Replacement Products Research Articles

Current and emerging factor VIII replacement products for hemophilia A.

Hemophilia A is a congenital X-linked bleeding disorder caused by coagulation factor VIII (FVIII) deficiency. Routine infusion of factor replacement products is the current standard of care; however, the development of alloantibodies against FVIII remains a challenge. The treatment of hemophilia has undergone major advances over the past century to improve safety, effectiveness, manufacturing, and convenience of factor products. Major recent advances in the treatment of hemophilia A include the emergence of extended half-life products, factor VIII orthologs, and gene therapy products. Extended half-life products were designed to decrease the frequency of infusions, but only modest half-life extension is achieved. Factor VIII orthologs featuring lower cross-reactivity with anti-FVIII antibodies may be less susceptible to inactivation by inhibitors. Meanwhile, gene therapy may potentially provide a cure for hemophilia A, thus abrogating the need for protein-based factor replacement. This review aims to discuss current and emerging FVIII replacement products for hemophilia A.

Use of smoking cessation products: A survey of patients in community pharmacies.

At 17.3%, smoking rates in Manitoba continue to exceed the national average. In this province, a total health care spending of more than $200 million per year has been attributed to smoking. This study examined the use of smoking cessation agents, including nicotine replacement products and prescription medications, in a sample of smokers in the city of Winnipeg. A simple multiple-choice questionnaire was administered to willing individuals attending 2 community pharmacies in Winnipeg, Manitoba. Data on demographics, smoking habits, previous attempts of smoking cessation and previous and current use of over-the-counter and prescription smoking cessation products were collected anonymously. Of the 2237 individuals who were approached, 586 were smokers (26.2%) and 180 responded to the survey (30.7%); 48.9% were female. A majority of smokers (32.8%) reported smoking 16 to 25 cigarettes per day. More than 90% had smoked for more than 5 years, 27.2% had more than 5 previous quit attempts and 82.1% used smoking cessation products with the intention to quit. Self-motivation (44.4%) and family/friend advice (28.3%) were major reasons for quitting. Impact of health care practitioners' advice was low (6.4%). More than 80% of respondents reported that they had no insurance coverage for their smoking cessation products. Despite having the highest rate of use, both nicotine gum (33.3%) and patches (24.4%) were reported to have lower rates of perceived efficacy. Electronic cigarette (97.9%) and varenicline (70.6%) had the highest rates of reported effectiveness. Smokers wanting to quit undergo many attempts. Pharmacists should assume a key role in reaching out to smokers.

Doctor Referral of Overweight People to a Low-Energy Treatment (DROPLET) in primary care using total diet replacement products: a protocol for a randomised controlled trial

IntroductionThe global prevalence of obesity has risen significantly in recent decades. There is a pressing need to identify effective interventions to treat established obesity that can be delivered at scale....

INSIGHTS INTO HYDROTHERMAL ACTIVITY IN THE ITI OPHIOLITE (CENTRAL GREECE)

Scarce intensely epidotised doleritic dykes, up to 1.5 m thick, penetrate in sharp contact serpentinised peridotites of the remnant ophiolite nappe of the Iti ophiolite. They are generally whitish rocks characterised by distinct and irregularly distributed, olive-green areas within the rock mass. Petrographic evidence reveals that their assemblage is dominated by quartz and epidote. Albite, chlorite and titanite occur as accessory phases. Minor opaque minerals are represented by magnetite, pyrite and chalcopyrite, as well as relic Cr spinel,. The mineral assemblage of the studied rocks comprises replacement products of the original phases under greenschist facies conditions. Moreover, the almostexclusive bi-mineralic (quartz + epidote) assemblage of the altered doleritic rocks, as well as obliteration of the original doleritic textures imply extensive recrystallisation, controlled by hydrothermal circulation. The compositions of the phases in these dykes mark the most alteration-resistant chemical components that have the potential to remain in their original associations, during such extensive recrystallisation.

