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Indiscriminate disposal of agricultural wastes causes detrimental effects on the environment. Utilization of waste biomasses, and renewable feedstocks, for the production of value-added products, contributes to the economy. Potato peel is considered an interesting source of several bioactive compounds, among which are phenolic compounds, glycoalkaloids, polysaccharides, proteins, and vitamins. In this work, facile green synthesis of the semiconductor CuO nanoparticles using potato peel extract as a stabilizing agent was performed. The fabricated nanoparticles were characterized using field emission scanning electron microscopy, atomic force microscopy, X-ray diffraction, Fourier transform infrared spectrometer, thermogravimetric analysis, diffuse reflectance spectroscopy, and antibacterial tests, and then used for direct red 80 dye removal with the photocatalytic degradation and advanced oxidation processes. The prepared monoclinic crystalline nanoparticles represented 19.1 nm average crystallite size, 1.75 eV bandgap energy, and remarkable inhibition zone diameters of 21 and 27 mm for the growth of gram-negative and gram-positive bacteria, respectively. The dye degradation kinetics was fast with about 30 min needed to reach equilibrium, and more than 90% of the dye was removed in the first 2 min. The dye degradation was fitted to the pseudo-first-order Langmuir–Hinshelwood model.

[Display omitted] • GA-MOF was successfully in-situ synthesized in the CS matrix. • GM-CS/GA-MOF nanocomposite hydrogel beads was prepared via a simple approach. • GM-CS/GA-MOF displayed controlled release with a minor initial burst release. • GM-CS/GA-MOF showed notable antibacterial activity. • GM-CS/GA-MOF exhibited a cytocompatibility nature toward HFF2 cells. In the history of modern medicine, there has been a serious risk of antibacterial drugs as losing their effectiveness against bacteria. In this regard, nanocomposite hydrogel beads based on biopolymers such as chitosan (CS) have been recently developed as antibacterial platform. In this work, antibacterial copper-gallic acid metal–organic framework (GA-MOF) were developed to increase the biological efficiency of CS hydrogel beads. To end this, in-situ synthesis method was used to grow different concentration of GA-MOF into the hydrogel matrix. Also, gentamicin (GM) as the antibacterial drug was preloaded in the preparation of CS hydrogel beads to further enhance the antibacterial properties. Various analysis techniques were utilized for the validation of successful nanocomposites construction. In-vitro GA and GM release in the simulated physiological environmental (PBS, pH 7.4) were considered, revealing a controlled and sustained release profile during 72 h. Antibacterial studies showed inhibition zone of 26 ± 0.5 and 18 ± 0.5 mm for the Staphylococcus aureus and Escherichia coli bacteria, respectively. In addition, the MTT assay demonstrated good cytotoxicity (over 70 % cell viability after 48 h) for the human skin fibroblast HFF-2 cells. According to the results, the prepared nanocomposites have a good potential for use as an antibacterial bioplatform. [ABSTRACT FROM AUTHOR]

Background: Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes. Objectives: To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3–4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice. Methods: A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results. Results: Base-case results indicate that the intervention leads to cost savings (− £435) and improved effectiveness (+ 0.028 QALYs) over the patient’s lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall long-term cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs. Conclusions: The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3–4 undergoing angiographic procedures.

Post-traumatic stress disorder (PTSD) genetics are characterized by lower discoverability than most other psychiatric disorders. The contribution to biological understanding from previous genetic studies has thus been limited. We performed a multi-ancestry meta-analysis of genome-wide association studies across 1,222,882 individuals of European ancestry (137,136 cases) and 58,051 admixed individuals with African and Native American ancestry (13,624 cases). We identified 95 genome-wide significant loci (80 new). Convergent multi-omic approaches identified 43 potential causal genes, broadly classified as neurotransmitter and ion channel synaptic modulators (for example, GRIA1, GRM8and CACNA1E), developmental, axon guidance and transcription factors (for example, FOXP2, EFNA5and DCC), synaptic structure and function genes (for example, PCLO, NCAM1and PDE4B) and endocrine or immune regulators (for example, ESR1, TRAF3and TANK). Additional top genes influence stress, immune, fear and threat-related processes, previously hypothesized to underlie PTSD neurobiology. These findings strengthen our understanding of neurobiological systems relevant to PTSD pathophysiology, while also opening new areas for investigation.

