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Dat T Tran,1,2 Ilke Akpinar,1 Irvin Mayers,3 Tatiana Makhinova,2 Philip Jacobs3 1Institute of Health Economics, Edmonton, Alberta, Canada; 2Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada; 3Faculty of Medicine, University of Alberta, Edmonton, Alberta, CanadaCorrespondence: Dat T TranInstitute of Health Economics, #1200 – 10405 Jasper Avenue, Edmonton, Alberta T5J 3N4, CanadaTel +1 780 448 4881Fax +1 780 448 0018Email dttran@ualberta.caObjectives: To describe the trends in pharmacologic treatment for patients newly diagnosed with chronic obstructive pulmonary disease (COPD) in Alberta, Canada.Methods: We linked Alberta health databases to identify patients aged ≥35 years with incident COPD between April 2010 and March 2017. Incident cases were defined as those who did not have a hospitalization or outpatient visit with COPD in the previous 2 years. Patients were categorized into two groups: 1) incident cases at a hospital and 2) incident cases at an outpatient clinic, and both were followed until death or being censored by 31 March 2018. Utilization of COPD medication for 30 days following incident event and adherence in maintenance therapy over time were reported.Results: The study included 33,169 patients with incident COPD (hospital: 9,089; outpatient: 24,080). In 18,666 (56.3%) patients starting medication within 30 days of the incident event (2010: 52.7%; 2016: 56.6%; p=0.002), SABA (60.5%) and LABA/ICS (41.6%) were most commonly used. ICS (without LABA) was used in 14.2% and was used as monotherapy in 4.5% of patients. The proportion of patients who initiated any ICS was similar (hospital: 56.7%; outpatient: 55.7%; p=0.194) and decreased in both settings over time (p

A new hybrid geoid model for Turkey entitled Turkish Geoid Model-2020 (TG-20) has been determined and validated using historical and recently acquired terrestrial gravity and GPS/levelling data as well as the latest global geopotential and digital elevation models. Highly qualified new gravity data have enabled us to detect and correct some gross errors such as datum inconsistencies in the historical gravity data sets. The Least-Squares Modification of Stokes' formula with the Additive Corrections Method has been applied to compute gravimetric geoid model. Transformation to hybrid model has been carried out via 4-parameter fit to homogenously distributed historical GPS/levelling data. Quality assessment of the fit residuals has let us to find out some unrevealed outlying data in the historical GPS/levelling data set, which had already been utilised in the previous geoid model computations. Validation of the TG-20 over the seven different new GPS/levelling profiles has suggested standard deviations ranging between 1.2 and 6.3 cm, that is at least twice more accurate than the previous official geoid model. The results reveal that the recent measurement campaigns and the latest global models bring about a significant and substantial amount of improvement in computing and validating a high quality national geoid model. [ABSTRACT FROM AUTHOR]

Organophosphorus chemicals, including chemical warfare agents (CWAs) and insecticides, are acutely toxic materials that warrant capture and degradation. Metal-organic frameworks (MOFs) have emerged as a class of tunable, porous, crystalline materials capable of hydrolytically cleaving, and thus detoxifying, several organophosphorus nerve agents and their simulants. One such MOF is M-MFU-4l (M = metal), a bioinspired azolate framework whose metal node is composed of a variety of divalent first-row transition metals. While Cu-MFU-4l and Zn-MFU-4l are shown to rapidly degrade CWA simulants, Ni-MFU-4l and Co-MFU-4l display drastically lower activities. The lack of reactivity was hypothesized to arise from the strong binding of the phosphate product to the node, which deactivates the catalyst by preventing turnover. No such study has provided detailed insight into this mechanism. Here, we leverage isothermal titration calorimetry (ITC) to monitor the binding of an organophosphorus compound with the M-MFU-4l series to construct a complete thermodynamic profile ( K a , Δ H , Δ S , Δ G ) of this interaction. This study further establishes ITC as a viable technique to probe small differences in thermodynamics that result in stark differences in material properties, which may allow for better design of first-row transition metal MOF catalysts for organophosphorus hydrolysis.

