Fluorescence study of the interaction between albumin and layered double hydroxides.

Layered double hydroxides nanoparticles (LDH-NP) are increasingly studied for biomedical applications. Nevertheless, their interaction with biomolecules such as proteins needs further exploration for an effective application. In this work, the adsorption of bovine serum albumin (BSA) on LDH-NP and the conformation changes of the protein upon adsorption were characterized using fluorescence spectroscopy. First, the quenching of tryptophan residues of BSA by chloride-intercalated LDH-NP was explored and the BSA adsorption capacity of LDH-NP were determined. Then, the structural conformation of the protein was analyzed by fluorescence spectroscopy (including synchronous, polarization and quenching studies) at different surface coverages. Finally, the proclivity of adsorbed BSA molecules to assemble as amyloid fibril was evaluated. Due to the positive charging and low curvature of LDH-NP, BSA molecules were strongly adsorbed, which produced a quenching of the protein fluorescence and a large adsorption capacity. The effect on BSA conformation was dependent on surface coverage (SC): at low values ,t he tryptophan residues were in more hydrophobic environments and more accessible to quenchers than al high ones. At low SC, there is space between the BSA molecules to spread on the surface, which led to a conformation change. Contrarily, the native conformation around tryptophan residues of BSA was preserved at high SC due to the tight packing of the adsorbed protein molecules. As a result, BSA molecules are stabilized against the formation of amyloid fibrils at high SC, while at low SC they present a similar fibrillation than free BSA.

SARS-CoV-2 niches in human placenta revealed by spatial transcriptomics.

BACKGROUND: Functional placental niches are presumed to spatially separate maternal-fetal antigens and restrict the vertical transmission of pathogens. We hypothesized a high-resolution map of placental transcription could provide direct evidence for niche microenvironments with unique functions and transcription profiles. METHODS: We utilized Visium Spatial Transcriptomics paired with H&E staining to generate 17,927 spatial transcriptomes. By integrating these spatial transcriptomes with 273,944 placental single-cell and single-nuclei transcriptomes, we generated an atlas composed of at least 22 subpopulations in the maternal decidua, fetal chorionic villi, and chorioamniotic membranes. FINDINGS: Comparisons of placentae from uninfected healthy controls (n = 4) with COVID-19 asymptomatic (n = 4) and symptomatic (n = 5) infected participants demonstrated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection in syncytiotrophoblasts occurred in both the presence and the absence of maternal clinical disease. With spatial transcriptomics, we found that the limit of detection for SARS-CoV-2 was 1/7,000 cells, and placental niches without detectable viral transcripts were unperturbed. In contrast, niches with high SARS-CoV-2 transcript levels were associated with significant upregulation in pro-inflammatory cytokines and interferon-stimulated genes, altered metallopeptidase signaling (TIMP1), with coordinated shifts in macrophage polarization, histiocytic intervillositis, and perivillous fibrin deposition. Fetal sex differences in gene expression responses to SARS-CoV-2 were limited, with confirmed mapping limited to the maternal decidua in males. CONCLUSIONS: High-resolution placental transcriptomics with spatial resolution revealed dynamic responses to SARS-CoV-2 in coordinate microenvironments in the absence and presence of clinically evident disease. FUNDING: This work was supported by the NIH (R01HD091731 and T32-HD098069), NSF (2208903), the Burroughs Welcome Fund and the March of Dimes Preterm Birth Research Initiatives, and a Career Development Award from the American Society of Gene and Cell Therapy.

Patients Hospitalized for Complications of Cirrhosis may Have Benefited From Medicaid Expansion Under the Affordable Care Act.

