Cost-effectiveness of left ventricular assist devices (LVADs) for patients with advanced heart failure : analysis of the British NHS Bridge to Transplant (BTT) program

Background: A previous cost-effectiveness analysis showed that bridge to transplant (BTT) with early design left ventricular assist devices (LVADs) for advanced heart failure was more expensive than medical management while appearing less beneficial. Older LVADs were pulsatile, but current second and third generation LVADs are continuous flow pumps. This study aimed to estimate comparative cost-effectiveness of BTT with durable implantable continuous flow LVADs compared to medical management in the British NHS. Methods and results: A semi-Markov multi-state economic model was built using NHS costs data and patient data in the British NHS Blood and Transplant Database (BTDB). Quality-adjusted life years (QALYs) and incremental costs per QALY were calculated for patients receiving LVADs compared to those receiving inotrope supported medical management. LVADs cost £80,569 ($127,887) at 2011 prices and delivered greater benefit than medical management. The estimated probabilistic incremental cost-effectiveness ratio (ICER) was £53,527 ($84,963)/QALY (95%CI: £31,802–£94,853; $50,479–$150,560) (over a lifetime horizon). Estimates were sensitive to choice of comparator population, relative likelihood of receiving a heart transplant, time to transplant, and LVAD costs. Reducing the device cost by 15% decreased the ICER to £50,106 ($79,533)/QALY. Conclusions: Durable implantable continuous flow LVADs deliver greater benefits at higher costs than medical management in Britain. At the current UK threshold of £20,000 to £30,000/QALY LVADs are not cost effective but the ICER now begins to approach that of an intervention for end of life care recently recommended by the British NHS. Cost-effectiveness estimates are hampered by the lack of randomized trials

The ADAMTS (A Disintegrin and Metalloproteinase with Thrombospondin motifs) family

The ADAMTS (A Disintegrin and Metalloproteinase with Thrombospondin motifs) enzymes are secreted, multi-domain matrix-associated zinc metalloendopeptidases that have diverse roles in tissue morphogenesis and patho-physiological remodeling, in inflammation and in vascular biology. The human family includes 19 members that can be sub-grouped on the basis of their known substrates, namely the aggrecanases or proteoglycanases (ADAMTS1, 4, 5, 8, 9, 15 and 20), the procollagen N-propeptidases (ADAMTS2, 3 and 14), the cartilage oligomeric matrix protein-cleaving enzymes (ADAMTS7 and 12), the von-Willebrand Factor proteinase (ADAMTS13) and a group of orphan enzymes (ADAMTS6, 10, 16, 17, 18 and 19). Control of the structure and function of the extracellular matrix (ECM) is a central theme of the biology of the ADAMTS, as exemplified by the actions of the procollagen-N-propeptidases in collagen fibril assembly and of the aggrecanases in the cleavage or modification of ECM proteoglycans. Defects in certain family members give rise to inherited genetic disorders, while the aberrant expression or function of others is associated with arthritis, cancer and cardiovascular disease. In particular, ADAMTS4 and 5 have emerged as therapeutic targets in arthritis. Multiple ADAMTSs from different sub-groupings exert either positive or negative effects on tumorigenesis and metastasis, with both metalloproteinase-dependent and -independent actions known to occur. The basic ADAMTS structure comprises a metalloproteinase catalytic domain and a carboxy-terminal ancillary domain, the latter determining substrate specificity and the localization of the protease and its interaction partners; ancillary domains probably also have independent biological functions. Focusing primarily on the aggrecanases and proteoglycanases, this review provides a perspective on the evolution of the ADAMTS family, their links with developmental and disease mechanisms, and key questions for the future

O lugar dos corpos no judaísmo rabínico da era talmúdica e as perspectivas à sua volta

Tese de mestrado, História e Cultura das Religiões, Universidade de Lisboa, Faculdade de Letras, 2013RESUMO: Este trabalho pretende analisar qual era o lugar ocupado pelo corpo humano no entendimento rabínico nos primeiros séculos da era comum, comparativamente a outras perspectivas com as quais conviveu no mesmo período, de acordo com as diversas interpretações do texto bíblico. O judaísmo produziu um trabalho, o Talmude, que é um registo das discussões rabínicas, e é a partir desse documento que o assunto será tratado. Este trabalho aborda a questão da criação do homem, da diferença entre os géneros, da sexualidade e dos sentidos. O judaísmo desse período contrariou uma tendência ascética que foi absorvida de maneira mais intensa pelo cristianismo. O trabalho pretende reconhecer as diferenças nestes entendimentos e na conclusão apontar para reflexões sobre a importância destes no homem ocidental de hoje.ABSTRACT: The intente of this work is to analise the space occupied by the human body in the rabinic interpretation during the first centuries of the common era, in comparison to other points of views, shared within the same period, according to the various interpretations of biblical texts. Judaism has produced a document, the Talmud, which is a record of rabinic considerations, and this will be the main source of our discussion. This works encompasses the birth of men, the difference amongst genres, sexuality and the senses. The Judaism of this particular period has negated an asceptic notion which was taken in in a much more agressive manner by christianity. The work intends to recognize the diferences between the two ideologies and point into the direction of reflecting on the importance of such, in the role of the modern man