Enzymes are natural catalysts for a wide range of metabolic chemical transformations, including selective hydrolysis, oxidation, and phosphorylation. Herein, we demonstrate a strategy for the encapsulation of enzymes within a highly stable zirconium-based metal-organic framework. UiO-66-F 4 was synthesized under mild conditions using an enzyme-compatible amino acid modulator, serine, at a modest temperature in an aqueous solution. Enzyme@UiO-66-F 4 biocomposites were then formed by an in situ encapsulation route in which UiO-66-F 4 grows around the enzymes and, consequently, provides protection for the enzymes. A range of enzymes, namely, lysozyme, horseradish peroxidase, and amano lipase, were successfully encapsulated within UiO-66-F 4 . We further demonstrate that the resulting biocomposites are stable under conditions that could denature many enzymes. Horseradish peroxidase encapsulated within UiO-66-F 4 maintained its biological activity even after being treated with the proteolytic enzyme pepsin and heated at 60 °C. This strategy expands the toolbox of potential metal-organic frameworks with different topologies or functionalities that can be used as enzyme encapsulation hosts. We also demonstrate that this versatile process of in situ encapsulation of enzymes under mild conditions (i.e., submerged in water and at a modest temperature) can be generalized to encapsulate enzymes of various sizes within UiO-66-F 4 while protecting them from harsh conditions (i.e., high temperatures, contact with denaturants or organic solvents).

Objectives: Many publicly funded health systems use a mix of privately and publicly operated providers of care to deliver elective surgical services. The aim of this systematic review was to assess the role of privately operated but publicly funded provision of surgical services for adult patients who had cataract or orthopedic surgery within publicly funded health systems in high-income countries., Methods: Electronic databases (Ovid MEDLINE, OVID Embase, and EBSCO EconLit) were searched on 26 March 2021, and gray literature sources were searched on 6 April 2021. Two reviewers independently applied inclusion and exclusion criteria to identify studies, and extracted data. The outcomes evaluated include accessibility, acceptability, safety, clinical effectiveness, efficiency, and cost/cost-effectiveness., Results: Twenty-nine primary studies met the inclusion criteria and were synthesized narratively. We found mixed results across each of our reported outcomes. Wait times were shorter for patients treated in private facilities. There was evidence that some private facilities cherry-pick or cream-skim by selecting less complex patients, which increases the postoperative length of stay and costs for public facilities, restricts access to private facilities for certain groups of patients, and increases inequality within the health system. Seven studies found improved safety outcomes in private facilities, noting that private patients had a lower preoperative risk of complications. Only two studies reported cost and cost-effectiveness outcomes. One costing study concluded that private facilities' costs were lower than those of public facilities, and a cost-utility study showed that private contracting to reduce public waiting times for joint replacement was cost-effective., Conclusions: Limited evidence exists that private-sector contracts address existing healthcare delivery problems. Value for money also remains to be evaluated properly.

Background: Appropriate management of chronic obstructive pulmonary disease (COPD) patients following acute exacerbations can reduce the risk of future exacerbations, improve health status, and lower care costs. While a transition care bundle (TCB) was associated with lower readmissions to hospitals than usual care (UC), it remains unclear whether the TCB was associated with cost savings., Objective: The aim of this study was to evaluate how this TCB was associated with future Emergency Department (ED)/outpatient visits, hospital readmissions, and costs in Alberta, Canada., Methods: Patients who were aged 35 years or older, who were admitted to hospital for a COPD exacerbation, and had not been treated with a care bundle received either TCB or UC. Those who received the TCB were then randomized to either TCB alone or TCB enhanced with a care coordinator. Data collected were ED/outpatient visits, hospital admissions and associated resources used for index admissions, and 7-, 30- and 90-day post-index discharge. A decision model with a 90-day time horizon was developed to estimate the cost. A generalized linear regression was conducted to adjust for imbalance in patient characteristics and comorbidities, and a sensitivity analysis was conducted on the proportion of patients' combined ED/outpatient visits and inpatient admissions as well as the use of a care coordinator., Results: Differences in length of stay (LOS) and costs between groups were statistically significant, although with some exceptions. Inpatient LOS and costs were 7.1 days (95% confidence interval [CI] 6.9-7.3) and Canadian dollars (CAN$) 13,131 (95% CI CAN$12,969-CAN$13,294) in UC, 6.1 days (95% CI 5.8-6.5) and CAN$7634 (95% CI CAN$7546-CAN$7722) in TCB with a coordinator, and 5.9 days (95% CI 5.6-6.2) and CAN$8080 (95% CI CAN$7975-CAN$8184) in TCB without a coordinator. Decision modelling indicated TCB was less costly than UC, with a mean (standard deviation [SD]) of CAN$10,172 (40) versus CAN$15,588 (85), and TCB with a coordinator was slightly less costly than without a coordinator (CAN$10,109 [49] versus CAN$10,244 [57])., Conclusion: This study suggests that the use of the TCB, with or without a care coordinator, appears to be an economically attractive intervention compared with UC., (© 2023. The Author(s).)