Objective: The benefit of the Affordable Care Act (ACA) for patients with cirrhosis is unclear. We determined the impact of ACA expansion on outcomes in patients hospitalized for complications of cirrhosis. Patients and Methods: We compared hospitalizations; in-hospital outcomes; and readmissions among patients with cirrhosis identified using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, 10th Revision, codes in states that expanded Medicaid under ACA (expanded [E] states) and those that did not (nonexpanded [NE] states). Data from the State Inpatient Databases were obtained for 3 pairs of contiguous E and NE states with both pre-ACA expansion and post-ACA expansion data. The difference-in-difference analysis was performed to compare the pre- and post-ACA data between the E and NE states. The outcomes were admission rates, hospital complications, resource utilization, length of stay, in-hospital mortality, discharge destination, cost of initial hospitalization, and readmission characteristics. Results: There were 228,349 admissions (E states, 149,705; NE states, 78,644). After ACA implementation, the E states had lower rates of admission increase per 100,000 population (22.9 in E states vs 25.5 in NE states, P=.005), sepsis (relative risk, 0.884; P=.0084), and hepatic coma (relative risk, 0.763; P<.001) than the NE states. The length of stay was lower by 0.21 days (P=.00028), with a $587.40 lower cost per hospitalization (P=.00091), in the E states than in the NE states. The readmission rates within 30, 60, and 90 days decreased in the E states after ACA implementation but increased in the NE states after ACA implementation. Conclusion: Among patients hospitalized for cirrhosis, quality indicators, such as the rate of admission increase, complications, costs, and readmissions, were more favorable in the states that expanded Medicaid. Medicaid expansion under ACA may have benefited patients with cirrhosis.

Wastewater based epidemiology as a silent sentinel of the trend of SARS-CoV-2 circulation in the community in central Argentina.

Monitoring wastewater for the traces of viruses allows effective surveillance of entire communities, including symptomatic and asymptomatic infected individuals, providing information on whether a specific pathogen is circulating in a population. In the context of the COVID-19 pandemic, 261 wastewater samples from six communities of the province of Córdoba, Argentina were analyzed. From mid-May 2020 to the end of August 2021, raw sewage samples were collected from the central network pipe that enters into the Wastewater Treatment Plants (WWTP) in Córdoba city and five communities in the Punilla Valley. SARS-CoV-2 was concentrated by using the polyethylene glycol-6000 precipitation method. Viral genomes were extracted from concentrated samples, and N- and E-SARS-CoV-2 genes were detected by using real time RT-PCR. Wastewater samples that resulted positive for SARS-CoV-2 genome detection were subjected to viral variants of concern (VOCs) identification by real time RT-PCR. Overall, just by using the identification of the N gene or E gene, the rates of viral genome detection were 43.4% (86/198) and 51.5% (102/198) respectively, and by using both methodologies (positivity criterion: detection of N and / or E gene), the detection rate was 71.2% (141/198). Thereby, the optimal strategy to study the SARS-CoV-2 genome in wastewater would be the use of the combined detection of both genes. Detection of SARS-CoV-2 variants in wastewater reflected their circulation in the community, showing no VOCs detection in the first COVID-19 wave and their co-circulation with Gamma, Alpha and Delta VOCs during 2021. Therefore, SARS-CoV-2 Wastewater Based Epidemiology (WBE) described the introduction, permanence and/or the co-circulation of viral variants in the community. In geographical areas with a stable population, SARS-CoV-2 WBE could be used as an early warning sign of new COVID-19 cases, whereas in localities with a low number of inhabitants and high tourist influx, WBE may only be useful to reflect the circulation of the virus in the community. Overall, the monitoring of SARS-CoV-2 in wastewater can become a silent sentinel of the trend of viral circulation in the community, providing supplementary information for clinical surveillance to support public health measures.

Prosthetic Rehabilitation in a Patient With Orbital Exenteration: The First Hybrid System With Miniplates and Magnetic Retention Described in Humans.

