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The author discusses guidelines related to management, diagnosis and prevention of infections due to implantable cardiac electronic devices (ICEDs). Topics discussed include several ICEDs like cardiac resynchronisation therapy, implantable cardioverter defibrillators and permanent pacemakers, characterization of ICED infections which include postimplantation inflammation, swelling and cellulitis, antimicrobial strategy for treatment of ICEDs and implantation in ventilated rooms.

Disparities in opioid prescribing by race/ethnicity have been described in many healthcare settings, with White patients being more likely to receive an opioid prescription than other races studied. As surgeons increase prescribing of nonopioid medications in response to the opioid epidemic, it is unknown whether postoperative prescribing disparities also exist for these medications, specifically gabapentinoids. We conducted a retrospective cohort study using a 20% Medicare sample for 2013–2018. We included patients ≥66 years without prior gabapentinoid use who underwent one of 14 common surgical procedures. The primary outcome was the proportion of patients prescribed gabapentinoids at discharge among racial and ethnic groups. Secondary outcomes were days' supply of gabapentinoids, opioid prescribing at discharge, and oral morphine equivalent (OME) of opioid prescriptions. Trends over time were constructed by analyzing proportion of postoperative prescribing of gabapentinoids and opioids for each year. For trends by year by racial/ethnic groups, we ran a multivariable logistic regression with an interaction term of procedure year and racial/ethnic group. Of the 494,922 patients in the cohort (54% female, 86% White, 5% Black, 5% Hispanic, mean age 73.7 years), 3.7% received a new gabapentinoid prescription. Gabapentinoid prescribing increased over time for all groups and did not differ significantly among groups (P = 0.13). Opioid prescribing also increased, with higher proportion of prescribing to White patients than to Black and Hispanic patients in every year except 2014. We found no significant prescribing variation of gabapentinoids in the postoperative period between racial/ethnic groups. Importantly, we found that despite national attention to disparities in opioid prescribing, variation continues to persist in postoperative opioid prescribing, with a higher proportion of White patients being prescribed opioids, a difference that persisted over time. [ABSTRACT FROM AUTHOR]

The electronic structure of CrF and CrCl in X[sup 6]Sigma+, [sup 6]Pi, [sup 6]Delta, A [sup 6]Sigma+, [sup 4]Sigma+, [sup 4]Pi, and [sup 4]Delta states that correlate with the low lying [sup 6]S, [sup 6]D, and [sup 4]D states of Cr[sup +] have been studied, using large atomic natural orbital (ANO) basis sets and a variety of ab initio methods, including multi-reference configuration interaction (MRCI) and coupled cluster with perturbative triples (RCCSD(T)). We include scalar relativistic effects perturbatively and also explore the consequence of correlating the 3s and 3p electrons on the transition metal. We report T[sub e]; R[sub e]; omega[sub e], as well as dipole moments, bond energies, and charge distributions and compare with the available experimental data as well as previous theoretical results. [ABSTRACT FROM AUTHOR]

The electronic structure of the dipositive transition metal hydrides ScH2 , TiH2 , VH2 , CrH2 and MnH2 has been studied, using MCSCF and internally contracted MRCI techniques. All electronic states that correlate with the lowest term of the dipositive transition metal and H(2S) have been studied as a function of internuclear separation, and we find that ScH2 , TiH2 , VH2 , as well as several states of CrH2 , are thermodynamically stable. The potential energy curves of MnH2 cross the relevant repulsive M large separations to ensure that the character of the molecule at equilibrium is well represented energies are discussed. Most interesting is the nature of the bonding and its variation as one goes from ScH2 to MnH2 . All of these molecules have a large electrostatic component to the bonding that arises from the cation polarizing the H atom. Additionally, they have a conventional sigma bond between the 3d orbital and the H1s orbital, which decreases in importance as one goes from ScH2 to MnH2 and is essentially gone at CrH2 . This reflects the contraction of the 3d orbitals, the increasing ionization energy as well as the increasingly larger exchange energy in the high-spin 3d shell, as one goes from ScH2 to MnH2 . Rather than disrupt the high-spin coupling to bond to a 3dsigma orbital, the H atom essentially couples its spin antiferomagnetically to the intact spin state of the transition metal dication. by Mn2 H. The ordering of the electronic states, their bond lengths and dissociation sigma sigma H curves at sufficiently. [ABSTRACT FROM AUTHOR]

Outlines a number of initiatives to provide for the housing needs of aging population in Singapore. Social stability and housing; Aging, family patterns and housing policy; Retirement age in Singapore.

