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Random execution of run sequences is employed in response surface designs to avoid bias in the response. Since the randomization of run sequences may induce frequent changes in the factor levels, which makes it difficult or expensive for the experimenter, especially when hard-to-change factors are involved in the experiment. Mostly, second order response surface designs (SORDs) are being used to explore the functional relationship between the response and the input variables. But when the lack of fit of the model becomes significant, it is desirable to explore the relationship with a polynomial model of order three. This requires third order rotatable designs (TORDs), which can be sequentially implemented by adding few more runs to the SORDs. In this paper, the construction of sequential TORDs with minimum level changes in the run sequences has been discussed. [ABSTRACT FROM AUTHOR]

The reliability and availability of a Jet Unmanned Aerial Vehicle (JUAV) for balloon downing are evaluated in this third part of the paper. The paper delves into the challenges faced by traditional air defence systems in countering high-altitude balloons, leading to the proposal of substituting missiles with Unmanned Aerial Vehicles (UAVs), specifically the Jet Unmanned Aerial Vehicle (JUAV). The best solution found in the previous section is a derivation of the 1:6 scale RC model of the Lockheed F104C. This is designed for balloon downing, and the essay meticulously analyses its reliability, failure probabilities, and maintenance strategies for various subsystems. The engine is replaced with a more powerful micro-jet, and an 84 mm recoilless cannon is added at the base of the tail. The scaled-down model can use most data derived from the full-scale airplane flight manual, corrected for larger thrust-to-weight and lower wing-loading. Several adjustments and additions are made on sensors, autopilot, On-Line Diagnostic System, communication system, and firing system to increase the reliability of the system. Due to the relatively short design life of the RC model, the Time Between Overhaul (TBO) of the UAV is reduced to 25 h. Consequently, the study emphasizes the importance of simplicity, operational reliability, and adaptability in the development and assessment of modern missile defence systems. The reliability of the JUAVI is presented as 98.14% for 50 consecutive fully automatic missions, highlighting its potential significance in bolstering national security. [ABSTRACT FROM AUTHOR]

Integrated application of organic and inorganic fertilizers needs a specific formulation to enhance plant performance and reduce fertilization costs. Therefore, a pot experiment was conducted to evaluate the cost and effects of inorganic or organic fertilizers and their integrated forms, while containing the same levels of major nutrients, on Aloe barbadensis performance under the agro-climatic conditions of Afghanistan. The treatments were: control; 200 kg ha−1 N, P2O5, and K2O each, in the form of inorganic fertilizer (IF-200); 200 kg ha−1 N, P2O5, and K2O each, in the form of nutrient-rich organic fertilizer (NrOF-200); 200 kg ha−1 N, P2O5, and K2O each, in the form of 50% IF and 50% NrOF (IF + NrOF-200); 400 kg ha−1 N, P2O5 and K2O each, in the form of 50% IF and 50% NrOF (IF + NrOF-400); and 400 kg ha−1 N, P2O5 and K2O each, in the form of IF (IF-400). The results revealed that the IF + NrOF-200 treatment led to significantly increased fresh and dry biomass yields compared to the control. The yield was also greater when the same levels of major nutrients were applied in the combined organic and inorganic forms (IF + NrOF-200) than when applied in the inorganic (IF-200) or organic (NrOF-200) forms alone. This study also reveals that, despite doubling the major nutrient levels in the IF + NrOF-400 and IF-400 treatments, the IF + NrOF-200 treatment with half the nutrient amount showed a similar result, indicating its cost effectiveness in Aloe vera production in Afghanistan. [ABSTRACT FROM AUTHOR]

