A trial fibrillation (AF) increases the risk of stroke, disability, dementia, and death, with a characteristic profile of more severe, disabling, and recurrent stroke compared with stroke without AF. [1][2][3][4] With aging populations, the prevalence of AF is projected to increase ≥2-fold by 2050, accompanied by an increase in the frequency of AF-associated stroke. 5 Accurate health economic data are important to inform health policy decisions to respond to this societal increase in AF prevalence, such as population screening programs. Reliable data on the cost of stroke associated with AF (AF-stroke) are also essential for rigorous cost-effectiveness studies of new oral anticoagulant agents, which guide reimbursement decisions for healthcare providers internationally. [6][7][8][9] Existing hospital-based studies have described high costs of stroke associated with AF. [10][11][12][13][14][15] However, existing studies have been limited by the reporting of acute hospital costs only, or by the inclusion of selected AF-stroke subgroups, such as hospitalized patients, nonaphasic patients, those with first-ever stroke only, or 1-year survivors. No cost studies of AF-stroke have been performed in unselected patients, including costs of community healthcare and indirect costs associated with lost productivity, leading to substantial underestimation of the Background and Purpose-No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents. Methods-In a population-based prospective study of incident and recurrent stroke treated in hospital and community settings, we investigated direct (healthcare related) and indirect costs for a 2-year period. Survival, disability, poststroke residence, and healthcare use were determined at 90 days, 1 year, and 2 years. Acute hospital cost was determined using a case-mix approach, and other costs using a bottom-up approach (2007 prices). Results-In 568 patients ascertained in 1 year (2006), the total estimated 2-year cost was $33.84 million. In the overall sample, AF-stroke accounted for 31% (177) of patients, but a higher proportion of costs (40.5% of total and 45% of nursing home costs). On a per-patient basis compared with non-AF-stroke, AF-stroke was associated with higher total (P<0.001) and acute hospital costs (P<0.001), and greater nursing home (P=0.001) and general practitioner (P<0.001) costs among 90-day survivors. After stratification by stroke severity in survivors, AF was associated with 2-fold increase in costs in patients with mild-moderate (National Institutes of Health Stroke Scale, 0-15) stroke (P<0.001) but not in severe stroke (National Institutes of Health Stroke Scale ≥16; P=0.7). Conclusions-In our population study, AF-stroke was associated with substantially higher total, acute hospital, nursing home, and general practitioner cos...

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ObjectiveTo assess the prevalence and determinants of haematinic deficiency (lack of B12 folate or iron) and macrocytosis in blood from a national population-based study of middle-aged and older adults.MethodsA cross-sectional study involving 1,207 adults aged ≥45 years, recruited from a sub-study of the Irish National Survey of Lifestyle Attitudes and Nutrition (SLÁN 2007). Participants completed a health and lifestyle questionnaire and a standard food frequency questionnaire. Non-fasting blood samples were obtained for measurement of full blood count and expert morphological assessment, serum ferritin, soluble transferrin receptor assay (sTfR), B12, folate and coeliac antibodies. Blood samples were also assayed for thyroid function (T4, TSH), liver function, aminotransferase (AST) and gamma-glutamyl transferase (GGT).ResultsThe overall prevalence (95% C.I.) of anaemia (Hb <13.5g/dl men and 11.3 g/dl women) was 4.6% (2.9%–6.4%) in men and 1.0% (0.2%–1.9%) in women. Iron deficiency (ferritin <17ng/ml men and <11ng/ml in women) was detected in 6.3% of participants (3.7% in males and 8.7% in females, p<0.001). Based on both low ferritin and raised sTfR (>21nmol/ml) only 2.3% were iron-deficient. 3.0% and 2.7% were found to have low levels of serum folate (<2.3ng/ml) and serum B12 (<120ng/l) respectively. Clinically significant macrocytosis (MCV>99fl) was detected in 8.4% of subjects. Strong, significant and independent associations with macrocytosis were observed for lower social status, current smoking status, moderate to heavy alcohol intake, elevated GGT levels, deficiency of folate and vitamin B12, hypothyroidism and coeliac disease. The population attributable fraction (PAF) for macrocytosis associated with elevated GGT (25.0%) and smoking (24.6%) was higher than for excess alcohol intake (6.3%), folate deficiency (10.5%) or vitamin B12 (3.4%).ConclusionsHaematinic deficiency and macrocytosis are common in middle-aged/older adults in Ireland. Macrocytosis is more likely to be attributable to an elevated GGT and smoking than vitamin B12 or folate deficiency.

