The economic value of insulin glargine 300 U/mL (Gla-300) in people ≥18 years of age with type 2 diabetes mellitus: a value-based economic model from a U.S. payer perspective.

AIMS: This study aimed to evaluate the value and affordability of insulin glargine 300 U/mL (Gla-300) in a budget impact model from a United States (U.S.) payer perspective by leveraging recent real-world evidence (RWE) studies and incorporating the recent insulin price caps where applicable. MATERIALS AND METHODS: An economic model for a hypothetical one million U.S. health-plan population was developed to assess the budgetary impact of therapeutic interchanges in either direction between the two long- and longer-acting basal insulins (BIs) for patients with type 2 diabetes over a three-year model horizon. The utilization of long-acting BIs, longer-acting BIs, biosimilar BIs, and insulin degludec (IDeg-100) were informed by IQVIA data and internal forecasting at Sanofi. The DELIVER-2 and DELIVER-naïve studies provided healthcare resource utilization (HCRU) parameters. In the model base case, 24% of patients switched from long-acting BIs to insulin glargine biosimilars, IDeg-100, and other longer-acting BIs (Gla-300) by projected year 3. RESULTS: The base case total costs were $10,145 per patient per year (PPPY) in year 3 for the cumulative population. When all patients switched to Gla-300, the total costs in year 3 were $8,799, reflecting a net savings of -$660 PPPY compared to the budget increase of $686 PPPY in the base case. However, the longer-acting to long-acting BIs reversal scenario demonstrated a budgetary decrease of $676 PPPY over the model horizon. The reduction in incremental PPPY cost of $93 was observed using net drug costs rather than wholesale acquisition costs (WAC). LIMITATIONS: The market shares for years 1-3 were based on expectations supported by the clinicians' expert opinions and were not obtained from real-world data. CONCLUSIONS: The economic value of increased utilization of Gla-300 was driven by the reduction in HCRU, costs and market shares assumptions. Budgetary reductions were achieved by switching patients from long-acting BIs to Gla-300.

Type 2 Diabetes (T2D) is a chronic and debilitating condition that can lead to severe macro or microvascular complications. To mitigate these complications, it is crucial to effectively manage blood glucose levels. When other treatments prove ineffective in achieving adequate glucose control, insulin-based therapy becomes necessary. However, insulin-based treatments often come with the risk of hypoglycemic episodes, which can lead to increased utilization of healthcare resources (HCRU) and have a negative impact on costs.This study aimed to assess the budgetary impact of higher market shares of longer-acting basal insulins (specifically insulin glargine Gla-300) compared to long-acting basal insulins, insulin glargine biosimilars, and insulin degludec (IDeg) in the treatment of T2D. The perspective taken was that of a U.S. payer, taking into account the recent insulin price caps where applicable.The economic benefit of increased utilization of Gla-300 was driven by reductions in HCRU, costs, and market share assumptions. This resulted in a budgetary increase of $686 per patient per year (PPPY). In an alternative scenario where all patients transitioned to Gla-300, it led to a net savings of $660 PPPY.These findings provide valuable insights for decision-makers and healthcare professionals when making choices related to formulary placement and treatment utilization.

Determination of optimal prey for rearing the Tropical Gar Atractosteus tropicus (Lepisosteiformes: Lepisosteidae) / Determinación de presas óptimas para la crianza del pejelagarto Atractosteus tropicus (Lepisosteiformes: Lepisosteidae)

Abstract Larval feeding studies of both ornamental and consumable fish species are important for formulating successful management, and culture strategies for conservation purposes. In the present study, we evaluated prey selectivity for the tropical gar Atractosteus tropicus in the larval stage (first 8 weeks) using the zooplankton Artemia fransiscana, Daphnia pulex and Moina macrocopa as prey following the hypothesis that prey selection of the fish species is related not only to prey species preferences but to the difference in prey densities present in the environment. Functional responses were tested at prey densities of 0.2, 0.5, 1.0, 2.0, 4.0 and 8.0 ind. mL-1 and analyzed using Manly's α. For prey selectivity, we used the three zooplankton species at three different densities. In these two experiments the fish larvae were allowed to feed for 45 min. To quantify feeding behavior (encounters, attacks, captures, ingestions, rejections) we used a density of 1 ind. mL-1 using each prey species based on 10 minutes of direct observation. Our results showed a functional response Type II for A. tropicus preying mostly on A. franciscana and M. macrocopa. The Manly's α index showed that M. macrocopa and A. franciscana are the most preys selected. The values for encounters for the three prey species were relatively constant during the eight weeks. Encounter values for the cladocerans were low in comparison to A. franciscana; however, high success in capture and ingestion was observed for all prey species used. Our results from the functional response experiments supports the hypothesis that A. tropicus is an active predator presenting a functional response of a carnivorous fish and the shift in prey selection suggests that even at low prey availability, A. tropicus is able to manipulate and feed on zooplankton of wide range in size. Also, according to our results, we suggest the use of a mix of A. franciscana and M. macrocopa to feed A. tropicus in culture systems in concentrations ≈ 2 ind. mL-1 during the first 3 weeks of age and then shift to M. macrocopa from the 4 week. Our results, in conjunction with studies on the survivorship of the juveniles would aid in conservation efforts and improve the production of gars in aquaculture. Rev. Biol. Trop. 66(3): 1018-1033. Epub 2018 September 01.