Medical tourism in India has an immense scope, primarily due to the unavailability or inaccessibility of medical treatment in border areas of native countries, such as Bangladesh and Myanmar. Also, the significantly low cost of complex surgery and highly skilled doctors are the most significant factors for driving tourism in India. Thus, there is a vast scope for entrepreneurship in this area. On the other hand, it is being covered by lush forests, lakes, and hills. This study aims to develop a model to increase the population of outbound or international patients and their families for medical services. Tripura, being topographically easily accessible for patients from Bangladesh and Myanmar, can be commuted within hours. The study was cross-sectional, and a purposive sampling technique was used. The data was collected using a 5-point rating scale specifically constructed to understand the factors enhancing medical tourism. Various hospitals that provide medical services to domestic (other states in India) & international clients, tourism agencies, and relevant sources have contributed to this study. [ABSTRACT FROM AUTHOR]

The acute crisis of carbapenem resistance impedes the empirical use of carbapenems in medical emergencies, especially, bloodstream infections. Carbapenemase-producing carbapenem-resistant organisms (CP-CROs) attribute high case-fatality, necessitating rapid diagnostics to initiate early targeted antibiotics. Expensive diagnostics are the major driver of antibiotic misuse, neglecting evidence-based treatment in India. One in-house molecular diagnostics assay was customized for rapid detection of CP-CROs using positive blood-culture (BC) broths at a low-cost. The assay was validated using a known-set of isolates and evaluated on positive BC broths. DNA was extracted from positive BC broths using a modified alkali-wash/heat-lysis method. One end-point multiplex-PCR was customized targeting five carbapenemases (KPC, NDM, VIM, OXA-48-, and OXA-23-type) with 16S-rDNA as internal extraction control. Carbapenem resistance due to other carbapenemases, efflux-pump activity, and loss of porins was not under the scope of the assay. Promising analytical performances (sensitivity and specificity, >90%; kappa = 0.87), encouraged to assess diagnostic value, qualified the assay for the WHO minimal requirements (both≥95%) for a multiplex-PCR. Higher LR+ (>10) and lower LR− (<0.1) indicate a good diagnostic tool for ruling in or ruling out CRO bloodstream infections. Inclusion of OXA-23-type improved assay positivity. Multiple carbapenemases were detected in>30% of samples. Good concordance was found (kappa = 0.91) with twenty-six discrepant results. The results were available in 3 hours. The running cost of the assay was US$10 per sample. Fast and reliable detection of carbapenemase(s) allows clinicians and infection-control practitioners to execute early-directed therapy and containment measures. This convenient approach facilitates implementing the assay in resource-limited healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: The study aims to analyze the quality of studies that make economic evaluations for amyotrophic lateral sclerosis (ALS). Assessing the quality of studies can guide policy-making and planning. Methods: One of the most recognized checklists "The Consensus on Health Economic Criteria" (CHEC)-list designed by Evers et al. in 2005 aims to answer two important questions: is the methodology of the study appropriate, and are the results of the study valid? We reviewed studies focusing on ALS and its economic costs, and evaluated the studies with (CHEC)-list. Results: We examined 25 articles in terms of their cost evaluation and quality. It is seen that they mainly focus on medical costs, ignoring social care costs. When the quality of the studies is examined, it is seen that the studies overall achieve high scores in terms of their purpose and research question, but some of the studies score low in terms of ethical dimension, comprehensiveness of expenditure items, their application of sensitivity analyses and their study design. Conclusions: The main recommendation of our study for future cost evaluation studies is that they should focus on the questions in the checklist that are scored low overall by the 25 articles, and consider the social care costs as well as medical costs. Our recommendations when designing cost studies can be applied to other chronic diseases with long-term economic costs like ALS. [ABSTRACT FROM AUTHOR]

Abstract In industry and research areas, the importance of reliable and optimally designed BGA components has remarkably grown. To tackle this challenge, we elaborated an innovative approach that optimizes of the BGA’s structure. By adopting the RBDO method, we assess the geometric design variables of the BGA component and determine the optimal variables that promote the structure’s efficiency level. Our approach considers technical and economic feasibility, ensuring an optimal design of the BGA solder joints. This work rests upon coupling Ansys and MATLAB software. The current paper reports our investigation’s results, highlighting our approach’s benefits and potential for practical applications. [ABSTRACT FROM AUTHOR]