Determines the structure of polybutene oligomers using nuclear magnetic resonance techniques. Mechanism of polymer formation; Use of the two-dimensional incredible natural abundance double quantum transfer experiment spectra; Discovery of an isopropyl group at the beginning of the chain in the main isomer of polybutene.

Relates the impact of the Mozarts' encounter with the Sicilian tenor, Guglielmo d'Ettore. D'Ettore as a crucial figure in Mozart's baptism as a composer of opera seria; Brief biological survey on d'Ettore; Suggesting further examination on the biographical documentation of the lives of the singers for whom operas were composed to understand the operas' compositional history.

Describes a Michigan State University program to encourage participation of underrepresented minorities in chemistry. Discussion of Charles Drew program; Supplement for lectures and recitations; Placement of students in research environment.

Presents a critique of the novels of J.M. Coetzee. Points of view in the novels; Tense of the novels.

Comments on two books by Salman Rushdie, "Midnight's Children" and "Shame," which focus on the Indian subcontinent. Structure of the books; Information on the characters in the books; Comparison between the books.

Fusion power plant designs based on magnetic confinement, such as the tokamak design, offer a promising route to sustainable fusion power but require robust exhaust solutions capable of tolerating intense heat and particle fluxes from the plasma at the core of the device. Turbulent plasma transport in the region where the interface between the plasma and the materials of the device is handled - called the divertor volume - is poorly understood, yet impacts several key factors ultimately affecting device performance. In this article a comprehensive study of the underlying physics of turbulence in the divertor volume is conducted using data collected in the final experimental campaign of the Mega Ampere Spherical Tokamak device, compared to high fidelity nonlinear simulations. The physics of the turbulence is shown to be strongly dependant on the geometry of the divertor volume - a potentially important result as the community looks to advanced divertor designs with complex geometry for future fusion power plants. These results lay the foundations of a first-principles physics basis for turbulent transport in the tokamak divertor, providing a critical step towards a predictive understanding of tokamak divertor plasma solutions. Fusion generated within magnetically confined plasmas offers a promising route to clean baseload energy but the intense heat and particle flux generated in the process presents a major challenge for future power plant devices. Through a combination of experiment and computational analysis the authors develop a potential first-principals understanding of turbulent processes in the divertor of their device, where excess heat is handled, paving the way to predictive tokamak solutions for the future. [ABSTRACT FROM AUTHOR]

• First theoretical study of the electronic and geometric structure of the low-lying states of ScNH. • First theoretical study of the 2Π r state of YNH and its relationship to the 2Π i state. • First detailed study and comparison of the bonding in ScNH and YNH. We report the results of multi-reference configuration interaction calculations of the electronic and geometric structures of the X 2Σ+, B 2Σ+, Ã2Π i , Ã2Π r &2Δ states of the transition metal imides, ScNH and YNH, and compare with the available experimental data. The metal is bonded to the NH group by a double bond in the π system for all states. There are 4 π electrons in the X 2Σ+, B 2Σ+, Ã2Π r &2Δ states and 3 in the Ã2Π i. The atomic orbital composition in the 4 π states is remarkably similar, the average being 75 % 2 p π + 21 % d π + 4 % p π while in the 3 π state we have 88 % 2 p π + 10 % d π + 2 % p π . [ABSTRACT FROM AUTHOR]