Background: Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative management is considered to be as important as the surgery itself. A bioabsorbable corticosteroid-eluting sinus implant (CESI) (Propel®, mometasone furoate 370 µg) has been used as an alternative post-FESS treatment. Objective: The objective of this study was to assess the cost effectiveness of the corticosteroid-eluting implant versus non-corticosteroid-eluting spacer following FESS for treatment of patients with CRS. Methods: A decision tree model was developed to estimate the cost and effectiveness in each strategy. Costs and effects were estimated from a UK National Health Service (NHS) and personal social services perspective over a 6-month time horizon. Model pathways and parameters were informed by existing clinical guidelines and literature and sensitivity analyses were conducted to explore uncertainties in base-case assumptions. Results: Over a 6-month time horizon, inserting CESI at the end of FESS is less costly (£4646 vs. £4655 per patient) and is the more effective intervention [total quality-adjusted life-years (QALYs) over 6 months 0.443 vs. 0.444] than non-corticosteroid-eluting spacers; hence, it is a dominant strategy. The probabilistic analysis results indicate that CESI following FESS has a 62% probability of being cost effective at the £20,000/per QALY willingness-to-pay threshold and 56% probability of being a cost-saving intervention. Conclusions: The use of CESI after FESS results in fewer post-operative complications than non-corticosteroid-eluting implants and may be a cost-saving technology over a 6-month time horizon. Although the cost of initial treatment with the CESI is greater, cost savings are made due to a reduction in the number of complications experienced.

Background: Acute coronary syndrome patients receiving dual antiplatelet therapy who need emergent or urgent cardiac surgery are at high risk of major bleeding, which can impair postoperative outcomes. CytoSorb®, a blood purification technology based on adsorbent polymer, has been demonstrated to remove ticagrelor from blood during on-pump cardiac surgery. Objective: The aim of this study was to evaluate the cost utility of intraoperative removal of ticagrelor using CytoSorb versus usual care among patients requiring emergent or urgent cardiac surgery in the UK. Methods: A de novo decision analytic model, based on current treatment pathways, was developed to estimate the short- and long-term costs and outcomes. Results from randomised clinical trials and national standard sources such as National Health Service (NHS) reference costs were used to inform the model. Costs were estimated from the NHS and Personal Social Services perspective. Deterministic and probabilistic sensitivity analyses (PSAs) explored the uncertainty surrounding the input parameters. Results: In emergent cardiac surgery, intraoperative removal of ticagrelor using CytoSorb was less costly (£12,933 vs. £16,874) and more effective (0.06201vs. 0.06091 quality-adjusted life-years) than cardiac surgery without physiologic clearance of ticagrelor over a 30-day time horizon. For urgent cardiac surgery, the use of CytoSorb was less costly than any of the three comparators—delaying surgery for natural washout without adjunctive therapy, adjunctive therapy with short-acting antiplatelet agents, or adjunctive therapy with low-molecular-weight heparin. Results from the PSAs showed that CytoSorb has a high probability of being cost saving (99% in emergent cardiac surgery and 53–77% in urgent cardiac surgery, depending on the comparators). Cost savings derive from fewer transfusions of blood products and re-thoracotomies, and shorter stay in the hospital/intensive care unit. Conclusions: The implementation of CytoSorb as an intraoperative intervention for patients receiving ticagrelor undergoing emergent or urgent cardiac surgery is a cost-saving strategy, yielding improvement in perioperative and postoperative outcomes and decreased health resource use.

The aim of the present study was to evaluate the potential and challenges of electrospun Nafion membranes as gel polymer electrolytes (GPEs) for application in lithium-ion batteries. The pure Nafion membranes encountered certain challenges that were successfully addressed by incorporating poly(ethylene oxide) (PEO) as a carrier polymer and poly(vinyl alcohol) (PVA) as an auxiliary polymer. This integration led to substantial enhancements in the membrane characteristics and overall performance. The properties of the prepared electrospun membranes were evaluated using different characterization techniques including scanning electron microscopy (SEM), tensile analysis, contact angle measurements, differential scanning calorimetry (DSC), and linear sweep voltammetry (LSV). The obtained results demonstrated that the electrospun Nafion/PVA membranes exhibited a notably high ionic conductivity of 5 mS/cm, which was considerably higher than that of recast Nafion membranes (0.22 mS/cm). Moreover, the membranes demonstrated exceptional electrochemical stability up to 7 V. Furthermore, the electrospun Nafion/PVA membranes displayed an impressive discharge capacity of approximately 117 mAh/g at 0.1 C, accompanied by remarkable long-term cyclic stability. Even after 50 cycles, the membranes maintained a Coulombic efficiency of 89%. These results highlight the superior battery performance and reliability of the developed membranes.

