After starting this drug, they had fewer infections and could be treated at the doctor's office. They had fewer infections during the COVID-19 pandemic than before the pandemic.

Cost-effectiveness of empagliflozin as add-on to standard of care for chronic kidney disease management in the United Kingdom.

OBJECTIVE: The sodium-glucose co-transporter-2 inhibitor empagliflozin was approved for treatment of adults with chronic kidney disease (CKD) on the basis of its demonstrated ability to slow CKD progression and reduce the risk of cardiovascular death. This analysis was performed to assess the cost-effectiveness of empagliflozin plus standard of care (SoC) vs SoC alone in the treatment of CKD in the UK. METHODS: A comprehensive, patient-level CKD progression model that simulates the evolution of risk factors for disease progression based on CKD-specific equations and clinical data was used to project a broad range of CKD-related complications. Patient baseline characteristics, distribution across Kidney Disease Improving Global Outcomes (KDIGO) health states, and changes in estimated glomerular filtration rate (eGFR), urine albumin-creatinine ratio (uACR), and other parameters while on treatment were derived from the EMPA-KIDNEY trial. UK cost and utilities/disutilities were sourced from the literature. Univariate and probabilistic sensitivity analyses were conducted. Annual discounting of 3.5% was applied on costs and outcomes. RESULTS: Over a 50-year horizon, SoC resulted in per-patient costs, life years, and QALYs of £95,930, 8.55, and 6.28, respectively. Empagliflozin plus SoC resulted in an incremental gain in life years (+1.04) and QALYs (+0.84), while decreasing per-patient costs by £6,019. Empagliflozin was more effective and less costly (dominant) with a net monetary benefit of £22,849 at the willingness-to-pay threshold of £20,000. Although treatment cost was higher for empagliflozin, this was more than offset by savings in kidney replacement therapy. Empagliflozin remained highly cost-effective in patients with and without diabetes, and across scenario and sensitivity analyses. LIMITATIONS: This analysis is limited by reliance on short-term clinical trial data and by uncertainties in modelling CKD progression. CONCLUSIONS: Empagliflozin as an add-on to SoC for treatment of adults with CKD represents cost-effective use of UK National Health Service (NHS) resources.