Cytomegalovirus (CMV) infections occur worldwide and primary infection usually occurs in early childhood and is often asymptomatic whereas primary infection in adults may result in symptomatic illness. CMV establishes a chronic latent infection with intermittent periods of reactivation. Primary infection or reactivation associate with increased mortality and morbidity in those who are immunocompromised. Transplacental transmission may result in significant birth defects or long-term sensorineural hearing loss.We performed a study to determine the CMV seroprevalence and the association between HLA Class I alleles and frequency of CMV infection in Ireland. The presence of CMV IgG, a marker of previous CMV infection, was determined for a cohort of 1849 HLA typed solid organ transplant donors between 1990 and 2013. The presence of CMV IgG was correlated with HLA type.The CMV seroprevalence in solid organ transplant donors was 33.4% (range 22–48% per annum) over the time period 1990 to 2013. Multivariate logistic regression analysis showed that both age and HLA alleles were associated with CMV seropositivity. A significant and positive relationship between age and CMV seropositivity was observed (OR = 1.013, P < 0.001, CI [1.007, 1.019]). Chi-square analysis revealed that the female gender was independently associated with CMV seropositivity (P < 0.01). Seroprevalence in women of reproductive age (20–39 years) was significantly higher than men of the same age (37% vs 26%, P < 0.01). The frequencies of HLA-A1, HLA-A2, and HLA-A3 in our cohort were 40.8%, 48.8%, and 25.9%, respectively. Logistic regression analysis showed that the presence of HLA-A1 but not HLA-A2 or HLA-A3 was independently associated with CMV seronegativity (P < 0.01). Interestingly, individuals who co-expressed HLA-A2 and HLA-A3 alleles were significantly more likely to be CMV seropositive (P < 0.02). The frequencies of HLA-B5, HLA-B7, and HLA-B8 in our cohort were 6.1%, 31.2%, and 30.8%, respectively. The presence of the most common inherited haplotype in the Irish population, HLA-A1, B8 was significantly associated with CMV seronegativity (OR = 1.278, P < 0.001, CI [1.049, 1.556]).CMV seroprevalence is lower in Ireland compared with other countries. The high frequency of HLA-A1 in the Irish population may, in part, have a role in the reduced susceptibility to CMV infection.

The semiautomated hand-held device MED results were lower than that of the conventional panel method and may prolong the treatment course by 2-3 treatments. The hand-held tester is a fast and reproducible method, and may allow more phototherapy units, limited by staff and time, to do MED testing.

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& CONCLUSIONSAccelerated environmental stress tests (EST) are applied during the manufacturing process to improve reliability by precipitating and detecting latent defects. This test represents an in-process manufacturing screen and the objective of performing it is to avoid early field failures that reduce the customer satisfaction level and increase warranty and compensation costs.Temperature cycling during EST is one of the most commonly used test procedures. Although it is an expensive and energy intensive procedure, usually a lengthy test is initially recommended for a new product. Based on the product test performance or a possible manufacturing process modification, the test duration and regime may be changed after some period. Even if the number of test cycles is reduced, EST continues to be an expensive test and a major process bottleneck.This paper uses Generalized Linear Modeling (GLM) to investigate the effects of the production and EST test variables on the population under test. Both the number of units rejected and the time to failure can be modeled as a regression function of covariates representative of the test environment. The field reliability function is written as a product of the unconditional reliability in each segment of the test profile such as dwell, ramp, etc. The next step is to apply the result of the temperature cycle EST GLM to a mathematical cost model. This cost model includes both the test cost and the warranty and compensation costs of the early field failures. The optimum test regime and number of cycles, which minimizes the total cost is determined by combining the GLM and the cost model. In this way the production test regime can be optimized in terms of field reliability/test cost trade-off. Notations T: Initial EST duration, i.e. 480 minutes τ : Optimum EST duration p t : p -quantile of the lifetime distribution 0 t : Failure time in EST C : Fixed cost of performing EST per unit V