(Logistics Services Strategies)

Bulgarian Abstract:Тази статия изследва различни стратегии, приложими за логистични услуги. Акцентът е върху стратегии, насочени към постигане на конкурентно предимство. Конкурентна стратегия може да се разглежда в процеса на вземане на определени действия за създаване на защитна позиция в организация за успешно справяне с петте конкурентни сили (конкуренти, потенциални нови участници, купувачи, подмяна продукти или услуги, доставчици) и получаване на по-висока възвръщаемост на инвестиции за компанията. Организациите трябва да намерят различни подходи за постигане на тези цели, както и най-добрата стратегия на компанията трябва да бъде приемането на уникална схема, отразяваща неговите специфични характеристики. С най-широко приложение, обаче, са по своята същност три последователни основни стратегии (които да се прилагат поотделно или съвместно), когато изграждането на такава дългосрочна позиция за отбрана и постигане на по-добри резултати, отколкото конкуренти в рамките на определена дейност. В така наречената матрица на клиентите рекламации може да се използва като инструмент за подпомагане на формулирането на общите логистични стратегическо поведение към клиентите на организацията. Четири логистични стратегии могат да се извлекат от матрицата, а компанията може да прилага такива стратегии на своите клиенти според тяхната рентабилност и разходи за логистични услуги. Документът по-нататъшни анализи на възможностите за персонализиране на стратегията за логистични услуги и разработване на подходяща програма. Персонализиране на стратегията за логистични услуги на клиентите означава намиране на фокусна точка, където служителите могат да стигнат заедно до заключение, че клиентът плаща за логистични услуги. В резултат на това, персоналът трябва да започне да извършва необходимите логистични услуги със страст и постоянство. Чрез персонализиране на стратегията за логистични услуги, управление може да създаде стабилна основа за постигане на сътрудничество персонал за изпълнение на стратегията. Целта на тази статия е да се подчертаят различни видове логистични стратегии и да изследват своите функции и възможности за кандидатстване. English Abstract:This paper explores various strategies applicable to logistics services. The emphasis is on strategies aiming at the achievement of a competitive advantage. A competitive strategy may be viewed through the process of taking certain actions to create a defensive position in an organization to successfully coping with the five competitive forces (competitors, potential new entrants, buyers, replacement products or services, suppliers) and receiving higher returns on investment for the company. Organizations shall find different approaches to achieving these goals, and the best strategy of the company shall be the adoption of a unique scheme reflecting its specific characteristics. With the widest application, however, are three inherently consistent core strategies (to be applied severally or jointly) when building such a long-term defence position and achieving better performance than competitors within a specific activity. The so- called Matrix of Customer Returns can be used as a helping tool for formulating a general logistics strategic behaviour towards the clients of the organization. Four logistics strategies may derive from the matrix, and the company may apply such strategies to its customers according to their profitability and costs for logistics services. The paper further analyses the opportunities for customizing the logistics services strategy and developing an adequate program. Personalizing the logistics customer services strategy means finding the focal point where employees may reach together a conclusion that the customer pays for the logistics services. As a result, the staff shall start performing the necessary logistics services with passion and persistence. By customizing the logistics services strategy, management can create a solid foundation for achieving staff collaboration for the implementation of the strategy. The purpose of this paper is to highlight different types of logistics strategies and to explore their features and application capabilities.

Hydrothermal reequilibration of igneous magnetite in altered granitic plutons and its implications for magnetite classification schemes: Insights from the Handan-Xingtai iron district, North China Craton

Magnetite is a common mineral in igneous rocks and has been used as an important petrogenetic indicator as its compositions and textures reflect changing physiochemical parameters such as temperature, oxygen fugacity and melt compositions. In upper crustal settings, igneous rocks are often altered by hydrothermal fluids such that the original textures and compositions of igneous magnetite may be partly or completely obliterated, posing interpretive problems in petrological and geochemical studies. In this paper, we present textural and compositional data of magnetite from variably albitized granitoid rocks in the Handan-Xingtai district, North China Craton to characterize the hydrothermal reequilibration of igneous magnetite.Four types of magnetite have been identified in the samples studied: pristine igneous magnetite (type 1), reequilibrated porous magnetite (type 2), reequilibrated nonporous magnetite (type 3), and hydrothermal magnetite (type 4). Pristine igneous magnetite contains abundant well-developed ilmenite exsolution lamellae that are largely replaced by titanite during subsequent hydrothermal alteration. The titanite has a larger molar volume than its precursor ilmenite and thus causes micro-fractures in the host magnetite grains, facilitating dissolution and reprecipitation of magnetite. During sodic alteration, the igneous magnetite is extensively replaced by type 2 and type 3 magnetite via fluid-induced dissolution and reprecipitation. Porous type 2 magnetite is the initial replacement product of igneous magnetite and is subsequently replaced by the nonoporous type 3 variety as its surface area is reduced and compositional equilibrium with the altering fluid is achieved. Hydrothermal type 4 magnetite is generally euhedral and lacks exsolution lamellae and porosity, and is interpreted to precipitate directly from the ore-forming fluids.Hydrothermal reequilibration of igneous magnetite has led to progressive chemical purification, during which trace elements such as Ti, Al, Mg, Zn, and Cr contents decrease dramatically (up to 2–3 orders of magnitude different), coupled with significant increase in iron concentrations from less than 64wt.% to higher than 70wt.%. Results presented here show that magnetite is much more susceptible to textural and compositional reequilibration than previously thought. The reequilibrated magnetite has geochemical patterns that may be distinctively different from its precursor, making existing discrimination plots questionable when applied to genetic interpretation. Based on textural characterization and high-resolution in situ compositional analyses, we propose that the Fe versus V/Ti diagram can be more confidently used to discriminate between pristine igneous magnetite, reequilibrated magnetite, and hydrothermal magnetite.

