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Lugade V, Torbitt M, O’Brien SR, Silsupadol P. Smartphone- and Paper-Based Delivery of Balance Intervention for Older Adults Are Equally Effective, Enjoyable, and of High Fidelity: A Randomized Controlled Trial. SENSORS (BASEL, SWITZERLAND) 2023; 23:7451. [PMID: 37687907 PMCID: PMC10490587 DOI: 10.3390/s23177451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023]
Abstract
Home-based rehabilitation programs for older adults have demonstrated effectiveness, desirability, and reduced burden. However, the feasibility and effectiveness of balance-intervention training delivered through traditional paper-versus novel smartphone-based methods is unknown. Therefore, the purpose of this study was to evaluate if a home-based balance-intervention program could equally improve balance performance when delivered via smartphone or paper among adults over the age of 65. A total of 31 older adults were randomized into either a paper or phone group and completed a 4-week asynchronous self-guided balance intervention across 12 sessions for approximately 30 min per session. Baseline, 4-week, and 8-week walking and standing balance evaluations were performed, with exercise duration and adherence recorded. Additional self-reported measures were collected regarding the enjoyment, usability, difficulty, and length of the exercise program. Twenty-nine participants completed the balance program and three assessments, with no group differences found for any outcome measure. Older adults demonstrated an approximately 0.06 m/s faster gait velocity and modified balance strategies during walking and standing conditions following the intervention protocol. Participants further self-reported similar enjoyment, difficulty, and exercise effectiveness. Results of this study demonstrated the potential to safely deliver home-based interventions as well as the feasibility and effectiveness of delivering balance intervention through a smartphone-based application.
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Affiliation(s)
- Vipul Lugade
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
| | - Molly Torbitt
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
- Department of Physical Therapy Education, College of Health Professions, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY 13210, USA
| | - Suzanne R. O’Brien
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
| | - Patima Silsupadol
- Division of Physical Therapy, Decker College of Nursing and Health Sciences, SUNY Binghamton University, 4400 Vestal Parkway East, Binghamton, New York, NY 13902, USA; (M.T.); (S.R.O.); (P.S.)
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Towards sustainability and affordability of expensive cell and gene therapies? Applying a cost-based pricing model to estimate prices for Libmeldy and Zolgensma. Cytotherapy 2022; 24:1245-1258. [PMID: 36216697 DOI: 10.1016/j.jcyt.2022.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AIMS Drug prices are regarded as one of the most influential factors in determining accessibility and affordability to novel therapies. Cell and gene therapies such as OTL-200 (brand name: Libmeldy) and AVXS-101 (brand name: Zolgensma) with (expected) list prices of 3.0 million EUR and 1.9 million EUR per treatment, respectively, spark a global debate on the affordability of such therapies. The aim of this study was to use a recently published cost-based pricing model to calculate prices for cell and gene therapies, with OTL-200 and AVXS-101 as case study examples. METHODS Using the pricing model proposed by Uyl-de Groot and Löwenberg, we estimated a price for both therapies. We searched the literature and online public sources to estimate (i) research and development (R&D) expenses adjusted for risk of failure and cost of capital, (ii) the eligible patient population and (iii) costs of drug manufacturing to calculate a base-case price for OTL-200 and AVXS-101. All model input parameters were varied in a stepwise, deterministic sensitivity analysis and scenario analyses to assess their impact on the calculated prices. RESULTS Prices for OTL-200 and AVXS-101 were estimated at 1 048 138 EUR and 380 444 EUR per treatment, respectively. In deterministic sensitivity analyses, varying R&D estimates had the greatest impact on the price for OTL-200, whereas for AVXS-101, changes in the profit margin changed the calculated price substantially. Highest prices in scenario analyses were achieved when assuming the lowest number of patients for OTL-200 and highest R&D expenses for AVXS-101. The lowest R&D expenses scenario resulted in lowest prices for either therapy. CONCLUSIONS Our results show that, using the proposed model, prices for both OTL-200 and AVXS-101 lie substantially below the currently (proposed) list prices for both therapies. Nevertheless, the uncertainty of the used model input parameters is considerable, which translates in a wide range of estimated prices. This is mainly because of a lack of transparency from pharmaceutical companies regarding R&D expenses and the costs of drug manufacturing. Simultaneously, the disease indications for both therapies remain heavily understudied in terms of their epidemiological profile. Despite the considerable variation in the estimated prices, our results may support the public debate on value-based and cost-based pricing models, and on "fair" drug prices in general.
