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AbstractAimsTo compare long-term healthcare resource utilization (HCRU) and costs among patients who initiated ixekizumab (IXE) or adalimumab (ADA) for treatment of psoriasis in the United States.MethodsAdult patients with psoriasis who had ≥1 claim for IXE or ADA were identified from IBM MarketScan claims databases prior to the COVID-19 pandemic (1 March 2016–31 October 2019). The index date was the date of first claim for the index drug of interest. Inverse probability of treatment weighting was employed to balance treatment cohorts. All-cause and psoriasis-related HCRU and costs were examined for 24 months of follow-up. Costs were reported as per patient per month. Costs of psoriasis-related biologics were adjusted using published Institute for Clinical and Economic Review (ICER) discount factors. Index drug costs were adjusted for adherence and ICER discount rates.ResultsThe analyses included 407 IXE and 2,702 ADA users. IXE users had significantly higher inpatient admission rate (all-cause HCRU: 14.9% vs. 11.0%; p =0.012) and greater mean length of stay per admission (days, 6.6 vs. 4.1; p =0.004) than ADA users. ICER-adjusted costs were significantly higher in IXE than ADA users (all-cause costs: $4,132 vs. $3,610; p <0.001; psoriasis-related costs $3,077 vs. $2,700; p <0.001). After adjusting for ICER and adherence, IXE and ADA drug costs were comparable ($3,636 vs. $3,677; p =0.714).LimitationsStudy relied on administrative claims data, subjected to data coding limitations and data entry errors. Rebates, patient assistance programs, and commission to wholesalers are not always captured in claims. Adjustment made by ICER discount factors may lead to double-discounting if the discounts have been applied in claim payments.ConclusionsAll-cause HCRU was higher in IXE than ADA users. Healthcare costs were also higher in IXE than ADA users after ICER adjustment, over 24 months. Cost differences were largely driven by higher treatment adherence associated with IXE. Index drug costs were comparable after ICER and adherence adjustments.

Objective: The aim of this study was to compare healthcare costs between ixekizumab (IXE)-treated and secukinumab (SEC)-treated patients with psoriasis over a 24-month follow-up period in the United States. Methods: Patients with psoriasis diagnosis were identified from IBM Watson Health MarketScan®Research Databases; those with one or more claim for index drug (IXE or SEC) between March 1, 2016 and October 31, 2019 were included. Included patients were ≥ 18 years old and had continuous enrollment with medical and pharmacy benefits ≥ 6 months before and ≥ 24 months after index date. Patients were classified as IXE or SEC users based on drug received at index. Per patient per month (PPPM) all-cause, psoriasis-related, and index drug costs for IXE and SEC users were estimated over 24 months of follow-up. Institute for Clinical and Economic Review (ICER) discount factors were applied to adjust pharmacy costs. Index drug costs were additionally adjusted for adherence. Inverse probability of treatment weighting was used to address cohort imbalances. Chi-square/ttests were used to compare IXE versus SEC users; pvalue &lt; 0.05 was considered statistically significant. Results: Overall, 1461 patients (IXE users, n= 471; SEC users, n= 990) were included. IXE versus SEC users had higher weighted PPPM all-cause, psoriasis-related, and index drug costs (p ≤ 0.001). IXE versus SEC users had comparable ICER-adjusted mean PPPM all-cause costs (US$4172 ± 3349 vs US$3978 ± 2619; p = 0.227) and psoriasis-related costs (US$2950 ± 1332 vs US$2899 ± 1152; p = 0.447). After applying ICER and adherence adjustments, index drug costs were similar between IXE and SEC users (US$3794 ± 1822 vs US$3766 ± 1973; p = 0.795). Conclusions: All-cause and psoriasis-related costs were comparable between IXE and SEC users after ICER adjustments; index drug costs were similar after ICER and adherence adjustments.