Natural vegan meal replacement: metabolic and oxidative modulation on overweight subjects

Background: Obesity correlates with insulin resistance, dyslipidemia, oxidative stress, cardiovascular diseases. Meal replacement (MR) products offer a possible strategy for weight management and subsequent reduction in obesity-related risk factors. Aims/Methods: twenty-seven healthy overweight subjects (6M/21F, age range 21-70, BMI range 25.0-43.8 kg/m 2 ) were enrolled to test the efficacy of a MR supplement (GoJuvo®). Main aims: a) short-term: to compare glycaemic status and triglycerides levels at baseline (T0), after MR supplementation and after a standard Mediterranean meal taken 4 hours after MR; long-term: to evaluate, in 20 out of the 27 subjects, over three months (T1), the effects of the MR, b) taken together with a standard prescribed diet, and to compare it with the effects on the parameters of 20 controls only on the standard diet. Anthropometric parameters, lipid and glycaemia profile, oxidative status (oxidized LDL concentrations) and homocysteine metabolism were measured at T0 and T1. Results: Short-term aim: overweight/obese subjects’ post-prandial MR insulin and triglycerides values were significantly lower than values after the standard meal (mean delta values p=0.0001 and p=0.006, respectively); long-term aim: at T1, subjects showed a significant improvement in anthropometric indices (p<0.05), a considerable decrease in ox-LDL levels and a significant improvement in Hcy metabolism (p<0.001). Conclusions: GoJuvo® modulated metabolic indices associated with the development of type 2 diabetes, possibly due to its fibre content. Subjects at T1 showed a significant decrease in homocysteine mia with an increase in folate levels and an anti-oxidative action on lipid peroxidation, most likely contributing to a reduction in cardiovascular risk.

The Experimental Tobacco Marketplace II: Substitutability and sex effects in dual electronic cigarette and conventional cigarette users

AimThe aim of the current study was to evaluate tobacco product purchasing in the Experimental: Tobacco Marketplace (ETM) among male and female smokers who also use e-cigarettes. We hypothesized a high substitution profile for e-cigarettes and that males would purchase more Snus than females. MethodsThe ETM is an online market used in clinical abuse liability research to mimic real-world purchasing patterns. Tobacco products, including each participant’s usual choice of conventional and e-cigarettes, were presented along with a price and description of nicotine content. Participants were endowed with an account balance based on the number of cigarettes and e-cigarettes consumed per week. Each participant was exposed to four ETM sessions in random order during which the price of conventional cigarettes was manipulated. ResultsCigarette consumption decreased as price increased. A mixed factor three-way ANOVA revealed a significant main effect of price (i.e., more alternative products were purchased at higher cigarette prices), product (i.e., more e-cigarettes were purchased than gum, lozenges, and Snus), and sex (i.e., males purchased more than females). A significant three-way interaction indicated that males purchased more e-cigarettes, Snus, and dip than females at higher cigarette prices. ConclusionThis study suggests that the user profile of cigarette smokers is associated with behavioral economic measures of alternative product substitution and indicates that the evaluation of nicotine replacement products should be considered for both males and females separately.

Tobacco Harm Reduction with Vaporised Nicotine (THRiVe): The Study Protocol of an Uncontrolled Feasibility Study of Novel Nicotine Replacement Products among People Living with HIV Who Smoke.