The widespread availability of cheap, mass-produced balloons puts a strain on the financial and manufacturing capacities of most aerial interception systems. In the past, high-altitude guided balloons that were between 65,000 ft (19.812 m) and 95,000 ft (27.432 m) in the air have been destroyed successfully by modifying bombers and airplanes to use a high-power laser system. High Altitude Long Endurance (HALE) Unmanned Aerial Vehicles (UAV) with laser systems are also on the market. Nevertheless, the cost to produce and maintain these systems is extremely high. A very cost-effective alternative is to create a mini—Unmanned Aerial Vehicle Interceptor (UAVI) that can intercept and bring down a balloon at a height of 65,000 ft (19.812 m) and has a Maximum Take Off Weight (MTOW) under 100 kg. To enable mass production, the UAVI should make use of readily available components and a simplified carbon fibre reinforced polymers (CFRP) structure. The vehicle also has a commercial microjet engine with an appropriate air intake and nozzle. This paper introduces the design of a cost effective UAVI to minimize the cost this analysis starts from existing, off-the-shelf Radio Commanded (RC) models. An ad-hoc design was then compared. [ABSTRACT FROM AUTHOR]

Uncontrolled glycated hemoglobin (HbA1c) levels are associated with adverse events among complex diabetic patients. These adverse events present serious health risks to affected patients and are associated with significant financial costs. Thus, a high-quality predictive model that could identify high-risk patients so as to inform preventative treatment has the potential to improve patient outcomes while reducing healthcare costs. Because the biomarker information needed to predict risk is costly and burdensome, it is desirable that such a model collect only as much information as is needed on each patient so as to render an accurate prediction. We propose a sequential predictive model that uses accumulating patient longitudinal data to classify patients as: high-risk, low-risk, or uncertain. Patients classified as high-risk are then recommended to receive preventative treatment and those classified as low-risk are recommended to standard care. Patients classified as uncertain are monitored until a high-risk or low-risk determination is made. We construct the model using claims and enrollment files from Medicare, linked with patient electronic health records (EHR) data. The proposed model uses functional principal components to accommodate noisy longitudinal data and weighting to deal with missingness and sampling bias. The proposed method demonstrates higher predictive accuracy and lower cost than competing methods in a series of simulation experiments and application to data on complex patients with diabetes. for this article are available online. [ABSTRACT FROM AUTHOR]

Malnutrition is increasing across the globe owing to urbanization, poverty, and climatic changes. In the current circumstances, alternative and unexplored sources of food and nutrients are getting attention. The current sources of food cannot meet the ever-increasing population demand. The demand for animal-source protein is estimated be double due to a projected 50% rise in the world population by the year 2050. Moreover, global animal protein supply chains are not only vulnerable to natural disasters but also a significant source of greenhouse gas emissions. Mycoprotein is considered an excellent alternative to animal protein due to its amino acid profile and cost-effectiveness. Mycoprotein is produced by Fusarium venenatum, a naturally occurring fungus that can be used as a substitute for conventional animal protein sources. Mycoprotein is high in protein and fiber while low in cholesterol, fat, sugar, and salt. Mycoprotein offers excellent functional and therapeutic potential in mitigating various health disorders. Furthermore, it helps maintain muscle synthesis and optimal plasma and cholesterol levels, regulating insulin, glucose, and satiety. This review is focused on the mycoprotein's origin and production, with a particular emphasis on its nutritional, health, and economic opportunities and challenges. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the cost-effectiveness of anlotinib versus pembrolizumab and nivolumab as the third-line treatment in recurrent small cell lung cancer (SCLC) patients from the Chinese healthcare system perspective. A Markov model was built to simulate the costs and health outcomes in the 4-year horizon. Efficacy and safety data of anlotinib, pembrolizumab, and nivolumab in patients with recurrent SCLC were derived from three studies. Cost and utility values were derived from local charges, the published literature, and related databases. Three scenario analyses and sensitivity analyses were performed to explore the robustness of the results. Compared with anlotinib, pembrolizumab and nivolumab were estimated to gain an additional 0.18 and 0.10 quality-adjusted life years (QALYs) at an incremental cost of $10,446 and $5,182, resulting in an increment cost-utility ratio (ICUR) of $58,221/QALY and $56,733/QALY. The sensitivity analyses showed that the likelihood of anlotinib being cost-effective was 87.5% to 99.9% at a willingness-to-pay (WTP) threshold of $11,144 to $33,431/QALY. The scenario analyses indicated that the results varied in different scenarios. The findings suggest that anlotinib could be the most cost-effective option versus pembrolizumab and nivolumab in the third-line treatment of recurrent SCLC from the Chinese healthcare system perspective. [ABSTRACT FROM AUTHOR]

