Comparison of pneumonia incidence between long-acting muscarinic antagonist and inhaled corticosteroid plus long-acting beta agonist in patients with COPD.

Few studies have directly compared the incidence of pneumonia in patients on common chronic obstructive pulmonary disease (COPD) treatments such as long-acting muscarinic antagonists (LAMA) with those on inhaled corticosteroids and long-acting ß2-agonist (ICS/LABA). Moreover, risk factors for pneumonia in COPD are still unclear. We aimed to compare the incidence of pneumonia in COPD patients on LAMA and those on ICS/LABA and explored the risk factors associated with pneumonia. This nationwide cohort study used Korean National Health Insurance claim data from January 2002 to April 2016. Patients who received COPD medication, either LAMA or ICS/LABA, with the COPD diagnostic code, were selected. We enrolled patients with good compliance (medication possession ratio ≥ 80%). The primary outcome was pneumonia in COPD patients initiating LAMA or ICS/LABA. We investigated the risk factors associated with pneumonia, including the sub-types of ICS treatments. After propensity score matching, the incidence rate per 1000 person-years of pneumonia was 93.96 for LAMA (n = 1003) and 136.42 for ICS/LABA (n = 1003) patients (p < 0.001). The adjusted hazard ratio (HR) for pneumonia in patients on fluticasone/LABA was 1.496 (95% confidence interval [CI] 1.204-1.859) compared with LAMA (p < 0.001). In multivariable analysis, a history of pneumonia was a risk factor associated with pneumonia (HR 2.123; 95% CI 1.580-2.852; p < 0.001). The incidence of pneumonia was higher in COPD patients on ICS/LABA compared with those on LAMA. It is recommended that ICS use be avoided in COPD patients with high pneumonia risk.

Temporal impact of the publication of guidelines and randomised evidence on the adoption of hypofractionated whole breast radiotherapy for early-stage breast cancer.

INTRODUCTION: Clinical data supporting the use of hypofractionated whole breast radiotherapy (HF-WBRT) in early-stage breast cancer patients have accumulated over the last decade. Despite the availability of the published evidence, the adoption rate of HF-WBRT has been slower-than-expected. We sought to assess the temporal impact of the publication of the guidelines and randomised evidence on the practice pattern of HF-WBRT and identify clinical predictors of its utilisation. METHODS: Women with early-stage breast cancer who received adjuvant WBRT at Canberra Health Services between 2008 and 2016 were identified from clinical databases. The patterns of HF-WBRT use were analysed in relation to pre-specified time periods (before and after the guideline publications) in the entire cohort as well as in a patient subset fulfilling the criteria for HF-WBRT according to the guidelines (referred to as 'guideline-endorsed subset'). The impact of clinical variables, treating clinicians and the time periods on the adoption of HF-WBRT was assessed by hierarchical multivariate logistic regressions. RESULTS: Of the entire cohort (n = 1171), the guideline-endorsed subset constituted 51.6% (n = 604) of the patients. HF-WBRT was utilised in 32.8% of the entire cohort and 46.2% of the guideline-endorsed subset. Between 2008 and 2016, HF-WBRT use rate increased from 12.1% to 56.6% in a non-linear pattern. Release of international and local consensus guidelines significantly correlated with the increase in HF-WBRT utilisation rate. The use of chemotherapy and/or tumour bed boost radiotherapy (TBBR), chest wall sepJMIROtion distance (CWSD) and patient age were significant predictors of HF-WBRT use on multivariate analyses. After factoring in the effects of individual clinicians and the time periods on hierarchical multivariate analyses, the use of chemotherapy, TBBR, and CWSD remained as significant variables. Clinicians contributed to the variability in the HF-WBRT adoption pattern. CONCLUSION: The temporal uptake pattern and the predictors of adjuvant HF-WBRT use in early breast cancer patients largely reflected the accumulating clinical evidence and the publication of the consensus guidelines. This study identified potentially modifiable factors associated with slower-than-expected uptake rate of HF-WBRT. Understanding why there is variability in clinicians' readiness to adopt the abbreviated treatment despite the availability of advanced radiotherapy techniques and the updated evidence is an important step towards formulating effective strategies to optimise the radiotherapeutic management of this common malignancy.