The authors report the case of an 80-year-old male patient who had a modified left orbit exenteration with preservation of myocutaneus eyelid flap. The radical surgical treatment was performed due to high-grade recurrent pleomorphic conjunctival sarcoma with extension to the sclera and medial orbit. Five previous resection surgeries were performed, until the exenteration was considered. Prosthetic rehabilitation was planned integrating interdisciplinary biomedical knowledge, to create a new hybrid osteointegrated method with costume-made titanium miniplates and magnetic retention. During the second-year follow up, the system appeared osteointegrated. No failures from the retention mechanism have been reported. The patient reported to have a functional role inside and outside his house. Social interactions have not been limited by the anatomical facial defect. This new hybrid system is a feasible option to rehabilitate patients with orbital or facial defects, even for the elderly.

3D simulation of aneurysm clipping: Data analysis.

Aneurysm clipping requires the proficiency of several skills, yet the traditional way of practicing them has been recently challenged. The use of simulators could be an alternative educational tool. The aim of this data analysis is to provide further evaluation of a reusable low-cost 3D printed training model we developed for aneurysm clipping [1]. The simulator was designed to replicate the bone structure, arteries and targeted aneurysms. Thirty-two neurosurgery residents performed a craniotomy and aneurysm clipping using the model and then filled out a survey. The survey was designed in two parts: a 5-point Likert scale questionnaire and three questions requiring written responses [1]. Two dimensions of the model were evaluated by the questionnaire: the face validity, assessed by 5 questions about the realism of the model, and the content validity, assessed by 6 questions regarding the usefulness of the model during the different steps of the training procedure. The three questions requiring written responses referred to the strengths and weaknesses of the simulator and a global yes/no question as to whether or not they would repeat the experience. Demographic data, experience level and survey responses of the residents were grouped in a dataset [2]. A descriptive analysis was performed for each dimension. Then, the groups were compared according to their level of expertise (Junior and Senior groups) with an independent sample t-test. A Confirmatory Factor Analysis (CFA) was estimated, using a Weighted Least Squares Mean Variance adjusted (WLSMV) which works best for the ordinal data [3]. Fitness was calculated using chi-square (χ2) test, Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and the Root Mean Square Error of Approximation (RMSEA). A non-significant χ2, CFI and TLI greater than 0.90 and RMSEA < 0.08 were considered an acceptable fit [4]. All data analysis was performed using IBM SPSS 23.0 statistical software. Data are reported as mean + standard deviation (SD). A probability p < 0.05 was considered significant. Exploratory Factor Analysis was done to explore the factorial structure of the 11-items scale in the sample, first we performed a principal components analysis. The Kaiser-Meyer-Olkin measure verified the sampling adequacy for the analysis (KMO = 0.784; Bartlett's Test of Sphericity χ2 (55) = 243.44, p < .001), indicating correlation is adequate for factor analysis. Considering Eigen values greater than 1, a two-factor solution explained 73.1% of the variance but left one item in factor 2 (Q 11). The results of this factor analysis are presented in Table 1. Confirmatory Factor Analysis, considering only the 10 items in the first factor (removing question 11 of our model), was performed. This model reached the following fit: χ2 (35) = 38.821, p > .05; CFI = 0.997; TLI = 0.996; RMSEA 0.058, without any error terms to exhibit covariance. Regarding the reliability of the questionnaire, the internal consistency was explored in the 10 items selected in the confirmatory factor analysis with an alpha coefficient (α = 0.941).

Quantifying the Importance of COVID-19 Vaccination to Our Future Outlook.

Predictive models have played a critical role in local, national, and international response to the COVID-19 pandemic. In the United States, health care systems and governmental agencies have relied on several models, such as the Institute for Health Metrics and Evaluation, Youyang Gu (YYG), Massachusetts Institute of Technology, and Centers for Disease Control and Prevention ensemble, to predict short- and long-term trends in disease activity. The Mayo Clinic Bayesian SIR model, recently made publicly available, has informed Mayo Clinic practice leadership at all sites across the United States and has been shared with Minnesota governmental leadership to help inform critical decisions during the past year. One key to the accuracy of the Mayo Clinic model is its ability to adapt to the constantly changing dynamics of the pandemic and uncertainties of human behavior, such as changes in the rate of contact among the population over time and by geographic location and now new virus variants. The Mayo Clinic model can also be used to forecast COVID-19 trends in different hypothetical worlds in which no vaccine is available, vaccinations are no longer being accepted from this point forward, and 75% of the population is already vaccinated. Surveys indicate that half of American adults are hesitant to receive a COVID-19 vaccine, and lack of understanding of the benefits of vaccination is an important barrier to use. The focus of this paper is to illustrate the stark contrast between these 3 scenarios and to demonstrate, mathematically, the benefit of high vaccine uptake on the future course of the pandemic.