Tropical forests store 40–50 per cent of terrestrial vegetation carbon1. However, spatial variations in aboveground live tree biomass carbon (AGC) stocks remain poorly understood, in particular in tropical montane forests2. Owing to climatic and soil changes with increasing elevation3, AGC stocks are lower in tropical montane forests compared with lowland forests2. Here we assemble and analyse a dataset of structurally intact old-growth forests (AfriMont) spanning 44 montane sites in 12 African countries. We find that montane sites in the AfriMont plot network have a mean AGC stock of 149.4 megagrams of carbon per hectare (95% confidence interval 137.1–164.2), which is comparable to lowland forests in the African Tropical Rainforest Observation Network4and about 70 per cent and 32 per cent higher than averages from plot networks in montane2,5,6and lowland7forests in the Neotropics, respectively. Notably, our results are two-thirds higher than the Intergovernmental Panel on Climate Change default values for these forests in Africa8. We find that the low stem density and high abundance of large trees of African lowland forests4is mirrored in the montane forests sampled. This carbon store is endangered: we estimate that 0.8 million hectares of old-growth African montane forest have been lost since 2000. We provide country-specific montane forest AGC stock estimates modelled from our plot network to help to guide forest conservation and reforestation interventions. Our findings highlight the need for conserving these biodiverse9,10and carbon-rich ecosystems.

Objective.To characterize skin severity and joint activity outcomes and associated treatment changes in patients with psoriatic arthritis (PsA) through 12 months of follow-up after enrollment in the Corrona Psoriatic Arthritis/Spondyloarthritis (PsA/SpA) Registry.Methods.Patients ≥ 18 years of age with a diagnosis of PsA and a history of psoriasis between March 21, 2013, and September 30, 2016, were enrolled (n = 647). Demographics, clinical features, and treatment characteristics were collected and stratified by skin severity and joint activity. Change in joint and skin from enrollment to the 12-month visit was classified by change in category of Clinical Disease Activity Index (CDAI) or body surface area (BSA). Tests of association evaluated the relationship between changes in therapy and changes in skin severity and joint activity.Results.Patients with improvement in both joint activity and skin severity saw the largest median reduction in both CDAI and BSA, while those who worsened in both had the greatest median increase in both CDAI and BSA. The majority of PsA patients (> 50%) had no change in skin severity regardless if they had reduced therapy (50%), no therapy changes (54%), or increased therapy (56%; P= 0.5875). However, there was a significant association between changes in therapy and changes in joint activity (P< 0.001). Patients who increased therapy were more likely to have improvement in joint activity (32%) compared to patients who reduced therapy (22%) or had no therapy changes (11%).Conclusion.The clinical implication for our findings suggests the assessment and incorporation of both skin and joint components may be advisable.

Background:Real-world data on patients newly initiating ixekizumab is limited. Our study describes the characteristics of patients who initiated ixekizumab and other biologics for psoriasis treatment in North American dermatological practices. Materials & methods:Characteristics of patients ascertained at registry enrollment are described via means and frequencies. Results:Compared with other biologic initiators, ixekizumab initiators had: longer disease duration (17.1 vs 15.1 years); more were considered least severe by body surface area (33 vs 26%); moderate-to-severe by IGA (56 vs 48%); were biologic-experienced (80 vs 52%); obese (54 vs 47%); and experienced greater impact in work productivity (5.3 vs 2.9%) versus other biologic initiators. Conclusion:Psoriasis patients initiating ixekizumab had more severe disease, biologic experience, and worse patient-reported outcomes than those initiating other biologics.

AbstractAim:To characterize treatment patterns of psoriasis patients in a large US managed care database.Materials and methods:Adults with newly-diagnosed psoriasis were identified from July 3, 2006–August 31, 2014. Patients had continuous enrollment with medical and pharmacy benefits for ≥6 months prior to and ≥1 year following the index date. The index date was the point at which any of the following inclusion criteria were satisfied: first psoriasis diagnosis by a dermatologist, ≥ 2 psoriasis diagnoses ≥30 days apart, or a diagnosis of psoriasis followed by a claim for psoriasis therapy. Of primary interest was to measure and describe the following psoriasis treatment patterns: utilization rates, time to treatment discontinuation, and lines of therapy for various therapeutic classes of pharmacologic therapies.Results:From the 128,308 patients identified, 53% were female, mean ± SD age was 50 ± 16 years, with median 3 years follow-up. Topicals were received by 86% of patients, non-biologic systemics by 13%, biologics by 6%, phototherapy by 5%, and 13% received no psoriasis-related medication. Median time from index to first treatment was 0 days for topical, 6 months for non-biologic systemic, and 6 months for biologic. Of those treated, first-line therapies included topical (95%), non-biologic systemic (4%), and biologic (2%). For those with second-line treatment, non-biologic systemic (71%) and biologic (30%) therapies were more common. The most common treatment pattern was topicals only (83%), while all other patterns comprised <5% of the treatment patterns observed.Limitations:Like other observational studies, limitations to consider when interpreting results include the 6-month pre-index period of no psoriasis or the psoriasis medication claim may not perfectly select only incident user of psoriasis medications, claims-based algorithms may not accurately represent true treatment patterns, absence of over-the-counter medications data, and having no trend analyses over time or between groups.Conclusions:While the majority of patients with psoriasis initiated a pharmacological therapy, a significant portion did not have a claim for any psoriasis medication. Topical treatments are the most commonly used treatments for psoriasis. Non-biologic systemic and biologic therapies were rarely used first line, but became more common in later lines of treatment.