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Ji X, Rao Z, Zhang W, Liu C, Wang Z, Zhang S, Zhang B, Hu M, Servati P, Xiao X. Airline Point-of-Care System on Seat Belt for Hybrid Physiological Signal Monitoring. MICROMACHINES 2022; 13:mi13111880. [PMID: 36363901 PMCID: PMC9694689 DOI: 10.3390/mi13111880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 05/31/2023]
Abstract
With a focus on disease prevention and health promotion, a reactive and disease-centric healthcare system is revolutionized to a point-of-care model by the application of wearable devices. The convenience and low cost made it possible for long-term monitoring of health problems in long-distance traveling such as flights. While most of the existing health monitoring systems on aircrafts are limited for pilots, point-of-care systems provide choices for passengers to enjoy healthcare at the same level. Here in this paper, an airline point-of-care system containing hybrid electrocardiogram (ECG), breathing, and motion signals detection is proposed. At the same time, we propose the diagnosis of sleep apnea-hypopnea syndrome (SAHS) on flights as an application of this system to satisfy the inevitable demands for sleeping on long-haul flights. The hardware design includes ECG electrodes, flexible piezoelectric belts, and a control box, which enables the system to detect the original data of ECG, breathing, and motion signals. By processing these data with interval extraction-based feature selection method, the signals would be characterized and then provided for the long short-term memory recurrent neural network (LSTM-RNN) to classify the SAHS. Compared with other machine learning methods, our model shows high accuracy up to 84-85% with the lowest overfit problem, which proves its potential application in other related fields.
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Affiliation(s)
- Xiaoqiang Ji
- School of Life Science and Technology, Changchun University of Science and Technology, Changchun 130022, China
| | - Zhi Rao
- School of Life Science and Technology, Changchun University of Science and Technology, Changchun 130022, China
| | - Wei Zhang
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
| | - Chang Liu
- Department of Materials Science and Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
| | - Zimo Wang
- Department of Materials Science and Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
| | - Shuo Zhang
- School of Life Science and Technology, Changchun University of Science and Technology, Changchun 130022, China
| | - Butian Zhang
- Department of Imaging, China-Japan Union Hospital of Jilin University, Changchun 130033, China
| | - Menglei Hu
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Peyman Servati
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Xiao Xiao
- Department of Electrical and Computer Engineering, College of Design and Engineering, National University of Singapore, Singapore 117583, Singapore
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Tang X, Deng B, Zang A, He X, Zhou Y, Wang D, Li D, Dai X, Chen J, Zhang X, Liu Y, Xu Y, Chen J, Zheng W, Zhang L, Gao C, Yang H, Li B, Wang X. Characterization of age-related immune features after autologous NK cell infusion: Protocol for an open-label and randomized controlled trial. Front Immunol 2022; 13:940577. [PMID: 36248873 PMCID: PMC9562930 DOI: 10.3389/fimmu.2022.940577] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/05/2022] [Indexed: 01/07/2023] Open
Abstract
Background Aging is usually accompanied by functional declines of the immune system, especially in T-cell responses. However, little is known about ways to alleviate this. Methods Here, 37 middle-aged healthy participants were recruited, among which 32 were intravenously administrated with expanded NK cells and 5 with normal saline. Then, we monitored changes of peripheral senescent and exhausted T cells within 4 weeks after infusion by flow cytometry, as well as serum levels of senescence-associated secretory phenotype (SASP)-related factors. In vitro co-culture assays were performed to study NK-mediated cytotoxic activity against senescent or exhausted T cells. Functional and phenotypic alteration of NK cells before and after expansion was finally characterized. Results After NK cell infusion, senescent