高速铁路40m箱梁现浇碗扣式支架施工技术及承载力检算

文章结合南广高速铁路右线贵港特大桥的具体施工实例,从支架基底处理、碗扣式支架搭设、通车门洞设置方面详细介绍了高速铁路现浇箱梁施工方案,并通过支架承载力检算,验证了方案的可行性,为今后类似工程的施工提供参考。     

获得性免疫缺陷综合征并发动眼神经麻痹的临床特征

目的观察就诊于眼科的获得性免疫缺陷综合征并发单侧动眼神经麻痹的眼部表现、系统特征和治疗情况。方法回顾分析4例4眼艾滋病并发单侧动眼神经麻痹患者的眼部表现、视敏度、色觉检查、上睑下垂程度、瞳孔及眼外肌受累、复视情况;CD4+T淋巴细胞计数,给予口服高效抗逆转录病毒药物治疗联合抗病毒药物治疗,随诊观察2～6个月。结果初诊时检查,视敏度2眼为6/9,1眼为6/18,1眼为6/36;色觉检查均正常;上睑下垂3例为重度,1例为中度;瞳孔扩大固定,直径为5～7mm;水平性复视,眼球处于外转位,外转正常、不能向上、下、内转动,CD4+T淋巴细胞计数1例为200个/ul,3例介于100～200个/ul之间;经高效抗逆转录病毒药物治疗后CD4+T淋巴细胞计数上升到≥300个/ul。结论排除颅内、眶内占位,其他因素所致脑梗塞,对不明原因的单眼动眼神经麻痹患者,建议作血清人类免疫缺陷病毒(Human immunodeficiency virus,HIV)抗体检测,避免漏诊误诊。     

Costs of providing infusion therapy for patients with inflammatory bowel disease in a hospital-based infusion center setting

Aims: Inflammatory bowel disease (IBD) (e.g. ulcerative colitis [UC] and Crohn’s disease [CD]) severely impacts patient quality-of-life. Moderate-to-severe disease is often treated with biologics requiring infusion therapy, adding incremental costs beyond drug costs. This study evaluates US hospital-based infusion services costs for treatment of UC or CD patients receiving infliximab or vedolizumab therapy.

Materials and methods: A model was developed, estimating annual costs of providing monitored infusions using an activity-based costing framework approach. Multiple sources (published literature, treatment product inserts) informed base-case model input estimates.

Results: The total modeled per patient infusion therapy costs in Year 1 with infliximab and vedolizumab was $38,782 and $41,320, respectively, and Year 2+, $49,897 and $36,197, respectively. Drug acquisition cost was the largest total costs driver (90–93%), followed by costs associated with hospital-based infusion provision: labor (53–56%, non-drug costs), allocated overhead (23%, non-drug costs), non-labor (23%, non-drug costs), and laboratory (7–10%, non-drug costs).

Limitations: Limitations included reliance on published estimates, base-case cost estimates infusion drug, and supplies, not accounting for volume pricing, assumption of a small hospital infusion center, and that, given the model adopts the hospital perspective, costs to the patient were not included in infusion administration cost base-case estimates.

Conclusions: This model is an early step towards a framework to fully analyze infusion therapies’ associated costs. Given the lack of published data, it would be beneficial for hospital administrators to assess total costs and trade-offs with alternative means of providing biologic therapies. This analysis highlights the value to hospital administrators of assessing cost associated with infusion patient mix to make more informed resource allocation decisions. As the landscape for reimbursement changes, tools for evaluating the costs of infusion therapy may help hospital administrators make informed choices and weigh trade-offs associated with providing infusion services for IBD patients.     

Comparison of healthcare resource utilization and costs in patients hospitalized for acute coronary syndrome managed with percutaneous coronary intervention and receiving prasugrel or ticagrelor

Abstract

Objective:

To compare healthcare resource utilization (HCRU) and healthcare costs in patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with prasugrel or ticagrelor.     

Medical resource use and costs associated with chylomicronemia

Abstract

Background:

The prevalence of severe hypertriglyceridemia (TG?>?1000?mg/dl) is estimated at 150–400 per 100,000 individuals in North America. Severe hypertriglyceridemia in the fasting state is associated with increased acute pancreatitis risk and is a sign of chylomicronemia which reflects the accumulation in the bloodstream of chylomicrons, the large lipoprotein particles produced in the gut after a meal.

Objective:

To assess medical resource use and costs associated with chylomicronemia.

Methods:

Patients with chylomicronemia of different causes (≥2 diagnoses with ICD-9 code 272.3) were identified from a large US claims database (years 2000 to 2009) and matched 1:1 to controls free of chylomicronemia based on age, gender, demographics, comorbidities, and use of lipid lowering drugs. During a 1-year study period, medical resource use and costs associated with chylomicronemia or acute pancreatitis were compared between matched cases and controls.

Results:

Among 6472 matched pairs, annual per-patient medical costs, calculated independently of the occurrence of acute pancreatitis, were significantly greater by $808 for chylomicronemia cases vs controls ($8029 vs $7220, p?<?0.01), half of which was attributable to chylomicronemia-related services (p?<?0.01). Chylomicronemia cases with a history of acute pancreatitis (n?=?46) had greater rates of inpatient visits (p?<?0.05) and greater average costs for subsequent acute pancreatitis or abdominal pain (p?<?0.01) as well as greater total medical costs ($33,587 vs $4402, p?<?0.01) vs matched controls. The average episode of acute pancreatitis (n?=?104 episodes) generated medical costs of $31,820, almost entirely due to inpatient stays.

