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Alexis T Mickle,1 Greta Lozano-Ortega,1 Veronique Gaudet,2 Evan Popoff,1 Martin Barbeau,2 Steve Mathieu3 1Broadstreet Health Economics & Outcomes Research, Vancouver, British Columbia, Canada; 2Market Access and Government Affairs, Bausch Health, Canada Inc., Laval, Québec, Canada; 3Service de Dermatologie, Centre hospitalier de l’Université de Québec–Université Laval, Québec, Québec, CanadaCorrespondence: Greta Lozano-Ortega, Broadstreet Health Economics and Outcomes Research, 201 – 343 Railway Street, Vancouver, British Columbia, Canada, V6A 1A4, Tel +1 604-679-8000, Email glozano-ortega@broadstreetheor.comBackground: Toenail onychomycosis affects approximately 6.7% of Canadians. Symptoms include nail discolouration/disfiguration and pain; psychosocial impacts contribute to reduced health-related quality-of-life. Comorbid diabetes increases the risk of complications and exacerbates burden. Treatment may include topical therapy and/or oral agents.Purpose: To understand toenail onychomycosis treatment preferences, and to quantify the impact of toenail onychomycosis, with or without diabetes, on patient well-being.Methods: Adults living in Canada with self-reported, physician-diagnosed, toenail onychomycosis were recruited online. A discrete choice experiment was used to quantify treatment preferences. Scenarios were randomized; data were analyzed using conditional logit regression. Health state utilities were estimated using the Health Utilities Index Mark 3®. Results were stratified by diabetes status and toenail onychomycosis severity; the Wilcoxon Rank Sum test was used to assess between-group utility differences.Results: Three-hundred thirteen participants with toenail onychomycosis were included (161 had comorbid diabetes; 61.3%, severe onychomycosis). The mean age was 57.7 years; 55.9% were male. Treatment attributes with statistically significant impacts on patient preferences were efficacy (odds ratio [OR],1.04; 95% confidence interval [CI], 1.02– 1.05 per 1% increased treatment success), administration method (one pill versus topical nail lacquer reference, 1.14; 1.04– 1.26; topical solution applicator versus reference: 1.15; 1.03– 1.29), severe adverse events (0.85; 0.80– 0.90 per 1% increased risk), and risk of potential pharmacodynamic (0.80; 0.76– 0.85) and alcohol (0.93; 0.88– 0.98) interactions; preferences were more pronounced for efficacy and avoiding severe adverse events among toenail onychomycosis patients with comorbid diabetes. The mean (95% CI) utility value was 0.73 (0.70– 0.75) overall, and statistically significantly lower (p=0.02) for toenail onychomycosis patients with diabetes (0.70; CI, 0.66– 0.73) than those without (0.76; CI, 0.72– 0.79).Conclusion: Among patients with toenail onychomycosis, the presence of diabetes was associated with differing treatment-related preferences. Utility values for patients with toenail onychomycosis represent a significant decline from full health that is exacerbated by comorbid diabetes.Keywords: health-related-quality-of-life, utilities, discrete choice experiment, fungus

This study was undertaken to investigate the biomechanical demands on the low back of Massage Therapists performing typical massage therapy techniques and the nature of the associated cumulative exposure. Ten Massage Therapists performed a standardized relaxation back massage that incorporated a series of basic massage therapy techniques used in standard treatments. The 44-minute massage treatment was videotaped and a posture-matching approach was used to determine 3D peak and cumulative loads on the low back. Although the resultant peak low back loads would be considered safe in relation to current published compression and shear guidelines, the cumulative loading values were well within the ranges considered disconcerting in other health care and industrial workers. The therapists were found to assume non-neutral trunk, neck and arm postures for a significant portion of the massage, which could place these professionals at risk of cumulative musculoskeletal disorders. [ABSTRACT FROM AUTHOR]

Conventional fluorescence-detection systems typically involve a separate laser excitation source shining directly down towards the photodetectors, with the fluorescent sample in-between. A major issue with such systems is the strong excitation light signal that can saturate detection circuitry and/or make detection of the fluorescent signal difficult, even with optical filtering. A fluorescence-detection system is described consisting of light emitting diode dies bonded on top of a CMOS imaging chip. Such a system facilitates a high level of integration while potentially reducing the excitation light hitting the photodetectors. Model results are used to predict the shape of the imager response to excitation light. Experimental results confirm the validity of the model. [ABSTRACT FROM AUTHOR]