Christina Chen

Cost-effectiveness analysis of alternative screening and treatment strategies for heterozygous familial hypercholesterolemia in the United States

BACKGROUND/OBJECTIVESnFamilial hypercholesterolemia (FH) is a genetic disorder that leads to premature heart disease or stroke if untreated. Statins are effective for individuals with FH but less than 20% of actual cases are diagnosed in the US and many people are not adherent to treatment. Using new knowledge regarding mutations responsible for FH, some European countries have developed genetic FH screening strategies, many of which have been shown to be cost-effective. This study evaluates the cost-effectiveness of genetic screening and lipid-based screening with statin adherence measures compared to lipid-based screening alone in the US.nnnMETHODSnA decision tree was used to estimate disease detection with the three screening strategies, while a Markov model was used to model disease progression until death, quality-adjusted life years (QALYs) and costs from a US societal perspective.nnnRESULTSnThe results showed that Genetic Screening cost

Spectral Analyses of Wrist Motion in Individuals Poststroke The Development of a Performance Measure With Promise for Unsupervised Settings

15,594 for 18.29 QALYs per person and Lipid Screening with adherence measures cost

Atrial Fibrillation Pacing Decreases Intravascular Shear Stress in a New Zealand White Rabbit Model: Implications in Endothelial Function

16,385 for 18.77 QALYs compared with

Developmental neurogenetics and multimodal neuroimaging of sex differences in autism

10,396 for 18.28 QALYs for Lipid Screening alone. The incremental cost-effectiveness ratio (ICER) of Genetic Screening versus Lipid Screening was

Economic Burden of Illness among Persons with Hemophilia B from HUGS Vb: Examining the Association of Severity and Treatment Regimens with Costs and Annual Bleed Rates

519,813/QALY and that of Lipid Screening with adherence measures versus Lipid Screening alone was

Examining the Relationship between Verbal Fluency and Brain Morphometry in Boys and Girls with Autism Spectrum Disorders

12,223/QALY. At a US willingness-to-pay threshold of

Characteristics Associated With Annual Bleeding Frequency Among Hemophilia Patients In The United States

150,000/QALY Genetic Screening is not cost-effective compared with Lipid Screening. Sensitivity analyses showed that results were robust to reasonable variations in model parameters.nnnCONCLUSIONSnAlthough genetic screening is currently not a cost-effective option in the US, health outcomes for FH individuals could benefit from adherence measures encouraging statin use.

Promise of Precision Medicine.

Background. Upper extremity use in daily life is a critical ingredient of continued functional recovery after cerebral stroke. However, time-evolutions of use-dependent motion quality are poorly understood due to limitations of existing measurement tools. Objective. Proof-of-concept study to determine if spectral analyses explain the variability of known temporal kinematic movement quality (ie, movement duration, number of peaks, jerk) for uncontrolled reach-to-grasp tasks. Methods. Ten individuals with chronic stroke performed unimanual goal-directed movements using both hands, with and without task object present, wearing accelerometers on each wrist. Temporal and spectral measures were extracted for each gesture. The effects of performance condition on outcome measures were determined using 2-way, within subject, hand (nonparetic vs paretic) × object (present vs absent) analysis of variance. Regression analyses determined if spectral measures explained the variability of the temporal measures. Results. There were main effects of hand on all 3 temporal measures and main effects of object on movement duration and peaks. For the paretic limb, spectral measures explain 41.2% and 51.1% of the variability in movement duration and peaks, respectively. For the nonparetic limb, spectral measures explain 40.1%, 42.5%, and 27.8% of the variability of movement duration, peaks, and jerk, respectively. Conclusions. Spectral measures explain the variability of motion efficiency and control in individuals with stroke. Signal power from 1.0 to 2.0 Hz is sensitive to changes in hand and object. Analyzing the evolution of this measure in ambient environments may provide as yet uncharted information useful for evaluating long-term recovery.

Cost-Effectiveness Analysis Of Alternative Screening And Treatment Strategies For Familial Hypercholesterolemia In The United States

Atrial fibrillation (AF) is characterized by multiple rapid and irregular atrial depolarization, leading to rapid ventricular responses exceeding 100 beats per minute (bpm). We hypothesized that rapid and irregular pacing reduced intravascular shear stress (ISS) with implication to modulating endothelial responses. To simulate AF, we paced the left atrial appendage of New Zealand White rabbits (n = 4) at rapid and irregular intervals. Surface electrical cardiograms were recorded for atrial and ventricular rhythm, and intravascular convective heat transfer was measured by microthermal sensors, from which ISS was inferred. Rapid and irregular pacing decreased arterial systolic and diastolic pressures (baseline, 99/75xa0mmHg; rapid regular pacing, 92/73; rapid irregular pacing, 90/68; p < 0.001, n = 4), temporal gradients (