MnO2has garnered significant interest as a cathode material for aqueous zinc-ion batteries (ZIBs) owing to its cost-effectiveness and abundance of manganese. Nevertheless, its practical application is hindered by significant volume changes during charge/discharge processes, along with its intrinsic poor conductivity. In this study, we have designed a nanocomposite structure by concurrently synthesizing MnO2and electrochemically unzipping multiwalled carbon nanotubes (MWCNTs) into partially oxidized graphene nanosheets using a one-step pulse potential electrodeposition method. This in-situ generated MnO2/partially oxidized graphene nanostructure, employed as a cathode material in ZIBs, displays an impressive reversible capacity of 314.7 mA h g–1at a rate of 0.1 A g–1, along with outstanding capacity retention of 94.2% after 3000 cycles at 2 A g–1. The remarkable electrochemical performance can be ascribed to the improved electronic conductivity, remarkable structural stability, and substantial surface area of the electrode. Consequently, our study introduces a promising strategy for fabricating high-performance and long-lasting cathodes for ZIBs.

Paleo-liquefaction features of sand dykes and sand blows were identified in the 1990s at multiple host sediments in the Fraser River delta in southern British Columbia all younger than 3500 BP. These paleo-liquefaction sites could be linked to Cascadia subduction earthquakes. Empirical magnitude-bound relationships are often used to estimate paleo-earthquake magnitudes. To determine the lower bound magnitude of Cascadia interface earthquakes that could have generated the paleo-liquefaction features, we use ground motion prediction equations for interface earthquakes from the sixth Canadian seismic hazard model of the 2020 National Building Code of Canada. We estimate the minimum Mand its peak ground acceleration (amax) of an interface earthquake required to initiate paleo-liquefaction in the study region. Starting with three full-rupture deterministic scenarios of varying source-to-site distance, we determine the minimum Mrequired from Cascadia subduction zone interface mega-thrust earthquakes to induce liquefaction in the Fraser River delta spans 8.0–8.9 with a corresponding amaxrange of 0.09–0.13g. We also perform a back-calculation paleo-liquefaction analysis in a probabilistic framework to incorporate aleatory uncertainties (cone penetration resistance, groundwater table, and amax) and epistemic uncertainties (liquefaction simplified model) via the Monte Carlo simulation. The developed probabilistic methodology is also applicable to a forward liquefaction assessment and other liquefaction sites globally. The median Mfrom this probabilistic paleo-liquefaction for the four investigated sites lies between 8.8 and 9.0. Our probabilistic results also reveal that Cascadia interface earthquakes with M> 8.9 lead to a 31%–57% probability of liquefaction triggering in the Fraser River delta. In addition, we developed deterministic and probabilistic magnitude-bound curves specific to Cascadia interface earthquakes and representative site class E conditions. These curves provide more accurate magnitude estimations for predicting seismic-induced liquefaction from Cascadia interface earthquakes for sites in the Pacific Northwest than empirical bound curves.

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A Haar cascade classifier is a machine learning (ML) algorithm used for object detection. In this paper, the Haar algorithm is introduced in the context of a non-destructive evaluation of fibrereinforced composite (FRC) structures. The Haar learning model is used for flaw identification from thermal images. Thermal images are created from cross-ply (CP) carbon fibre-reinforced laminates with flat-bottomed holes (6–10 mm) of different depths from the surface (0.5–1.5 mm). After training is complete, the model successfully detects similar artificial flaws in previously unseen thermal images. In doing so, the feasibility of Haar classifiers for automatic evaluation of FRCs is established.