Employing correlation consistent basis sets of quadruple-zeta quality and applying both multireference configuration interaction and single-reference coupled cluster methodologies, we studied the electronic and geometrical structure of the [V,O,H]0,+ species. The electronic structure of HVO0,+ is explained by considering a hydrogen atom approaching VO0,+, while VOH0,+ molecules are viewed in terms of the interaction of V+,2+ with OH-. The potential energy curves for H-VO0,+ and V0,+-OH have been constructed as functions of the distance between the interacting subunits, and the potential energy curves have also been determined as functions of the H-V-O angle. For the stationary points that we have located, we report energies, geometries, harmonic frequencies, and dipole moments. We find that the most stable bent HVO0,+ structure is lower in energy than any of the linear HVO0,+ structures. Similarly, the most stable state of bent VOH is lower in energy than the linear structures, but linear VOH+ is lower in energy than bent VOH+. The global minimum on the potential energy surface for the neutral species is the X3A″ state of bent HVO, although the X5A″ state of bent VOH is less than 5 kcal/mol higher in energy. The global minimum on the potential surface for the cation is the X4Σ- state of linear VOH+, with bent VOH+ and bent HVO+ both more than 10 kcal/mol higher in energy. For the neutral species, the bent geometries exhibit significantly higher dipole moments than the linear structures. [ABSTRACT FROM AUTHOR]

Kavi Bhalla and colleagues invite individuals and organizations to provide local injury data sources to help inform estimates of the global burden of injuries. [ABSTRACT FROM AUTHOR]

The author reflects on the use of antibiotic prophylaxis for the treatment of infective endocarditis. The author suggests that while antibiotic prophylaxis has been used in cardiac and dental practices for a half century evidence of its effectiveness is limited. The author argues that practices for prophylaxis of infective endocarditis seem set to change and that new guidelines will provide simple protocols for their use.

Abstract: Objective: To determine whether including the study questionnaire with a letter of invitation improves the response rate in a telephone-based survey. Study Design and Setting: This randomized controlled trial was part of a larger study to assess patient preferences for novel and controversial treatments for inflammatory bowel disease at Royal Prince Alfred Hospital, a tertiary referral teaching hospital in Sydney, Australia. Results: Of 270 eligible patients, 124 (46%) were randomized to receive the questionnaire plus invitation whereas 146 (54%) were in the control group receiving a letter of invitation only. The consent rate was 26% for those receiving the questionnaire and 36% for the control group. The odds ratio for consent to participate among those sent the questionnaire to those not sent the questionnaire was 0.63 (95% CI=0.37–1.07). Conclusion: This study found that the advance mailing of a questionnaire to potential participants in a telephone survey reduced the likelihood of their participation. [Copyright &y& Elsevier]

An amendment to this paper has been published and can be accessed via a link at the top of the paper. [ABSTRACT FROM AUTHOR]

Gene expression changes resulting from social interactions may give rise to long term behavioral change, or simply reflect the activity of neural circuitry associated with behavioral expression. In honey bees, social cues broadly modulate aggressive behavior and brain gene expression. Previous studies suggest that expression changes are limited to contexts in which social cues give rise to stable, relatively long-term changes in behavior. Here we use a traditional beekeeping approach that inhibits aggression, smoke exposure, to deprive individuals of aggression-inducing olfactory cues and evaluate whether behavioral changes occur in absence of expression variation in a set of four biomarker genes (drat, cyp6g1/2, GB53860, inos) associated with aggression in previous studies. We also evaluate two markers of a brain hypoxic response (hif1α, hsf) to determine whether smoke induces molecular changes at all. We find that bees with blocked sensory perception as a result of smoke exposure show a strong, temporary inhibition of aggression relative to bees allowed to perceive normal social cues. However, blocking sensory perception had minimal impacts on aggression-relevant gene expression, althought it did induce a hypoxic molecular response in the brain. Results suggest that certain genes differentiate social cue-induced changes in aggression from long-term modulation of this phenotype. [ABSTRACT FROM AUTHOR]

Presents information on the book `MiddleMarch,' by George Eliot. Characters; Theme; Explanation on some excerpts.

