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Background: This is one of the first head-to-head real-world evidence studies comparing stroke-related and bleed-related healthcare and resource utilization (HCRU) and costs among non-valvular atrial fibrillation (NVAF) patients initiating oral anticoagulants.Methods: Adult NVAF patients newly diagnosed and treated with dabigatran, rivaroxaban, or warfarin between 10/01/2010 and 12/31/2014 were identified using MarketScan Commercial and Medicare Supplemental databases. Per-patient-per-month stroke and bleed-related HCRU and costs were reported.Results: Dabigatran patients were matched 1:1 to 26,592 rivaroxaban and 33,024 warfarin patients (mean age=68 years). Compared to rivaroxaban, dabigatran patients had lower bleed-related inpatient and outpatient HCRU (0.004 vs. 0.005; 0.099 vs. 0.145) and significantly lower adjusted bleed-related costs ($116 vs. $172), all p <0.05. Compared to warfarin, dabigatran patients had significantly lower stroke-related outpatient visits (0.034 vs. 0.048, p<0.001) and higher bleed-related outpatient visits (0.101 vs. 0.091, p=0.045). Multivariate adjusted bleed-related costs were significantly lower for dabigatran patients than warfarin patients ($94 vs. $138, p<0.001).Conclusions: The results suggest that dabigatran patients had lower bleed-related HCRU and costs than rivaroxaban patients, and lower outpatient stroke-related HCRU, higher bleed-related outpatient HCRU, and lower bleed-related costs than warfarin patients. It provides valuable stroke-related and bleed-related HCRU and costs information among commercially insured and Medicare patients. [ABSTRACT FROM AUTHOR]

Background: We compared healthcare utilization outcomes and persistence among non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran or warfarin.Methods: Using a nationwide, US administrative claims database, a retrospective matched-cohort of newly diagnosed NVAF patients (age≥18 years) treated with dabigatran or warfarin (propensity score matched 1:1) in 01/01/2011-12/31/2013 was evaluated. All-cause, stroke-, and bleed-specific per patient per month (PPPM) healthcare resource utilization (HCRU), incidence rate of hospitalization for stroke or bleed, 30-day readmission, and persistence were reported.Results: In total, 18,890 dabigatran patients were matched to corresponding warfarin patients. Compared to warfarin users, dabigatran users PPPM had significantly fewer all-cause hospitalizations (0.04 vs 0.05), total outpatient visits (3.98 vs 5.87), and lower 30-day readmissions (14.5% vs 17.4%, all p < 0.001). Dabigatran users had lower incidence rate for stroke (0.65 vs 1.06) and bleed (1.69 vs 2.20), stroke (0.0006 vs 0.0011, p < 0.001) and bleed-specific hospitalizations (0.002 vs 0.003, p = 0.008), and stroke (0.03 vs 0.04, p < 0.001) and bleed-specific outpatient visits (0.07 vs 0.08, p = 0.018), and significantly lower non-persistence (62.1% vs 66.3%, p < 0.001).Conclusion: Among newly diagnosed newly treated NVAF patients, dabigatran users had significantly lower all-cause, stroke- and bleed-specific HCRU, lower risk of hospitalization for stroke or bleed events, lower 30-day readmissions, and higher persistence than warfarin users. [ABSTRACT FROM AUTHOR]

Objective: To identify systemic treatment in the real-world following treatment with a cyclin-dependent kinase 4/6 inhibitor (CDKi) among post-menopausal women with hormone receptor positive, human epidermal growth factor receptor 2 Negative (HR+/HER2-) metastatic breast cancer (mBC).Methods: Post-menopausal women with HR+/HER2- mBC were identified from MarketScan claims databases between January 1, 2012 and October 31, 2017. Eligible mBC patients who received a CDKi-based line of therapy following metastasis diagnosis were selected. A line of therapy ended at the earlier of systemic therapy discontinuation, switch to new treatment, or censoring.Results: In total, 525 patients that received systemic therapy after a CDKi-based line were included (39.6% transitioned from use of a CDKi-based regimen in first line following metastasis diagnosis to any second line, and 60.4% shifted from a CDKi-based [second, third, or fourth line] to a subsequent line). Of post-CDKi second line regimens (n = 208), 38.0% were endocrine only, 35.6% were chemotherapy-based, 14.4% were everolimus-based, 9.6% were also CDKi-based line, and 2.4% were others. After adjusting for demographic and clinical characteristics, patients transitioning from a CDKi-based line to chemotherapy (vs others) had a trend of being more likely to have recurrent rapidly progressing disease, and were significantly less likely to have the prior CDKi-based line in combination with an AI (both p < .05).Conclusions: This population-based study suggests that rapidly progressing disease, metastatic site location, age, and endocrine therapy partner may be predictive of subsequent systemic therapy regimen selection after progression on a CDKi-based line therapy in patients with HR+/HER2- mBC. [ABSTRACT FROM AUTHOR]