Background: Surgical site infections (SSIs) account for up to 18% of all healthcare-associated infections (HAIs). The Caresyntax data-driven surgery platform incorporates the most common risk factors for SSI, to identify high-risk surgical patients before they leave the operating theatre and treat them prophylactically with negative pressure wound therapy (NPWT). An economic analysis was performed to assess the costs and health outcomes associated with introduction of the technology in the English healthcare setting. Methods: A hybrid decision tree/Markov model was developed to reflect the treatment pathways that patients undergoing colorectal surgery would typically follow, both over the short term (30-day hospital setting) and long term (lifetime). The analysis considered implementation of Caresyntax’s platform-based SSI predictive algorithm in the hospital setting, compared with standard of care, from an English National Health Service (NHS) perspective. The base-case analysis presents results in terms of cost per quality-adjusted life-year (QALY) gained, as well as operational impact. Results: The base-case analysis indicates that the intervention leads to a cost saving of £55.52m across the total NHS colorectal surgery patient population in 1 year. In addition, the intervention has a 98.36% probability of being cost effective over a lifetime horizon. The intervention results in the avoidance of 19,744 SSI events, as well 191,911 excess hospital bed days saved. Conclusion: Caresyntax’s platform-based SSI predictive algorithm has the potential to result in cost savings and improved patient quality of life. Additionally, operational gains for the healthcare provider, including reduced infection rates and hospital bed days saved, have been shown through the economic modeling.

Varicella usually resolves without complications. However, there is a risk of necrotizing soft tissue infections such as necrotizing fasciitis (NF) that can complicate the management.

Surface molecularly imprinted polymers (MIPs) are an efficient and rapidly advancing approach, increasingly being utilized in drug delivery systems (DDSs). This research involved synthesizing a core-shell structure, consisting of a metal-organic framework (MOF) core and a doxorubicin (DOX) imprinted polymethacrylamide shell, prepared via precipitation polymerization method in green media. The resulting MOF@MIP was utilized as a nanocarrier for DOX delivery, exhibiting high drug loading capacity and pH responsiveness delivery. The materials were characterized using different techniques such as X-ray diffraction (XRD), scanning electron microscopy (SEM), fourier transform infrared (FTIR), transmission electron microscopy (TEM), dynamic light scattering (DLS), thermal gravimetric analysis (TGA), and zeta potential (ZP). In vitro studies on DOX loading and release demonstrated that a higher amount of DOX was released in a sustained manner under tumor tissue conditions (pH 5, 41 °C) compared to normal physiological conditions (pH 7.4, 37 °C). Additionally, cytotoxicity evaluations revealed significant cytotoxic effects of DOX-loaded MOF@MIP on MCF-7 cells (IC50: 2 μg/mL). Based on these findings, the synthesized MOF@MIP shows promise as a potential candidate for the development of anticancer therapeutic delivery platforms.

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Background: Nonalcoholic steatohepatitis (NASH) is characterized by inflammation and hepatocellular damage caused by accumulation of fat in the liver. Resmetirom (MGL-3196) is an orally administered, small-molecule, liver-targeted, selective thyroid hormone receptor-βagonist. This early analysis explored the potential cost effectiveness of resmetirom for the treatment of NASH from a US commercial payer perspective. Methods: An early economic model was developed to reflect the clinical pathways typically followed by patients with NASH and liver fibrosis. Use of resmetirom, compared with placebo, was assessed. The Markov model structure was informed by a previous modeling study and a randomized, double-blind, placebo-controlled, phase II trial of resmetirom. Costs and outcomes were assessed over a lifetime time horizon with results presented in terms of cost per quality-adjusted life-year (QALY) gained. Results: Resmetirom treatment resulted in increased costs of US$66,764 per patient, while increasing QALYs by 1.24. The incremental cost-effectiveness ratio was US$53,929 per QALY gained, indicating resmetirom treatment would potentially be cost effective at a willingness-to-pay (WTP) threshold of US$100,000. Results indicated that resmetirom would reduce the lifetime number of cases of decompensated cirrhosis (− 87), hepatocellular carcinoma (− 59), and liver transplants (− 30) per 1,000 patients compared with placebo. Resmetirom treatment remained cost effective at a US$100,000 WTP threshold up to a daily price point of US$72.00. Conclusion: Resmetirom is a potentially cost-effective treatment option for patients with NASH and liver fibrosis based on an analysis performed from a US commercial payer perspective. Future economic analyses of the technology should, however, focus on overcoming the limitations of existing modeling methodology.

In the composite industry, wet lay-up and vacuum bagging are widely used, low-cost manufacturing processes. This paper investigates the mechanical performance of wet layup and vacuum bagged carbon fibre-reinforced laminates compressed in a hydraulic press at different compaction pressures. The external compaction pressure is shown to significantly reduce void content, and increase the fibre volume fraction and mechanical performance of tested laminates. The tensile and flexural properties of tested specimens subjected to high levels of external compaction pressure are found to be comparable to those of out-of-autoclave (OOA) prepreg specimens. It is summised that the use of external compaction pressure over wet layup and vacuum bagged composites offers a low-cost (and low-energy) industrial processing route for manufacturing high-performance carbon fibre-reinforced components.