A letter to the editor is presented related to revision of the book "International Statistical Classification of Diseases and Related Health Problems" concerning explaining the World Health Organization's approach toward death statistics.

Introduction: Patient advocacy is a core value in medical education. Although students learn about social determinants of health (SDH) in the pre‐clinical years, applying this knowledge to patients during clerkship rotations is not prioritized. Physicians must be equipped to address social factors that affect health and recognize their roles as patient advocates to improve care and promote health equity. We created an experience‐based learning curriculum called Advocacy in Action (AiA) to promote the development and application of health advocacy knowledge and skills during an Internal Medicine (IM) clerkship rotation. Methods: Sixty‐six students completed a mandatory curriculum, including an introductory workshop on SDH and patient advocacy using tools for communication, counselling and collaboration skills. They then actively participated in patient advocacy activities, wrote about their experience and joined a small group debriefing about it. Forty‐nine written reflections were reviewed for analysis of the impact of this curriculum on student perspectives. Results: Written reflections had prominent themes surrounding advocacy skills development, meaningful personal experiences, interprofessional dynamics in patient advocacy and discovery of barriers to optimal patient care. Discussion: AiA is a novel method to apply classroom knowledge of SDH to the clinical setting in order to incorporate advocacy in daily patient care. Students learned about communication with patients, working with interprofessional team members to create better health outcomes and empathy/compassion from this curriculum. It is important to utilize experiential models of individual patient‐level advocacy during clerkships so that students can continuously reflect on and integrate advocacy into their future careers. [ABSTRACT FROM AUTHOR]

Objective: To identify external causes of unintentional childhood injury presenting to Australian EDs. Methods: Six major paediatric hospitals in four Australian states supplied de‐identified ED data for 2011–2017 on age, sex, attendance time/date, presenting problem, injury diagnosis, triage category and mode of separation. Three hospitals supplied data on external cause and intent of injury. A machine classifier tool was used to supplement the missing external cause coding in the remaining hospitals to enable the compilation of a standardised dataset for childhood injury causes analysis. Results: A total of 486 762 ED presentations for unintentional injury in children aged 0–14 years were analysed. The leading specified cause of ED presentations was low fall (35.0%) followed by struck/collision with an object (13.8%) with little sex difference observed. Males aged 10–14 years had higher rates of motorcycle, pedal cycle and fire/flame‐related injury and lower rates of horse‐related injury and drug/medicinal substance poisoning compared with females. The leading specified external cause resulting in hospitalisation was low fall (32.2%) followed by struck/collision with an object (11.1%). The injuries with the highest proportion of children being hospitalised were drownings (64.4%), pedestrian (53.4%), motorcycle (52.7%) and horse‐related injuries (50.0%). Conclusions: This is the first large‐scale study since the 1980s to explore external causes of unintentional childhood injury presenting to Australian paediatric EDs. It demonstrates a hybrid human–machine learning approach to create a standardised database to overcome data deficiencies. The results supplement existing knowledge of hospitalised paediatric injury to better understand the causes of childhood injury by age and sex, which require health service utilisation. [ABSTRACT FROM AUTHOR]

Unabated activation of the NLR family pyrin domain–containing 3 (NLRP3) inflammasome is linked with the pathogenesis of various inflammatory disorders. Polo-like kinase 1 (PLK1) has been widely studied for its role in mitosis. Here, using both pharmacological and genetic approaches, we demonstrate that PLK1 promoted NLRP3 inflammasome activation at cell interphase. Using an unbiased proximity-dependent biotin identification (Bio-ID) screen for the PLK1 interactome in macrophages, we show an enhanced proximal association of NLRP3 with PLK1 upon NLRP3 inflammasome activation. We further confirmed the interaction between PLK1 and NLRP3 and identified the interacting domains. Mechanistically, we show that PLK1 orchestrated the microtubule-organizing center (MTOC) structure and NLRP3 subcellular positioning upon inflammasome activation. Treatment with a selective PLK1 kinase inhibitor suppressed IL-1β production in in vivo inflammatory models, including LPS-induced endotoxemia and monosodium urate–induced peritonitis in mice. Our results uncover a role of PLK1 in regulating NLRP3 inflammasome activation during interphase and identify pharmacological inhibition of PLK1 as a potential therapeutic strategy for inflammatory diseases with excessive NLRP3 inflammasome activation. [ABSTRACT FROM AUTHOR]

