Work absenteeism and disability associated with psoriasis and psoriatic arthritis in the USA-a retrospective study of claims data from 2009 TO 2020.

OBJECTIVES: To compare work absenteeism and short-term disability among adults with psoriasis or psoriatic arthritis (PsA), versus controls in the USA. METHODS: Adults eligible for work absenteeism and/or short-term disability benefits between 1/1/2009 and 4/30/2020 were screened in the IBM® MarketScan® Commercial and Health and Productivity Management Databases. The following groups were defined: (1) psoriasis: ≥ 2 psoriasis diagnoses ≥ 30 days apart and no PsA diagnoses; (2) PsA: ≥ 2 PsA diagnoses ≥ 30 days apart; (3) control: absence of psoriasis and PsA diagnoses. Controls were matched to psoriasis and PsA patients based on age, gender, index year, and comorbidities. Non-recreational work absences and sick leaves were evaluated in absentee-eligible patients, and short-term disability was evaluated in short-term disability-eligible patients. Costs (in 2019 USD) associated with each type of work absence were evaluated. RESULTS: 4261 psoriasis and 616 PsA absentee-eligible and 25,213 psoriasis and 3480 PsA short-term disability-eligible patients were matched to controls. Average non-recreational work absence costs were $1681, $1657, and $1217 for the PsA, psoriasis, and control group, respectively. Compared with psoriasis patients and controls, more PsA patients had sick leaves after 1 year (56.2% versus 55.6% and 41.5%, p < 0.0001). Similarly, short-term disability was more frequent in PsA patients than psoriasis patients and controls at year one (8.8% versus 5.6% and 4.7%, p < 0.0001) and corresponding costs were higher ($605, $406, and $335 on average, p < 0.0001). CONCLUSION: Annual work absenteeism and short-term disability were consistently greater among patients with PsA and psoriasis than controls, highlighting the substantial economic burden of psoriatic disease. Key points • Patients with PsA had greater short-term disability compared with patients with psoriasis and patients with neither psoriasis nor PsA. • Patients with PsA and patients with psoriasis incurred greater non-recreational work absences and sick leaves than patients with neither psoriasis nor PsA.

Healthcare utilization and costs among patients with psoriasis and psoriatic arthritis in the USA-a retrospective study of claims data from 2009 to 2020.

OBJECTIVES: To compare healthcare resource utilization and costs among patients with psoriasis, psoriatic arthritis (PsA), and a control group of patients without psoriasis and PsA in the USA. METHODS: The IBM® MarketScan® Commercial Database was used to identify three adult patient groups from 1/1/2009 through 4/30/2020: (1) Psoriasis: ≥ 2 diagnoses ≥ 30 days apart for psoriasis (no PsA diagnoses); (2) PsA: ≥ 2 diagnoses for PsA; (3) Control: no psoriasis or PsA diagnoses in their entire claims records. Patients with comorbid rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, or ulcerative colitis were excluded from the analyses. Controls were matched 1:1 to psoriasis and PsA patients based on age, gender, index year, and number of non-rheumatological comorbidities. Healthcare resource utilization and costs (in 2019 USD) were evaluated descriptively and through mixed models for five years of follow-up. RESULTS: A total of 142,531 psoriasis and 21,428 PsA patients were matched to the control group (N = 163,959). Annual all-cause healthcare costs per patient were $7,470, $11,062, and $29,742 for the control, psoriasis, and PsA groups, respectively. All-cause healthcare costs increased over time and were significantly greater among PsA vs. psoriasis (p < 0.0001) and the control groups (p < 0.0001). Across all categories of healthcare resources, utilization was greatest among patients with PsA and lowest in the control group. CONCLUSION: Annual healthcare costs and resource utilization were significantly higher with PsA compared with psoriasis and the control group, confirming the substantial economic burden of PsA. The cost disparity between these patient groups highlights a continued unmet medical need. Key Points • Patients with PsA incurred significantly greater healthcare resource utilization and costs than patients with psoriasis and patients without psoriasis and PsA. • Significantly greater costs and healthcare resource utilization were also observed among patients with psoriasis compared with patients without psoriasis and PsA.

A multinational assessment of work-related productivity loss and indirect costs from a survey of patients with psoriasis.