In the composite industry, wet lay-up and vacuum bagging are widely used, low-cost manufacturing processes. This paper investigates the mechanical performance of wet layup and vacuum bagged carbon fibre-reinforced laminates compressed in a hydraulic press at different compaction pressures. The external compaction pressure is shown to significantly reduce void content, and increase the fibre volume fraction and mechanical performance of tested laminates. The tensile and flexural properties of tested specimens subjected to high levels of external compaction pressure are found to be comparable to those of out-of-autoclave (OOA) prepreg specimens. It is summised that the use of external compaction pressure over wet layup and vacuum bagged composites offers a low-cost (and low-energy) industrial processing route for manufacturing high-performance carbon fibre-reinforced components.

Smoking is a common public problem leading to increases in oxidative stress and decreases in the levels of some micronutrients, finally affecting adipokine levels. The aim of this study was to compare the serum levels of omentin (intelectin-1), chemerin, TNF-α, and some micronutrient intakes in male smokers and non-smokers.

This research introduces an optimal adaptive fuzzy controller consisting of two fuzzy systems each including 1 output, 2 inputs, and 25 fuzzy rules. The designed fuzzy sytems, in turn, comprises Gaussian membership functions and applies the singleton fuzzifier, center average defuzzifier, and product inference engine. Moreover, the Gravitational Search Algorithm (GSA) is utilized to ascertain the optimum parameters of the controller. The body acceleration and the relative displacement between the tire and the sprung mass are utilized to form a proper objective function in the optimization procedure. Results show the dominance of the proposed approach over the conventional controllers.

Background: The most common intra-articular knee injury is a meniscal tear, which commonly occurs secondary to trauma following twisting or hyperflexion. Treatment options for meniscal tears can either be surgical or non-surgical, and range from rest, exercise, bracing and physical therapy to surgical intervention, including meniscal repair and partial meniscectomy. In patients with persistent pain following loss of meniscus tissue, treatment can include partial replacement or meniscal allograft transplantation. The NUsurface®prosthesis has been developed as a treatment option for patients experiencing persistent knee pain post medial meniscus (MM) surgery. Objective: The aim of this study was to assess the cost effectiveness of MM replacement using NUsurface for the treatment of patients with medial compartment pain following previous partial medial meniscectomy, from a UK health service perspective. Methods: An economic decision-analytic model was developed to assess the cost per quality-adjusted life-year (QALY) gained associated with the introduction of MM replacement using NUsurface compared with non-surgical standard of care, over a lifetime time horizon. The model structure was primarily informed by a previous clinical trial (VENUS) and was developed based on the clinical pathways typically followed by patients with this condition, with treatment pathways and probabilities of clinical progression adjusted depending on whether patients were receiving the intervention or undergoing current practice. A hypothetical cohort of adult patients (mean age of 50 years) was modelled, with clinical data sourced from the VENUS study as well as relevant UK literature. Both deterministic and probabilistic sensitivity analyses were carried out to explore uncertainty in the model results. Results: The base-case probabilistic results indicate that MM replacement using NUsurface is likely to be cost effective across a range of willingness-to-pay (WTP) thresholds (95% probability of being cost effective at the National Institute for Health and Care Excellence (NICE)-recommended £20,000 WTP threshold). Although per-patient costs increase, QALYs are also gained, with the incremental cost per QALY (probabilistic value = £5011) being below £20,000. Deterministic sensitivity analyses indicate that the parameters that have the greatest impact on results are the failure rate in the control group (current practice), utility scores, and the cost of undergoing MM replacement using NUsurface. Conclusions: Based on the analysis presented, MM replacement with the NUsurface prosthetic implant is likely to be a cost-effective use of UK health care service resources compared with current standard care.

Pleuropulmonary blastoma (PPB) in children can present with symptoms such as chest or abdominal pain, cough, fever, and respiratory distress, often leading to misdiagnosis as infections, pneumothorax, or pneumonia.

The objective of this systematic review of case reports is to evaluate the efficacy and safety of combining surgical sharp debridement with maggot debridement therapy (MDT) for the treatment of diabetic foot ulcers (DFUs).

