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Cost-effectiveness of Crohn's disease post-operative care

World journal of Gastroenterology 2016年第14期22卷 3860-3868页

作者： Emily K Wright Michael A Kamm Peter Dr Cruz Amy L Hamilton Kathryn j Ritchie Sally j Bell steven j brown William R Connell Paul V Desmond Danny Liew Department of Gastroenterology St Vincent's Hospital University of Melbourne Fitzroy VIC 3065 Melbourne Australia Imperial College London SW7 2AZ United Kingdom Melbourne EpiCentre University of Melbourne and Melbourne Health Parkville VIC 3010 Melbourne Australia

AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn's disease following intestinal resection.METHODS: In the "POCER" study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care(6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin(FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients(active care n = 43, standardcare n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those inremission [ $ 26347( IQR 25045-27485) vs $2729(IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented. CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.

关键词： Crohn’s disease Post-operative Health economics Health care cost Biologics

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Nutritional epigenetics education improves diet and attitude of parents of children with autism or attention deficit/hyperactivity disorder

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World journal of Psychiatry 2024年第1期14卷 159-178页

作者： Renee j Dufault Katherine M Adler David O Carpenter steven G Gilbert Raquel A Crider College of Graduate Health Studies A.T.Still UniversityKirksvilleMO 63501United States Department of Research Food Ingredient and Health Research InstituteNaalehuHI 96772United States Department of Health Sciences University of New HavenWest HavenCT 06516United States Institute for Health and the Environment School of Public HealthState University of New YorkAlbanyNY 12222United States Department of Research Institute of Neurotoxicology and Neurological DisordersSeattleWA 98105United States Department of Statistics Food Ingredient and Health Research InstituteNaalehuHI 96772United States

BACKGROUND Unhealthy maternal diet leads to heavy metal exposures from the consumption of ultra-processed foods that may impact gene behavior across generations,creating conditions for the neurodevelopmental disorders known as autism and attention deficit/hyperactivity disorder(ADHD).Children with these disorders have difficulty metabolizing and excreting heavy metals from their bloodstream,and the severity of their symptoms correlates with the heavy metal levels measured in their blood.Psychiatrists may play a key role in helping parents reduce their ultra-processed food and dietary heavy metal intake by providing access to effective nutritional epigenetics education.AIM To test the efficacy of nutritional epigenetics instruction in reducing parental ultra-processed food intake.METHODS The study utilized a semi-randomized test and control group pretest-posttest pilot study design with participants recruited from parents having a learning-disabled child with autism or ADHD.Twenty-two parents who met the inclusion criteria were randomly selected to serve in the test(n=11)or control(n=11)group.The test group participated in the six-week online nutritional epigenetics tutorial,while the control group did not.The efficacy of the nutritional epigenetics instruction was determined by measuring changes in parent diet and attitude using data derived from an online diet survey administered to the participants during the pre and post intervention periods.Diet intake scores were derived for both ultra-processed and whole/organic foods.Paired sample t-tests were conducted to determine any differences in mean diet scores within each group.RESULTS There was a significant difference in the diet scores of the test group between the pre-and post-intervention periods.The parents in the test group significantly reduced their intake of ultra-processed foods with a preintervention diet score of 70(mean=5.385,SD=2.534)and a post-intervention diet score of 113(mean=8.692,SD=1.750)and the paired t-test analysis showing a significance of

关键词： Epigenomics Parenteral nutrition Autism Attention deficit/hyperactivity disorder Ultra-processed foods Heavy metals

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Development,validation,and transportability of several machine-learned,non-exercise-based VO_(2max)prediction models for older adults

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journal of Sport and Health Science 2024年第5期13卷 611-620页

作者： Benjamin T.Schumacher Michael j.LaMonte Andrea Z.LaCroix Eleanor M.Simonsick steven P.Hooker Humberto Parada jr. john Bellettiere Arun Kumar Herbert Wertheim School of Public Health and Human Longevity Science University of California San DiegoLa JollaCA 92093USA Department of Epidemiology and Environmental Health School of Public Health and Health ProfessionsUniversity at BuffaloState University of New YorkBuffaloNY 14214USA Translational Gerontology Branch Intramural Research ProgramNational Institute on AgingNational Institutes of HealthBaltimoreMD 21225USA College of Health and Human Services San Diego State UniversitySan DiegoCA 92182USA Division of Epidemiology and Biostatistics School of Public HealthSan Diego State UniversitySan DiegoCA 92182USA University of California San Diego Moores Cancer Center La JollaCA 92093USA Computer Science and Engineering and Halicioglu Data Science Institute University of California San DiegoLa JollaCA 92093USA