Near-infrared (NIR) light is known to have outstanding optical penetration in biological tissues and to be non-invasive to cells compared with visible light. These characteristics make NIR-specific light optimal for numerous biological applications, such as the sensing of biomolecules or in theranostics. Over the years, significant progress has been achieved in the synthesis of fluorescent cyclophanes for sensing, bioimaging, and making optoelectronic materials. The preparation of NIR-emissive porphyrin-free cyclophanes is, however, still challenging. In an attempt for fluorescence emissions to reach into the NIR spectral region, employing organic tetracationic cyclophanes, we have inserted two 9,10-divinylanthracene units between two of the pyridinium units in cyclobis(paraquat- p -phenylene). Steady-state absorption, fluorescence, and transient-absorption spectroscopies reveal the deep-red and NIR photoluminescence of this cyclophane. This tetracationic cyclophane is highly soluble in water and has been employed successfully as a probe for live-cell imaging in a breast cancer cell line (MCF-7).

Nowadays, the removal of pharmaceutical contaminants from water resources and wastewater is of great importance due to environmental and health issues. Over the decades, various methods have been reported to remove pollutants from wastewater. Among the developed methods, advanced oxidation processes (AOPs) have received significant attention from researchers. In this study, we report the one-pot synthesis of graphene hydrogel-metal (GH-M, M: Co, Ni, Cu) nanocomposites via the combination of polyol and hydrothermal methods. The structure of the resulting nanocomposites was examined by transmission electron microscopy (TEM), inductively coupled plasma-mass spectroscopy (ICP-MS), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), and Raman spectroscopy methods. Afterward, as-prepared GH-Cu, GH-Co, and GH-Ni nanocomposites were used to prepare cathodes for the electro-Fenton (EF) process to remove rifampicin (RIF) from polluted water. The effect of operational parameters, including current density (mA/cm 2 ), initial pH, initial RIF concentration (mg/L), and process time (min) was investigated via response surface methodology (RSM). The optimal values for current density, pH, initial RIF concentration, and process time using GH-Ni as cathode were 30 mA/cm 2 , 5, 30 mg/L, and 90 min, respectively. The results at optimal values showed that the maximum RIF removal efficiency for GH-Cu, GH-Co, and GH-Ni cathodes was 90.47, 92.60, and 93.69%, respectively. Brunauer Emmett Teller (BET), atomic force microscopy (AFM), energy-dispersive X-ray (EDX), and cyclic voltammetry (CV) analyses were performed to investigate the performance of the cathodes for the RIF removal. Finally, total organic carbon (TOC), gas chromatography-mass spectrometry (GC-MS), and atomic absorption spectroscopy (AAS) analyses were performed for further investigation of the RIF removal from polluted water. The results claimed that one-pot synthesized GH-M cathodes can effectively remove RIF from polluted water through EF process., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Fibrous activated carbon has attracted emerging research interests due to its remarkable adsorption performance for volatile organic compounds (VOCs). Though this adsorption behavior for VOCs is closely related to the pore structure on the surface of activated carbon fiber (ACF), few researchers paid attentions to the influence of textural properties of this adsorption process. Especially, cotton-based activated carbon fiber (CACF) for adsorbing benzene pollutant is rarely reported. Herein, in order to develop a high-performance adsorbent for the removal of VOCs pollutants, this work studied the influence of textural properties of CACF on the adsorption of benzene. The results showed that the increase of carbonization temperature would lead to the reduction of mesopores but the increase of micropores for CACF; the embedment of phosphoric acid and its derivatives into the carbon