Objectives: Compare costs and healthcare resource utilization (HCRU) among newly-diagnosed non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran vs apixaban, rivaroxaban, or warfarin.Methods: Newly-diagnosed adult NVAF patients initiating dabigatran, apixaban, rivaroxaban, or warfarin (index event) between October 1, 2010-December 31, 2014 were identified using MarketScan claims data, and followed until medication discontinuation, switch, inpatient death, enrollment end, or study end (December 31, 2015). Dabigatran patients were propensity-score matched 1:1 separately with apixaban, rivaroxaban, and warfarin patients. Per-patient-per-month (PPPM) all-cause cost, HCRU, and 30-day re-admissions were reported. Costs were analyzed using generalized linear models.Results: Final cohorts, each matched with dabigatran patients, included 8,857 apixaban patients, 26,592 rivaroxaban patients, and 33,046 warfarin patients. Dabigatran patients had lower adjusted PPPM total healthcare, inpatient, and outpatient costs compared to rivaroxaban ($4,093 vs $4,636, $1,476 vs $1,862, and $2,016 vs $2,121, respectively, all p ≤ .001) and warfarin ($4,199 vs $4,872, $1,505 vs $1,851, and $2,049 vs $2,514, respectively, all p < .001). Adjusted costs were similar for dabigatran and apixaban. Dabigatran patients had significantly fewer hospitalizations, outpatient visits, and pharmacy claims than rivaroxaban patients (0.06 vs 0.07, 4.84 vs 4.96 and 4.80 vs 4.93, respectively, all p < .020) and warfarin patients (0.06 vs 0.07, 4.77 vs 6.88, and 4.76 vs 5.89, respectively, all p < .001). Dabigatran patients had similar hospitalizations to apixaban, but higher outpatient visits (4.70 vs 4.31) and pharmacy claims (4.86 vs 4.61), both p < .001.Conclusions: This real-world study found adjusted all-cause costs were lower for dabigatran compared to rivaroxaban and warfarin patients and similar to apixaban patients. [ABSTRACT FROM AUTHOR]

Objective: To compare healthcare costs of adults with type 2 diabetes (T2D) after initiation of saxagliptin or linagliptin, two antidiabetic medications in the dipeptidyl peptidase-4 inhibitor medication class.Methods: Patients with T2D who were at least 18 years old and initiated saxagliptin or linagliptin (index date) between 1 June 2011 and 30 June 2014 were identified in the MarketScan Commercial and Medicare Supplemental Databases. All-cause healthcare costs and diabetes-related costs (T2D diagnosis on a medical claim and/or an antidiabetic medication claim) were measured in the 1 year follow-up period. Saxagliptin and linagliptin initiators were matched using propensity score methods. Cost ratios (CRs) and predicted costs were estimated from generalized linear models and recycled predictions.Results: There were 34,560 saxagliptin initiators and 18,175 linagliptin initiators identified (mean ages 57 and 59; 55% and 56% male, respectively). Before matching, saxagliptin initiators had significantly lower all-cause total healthcare costs than linagliptin initiators (mean = $15,335 [SD $28,923] vs. mean = $20,069 [SD $48,541], p < .001) and significantly lower diabetes-related total healthcare costs (mean = $6109 [SD $13,851] vs. mean = $7393 [SD $26,041], p < .001). In matched analyses (n = 16,069 per cohort), saxagliptin initiators had lower all-cause follow-up costs than linagliptin initiators (CR = 0.953, 95% CI = 0.932-0.974, p < .001; predicted costs = $17,211 vs. $18,068). There was no significant difference in diabetes-related total costs after matching; however, diabetes-related medical costs were significantly lower for saxagliptin initiators (CR = 0.959, 95% CI = 0.927-0.993, p = 0.017; predicted costs = $3989 vs. $4159).Conclusions: Adult patients with T2D initiating treatment with saxagliptin had lower total all-cause healthcare costs and diabetes-related medical costs over 1 year compared with patients initiating treatment with linagliptin. [ABSTRACT FROM AUTHOR]