Background:There exist few maximal oxygen uptake(VO_(2max))non-exercise-based prediction equations,fewer using machine learning(ML),and none specifically for older adults.Since direct measurement of VO_(2max)is infeasible in large epidemiologic cohort studies,we sought to develop,validate,compare,and assess the transportability of several ML VO_(2max)prediction algorithms.Methods:The Baltimore Longitudinal Study of Aging(BLSA)participants with valid VO2_(max)tests were included(n=1080).Least absolute shrinkage and selection operator,linear-and tree-boosted extreme gradient boosting,random forest,and support vector machine(SVM)algorithms were trained to predict VO_(2max)values.We developed these algorithms for:(a)the overall BLSA,(b)by sex,(c)using all BLSA variables,and(d)variables common in aging cohorts.Finally,we quantified the associations between measured and predicted VO_(2max)and mortality.Results:The age was 69.0±10.4 years(mean±SD)and the measured VO_(2max)was 21.6±5.9 mL/kg/min.Least absolute shrinkage and selection operator,linear-and tree-boosted extreme gradient boosting,random forest,and support vector machine yielded root mean squared errors of 3.4 mL/kg/min,3.6 mL/kg/min,3.4 mL/kg/min,3.6 mL/kg/min,and 3.5 mL/kg/min,respectively.Incremental quartiles of measured VO_(2max)showed an inverse gradient in mortality risk.Predicted VO_(2max)variables yielded similar effect estimates but were not robust to adjustment.Conclusion:Measured VO_(2max)is a strong predictor of mortality.Using ML can improve the accuracy of prediction as compared to simpler approaches but estimates of association with mortality remain sensitive to adjustment.Future studies should seek to reproduce these results so that VO_(2max),an important vital sign,can be more broadly studied as a modifiable target for promoting functional resiliency and healthy aging.

关键词： Cardiorespiratory fitness Prediction algorithms Epidemiology Mortality

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低GWP值制冷剂的有限选择

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暖通空调 2017年第8期47卷 41-50页

作者： Mark O.McLinden j.steven brown Riccardo Brignoli Andrei F.Kazakov Piotr A.Domanski 张磊华美国国家标准和技术研究院美国天主教大学亚太建设科技信息研究院有限公司

作为现今空调系统常用的制冷剂,氢氟烃是一类潜在温室气体,并且它们对气候变化的影响会不断增长。未来,氢氟烃的使用将逐渐减少,因此必须寻找适合的替代工质。本文显示,仅有少数几种单一工质具有作为制冷剂所必需拥有的化学、环境、热... 详细信息

作为现今空调系统常用的制冷剂,氢氟烃是一类潜在温室气体,并且它们对气候变化的影响会不断增长。未来,氢氟烃的使用将逐渐减少,因此必须寻找适合的替代工质。本文显示,仅有少数几种单一工质具有作为制冷剂所必需拥有的化学、环境、热力学和安全的综合特性,同时这些工质至少是微可燃的。根据筛选标准从一个综合化学品数据库中搜索了一些替代品。对于这些通过了热力学和环境特性筛选(临界温度和全球变暖潜能值)的工质,在小型空调系统中进行了性能模拟,其中包括换热器的优化。发现当考虑到更实际的系统时,存在于理想分析中的效率和制冷量之间的平衡就消失了。最高效率出现在较高单位容积制冷量附近,但存在于这个范围内的工质极少。

关键词：低GWP值制冷剂替代物可燃性筛选性能模拟单位容积制冷量

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Reprogramming cholesterol metabolism in macrophages and its role in host defense against cholesterol-dependent cytolysins

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Cellular & Molecular Immunology 2022年第3期19卷 327-336页

作者： Min-Sub Lee steven j.Bensinger Department of Molecular and Medical Pharmacology University of CaliforniaLos AngelesCA90095USA Department of Microbiology Immunology and Molecular GeneticsUniversity of CaliforniaLos AngelesCA90095USA