CD28-, CD57+, CD28-CD57+, and CD28-KLRG1+ CD4+ and CD8+ T-cell populations decreased significantly, so did PD-1+ and TIM-3+ T cells. These changes were continuously observed for 4 weeks. Nevertheless, no significant changes were observed in the normal saline group. Moreover, SASP-related factors including IL-6, IL-8, IL-1α, IL-17, MIP-1α, MIP-1β, and MMP1 were significantly decreased after NK cell infusion. Further co-culture assays showed that expanded NK cells specifically and dramatically eliminated senescent CD4+ T cells other than CD28+CD4+ T cells. They also showed improved cytotoxic activity, with different expression patterns of activating and inhibitory receptors including NKG2C, NKG2A, KLRG1, LAG3, CD57, and TIM3. Conclusion Our findings imply that T-cell senescence and exhaustion is a reversible process in healthy individuals, and autologous NK cell administration can be introduced to alleviate the aging. Clinical Trial Registration ClinicalTrials.gov, ChiCTR-OOh-17011878.
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Affiliation(s)
- Xiaofeng Tang
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
| | - Biaolong Deng
- Department of Immunology and Microbiology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Aiping Zang
- Department of Research and Development, Shanghai Origincell Medical Technology Co., Ltd., Origincell Technology Group Co., Ltd., Shanghai, China
| | - Xiaowen He
- Department of Research and Development, Shanghai Origincell Medical Technology Co., Ltd., Origincell Technology Group Co., Ltd., Shanghai, China
| | - Ye Zhou
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
| | - Daimeng Wang
- Department of Research and Development, Shanghai Origincell Medical Technology Co., Ltd., Origincell Technology Group Co., Ltd., Shanghai, China
| | - Dan Li
- Department of Immunology and Microbiology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueyu Dai
- Department of Immunology and Microbiology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jieqiong Chen
- Department of Research and Development, Shanghai Affinity Biopharmaceutical Co., Ltd., Shanghai, China
| | - Xuhua Zhang
- Department of Research and Development, Shanghai Origincell Medical Technology Co., Ltd., Origincell Technology Group Co., Ltd., Shanghai, China
| | - Ye Liu
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
| | - Yonghua Xu
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
| | - Jingjing Chen
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
| | - Weijie Zheng
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
| | - Luding Zhang
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
| | - Constance Gao
- Department of Biology, College of Science, Northeastern University, Boston, MA, United States
| | - Huanfeng Yang
- Department of Research and Development, Shanghai Origincell Medical Technology Co., Ltd., Origincell Technology Group Co., Ltd., Shanghai, China
| | - Bin Li
- Department of Immunology and Microbiology, Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xueqi Wang
- Department of Blood Transfusion, Changzheng Hospital, Shanghai, China
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Faridi KF, Dayoub EJ, Ross JS, Dhruva SS, Ahmad T, Desai NR. Medicare Coverage and Out-of-Pocket Costs of Quadruple Drug Therapy for Heart Failure. J Am Coll Cardiol 2022; 79:2516-2525. [PMID: 35738713 PMCID: PMC8972353 DOI: 10.1016/j.jacc.2022.04.031] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/17/2022] [Accepted: 04/05/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Beta-blockers, angiotensin receptor-neprilysin inhibitor (ARNI), mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors (SGLT2i), known as quadruple therapy, are recommended for patients with heart failure with reduced ejection fraction (HFrEF). OBJECTIVES This study sought to determine Medicare coverage and out-of-pocket (OOP) costs of quadruple therapy and regimens excluding ARNI or SGLT2i. METHODS This study assessed cost sharing, prior authorization, and step therapy in all 4,068 Medicare prescription drug plans in 2020. OOP costs were determined during the standard coverage period and annually based on the Medicare Part D standard benefit, inclusive of deductible, standard coverage, coverage gap, and catastrophic coverage. RESULTS Tier ≥3 cost