Objective: To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and dabigatran in the US.Methods: A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF on rivaroxaban or dabigatran between October 2010 and March 2013. The index date was the date of the first prescription of rivaroxaban or dabigatran. All patients had ≥6 months of data prior to the index date and were followed until the earliest of inpatient death, end of continuous enrollment, or end of the study period. Rivaroxaban patients were matched 1:1 with dabigatran patients using the propensity score matching technique. Cox proportional hazards models were employed to estimate the adjusted hazard ratios (aHRs) of non-persistence and discontinuation. Persistence was defined as absence of a refill gap of ≥60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up.Results: A total of 30,337 NVAF patients on rivaroxaban or dabigatran met the study criteria. All 7259 rivaroxaban patients were matched 1:1 to dabigatran patients. Compared with dabigatran users, rivaroxaban patients were 11% less likely to become non-persistent with therapy (aHR: 0.89, 95% CI 0.84-0.95) and 29% less likely to discontinue therapy (aHR: 0.71, 95% CI 0.66-0.77).Limitations: Claims data are subject to miscoding and inaccuracies. Refill data may not fully reflect actual medication taken. Confounding may remain even after propensity score matching and additional adjustments in model. Longer follow-up may produce more precise estimates of persistence and discontinuation.Conclusions: This matched cohort analysis indicated that, compared to dabigatran, rivaroxaban was associated with better persistence and lower rates of discontinuation. [ABSTRACT FROM AUTHOR]

Objectives: To compare real-world persistence and discontinuation among non-valvular atrial fibrillation (NVAF) patients on rivaroxaban and warfarin in the US. Research design and methods: A large nationally representative US claims database was used to conduct a retrospective cohort analysis of patients with NVAF treated with rivaroxaban or warfarin from 1 July 2010 through 31 March 2013. Index date was the date of the first prescription of rivaroxaban or warfarin. All patients were followed until the earliest of inpatient death, end of continuous enrollment, or end of study period. Rivaroxaban patients were matched 1:1 by propensity scores. Medication persistence was defined as absence of refill gap of ≥60 days. Discontinuation was defined as no additional refill for at least 90 days and until the end of follow-up. Cox proportional hazards models were estimated to examine the adjusted hazard ratios (aHRs) of rivaroxaban vs. warfarin on non-persistence and discontinuation. Results: A total of 32,886 NVAF patients on rivaroxaban or warfarin met the study inclusion criteria. Each of the 7259 rivaroxaban patients identified were matched 1:1 to warfarin patients. Patients on rivaroxaban had a significantly better rate of persistence (aHR: 0.63, 95% CI 0.59–0.68) and lower rate of discontinuation (aHR: 0.54, 95% CI 0.49–0.58) compared to warfarin recipients. Limitations: Claims data may have contained inaccuracies and miscoding. Confounding may remain even after propensity score matching and additional adjustments in model. Refill data may not fully reflect actual medication use. Longer follow-up may produce more precise estimates of persistence and discontinuation. Conclusion: This matched cohort analysis indicated that rivaroxaban was associated with significantly higher medication persistence and lower discontinuation rates compared to warfarin. [ABSTRACT FROM AUTHOR]

Thirty years since publication of David Harvey's Social Justice and the City is an appropriate time for a review of social justice and the South African city. The issue is complicated by questions of definition: what qualifies as ‘the city’ or ‘urban’ in this context. Alternative theoretical perspectives have proliferated over the past thirty years, but they share common concerns with the distribution of means of well-being and the structures involved. The social injustice of apartheid was easy to demonstrate, from various theoretical perspectives. While the end of apartheid promised a more just society, gross inequalities are being perpetuated in the post-apartheid city and in society at large. The present trajectory is indefensible morally; in this respect, South Africa may be a microcosm of the world at large. Social justice in the (South African) city requires fundamental changes in political economy and its moral foundations, not only in this country but globally. [ABSTRACT FROM AUTHOR]

