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Background. Endometriosis is a chronic gynecological disorder that generally affects women of reproductive age which is characterized by implantation of endometrial tissue, both glands and stroma outside the uterus. Research shows that the initial onset of endometriosis patients begins in adolescence. The high prevalence with atypical symptoms leads to long term delay in establishing the appropriate diagnosis. Further developments in the field of early endometriosis screening will greatly assist clinicians, especially general practitioners in areas with limited health facilities, in early detection of endometriosis. Methods. Using the electronic databases, comprehensive literature searches were conducted with the specific keywords. Full-text manuscripts published were reviewed for relevancy and importantly, reference lists were cross-checked for additional relevant studies. Results. Dysmenorrhea, chronic pelvic pain, dyspareunia, dysuria, dyschezia, and glycoprotein were found dominantly in all analyzed literature. The occurrence of endometriosis affects the functioning of women in multiple aspects of life. Endometriosis places a significant burden on teens and adult women, their families, and society as a whole. Conclusion. Combination of structured past history taking, and several biomarker level might be useful as a screening tool that easy to use and cost effective, as early diagnosis is expected to prevent further progression of endometriosis especially in adolescence.

South Africa has a well established National School Nutrition Programme (NSNP). Despite rescheduling the mealtime to two hours after the start of the school day to accommodate learners who come to school on an empty stomach, a gap still exists as many children start their learning day with low energy and concentration levels. A costeffective, energy-dense snack served at the start of the school day can be a solution to sustain learners until the main meal is served. Cross-sectional surveys were used to determine the snack preferences of children and the product development process was used to develop a suitable snack. An energy-dense peanut butter biscuit was developed based on those surveys as well as a scoping review of previous snack studies. The energydense developed product provided 1388kJ (61.0%) of energy from fat, 688kJ (30.2%) of energy from carbohydrates and 201kJ (8.8%) of energy from protein per 100g. The biscuit conformed to microbial testing standards. Shelf-life analysis projected a shelf-life of five weeks fresh and five months in food grade packaging. Sensory results showed that there was no significant difference in sensory scores across gender (p=0.691) and age (p=0.706). More of the learners (n=56, 69.1%) found the biscuit to be ‘Super good’ than the other ratings (p

Characterization of deformation related properties like creep, moisture expansion, drying shrinkage, and others, usually require a high number of specimens and long-term tests. Traditional measuring methods, such as LVDTs or Strain Gauges, end up being expensive, considering the initial cost, the time they are allocated to the experimental campaign, and the required data acquisition systems. This research proposes an innovative cost-effective solution to measure strains on building material using microscope scale images. The main features of the method are: a) cost-effective, b) appropriate for long-term tests, c) possibility of using with high number of specimens, d) good precision (, This work was financed by European Union’s Horizon 2020 research and innovation programme through Marie Sklodowska-Curie project SUBLime [Grant Agreement no. 955986]. This work was partly financed by FCT / MCTES through national funds (PIDDAC) under the R&D Unit Institute for Sustainability and Innovation in Structural Engineering (ISISE), under reference UIDB / 04029/2020.

Assembling cost-effective passive trapping systems for herpetofauna community sampling

The building sector accounts for a substantial amount of energy consumption, resulting in higher carbon emissions and environmental impact worldwide. Electrification and energy efficiency in building systems can be the key to decarbonization in buildings. This research proposes new heating and cooling loops consisting of heat pumps to lower natural gas usage in building systems. Typical chillers and boilers in the cooling and heating loops are replaced with heat pumps to serve the loads and maintain thermal comfort in the building. In addition, a new optimal supply air temperature (SAT) reset strategy is also implemented with the proposed configuration for better system performance. A large multi-zone office building is simulated as a case study to measure the conventional system’s electricity and natural gas consumption and the proposed design. Even with heat pumps that use electricity as the energy source, electricity consumption is reduced by 3.3% to 11.8% in different climate zones for the proposed system. On the other hand, 10.2% to 67% lower natural gas is consumed when the proposed system and the optimal SAT reset are utilized. The carbon emission is also reduced by 10.8% to 38% compared to the conventional system. The results show that the proposed design and optimization strategy can lead to significant energy and cost savings in conjunction with lower carbon emissions.

Background: Cancers of the nose and paranasal sinuses are not uncommon in our setting and most patients present very late, amplifying the challenge of post-surgical prosthodontics rehabilitation. Management of these patients require multi-disciplinary approach involving the otorhinolaryngologist, maxilla-facial surgeon, oncologist, radiotherapist, prosthodontist, psychologist and speech therapist, who may not be available in some centres in low income Countries. Availability and affordability of prosthodontic materials is another confounding factor to grapple with, in our resource-challenged hospital setting. Objective: To present a simple, innovative, very cost-effective, surgical obturator and its application technique, with good outcome, in the rehabilitation of post-maxillectomy patients in our centre. Methodology: Three patients with stage 4 sino-nasal carcinoma (T4N0M0) had total or extended total maxillectomy done. A soft, pliable polyethylene sheet, with hemi-palate shape was sutured to occlude the oro-naso-antral defect and allowed in-situ for four to eight weeks. Results: All the patients tolerated the stent very well, commenced oral feeding 24 hours after surgery, achieved reasonable speech for communication and had no challenge of regurgitation of fluid or food into the nose. Cosmetic outcome was very satisfactory. Conclusion: Absence of prosthodontist and surgical obturator materials should no longer be an excuse for failing to do a much needed surgical treatment of these cancer patients. The technique is recommended in view of the enormous cost benefit, even in centres that are financially comfortable.

Background: Heart failure (HF) readmissions pose a major burden to patients and the healthcare system. We evaluated whether outpatient intravenous (IV) diuretic clinic is a safe and effective strategy to reduce HF hospitalizations. Methods: We reviewed 34 clinic encounters with 27 unique patients (median age 72) who had volume overload refractory to oral diuretics that were treated with IV furosemide in the outpatient clinic. One patient (2.9%) was admitted to the hospital directly, and the rest were discharged home. Results: More than 80% of the patients had continued weight loss for 7 days (median weight loss 5.4 lb). During the median follow-up period of 15 months, 15 patients (56%) had subsequent HF hospitalizations. HF admission was delayed by a median of 22 days from the clinic visit and 138 days from the previous HF admission prior to clinic visit. Estimated cost saving per admission avoided was $10,395. One patient developed severe hypokalemia (< 3.0 mmol/L), and the remaining had no adverse events. Conclusion: Outpatient IV diuresis is effective and well tolerated. It leads to significant weight loss, persisting in the majority of patients for 7 days. In select patients, it should be considered as a strategy to rapidly improve symptoms, reduce hospitalizations and decrease costs. J Clin Med Res. 2021;13(4):245-251 doi: https://doi.org/10.14740/jocmr4499

The ability to provide high sensitivity with small footprints makes miniaturized electrodes key components of biosensing, wearable electronics and lab‐on‐a‐chip devices. Recently, thin film deposition onto polystyrene films, followed by thermal shrinking has been used to produce microstructured electrodes (MSEs) with high electroactive surface area (ESA). Nevertheless, the high cost associated with film deposition through evaporation used in microfabrication and the variability in performance of screen‐printed electrodes (SPEs) remain key barriers that limit their widespread deployment. Here, a simple and inexpensive method is developed for the solution‐based patterning of high‐quality metallic films on polystyrene substrates for MSE fabrication. The ESA of electrodes produced through this method is 2 × and 12 × larger than that of microstructured and planar electrodes produced through sputtering, respectively, and their cost is only 20% of sputtered ones. This methodology allows the fabrication of on‐chip microstructured electrochemical cells (SMECs) with excellent analytical performance (3% RSD inter‐day reproducibility and 0.3% RSD repeatability), superior to that of commercially available SPEs. In addition, the ESA of SMECs is significantly higher than that of SPEs, and they show excellent response toward dopamine detection. We anticipate that this solution‐based fabrication approach will expedite the development of miniaturized sensing platforms for point‐of‐care applications.