layers contributed to the formation of pore structure for CACF; furthermore, specific surface area of CACF can also be enlarged by increasing the concentration of phosphoric acid. More importantly, it was found that the adsorption capacity of CACF for benzene was strongly dependent on the specific surface area and volume of micropores within CACF because micropores can provide more favorable binding sites. This adsorption process preferred to occur on the wall of micropores, then the accumulated benzene would slowly fill the pores. Interestingly, the decrease of pore size of micropores can unexpectedly improve the affinity of CACF to benzene on the contrary. This work provides a new strategy to develop porous structured ACF materials for the high-performance adsorption of VOCs., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The environment is the most important reservoir for both resistance mechanisms and gene transfer in biological science studies. This study gives a bibliometric overview of studies of "antibiotic resistance" and "Escherichia coli" in the field of "Agricultural and Biological Sciences" from 2015 to 2019 to assess both research trends and scholarly networks in diverse research disciplines. The two keywords of "antibiotic resistance" and "Escherichia coli" were selected to search in the Scopus database. Each review article was categorized into materials, natural waters (i.e., seawater, freshwater) and wastewater, journal name, and quartile in category of the journal, the year of publication, and the country. Bibliometric indicators and visualization maps were utilized to analyse the retrieved data quantitatively and qualitatively. A total of 1376 publications in the field of agricultural and biological sciences over the last 5 years were obtained using the keywords of antibiotic resistance and Escherichia coli. With additional keywords of freshwater and wastewater, 4 and 24 studies were obtained, respectively. Wastewater was found to be the most common working environment for the keywords of antibiotic resistance and Escherichia coli. It is also found that the studies of antibiotic resistance are mainly conducted in wastewater environments, focusing on human and food health. Working under "One Health" consisting of human, animal and agriculture, and environmental health could be the only permanent and effective approach to solving antibiotic resistance-related issues.

Antibiotic resistance is considered by the countries to be a global health issue and a huge threat to public health. The reduction of resistant microorganisms from water/wastewater is of importance in environmental sciences since they are resistant in the aquatic environment. In this study, a bibliometric analysis of literature from the field of environmental science in water ecosystems from 2015 to 2019 was carried out using the keywords "Antibiotic Resistance (AR)" and "Escherichia coli". Furthermore, using the keywords of "Fresh Water," "Sea Water," and "Waste Water," 155, 52, and 57 studies were discovered, respectively. It is found that 217 studies of the total 2115 studies investigated on AR are mostly performed in the "Waste Water" by considering human health. Given the studies, an up-to-date solution should be proposed since the release of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) from wastewater treatment plants needs to be mitigated. For this reason, it is obvious that working on micro and macro ecosystems will increase the probability of solutions in antibiotic resistance. A discussion of removal techniques for coliform bacteria, particularly antibiotic resistant Escherichia coli, was presented. One of the unique values of this study is to offer an innovative solution that removing them by metal-organic frameworks (MOFs) are emerging crystalline hybrid materials. MOFs are used for environmental, biological, and food antimicrobial substances efficiently. Therefore, we can give inspiration to the future studies of antimicrobial resistance removal via adsorption using MOFs as adsorbents. Graphical Abstract.