The role of traditional restaurants in tourist destination loyalty.

The aim of this study is to examine the effect that visitor satisfaction with traditional restaurants has on perceptions of the local gastronomy, the overall image of a city and loyalty to that destination. Fieldwork has been carried out in Córdoba, a city in southern Spain famous for being a UNESCO World Heritage city and for its traditional gastronomy. The methodology used is based on structural equation modeling (PLS-SEM). This paper makes a novel contribution in that no previous studies to date have explored satisfaction with traditional restaurants, with respect to the food, the service and the atmosphere. To achieve the proposed objective, a structured questionnaire has been used to find out the opinions of diners in renowned restaurants that base their cuisine on traditional dishes made with quality local ingredients. The results obtained confirm that a satisfactory experience with the food of a traditional restaurant has a positive effect on the image of the destination and the gastronomy of the place, as well as on visitors' intentions to recommend and repeat the visit to said destination. Based on the analysis carried out, effective strategies are suggested to help manage these types of restaurants. The study provides theoretical and practical implications from a gastronomic perspective, which can enable tourism managers to employ new strategies to retain tourists visiting a city, based on increasing their post-experience satisfaction with restaurants featuring local cuisine.

Dark Tourism in Southern Spain (Córdoba): An Analysis of the Demand.

In recent decades, there has been a change in tourists' tastes; they want to experience something novel. To satisfy this demand, a new type of tourism, known as "dark tourism", has arisen; it has various modalities, among which cemetery tourism and ghost tourism stand out, in addition to very different motivations from those of the cultural tourist. In this type of tourism, cemeteries are not visited to appreciate their architecture or heritage but to explore a morbid curiosity about the people buried there; ghost tourism or paranormal tourism seizes on the desire to know the events that occurred there and tends to have macabre content. This study analyzes dark tourism in the province of Córdoba in southern Spain with the aim of knowing the profile of the tourist and his motivation. This study additionally will forecast the demand for this type of tourism, using autoregressive integrated moving average (ARIMA) models, which allow us to know this market's evolution and whether any promotional action should be carried out to promote it.

The Spanish Labor Market: A Gender Approach.

The massive incorporation of Spanish women into the labor market is a phenomenon that began in the second half of the 20th century, being many the obstacles that this group has had to overcome to reach the current situation, where getting a job can be an achievement that, in many cases, does not correspond to the capacity and academic training of the worker, creating a labor and economic imbalance (the cost in training is not rewarded with the work done). In this work, the Spanish labor market was analyzed through the labor force survey (EPA) from a gender perspective, demonstrating the existing inequalities at the labor level, both of employment and unemployment rates, and of jobs where the glass ceiling is evident and of economic remuneration where the salary gap continues to be important. In addition, through an ARIMA model, the evolution of the number of Spanish working women was analyzed, and how the economic crisis of 2009 and the sanitaria have affected their employment in the various crises (COVID-19). Measures to solve the problem as well as laws and active policies in favor of the creation of female jobs and a greater awareness of empowerment on the part of the female collective are proposed.

Association between dehydroepiandrosterone levels and cardiovascular risk in public sector health workers in a Peruvian region.