Purpose: Patients with advanced cancer typically demonstrate sharp deterioration in physical function and psychological status during the last months of life. This study evaluates the relationship between survival in patients with advanced cancer and longitudinal assessment of anxiety, depression, fatigue, pain interference, and/or physical function using the US National Institute of Health Patient Reported Outcomes Information System.Methods: Mixed-effects models were used to evaluate patient-reported outcome trajectories over time among patients with advanced loco-regional or metastatic cancer receiving care in a hospital-based palliative care clinic. Cox regression analysis was used to assess the statistical significance of differences in the probability of survival associated with patient-reported outcome scores.Results: A total of 472 patients completed 1992 assessments during the 18-month study period. Longitudinal scores for fatigue, pain interference, and physical function demonstrated statistically significant non-linear trajectories. Scores for depression, fatigue, pain interference, and physical function were highly statistically significant predictors of survival (p < 0.01). Clinically meaningful differences in the probability of survival were demonstrated between patients with scores at the 25th vs. 75th percentiles, with absolute differences in survival at 6 and 12 months after assessment from 10 to 18 percentage points.Conclusions: Patient-reported outcomes can be used to reliably estimate where patients are along the trajectory of deteriorating health status leading toward the end of life, and for identifying patients with declining symptoms in need of referral to palliative care or more aggressive symptom management. [ABSTRACT FROM AUTHOR]

Background: Night float rotations, where residents admit patients to the hospital, are opportunities for practice-based learning. However, night float residents receive little feedback on their diagnostic and management reasoning, which limits learning. Aim: Improve night float residents' practice-based learning skills through feedback solicitation and chart review with guided reflection. Setting/Participants: Second- and third-year internal medicine residents on a 1-month night float rotation between January and August 2017. Program Description: Residents performed chart review of a subset of patients they admitted during a night float rotation and completed reflection worksheets detailing patients' clinical courses. Residents solicited feedback regarding their initial management from day team attending physicians and senior residents. Program Evaluation: Sixty-eight of 82 (83%) eligible residents participated in this intervention. We evaluated 248 reflection worksheets using content analysis. Major themes that emerged from chart review included residents' identification of future clinical practice changes, evolution of differential diagnoses, recognition of clinical reasoning gaps, and evaluation of resident-provider interactions. Discussion: Structured reflection and feedback during night float rotations is an opportunity to improve practice-based learning through lessons on disease progression, clinical reasoning, and communication. [ABSTRACT FROM AUTHOR]

Maternal stress is a common source of heritable health and behavioral variation. This type of maternal effect could be particularly important for honey bees (Apis mellifera), as a single queen is responsible for many generations of workers who perform all colony functions including raising subsequent worker generations. Multiple factors work synergistically to cause colony loss, but a role for maternal stress effects is unstudied. We used an artificial cold temperature treatment as a proof-of-concept approach to investigate whether acute queen stress causes changes in worker phenotypes, including egg hatching rate, development time, and adult behavior and immune function. We found that queen stress impacts early-life phenotypes (egg hatching and development time), with more limited impacts on adult phenotypes (behavior and immune function). Thus, if maternal stress impacts colony health, it is likely through cumulative impacts on worker population numbers, not through phenotypic effects that impact individual adult worker behavior or health resilience. This study addresses an important and overlooked question, and provides a baseline understanding of the likely impacts of queen stress on worker phenotypes. [ABSTRACT FROM AUTHOR]