We report the design and testing of a sensor pad based on optical and flexible materials for the development of pressure monitoring devices. This project aims to create a flexible and low-cost pressure sensor based on a two-dimensional grid of plastic optical fibers embedded in a pad of flexible and stretchable polydimethylsiloxane (PDMS). The opposite ends of each fiber are connected to an LED and a photodiode, respectively, to excite and measure light intensity changes due to the local bending of the pressure points on the PDMS pad. Tests were performed in order to study the sensitivity and repeatability of the designed flexible pressure sensor.

In order to meet the demands of desirable efficiency, transformerless DC/DC equipment with great voltage step-down are inevitable needed. This research offers a unique type of high-frequency, high-voltage-gain DC/DC converter, which comprises a switched capacitor (SC) converter and a buck converter. Thanks to the transformation of a two-stage converter to a single-stage converter, it has a considerable ratio of step-down voltage transformation and a reasonable duty cycle. In addition, it can permit low voltage stress on the switches. The simple control method and easy driving circuit implementation makes it scalable for high-power-level devices. Low cost can be realized as fewer components are needed. Under all operational circumstances, total soft-charging and low equipment voltage stresses are accomplished. Compared to those classic high-voltage-gain converters, the proposed converter exhibits merits of higher efficiency, higher flexibility, lower ripples, and lower costs. A comprehensive analysis is carried out for the converter’s steady-state operations. With a 1 MHz switching frequency, a 900 W prototype of a 20-time converter is constructed, with a peak efficiency of 92.5%. Simulations and experiments verify the effectiveness of the theoretical investigation of the converter’s operation.

This paper reveals the fundamental reason for the asymmetrical issue in magnetic-geared machines (MGMs) based on flux modulation theory. The analysis indicates that the magnetic circuits of three-phase windings in MGMs are inherently asymmetrical. This asymmetrical issue is even more severe in conventional consequent-pole MGMs (CP-MGMs) because of the more distorted magnetic field. Hence, to address the asymmetrical issue, a novel structure featuring enhanced harmonic elimination capability is proposed in this paper. Consequently, torque density can also be improved. In particular, the proposed CP-MGM employs modular structure and axially embedded permanent magnets (PMs) to achieve symmetrical back electromotive force (EMF) waveforms and improved torque capability, respectively. To further improve the electromagnetic performance of the proposed CP-MGM, the PM arc ratio and flux modulator width ratio are analytically designed, which provides a general design guideline for CP-MGMs. To illustrate the merits of the proposed CP-MGM, a few other MGMs are included for a fair comparison based on finite element analysis (FEA). Results show the proposed CP-MGM can achieve more symmetrical back EMF waveforms and lower torque ripple, as well as lower PM consumption and higher torque density, as compared with its MGM counterparts. Published version Schaeffler Group Research Grant M4062765.040.601001

The article below describes a simple methodology to prepare cost-effective biodegradable poly(ester urethane)s (PEUs) with ordered hard segments (OHS) for medical application as long-term implants. A low-cost diurethane diol (1,4-butanediol-hexanediisocyanate-1,4-butanediol, BHB) was first designed and synthesized. Consequently, the BHB was employed as a chain extender to react with NCO-terminated poly(ε-caprolactone) to obtain PEUs. The molecular structural formats for BHB and PEUs were defined through NMR, FT-IR, and MS together with GPC, while the influence of OHS content on physical/chemical features for casted PEU films was investigated. The introduction of OHS could contribute to forming denser hydrogen-bonds, and consequently produce a compact network structure, resulting in great tensile capacity, low water absorption, and slow hydrolytic degradation rate by PEU films. PEU-2.0 films, which possessed the highest OHS content within PEUs, exhibited 40.6 MPa tensile strength together with 477% elongation at break, 4.3 wt % equilibrium water absorption and only 29.5% weight loss post-12 months’ degradation. In addition, cytotoxicity analysis of film extracts indicated that the cell viability of all PEUs containing OHS exceeded 75%, indicating good cytocompatibility. Due to outstanding tensile features, high biostability, nontoxic and absorbable degradation products and acceptable cytocompatibility, the cost-effective materials exhibited promising applications in the field of long-term implants.

Before being exported, mangoes generally undergo rigorous external and internal quality inspection processes in which near-infrared (NIR) spectral approaches are favorable for grading purposes. A successful NIR-based grading system depends largely on high-quality spectral sensors and the reliability of the classifier. Motivated by the high economic impact of Cat Hoa Loc mangoes (Mangifera indica L.), we demonstrated that the sweetness of that mangoes could be precisely graded based on a random forest (RF) classifier in a three-phase approach with a low-cost Visible-Near infrared (VIS-NIR) multispectral sensor chipset. This approach is so-called RPR because RF, Partial Least Squares regression, and RF were respectively applied to consecutively determine the significant VIS-NIR responses, the good features as input variables, and the reliable RF classifier via our formulated discriminant index (DI). The experimental results confirmed that higher classification accuracy was achieved by using the extracted latent features rather than the raw VIS-NIR data. The DI was effectively used as a reliability measure to select the optimal classifier among those of identical training and testing accuracies of 100% and 82.1%, respectively. Performance comparison between the optimal RF classifier with a Support Vector Machines classifier and a multinomial logistic regression showed that the developed RF classifier was superior in various performance indices. Therefore, it is promising to extend the proposed approach to more complicated fruit grading problems with sufficient VIS-NIR datasets that are acquired from low-cost multispectral sensors.

With the advantages of small size, low cost, and moderate accuracy, an open-loop fiber-optic gyroscope (FOG) has a wide range of applications around control and automation. For the most cost-sensitive applications, a simple and stable digital algorithm with a reduced control-circuit volume and cost is highly desirable to realize high-precision control of a FOG. In this work, a new algorithm for an open-loop FOG is proposed based on the discrete multi-point demodulation in the sinusoidal modulation period. Utilizing this algorithm, stable control and angular velocity calculation of a gyro are realized with effectively suppressed gyro error. The use of this algorithm greatly reduces the requirements for processing power and simplifies the gyro circuit. Based on this algorithm, a digital FOG with a volume of only 25 × 20 × 40 mm3 achieves a bias instability of less than 0.15°/h, an angle random walk (ARW) of less than 0.015°/√h, a start-up time of less than 1 s, and a 3 dB bandwidth beyond 160 Hz. This low-cost, compact, and high-performance gyro is sufficient to satisfy the requirements of applications in the navigation and control fields such as unmanned driving.

(1) Background: Radiotherapeutic treatments of ocular tumors are often challenging because of nearby radiosensitive structures and the high doses required to treat radioresistant cancers such as uveal melanomas. Although increased local control rates can be obtained with advanced techniques such as proton therapy and stereotactic radiosurgery, these modalities are not always accessible to patients (due to high costs or low availability) and side effects in structures such as the lens, eyelids or anterior chamber remain an issue. Minibeam radiation therapy (MBRT) could represent a promising alternative in this regard. MBRT is an innovative new treatment approach where the irradiation field is composed of multiple sub-millimetric beamlets, spaced apart by a few millimetres. This creates a so-called spatial fractionation of the dose which, in small animal experiments, has been shown to increase normal tissue sparing while simultaneously providing high tumour control rates. Moreover, MBRT with orthovoltage X-rays could be easily implemented in widely available and comparably inexpensive irradiation platforms. (2) Methods: Monte Carlo simulations were performed using the TOPAS toolkit to evaluate orthovoltage X-ray MBRT as a potential alternative for treating ocular tumours. Dose distributions were simulated in CT images of a human head, considering six different irradiation configurations. (3) Results: The mean, peak and valley doses were assessed in a generic target region and in different organs at risk. The obtained doses were comparable to those reported in previous X-ray MBRT animal studies where good normal tissue sparing and tumour control (rat glioma models) were found. (4) Conclusions: A proof-of-concept study for the application of orthovoltage X-ray MBRT to ocular tumours was performed. The simulation results encourage the realisation of dedicated animal studies considering minibeam irradiations of the eye to specifically assess ocular and orbital toxicities as well as tumour response. If proven successful, orthovoltage X-ray minibeams could become a cost-effective treatment alternative, in particular for developing countries.

