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Background: Efgartigimod, a human immunoglobulin G (IgG)1 antibody Fc fragment, blocks the neonatal Fc receptor, decreasing IgG recycling and reducing pathogenic IgG autoantibody levels. ADHERE assessed the efficacy and safety of efgartigimod PH20 subcutaneous (SC; co-formulated with recombinant human hyaluronidase PH20) in chronic inflammatory demyelinating polyneuropathy (CIDP). Methods: ADHERE enrolled participants with CIDP (treatment naive or on standard treatments withdrawn during run-in period) and consisted of open-label Stage A (efgartigimod PH20 SC once weekly [QW]), and randomized (1:1) Stage B (efgartigimod or placebo QW). Primary outcomes were clinical improvement (assessed with aINCAT, I-RODS, or mean grip strength; Stage A) and time to first aINCAT score deterioration (relapse; Stage B). Secondary outcomes included treatment-emergent adverse events (TEAEs) incidence. Results: 322 participants entered Stage A. 214 (66.5%) were considered responders, randomized, and treated in Stage B. Efgartigimod significantly reduced the risk of relapse (HR: 0.394; 95% CI: 0.25–0.61) versus placebo (p=0.000039). Reduced risk of relapse occurred in participants receiving corticosteroids, intravenous or SC immunoglobulin, or no treatment before study entry. Most TEAEs were mild to moderate; 3 deaths occurred, none related to efgartigimod. Conclusions: Participants treated with efgartigimod PH20 SC maintained a clinical response and remained relapse-free longer than those treated with placebo.
Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity.
Methods
We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year.
Results
The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126–10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520–5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854–2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444–939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854).
Conclusions
The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.
With the proportion of older adults in Hong Kong projected to double in size in the next 30 years, it is important to develop measures for detecting individuals in the earliest stage of Alzheimer's disease (AD, 0.5 in Clinical Dementia Rating, CDR). We tested the utility of a non-verbal prospective memory task (PM, ability to remember what one has to do when a specific event occurs in the future) as an early marker for AD in Hong Kong Chinese.
Methods:
A large community dwelling sample of older adults who are healthy controls (CDR 0, N = 125), in the earliest stage of AD (CDR 0.5, N = 125), or with mild AD (CDR 1, N = 30) participated in this study. Their reaction time/accuracy data were analyzed by mixed-factor analyses of variance to compare the performance of the three CDR groups. Logistic regression analyses were performed to test the discriminative power of these measures for CDR 0 versus 0.5 participants.
Results:
Prospective memory performance declined as a function of AD severity: CDR 0 > CDR 0.5 > CDR 1, suggesting the effects of early-stage AD and AD progression on PM. After partialling out the variance explained by psychometric measures (e.g., ADAS-Cog), reaction time/accuracy measures that reflected the PM still significantly discriminated between CDR 0 versus 0.5 participants in most of the cases.
Conclusion:
The effectiveness of PM measures in discriminating individuals in the earliest stage of AD from healthy older adults suggests that these measures should be further developed as tools for early-stage AD discrimination.
An outbreak of diarrhoea due to Salmonella worthington in five newborn babies, 5 weeks after a similar outbreak in 13 babies for which no cause had been found, occurred in the nursery of a maternity ward. The source of infection was traced to the contaminated rubber tubing of a mechanical suction apparatus. S. worthington was isolated from the rubber tubing and the Y connexion of the suction apparatus from which all the five infected babies had received suction. Reflux of contaminated amniotic fluid into the sterile catheter connected to the apparatus some time before use could have been the means of introducing the infected material to the oropharynx of the newborn babies, and amniotic fluid, acting as a good medium to support the growth of S. worthington, might be responsible for the long-lasting contamination.
Salmonella johannesburg (1, 40: b: e, n, x), a previously rare salmonella serotype, has established itself rapidly as an important and highly prevalent cause of gastroenteritis among children. The clinical features of the infection are usually mild but chronic. It has been suggested that S. johannesburg was introduced into Hong Kong through imported foods but no common vehicle could be traced as the source of infection. A thorough investigation of one paediatric ward in a general hospital revealed that non-infected patients admitted to the ward usually acquired S. johannesburg infection within 3–7 days, with or without symptoms. Thus hospital cross-infection could be a significant factor in contributing to its rapid spread in the community. Furthermore, the rapidity with which S. johannesburg spread was facilitated by (a) its tendency to produce a chronic infection, (b) its multiple resistance to antibiotics, and (c) the higher infectivity of S. johannesburg over other salmonellas endemic in this locality. These factors combined with the overcrowded conditions in many of the hospitals in Hong Kong facilitated the occurrence of hospital infection, which in its turn contributed to the spread of the infection in the local community.
To investigate and compare the sensitivity and specificity of computed tomography and of endoscopy, as diagnostic tests for foreign body ingestion.
Materials and methods:
Over a two-year period, Asian patients with suspected foreign body ingestion were studied. The clinical findings, computed tomography images, endoscopic results, treatment and outcomes were prospectively analysed.
Results:
Over the study period, 193 patients were admitted for foreign body ingestion, complaining of a persistent foreign body sensation in the neck. The sensitivity and specificity of computed tomography were 78 and 96 per cent, respectively; the positive predictive value was 75 per cent and the negative predictive value 97 per cent. The diagnostic accuracy of computed tomography was 94 per cent.
Conclusion:
Our study showed that computed tomography had high negative predictive value and accuracy in the diagnosis of foreign body ingestion. It was useful if endoscopy showed negative findings but the patient still had persistent symptoms of foreign body ingestion.
The aim of this study was to compare the linear growth of children with cerebral palsy (CP) with that of children without CP. The segmental lengths (humerus, ulna, femur, tibia, and spine), recumbent length, body weight, and bone age of 62 children with CP (age range 2.25 to 14 years, mean 7.13 years) were measured and compared with 68 children without CP (age range 1.50 to 12.67 years, mean 6.73 years). The results show that bone-age delay is common in children with CP (68% with a delay of more than 1 year). The linear growth of children with CP is similar to that of children without CP when bone age is used instead of chronological age. There is a strong correlation between segmental lengths and body height. Hence, this study favours using segmental lengths for estimating height in children with CP and using the comparison group as a reference for this purpose. Nutritional and non-nutritional factors on bone-age delay are discussed.
An approximate method is developed for computing the values of European options on the maximum or the minimum of several assets. The method is very fast and is accurate for parameter ranges that are often of the most interest. The approach casts the problem in terms of order statistics and can be used to handle situations where the initial asset prices, the asset variances, and the covariances are all unequal. Numerical values are given to illustrate the accuracy of the method.
We have developed a new cluster ion source that can generate intense beams of metal and semiconductor clusters of a very wide-size range. With the source, we have observed intense beams of carbon clusters with mean cluster sizes of up to 4000 atoms/clusters. However, we have found that for generating small fullerenes, such as C60 and C70, the recently discovered technique by Kraetschmer et al. is much more efficient. By improving the technique, we have generated gram quantities of C60 and C70 and systematically investigated their thermal desorption properties. During the heating process, we have discovered that at high temperatures the bulk fullerenes, fullerite, transformed to another form of carbon, which still evaporates at temperatures above 700 C, but does not dissolve in benzene.
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