The linear TiCH molecule is studied by ab initio quantum mechanical calculations using quantitative basis sets and highly correlated computational methods. Potential energy curves along the Ti2CH coordinate have been computed to obtain a better understanding of molecular formation in eight low-lying states of the molecule. Total energies, dissociation energies (with respect to Ti +CH), equilibrium distances, and dipole moments are reported. Simple valence bond Lewis diagrams are used to interpret the nature of the bonding in all of the states studied. [ABSTRACT FROM AUTHOR]

Background: Patient understanding of their care, supported by physician involvement and consistent communication, is key to positive health outcomes. However, patient and care team characteristics can hinder this understanding. Objective : We aimed to assess inpatients' understanding of their care and their perceived receipt of mixed messages, as well as the associated patient, care team, and hospitalization characteristics. Design : We administered a 30-item survey to inpatients between February 2020 and November 2021 and incorporated other hospitalization data from patients' health records. Participants: Randomly selected inpatients at two urban academic hospitals in the USA who were (1) admitted to general medicine services and (2) on or past the third day of their hospitalization. Main Measures: Outcome measures include (1) knowledge of main doctor and (2) frequency of mixed messages. Potential predictors included mean notes per day, number of consultants involved in the patient's care, number of unit transfers, number of attending physicians, length of stay, age, sex, insurance type, and primary race. Key Results: A total of 172 patients participated in our survey. Most patients were unaware of their main doctor, an issue related to more daily interactions with care team members. Twenty-three percent of patients reported receiving mixed messages at least sometimes, most often between doctors on the primary team and consulting doctors. However, the likelihood of receiving mixed messages decreased with more daily interactions with care team members. Conclusions: Patients were often unaware of their main doctor, and almost a quarter perceived receiving mixed messages about their care. Future research should examine patients' understanding of different aspects of their care, and the nature of interactions that might improve clarity around who's in charge while simultaneously reducing the receipt of mixed messages. [ABSTRACT FROM AUTHOR]

The article discusses research done on the benefit of early surgery in patients with prosthetic valve endocarditis (PVE) and associated complications. It references a study by B. Prendergast and J. Harrison, published in the online edition of the journal "Nature Reviews Cardiology" on September 3, 2013. The study examined a total of 1,025 patients who underwent early surgery. Results suggested that early surgery might not be beneficial to patients with PVE.

An abstract of the article "A comparison of late gadolinium enhancement magnetic resonance imaging and left atrial endocardial voltage," by James Harriso, Nick Linton, Steven Williams, Rashed Karim, Kawal Rhode, Matthew Wright, Tobias Schaeffter, Reza Razavi and Mark O'Neill is presented.

An abstract of the article "Dual-IR late gadolinium enhancement achieves better blood suppression than traditional IR in a swine model of atrial radiofrequency ablation scar," by Sarah A. Peel and colleagues is presented.

An abstract of the article "Magnetic resonance imaging of acute and chronic atrial ablation injury-a histological validation study," by James Harrison and colleagues is presented.

An abstract of the article "Prediction of gaps in atrial ablation lesion sets by late gadolinium enhancement magnetic resonance imaging," by James Harrison, Nick Linton, Steven Williams, and colleagues is presented.

Double resonance spectra have been obtained for nitrogen and benzene molecules in the low density region of a molecular beam by use of stimulated Raman pumping followed by ionization probing. For N2 the photoionization step was via a 2+2 resonantly enhanced multiphoton ionization process using the a1Πg(v=2)←X1Σg(v=1) two-photon resonance. The detection limit is 103–104 times lower than for the direct optical measurement of a stimulated Raman signal. For benzene, a more efficient 1+1 ionization step permitted measurements at state densities less than 1010 cm-3 and the Raman step yielded linewidths of 30 MHz for the Q-branch lines of the weak Raman active ν16 fundamental. © 1996 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor in response to the article "Addressing the Growing Burden of Trauma and Injury in Low- and Middle-Income Countries," by K. Hofman et al in the 2005 issue.