ABSTRACTObjective:The prevalence of migraine is higher in patients with gastrointestinal disorders. Possible underlying mechanisms could be increased intestinal permeability and systemic inflammation. Probiotics may reduce gut permeability as well as inflammation, and therefore may improve the clinical features of migraine. This systematic review and meta-analysis aimed to evaluate the impact of probiotic supplementation on the frequency and severity of migraine attacks.Methods:A systematic review of the literature was conducted using ISI Web of Science, PubMed/Medline, Scopus, Cochrane Library, EMBASE, Google Scholar, Magiran.com and Sid.ir to identify eligible studies published up to October 2019. A meta-analysis of eligible trials was performed using the random-effects model to estimate pooled effect size.Results:Three randomized controlled trials with 179 patients (probiotic group = 94, placebo group = 85) were included. Probiotic supplementation had no significant effect on frequency (weighted mean difference (WMD) = −2.54 attacks/month, 95%CI: −5.31–0.22, p = 0.071) and severity of migraine attacks (WMD = −1.23 visual analog scale (VAS) score, 95%CI = −3.37–0.92, p = 0.262) with significant heterogeneity among the studies (I2 = 98%, p < 0.001).Conclusions:A pooled analysis of available randomized controlled clinical trials showed that probiotic supplementation had no significant effect on the frequency and severity of episodic migraine attacks.

Objective: As a recognized therapy to improve airway clearance, high-frequency chest wall oscillation (HFCWO) is used to manage reduced vital capacity in patients with complex neuromuscular disorders (cNMD). This study aimed to investigate the budget impact of HFCWO versus chest wall physical therapy (CWPT) from a US-commercial payer perspective. Methods: In combination with a previously developed cost-effectiveness model, a budget impact model was developed to evaluate the incremental budgetary impact associated with introducing a HFCWO device over a 5-year time horizon. The model compared the cost implications associated with the commonly used CWPT procedure, as the current scenario, with a new scenario consisting of 80% of market share for HFCWO. The resource use and costs included in the analyses were costs associated with the HFCWO device (Vest™ System) and its consumables, patient training, and medical services such as hospitalization, medications, emergency room, and outpatient visits. The primary outcome measures included total and incremental budgetary impact per member per year (PMPY). Results: In a hypothetical plan of 1,000,000 members (men: 49.2%), 2099 patients with cNMD were estimated to be eligible to receive airway clearance services over 5 years. The new scenario (HFCWO and CWPT [US$24 PMPY]) was cost-saving compared with the current scenario (CWPT only [$34 PMPY]) with a cost reduction of US$9.46 PMPY. The model estimated a net cost-saving of US$1,594,131 and US$9,591,343 over 1 and 5 years, respectively. Conclusion: This study suggests the HFCWO technique to manage the reduction in vital capacity in patients with cNMD would lead to favorable budget impact results.

Background: Coronary artery disease (CAD) is the most common type of heart and circulatory disease and is the leading cause of death worldwide. The current diagnostic pathway can lead to patient complications and is also extremely costly. A new medical device, the CADScor System (Acarix AB), was developed for the acoustic detection of CAD before patients undergo invasive diagnostic procedures. Objectives: Our objective was to assess the cost utility of the CADScor System for the diagnosis of CAD at an early stage in the diagnostic testing pathway in England. Methods: A two-part economic model, consisting of a decision tree and Markov model, was developed to consider the cost utility (cost per quality-adjusted life-year [QALY] gained) of introducing the CADScor System for the diagnosis of CAD. The decision tree component explored the short-term costs and diagnostic outcomes associated with introduction of the test compared with the existing testing pathway. A Markov model was developed to explore the longer-term health and economic implications of the condition and original diagnosis, with costs and health effects estimated over different time horizons. Parameter uncertainty was explored in deterministic and probabilistic sensitivity analyses. Results: Base-case results indicated that the CADScor System would result in cost savings (− £131 per patient) and a marginal increase in QALYs (0.00001) over a 1-year time horizon. Probabilistic results indicated that the intervention had a > 99% probability of being cost effective at a willingness-to-pay threshold of £20,000 per QALY gained and 100% probability of being cost saving. Results from the deterministic sensitivity analyses indicated that variations in parameters related to the accuracy and cost of the CADScor System, and the prevalence of CAD, had the greatest impact on the overall results. The overall cost saving was estimated to be over £12.3 million per 100,000 eligible patient population. Conclusions: The CADScor System is a potentially cost-saving test for the diagnosis of CAD. When initiated before the use of non-invasive cardiac imaging tests such as computed tomography coronary angiography, the test reduced costs to the healthcare service over various time horizons.