Alterations in dehydroepiandrosterone sulfate (DHEAS) levels have been shown to affect the cardiovascular system. This study examined the associations between DHEAS levels and cardiovascular risk in workers of a public hospital in Lima, Peru. The analytical cross-sectional study was conducted at the Hospital de Huaycán, Peru. The cardiovascular risk was assessed in health workers using the Framingham score and categorized into high and low cardiovascular risk groups, and then the DHEAS levels of both groups were compared. Two hundred ninety-six health workers were studied, 67.2% showed low cardiovascular risk, 22.3% intermediate and 10.5% high. DHEAS levels were lower in the high cardiovascular risk group (2156.9 vs 2814.6 ng/mL; P < 0.05) and showed negative association (prevalence rate ratio 0.14, 95% IC 0.04-0.53; P < 0.05) in multivariable analysis (P < 0.05). DHEAS, glycosylated hemoglobin, pulse pressure and mean arterial pressure show an independent association with high cardiovascular risk in a group of health workers. Additional variables should be considered for cardiovascular risk assessment.

Analysis of the demand for gastronomic tourism in Andalusia (Spain).

In recent years, gastronomy has become a fundamental motivation to travel. Learning how to prepare gastronomic dishes and about the raw materials that compose them has attracted increasing numbers of tourists. In Andalusia (region of southern Spain), there are many quality products endorsed by Protected Designations of Origin, around which gastronomic routes have been created, some visited often (e.g., wine) and others remaining unknown (e.g., ham and oil). This study analyses the profile of gastronomic tourists in Andalusia to understand their motivations and estimates the demand for gastronomic tourism using seasonal autoregressive integrated moving average (SARIMA) models. The results obtained indicate that the gastronomic tourist in Andalusia is very satisfied with the places he/she visits and the gastronomy he/she savours. However, the demand for this tourist sector is very low and heterogeneous; while wine tourism is well established, tourism focusing on certain products, such as olive oil or ham, is practically non-existent. To obtain a homogeneous demand, synergies or pairings should be created between food products, e.g., wine-ham, oil-ham, etc., to attract a greater number of tourists and distinguish Andalusia as a gastronomic holiday destination.

Reusable Low-Cost 3D Training Model for Aneurysm Clipping.

BACKGROUND: Aneurysm clipping requires the proficiency of several skills, yet the traditional way of practicing them has been recently challenged, especially by the growth of endovascular techniques. The use of simulators could be an alternative educational tool, but some of them are cumbersome, expensive to implement, or lacking in realism. The aim of this study is to evaluate a reusable low-cost 3-dimensional printed training model we developed for aneurysm clipping. METHODS: The simulator was designed to replicate the bone structure, arteries, and targeted aneurysms. Thirty-two neurosurgery residents performed a craniotomy and aneurysm clipping using the model and then filled out a survey. They were divided into Junior and Senior groups. Descriptive, exploratory, and confirmatory factor analysis was performed using IBM SPSS statistical software. RESULTS: The overall residents' response was positive, with high scores to face validity and content validity questions. There was no significant statistical difference between the Junior and Senior groups. The confirmatory factor and internal consistency analysis confirmed that the evaluation was highly reliable. Globally, 97% of the residents found the model was useful and would repeat the simulator experience. The financial cost is $2500 USD for implementation and only $180 USD if further training sessions are required. CONCLUSIONS: The main strengths of our training model are its highlighted realism, adaptability to trainees of different levels of expertise, sustainability, and low cost. Our data support the concept that it can be incorporated as a new training opportunity during professional specialty meetings and/or within residency academic programs.

Tourist loyalty and mosque tourism: The case of the Mosque-Cathedral in Córdoba (Spain).