The vibration-rotation spectra of the ν 1 and ν 8 fundamental bands of 32 SF 4 have been observed using Fourier-transform infrared spectroscopy. The band centre of the c -type ν 1 symmetric sulphur-equatorial-fluorine stretching vibration was observed at 891.6 cm -1 and that for the b -type ν 8 asymmetric sulphur-equatorial-fluorine stretching vibration at 864.6 cm -1 . In total, 2044 rovibrational transitions have been assigned. Analysis of the spectra showed that the rotational states of the ν 1 =1 and ν 8 =1 upper vibrational levels are coupled by an a -type Coriolis interaction. This coupling has been treated both using perturbation theory and by the explicit inclusion of an appropriate Hamiltonian matrix element in a combined fit of the data for both bands. Spectroscopic parameters have been determined for the ground, ν 1 =1 and ν 8 = 1 vibrational levels. Weaker transitions resulting from difference bands and the fundamental bands of the 34 SF 4 isotopomer have been identified but could not be assigned, because of the density of lines in the room-temperature spectrum. The possibility that discrepancies between the observed and predicted spectra of the ν 1 fundamental may result from either a Coriolis interaction with the states of another vibrational level, or the effects of intramolecular exchange of axial and equatorial fluorine atoms is considered. The discussion is supported by theoretical calculations which show that the likely path for intramolecular exchange is via a C 4v transition state. [ABSTRACT FROM AUTHOR]

Presents obituaries for Dorothy Owen, a British archivist, author and historical researcher and for Angela Jean Wait, an archivist and scholar in Great Britain who died on March 30, 2002. Background on Owen's archival career; Details of edited works of Owen; Educational background of Wait; Details of Wait's political activities.

Presents obituaries for archivists Gerald Alymer and Kathleen Major in Oxford, England.

Provides brief indications on how the return of social justice to the geographical agenda may have a bearing on the new South Africa. Spatial inequality in living standards; Dependence of secured entitlement on national citizenship; Variability of moral relativism; Principle of impartiality; Implications for the new South Africa.

Presents arguments on the moral issues in the teaching of Geography in higher education. Case for moral teaching; Questions which should be asked by Geography students; Moral issues with a geographical dimension.

Insurance coverage for “nonphysical” losses is one of the latest emerging areas of insurance disputes. The two primary examples of such loss are emotional distress claims and stigma damages. Although emotional distress coverage is usually litigated in the context of business torts, its resolution there will affect the toxic tort area, because contamination‐related claims increasingly allege some sort of emotional distress resulting from exposure or threatened exposure to toxic materials. With respect to stigma damages, policyholders are increasingly finding coverage for both third‐ and first‐party claims involving diminution in property value caused by proximity to contaminated land. For each of these examples, this article reports the underlying coverage theories, the arguments against coverage advanced by insurers, the leading cases, and the latest developments. [ABSTRACT FROM PUBLISHER]

Examines the motion picture Matewan as a fictional representation and powerful influence on the town of Matewan, West Virginia. Details on the images of Appalachia; Duties and responsibilities of the Matewan Development Center (MDC); Purpose of creating the MDC.

During the years 1984-85, the arrival of an integrated automated library system (NOTIS) forced Auburn University Libraries to reevaluate the status of its name authority system. Central to the evaluation process was the preservation of the major investment made in the card name authority file as a result of AACR2. To achieve this, a process of migrating the valuable information from the card file into an online environment was developed. The final result of this process was a new authority structure with current and potential capabilities superior to the previous manual system. [ABSTRACT FROM PUBLISHER]

Comments on the characters of the play `Hamlet,' by William Shakespeare. Application of the energy from a dialogical engagement of opposing verbal styles; Cruelty of the character Hamlet to Ophelia; Attempt of Hamlet to destroy his heroic image instilled into Ophelia.

A number of points raised in the review of author's book "The Geography of Social Well-being in the United States," in the March 1974 issue require a response. The author would like to thank Frederick P. Stutz for pointing out two errors which should be corrected. The author shares some of his reservations about the "wholesale" use of factor analyses. The author supposes that risks are involved in writing such a short book with such a grandiloquent title. Like the "Great Society" social programs of the 1960s, it may create unfulfilled expectations which can make people worse off or less satisfied in a relative sense.

Reports on a model for the clinical evaluation of analgesic drugs, which is considered an interesting class of models for longitudinal data with dropouts. View that the random effects associated with the response process and with the dropout process related to this model are independent; Execution of a calculation to study the dropout cases discussed in the article; Argument against the use of information dropout models; View that models for informative dropout need to reflect, at least qualitatively, scientific information appropriate to the particular application under consideration.