In this paper, single and two variant martensitic transformations including twinning are studied using the phase field approach based on local elasticity and nonlocal integral elasticity including the surface tension. In contrast to the well-known two-phase (TP) kernel, the compensated TP (CTP) kernel fulfills the normalization condition for the boundary region and removes boundary effects. The coupled local/nonlocal integral elasticity and Ginzburg–Landau equations are solved using the FEM and the verification of numerical procedure is presented. The local and nonlocal models with both kernels are compared for various phase transformation examples. For a single variant in a homogeneous sample under uniform applied stress, the TP kernel resolves an unphysically heterogeneous growth and consequently, the surface tension appears. In contrast, the CTP kernel and local model predict a similar homogeneous growth with zero surface tension since no interface appears. Including a boundary layer with a lower Young’s modulus than the bulk region results in a heterogeneous growth for all the models. For the creation of a stationary austenite–martensite interface, both kernels show the same solution different than that of the local model. For the formation of a martensite–martensite interface, all the models show the same solution, where the angle between the martensitic planes is in a very good agreement with existing MD simulations and analytical solution. For the embryo growth of both martensitic variants, a similar evolution occurs for the local model and the CTP kernel. Generally, the CTP kernel gives a maximum stress larger than the TP kernel and lower than the local model. However, the kernel can predict larger stresses than the local model if their morphologies are not similar at the same time. For the creation of twin structures, both kernels lead to a larger number of twins since they resolve lower stresses than the local model and their twin structures are the same since they are not affected by the boundaries due to their large distance. The ratio of the characteristic length to the martensite–martensite interface width is also found as a key parameter in resolving the twin structure. For the two variant martensitic transformation in the presence of a crack, despite a similar evolution, the TP kernel and the local model show the fastest and slowest transformations, as well as the lowest and highest stress concentrations at the crack tip, respectively. However, the local model shows a lower stress concentration when austenite appears at the crack tip. In all the given examples, the surface tension is found generally much smaller than the total stress; thus, it shows no practical effect on the PT.

Background: Targeted temperature management (TTM) has been shown to improve neurological outcomes and survival in patients resuscitated from cardiac arrest; however, the cost effectiveness of multiple TTM methods is not well studied. Objective: This study aimed to evaluate the cost effectiveness of intravascular temperature management (IVTM) using Thermogard XP compared with surface cooling methods after cardiac arrest in the England from the perspectives of the UK national health service and Personal Social Services. Methods: We developed a multi-state Markov model that evaluated IVTM (Thermogard XP) compared with surface cooling using two different devices (Blanketrol III and Arctic Sun 5000) over a short-term and lifetime time horizon. Model input parameters were obtained from the literature and local databases. We assumed a hypothetical cohort of 1000 patients who required TTM after cardiac arrest per year in the England. The outcomes were costs (in £, year 2019 values) and quality-adjusted life-years (QALYs), discounted at 3.5% annually. Deterministic and probabilistic sensitivity analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results. Results: The cost-effectiveness analysis determined that Thermogard XP resulted in direct cost savings of £2339 and £2925 (per patient) compared with Blanketrol III and Arctic Sun 5000, respectively, and a gain of 0.98 QALYs over the patient lifetime. The probabilistic sensitivity analysis demonstrated that the probability of Thermogard XP being cost saving would be 69.2% and 65.3% versus the Arctic Sun 5000 and Blanketrol III, respectively. Conclusion: Implementation of IVTM using Thermogard XP can lead to cost savings and improved patient quality of life versus surface cooling methods.