Cholesterol is a critical lipid for all mammalian cells,ensuring proper membrane integrity,fluidity,and biochemical function.Accumulating evidence indicates that macrophages rapidly and profoundly reprogram their cholesterol metabolism in response to activation signals to support host defense processes.However,our understanding of the molecular details underlying how and why cholesterol homeostasis is specifically reshaped during immune responses remains less well understood.This review discusses our current knowledge of cellular cholesterol homeostatic machinery and introduces emerging concepts regarding how plasma membrane cholesterol is partitioned into distinct pools.We then discuss how proinflammatory signals can markedly reshape the cholesterol metabolism of macrophages,with a focus on the differences between MyD88-dependent pattern recognition receptors and the interferon signaling pathway.We also discuss recent work investigating the capacity of these proinflammatory signals to selectively reshape plasma membrane cholesterol homeostasis.We examine how these changes in plasma membrane cholesterol metabolism influence sensitivity to a set of microbial pore-forming toxins known as cholesterol-dependent cytolysins that specifically target cholesterol for their effector functions.We also discuss whether lipid metabolic reprogramming can be leveraged for therapy to mitigate tissue damage mediated by cholesterol-dependent cytolysins in necrotizing fasciitis and other related infections.We expect that advancing our understanding of the crosstalk between metabolism and innate immunity will help explain how inflammation underlies metabolic diseases and highlight pathways that could be targeted to normalize metabolic homeostasis in disease states.

关键词： Cholesterol Macrophages Innate Immunity Metabolism

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Adding Value to Crop Production Systems by Integrating Forage Cover Crop Grazing

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American journal of Plant Sciences 2024年第3期15卷 180-192页

作者： Robert B. Mitchell Daren D. Redfearn Kenneth P. Vogel Terry j. Klopfenstein Galen Erickson P. Stephen Baenziger Bruce E. Anderson Mary E. Drewnoski jay Parsons steven D. Masterson Marty R. Schmer Virginia L. jin USDA-ARS Wheat Sorghum and Forage Research Unit University of Nebraska-Lincoln Lincoln NE USA Department of Agronomy and Horticulture University of Nebraska-Lincoln Lincoln NE USA Department of Animal Science University of Nebraska-Lincoln Lincoln NE USA Department of Agricultural Economics University of Nebraska-Lincoln Lincoln NE USA USDA-ARS Agroecosystem Management Research Unit University of Nebraska-Lincoln Lincoln NE USA

In addition to their value as cereal grains, wheat (Triticum aestivum L.) and triticale (× Triticosecale Wittmack) are important cool-season annual forages and cover crops. Yearling steer (Bos taurus) performance was compared in the spring following autumn establishment as for age cover crops after soybean [Glycine max (L.) Merr.] grain harvest. Replicated pastures (0.4 ha) were no-till seeded in three consecutive years into soybean stubble in autumn, fertilized, and grazed the following spring near Ithaca, NE, USA. Each pasture (n = 3) was continuously stocked in spring with four yearling steers (380 ± 38 kg) for 17, 32, and 28 d in 2005, 2006, and 2007, respectively. In 2005, average daily gain (ADG) for steers grazing triticale exceeded the ADG for wheat by 0.31 kghd-1d-1. In 2006, wheat ADG exceeded that for triticale by 0.12 kghd-1d-1. In 2007, steers grazing wheat lost weight, while steers grazing triticale gained 0.20 kghd-1d-1. Based on the 3-year average animal gains valued at $1.32 kg-1, mean net return ($ ha-1 yr-1) was $62.15 for triticale and $22.55 for wheat. Since these grazed cover crops provide ecosystem services in addition to forage, grazing could be viewed as a mechanism for recovering costs and adds additional value to the system. Based on this 3-year grazing trial, triticale was superior to wheat and likely will provide the most stable beef yearling performance across years with variable weather for the western Cornbelt USA.