Smoking is a leading cause of morbidity and premature mortality among people living with HIV (PLHIV), who have high rates of tobacco smoking. Vaporised nicotine products (VNPs) are growing in popularity as a quit aid and harm reduction tool. However, little is known about their acceptability and use among PLHIV. Using a pragmatic, uncontrolled, mixed methods design this exploratory clinical trial aims to examine the feasibility of conducting a powered randomised clinical trial of VNPs as a smoking cessation and harm reduction intervention among vulnerable populations, such as PLHIV who smoke tobacco. Convenience sampling and snowball methods will be used to recruit participants (N = 30) who will receive two VNPs and up to 12 weeks’ supply of nicotine e-liquid to use in a quit attempt. Surveys will be completed at weeks 0 (baseline), 4, 8, 12 (end of treatment) and 24 (end of the study) and qualitative interviews at weeks 0 and 12. As far as we are aware, this feasibility study is the first to trial VNPs among PLHIV for smoking cessation. If feasible and effective, this intervention could offer a new approach to reducing the high burden of tobacco-related disease among PLHIV and other vulnerable populations.

Investigation of reasons for commercialization of prototypes reached as a result of R D and innovation activities and reasons for successful and unsuccessful commercialization

In economic systems where commercialization of R & D activities is an important problem, it is important for the competitiveness of national economies to determine the extent to which SMEs can commercialize their R & D activities and to determine the reasons for commercialization/non-commercialization and to make proposals for SMEs to achieve successful commercialization. Within the scope of KOSGEB and TUBITAK support, the enterprises that successfully completed an R & D project and reached the prototype were determined. 54 enterprises that carried out the project to commercialize R & D projects within the framework of Industrial Application Support Program have been determined as sample. In the study, which is applied qualitative research design, one of the purposeful sampling methods, extreme and deviant sampling method is used. Companies that have achieved turnover increase, asset increase and employment increase by completing Industrial Application Project have been determined by document examination method. The reasons for commercialization and non-commercialization were researched by structured interview method on enterprises that can and cannot commercialize in these companies. At the end of the R & D and commercialization processes, it was determined that the enterprises did not decrease at least and that the processes they applied in this scope created added value. It has been seen that the technical viewpoint is dominant in R & D activities. From the beginning of the R & D period, it has been determined that market and marketing oriented analyzes are inadequate. After reaching the prototype, it was determined that businesses focused on new R & D projects rather than professional commercialization. It has been determined that the commercialization process has failed due to the lack of adequate market analysis before the R & D project and the projecting of the existing or replacement products in the market.

Electronic Cigarettes in Germany: Patterns of Use and Perceived Health Improvement

Aims: The aim of the study was to characterize e-cigarette users in terms of their consumption patterns, motives, and the perceived health benefits they experience from using e-cigarettes. Design: The study was a cross-sectional online survey in 2015. A total of 3,320 German e-cigarette users were enrolled. A total of 91.5% were former tobacco smokers, 7.5% used both e-cigarettes and tobacco products, 1.0% were never-smokers. Results: No differences were found between ex-smokers and dual users with regard to sociodemographic and smoking history (mean age 40.8 years, 81% men, 45% with a high school degree or above). Both groups had smoked 26.4 tobacco cigarettes a day for 22 years, had unsuccessfully tried to quit smoking using various other nicotine replacement products, and had used e-cigarettes for an average of 2 years. Ex-smokers consumed lower nicotine strength and more liquid per month, experienced more positive health changes, and had made vaping their hobby. Never-smokers were about 5 years younger, used liquid without nicotine and without tobacco flavor, and had no physical dependency. Conclusions: E-cigarettes were primarily used as an alternative to smoking and a substitute for nicotine. More dual users than ex-smokers used e-cigarettes in places where smoking is forbidden. Positive health changes were more pronounced in ex-smokers than dual users.

Comparison of the efficacy of a commercial footbath product with copper sulfate for the control of digital dermatitis