AbstractAims:To describe healthcare resource utilization (HCRU) and costs among biologic-treated psoriasis patients in the US, overall and by disease severity.Materials and methods:IQVIA PharMetrics Plus administrative claims data were linked with Modernizing Medicine Data Services Electronic Health Record data and used to select adult psoriasis patients between April 1, 2010 and December 31, 2014. Eligible patients were classified by disease severity (mild, moderate, severe) using a hierarchy of available clinical measures. One-year outcomes included all-cause and psoriasis-related outpatient, emergency department, inpatient, and pharmacy HCRU and costs.Results:This study identified 2,130 biologic-treated psoriasis patients: 282 (13%) had mild, 116 (5%) moderate, and 49 (2%) severe disease; 1,683 (79%) could not be classified. The mean age was 47.6 years; 45.4% were female. Relative to mild psoriasis patients, patients with moderate or severe disease had more median all-cause outpatient encounters (28.0 [mild] vs 32.0 [moderate], 36.0 [severe]), more median psoriasis-related outpatient encounters (6.0 [mild] vs 7.5 [moderate], 8.0 [severe]), and a higher proportion of overall claims for medications that were psoriasis-related (28% [mild] vs 37% [moderate], 34% [severe]). Relative to mild psoriasis patients, patients with moderate or severe disease had higher median all-cause total costs ($37.7k [mild] vs $42.3k [moderate], $49.3k [severe]), higher median psoriasis-related total costs ($32.7k [mild] vs $34.9k [moderate], $40.5k [severe]), higher median all-cause pharmacy costs ($33.9k [mild] vs $36.5k [moderate], $36.4k [severe]), and higher median psoriasis-related pharmacy costs ($32.2k [mild] vs $33.9k [moderate], $35.6k [severe]).Limitations:The assessment of psoriasis disease severity may not have necessarily coincided with the timing of biologic use. The definition of disease severity prevented the assessment of temporality, and may have introduced selection bias.Conclusions:Biologic-treated patients with moderate or severe psoriasis cost the healthcare system more than patients with mild psoriasis, primarily driven by higher pharmacy costs and more outpatient encounters.

The objective of this study was to evaluate the gross and histo-pathological lesions caused by plastic bags in the rumen of sheep. Sixteen (16) castrated, one-year old Dorper sheep were used for the study. The animals were divided into 4 groups each consisting of 4 sheep. Three of the groups had 129g, 258g and 387g of plastic bags, respectively, introduced into the rumen through rumenotomy, while the fourth group, without implants served as control. All the animals were observed daily for 6weeks following implantation. All animals were euthanized on day 42 and subjected to gross and histopathological examination. Gross changes observed at post mortem included; atrophy of the muscle and body fat, atrophy and fibrosis of the spleen, liver, kidneys and hydropericardium. Gross lesions in the rumen included stunting, atrophy, thinning and loss of ruminal papillae, erosion, ulcerations and nodular formation on the ruminal mucosa. Histopathological examination revealed atrophy, ulceration, erosion and disruptions of the stratified epithelial layer of the papillae. Other changes included parakeratosis, hyperkeratosis, prominent rete pegs, oedema and severe hydropic degeneration of different parts of the mucosal layer. There was increased mononuclear cell infiltration, increase in the number of lymphatic vessels and lymphangiectasis in the submucosa and oedema in the muscularis and serosal layers. The pathological changes observed contributed to clinical signs and may interfere with the absorption of nutrients resulting in poor condition of the animal, and loss of production and productivity.