Assessment of the validity of multiple obesity indices compared with obesity-related co-morbidities.

OBJECTIVE: The aim of the present study was to compare selected obesity indicators with comprehensive health status. DESIGN: The study employed a pooled cross-sectional design. SETTING: BMI, waist circumference, waist-to-height ratio (WHtR) and body fat percentage were considered as indirect obesity indicators. The Edmonton Obesity Staging System (EOSS) was used as a composite indicator to comprehensively reflect obesity-related co-morbidities. Cohen's κ coefficient was used to evaluate inter-measurement agreement for obesity. Conformity of indirect obesity indicators to the EOSS was assessed based on percentage agreement (proportion classified as obese and severely unhealthy as a result of obesity among the total sample), sensitivity (proportion classified as obese among individuals severely unhealthy as a result of obesity) and specificity (proportion classified as non-obese among fairly healthy individuals). Logistic regression analysis was used to identify the sociodemographic factors most strongly associated with conformity.ParticipantsThe study included 17338 adults from the Korea National Health and Nutrition Examination survey conducted between July 2008 and May 2011. RESULTS: Level of conformity to the EOSS was highest for WHtR (60·77 %) and lowest for BMI (35·96 %). WHtR and BMI had the highest sensitivity (53·7 %) and specificity (98·4 %), respectively. Predictability of conformity was lower among men for all indirect obesity indicators. CONCLUSIONS: WHtR has the greatest potential to identify individuals at risk of health problems due to obesity. Individual demographic factors must be considered in selecting the most appropriate obesity measurement.

Novel phenothiazine-based organic dyes with a heteroleptic dual-electron-acceptor for dye-sensitized solar cells.

We designed a novel organic dye with a heteroleptic dual-electron acceptor (cyanocrylic acid and rhodanine-acetic acid) on each side of a phenothiazine-based organic dye as a photosensitizer for dye-sensitized solar cells (DSSCs). Density functional theory (DFT) and time-dependent density functional theory (TDDFT) calculations were used to estimate the photovoltaic properties of the dyes, with the findings showing that the organic dyes when used in the heteroleptic dual-electron-acceptor type resulted in higher performance than their single electron-acceptor and homoleptic dual-electron-acceptor counterparts due to the higher molar extinction coefficients and the orientation of the adsorbed dye. It was attributed to relatively broad and intense absorption spectra in the visible region with the rhodanine-acetic acid moiety and abundant electronic coupling with TiO2 of the cyanoacrylic acid anchoring group.

Synthesis and photophysical studies of blue phosphorescent Ir(III) complexes with dimethylphenylphospine.

New blue emitting mixed ligand iridium(III) complexes comprising one cyclometalating, two phosphines trans to each other such as Ir{(CF3)2Meppy}(PPhMe3)2(H)(L) [L = CI, NCMe, CN] [(CF3)2Meppy = 2-(3', 5'-bis-trifluoromethylphenyl)-4-methylpyridine] were synthesized and studied to tune the phosphorescence wavelength to the deep blue region and to enhance the luminescence efficiencies. To achieve deep blue emission, the trifluoromethyl group substituted on the phenyl ring and the methyl group substituted on the pyridyl ring increased HOMO-LUMO gap and achieved the hypsochromic shift. To gain insight into the factors responsible for the emission color change and the different luminescence efficiency, we investigate the electron-withdrawing capabilities of ancillary ligands using the DFT and TD-DFT calculations on the ground and excited states of the complexes. From these results, we discuss how the ancillary ligand influences the emission peak as well as the metal to ligand charge transfer (MLCT) transition efficiency. The maximum emission spectra of Ir{(CF3)2Meppy}(PPhMe3)2(H)(Cl), [Ir{(CF3),Meppy)(PPhMe3),(H)(NCMe)]+ and Ir{(CF3)2Meppy}(PPhMe3)2(H)(CN) were in the ranges of 441, 435, 434 nm, respectively.