Digital dermatitis (DD) is the most prevalent foot lesion affecting dairy herds worldwide. Its implications include production losses and decreased animal welfare. Footbathing is the most common herd-level prevention strategy for DD. Because many common footbath products have negative environmental and health consequences, replacement products expected to have improved safety but equal efficacy are being developed. Therefore, the aim of this study was to evaluate the efficacy of a new quaternary ammonium-based commercial footbath product (QAC) for reducing the prevalence of active DD lesions compared with an industry standard (copper sulfate; CuSO4) and typical on-farm footbath practices. A controlled intervention trial was conducted on 19 Alberta dairy farms over 12 wk, with 9 farms allocated to the QAC group (1% QAC daily, 5 d/wk), 5 to the CuSO4 group (5% CuSO4 daily, 5 d/wk), and 5 to a noninterference group (maintained typical footbath practices). A total of 22,285 observations on 3,465 lactating cows were assessed for DD lesions and leg cleanliness in the milking parlor. Five farms discontinued use of the QAC product for various reasons. Noninferiority analysis was used to assess QAC ability to decrease the proportion of cows with 1 or more active DD lesions compared with CuSO4 after 6 wk. Multilevel logistic regression models for repeated measures were used to evaluate efficacy of QAC compared with CuSO4 and noninterference farms in reducing the prevalence of active DD lesions at the foot level over 12 wk. The noninferiority analysis determined that the proportion of cows with 1 or more active DD lesion decreased 2.19 (95% CI: 1.39-3.46) times less after 6 wk of study on the QAC farms compared with CuSO4 farms, making QAC inferior to CuSO4. The multilevel logistic regression models determined that the proportion of active DD lesions increased in the QAC herds, whereas this proportion decreased in the CuSO4 and noninterference herds over 12 wk. Additionally, cows in mid- and late-lactation had a higher odds of having active DD compared with fresh cows. Older cows (parity 3 and ≥4) had a decreased odds of active DD compared with first-parity cows. At the farm level, a higher baseline active DD prevalence resulted in increased odds of active DD; however, this did not modify the effect of treatment or week of study. We concluded that QAC was inferior to CuSO4 and typical on-farm footbath practices, and further development of novel footbath products is required to develop an ideal alternative.

Temporal trends of PBDEs and emerging flame retardants in belugas from the St. Lawrence Estuary (Canada) and comparisons with minke whales and Canadian Arctic belugas

An exponential level increase of the ubiquitous halogenated flame retardant (HFR) class polybrominated diphenyl ether (PBDE) has been documented during the 1990s in endangered belugas (Delphinapterus leucas) from the St. Lawrence Estuary (SLE), Eastern Canada. The recent worldwide bans and regulations of PBDE mixtures led to their replacement by alternative HFRs (so-called emerging HFRs) that are increasingly being reported in various environmental compartments. There are, however, limited knowledge on the spatial and temporal trends of PBDEs and emerging HFRs in cetaceans, especially after restrictions on PBDE usage. The first objective of this study was to investigate the occurrence of HFRs (35 PBDE congeners and 13 emerging compounds) in the blubber of belugas and minke whales (Balænoptera acutorostrata) found dead in the Estuary or Gulf of St. Lawrence as well as belugas from Nunavik (Canadian Arctic) collected as part of the Inuit subsistence hunt. A second objective was to investigate the trends of HFR concentrations in SLE beluga males between 1997 and 2013. PBDEs were the most abundant HFRs in all three whale populations, while hexabromobenzene (HBB), Chlordene Plus (CPlus), Dechlorane Plus (DP), and Dechlorane 604 Component B (Dec-604 CB) were quantified in the majority of blubber samples. Overall, concentrations of emerging HFRs were notably greater in SLE belugas compared to the two other whale populations, with the exception of DP and Dec-604 CB that were found in greater concentrations in Canadian Arctic belugas. No significant trend in blubber PBDE concentrations was found in SLE belugas during this 17-year period. This suggests that global PBDE regulations are too recent to observe changes in PBDE concentrations in belugas from this highly HFR-exposed environment. In contrast, concentrations of HBB and CPlus in SLE belugas decreased slightly from 1997 to 2013, while DP increased up until 2000 and decreased slightly thereafter. The occurrence and temporal variations of PBDEs and their replacement products in these cetaceans warrant continuous monitoring.

Ferric pyrophosphate citrate as an iron replacement agent for patients receiving hemodialysis.

Treatment of anemia remains an integral component in the care of patients with end stage kidney disease receiving dialysis. Currently, both erythropoiesis stimulating agents and iron replacement agents remain important anemia management strategies for patients undergoing hemodialysis (HD). Ferric pyrophosphate citrate (FPC) was approved by the U.S. Food and Drug Administration in January 2015 as an iron replacement product in adult patients receiving long-term maintenance HD. FPC is administered to patients on HD through the dialysate. Multicenter randomized, placebo-controlled phase three clinical studies (CRUISE 1 and 2) have found dialysate FPC to maintain hemoglobin level and iron balance in patients receiving chronic HD. Adverse events were similar in both the dialysate FPC-treated and placebo groups. Another study showed a significant reduction in the prescribed erythropoietin-stimulating agents dose at the end of treatment in the dialysate FPC-treated group compared with placebo. These studies have shown that dialysate FPC is efficacious and well tolerated. In this article, we review clinical studies evaluating the efficacy and safety of FPC and also propose a protocol for iron replacement in HD units where dialysate FPC is to be used.