Loyalty is important in the tourism sector since tourists are the key to returning to a destination or recommending it, which is a determining factor in the management of tourist sites. The tourism of Mosques, is a contextualized tourism within religious and cultural tourism. This research aims to analyze the loyalty of tourists of Islamic origin in the Cathedral Mosque of Cordoba. Unlike previous studies, this research adopts a comprehensive approach by considering cultural factors in the analysis of loyalty of Islamic tourists in mosque tourism. The methodology used in this study was a structural equation model with a partial least squares (PLS) analysis. The sample is made up of 262 tourists of Islamic origin at Cordoba Cathedral Mosque. This model does not correspond to factors identified by the previous literature, which adopts an religious perspective of Islamic tourists in mosque tourism. The methodology used in this study was a structural equation model with a partial least squares (PLS) analysis. The sample is made up of 262 tourists of Islamic origin in Cordoba Cathedral Mosque. This model does not correspond to factors identified by the previous literature, which adopts an religious perspective.

Loyalty in Heritage Tourism: The Case of Córdoba and Its Four World Heritage Sites.

The aim of this research is to study visitor loyalty at a destination with heritage sites and to use the results to improve the competitiveness of the destination. This study used the SPSS AMOS software with a model of structural equations to evaluate the proposed hypotheses. A questionnaire was given to a sample of 428 tourists who visited the heritage sites in Córdoba. The management of any World Heritage City needs to know about the visitors' experience at the destination, which includes their expectations for the trip, expected quality of the destination, satisfaction with the destination, and how these affect visitor loyalty to the city, because it is important to get the visitor to recommend, and return to, the destination. In the case of Córdoba, the research has proven that visitor loyalty depends on visitor satisfaction with the destination, which depends on the perceived quality and value of the visit. In addition, the following areas for improvement have been identified: improvement of the information about the destination, improvement of waiting times and the professionalization of specialized tour guides at heritage sites. Therefore, the findings are important for city managers in order to be able to take actions which increase the loyalty to, and competitiveness of, the city compared to other similar destinations with heritage sites.

Propiedades psicométricas del Cuestionario de Personalidad Resistente (versión no laboral) en la población cubana / Psychometric properties of the Hardiness Questionnaire (non-work version) in the Cuban population

Resumen: La personalidad resistente constituye un constructo de suma importancia en la protección de la salud, por lo cual es imprescindible la adaptación y validación de instrumentos que permitan evaluarla. El objetivo de este estudio fue estimar las propiedades psicométricas del Cuestionario de Personalidad Resistente (versión no laboral) en la población cubana. Se efectuó un estudio instrumental que incluyó 400 sujetos residentes en 6 provincias de Cuba. La edad media fue de 48 (±14.7) años; el 54.5 % de la muestra fue del sexo femenino. Se estimaron tres modelos, de ellos el que mostró mejores índices de ajuste fue el trifactorial (control, implicación y reto) con un factor de segundo orden (personalidad resistente) reducido a partir de la eliminación de dos reactivos. Se obtuvieron valores aceptables de confiabilidad tanto global (a=0.83) como en cada dimensión: control y reto (a=0.77) e implicación (a=0.70). La validez concurrente aporta evidencia sobre el valor de las subescalas control y compromiso.

Abstract: The hardiness is a variable of great importance in the protection of health, so the validation and adaptation of instruments to evaluate it are necessary. The objective of the research was to evaluate the psychometric properties of the Hardiness Questionnaire (non-work version) for a sample of the Cuban population. An instrumental study was carried out based on the quantitative research paradigm. The sample selection was made based on a cluster sampling that included 400 subjects residing in six provinces of the country. The standard age chosen was 48 (±14.7); 54.5 % of the simple was for females. Three models were estimated, the one who showed better scores was the trifactorial one (control, implication and challenge) with a factor of a second order (hardiness) reduced from the elimination of two reactive. Some acceptable figures of reliability were obtained, both global (a=0.83) and as in each dimension: control and challenge (a=0.77) and implication (a=0.70). The recurrent validity brings evidence of the value of the subscales control and commitment.

The Loyalty of Tourism in Synagogues: The Special Case of the Synagogue of Córdoba.