Speech-in-noise tests are used to assess the ability of the human auditory system to perceive speech in a noisy environment. Early diagnosis of hearing deficits helps health professionals to plan for the most appropriate management. However, hospitals and auditory clinics have a shortage of reliable Arabic versions of speech-in-noise tests. Additionally, access to specialized healthcare facilities is associated with socioeconomic status. Hence, individuals with compromised socioeconomic status do not have proper access to healthcare. Thus, In the current study, a mobile and cost-effective Arabic speech-in-noise test was developed and tested on 30 normal-hearing subjects, and their ability to perceive words-in-noise was evaluated. Moreover, a comparison between two different background noises was explored (multi-talker babble noise and white noise). The results revealed a significant difference in the thresholds between the two types of background noises. The percent-correct scores ranged from 100% to 54.17% for the white background noise and 91.57% to 50% for the multi-talker babble background noise. The proposed Arabic word-in-noise screening tool has the potential to be used effectively to screen for deteriorated speech perception abilities, particularly in low-resource settings.

Background: Nonhealing ulcers can occur due to a variety of causes and are associated with high morbidity, expensive, and prolonged treatment. We conducted this study to determine the efficacy of autologous platelet-rich fibrin (PRF) in nonhealing ulcers in various disorders, which is a very cost-effective and safe treatment option. Materials and Methods: Eighteen patients with nonhealing leg ulcers were included. The ulcers were treated with PRF at weekly intervals. The response to treatment was recorded by calculating the area of ulcer at baseline and at every subsequent visit till the ulcers healed. Results: The study included 18 patients of nonhealing leg ulcers due to leprosy (n = 6), neuropathic ulcer (n = 4), venous ulcer (n = 3), diabetic foot ulcer (n = 2), post-traumatic ulcer (n = 2), and post-full-thickness skin graft ulcer (n = 1). The mean size of the ulcers was 8.44 cm2 and mean duration was 5.55 months. The mean age of the patients was 40.5 years. The minimum and the maximum sittings required were three and nine, respectively (mean 5). No adverse events were noted. Conclusion: The treatment of nonhealing ulcer with PRF is an easy, safe, simple, and cost-effective method.

Over the last year, Cal Poly Pomona has made a significant push to become a consistent space-faring university through the development of CubeSats. These small satellites are complex in many ways, but arguably one of the most important and elaborate areas in development is the Attitude Determination and Control System (ADCS). In taking on the developmental challenge of ADCS design and implementation on the BroncoSat-1 Satellite, the team at Cal Poly Pomona wanted to have the ability to validate the on-orbit control systems. To accurately test the satellite's control system, an on-orbit environment needs to be simulated in a lab setting. To achieve this simulated test environment, two systems were needed, the first being a Helmholtz cage which allows for the simulation of Earth’s magnetic field for any point in Low Earth Orbit and a balancing system seated on hemispherical air bearing that allows for frictionless rotation and the ability to align the center of rotation with the center of mass of the system which will negate the experienced gravity torques. Along with simulating the environment having the ability to get consistent refined data was an important requirement for the team that was met by implementing motion-tracking cameras that precisely follow and record the movements of the testbed. For this system, the team was operating under very tight budgetary and scheduling restrictions, which led to a simple design at its roots but robust enough to enable basic ADCS testing and validation. With current industry trends, there will be a continuing increase in launch opportunities for small satellites in the years to come, and the ability for new groups to be able to verify their control systems with cheap yet efficient systems will also become more necessary as they try and meet more frequent launch cadences.

Background In the area where there is a lack of medical experts, telemedicine gives a lot of benefits to deal with the distance and limited public infrastructure. Objective This study aimed to review the literature on the cost-effectiveness of telemedicine in Asian countries and possibly to provide recommendations on implementing telemedicine in this region. Methods Articles were independently screened in two selected databases (PubMed and EBSCO). The framework of patient, intervention, comparison, and outcome (PICO) was applied by considering Asian population, the intervention of telemedicine, current situation (without telemedicine) as the comparator, and cost per QALY gained as the major outcome. Results A total of 870 articles were identified from two databases: PubMed (n = 689 articles) and EBSCO (n = 181 articles). After removing 181 duplicates, 689 articles were screened by title and abstract, excluding 665 records. After the full-text screening on 24 articles, 8 articles were selected for further analysis. Various perspectives were applied in the included studies, such as societal, healthcare, and program perspectives. All studies applied different time horizons, such as 3-month, 25-year, 40-year, and lifetime. Among all included studies, several studies applied mathematical modeling. Conclusion The implementation of telemedicine in Asia can be a promising intervention since it can enhance the effectiveness of health services by saving time and travel costs. It also can reduce the overall costs of treatment, improve patients’ quality of life, and expand access to essential health services.

Background: Glioblastoma multiforme (GBM) is a fatal type of brain tumor with a high incidence among elderly people. Temozolomide (TMZ) has proven to be an effective chemotherapeutic agent with significant survival benefits. This study aimed to evaluate the economic outcomes of radiotherapy (RT) and TMZ for the treatment of newly diagnosed GBM in elderly people in the United States (US) and China.Methods: A partitioned survival model was constructed for RT plus TMZ and RT alone among patients with methylated and unmethylated tumor status. Base case calculations and one-way and probabilistic sensitivity analyses were performed. Life-years, quality-adjusted life-years (QALYs), costs (in 2021 US dollars [$] and Chinese Yuan Renminbi [¥]), and incremental cost-effectiveness ratios (ICERs) were calculated.Results: RT plus TMZ was found to be associated with significantly higher costs and QALYs in all groups. Only US patients with methylated status receiving RT plus TMZ had an ICER ($89358.51) less than the willingness-to-pay (WTP) threshold of $100000 per QALY gained when compared with receiving RT alone. When the WTP threshold ranged from $100000 to $150000 from the US perspective, the probability of RT plus TMZ being cost-effective increased from 80.5 to 99.8%. The cost of TMZ must be lower than ¥120 per 20 mg for RT plus TMZ to be cost-effective among patients with methylated tumor status in China.Conclusion: RT plus TMZ was not cost-effective in China, and a reduction in the TMZ price was justified. However, it is highly likely to be cost-effective for patients with methylated tumor status in the US.

Together with protective measures, routine screening for severe acute respiratory syndrome coronavirus 2 infection helps provide a safe working environment. We evaluated a pooled nucleic acid testing strategy in a research laboratory. It allowed lab activity to be maintained and would save 25 920 person-hours and $1 684 800/year by increasing the margin of safety for returning to work.