BACKGROUND: Total work productivity loss (WPL) and associated indirect costs contribute to the economic burden of psoriasis. OBJECTIVES: To estimate total WPL and related indirect costs, and identify predictors of WPL associated with psoriasis severity in France, Germany, Spain, the U.K. and Italy (EU5) and the U.S.A. METHODS: Data from the 2015 Adelphi Real World Psoriasis Disease Specific Programme, analysed for absenteeism, presenteeism and total WPL, were quantified (0-100%) from participants who completed the Work Productivity and Activity Impairment (WPAI) instrument. These measures were converted to indirect costs using the human capital method. Univariate and multivariate statistical analyses controlling for patient demographic and clinical characteristics were conducted. RESULTS: Of the 936 respondents (29·6% U.S.A., 70·4% EU5) who completed the WPAI, 32·6%, 40·7% and 26·6% had mild [body surface area (BSA) 0-2%], moderate (BSA 3-10%) and severe (BSA > 10%) psoriasis, respectively. Average age, Dermatology Life Quality Index (DLQI) score and BSA were, respectively, 42·4 years, 5·1 and 9·6%; and 37·2% of respondents were female. Mean percentages of total WPL for respondents with mild, moderate and severe psoriasis were 10·1%, 18·9% and 29·4%, respectively. Presenteeism contributed considerably more to total WPL than did absenteeism across all countries and disease severity classes. Mean annual indirect costs per patient due to WPL ranged from 3742 U.S. dollars in Spain to 9591 U.S. dollars in the U.S.A. Multivariate regression showed that a one-unit increase in DLQI score increases total WPL by 1·8% (P < 0·001). CONCLUSIONS: WPL increased progressively with increasing DLQI scores and BSA, confirming the relationship between psoriasis severity and its economic burden. What's already known about this topic? The economic burden of psoriasis is exceptionally high given the high prevalence and lifelong nature of the condition. Several studies have attempted to assess the overall economic burden of psoriasis but there is a lack of comparative data from different countries, and issues around inconsistent methodologies, including statistical analyses. Total work productivity loss (WPL) and associated indirect costs are believed to contribute to the economic burden of psoriasis. What does this study add? This study measured total WPL and indirect costs via the same method and at the same time point in the U.S.A., France, Germany, Spain, U.K. and Italy. Total WPL increased progressively with psoriasis disease severity. Disease severity and Dermatology Life Quality Index scores significantly correlated with WPL after controlling for patient demographic and clinical characteristics. The U.S.A. had the highest annual mean indirect costs associated with total WPL. Linked Comment: Drabo et al. Br J Dermatol 2020; 183:420-421.

Persistent effects of pre-Columbian plant domestication on Amazonian forest composition.

The extent to which pre-Columbian societies altered Amazonian landscapes is hotly debated. We performed a basin-wide analysis of pre-Columbian impacts on Amazonian forests by overlaying known archaeological sites in Amazonia with the distributions and abundances of 85 woody species domesticated by pre-Columbian peoples. Domesticated species are five times more likely than nondomesticated species to be hyperdominant. Across the basin, the relative abundance and richness of domesticated species increase in forests on and around archaeological sites. In southwestern and eastern Amazonia, distance to archaeological sites strongly influences the relative abundance and richness of domesticated species. Our analyses indicate that modern tree communities in Amazonia are structured to an important extent by a long history of plant domestication by Amazonian peoples.

Enfoque de cadena de valor local / Guía de aplicación

El documento está dirigido principalmente a técnicos que trabajan en los niveles municipales, en el campo de promoción y desarrollo económico municipal.La particularidad de esta guía es que los estudios de cadenas son realizados a través de un proceso de amplia participación de actores locales, particularmente productores, haciendo una contribución para enriquecer los procesos de planificación participativa incorporando el componente económico a través de una visión sistémica de lka producción y la transformación

Construction and analysis of bacterial artificial chromosome libraries from a marine microbial assemblage.

Cultivation-independent surveys of ribosomal RNA genes have revealed the existence of novel microbial lineages, many with no known cultivated representatives. Ribosomal RNA-based analyses, however, often do not provide significant information beyond phylogenetic affiliation. Analysis of large genome fragments recovered directly from microbial communities represents one promising approach for characterizing uncultivated microbial species better. To assess further the utility of this approach, we constructed large-insert bacterial artificial chromosome (BAC) libraries from the genomic DNA of planktonic marine microbial assemblages. The BAC libraries we prepared had average insert sizes of 80 kb, with maximal insert sizes > 150 kb. A rapid screening method assessing the phylogenetic diversity and representation in the library was developed and applied. In general, representation in the libraries agreed well with previous culture-independent surveys based on polymerase chain reaction (PCR)amplified rRNA fragments. A significant fraction of the genome fragments in the BAC libraries originated from as yet uncultivated microbial species, thought to be abundant and widely distributed in the marine environment. One entire BAC insert, derived from an uncultivated, surface-dwelling euryarchaeote, was sequenced completely. The planktonic euryarchaeal genome fragment contained some typical archaeal genes, as well as unique open reading frames (ORFs) suggesting novel function. In total, our results verify the utility of BAC libraries for providing access to the genomes of as yet uncultivated microbial species. Further analysis of these BAC libraries has the potential to provide significant insight into the genomic potential and ecological roles of many indigenous microbial species, cultivated or not.