Resumen Estudios sobre alimentación en etapa larvaria en peces ornamentales como de consumo son importantes para formular estrategias exitosas de manejo y cultivo con fines de conservación. En el presente estudio evaluamos la selectividad de presa del pejelagarto Atractosteus tropicus en etapas larvarias (primeras 8 semanas) utilizando el zooplancton Artemia fransiscana, Daphnia pulex y Moina macrocopa como presas, probando la hipótesis de que la selección de presas en peces está relacionada no solamente a la preferencia por la especie de presa sino también a la diferencia en la densidad de presas en el ambiente. También se probó la respuesta funcional con densidades de presa de 0.2, 0.5, 1.0, 2.0, 4.0 y 8.0 ind. mL-1. Para la selección de presa, utilizamos las tres especies de zooplancton en tres densidades diferentes. En ambos experimentos, las larvas de los peces se alimentaron por 45 min. Para cuantificar el comportamiento alimenticio (encuentros, ataques, capturas, ingestiones y rechazos), se usó una densidad de 1 ind. mL-1utilizando cada especie de presa mediante observación directa por 10 minutos. Nuestros resultados muestran que A. tropicus presenta una respuesta funcional Tipo II, depredando principalmente A. franciscana y M. macrocopa. El índice α de Manly mostró que las especies M. macrocopa and A. franciscana fueron las mayormente seleccionadas. Los valores de encuentros para las tres especies de presa fueron relativamente constantes a lo largo de las ocho semanas. Los valores de ataque, captura e ingestión para los cladóceros fueron bajos; sin embargo, se observó gran éxito en la captura e ingestión para todas las especias de presa utilizadas. Nuestros resultados sobre los experimentos de respuesta funcional soportan la hipótesis de que A. tropicus es un depredador activo y presenta una respuesta funcional relacionada con especies de peces carnívoras y que el cambio en la selección de presas sugiere que aún a bajas densidades y disponibilidad de presas, A. tropicus es capaz de manipular y alimentarse de presas de diferentes tamaños. También, sugerimos el uso de una mezcla de A. franciscana y M. macrocopa para alimentar a A. tropicus en sistemas de cultivo en concentraciones ≈ 2 ind. mL-1 durante las primeras tres semanas de edad y después cambiar a M. macrocopa a partir de la cuarta semana. Nuestros resultados, junto con estudios de sobrevivencia de los juveniles pueden ayudar a generar esfuerzos de conservación y mejorar la producción de pejelagarto en acuicultura.

Potencial inseticida de óleos essenciais sobre Tribolium castaneum em milho armazenado / Insecticidal potential of essential oils on Tribolium castaneum in stored maize

RESUMO O presente trabalho teve como objetivo investigar o potencial inseticida de óleos essenciais de Croton heliotropiifolius, Croton pulegiodorus, Myracrodruon urundeuva e Ocimumbasilicum sobre adultos de Tribolium castaneumem milho armazenado. Para cada óleo foram realizados bioensaios de fumigação, repelência e o efeito sobre a taxa instantânea de crescimento (ri), em cinco concentrações (0; 5; 10; 15 e 20 μL). Os bioensaios foram conduzidos sob condições constantes de temperatura (28±2 ºC), umidade relativa (70±5%) e escoto fase de 24 horas. Nos testes de fumigação diferentes concentrações dos óleos foi aplicado em tiras de papel filtro presas na parte inferior da tampa da câmara de fumigação (1,5L), a qual continha 20 gramas de substrato alimentar e 10 insetos adultos de T. castaneum não sexados. A mortalidade dos insetos foi avaliada após 48 horas de exposição. Os testes de repelência foram efetuados em arenas compostas por dois frascos ligados a uma caixa central. Em um frasco foi depositado o substrato alimentar com diferentes concentrações do óleo essencial, e, no outro, foi depositado apenas alimento (testemunha). Dez insetos adultos foram liberados na caixa central, ficando expostos por 5 dias para avaliação da preferência. Nos bioensaios de fumigação observou-se atividade inseticida do óleo essencial de M. urundeuva sobre adultos de T. castaneum. Nos bioensaios de repelência, todos os óleos testados apresentaram efeito repelente. A emergência de T. castaneumreduziu entre 33 e 100% quando foram criados em pó de milho tratado com os óleos essenciais. Os óleos essenciais de C. pulegiodorus e O. basilicum ocasionaram redução do crescimento populacional de T. castaneum em grãos de milho tratados. Os óleos testados demonstraram ser uma alternativa eficiente de controle para o uso nos programas de manejo de T. castaneum em unidades armazenadoras.