Objective: The objective of this study was to estimate the provincial and nationwide costs of industry-sponsored drug clinical trials (CTs) in Canada., Methods: We used the Aggregate Analysis of ClinicalTrials.gov (AACT) database, and included all industry-sponsored drug CTs that were conducted in Canada and completed in 2016. We estimated the costs of the study drugs using the market price. Estimates of the costs of management and patient services were based on industry contracts., Results: The sample included 394 CTs that were conducted in 2039 facilities in Canada and provided services for 20,126 Canadian enrollees. Two-thirds of the CTs (277 of 394) were in the non-cancer category. On average, the drug costs per patient were 89,680 Canadian dollars ($Can) during the lifespan of the CTs, and were higher in cancer CTs than in non-cancer CTs ($Can216,876 vs. $Can65,274). The total costs of industry-sponsored drug CTs completed in 2016 was $Can2093.7 million. Drug costs accounted for the majority of this total ($Can1804.9 million). Ontario ($Can781.2 million) and Quebec ($Can757.5 million) had the highest costs., Conclusion: The costs of industry-sponsored drug CTs completed in 2016 when measured in terms of market prices in Canada were valued at $Can2.1 billion.

Objective: Our objective was to describe the costs of industry-sponsored clinical trials for medical devices in Northern Alberta, Canada., Methods: We used centralized data to identify all industry-sponsored medical device clinical trials initiated in Northern Alberta from 2012 to 2016. For each arm of each trial, we calculated the price of devices provided by the sponsor and the cost of clinical and administrative services that were incurred to clinically operationalize the treatment., Results: Our sample consisted of 18 device trials initiated between January 2012 and January 2016. The overall cost (Canadian dollars [$Can], year 2018 values) per enrolee was $Can18,243 for the experimental arm and $Can13,827 for the control arm. Devices were the highest cost component, at $Can13,446 per enrollee in the experimental arm. Clinical costs in the control arms were higher on average ($Can7202 vs. 2504) than those in the experimental arms., Conclusion: Data from industry-sponsored clinical trials can provide important information on the full costs of device-related interventions. As device costs rise, and as policy makers require more evidence on device-related treatments, the cost of medical device-driven interventions should be documented along with their effectiveness.

Clinical research is funded by industry, governments, charities, and hospitals. It is important to know the economic commitment of the various funding bodies, but until now there has been no national source available which provides these data. We surveyed the major funders to provide such a measure. There is evidence that government and charity funding of medical research is a trigger for private sector research investment; therefore, tracking all sources of funding for clinical research will provide policy-makers with an overall picture of health research funding. These data support policy decision-making related to clinical research in Canada.

Uremic toxins often accumulate in patients with compromised kidney function, like those with chronic kidney disease (CKD), leading to major clinical complications including serious illness and death. Sufficient removal of these toxins from the blood increases the efficacy of hemodialysis, as well as the survival rate, in CKD patients. Understanding the interactions between an adsorbent and the uremic toxins is critical for designing effective materials to remove these toxic compounds. Herein, we study the adsorption behavior of the uremic toxins, p-cresyl sulfate, indoxyl sulfate, and hippuric acid, in a series of zirconium-based metal-organic frameworks (MOFs). The pyrene-based MOF, NU-1000, offers the highest toxin removal efficiency of all the MOFs in this study. Other Zr-based MOFs possessing comparable surface areas and pore sizes to NU-1000 while lacking an extended aromatic system have much lower toxin removal efficiency. From single-crystal X-ray diffraction analyses assisted by density functional theory calculations, we determined that the high adsorption capacity of NU-1000 can be attributed to the highly hydrophobic adsorption sites sandwiched by two pyrene linkers and the hydroxyls and water molecules on the Zr 6 nodes, which are capable of hydrogen bonding with polar functional groups of guest molecules. Further, NU-1000 almost completely removes p-cresyl sulfate from human serum albumin, a protein that these uremic toxins bind to in the body. These results offer design principles for potential MOFs candidates for uremic toxin removal.