Current evidence shows that individuals with gastric dysplasia, severe and extensive gastric atrophy, extensive gastric intestinal metaplasia and the incomplete subtype of intestinal metaplasia are at high risk for gastric cancer (GC) development. There are several approaches to identifying these subjects, including noninvasive methods, esophagogastroduodenoscopy and histology. The main approach in Western countries is histology-based while that in Eastern countries with a high prevalence of GC is endoscopy-based. Regarding asymptomatic individuals, the key issues in selecting applicable approaches are the ability to reduce GC mortality and the cost-effectiveness of the approach. At present, population-based screening programs have only been applied in a few Asian countries with a high risk of GC. Pre-endoscopic risk assessment based on demographic and clinical features, such as ethnicity, age, gender, smoking and Helicobacter pylori status, is helpful for identifying subjects with high pre-test probability for a possibly cost-effective approach, especially in intermediate- and low-risk countries. Regarding symptomatic patients with indications for esophagogastroduodenoscopy, the importance of opportunistic screening should be emphasized. The combination of endoscopic and histological approaches should always be considered as endoscopy provides a real-time assessment of the patient’s risk level. In addition, imaging enhanced endoscopy (IEE) has been shown to facilitate targeted biopsies resulting in better correlation between endoscopic and histological findings. Currently, the use of IEE is recommended for endoscopic examinations, and the Operative Link for Gastric Intestinal Metaplasia or Operative Link on Gastritis Assessment grading systems are recommended for histological examinations whenever available. However, resource limitations are an important barrier in many regions worldwide. Thus, for an approach to be applicable in real-life practice, it should be not only evidence-based but also resource-sensitive. In this review, we discuss the current understanding and approaches to identifying high-risk individuals from western and eastern perspectives, as well as the possibility of an integrated, resource-sensitive approach.

Objective: To estimate the cost of wound care to the Irish health-care system. Methods: A bottom-up, prevalence-based analysis was undertaken using a decision analytic model to estimate costs. Health-care resource activity was identified from a recently published study from the UK and was valued using unit cost data for Ireland. Results: The base case analysis estimated the total annual healthcare cost of wound care to be €629,064,198 (95% Confidence interval (CI): €452,673,358 to €844,087,124), accounting for 5% (95% CI: 3% to 6%) of total public health expenditure in Ireland in 2013. The average cost per patient was €3,941 (95% CI: €2,836 to €5,287). However, this study is subject to many limitations and plausible changes in the model's inputs showed that the total annual health-care cost of wound care could range from €281,438,970 to €844,316,912. Conclusion: Caring for wounds places a substantial burden on the Irish health-care system. In light of growing pressures to finance an already resource-constrained health-care system, these results provide useful information for those charged with future wound care service design and provision in Ireland and elsewhere.

[Aim]The aim of the present study was to evaluate the effectiveness of the circular gait test as a method for detecting side‐to‐side straight‐line gait asymmetry in older adults. [Methods] A total of 25 healthy older adults and 20 healthy young adults participated in this study. Walking speeds, right‐ and left‐leg step lengths, and stance durations were measured during straight‐line walking using a triaxial accelerometer (G‐walk from Bertec Japan). Step length and stance duration laterality were calculated using the side‐to‐side difference (|Left – Right|) and asymmetry index (|Left − Right, mean right and left values × 100). For circular gait, the time required to walk twice around a 1‐m diameter circle for right and left rotations was measured, and the laterality was calculated using the same formula as that described for the straight‐line gait. [Results] The results showed no differences in straight‐line step length or stance duration laterality between groups. However, circular gait asymmetry was significantly higher for older participants. A significant correlation was confirmed between circular gait time and straight‐line step length for older adults (r = 0.404). [Conclusions] The present study suggested that the circular gait test had better potential to detect age‐related changes in gait laterality than straight‐line gait step length or stance duration, and it might work as a simple assessment method for detecting laterality in straight‐line walking.

Objective: To evaluate the cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole in post-menopausal women with hormone receptor positive (HR+) and human epidermal growth receptor 2 negative (HER2-) advanced breast cancer from a UK payer perspective. Methods: A cohort-based partitioned survival model was developed to evaluate the cost-effectiveness of ribociclib plus letrozole versus palbociclib plus letrozole in post-menopausal women with HR+/HER2- advanced breast cancer over a lifetime horizon. The analysis was carried out from a National Health Services and Personal Social Services perspective, and results are presented in incremental costs per quality adjusted life years. Clinical data from three randomized controlled trials (MONALEESA-2, PALOMA-1 and PALOMA-2 studies) were used, and supplemented with available real world evidence. Costs categories comprised of drug acquisition, medical management, and treatment of adverse events. Healthcare resource utilization data were identified from literature and unit costs sourced from secondary sources. Utility values were derived from MONALEESA-2 study and were supported with values identified from literature. Both deterministic and probabilistic analyses were carried out to assess uncertainty. Results: In the base case, treatment with ribociclib plus letrozole increased mean progression free survival (PFS) by 4.1 months and overall survival by 5.0 months compared to palbociclib plus letrozole. Further, treatment with ribociclib plus letrozole resulted in cost-savings of £8464 and incremental QALYs of 0.261, demonstrating that treatment with ribociclib plus letrozole is dominant to treatment with palbociclib plus letrozole. The probabilistic analysis also yielded mean cost-savings of £7914 and mean QALY gain of 0.273. At willingness-to-pay threshold of £30 000 per QALY, treatment with ribociclib plus letrozole had a 92% probability of being cost-effective compared to palbociclib and letrozole. Conclusions: The results of the analysis demonstrate that ribociclib plus letrozole treatment is both cost-saving and a cost-effective option amongst the available cyclin dependent kinase 4/6 inhibitors for the treatment of post-menopausal women with advanced breast cancer. The biggest driver of the cost savings were the lower acquisition costs of ribociclib.

Sheep blowfly strike (ovine cutaneous myiasis) is a widespread economic and welfare problem in sheep husbandry in many parts of the world. Strike incidence is determined by a complex interaction of fly abundance, host susceptibility and climate, combined with farmer husbandry and intervention strategies. Sheep farmers adopt a range of approaches to the type and timing of the management used for the control of blowfly strike, the rational basis for which is often not robust. Here a deterministic model, based on existing data relating to fly abundance, seasonal risk and strike incidence, is used to compare the variable costs associated with different strike management strategies. The model shows that not employing prophylactic treatment is the lowest cost strategy only where strike risk is low. In all other circumstances, prophylactic treatment incurs lower costs than not doing so, because the deaths associated with strike outweigh the costs of prophylactic treatment. Lamb treatment, in particular, has a substantial effect on strike and cost reduction, since lambs are the most abundant age-class of animals and are at the highest risk over the period when fly abundance is the greatest. Early-season treatment of ewes before shearing is also an important component of the lowest cost strategies, particularly when the blowfly season is extended. While the rational choice of the most appropriate strike management strategy is essential in the context of farm economics, welfare considerations lend added importance to treatment decisions that reduce strike incidence.

Global Vertical Farming (VF) applications with characteristic Industry 4.0 connectivity will become more and more relevant as the challenges of food supply continue to increase worldwide. In this work, a cost-effective and portable instrument that enables accurate pH measurements for VF applications is presented. We demonstrate that by performing a well-designed calibration of the sensor, a near Nernstian response, 57.56 [mV/pH], ensues. The system is compared to a ten-fold more expensive laboratory gold standard, and is shown to be accurate in determining the pH of substances in the 2–14 range. The instrument yields precise pH results with an average absolute deviation of 0.06 pH units and a standard deviation of 0.03 pH units. The performance of the instrument is ADC-limited, with a minimum detectable value of 0.028 pH units, and a typical absolute accuracy of ±0.062 pH units. By meticulously designing bias and amplification circuitry of the signal conditioning stage, and by optimizing the signal acquisition section of the instrument, a (minimum) four-fold improvement in performance is expected.