Tourism in synagogues is an activity which is increasing in popularity due to the current interest in cultural and patrimonial heritage. The synagogue in Córdoba has become an irreplaceable Jewish tourist destination in Spain due to its origins, construction, conservation, and recognition by international organizations. This article analyzes the loyalty of tourism in synagogues using variables such as satisfaction, loyalty and the expected and perceived value of the destination and the historical monument using a structural research equations methodology. No previous studies on tourism at synagogues using structural equations have been made. The data was obtained by means of a survey given to 350 tourists visiting this cultural heritage site. The results showed that there is strong loyalty to the heritage site as well as the destination.

Comparing outcomes and costs among warfarin-sensitive patients versus warfarin-insensitive patients using The Right Drug, Right Dose, Right Time: Using genomic data to individualize treatment (RIGHT) 10K warfarin cohort.

Oral anticoagulant (OAC) therapy has been the main treatment approach for stroke prevention for decades. Warfarin is the most widely prescribed OAC in the United States, but is difficult to manage due to variability in dose requirements across individuals. Pharmacogenomics may mitigate risk concerns related to warfarin use by fostering the opportunity to facilitate individualized medicine approaches to warfarin treatment (e.g., genome-guided dosing). While various economic evaluations exist examining the cost-effectiveness of pharmacogenomics testing for warfarin, few observational studies exist to support these studies, with even fewer using genotype as the main exposure of interest. We examined a cohort of individuals initiating warfarin therapy between 2004 and 2017 and examined bleeding and cost outcomes for the year following initiation using Mayo Clinic's billing and administrative data, as well the Mayo Clinic Rochester Cost Data Warehouse. Analyses included descriptive summaries, comparison of characteristics across exposure groups, reporting of crude outcomes, and multivariate analyses. We included N = 1,143 patients for analyses. Just over a third of our study population (34.9%) carried a warfarin-sensitive phenotype. Sensitive individuals differed in their baseline characteristics by being of older age and having a higher number of comorbid conditions; myocardial infarction, diabetes, and cancer in particular. The occurrence of bleeding events was not significantly different across exposure groups. No significant differences across exposure groups existed in either the likelihood of incurring all-cause healthcare costs or in the magnitude of those costs. Warfarin-sensitive individuals were no more likely to utilize cardiovascular-related healthcare services; however, they had lower total and inpatient cardiovascular-related costs compared to warfarin-insensitive patients. No significant differences existed in any other categories of costs. We found limited evidence that warfarin-sensitive individuals have different healthcare spending than warfarin-insensitive individuals. Additional real-world studies are needed to support the traditional economic evaluations currently existing in the literature.

Ciprofloxacin-intercalated layered double hydroxide-in-hybrid films as composite dressings for controlled antimicrobial topical delivery.

Films based on biopolymers and loaded with antimicrobial agents are convenient pharmaceutical dosage forms for topical application. Inorganic carriers loaded with these agents lead to composite materials, which combined with polymers produce further functionality. Here, hybrid composite films based on layered double hydroxide (LDH) and hyaluronan (HS) as ciprofloxacin (Cip) delivery systems were studied as an alternative for prophylaxis and treatment of opportunistic infections in wounds. Cip-intercalated Zn-Al LDH (LDH-Cip), with high drug loading and crystallinity, were obtained by a precipitation at variable pH method, and then included in a HS dispersion for obtaining the hybrid composite films by solvent casting. Physicochemical characterization of films showed that a composite material where the HS acted as matrix and LDH-Cip aggregates acted as filler were obtained. LDH-Cip were uniformly dispersed along the (LDH-Cip)/HS films, which exhibited roughness in their surface, increasing their swelling capacity in PBS pH = 5.8. Controlled releases of Cip toward PBS at pH = 5.8 and 7.4 were obtained, and the best fits for the release profiles were found with Higuchi and Korsmeyer-Peppas models, respectively. (LDH-Cip)/HS films exhibited antimicrobial activity against S. aureus. These films would then provide sustained release of Cip after topical administration, maintaining a suitable level of antibacterial activity, combined with the wound healing properties of the HS. The interesting properties shown by the (LDH-Cip)/HS films make them a promising alternative for application in skin wounds.