ABSTRACT The current work aimed at to investigate the insecticide potential of essential oils of Croton heliotropiifolius, Croton pulegiodorus, Myracrodruon urundeuva and Ocimum basilicum on adults of Tribolium castaneum in stored maize. For each oil, it were performed fumigation tests, repellency and the effect on the instantaneous rate of increase (ri), in five concentrations (0; 5; 10; 15 e 20 μL). Bioassays were carried out under constant temperature conditions (28±2 °C), relative humidity (70±5%) and scot phase of 24 hours. In fumigation different concentrations of test oils were applied on filter paper strips attached on the bottom of the fumigation chamber cover (1.5 L), which contained 20 grams of food substrate and 10 unsexed adults of T. castaneum. The insect mortality was recorded after 48 hours of exposure. The repellency tests were performed in arenas composed of two pots connected to a central box. In a pot it was deposited feed substrate, with concentrations of the essential oil, in the other pot (control) it was deposited only food. Ten adult insects were released in the central box, being exposed for 5 days to evaluate the preference. In the fumigation tests, insecticide activity of the essential oil of M. urundeuva was observed on adults of T. castaneum. In the repellency tests, all the tested oils presented repellent effect. The emergency of T. castaneumreduced between 33% and 100% when they were in the powdered maize treated with the essential oils. Maize grains treated with C. pulegiodorus and O. basilicum essential oils caused a significant decrease in the populations of T. castaneum. The tested oils proved to be an efficient control alternative for the use in managing programs of T. castaneum in storing units.

A commentary on the XIII(th) International Rotifer Symposium (Shillong, 2012).

Rotifers have attracted the attention of biologists for well over 200 years. Interest in these exquisite animals rests in their diverse morphology, short generation time resulting in high growth rates, ability to withstand desiccation, and wide distribution, coupled with evidence of cryptic speciation. Moreover, three modes of reproduction are present in the phylum: obligatory sexuality, cyclical parthenogenesis, and obligatory ameiotic parthenogenesis. Thus, this phylum offers a rich field of study. Recognizing the need to share advances in knowledge, a triennial meeting, the International Rotifer Symposium (IRS), was begun in 1976. The most recent symposium (13(th) IRS) was held at Shillong (India) from 18-24, November 2012. In this commentary we considered the development of rotifer research as viewed through the lens of more than 35 years of IRS. Initially papers presented at the IRS focused on ecology, morphology, and pure taxonomic problems, with little applied work being reported. However, after more than three decades, the emphasis has swung to a balance of both basic (e.g., aging, ecology, genetics, and taxonomy) and applied (aquaculture and ecotoxicology) research.

Demography of zooplankton (Anuraeopsis fissa, Brachionus rubens and Moina macrocopa) fed Chlorella vulgaris and Scenedesmus acutus cultured on different media