Nutritional Status 6 Weeks After Gastric Bypass Bariatric Surgery: Comparison of Two Nutritional Support Plans

Bariatric surgery has helped many people lose weight, but can create nutritional problems. Most studies on these problems have examined subjects way after surgery, and have not paid attention to variations in nutrition support. The present study looked at various measures pre‐surgery and 6 weeks after surgery in premenopausal females on one of two nutrition plans (a best selling meal replacement product + other supplements or a new meal replacement product). Both groups lost weight, though early weight loss was higher with the new product. Based on plasma ceruloplasmin, copper status declined by 6 weeks in the conventional nutrition support group, but not with the new formulation. Iron status improved in both groups based on ferritin to c‐reactive protein ratios. Magnesium status improved just with the new formulation based on 2 measures. In both groups, plasma measures of vitamin D and B12 did not change, but vitamin A status, based on retinol binding protein, declined. A urine measure of a bone resorption decreased in both groups. Urinary potassium rose with the new formulation, which had added potassium (the products in the other plan did not). Blood sugar fell with the new formulation, possibly due to the type of fiber used. Two plasma markers of liver damage increased with the traditional nutrition support products, but not with the new formulation. Plasma homocysteine fell in the traditional group, but not with the new formulation. In conclusion, some, but not all examined nutritional related parameters changed by 6 weeks after bariatric surgery. Some of the changes were affected by the type of nutritional support provided.

Faktor-Faktor yang Memengaruhi Daya Saing Industri Unggas Ayam Kampung (Studi Kasus PT Dwi dan Rachmat Farm, Bogor)

The poultry industry in Indonesia often experience ups and downs the last few years. The volatility of broiler effort to shocks opportunities to develop local businesses like poultry chicken that is currently growing in popularity compared with other poultry meat. Chicken poultry industry is highly prospective, given the need for animal protein derived from poultry meat is increasing and is supported by the rapid development of the culinary industry today. The purpose of this study to identify the factors affecting the competitiveness of the poultry industry chicken. Descriptive research method, processed and analyzed using the Porter Diamond Model. The results showed the factors that influence competitiveness the poultry industry kampong chicken which has the highest attribute values, namely: human resources, the number of buyers and buyer growth rate, breeding, industrial replacement products, roadmap and business plan development of chicken, a conducive business climate. Attributes of the lowest infrastructure, capital resources, integration of industry suppliers and facilitation of exports.

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial.

SummaryObjectiveThe Action for Health in Diabetes (Look AHEAD) trial was a randomized controlled clinical trial to compare the effects of 10 years of intensive lifestyle intervention (ILI) with a control condition of diabetes support and education (DSE) on health outcomes in over 5,000 participants with type 2 diabetes. The ILI had significantly greater weight losses than DSE throughout the trial. The goal of this analysis is to describe the cost of delivering the intervention.MethodsThe ILI was designed to promote weight loss and increase physical activity. It involved a combination of group plus individual intervention sessions, with decreasing frequency of contact over the 10 years. The intervention incorporated a variety of strategies, including meal replacement products, to improve weight loss outcomes. The costs of intervention delivery were derived from staff surveys of effort and from records of intervention materials from the 16 US academic clinical trial sites. Costs were calculated from the payer perspective and presented in 2012 dollars.ResultsDuring the first year, when intervention delivery was most intensive, the annual cost of intervention delivery, averaged (standard deviation) across clinical sites, was $2,864.6 ($513.3) per ILI participant compared with $202.4 ($76.6) per DSE participant. As intervention intensity declined, costs decreased, such that from years 5 to 9 of the trial, the annual cost of intervention was $1,119.8 ($227.7) per ILI participant and $102.9 ($33.0) per DSE participant. Staffing accounted for the majority of costs throughout the trial, with meal replacements and materials to promote adherence accounting for smaller shares.ConclusionsThe sustained weight losses produced by the Look AHEAD intervention were supported by intervention costs that were within the range of other weight loss programmes. Future work will include an evaluation of the cost‐effectiveness of the ILI and will contain additional follow‐up data.