Refereed/Peer-reviewed Determination of coagulant dosage in drinking water treatment is related to the requirements for drinking water quality as well as the treatment costs. Selection of appropriate coagulant dosages has been an issue for water treatment utilities, though empirical approaches were normally considered or employed. Inspired by the theory of elasticity in microeconomics, this study explored a novel approach for the cost-effective optimum coagulant dosage. This could enable water utilities to achieve the maximum possible removal efficiency of precursors for disinfection by products (DBPs) while maintain an economical dosage without incurring an excessive cost. The relationships between DBP formation potential (DBPFP) and several relevant water quality parameters were first examined and evaluated. UV254 was found the most appropriate DBPFP indicator with the highest correlation coefficients. Based on the relationship of UV254 and DBPFP, an approach for determination of cost-effective optimum coagulant dosage was delineated. The results showed that use of the cost-effective optimum coagulant dosage, which account for approximately 33% of optimum coagulant dosage, could achieve 79% of maximum removal efficiencies of UV254 for the source waters tested, thereby substantially reducing the formation of DBPs. Further increase the coagulant dosage was believed uneconomical since the increase in UV254 removal was limited. Similar results were obtained with different coagulants and with raw water samples with diverse water qualities. The results suggest that the proposed approach could provide a mathematical tool for cost-effective optimum coagulant dosage control which could at the same time achieve sufficient removal of natural organic matter to reduce DBPs formation.

5-Hydroxymethylcytosine (5hmC), the oxidative product of 5-methylcytosine (5mC) catalyzed by ten-eleven translocation (TET) enzymes, plays an important role in many biological processes as an epigenetic mediator. Prior studies have shown that 5hmC can be selectively labeled with chemically-modified glucose moieties and enriched using click chemistry with biotin affinity approaches. Besides, DNA deaminases of the AID/APOBEC family can discriminate modified 5hmC bases from cytosine (C)or 5-methylcytosine (5mC). Herein, we developed a method based on ESC whole-genome analysis which could enrich 5hmC-containing DNA by selective chemical labeling and locate 5hmC sites at single-base resolution with enzyme-based deamination. The combination experimental design is an extension of previous methods, and we hope that this cost-effective single base resolution 5hmC sequencing method could be used to promote the mechanism and diagnosis research of 5hmC.

Methotrexate is a highly effective medication that is the mainstay of treatment for numerous complex dermatological and rheumatological disorders. However, its use requires close monitoring as it has serious side effects that could be fatal if not recognized promptly. Herein, we present an interesting case of methotrexate toxicity leading to a prolonged hospital stay with resultant increase in health care cost and patient dissatisfaction. It remains of pivotal importance for primary care physicians and hospitalists to be aware of its side effect profile. As such, early recognition of methotrexate toxicity can result in earlier initiation of goal-directed therapies, leading to improved outcomes and shorter hospital stay. Patient education and effective communication between health care providers and the patient are of utmost importance in ensuring patient safety.

Together with protective measures, routine screening for severe acute respiratory syndrome coronavirus 2 infection helps provide a safe working environment. We evaluated a pooled nucleic acid testing strategy in a research laboratory. It allowed lab activity to be maintained and would save 25 920 person-hours and $1 684 800/year by increasing the margin of safety for returning to work.

This article reports the treatment outcomes of 167 COVID-19 positive patients who were treated with a stand-alone Ayurvedic therapeutic intervention. The main outcomes are quick resolution of symptoms, no deterioration in any of the cases and safe treatment for patients with multiple comorbidities. There was no observed mortality. There were no adverse events due to the Ayurvedic medications. The treatment was undertaken in an out-patient setting and at a low cost.The efficacy and safety of the treatment, and the quick resolution of symptoms were demonstrated. This shows that if COVID-19 patients are treated with Ayurvedic medicines early in the course of COVID-SARS-2 infection, Ayurveda has the potential to prevent progression and deterioration of the disease, with decreased morbidity and mortality.

Background Cryptococcal meningitis in HIV-infected patients in sub-Saharan Africa accounts for three-quarters of the global cases and 135,000 deaths per annum. Current treatment includes the use of fluconazole and amphotericin B. Recent evidence has shown that the synergistic use of flucytosine improves efficacy and reduces toxicity, however affordability and availability has hampered access to flucytosine in many countries. This study investigated the evidence and cost implications of introducing flucytosine as induction therapy for cryptococcal meningitis in HIV-infected adults in South Africa. Methods A decision analytic cost-effectiveness and cost impact model was developed based on survival estimates from the ACTA trial and local costs for flucytosine as induction therapy in HIV-infected adults with cryptococcal meningitis in a public sector setting in South Africa. The model considered five treatment arms: (a) standard of care; 2-week course amphotericin B/fluconazole (2wk AmBd/Flu), (b) 2-week course amphotericin B/flucytosine (2wk AmBd/5FC), (c) short course; 1-week course amphotericin B/flucytosine (1wk AmBd/5FC) (d) oral course; 2-week oral fluconazole/flucytosine (oral) and e) 1-week course amphotericin B/fluconazole (1wk AmBd/Flu). A sensitivity analysis was conducted on key variables. Results The highest total treatment costs are in the 2-week AmBd/5FC arm followed by the 2-week oral regimen, the 1-week AmBd/5FC, then standard of care with the lowest cost in the 1-week AmBd/Flu arm. Compared to the lowest cost option the 1-week flucytosine course is most cost-effective at USD119/QALY. The cost impact analysis shows that the 1-week flucytosine course has an incremental cost of just over USD293 per patient per year compared to what is currently spent on standard of care. Sensitivity analyses suggest that the model is most sensitive to life expectancy and hospital costs, particularly infusion costs and length of stay. Conclusions The addition of flucytosine as induction therapy for the treatment of cryptococcal meningitis in patients infected with HIV is cost-effective when it is used as a 1-week AmBd/5FC regimen. Savings could be achieved with early discharge of patients as well as a reduction in the price of flucytosine.

Introduction The importance of routine follow-up of several relatively simple stable injuries (SSIs) is questionable. Multiple studies show that direct discharge (DD) of patients with SSIs from the Emergency Department results in patient outcomes and experiences comparable to ‘standard care’ with outpatient follow-up. The purpose of this study was to evaluate to which extent DD of SSIs has been adopted amongst trauma and orthopedic surgeons internationally, and to assess the variation in the management of these common injuries. Methods An online survey was sent to members of an international trauma- and orthopaedic surgery collaboration. Participants, all trauma- or orthopaedic surgeons, were presented with eleven hypothetical cases of patients with simple stable injuries in which they were asked to outline their treatment plan regarding number of follow-up appointments and radiographs, physiotherapy and when to start functional movement. The primary outcome was the proportion of surgeons selecting direct discharge (i.e. zero scheduled appointments), per injury. Secondary outcomes included clinical agreement (>80% of respondents answering similarly) on total number of follow-up appointments (0, 1 or ≥2), radiographs (0, 1 or ≥2), routine physiotherapy referral (yes/no) and when to start functional movement (weeks). Results 138 of 667 (20.7%) surgeons completed the survey. Adoption of direct discharge ranged from 4-45% of case examples. In 10 out of 11 cases, less than 25% of surgeons selected direct discharge. Clinical agreement regarding number of appointments and when to start functional movement was not reached for any of the injuries. There was clinical agreement on number of radiographs for one injury and for four injuries regarding routine referral to a physiotherapist. Discussion Despite available evidence, DD of SSIs has not been widely adopted worldwide. Practice variation still exists even for these common injuries. This variation suggests inefficiency and consequently unnecessarily high healthcare costs. (Orthopaedic) trauma surgeons are encouraged to evaluate their current treatment protocols of SSIs.