关键词： Cover crops Soybean Triticale Wheat

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Prophylactic fixation of the unaffected contralateral side in children with slipped capital femoral epiphysis seems favorable:A systematic review

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World journal of Orthopedics 2022年第5期13卷 515-527页

作者： steven j C Vink Renée A van Stralen Sophie Moerman Christiaan j A van Bergen Department of Orthopedic Surgery Erasmus Medical CenterRotterdam 3015GDNetherlands Department of Orthopedic Surgery University Medical Center GroningenGroningen 9713GZNetherlands Department of Orthopedic Surgery Amphia HospitalBreda 4818CKNetherlands

BACKGROUND Slipped capital femoral epiphysis(SCFE)occurs in adolescents and has an incidence of around 10 per 100000 children.Children presenting with a unilateral SCFE are 2335 times more likely to develop a contralateral SCFE than the general population.Prognostic factors that have been suggested to increase the risk of contralateral slip include a younger patient,an underlying endocrine disorder,growth hormone use and a higher radiographic posterior sloping angle.However,there is still much debate on the advantages and disadvantages of prophylactic fixation of the unaffected side in an otherwise healthy patient.AIM To investigate the risk rate of contralateral SCFE and assess the(dis)advantages of prophylactic fixation of the contralateral hip.METHODS A systematic literature search was performed in the Embase,Medline,Web of Science Core Collection and Cochrane databases.Search terms included‘slipped capital femoral epiphysis,’‘fixation,’‘contralateral,’and derivatives.The eligibility of the acquired articles was independently assessed by the authors and additional relevant articles were included through cross-referencing.Publications were considered eligible for inclusion if they presented data about otherwise healthy children with primarily unilateral SCFE and the outcomes of prophylactically pinning their unaffected side,or about the rates of contralateral slips and complications thereof.The study quality of the included articles was assessed independently by the authors by means of the methodological index for non-randomized studies criteria.RESULTS Of 293 identified unique publications,we included 26 studies with a total of 12897 patients.1762 patients(14%)developed a subsequent symptomatic contralateral slip.In addition,38%of patients developed a subsequent slip on the contralateral side without experiencing clinical symptoms.The most outspoken advantage of prophylactic fixation of the contralateral hip in the literature is prevention of an(asymptomatic)slip,thus reducing the increased risk of avascular n

关键词： Slipped capital femoral epiphysis Primary prevention Postoperative complications Risk factors Radiography

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High-energy sodium-ion hybrid capacitors through nanograin-boundary-induced pseudocapacitance of Co_(3)O_(4) nanorods

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journal of Energy Chemistry 2022年第6期31卷 338-346,I0009页

作者： Wenliang Feng Venkata Sai Avvaru steven jHinder Vinodkumar Etacheri IMDEA Materials Institute C/Eric Kandel 2GetafeMadrid 28906Spain Universidad Politécnica de Madrid E.T.S.de Ingenieros de Caminos28040 MadridSpain Universidad Autónoma de Madrid C/Francisco Tomás y Valiente728049 MadridSpain Surface Analysis Laboratory Faculty of Engineering and Physical Sciences University of Surrey GuildfordSurrey GU27XHUnited Kingdom

Sodium-ion hybrid capacitors (SICs) have been proposed to bridge performance gaps between batteries and supercapacitors,and thus realize both high energy density and power density in a single configuration.Nevertheless,applications of SICs are severely restricted by their insufficient energy densities (<100Wh/kg) resulted from the kinetics imbalance between cathodes and anodes.Herein,we report a nanograin-boundary-rich hierarchical Co_(3)O_(4) nanorod anode composed of~20 nm nanocrystallites.Extreme pseudocapacitance (up to 72%@1.0 mV/s) is achieved through nanograin-boundary-induced pseudocapacitive-type Na^(+) storage process.Co_(3)O_(4) nanorod anode delivers in this case highly reversible capacity (810 mAh/g@0.025 A/g),excellent rate capability (335 mAh/g@5.0 A/g),and improved cycle stability (100 cycles@1.0 A/g with negligible capacity degradation).The outstanding performance can be credited to the hierarchical morphology of Co_(3)O_(4) nanorods and the well-designed nanograinboundaries between nanocrystallites that avoid particle agglomeration,induce pseudocapacitive-type Na^(+) storage,and accommodate volume variation during sodiation-desodiation processes.Nitrogendoping of the Co_(3)O_(4) nanorods not only generates defects for extra surficial Na^(+) storage but also increases the electronic conductivity for efficient charge separation and lowers energy barrier for Na^(+) intercalation.Synergy of conventional reaction mechanism and pseudocapacitive-type Na^(+) storage enables high specific capacity,rapid Na^(+) diffusion,and improved structural stability of the Co_(3)O_(4) nanorod electrode.The SIC integrating this highly pseudocapacitive anode and activated carbon cathode delivers exceptional energy density (175 Wh/kg@40 W/kg),power density (6632 W/kg@37 Wh/kg),cycle life (6000 cycles@1.0 A/g with a capacity retention of 81%),and coulombic efficiency (~100%).