Prevalence of tobacco in Darbhanga district: A hospital-based cross-sectional study.

Chewing tobacco, smoking, and consumption of alcoholic beverages have become common social habits in India. No study has been conducted so far in this part of Bihar regarding the prevalence of tobacco. The aim of this study was to estimate the prevalence of tobacco use, its influences, triggers, and associated oral lesions. A hospital-based cross-sectional study was conducted. Patients who consume tobacco in any form were selected and were interviewed through a pretested structured questionnaire in relation to their tobacco habits, its influences, and triggers. In addition, clinical examination was carried out to check for any tobacco-related oral lesions. The overall prevalence of tobacco use was 16.69%, out of which 14.48% were males and 2.21% were females. The most affected age group was from 19 to 50 years. 13.45% were below 18 years of age. 43.40% males and 77.42% females having the tobacco habit were illiterates. The majority of individuals were addicted due to peer pressure and friends, some acquired it, due to loneliness, stress, and for adapting themselves in the work place. Females frequently used smokeless for cleaning teeth. The most common oral mucosal lesion in both males (53.26%) and females (18.55%) was tobacco hyperkeratosis. The present study reflects the high prevalence rates of tobacco use among various sections of society. Apart from mass against tobacco products, authorities should focus on strict enforcement of law and promote research for creating new and harmless replacement products.

Novel Polyfluorinated Compounds Identified Using High Resolution Mass Spectrometry Downstream of Manufacturing Facilities near Decatur, Alabama.

Concern over persistence, bioaccumulation, and toxicity has led to international regulation and phase-outs of certain perfluorinated compounds and little is known about their replacement products. High resolution mass spectrometry was used to investigate the occurrence and identity of replacement fluorinated compounds in surface water and sediment of the Tennessee River near Decatur, Alabama. Analysis of legacy Per- and polyfluoroalkyl substances (PFASs) revealed a marked increase in concentrations downstream of manufacturing facilities, with the most abundant compounds being perfluorooctanesulfonate (PFOS), perfluorobutanesulfonate (PFBS), and perfluorooctanoic acid (PFOA) as high as 220 ng L-1, 160 ng L-1, and 120 ng L-1, respectively. A series of nine polyfluorinated carboxylic acids was discovered, each differing by CF2CH2. These acids are likely products or byproducts of a manufacturing process that uses 1,1-difluoroethene, which is registered to a manufacturing facility in the area. Two other predominant compounds discovered have structures consistent with perfluorobutanesulfonate and perfluoroheptanoic acid but have a single hydrogen substituted for a fluorine someplace in their structure. A polyfluoroalkyl sulfate with differing mixes of hydrogen and fluorine substitution was also observed. N-methyl perfluorobutane sulfonamidoacetic acid (MeFBSAA) was observed at high concentrations and several other perfluorobutane sulfonamido substances were present as well.

ADONA and perfluoroalkylated substances in plasma samples of German blood donors living in South Germany.

Perfluorinated compounds are fully fluorinated anthropogenic substances that have been used in various products, applications, and industrial processes. Due to their persistence and toxic effects, some of them are restricted, and therefore replacement products have been developed. The aim of the study was to quantify the body burden of different perfluorinated substances in two adult populations living close to or about 80km apart from a former perfluorooctanoate (PFOA) production plant who are exposed via drinking water, and in a control population. In this plant, the replacement emulsifier 3H-perfluoro-3-[(3-methoxy-propoxy)propanoic acid] (ADONA) has been used in the production of fluoropolymers since 2008. We quantified 7 perfluorinated compounds and ADONA in a total of 396 plasma samples collected at different time points. With regard to samples collected in 2015 or 2016, the highest 95th percentile levels were 13.5μg/l for perfluorooctane sulfonate (PFOS), 3.0μg/l for perfluorononanoate (PFNA), and 1.5μg/l for perfluorohexane sulfonate (PFHxS). For PFOA, the highest 95th percentile was found at the site close to the facility (85.5μg/l), while in the control region the value was 2.4μg/l. Overall, the concentration of PFOA and PFOS declined over time in all study regions. ADONA was detected only in few samples slightly above the limit of quantification (0.2μg/l). While health risks related to ADONA are unlikely under the present exposure situation, the exposure to PFOA via tap water should be reduced markedly, especially for the population living close to the plant.