Mango (Mangifera Indica L.) is a major tropical fruit rich in sugar, organic acids and flavonoids, making it suitable fruit for wine making. In the present study, five varieties of mango (Baganpalli, Langra, Dashehari, Alphonso, and Totapuri) were utilized for wine production using two different yeast strains namely, Saccharomyces cerevisiae MTCC 178 and isolated yeast. The physiochemical analysis of wine produced from chosen mango varieties showed that North Indian local mango variety (Dashehari) gave better results in terms of organoleptic and functional attributes. The Saccharomyces cerevisiae MTCC 178 treated Dashehari wine possessed 6.1 ± 0.26% TSS, 2.1 ± 0.08% reducing sugar, 0.657% titratable acidity, 0.11 ± 0.00% volatile acidity, 12% ethanol (v/v) and pH 3.7 ± 0.10 comparable to Baganpalli mango wine. HPLC analysis of Saccharomyces cerevisiae MTCC 178 inoculated Dashehari mango wine revealed the presence of primarily; gallic acid (RT-4.4 min), Galloyl-A-type, procyanidin (RT-5.2 min), 2,2,6-Trimethyl-6-vinyltetrahydropyran (RT-8.91 min), β-Pinene (RT-11.47 min) and Caffeoyl-quinic acid (RT-12.15 min) showing potential antioxidant, anti-cancerous, anti-inflammatory and antimicrobial properties. The local mango varieties wine showed significant (p

Background: Both whole exome sequencing and copy number variants sequencing were applied to identify the genetic cause of rare pediatric disorders. In our study, we aimed to investigate the diagnostic yield of parallel tests of trio whole exome sequencing and copy number variants sequencing and its clinical utility. Methods: After collecting detailed clinical information, a total of 60 patients were referred to parallel tests of whole exome sequencing and copy number variants sequencing, which used shared initial libraries. Results: 26 pathogenic or likely pathogenic single nucleotide variants and 11 copy number variants were identified in 32 patients. 65.4% (17/26) of the SNVs were novel. The overall diagnosis rate was 53.3%. For the patients with positive results, 22 (36.7%) patients were diagnosed by whole exome sequencing and 10 (16.7%) patients were diagnosed by copy number variants sequencing. We also reviewed clinical impact on selected cases. Conclusion: We adopted an approach by performing parallel tests of trio whole exome sequencing and copy number variants sequencing with shared initial libraries. This strategy is relatively efficient and cost-effective for the diagnosis of rare pediatric disorders with high heterogeneity.

Despite the fact that morbidity and mortality rates due to dengue infection in Indonesia are relatively high, a dengue vaccination has not yet been introduced. Next to vaccination, Wolbachia-infected mosquitoes and health education have been considered to be potential interventions to prevent dengue infection in Indonesia. This study was aimed to analyse the cost-effectiveness of dengue vaccination in Indonesia whilst taking Wolbachia and health education programs into account. An age-structured decision tree model was developed to assess the cost-effectiveness. Approximately 4,701,100 children were followed-up in a 10-year time horizon within a 1-year analytical cycle. We compared three vaccination strategies: one focussing on vaccination only, another combining vaccination and a Wolbachia program, and a third scenario combining vaccination and health education. All scenarios were compared with a no-intervention strategy. The result showed that only vaccination would reduce dengue fever (DF), dengue haemorrhagic fever (DHF), and dengue shock syndrome (DSS) by 123,203; 97,140 and 283 cases, respectively. It would save treatment cost at $10.3 million and $6.2 million from the healthcare and payer perspectives, respectively. The combination of vaccination and a Wolbachia program would reduce DF, DHF and DSS by 292,488; 230,541; and 672 cases, respectively. It would also save treatment cost at $24.3 million and $14.6 million from the healthcare and payer perspectives, respectively. The combination of vaccination and health education would reduce DF, DHF, and DSS by 187,986; 148,220; and 432 cases, respectively. It would save treatment cost at $15.6 million and $9.4 million from the healthcare and payer perspectives, respectively. The incremental cost-effectiveness ratios (ICERs) from the healthcare perspective were estimated to be $9995, $4460, and $6399 per quality-adjusted life year (QALY) gained for the respective scenarios. ICERs from the payer perspective were slightly higher. It can be concluded that vaccination combined with a Wolbachia program was confirmed to be the most cost-effective intervention. Dengue infection rate, vaccine efficacy, cost of Wolbachia program, underreporting factor for hospitalization, vaccine price and mortality rate were considered to be the most influential parameters affecting the ICERs.

Therapeutic anti-HER2 antibodies and antibody–drug conjugates (ADCs) have undoubtedly benefitted patients. Nonetheless, patients ultimately relapse—some sooner than others. Currently approved anti-HER2 drugs are expensive and their cost-effectiveness is debated. There is increased awareness that internalization and lysosomal processing including subsequent payload intracellular accumulation and retention for ADCs are critical therapeutic attributes. Although HER2 preferential overexpression on the surface of tumor cells is attractive, its poor internalization and trafficking to lysosomes has been linked to poor therapeutic outcomes. To help address such issues, this review will comprehensively detail the most relevant findings on internalization and cellular accumulation for approved and investigational anti-HER2 antibodies and ADCs. The improved clarity of the HER2 system could improve antibody and ADC designs and approaches for next-generation anti-HER2 and other receptor targeting agents.

Background Neurological patients who are ventilator-dependent occupy scarce beds in the hospitals for prolonged periods of time. Most, if not all, can be discharged on home mechanical ventilation (HMV). However, due to lack of insurance and state support, it remains prohibitively expensive for the vast majority of those who require it most. Materials and Methods The authors discuss three patients admitted in the Department of Neurosurgery between January and August 2019, who were discharged on HMV after remaining on ventilator support for prolonged period in the hospital. Each patient was discharged with two units (one as standby) of AgVa home ventilator (AgVa Healthcare; New Delhi, India), one Ambu-bag, one pulse oximeter, and one backup power supply unit capable of supplying power to ventilator for a minimum of 24 hours. All the equipment were given free-of-cost through donations by hospital staffs and other donors. All patients were followed up telephonically from their homes and the incidence of complications, ventilator malfunction, and additional cost of HMV on the families were ascertained. Observation and Results Of the three patients, two were male and one female. Age ranged from 12 to 17 years. The duration of in-hospital ventilator support prior to discharge on HMV varied from 1 to 5 years. There was no insurance cover available for any of the patients with all expenses being “out of pocket.” The equipment cost Indian Rupees (INR) 115,700 (USD 1,615: two units of AgVa home ventilator costing INR 100,000 [USD 1,396], one Ambu-bag costing INR 1,100 [USD 15], one pulse oximeter costing INR 1,600 [USD 22], and one backup power supply unit costing INR 13,000 [USD 182]). Discharge on HMV was planned on specific request from patients’ families and informed consent was taken from all. All patients had tracheostomies. Mode of HMV was pressure support ventilation in all. Telephonic follow-up ranged from 1 to 7 months. The cost of disposables was INR 100 per month (USD 0.7) for all the patients. No complications occurred in any patient. There was no incidence of ventilator-associated pneumonia (VAP) or ventilator malfunction. Conclusions Availability of cost-effective indigenous ventilator like AgVa home has made HMV possible, even for poor patients with neurological diseases, and has the potential to improve quality of life, decrease VAP rates, and free up scarce ventilator beds in hospitals. Longer-term follow-up in larger number of patients will improve the data on safety and feasibility in developing countries like India.