Multicolor immunofluorescence and flow cytometry utilizing cascade blue to purify murine hematopoietic stem cells from fetal liver and bone marrow.

BACKGROUND: Here we demonstrate the utility of cascade blue (CB), to purify hematopoietic stem cells by flow cytometry. Multicolor immunofluorescence and the sensitivity (signal-to-noise) of the fluorochromes are essential for the identification and isolation of rare stem cell populations. METHODS: We isolated hematopoietic stem cells utilizing a 407 nm laser line to excite CB and propidium iodide (PI) in combination with FITC, PE, and Red670 which were excited at 488 nm. RESULTS: CB is maximally excited using a 407 nm laser line, when compared to UV or 413 nm excitation. The increase in sensitivity of CB at 407 nm can be contributed to higher absorption of CB and a reduction of autofluorescence at this excitation wavelength (Ropp et al.: Cytometry 21: 309-317, 1995). CONCLUSIONS: Despite the fact that the CB antibody conjugate has a tendency to adhere specifically to a B cell subpopulation in bone marrow, we nevertheless could purify stem cells by using CB for the detection and elimination of lineage positive cells. Isolated stem cells from mouse fetal liver (Lin-CD34(+)Sca-1(+)c-Kit(high)) and adult bone marrow (Lin-CD34(-/low)Sca-1(+)c-Kit(+)) were transplanted into lethally irradiated mice, and the sorted stem cells had the ability to efficiently repopulate all mature hematopoietic lineages in recipient mice.

Hematopoietic stem cell maintenance and differentiation are supported by embryonic aorta-gonad-mesonephros region-derived endothelium.

Hematopoietic stem cells are capable of extensive self-renewal and expansion, particularly during embryonic growth. Although the molecular mechanisms involved with stem cell maintenance remain mysterious, it is now clear that an intraembryonic location, the aorta-gonad-mesonephros (AGM) region, is a site of residence and, potentially, amplification of the definitive hematopoietic stem cells that eventually seed the fetal liver and adult bone marrow. Because several studies suggested that morphologically defined hematopoietic stem/progenitor cells in the AGM region appeared to be attached in clusters to the ventrally located endothelium of the dorsal aorta, we derived cell lines from this intraembryonic site using an anti-CD34 antibody to select endothelial cells. Analysis of two different AGM-derived CD34(+) cell lines revealed that one, DAS 104-8, efficiently induced fetal-liver hematopoietic stem cells to differentiate down erythroid, myeloid, and B-lymphoid pathways, but it did not mediate self-renewal of these pluripotent cells. In contrast, a second cell line, DAS 104-4, was relatively inefficient at the induction of hematopoietic differentiation. Instead, this line provoked the expansion of early hematopoietic progenitor cells of the lin-CD34(+)Sca-1(+)c-Kit+ phenotype and was proficient at maintaining fetal liver-derived hematopoietic stem cells able to competitively repopulate the bone marrow of lethally irradiated mice. These data bolster the hypothesis that the endothelium of the AGM region acts to mediate the support and differentiation of hematopoietic stem cells in vivo.

Regímenes antibióticos en la prevención de sepsis de herida postapendicectomía / Antibiotic regimens in sepsis prevention of post-appendectomy wound

Se llevó a cabo un estudio prospectivo al azar de 318 casos consecutivos con apendicitis para dilucidar la eficacia y eficiencia de los regímenes profilácticos Gentamicina/Clindamicina (G/C), Penicilina/Cloranfenicol (PC) y Gentamicina/Metronidazol (G/M), en prevenir la sepsis de herida postapendicectomía. Hubo 3% de sepsis de herida en toda la muestra. 47 casos con heridas limpias contaminadas por apendicitis catarral recibieron sólo una dosis preoperatória y no hubo ningún caso de sepsis de herida. 173 casos, con heridas contaminadas por apendicitis supurada recibieron 24 horas de profilaxis y la sepsis de herida ocurrió en el 4% en cada uno de los grupos G/C y P/C. 98 pacientes con heridas sucias apendicitis gangrenada o perforada recibieron profilaxis por 72 horas y la sepsis de la herida ocurrió en el 5%, 6% y 5% en los grupos G/C, P/C y G/M respectivamente. Los antimicrobianos se administraron endovenosamente excepto el Metronidazol que se usó por vía oral y rectal. Concluimos que los regímenes C/G, P/C y G/M, son eficaces en la prevención de sepsis de herida postapendicectomía sin diferencias significativas (P > 0.40) y que el régimen Gentamicina/Metronidazol es el más eficiente