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The use of G-CSF post allogeneic transplant has become a common practice to accelerate neutrophil engraftment. There is some controversy in its use. To further evaluate the effectiveness, we compared outcomes in patients who underwent PBSCT, either with or without the planned use of G-CSF post SCT. Among consecutive 162 patients from October 2012 to October 2014, 65 patients received G-CSF post-PBSCT, and 97 did not. More patients in G-CSF group received MAC (78% vs. 55%). Patients who received G-CSF had earlier neutrophil engraftment (median days 11 vs. 14) and shorter post-transplant hospital stay (median days 16 vs. 20, p = 0.001). G-CSF use was associated with a higher rate of extensive chronic GVHD (44.3% vs.61.5%, p = 0.027). G-CSF cost the equivalent of 0.25 hospital days but shortened the initial transplant admission by 4 days. Early cost-benefit may be later offset by the economic burden of chronic GVHD and associated complications. [ABSTRACT FROM AUTHOR]

Polyurethane (PU) sponge with extreme wettability have been studied widely for oil/water separation. However, existing techniques to fabricate the PU sponge with extreme wettability often involve using the harmful and toxic chemicals with the complex fabrication processes. Here, a facile, environmentally friendly and cost-effective method is proposed to fabricate superhydrophobic-superoleophilic cement-coated PU sponge for oil/water separation. Due to rich porous structures and good elasticity, superhydrophobic sponge exhibited high adsorption capacity for various oils/organic solvents. The separation ability was less affected by complex conditions, including UV lamp irradiation, turbulent environment and continuous separation with vacuum pump assistance. Separation efficiency of oils/corrosive aqueous solutions mixtures could reach up to 99%, which suggested that this superhydrophobic cement-coated PU sponge could be a promising candidate for oil spill cleanup on the sea. [ABSTRACT FROM AUTHOR]

Objective: This economic evaluation aims to provide a preliminary assessment of the cost-effectiveness of radiofrequency ablation (RFA) compared with argon plasma coagulation (APC) when used to treat APC-refractory gastric antral vascular ectasia (GAVE) in symptomatic patients.Methods: A Markov model was constructed to undertake a cost-utility analysis for adults with persistent symptoms secondary to GAVE refractory to first line endoscopic therapy. The economic evaluation was conducted from a UK NHS and personal social services (PSS) perspective, with a 20-year time horizon, comparing RFA with APC. Patients transfer between health states defined by haemoglobin level. The clinical effectiveness data were sourced from expert opinion, resource use and costs were reflective of the UK NHS and benefits were quantified using Quality Adjusted Life Years (QALYs) with utility weights taken from the literature. The primary output was the Incremental Cost-Effectiveness Ratio (ICER), expressed as cost per QALY gained.Results: Over a lifetime time horizon, the base case ICER was £4840 per QALY gained with an 82.2% chance that RFA was cost-effective at a threshold of £20,000 per QALY gained. The model estimated that implementing RFA would result in reductions in the need for intravenous iron, endoscopic intervention and requirement for blood transfusions by 27.1%, 32.3% and 36.5% respectively. Compared to APC, RFA was associated with an estimated 36.7% fewer procedures.Conclusions: RFA treatment is likely to be cost-effective for patients with ongoing symptoms following failure of first line therapy with APC and could lead to substantive reductions in health care resource. [ABSTRACT FROM AUTHOR]