sharing was required by 99.1% of plans for ARNI and 98.5% for at least 1 SGLT2i. Only ARNI required prior authorization (24.3% of plans), and step therapy was required only for SGLT2is (5.4%) and eplerenone (0.8%). The median 30-day standard coverage OOP cost of quadruple therapy was $94 (IQR: $84-$100), including $47 (IQR: $40-$47) for ARNI and $45 (IQR: $40-$47) for SGLT2i. The median annual OOP cost of quadruple therapy was $2,217 (IQR: $1,956-$2,579) compared with $1,319 (IQR: $1,067-$1,675) when excluding SGLT2i and $1,322 (IQR: $1,025-$1,588) when including SGLT2i and substituting an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker for ARNI. The median 30-day OOP cost of generic regimens was $3 (IQR: $0-$9). CONCLUSIONS Medicare drug plans restrict coverage of quadruple therapy through cost sharing, with OOP costs that are substantially higher than generic regimens. Quadruple therapy may be unaffordable for many Medicare patients with HFrEF unless medication prices and cost sharing are reduced.
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Affiliation(s)
- Kamil F Faridi
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Health System, New Haven, Connecticut, USA.
| | - Elias J Dayoub
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph S Ross
- Center for Outcomes Research and Evaluation, Yale New Haven Health System, New Haven, Connecticut, USA; Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sanket S Dhruva
- Section of Cardiology, Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, California, USA
| | - Tariq Ahmad
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Health System, New Haven, Connecticut, USA
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Center for Outcomes Research and Evaluation, Yale New Haven Health System, New Haven, Connecticut, USA
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Tranvåg EJ, Haaland ØA, Robberstad B, Norheim OF. Appraising Drugs Based on Cost-effectiveness and Severity of Disease in Norwegian Drug Coverage Decisions. JAMA Netw Open 2022; 5:e2219503. [PMID: 35767256 PMCID: PMC9244608 DOI: 10.1001/jamanetworkopen.2022.19503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Rising health care costs are a major health policy challenge globally. Norway has implemented a priority-setting system intended to balance cost-effectiveness and concerns for fair distribution, but little is known about this strategy and whether it works in practice. OBJECTIVE To present and evaluate a systematic drug appraisal method that uses the severity of disease to account for a fair distribution of health in cost-effectiveness analysis, forming the basis for price negotiations and coverage decisions. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study uses confidential drug price information and publicly available data from health technology assessments and logistic and linear regression analyses to evaluate drug coverage decisions for the Norwegian specialized health care sector from 2014 to 2019. MAIN OUTCOMES AND MEASURES Drug coverage decisions by Norwegian authorities and incremental cost-effectiveness and severity of disease measured as absolute shortfall of quality adjusted life years. RESULTS Between 2014 and 2019, a total of 188 drugs were appraised, of which 113 were cancer drugs. The overall coverage rate was 73% (138 of 188). The number of annual appraisals increased during the observation period. Based on 83 chosen decisions, regression analysis showed that incremental cost-effectiveness ratios (ICER) based on negotiated drug prices, adjusted for severity-differentiated cost-effectiveness thresholds, was the variable that best projected drug approvals (OR, 0.60; 95% CI, 0.42-0.86). An increase in the ICER by $10 000 was associated with a reduction in the odds for approval of 40% for drugs assessed from 2018 to 2019. CONCLUSIONS AND RELEVANCE This cross-sectional study demonstrated how concerns for efficiency and fair distribution of health can be implemented systematically into drug appraisals and reimbursement decisions. New, expensive drugs are expected to escalate health care costs in the years to come, and it may be feasible to control costs by negotiating the prices of new drugs while appraising both their cost-effectiveness and how their health benefits are distributed.