Generally zooplankton growth is often limited by the quality of their algal diet. A cheaper common practice in aquaculture, is to culture algae with fertilizers; however, the demography of zooplankton when fed these algae has not yet been evaluated. We studied the population growth and life table demography of the rotifers Anuraeopsis fissa and Brachionus rubens, and the cladoceran Moina macrocopa. For this, the algae Scenedesmus acutus or Chlorella vulgaris were cultured on defined (Bold’s basal) medium or the commercial liquid fertilizer (Bayfolan). Experiments were conducted at one algal concentration 1.0x10(6)cells/mL of C. vulgaris or its equivalent dry weight of 0.5x10(6)cells/mL of S. acutus. The population dynamics were tested at 23±1ºC in 100mL transparent jars, each with 50mL of the test medium, with an initial density of 0.5indiv/mL, for a total of 48 test jars (3 zooplankton 2 algal species x 2 culture media x 4 replicates). For the life table experiments with M. macrocopa, we introduced 10 neonates (<24h old) into each test jar containing the specific algal type and concentration. For the rotifer experiments, we set 5mL tubes with one neonate each and 10 replicates for each algal species and culture medium. We found that the average rotifer life span was not influenced by the diet, but for M. macrocopa fed S. acutus cultured in Bold’s medium, the average lifespan was significantly lower than with the other diets. The gross and net reproductive rates of A. fissa (ranging from 18-36 offspring per female) were significantly higher for C. vulgaris cultured in Bold medium. Regardless of the culture medium, Chlorella resulted in significantly higher gross and net reproductive rates for B. rubens than S. acutus diets. The reproductive rates of M. macrocopa were significantly higher in all the tested diets except when fed with S. acutus in Bold medium. The population increase rate, derived from growth experiments of A. fissa and B. rubens, ranged from 0.1-0.25/d and were significantly higher on C. vulgaris cultured in liquid fertilizer as compared to the other diets. The growth rates of M. macrocopa ranged from 0.1 to 0.38/d, and were highest with diets of C. vulgaris cultured in Bold medium and S. acutus cultured in fertilizer. Thus, regardless of the culture medium used, the growth rates of the evaluated zooplankton species were higher with Chlorella than with Scenedesmus. The peak population density was highest (2 800ind/mL) for A. fissa fed Chlorella that was cultured on liquid fertilizers, while B. rubens and M. macrocopa had peak abundances of 480 and 12ind/mL, respectively under similar conditions.

Generalmente el crecimiento del zooplancton está a menudo limitado por la calidad de su dieta de algas. La demografía del zooplancton durante la alimentación con algas no ha sido estudiada, a pesar de que el cultivo de algas con fertilizantes es una práctica económica común en acuacultura. Se analizó la demografía de Anuraeopsis fissa y Brachionus rubens (rotíferos) y Moina macrocopa (cladóceros), alimentados con las algas verdes Scenedesmus acutus o Chlorella vulgaris cultivadas en medio Bold o fertilizante líquido comercial (Bayfolan, de Bayer). En los rotíferos no se observaron diferencias significativas en el promedio de vida, sin embargo, este parámetro en M. macrocopa con S. acutus cultivada en Medio Bold, fue significativamente menor que en otras dietas. Las tasas de reproducción bruta y neta de A. fissa fueron significativamente mayores con C. vulgaris cultivada en medio Bold, que con el fertilizante; estas tasas en B. rubens, independientemente del medio de cultivo, resultaron significativamente mayores con Chlorella que S. acutus. La tasa de reproducción de M. macrocopa fue significativamente mayor en todas, a excepción de S. acutus en Bold. En el crecimiento poblacional con A. fissa y B. rubens la tasa de crecimiento poblacional varió de 0.1 hasta 0.25/d, significativamente mayores en C. vulgaris cultivadas con fertilizante, en comparación con las otras dietas; en M. macrocopa la tasa de crecimiento varió desde 0.1 hasta 0.38/d, las más altas fueron: con C. vulgaris cultivadas en medio Bold y S. acutus cultivadas con fertilizante. Así, en todas las especies, la tasa de crecimiento fue más alta con Chlorella que con Scenedesmus.

MRSA outbreak at a transplantation unit

Methicillin-resistant Staphylococcus aureus (MRSA) infections frequently complicate the post-operative course of transplant recipients, and despite nasal carriage and endemic colonization, MRSA outbreaks are not commonly described. This study reports a case of MRSA outbreak and discusses infection control measures and recommendations for this situation.

From ultrasound images to block based region motion estimation.

By applying a hexagon-diamond search (HDS) method to an ultrasound image, the path of an object is able to be monitored by extracting images into macro-blocks, thereby achieving image redundancy is reduced from one frame to another, and also ascertaining the motion vector within the parameters searched. The HDS algorithm uses six search points to form the six sides of the hexagon pattern, a centre point, and a further four search points to create diamond pattern within the hexagon that clarifies the focus of the subject area.

From ultrasound images to block based region motion estimation

By applying a hexagon-diamond search (HDS) method to an ultrasound image, the path of an object is able to be monitored by extracting images into macro-blocks, thereby achieving image redundancy is reduced from one frame to another, and also ascertaining the motion vector within the parameters searched. The HDS algorithm uses six search points to form the six sides of the hexagon pattern, a centre point, and a further four search points to create diamond pattern within the hexagon that clarifies the focus of the subject area.