Limitations:

Triglyceride levels were not available to characterize disease severity.

Conclusions:

Patients with chylomicronemia, and especially those with a history of acute pancreatitis, incurred significantly greater total medical costs compared with individuals without chylomicronemia but with an otherwise comparable health profile.     

Economic evaluation of linaclotide for the treatment of adult patients with irritable bowel syndrome with constipation in the United States

Abstract

Objectives:

To use techniques of decision-analytic modeling to evaluate the effectiveness and costs of linaclotide vs lubiprostone in the treatment of adult patients with irritable bowel syndrome with constipation (IBS-C).

Methods:

Using model inputs derived from published literature, linaclotide Phase III trial data and a physician survey, a decision-tree model was constructed. Response to therapy was defined as (1) a ≥14-point increase from baseline in IBS-Quality-of-Life (IBS-QoL) questionnaire overall score at week 12 or (2) one of the top two responses (moderately/significantly relieved) on a 7-point IBS symptom relief question in ≥2 of 3 months. Patients who do not respond to therapy are assumed to fail therapy and accrue costs associated with a treatment failure. Model time horizon is aligned with clinical trial duration of 12 weeks. Model outputs include number of responders, quality-adjusted life-years (QALYs), and total costs (including direct and indirect). Both one-way and probabilistic sensitivity analyses were conducted.

Results:

Treatment for IBS-C with linaclotide produced more responders than lubiprostone for both response definitions (19.3% vs 13.0% and 61.8% vs 57.2% for IBS-QoL and symptom relief, respectively), lower per-patient costs ($803 vs $911 and $977 vs $1056), and higher QALYs (0.1921 vs 0.1917 and 0.1909 vs 0.1894) over the 12-week time horizon. Results were similar for most one-way sensitivity analyses. In probabilistic sensitivity analyses, the majority of simulations resulted in linaclotide having higher treatment response rates and lower per-patient costs.

Limitations:

There are no available head-to-head trials that compare linaclotide with lubiprostone; therefore, placebo-adjusted estimates of relative efficacy were derived for model inputs. The time horizon for this model is relatively short, as it was limited to the duration of available clinical trial data.

Conclusions:

Linaclotide was found to be a less costly option vs lubiprostone for the treatment of adult patients with IBS-C.     

舒血宁注射液联合丹参滴丸治疗急性冠脉综合征临床研究

目的探讨舒血宁注射液联合丹参滴丸治疗急性冠脉综合征的临床疗效。方法将我院2011年6月至2013年6月收治住院的60例急性冠脉综合征患者分为两组,对照组采用常规治疗,治疗组在对照组基础上采用舒血宁注射液联合丹参滴丸治疗,比较两组患者的临床疗效。结果治疗组总有效率为93.3%,显著高于对照组(73.3%),P<0.05。结论舒血宁注射液联合丹参滴丸治疗急性冠脉综合征疗效显著,值得在临床推广。     

Hidden Overhang of Domestic Debt and Its Role in the This-Time-Is-Different Syndrome: An Empirical Contingent Liabilities Model

The recent studies in public finance literature open an exciting research area on hidden overhang of domestic public debt and creative accounting. In this study, I identify hidden public debts in Turkey. I then develop a dynamical model that takes as given the stock of contingent liabilities generated by lending/borrowing relationships among public entities and looks for the debt (in)tolerance of government to liquidate it in finite periods. Last, I introduce a general empirical methodology to analyze the role of overborrowing in the this-time-is-different syndrome and test model outcome against data for hidden debts in Turkey's postliberalization period (1989-2010).     

An innovative regime switching model to forecast Taiwan tourism demand

The tourism industry has become a major part of economic development for many countries. These countries have greatly invested in tourism to attract more tourist arrivals. Hence, the need for more accurate forecasts of tourism demand is important. Various approaches have been applied to forecast tourism demand of different countries. However, tourism demands tend to be imprecise and their trends nonlinear. In addition, there may be drastic changes in the tourism demand time series. To properly handle these problems, this study proposes an innovative forecasting model to detect the regime switching properly and to apply fuzzy time-series model to forecast. The monthly tourist arrivals to Taiwan will be used as forecasting target. The analysis by the proposed model will be validated by the major events as well as previous studies.     

从五脏论治哮喘的发病和作用机制

哮喘是呼吸内科疾病的常见病,严重影响了患者的生命质量。西医病因及发病机制尚不十分清楚,目前国内外治疗尚无特殊方法,西医治疗哮喘,其起效快,但容易复发,而针对哮喘缓解期无特效药,激素维持治疗不良反应较大,且治标不治本。中药不良反应小,安全性高,无论哮喘的哪个阶段,均有较好的疗效,而且具有"治病求本"的特点,尤其针对缓解期,可以弥补西医治疗之不足。哮喘的病位在肺,可涉及诸脏,肺、脾、肾、肝、心五脏皆可致哮喘发作。现根据哮喘不同的病因病机和证候特点,利用中医的整体观念"治病求本,标本兼治",具体结合相关脏腑的病理生理特点进行五脏"辨证论治",探讨哮喘的发病机制。