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Affiliation(s)
- Eirik Joakim Tranvåg
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Ariansen Haaland
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bjarne Robberstad
- Research Group in Health Economics, Leadership, and Translational Ethics Research, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Ole Frithjof Norheim
- Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Centre for Cancer Biomarkers, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Niedens M, Yeager A, Vidoni ED, Barton K, Perales-Puchalt J, Dealey RP, Quinn D, Gage LA. A Collaborative Approach to Dementia Inclusion in Social Work Education: The Dementia Intensive. JOURNAL OF SOCIAL WORK EDUCATION 2022; 59:493-505. [PMID: 37397072 PMCID: PMC10309142 DOI: 10.1080/10437797.2022.2039820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 07/04/2023]
Abstract
There are 5.8 million Americans with Alzheimer's disease and this number is rising. Social Work can play a key role. Yet, like other disciplines, the field is ill prepared for the growing number of individuals and family members who are impacted physically, emotionally and financially. Compounding the challenge, the number of social work students identifying interest in the field is low. This mixed methods concurrent study assessed the preliminary efficacy of a day-long education event among social work students from eight social work programs. Pre- post-training survey included: 1) dementia knowledge, assessed with the Dementia Knowledge Assessment Scale, and 2) negative attitudes towards dementia, assessed by asking students to identify three words that reflected their thoughts on dementia, which were later rated as positive, negative or neutral by three external raters. Bivariate analyses showed that dementia knowledge (mean difference= 9.9) and attitudes (10% lower) improved from pre- to post-training (p<0.05). Collaboration between social work programs can increase student access to strength-based dementia education. Such programs hold the potential of improving dementia capability within the field of Social Work.
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Affiliation(s)
| | - Amy Yeager
- KU Alzheimer's Disease Research Center, Department of Neurology
| | - Eric D Vidoni
- KU Alzheimer's Disease Research Center, Department of Neurology
| | | | | | | | - Dory Quinn
- Pittsburg State University, Department of History, Philosophy & Social Sciences
| | - L Ashley Gage
- University of Central Missouri, Department of Social Work
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Chen G, Xiao X, Zhao X, Tat T, Bick M, Chen J. Electronic Textiles for Wearable Point-of-Care Systems. Chem Rev 2021; 122:3259-3291. [PMID: 34939791 DOI: 10.1021/acs.chemrev.1c00502] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Traditional public health systems are suffering from limited, delayed, and inefficient medical services, especially when confronted with the pandemic and the aging population. Fusing traditional textiles with diagnostic, therapeutic, and protective medical devices can unlock electronic textiles (e-textiles) as point-of-care platform technologies on the human body, continuously monitoring vital signs and implementing round-the-clock treatment protocols in close proximity to the patient. This review comprehensively summarizes the research advances on e-textiles for wearable point-of-care systems. We start with a brief introduction to emphasize the significance of e-textiles in the current healthcare system. Then, we describe textile sensors for diagnosis, textile therapeutic devices for medical treatment, and textile protective devices for prevention, by highlighting their working mechanisms, representative materials, and clinical application scenarios. Afterward, we detail e-textiles' connection technologies as the gateway for real-time data transmission and processing in the context of 5G technologies and Internet of Things. Finally, we provide new insights into the remaining challenges and future directions in the field of e-textiles. Fueled by advances in chemistry and materials science, textile-based diagnostic devices, therapeutic devices, protective medical devices, and communication units are expected to interact synergistically to construct intelligent, wearable point-of-care textile platforms, ultimately illuminating the future of healthcare system in the Internet of Things era.