Some gifted people have made invaluable contributions to the world that shaped the destiny of humanity. Identification and development of gifts and talents of gifted children has been viewed as critical in tapping this valuable human resource. This study investigated the extent to which children who had demonstrated evidence of high academic capability are assisted in Kenyan primary schools to nurture their gifting. The study revealed varied practices but showed that a lot remains to be done. The findings of the study provide a useful empirical basis for action by policymakers, curriculum developers, education administrators, teachers, parents and other people interested in educational welfare of gifted children.

Chloroform extract of Prunus africana(Hook f. (Rosaceae) did not cause clinical signs or pathology in rats at daily oral doses of up to 1000 mg/kg for 8 weeks. The extract caused marked clinical signs, organ damage and a 50% mortality rate at a dose of 3.3 g/kg for 6 days. The main lesions observed at this dose were marked centrilobular hepatocellular degeneration and necrosis, diffuse nephrosis, myocardial degeneration, lymphocytic necrosis and neuronal degeneration.

Discusses the political conditions in sub-Saharan African countries. Transformation into pluralist democracy; Management of change; Internal politics; Need for civil society; Redefining the state.

The repellancy of essential oils of eight Lippia species on maize weevils was compared with NN-diethyltoluamide (DEET). The larvicidal activity of these essential oils was also examined. As a repellant, the essential oil of L. ukambensis (chemotype camphor) was the most active. Other promising repellants were the essential oils of L. javanica, L. dauensis, L. somalensis and L. grandifolia. The essential oil of L. wilmsii was the most active as a larvicide. Individual hydrocarbon monoterpene constituents were generally more active than the oxygenated constituents of the essential oils.

A 70 methanol aerial part extract of Vernonia glabra caused a fall in blood pressure in anaesthetised rats. After the 50 µg dose, systolic, diastolic, and mean blood pressures decreased by 56, 66, and 61 respectively below the baseline levels. The adrenaline-like activity of the extract was not antagonised by L(-) propranolol on isolated rabbit heart. The extract caused contraction on the isolated rabbit ileum and was abolished with atropine, suggesting the presence of a compound with acetylcholine-like activity. The extract on isolated guinea pig ileum caused contraction which was dose related.

Equines are particularly susceptible to infection withTrypanosoma evansi andT. brucei, but rarely is naturalT. congolense andT. vivax infection seen in horses. An outbreak of trypanosomosis occurred in a herd of horses used for patrolling the pineapple fields on the Del Monte Farm, Thika, Kenya initially involving 6 horses. On subsequent screening of the entire group,T. brucei,T. congolense andT. vivax infections were detected in 16 of the 35 horses. The tests used for diagnosis included microscopic examination of stained blood smears, buffy coat technique, mouse inoculation and antigen detection enzyme immunoassay (antigen ELISA).

A methanol extract of Gutenburgia cordifolia showed a greater fall in diastolic than systolic blood pressure in anaesthetised rats. The plant extract produced cardiodepressant activity on isolated rabbit heart and caused contraction on isolated rabbit ileum. The contraction was reduced but not abolished with atropine. On isolated guinea pig ileum, the contraction was abolished by atropine, the presence of an acetylcholine-like compound in the plant extract is indicated.

A methanol extract derived from Gardenia jovis-tonantis showed bronchodilator activity on isolated guinea pig trachea. The extract also showed cardiorelaxant activity on isolated rabbit heart and caused a rapid fall in diastolic pressure in anaesthetised rats.

A methanol extract of O. corniculata showed relaxant activity on isolated rabbit ileum which was dose-dependent. The plant extract also showed cardiorelaxant activity on isolated rabbit heart. In anaesthetised rats, a fall in diastolic pressure, with a lesser fall in systolic pressure, was observed.

Myrica salicifolia Hoechst (Myricaceae) root extract was found to have analgesic activity in mice. In rats there was antipyretic but no antiinflammatory activity. Copyright © 2002 John Wiley & Sons, Ltd.

Myrica salicifoliaHoechst (Myricaceae) root extract was found to have analgesic activity in mice. In rats there was antipyretic but no antiinflammatory activity. Copyright © 2002 John Wiley & Sons, Ltd.

The effect of the tuber aqueous extract of Adenia globosa Engl. (Passifloraceae) on the isolated rat uterus was determined. The extract caused a dose-dependent contraction of the uterus. This activity would explain the traditional usage of this plant in hastening parturition in domestic animals.