关键词： Sodium-ion hybrid capacitor Cobalt oxide nanorod Nanograin-boundary Pseudocapacitance

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Benchmark Computations of the Phase Field Crystal and Functionalized Cahn-Hilliard Equations via Fully Implicit,Nesterov Accelerated Schemes

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Communications in Computational Physics 2023年第2期33卷 367-398页

作者： jea-Hyun Park Abner j.Salgado steven M.Wise Department of Mathematics University of California Santa BarbaraCA 93106USA Department of Mathematics University of Tennessee KnoxvilleTN 37996USA.

We introduce a fast solver for the phase field crystal(PFC)and functionalized Cahn-Hilliard(FCH)equations with periodic boundary conditions on a rectangular domain that features the preconditioned Nesterov’s accelerated gradient descent(PAGD)method.We discretize these problems with a Fourier collocation method in space,and employ various second-order schemes in time.We observe a significant speedup with this solver when compared to the preconditioned gradient descent(PGD)method.With the PAGD solver,fully implicit,second-order-in-time schemes are not only feasible to solve the PFC and FCH equations,but also do so more efficiently than some semi-implicit schemes in some cases where accuracy issues are taken into account.Benchmark computations of four different schemes for the PFC and FCH equations are conducted and the results indicate that,for the FCH experiments,the fully implicit schemes(midpoint rule and BDF2 equipped with the PAGD as a nonlinear time marching solver)perform better than their IMEX versions in terms of computational cost needed to achieve a certain precision.For the PFC,the results are not as conclusive as in the FCH experiments,which,we believe,is due to the fact that the nonlinearity in the PFC is milder nature compared to the FCH equation.We also discuss some practical matters in applying the PAGD.We introduce an averaged Newton preconditioner and a sweeping-friction strategy as heuristic ways to choose good preconditioner parameters.The sweeping-friction strategy exhibits almost as good a performance as the case of the best manually tuned parameters.

关键词： Phase field crystal functionalized Cahn-Hilliard preconditioning Nesterov acceleration nonlinear solver.

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Natural history,clinical characteristics,outcomes,and long-term follow-up of pain-free chronic pancreatitis

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Gastroenterology Report 2023年第1期11卷 309-315页

作者： Awais Ahmed Ishani Shah Rachel Bocchino steven D.Freedman Darshan j.Kothari Sunil G.Sheth Department of Medicine Division of GastroenterologyBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Medicine Division of Internal MedicineBeth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA Department of Medicine Division of GastroenterologyDuke UniversityDurhamNCUSA

Background:Chronic pancreatitis(CP)is characterized by chronic abdominal pain and functional insufficiency.However,a small subset of patients with prior acute pancreatitis(AP)and/or underlying risk factors for developing CP may be pain-free at diagnosis and may have a different clinical course.We aimed to compare the clinical characteristics,outcomes,and healthcare utilization between CP patients with and without pain.Methods:Reviewed patients with established CP were followed in our Pancreas Center between january 2016 and April 2021.Patients without risk factors for developing CP and/or without AP prior to their diagnosis and only with incidental radiologic features of CP were excluded,so as tominimize confounding factors of pancreatopathy unrelated to CP.Patients were divided into painful and pain-free groups to analyze differences in demographics,outcomes,and healthcare utilization.Results:Of 368 CP patients,49(13.3%)were pain-free at diagnosis and had remained so for>9 years.There were no significant differences in body mass index,race,sex,or co-morbidities between the two groups.Pain-free patients were older at diagnosis(53.9 vs 45.7,P=0.004)and had less recurrent AP(RAP)(43.8%vs 72.5%,P<0.001)and less exocrine pancreatic insufficiency(EPI)(34.7%vs 65.7%,P<0.001).Pain-free patients had less disability(2.2%vs 22.0%,P=0.003),mental illness(20.4%vs 61.0%,P<0.001),surgery(0.0%vs 15.0%,P=0.059),and therapeutic interventions(0.0%vs 16.4%,P=0.005)for pain.Conclusions:We described a unique subset of patients with underlying risk factors for CP and/or prior AP who were painfree at diagnosis.They were older at diagnosis,had less EPI and RAP,and overall favorable outcomes with minimal resource utilization.

关键词： chronic pancreatitis pain-free pancreatic insufficiency diabetes

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