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Affiliation(s)
- Guorui Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Xiao Xiao
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Xun Zhao
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Trinny Tat
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Michael Bick
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, United States
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Ito K, Chapman R, Pearson SD, Tafazzoli A, Yaffe K, Gurwitz JH. Evaluation of the Cost-effectiveness of Drug Treatment for Alzheimer Disease in a Simulation Model That Includes Caregiver and Societal Factors. JAMA Netw Open 2021; 4:e2129392. [PMID: 34677596 PMCID: PMC8536950 DOI: 10.1001/jamanetworkopen.2021.29392] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE The possibility of widespread use of a novel effective therapy for Alzheimer disease (AD) will present important clinical, policy, and financial challenges. OBJECTIVE To describe how including different patient, caregiver, and societal treatment-related factors affects estimates of the cost-effectiveness of a hypothetical disease-modifying AD treatment. DESIGN, SETTING, AND PARTICIPANTS In this economic evaluation, the Alzheimer Disease Archimedes Condition Event Simulator was used to simulate the prognosis of a hypothetical cohort of patients selected from the Alzheimer Disease Neuroimaging Initiative database who received the diagnosis of mild cognitive impairment (MCI). Scenario analyses that varied costs and quality of life inputs relevant to patients and caregivers were conducted. The analysis was designed and conducted from June 15, 2019, to September 30, 2020. EXPOSURES A hypothetical drug that would delay progression to dementia in individuals with MCI compared with usual care. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER), measured by cost per quality-adjusted life-year (QALY) gained. RESULTS The model included a simulated cohort of patients who scored between 24 and 30 on the Mini-Mental State Examination and had a global Clinical Dementia Rating scale of 0.5, with a required memory box score of 0.5 or higher, at baseline. Using a health care sector perspective, which included only individual patient health care costs, the ICER for the hypothetical treatment was $192 000 per QALY gained. The result decreased to $183 000 per QALY gained in a traditional societal perspective analysis with the inclusion of patient non-health care costs. The inclusion of estimated caregiver health care costs produced almost no change in the ICER, but the inclusion of QALYs gained by caregivers led to a substantial reduction in the ICER for the hypothetical treatment, to $107 000 per QALY gained in the health sector perspective. In the societal perspective scenario, with the broadest inclusion of patient and caregiver factors, the ICER decreased to $74 000 per added QALY. CONCLUSIONS AND RELEVANCE The findings of this economic evaluation suggest that policy makers should be aware that efforts to estimate and include the effects of AD treatments outside those on patients themselves can affect the results of the cost-effectiveness analyses that often underpin assessments of the value of new treatments. Further research and debate on including these factors in assessments that will inform discussions on fair pricing for new treatments are needed.
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Affiliation(s)
- Kouta Ito
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Rick Chapman
- Institute for Clinical and Economic Review, Boston, Massachusetts
| | | | | | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco
- San Francisco VA Medical Center, San Francisco, California
| | - Jerry H. Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
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Three-Day Remote Monitoring of Gait Among Young and Older Adults Using Participants' Personal Smartphones. J Aging Phys Act 2021; 29:1026-1033. [PMID: 34348231 DOI: 10.1123/japa.2020-0353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/18/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
Conventional one-time gait analyses do not evaluate walking across more than a few steps, cannot monitor changes longitudinally, and do not reflect performance in real-life environments. To successfully quantify age-related gait decrement, technology that can continuously monitor gait is vital. This study examined the feasibility and validity for participant smartphones to remotely assess gait. In addition, the authors investigated whether smartphone-derived measures could differentiate between young and older adults (fallers and nonfallers). A total of 63 adults completed clinical and gait assessment in the laboratory and donned their smartphones for 3 days in the real-life environment. A custom-built Android application collected triaxial accelerations with spatiotemporal gait measures computed and compared between groups. Across 11 brands and 10 Android versions, smartphone-derived gait parameters were valid. Furthermore, results indicated age-related differences in walking during the 3-day assessment. However, no disparities were found between older adult groups. Smartphone-based evaluations may improve real-life screening of adults with gait deficits.