Background The annual gross domestic expenditure on research and development (GERD) per capita of Indonesia ($24) remains relatively lower than the annual GERD per capita of neighboring countries, such as Vietnam ($36), Singapore ($1804), Malaysia ($361), and Thailand ($111). Objective The aim of this study was to conduct a cost-effectiveness analysis of spending on healthcare R&D to address the needs of developing innovative therapeutic products in Indonesia. Methods A decision tree model was developed by taking into account four stages of R&D: stage 1 from raw concept to feasibility, stage 2 from feasibility to development, stage 3 from development to early commercialization, and stage 4 from early to full commercialization. Considering a 3-year time horizon, a stage-dependent success rate was applied and analyses were conducted from a business perspective. Two scenarios were compared by assuming the government of Indonesia would increase GERD in health and medical sciences up to 2- and 3-times higher than the baseline (current situation) for the first and second scenario, respectively. Cost per number of innovative products in health and medical sciences was considered as the incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis was conducted to investigate the effects of different input parameters on the ICER. Results There was a statistically significant association (P-value

Background: Cutimed® Sorbact® is a dressing marketed as having antimicrobial properties and easy application without the threat of antibiotic resistance and difficult accessibility. There is little evidence on the clinical outcomes of the use of Cutimed® Sorbact® in adults and currently no evidence of use of Cutimed® Sorbact® on superficial-partial thickness burn injuries in children. Objective: To summarise the clinical outcome of burn wounds in children with superficial-partial thickness burns in which Cutimed® Sorbact® was used. Method: An observational case series was conducted in Edendale Hospital, Pietermaritzburg, South Africa over the course of four weeks. Patients where included if they were aged < 10 years and had a ⩽ 15% superficial-partial burn. The primary outcome measure was time to 95% re-epithelialisation. Secondary outcome measures included wound complications, adverse healing and number of dressing changes. Results: Ten patients (five girls, five boys; age range = 11 months–8 years) were included in this case series. All participants had a type VI Fitzpatrick skin type and 80% of burns were hot water burns. Of all patients treated with Cutimed® Sorbact®, 50% healed within seven days, 70% within 14 days and 100% within 21 days. There was only one wound complication noted in this study and there was no adverse healing in any burn wounds. The mean number of dressing changes was 1.4 (range = 1–2) and length of hospital stay was in the range of 0–11 days (mean = 5.1 days). Conclusion: Cutimed® Sorbact® is a safe, useful and cost-effective dressing that should be used as an alternative for superficial-partial burns in children., Lay Summary Cutimed® Sorbact® is a dressing used for burns that has unconventional ways to fight bacteria. This allows the dressing to work without becoming resistant to antibiotics and it is also easy to apply. In order to find out how well this dressing works in children, a study was performed in a South African hospital, Edendale, over four weeks. The main aim of the study was to find out how long the wounds took to heal when Cutimed® Sorbact® was put on a burn in children aged < 10 years. The study found that 50% of children’s burns healed within seven days and 100% healed within 21 days. There was one complication that was resolved and children stayed in hospital for an average of five days. Therefore, Cutimed® Sorbact® is a safe and cost-effective dressing that should be considered as an alternative for burns in children.

Background Several studies suggest that hemodynamic optimization therapies can reduce complications, the length of hospital stay and costs. However, Brazilian data are scarce. Therefore, the objective of this analysis was to evaluate whether the improvement demonstrated by hemodynamic optimization therapy in surgical patients could result in lower costs from the perspective of the Brazilian public unified health system. Methods A meta-analysis was performed comparing surgical patients who underwent hemodynamic optimization therapy (intervention) with patients who underwent standard therapy (control) in terms of complications and hospital costs. The cost-effectiveness analysis evaluated the clinical and financial benefits of hemodynamic optimization protocols for surgical patients. The analysis considered the clinical outcomes of randomized studies published in the last 20 years that involved surgeries and hemodynamic optimization therapy. Indirect costs (equipment depreciation, estate and management activities) were not included in the analysis. Results A total of 21 clinical trials with a total of 4872 surgical patients were selected. Comparison of the intervention and control groups showed lower rates of infectious (RR = 0.66; 95% CI = 0.58–0.74), renal (RR = 0.68; 95% CI = 0.54–0.87), and cardiovascular (RR = 0.87; 95% CI = 0.76–0.99) complications and a nonstatistically significant lower rate of respiratory complications (RR = 0.82; 95% CI = 0.67–1.02). There was no difference in mortality (RR = 1.02; 95% CI = 0.80–1.3) between groups. In the analysis of total costs, the intervention group showed a cost reduction of R$396,024.83-BRL ($90,161.38-USD) for every 1000 patients treated compared to the control group. The patients in the intervention group showed greater effectiveness, with 1.0 fewer days in the intensive care unit and hospital. In addition, there were 333 fewer patients with complications, with a consequent reduction of R$1,630,341.47-BRL ($371,173.27-USD) for every 1000 patients treated. Conclusions Hemodynamic optimization therapy is cost-effective and would increase the efficiency of and decrease the burden of the Brazilian public health system.

Background: Immunotherapy agents offer novel treatment options in advanced cancers. However, their use is limited in developing countries lacking unifying guidelines and can be followed by a financial burden. In this study, we aimed to provide an overview regarding the use of immunotherapy and the overall response to treatment in patients with metastatic disease in relation to cost-effectiveness. Methods: This was a retrospective study involving adult metastatic cancer patients, treated with programmed cell death-1 (PD-1) inhibitors at American University of Beirut Medical Center (AUBMC), a tertiary cancer center in Lebanon. Study enrollment began on January 1, 2014 and ended on January 12, 2016. Baseline demographics, epidemiological and clinical data were collected from the patients' records. Results: Our study consisted of 34 patients. Fifteen patients self-financed the treatment. The patients were prescribed immunotherapy without programmed cell death-ligand 1 (PD-L1) testing as it was not part of the guidelines at the time. Twenty-two patients were treated with nivolumab and 12 patients with pembrolizumab. Thirteen patients showed partial response or stable disease, while 21 patients showed progression. Conclusion: Improvement in terms of overall survival and progression-free survival has been undercut by the lack of availability of these drugs and their cost. Considering that a large percentage of patients do not respond to immunotherapy, there is a need to use guidelines such as a preset PD-L1 level that ensure cost-effectiveness and prevent resource waste. World J Oncol. 2020;11(4):150-157 doi: https://doi.org/10.14740/wjon1277

In this paper, we present the AISat-1 spacecraft, which is a 12 kg nano-satellite developed by the German Aerospace Center (DLR) in Bremen. Its primary purpose is the reception of AIS signals from a Low Earth Orbit (LEO) with the help of a newly developed deployable helix antenna. The bus architecture follows a low-cost approach – making use of commercial-of-the-shelf (COTS) components. The main challenge for the bus design was to reduce complexity as a baseline concept for achieving an adequate in-orbit lifetime with acceptable risk, requiring only a fraction of the overall costs of conventional satellite approaches. The AISat-1 is now 5 years in orbit and still operating. Thus, the challenges, the issues we experienced as well as the conclusions are presented in this paper.