Implementation of Basal-Bolus Therapy in Type 2 Diabetes:A Randomized Controlled Trial Comparing Bolus Insulin Delivery Using an Insulin Patch with an Insulin Pen

Background: Barriers to mealtime insulin include complexity, fear of injections, and lifestyle interference. This multicenter, randomized controlled trial evaluated efficacy, safety, and self-reported outcomes in adults with type 2 diabetes, inadequately controlled on basal insulin, initiating and managing mealtime insulin with a wearable patch versus an insulin pen. Methods: Adults with type 2 diabetes (n = 278, age: 59.2 +/- 8.9 years), were randomized to patch (n = 139) versus pen (n = 139) for 48 weeks, with crossover at week 44. Baseline insulin was divided 1:1 basal: bolus. Using a pattern-control logbook, subjects adjusted basal and bolus insulin weekly using fasting and premeal glucose targets. Results: Glycated hemoglobin (HbA1c) change (least squares mean +/- standard error) from baseline to week 24 (primary endpoint) improved (P \u3c 0.0001) in both arms, -1.7% +/- 0.1% and -1.6% +/- 0.1% for patch and pen (-18.6 +/- 1.1 and -17.5 +/- 1.1 mmol/mol), and was maintained at 44 weeks. The coefficient of variation of 7-point self-monitoring blood glucose decreased more (P = 0.02) from baseline to week 44 for patch versus pen. There were no differences in adverse events, including hypoglycemia (three severe episodes per arm), and changes in weight and insulin doses. Subject-reported treatment satisfaction, quality of life, experience ratings at week 24, and device preferences at week 48 significantly favored the patch. Most health care providers preferred patch for mealtime insulin. Conclusions: Bolus insulin delivered by patch and pen using an algorithm-based weekly insulin dose titration significantly improved HbA1c in adults with type 2 diabetes, with improved subject and health care provider experience and preference for the patch

Functionalisation of Ti6Al4V components fabricated using selective laser melting with a bioactive compound

Surface modification of an implant with a biomolecule is used to improve its biocompatibility and to reduce post-implant complications. In this study, a novel approach has been used to functionalise phosphonic acid monolayers with a drug. Ti6Al4V components fabricated using selective laser melting (SLM) were functionalised with Paracetamol (a pharmaceutically relevant biomolecule) using phosphonic acid based self-assembled monolayers (SAMs). The attachment, stability of the monolayers on the SLM fabricated surface and functionalisation of SAMs with Paracetamol were studied using X-ray photoelectron spectroscopy (XPS) and surface wettability measurements. The obtained results confirmed that SAMs were stable on the Ti6Al4V surface for over four weeks and then began to desorb from the surface. The reaction used to functionalise the phosphonic acid monolayers with Paracetamol was noted to be successful. Thus, the proposed method has the potential to immobilise drugs/proteins to SAM coated surfaces and improve their biocompatibility and reduce post-implant complications

The Nexus of Climate Change, COVID-19, and Environmental Justice on Children\u27s Health

Climate change poses a threat to children, who are increasingly vulnerable, depending on adults to protect them from the impacts of these changes including extreme weather events, poor air and water quality and risk to mental health. Children living in poverty carry additional burdens and risks, living in environments that consistently experience poor air and water quality from polluting industries, compounded by the effects of climate change. COVID-19 has placed additional challenges to children’s health and increases the complexity of addressing climate change and environmental justice. The intersection between climate change and COVID-19 exacerbates these existing disparities by impacting children\u27s physical and mental health that are a direct product of poverty and structural racism. This article examines the nexus of climate change, COVID-19, and environmental justice that impacts the mental and physical health of children including anxiety, stress, adverse childhood experiences, and depression; increases in violence and aggression; and the effects of air pollution. Public health professionals and health care providers must be aware of national strategies that protect children from environmental health risks and emerging infectious diseases, such as climate change and COVID-19, respectively

Exemplars of nursing leadership on climate change and health

Webinar Details: Sigma\u27s Climate and Health Webinar Series with the ANHE (Alliance of Nurses for Healthy Environments) Moderator: Teddie Potter, PhD, RN, FAAN Episode Details: See details file attached to this record. Across the nursing professions, nurses are taking up the mantle to lead in addressing climate change. Nurses are in key positions to lead the profession and are key collaborators with other health professionals to address climate change. On this webinar, hear from nurse leaders as they share examples of how nurses can lead within their nursing practice to address climate change and how they are inspiring others to take action