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Deng B, Zhang W, Zhu Y, Li Y, Li D, Li B. FOXP3 + regulatory T cells and age-related diseases. FEBS J 2021; 289:319-335. [PMID: 33529458 DOI: 10.1111/febs.15743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 01/29/2021] [Indexed: 12/17/2022]
Abstract
Regulatory T (Treg) cells are critical for the maintenance of immune homeostasis. Dysregulation of Treg cells has been implicated in the pathogenesis of autoimmunity and chronic inflammation, while aging is characterized by an accumulation of inflammatory markers in the peripheral blood, a phenomenon known as 'inflammaging'. The relationship between Treg cells and age-related diseases remains to be further studied. Increasing evidence revealed that Treg cells' dysfunction occurs in aged patients, suggesting that immune therapies targeting Treg cells may be a promising approach to treat diseases such as cancers and autoimmune diseases. Furthermore, drugs targeting Treg cells show encouraging results and contribute to CD8+ T-cell-mediated cytotoxic killing of tumor and infected cells. In general, a better understanding of Treg cell function may help us to develop new immune therapies against aging. In this review, we discuss potential therapeutic strategies to modify immune responses of relevance for aging to prevent and treat age-related diseases, as well as the challenges posed by the translation of novel immune therapies into clinical practice.
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Affiliation(s)
- Biaolong Deng
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, China
| | - Weiqi Zhang
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, China
| | - Yicheng Zhu
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, China
| | - Yangyang Li
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, China
| | - Dan Li
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, China
| | - Bin Li
- Shanghai Institute of Immunology, Shanghai Jiao Tong University School of Medicine, China.,Department of Immunology and Microbiology, Shanghai Jiao Tong University School of Medicine, China
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12
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Shafiee M, Hazrati M, Motalebi SA, Gholamzade S, Ghaem H, Ashari A. Can healthy life style predict successful aging among Iranian older adults? Med J Islam Repub Iran 2021; 34:139. [PMID: 33437735 PMCID: PMC7787035 DOI: 10.34171/mjiri.34.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Indexed: 11/11/2022] Open
Abstract
Background: Successful aging is a prominent and worldwide theme in gerontology. However, until recently, only few studies were conducted about successful aging in Iran. This study examined whether a healthy lifestyle could predict successful aging among older Iranians.
Methods: This cross sectional and descriptive study included 975 older Iranians who were selected through a multistage cluster-quota method from the health centers of Shiraz, Iran. A 5-part questionnaire, including demographic characteristics, the Seniors’ Healthy Lifestyle, Barthel Index, the Diner Life Satisfaction and Quality of Life, was used to collect the data. A logistic regression analysis was used in data analysis; data were analyzed using SPSS 21; and significance level was set at α = 0.05.
Results: The prevalence of successful aging among older Iranians was calculated at 24.0%. Results of multiple logistic regression analysis revealed that age (95% CI = 1.129- 1.702 and OR = 1.352), gender (95% CI = 0.412-0.764 and OR = 0.687), education level (95% CI = 1.443 – 1.699 and OR = 1.454), job (95% CI = 1.063-1.413 and OR = 1.185), monthly income (95% CI = 1.355-4.055 and OR = 2.272), insurance (95% CI = 0.344-0.842 and OR = 0.540), source of income (95% CI = 1.014-1.298 and OR = 1.145), and healthy lifestyle (95% CI = 0.772 - 0.858 and OR = 0.814) were predictors for successful aging.
Conclusion: Findings indicated that successful agers were mostly younger men, with higher education level and monthly income, who had insurance and a job and a healthy lifestyle. Thus, to age successfully, one must maintain and improve healthy lifestyle to prolong one’s health.