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Double-layer graphene nanoribbons promise potential application in nanoelectromechanical systems and optoelectronic devices, and knowledge about mechanical stability is a crucial parameter to flourish the application of these materials at the next generation of nanodevices. In this paper, molecular mechanics is utilized to investigate nonlinear buckling behavior, critical buckling stress, and lateral deflection of double-layered graphene nanoribbons under various configurations of stacking mode and chirality. The implicit arc-length iterative method (modified Riks method) with Ramm’s algorithm is utilized to analyze the nonlinear structural stability problem. The covalent bonds are modeled using three-dimensional beam elements in which elastic moduli are calculated based on molecular structural mechanics technique, and the interlayer van der Waals (vdW) interactions are modeled with nonlinear truss elements. An analytical expression for Young’s modulus of nonlinear truss elements is derived based on the Lennard–Jones potential function and implemented in numerical simulation with a UMAT subroutine based on FORTRAN code to capture the nonlinearity of the vdW interactions during the buckling analysis. The results indicate that the highest critical buckling stress and the minimum lateral deflection occur for armchair and zigzag chirality, both with AB stacking mode, respectively. Moreover, the critical buckling stress is found to be directly dependent on the mode shape number regardless of in-phase or anti-phase deflection direction of layers. Lateral deflection exhibits a similar trend with mode shape in anti-phase mode; however, it is decreasing by increasing mode shape number in in-phase mode.

ABSTRACTIntroduction:Migraine is a disabling neurovascular disorder characterized by increasing levels of pro-inflammatory cytokines and oxidative stress biomarkers. Curcumin and coenzyme Q10 (CoQ10) can exert neuroprotective effects through modulation of inflammation and oxidative stress. The aim of the present study was to evaluate the combined effects of nano-curcumin and CoQ10 supplementation on migraine symptoms and quality of life in migraine patients.Methods:One-hundred men and women (mean age 32 years) with episodic migraine based on the International Headache Society (IHS) criteria participated in this study. The subjects were randomly divided into four groups as (1) combination of nano-curcumin (80 mg) plus CoQ10 (300 mg), (2) nano-curcumin (80 mg), (3) CoQ10 (300 mg) and (4) the control (nano-curcumin and CoQ10 placebo included oral paraffin oil) beside usual prophylactic drugs for 8 weeks. Frequency, severity, duration of headache attacks, the headache diary results (HDR) and headache disability based on migraine-specific questionnaires were assessed at the baseline and end of the study.Results:Ninety-one of 100 patients completed the study. The results showed a significant effect of nano-curcumin and CoQ10 supplementation on frequency, severity, duration of migraine attacks and HDR compared to other groups (All P < 0.001). Nano-curcumin and CoQ10 group also had better scores in migraine-specific questionnaires at the end of the study compared to other groups (All P < 0.001). There were no side effects reported by the participants.Conclusions:These findings suggest a possible synergistic effect of nano-curcumin and CoQ10 on clinical features of migraine.Trial registration number:IRCT2017080135444N1.

Background: Respiratory rate (RR) is one of the most important physiologic measures for predicting patients’ deterioration of clinical condition and final prognosis. In several studies, RR has been the most important predictor of patients’ prognoses. Objectives: The objective of this study was to conduct a cost-utility analysis to estimate the cost and effectiveness of automatic respiratory rate monitoring (ARRM) with a non-invasive sensor (RespiraSense™) plus intermittent nurse-led RR monitoring (ARRM strategy) compared with intermittent nurse-led RR monitoring (IM strategy) in patients admitted to hospital in the UK with pneumonia. Methods: A decision analytic model was developed based on a hypothetical cohort of patients who were admitted to hospital with pneumonia. After admission, the patients could be monitored with either ARRM or IM strategies. The outcomes of interest included total costs and total effectiveness of each strategy, including length of stay (LoS) in hospital, LoS in intensive care unit, quality-adjusted life-years (QALYs), deaths, and incremental cost per QALY gained. An incremental cost of £20,000 or less per QALY gained was considered cost effective. A lifetime time horizon (38 years) was used to capture the long-term benefits. Probabilistic and deterministic sensitivity analyses were performed. Results: Total costs of patient care in ARRM and IM strategies were £1986.9 million and £2079.4 million, respectively. Total incremental QALYs lived were 3548 higher in the intervention arm (ARRM), meaning that the ARRM strategy was dominant (i.e., less costly [£92.6 million less] and more effective). The results were stable in probabilistic and most of the deterministic sensitivity analyses. Results from threshold analysis indicated that a minimum of 7 and 10% improvement in percentage of early detection of respiratory compromise is required for ARRM to become cost effective and cost saving, respectively. Conclusions: Our results indicate that ARRM using RespiraSense, in addition to intermittent nurse-led monitoring of RR, in patients admitted to the hospital with pneumonia could be a cost-saving and cost-effective intervention if the minimum clinical thresholds are met.