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Aims: Obstructive hypertrophic cardiomyopathy (oHCM) is a disease of the cardiomyocyte in which dynamic left ventricular outflow track obstruction may lead to heart failure, valvular disease, and sudden death. Little is known about healthcare resource utilization (HRU) and costs associated with oHCM. This study investigated the clinical and economic burden of oHCM in patients with or without symptoms associated with oHCM. Methods: We used the US IBM MarketScan Commercial and Medicare Supplemental database to identify patients with oHCM (January 2009-March 2019). Control patients without cardiomyopathy were matched to each patient with oHCM based on age, sex, region, and index year (3:1 ratio). One-year HRU and cost data were compared between all oHCM, symptomatic oHCM, and asymptomatic oHCM subgroups, and their respective controls. Results: Among 11,401 eligible patients with oHCM (mean age 57 years, 42% female), 5,667 (50%) were symptomatic (23% chest pain, 57% dyspnea, 29% fatigue, 17% syncope). oHCM was associated with significant increases in all-cause hospitalizations, hospital days, outpatient visits, and total healthcare costs (mean ± standard deviation: $26,929 ± 77,720 vs. $6,808 ± 25,712, p<.001) compared with matched controls. These differences were driven mainly by the clinical and economic burden of symptomatic oHCM, which was associated with significant increases in 1-year hospitalization rates (38.0 vs. 6.9%), hospital days (3.7 ± 9.9 vs. 0.4 ± 3.0), and total healthcare costs ($43,586 ± 103,756 vs. $6,768 ± 27,618; all p<.001). Adjustment for comorbidities had minimal impact on these differences. Limitations: The use of claims data relies on International Classification of Diseases (ICD-9 and ICD-10) diagnosis codes, which might be inaccurate. Only commercially insured patients were included. Conclusion: In a real-world population, oHCM was associated with substantial increases in HRU and incremental costs of ≥$20,000/year when compared with matched controls--a difference that increased to ≥$35,000/year among symptomatic patients. Further studies are warranted to understand the potential impact of specific therapies on HRU and the economic burden of oHCM. PLAIN LANGUAGE SUMMARY Obstructive hypertrophic cardiomyopathy (oHCM) is a medical condition in which the heart muscle becomes abnormally thick and can cause partial blockage of blood flow out of the heart. Some patients experience symptoms (such as shortness of breath, chest pain, and fatigue) from this condition while others do not. Little is known about the healthcare resource utilization (HRU) and costs associated with oHCM, and if there are any differences between patients with oHCM who experience symptoms versus those who are asymptomatic. Therefore, we performed a study to investigate the clinical and economic burden of oHCM in patients with or without symptoms associated with oHCM. Based on insurance claims data, ≥50% of all patients with diagnosed oHCM are symptomatic. Symptomatic patients experience nearly 8 times as many hospitalizations and cost the healthcare system >$35,000 per year more than matched controls. In contrast, asymptomatic patients with oHCM have a much smaller difference in HRU and costs (≥$3,600/year) compared with matched controls. The results of this study suggest that effective therapies for oHCM may provide economic value, even if the impact of therapy is limited solely to the relief of symptoms. [ABSTRACT FROM AUTHOR]

In response to clusters of carbapenem-resistant Enterobacteriaceae (CRE) in Illinois, USA, the Illinois Department of Public Health and the Centers for Disease Control and Prevention Chicago Prevention Epicenter launched a statewide Web-based registry designed for bidirectional data exchange among health care facilities. CRE occurrences are entered and searchable in the system, enabling interfacility communication of patient information. For rapid notification of facilities, admission feeds are automated. During the first 12 months of implementation (November 1, 2013-October 31, 2014), 1,557 CRE reports (≈4.3/day) were submitted from 115 acute care hospitals, 5 long-term acute care hospitals, 46 long-term care facilities, and 7 reference laboratories. Guided by a state and local public health task force of infection prevention specialists and microbiologists and a nonprofit informatics entity, Illinois Department of Public Health deployed a statewide registry of extensively drug-resistant organisms. The legal, technical, and collaborative underpinnings of the system enable rapid incorporation of other emerging organisms. [ABSTRACT FROM AUTHOR]

Climate variability and changes affect crop yields by causing climatic stresses during various stages of the plant life cycle. A crop growth model must be able to capture the observed relationships between crop yields and climate stresses before its credible use as a prediction tool. This study evaluated the ability of the geographically distributed cotton growth model redeveloped from GOSSYM in simulating U.S. cotton (Gossypium hirsutum L.) yields and their responses to climate stresses during 1979 to 2005. Driven by realistic climate conditions, the model reproduced long-term mean Cotton yields within ±10% of observations at the 30-km model resolution across virtually the entire U.S. Cotton Belt and correctly captured the critical dependence of their geographic distributions on regional climate characteristics. Significant correlations between simulated and observed interannual variations were found across 87% of the total harvest grids. The model also faithfully represented the predictive role of July to August air temperature and August to September soil temperature anomalies on interannual Cotton yield changes on unirrigated lands, with a similar but weaker predictive signal for irrigated lands as observed. The modeled cotton yields exhibited large, positive correlations with July to August leaf area index. These results indicate the model's ability to depict the regional impact of climate stresses on cotton yields and suggest the potential predictive value of satellite retrievals. They also provide a baseline reference for further model improvements and applications in the future study of climate-cotton interactions. [ABSTRACT FROM AUTHOR]

Studies were conducted on three herbaceous plant species growing in naturally high solar UV environments in the subalpine of Mauna Kea, Hawaii, USA, to determine if diurnal changes in epidermal UV transmittance (TUV) occur in these species, and to test whether manipulation of the solar radiation regime could alter these diurnal patterns. Additional field studies were conducted at Logan, Utah, USA, to determine if solar UV was causing diurnal TUV changes and to evaluate the relationship between diurnal changes in TUV and UV-absorbing pigments. Under clear skies, TUV, as measured with a UV-A-pulse amplitude modulation fluorometer for leaves of Verbascum thapsus and Oenothera stricta growing in native soils and Vicia faba growing in pots, was highest at predawn and sunset and lowest at midday. These patterns in TUV closely tracked diurnal changes in solar radiation and were the result of correlated changes in fluorescence induced by UV-A and blue radiation but not photochemical efficiency (Fv/Fm) or initial fluorescence yield (Fo). The magnitude of the midday reduction in TUV was greater for young leaves than for older leaves of Verbascum. Imposition of artificial shade eliminated the diurnal changes in TUV in Verbascum, but reduction in solar UV had no effect on diurnal TUV changes in Vicia. In Vicia, the diurnal changes in TUV occurred without detectable changes in the concentration of whole-leaf UV-absorbing compounds. Results suggest that plants actively control diurnal changes in UV shielding, and these changes occur in response to signals other than solar UV; however, the underlying mechanisms responsible for rapid changes in TUV remain unclear. [ABSTRACT FROM AUTHOR]