The United States Environmental Protection Agency (EPA) recognizes atrazine, a commonly used herbicide, as an endocrine disrupting compound. Excessive use of this agrochemical results in contamination of surface and ground water supplies via agricultural runoff. Efficient removal of atrazine from contaminated water supplies is paramount. Here, the mechanism governing atrazine adsorption in Zr 6 -based metal-organic frameworks (MOFs) has been thoroughly investigated by studying the effects of MOF linkers and topology on atrazine uptake capacity and uptake kinetics. We found that the mesopores of NU-1000 facilitated rapid atrazine uptake saturating in <5 min and that the pyrene-based linkers offered sufficient sites for π-π interactions with atrazine as demonstrated by the near 100% uptake. Without the presence of a pyrene-based linker, NU-1008, a MOF similar to NU-1000 with respect to surface area and pore size, removed <20% of the exposed atrazine. These results suggest that the atrazine uptake capacity demonstrated by NU-1000 stems from the presence of a pyrene core in the MOF linker, affirming that π-π stacking is responsible for driving atrazine adsorption. Furthermore, NU-1000 displays an exceptional atrazine removal capacity through three cycles of adsorption-desorption. Powder X-ray diffraction and Brunauer-Emmett-Teller surface area analysis confirmed the retention of MOF crystallinity and porosity throughout the adsorption-desorption cycles.

Competing Interests: Competing interests: None declared.

Isostructural metal-organic frameworks (MOFs) have been prepared from a variety of metal-oxide clusters, including transition metals, lanthanides, and actinides. Experimental and calculated shifts in O-H stretching frequencies for hydroxyl groups associated with the metal-oxide nodes reveal varying electronic properties for these units, thereby offering opportunities to tune support effects for other materials deposited onto these nodes.

Adding universal rectal screening to urogenital screening should positively impact rectal Chlamydia trachomatis (CT) incidence in affected populations. A dynamic Markov model was used to evaluate costs and outcomes of three rectal CT screening strategies among women attending sexually transmitted infection clinics in Alberta, Canada: universal urogenital-only screening (UG-only), additional selected (exposure-based) rectal screening (UG+SR), and additional universal rectal screening (UG+UR). The model included two mutually exclusive health states: infected and susceptible. Additionally, the model included two rounds of transmission: male sex partners of women infected with rectal-only CT and female sex partners of those men. CT complications impacting patients' quality of life (QALY) were considered. Alberta and Canadian data were used to estimate model inputs. We used a health care perspective, a time period of 10 years, and a discount rate of 3% for analyses. Compared to UG-only screening, the incremental cost effectiveness ratios (ICERs) were CA$34,000 and CA$49,000 per QALY gained for UG+SR and UG+UR screening strategies, respectively. Compared to UG+SR, the ICER was CA$62,000 per QALY gained for the UG+UR strategy. Both adjunct selected and universal rectal screening strategies are cost effective compared to UG-only screening, and UG+UR screening is cost effective when compared to UG+SR screening.

Background: Economic evaluation helps policy makers and healthcare payers make decisions on drug listing, coverage, and reimbursement. When economic evaluations are conducted before a product launch, the prices of the pharmaceuticals have to be forecast., Objective: The aim of this study was to examine the methods of establishing proxy prices and their accuracies compared with actual market prices after the product launch., Methods: We searched the literature for evaluations for drugs that were licensed in the US between 2010 and 2015. We reviewed the studies for the forecasting strategies used, and then estimated the difference between actual 2016 post-launch prices and what the proxy prices would be if the forecast was carried out in the US in 2016., Results: We identified six such studies, with seven drugs. Four studies used substitute drugs as proxies for the study drug, and three used other methods. The range of the values of actual minus proxy price varied considerably, and no trend was observed., Conclusion: Forecasting drug prices is as precarious as forecasting in other areas of the economy. We urge caution in reviewing and accepting a cost-effectiveness ratio that is based on forecast prices.

Purpose: In pharmaceutical clinical trials, industrial sponsors pay for study drugs and related healthcare services. We conducted a study to determine industry's economic contribution of these trials to the Alberta healthcare system.  Methods: We used data from two trial centers for cancer and non-cancer trials at the University of Alberta. For each trial (cancer, non-cancer), we calculated the cost of drugs provided by the sponsors using the market price, the cost of clinical services, and the cost of administrative services that they paid. We extrapolated these results to all trials in Alberta based on information obtained from the registration website ClinicalTrials.gov.  Results: Our sample consisted of 40 non-cancer and 39 cancer drug trials which were initiated in 2012. The monetary value of the industry sponsors' contribution was $799,055 per non-cancer and $630,243 per cancer drug trial. Drugs (in-trial and post-trial) accounted for 84% of the total contribution of the non-cancer drug trials whereas it represented 93% of all trial-related contributions in the cancer category. The total province-wide contribution of industry-sponsored drug trials which were initiated in 2012 was estimated to be $101 million, including open-label drugs in the non-cancer category.  Conclusions: Industry-sponsored pharmaceutical trials represent a major economic contributor to clinical research within the province.