Este trabajo se propone analizar las formas de trabajo institucional desarrolladas por distintos actores para la emergencia e implantación del Coste Efectivo de los Servicios de las Entidades Locales (CESEL). Los resultados del estudio de caso longitudinal realizado ponen de manifiesto que los principales actores, Gobierno Central y Ayuntamiento, llevaron a cabo diferentes formas de trabajo institucional (político, cultural y técnico), surgiendo conflictos durante su desarrollo debido a las distintas lógicas institucionales en las que se apoyaron: eficiencia económica e interés social, respectivamente. Este trabajo contribuye a la perspectiva teórica adoptada evidenciando que las formas en las que se desarrolla el trabajo institucional por distintos actores determinan la configuración final de la nueva institución que quiere crearse. Así, aunque la regulación estableció como finalidad del CESEL profundizar en el cumplimiento de los principios de eficiencia y de transparencia de la gestión pública local, las formas en las que se ha desarrollado el trabajo institucional durante su implantación lo han configurado como un instrumento de transparencia, presentando además serias limitaciones para que ésta sea efectiva. This paper aims to analyze the forms of institutional work carried out by different actors with regard to the emergence and implementation of Cost-Effective of Local Government Services (CESEL, Coste Efectivo de los Servicios de las Entidades Locales). The results of the longitudinal case study evidence that the main actors, Central Government and Local Government, carried out different types of institutional work (political, cultural and technical), by arising conflicts during their development due to the different institutional logics in which they were supported: economic efficiency and social interest, respectively. This work contributes to the theoretical perspective adopted by evidencing that the ways in which institutional work is developed by different actors determine the final configuration of the new institution that is to be created. Thus, although the regulation established that the purpose of CESEL is to deepen on compliance with the principles of efficiency and transparency of local public management, the ways in which the institutional work has been developed during its implementation have configured it as an instrument for transparency and also it presents serious limitations so that transparency is effective.

Wheat straw and animal wastes are important feedstock for biogas production in Europe. Yet, the high content of lignocellulosic and refractory materials causes the process to be relatively slow. Therefore, pretreatment methods have been proposed to shorten the hydrolysis phase. The present study examined the effectiveness of alkali pre-treatment (AP), ultrasonic pre-treatment (UP), and alkali-ultrasonic pre-treatment (AUP) applied on wheat straw (WS), solid fraction of cattle manure (SCM) and solid fraction of slaughterhouse waste (SSHW), by monitoring solubilisation ratio, anaerobic biodegradability and methane yield. The results indicate that the solubilisation ratio of the substrates improved regardless of the types of pre-treatment applied. Though, AP was more effective on WS and SSHW than other pre-treatments (UP and AUP), with approximately 47% and 17% extra methane, respectively. Moreover, AP of SCM caused an increased in methane production rate by 100% and minimised lag phase from 16 days to 1 day during anaerobic digestion. Based on Danish conditions, only AP of WS was economical prior to the biogas process due to high extra methane yield. A positive energy budget of 8 € t−1 VS was calculated. High-energy consumption during UP and AUP in laboratory scale hindered the positive benefits of these pre-treatments. info:eu-repo/semantics/acceptedVersion

International audience; Background:The aim of this study was to analyze the clinical and economic impact of robotic distal pancreatectomy, laparoscopic distal pancreatectomy, and open distal pancreatectomy.Methods:All consecutive patients who underwent distal pancreatic resection for benign and malignant diseases between January 2012 and December 2015 were prospectively included. Cost analysis was performed; all charges from patient admission to discharge were considered.Results:There were 21 robotic (RDP), 25 laparoscopic (LDP), and 43 open (ODP) procedures. Operative time was longer in the RDP group (RDP =345 minutes, LDP =306 min, ODP =251 min, P=0.01). Blood loss was higher in the ODP group (RDP =192 mL, LDP =356 mL, ODP =573 mL, P=0.0002). Spleen preservation was more frequent in the RDP group (RDP =66.6%, LDP =61.9%, ODP =9.3%, P=0.001). The rate of patients with Clavien-Dindo > grade III was higher in the ODP group (RDP =0%, LDP =12%, ODP =23%, P=0.01), especially for non-surgical complications, which were more frequent in the ODP group (RDP =9.5%, LDP =24%, ODP =41.8%, P=0.02). Length of hospital stay was increased in the ODP group (ODP =19 days, LDP =13 days, RDP =11 days, P=0.007). The total cost of the procedure, including the surgical procedure and postoperative course was higher in the ODP group (ODP =30,929 Euros, LDP =22,150 Euros, RDP =21,219 Euros, P=0.02).Conclusions:Cost-effective results of RDP seem to be similar to LDP with some better short-term outcomes.

Introduction The aim of this study was to evaluate the short-term cost-utility of insulin degludec (degludec) versus insulin glargine 100 units/mL (glargine U100) for the treatment of type 2 diabetes in the basal–bolus subgroup of the head-to-head cardiovascular (CV) outcome trial, DEVOTE. Methods A cost-utility analysis was conducted over a 2-year time horizon using a decision analytic model to compare costs in patients receiving once daily degludec or glargine U100, both as part of a basal–bolus regimen, in addition to standard care. Clinical outcomes and patient characteristics were taken exclusively from DEVOTE, whilst health-related quality of life utilities and UK-specific costs (expressed in 2016 GBP) were obtained from the literature. The analysis was conducted from the perspective of the National Health Service. Results Degludec was associated with mean cost savings of GBP 28.78 per patient relative to glargine U100 in patients with type 2 diabetes at high CV risk. Cost savings were driven by the reduction in risk of diabetes-related complications with degludec, which offset the higher treatment costs relative to glargine U100. Degludec was associated with a mean improvement of 0.0064 quality-adjusted life-years (QALYs) compared with glargine U100, with improvements driven predominantly by lower rates of severe hypoglycemia with degludec versus glargine U100. Improvements in quality-adjusted life expectancy combined with cost neutrality resulted in degludec being dominant over glargine U100. Sensitivity analyses demonstrated that the incremental cost-utility ratio was stable to variations in the majority of model inputs. Conclusion The present short-term modeling analysis found that for the basal–bolus subgroup of patients in DEVOTE, with a high risk of CV events, degludec was cost neutral (no additional costs) compared with glargine U100 over a 2-year time horizon in the UK setting. Furthermore, there were QALY gains with degludec, particularly due to the reduction in the risk of severe hypoglycemia. Funding Novo Nordisk A/S. Trial Registration ClinicalTrials.gov identifier, NCT01959529. Electronic supplementary material The online version of this article (10.1007/s13300-018-0430-4) contains supplementary material, which is available to authorized users.

Marek Psota,1 Maria Bucek Psenkova,1 Natalia Racekova,2 Antonio Ramirez de Arellano,3 Tom Vandebrouck,4 Barnaby Hunt5 1Pharm-In, Ltd., 2Novo Nordisk Ltd., Bratislava, Slovakia; 3Novo Nordisk Ltd., Madrid, Spain; 4Novo Nordisk nv, Brussels, Belgium; 5Ossian Health Economics and Communications, Basel, Switzerland Aims: To investigate the cost-effectiveness of once-daily insulin degludec/liraglutide (IDegLira) versus basal-bolus therapy in patients with type 2 diabetes not meeting glycemic targets on basal insulin from a healthcare payer perspective in Slovakia.Methods: Long-term clinical and economic outcomes for patients receiving IDegLira and basal-bolus therapy were estimated using the IMS CORE Diabetes Model based on a published pooled analysis of patient-level data.Results: IDegLira was associated with an improvement in quality-adjusted life expectancy of 0.29 quality-adjusted life years (QALYs) compared with basal-bolus therapy. The average lifetime cost per patient in the IDegLira arm was EUR 2,449 higher than in the basal-bolus therapy arm. Increased treatment costs with IDegLira were partially offset by cost savings from avoided diabetes-related complications. IDegLira was highly cost-effective versus basal-bolus therapy with an incremental cost-effectiveness ratio of EUR 8,590 per QALY gained, which is well below the cost-effectiveness threshold set by the law in Slovakia.Conclusion: IDegLira is cost-effective in Slovakia, providing a simple option for intensification of basal insulin therapy without increasing the risk of hypoglycemia or weight gain and with fewer daily injections than a basal-bolus regimen. Keywords: IDegLira, cost-effective, basal-bolus, insulin intensification, type 2 diabetes