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Affiliation(s)
- Mohsen Shafiee
- Department of Nursing Geriatric, Nursing and Midwifery School, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of nursing, Abadan University of Medical Sciences, Abadan, Iran
| | - Maryam Hazrati
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Deputy Ministry of Nursing Affaires, Ministry of Health and Medical Education, Tehran, Iran
| | - Seyedeh Ameneh Motalebi
- Social Determinants of Health Research Center, Research Institute for Prevention of Noncommunicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sakineh Gholamzade
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Haleh Ghaem
- Department of Epidemiology School of Health, Shiraz University of Medical Sciences. Shiraz, Iran
| | - Asmidawati Ashari
- Department of Human Development and Family Studies, Faculty of Human Ecology, Universiti Putra Malaysia, Serdang, Selangor
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13
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Affiliation(s)
- Jerry H Gurwitz
- Meyers Primary Care Institute, a joint endeavor of University of Massachusetts Medical School, Fallon Health, and Reliant Medical Group, Worcester.,Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Mathew S Maurer
- Center for Cardiac Amyloidosis, Division of Cardiology, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York
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14
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Gurwitz JH, Maurer MS. Initial Monthly Cost of Tafamidis—the Real Price for Patients—Reply. JAMA Cardiol 2020; 5:848. [DOI: 10.1001/jamacardio.2020.0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Jerry H. Gurwitz
- Meyers Primary Care Institute, Worcester, Massachusetts
- Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester
| | - Mathew S. Maurer
- Center for Cardiac Amyloidosis, Division of Cardiology, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York
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15
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Examining the Pharmacist Labor Supply in the United States: Increasing Medication Use, Aging Society, and Evolution of Pharmacy Practice. PHARMACY 2019; 7:pharmacy7030137. [PMID: 31546891 PMCID: PMC6789639 DOI: 10.3390/pharmacy7030137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/11/2019] [Accepted: 09/17/2019] [Indexed: 11/17/2022] Open
Abstract
The increasing number of pharmacists in the US has generated concern regarding potential oversupply. A 2018 analysis from the National Center for Health Workforce Analysis (NCHWA) in the US projected a best case scenario of an oversupply of more than 18,000 pharmacists in the year 2030. In this commentary, the limitations of this general health labor force analysis by the NCHWA are described. The goal of this work was to provide a more nuanced examination of the pharmacist labor demand in the US. Data from the US Bureau of Labor Statistics (BLS) and the US Medical Expenditure Panel Survey (MEPS) were utilized to examine, annually over a ten year period ending in 2017, the number of pharmacists, the ratio of pharmacists to persons living in the US, the ratio of pharmacists to older adults living in the US, and the ratio of medications to pharmacists. The number of pharmacists grew from 266,410 in 2008 to 309,330 in 2017. As anticipated, despite a growing US population, the ratio of people living in the US per pharmacist dropped unabated from 1141 to 1053 from 2008 to 2017, respectively. However, the reverse trend was observed for the ratio of persons 65 years or older per pharmacist. This ratio increased from 146.1 older adults to each pharmacist in 2008 to 164.3 in 2017. The accelerating demographic shift to an older population is also reversing an overall trend in the number of medications to pharmacist that will continue for the foreseeable future. While the ratio of medications to pharmacist dropped overall from 2008 to 2016, it has begun to rise again from 2016 to 2017. Beyond the increasing number of medications attributable to a rapidly aging population, there is a growing demand for clinical care from pharmacists due to the maturing environment of complex, costly medications for chronic disease treatment. As the portion of total health expenditure is increasingly devoted to medications and the US health delivery system continues its movement to community-based care, the demand for pharmacist care will require a larger number of pharmacists trained for advanced-practice care.
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Jacobson C, Emmert A, Rosenthal MB. CAR T-Cell Therapy: A Microcosm for the Challenges Ahead in Medicare. JAMA 2019; 322:923-924. [PMID: 31355862 DOI: 10.1001/jama.2019.10194] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Caron Jacobson
- Harvard Medical School, Boston, Massachusetts
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Amy Emmert
- Dana-Farber Cancer Institute, Boston, Massachusetts
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