Background: Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence, which is mainly characterized by increased cardiopulmonary mortality and morbidity. It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease, heart failure, and arrhythmias. The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes, which have previously been associated with cardiovascular mortality, in OSAS patients., Methods: Our study included 51 patients (mean age 41.6 ± 10.1 years) who were recently diagnosed with OSAS (apnea-hypopnea index [AHI] ≥5 events/h) and never received therapy. The control group consisted of 34 volunteers (mean age 43.1 ± 11.6 years) in whom OSAS was excluded (AHI <5 events/h). The longest QRS complexes was measured in the 12-lead electrocardiogram (ECG) and the presence of fragmentation in QRS complexes was investigated., Results: Fragmented QRS frequency was significantly higher in patients with OSAS (n = 31 [61%] vs. n = 12 [35%], P = 0.021). QRS and QTc durations were also significantly longer in OSAS patients than controls (99.8 ± 13.9 ms vs. 84.7 ± 14.3 ms, P < 0.001; 411.4 ± 26.9 ms vs. 390.1 ± 32.2 ms, P = 0.001, respectively). Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration (r = 0.292, P = 0.070). OSAS group had no correlation between AHI and QRS duration (r = -0.231, P = 0.203)., Conclusions: In our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients. Both parameters are related with increased cardiovascular mortality. Considering the prognostic importance of ECG parameters, it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.

Background: Cardiovascular complications are the leading causes of premature deaths in hemodialysis patients. Due to rapid changes in volume and electrolyte concentration following dialysis, the some electrocardiographic (ECG) changes or arrhythmias might be seen., Objective: To investigate the acute effects of hemodialysis on the ECG parameters in patients with chronic end-stage renal disease (ESRD)., Method: We included the consecutive ESRD patients who underwent a hemodialysis. Before and after hemodialysis, some 12 lead ECG parameters were analyzed by two different cardiologists by using electronic digital caliper device., Results: A total of 62 patients (mean 52 ± 15 years; 65% male) with ESRD undergoing hemodialysis were recruited to the study. P-wave amplitude, QRS amplitude, QRS duration, QTc dispersion, the sum of amplitudes in V1S + V5R derivations, total QRS amplitude, and duration were significantly greater in posthemodialysis patients compared to the prehemodialysis ones. However, T-wave amplitude and QTc duration were significantly lower in posthemodialysis patients., Conclusion: The ECG changes including prolangated QRS and increased QTc interval after hemodialysis should be kept in mind and assessed carefully in ESRD patients. Prolongation of these parameters may prove to be a further noninvasive marker of susceptibility to ventricular arrhythmias., (© 2014 Wiley Periodicals, Inc.)

Objectives: Economic evaluations, although not formally used in purchasing decisions for medical devices in Canada, are still being conducted and published. The aim of this study was to examine the way that prices have been included in Canadian economic evaluations of medical devices., Methods: We conducted a review of the economic concepts and implications of methods used for economic evaluations of the eleven most implanted medical devices from the Canadian perspective., Results: We found Canadian economic studies for five of the eleven medical devices and identified nineteen Canadian studies. Overall, the device costs were important components of total procedure cost, with an average ratio of 44.1 %. Observational estimates of the device costs were obtained from buyers or sellers in 13 of the 19 studies. Although most of the devices last more than 1 year, standard costing methods for capital equipment was never used. In addition, only eight studies included a sensitivity analysis for the device cost. None of the sensitivity analyses were based on actual price distributions., Conclusions: Economic evaluations are potentially important for policy making, but although they are being conducted, there is no standardized approach for incorporating medical device prices in economic analyses. Our review provides suggestions for improvements in how the prices are incorporated for economic evaluations of medical devices.