Maintaining suspension stability by effective particle dispersion in systems with attractive interactions can be accomplished by the addition of dispersants that modify the interparticle potential to provide steric or electrostatic barriers against aggregation. The efficacy of such dispersants is typically considered simply by the modification of suspension rheological properties as a function of the overall added dispersant concentration. However, such considerations do little to reveal the molecular origin of differences in dispersant efficacy because they do not consider differences in surface activity. We combine measured adsorption isotherms with the rheological characterization of the elasticity of colloidal gels formed by particle aggregation to provide a more meaningful assessment of dispersant efficacy. The rheological data show that the dispersants are effective at reducing particle aggregation, whereas, from the adsorption isotherms, they differ considerably in their surface coverage at constant overall concentration. When compared at constant dispersant particle surface coverage, the gel rheology shows marked differences across the different dispersants, as opposed to comparisons at constant overall dispersant concentration in the suspensions. In particular, the power-law volume fraction scaling of gel elasticity at constant coverage reveals clear differences in the critical volume fraction for gel formation for the different dispersants. The most efficacious dispersant is that associated with the largest critical volume fraction for gel formation at a given surface coverage. This work demonstrates the utility of rheological investigations coupled with accurate determinations of surface coverage to better differentiate dispersant performance, which may improve efforts to engineer new dispersant molecules. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the economic value of nivolumab versus docetaxel for advanced non-small cell lung cancer (aNSCLC) treatment after platinum-based chemotherapy in adults without epidermal growth factor receptor/anaplastic lymphoma kinase aberrations in China.Partitioned survival models evaluated lifetime costs and benefits of nivolumab versus docetaxel by squamous and non-squamous histologies from a Chinese healthcare payer perspective. Progression-free disease, progressed disease, and death health states were considered over a 20-year time horizon. Clinical data were derived from the CheckMate pivotal Phase III trials (ClinicalTrials.gov identifiers: NCT01642004, NCT01673867, NCT02613507); patient-level survival data were extrapolated using parametric functions. China-specific health state utilities, healthcare resource utilisation, and unit costs were applied. Sensitivity analyses explored uncertainty.Nivolumab resulted in extended survival (1.489 and 1.228 life-years [1.226 and 0.995 discounted]) and quality-adjusted survival benefits (1.034 and 0.833 quality-adjusted life-years) at additional costs of ¥214,353 (US$31,829) and ¥158,993 (US$23,608) versus docetaxel in squamous and non-squamous aNSCLC, respectively. Nivolumab was associated with higher acquisition costs, lower subsequent treatment costs, and lower adverse event management costs than docetaxel in both histologies. Drug acquisition costs, discount rate for outcomes, and average body weight were key model drivers. Stochastic results aligned with the deterministic results.Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. As a traditional healthcare payer perspective was applied, the true economic benefit of nivolumab may be underestimated as not all treatment benefits and costs of relevance to society were considered.Methods: To evaluate the economic value of nivolumab versus docetaxel for advanced non-small cell lung cancer (aNSCLC) treatment after platinum-based chemotherapy in adults without epidermal growth factor receptor/anaplastic lymphoma kinase aberrations in China.Partitioned survival models evaluated lifetime costs and benefits of nivolumab versus docetaxel by squamous and non-squamous histologies from a Chinese healthcare payer perspective. Progression-free disease, progressed disease, and death health states were considered over a 20-year time horizon. Clinical data were derived from the CheckMate pivotal Phase III trials (ClinicalTrials.gov identifiers: NCT01642004, NCT01673867, NCT02613507); patient-level survival data were extrapolated using parametric functions. China-specific health state utilities, healthcare resource utilisation, and unit costs were applied. Sensitivity analyses explored uncertainty.Nivolumab resulted in extended survival (1.489 and 1.228 life-years [1.226 and 0.995 discounted]) and quality-adjusted survival benefits (1.034 and 0.833 quality-adjusted life-years) at additional costs of ¥214,353 (US$31,829) and ¥158,993 (US$23,608) versus docetaxel in squamous and non-squamous aNSCLC, respectively. Nivolumab was associated with higher acquisition costs, lower subsequent treatment costs, and lower adverse event management costs than docetaxel in both histologies. Drug acquisition costs, discount rate for outcomes, and average body weight were key model drivers. Stochastic results aligned with the deterministic results.Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. As a traditional healthcare payer perspective was applied, the true economic benefit of nivolumab may be underestimated as not all treatment benefits and costs of relevance to society were considered.Results: To evaluate the economic value of nivolumab versus docetaxel for advanced non-small cell lung cancer (aNSCLC) treatment after platinum-based chemotherapy in adults without epidermal growth factor receptor/anaplastic lymphoma kinase aberrations in China.Partitioned survival models evaluated lifetime costs and benefits of nivolumab versus docetaxel by squamous and non-squamous histologies from a Chinese healthcare payer perspective. Progression-free disease, progressed disease, and death health states were considered over a 20-year time horizon. Clinical data were derived from the CheckMate pivotal Phase III trials (ClinicalTrials.gov identifiers: NCT01642004, NCT01673867, NCT02613507); patient-level survival data were extrapolated using parametric functions. China-specific health state utilities, healthcare resource utilisation, and unit costs were applied. Sensitivity analyses explored uncertainty.Nivolumab resulted in extended survival (1.489 and 1.228 life-years [1.226 and 0.995 discounted]) and quality-adjusted survival benefits (1.034 and 0.833 quality-adjusted life-years) at additional costs of ¥214,353 (US$31,829) and ¥158,993 (US$23,608) versus docetaxel in squamous and non-squamous aNSCLC, respectively. Nivolumab was associated with higher acquisition costs, lower subsequent treatment costs, and lower adverse event management costs than docetaxel in both histologies. Drug acquisition costs, discount rate for outcomes, and average body weight were key model drivers. Stochastic results aligned with the deterministic results.Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. As a traditional healthcare payer perspective was applied, the true economic benefit of nivolumab may be underestimated as not all treatment benefits and costs of relevance to society were considered.Conclusions: To evaluate the economic value of nivolumab versus docetaxel for advanced non-small cell lung cancer (aNSCLC) treatment after platinum-based chemotherapy in adults without epidermal growth factor receptor/anaplastic lymphoma kinase aberrations in China.Partitioned survival models evaluated lifetime costs and benefits of nivolumab versus docetaxel by squamous and non-squamous histologies from a Chinese healthcare payer perspective. Progression-free disease, progressed disease, and death health states were considered over a 20-year time horizon. Clinical data were derived from the CheckMate pivotal Phase III trials (ClinicalTrials.gov identifiers: NCT01642004, NCT01673867, NCT02613507); patient-level survival data were extrapolated using parametric functions. China-specific health state utilities, healthcare resource utilisation, and unit costs were applied. Sensitivity analyses explored uncertainty.Nivolumab resulted in extended survival (1.489 and 1.228 life-years [1.226 and 0.995 discounted]) and quality-adjusted survival benefits (1.034 and 0.833 quality-adjusted life-years) at additional costs of ¥214,353 (US$31,829) and ¥158,993 (US$23,608) versus docetaxel in squamous and non-squamous aNSCLC, respectively. Nivolumab was associated with higher acquisition costs, lower subsequent treatment costs, and lower adverse event management costs than docetaxel in both histologies. Drug acquisition costs, discount rate for outcomes, and average body weight were key model drivers. Stochastic results aligned with the deterministic results.Nivolumab yielded survival and quality-adjusted survival benefits at incremental cost versus docetaxel in aNSCLC. As a traditional healthcare payer perspective was applied, the true economic benefit of nivolumab may be underestimated as not all treatment benefits and costs of relevance to society were considered. [ABSTRACT FROM AUTHOR]

Discusses the 1955 novel 'The Inheritors,' by William Gerald Golding. Shift of the narrative point of view to Tuami in the final chapter; Rivalries and enmities among the Cro Magnons; Ways in which the title and the dominant theme of the novel force readers to consider whether members of Neanderthals were advancing.