Aims To evaluate adherence, persistence, glycaemic control and costs at 12‐month follow‐up for patients initiating dulaglutide versus liraglutide or exenatide once weekly. Materials and methods The present retrospective observational claims study included patients with type 2 diabetes (T2D) and ≥ 1 pharmacy claim for dulaglutide, liraglutide or exenatide once weekly from the HealthCore Integrated Research Database. Adherence was defined as proportion of days covered ≥80%, and persistence was measured by time to discontinuation of index therapy. Change from baseline in glycated haemoglobin (HbA1c) concentration was assessed in a subset with pre‐ and post‐index HbA1c results. Propensity scores were used to match the cohorts. Results The baseline characteristics were balanced for the matched cohorts, dulaglutide versus liraglutide (n = 2471) and dulaglutide versus exenatide once weekly (n = 1891). Among those initiating dulaglutide there was a significantly higher proportion of adherent patients compared with the groups initiating liraglutide (51.2% vs. 38.2%; P < 0.001) and exenatide once weekly (50.7% vs. 31.9%; P < 0.001). At 12 months, 55% of patients in the dulaglutide group versus 43.8% in the liraglutide group (P < 0.001), and 54.9% in the dulaglutide versus 34.4% in the exenatide once‐weekly group (P < 0.001) were persistent. The dulaglutide group had a significantly greater reduction in HbA1c than the liraglutide group (−34.24 vs. −31.94 mmol/mol; P = 0.032), and a greater, but nonsignificant, reduction in HbA1c than the exenatide once‐weekly group (−34.46 vs. −31.94 mmol/mol; P = 0.056). The diabetes‐related total costs were not significantly different between the dulaglutide and the liraglutide group ($16,174 vs. $16,694; P = 0.184), and were significantly higher for dulaglutide than for exenatide once weekly ($15,768 vs. $14,615; P = 0.005). Conclusions Adherence and persistence are important considerations in patient‐centric treatment selection for patients with T2D. Higher adherence and persistence for dulaglutide compared with liraglutide or exenatide once weekly are relevant criteria when choosing glucagon‐like peptide‐1 receptor agonist treatment for patients with T2D.

Abstract-We introduce a method, known as one-dimensional sonomyography (1-D SMG), that uses A-mode ultrasound signals to detect dynamic thickness changes in skeletal muscle during contraction. We custom-designed a 1-D SMG system to collect synchronized A-mode ultrasound, joint angle, and surface electromyography (EMG) signals of forearm muscles during wrist extension. We extracted the 1-D SMG signal from the ultrasound signal by automatically tracking the corresponding echoes, which we then used to calculate muscle thickness changes. We tested the right forearm muscles of nine nondisabled young subjects while they performed wrist extensions at 15.0, 22.5, and 30.0 cycles/min and their largest wrist extension angle ranged from 80° to 90°. We found that the muscle deformation and EMG root mean square signals correlated linearly with wrist extension angle. The ratio of deformation to wrist angle was significantly different among the subjects (p < 0.001) but not among the trials of different extension rates for each subject (p = 0.9). The results demonstrate that 1-D SMG can be reliably performed and that it has the potential for skeletal muscle assessment and prosthesis control.

Falls represent 40 per cent of hospital accidents, and consequences range from none to serious injuries. The purpose of this study was to estimate the average hospital cost and length of stay (LOS) associated with serious injurious falls in an acute care hospital. We used data from risk management and case costing databases to identify cost associated with a serious injury after an in-hospital fall. Thirty-seven injured patients were matched with 2,113 controls by the most responsible medical diagnosis, age, and gender. Cost and LOS were compared using t-tests and multivariate regression. Average costs for seriously injured fallers and non-faller controls were CAD$44,203 and CAD$13,507, while LOS was 45 and 11 days respectively. Hospital cost for a seriously injured faller was $30,696 (95% CI: $25,158 - $36,781) greater than the cost for a non-faller. Hospital managers have a leading role in creating system-wide falls prevention programs and reducing hospital costs.

Coronavirus disease 2019 (COVID-19) was first detected in December 2019 in Wuhan, China, with 11,669,259 positive cases and 539,906 deaths globally as of July 8, 2020. The objective of the present study was to determine whether meteorological parameters and air quality affect the transmission of COVID-19, analogous to SARS. We captured data from 29 provinces, including numbers of COVID-19 cases, meteorological parameters, air quality and population flow data, between Jan 21, 2020 and Apr 3, 2020. To evaluate the transmissibility of COVID-19, the basic reproductive ratio ( R 0 ) was calculated with the maximum likelihood “removal” method, which is based on chain-binomial model, and the association between COVID-19 and air pollutants or meteorological parameters was estimated by correlation analyses. The mean estimated value of R 0 was 1.79 ± 0.31 in 29 provinces, ranging from 1.08 to 2.45. The correlation between R 0 and the mean relative humidity was positive, with coefficient of 0.370. In provinces with high flow, indicators such as carbon monoxide (CO) and 24-h average concentration of carbon monoxide (CO_24 h) were positively correlated with R 0 , while nitrogen dioxide (NO 2 ), 24-h average concentration of nitrogen dioxide (NO 2 _24 h) and daily maximum temperature were inversely correlated to R 0 , with coefficients of 0.644, 0.661, −0.636, −0.657, −0.645, respectively. In provinces with medium flow, only the weather factors were correlated with R 0 , including mean/maximum/minimum air pressure and mean wind speed, with coefficients of −0.697, −0.697, −0.697 and −0.841, respectively. There was no correlation with R 0 and meteorological parameters or air pollutants in provinces with low flow. Our findings suggest that higher ambient CO concentration is a risk factor for increased transmissibility of the novel coronavirus, while higher temperature and air pressure, and efficient ventilation reduce its transmissibility. The effect of meteorological parameters and air pollutants varies in different regions, and requires that these issues be considered in future modeling disease transmissibility.

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