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−1VS was calculated. High-energy consumption during UP and AUP in laboratory scale hindered the positive benefits of these pre-treatments. [ABSTRACT FROM AUTHOR]

Gellan gum, produced by Sphingomonas paucimobilis, is increasingly used in food and pharmaceutical industries as stabilizing, emulsifying, texturing and gelling agents. However, its high production costs may limit its full commercial potential. Therefore, in this study, we investigated ways to reduce gellan gum production costs and improve yields. We first revealed corn steep liquor (CSL) as a cost-effective nutrient source that can improve gellan gum yields. We then systematically optimized culture conditions even further, and revealed that the addition of Triton X-100 surfactant and selected inorganic nitrogen sources improved gellan gum production. Under our optimized conditions (glucose 33.75 g/L, CSL 10 g/L, urea 2.5 g/L, MgSO4 1.08 g/L, KH2PO4 3.24 g/L, K2SO4 1 g/L and Triton X-100 0.75 g/L), we yielded a maximum concentration of 14.41 g/L, which was about 1.5-fold higher than non-optimized CSL-based medium. Our findings highlight the use of CSL as a cost effective and promising nutrient source for industrial production of gellan gum. [ABSTRACT FROM AUTHOR]

To select optimal LID in urban areas, an optimization assessment framework considering hydrological processes and cost-effectiveness is proposed. To provide the desired runoff reduction efficiencies, hydrological processes of LID were analyzed using a probabilistic analysis of rainfall event characteristics. Meanwhile, life-cycle costs were estimated to determine benefits and costs of implementing different LID units. Finally, various solutions having maximum runoff reductions but different costs were selected using the Non-dominated Sorting Genetic Algorithm II (NSGA-II). The results show that the bioretention cell, which had maximum runoff reduction capacity, was identified as a priority measure for implementation. However, given the potential for large implementation areas, resulting in marked runoff reduction benefits, permeable pavements are a more reasonable measure for the study area. Using the NSGA-II to identify optimal cost-effective LID options is convenient for decision makers, tasked with selecting solutions based on their available budgets and runoff reduction objectives in urban environments. [ABSTRACT FROM AUTHOR]

This article reviews the contents and research on the Strengthening Families Program (SFP), a family evidence-based seven- to 14-session intervention for drug prevention in high-risk children ages 0 to 17. Twelve Randomized Control Trials (RCTs) found significant improvements in youths' behavioral health, including 50% reductions in substance misuse, depression/anxiety, and child maltreatment. Culturally adapted SFP versions have improved family relations and the children's behavioral health in 36 countries. To reduce costs of SFP's family groups, a SFP Years DVD was developed and found effective in schools, health clinics, child welfare, and juvenile justice. Future directions include putting SFP on the Web and on smartphones. [ABSTRACT FROM AUTHOR]

Dengue endemic is a serious healthcare concern in tropical and subtropical countries. Although well-established laboratory tests can provide early diagnosis of acute dengue infections, access to these tests is limited in developing countries, presenting an urgent need to develop simple, rapid, and robust diagnostic tools. Point-of-care (POC) devices, particularly paper-based POC devices, are typically rapid, cost-effective and user-friendly, and they can be used as diagnostic tools for the prompt diagnosis of dengue at POC settings. Here, we review the importance of rapid dengue diagnosis, current dengue diagnostic methods, and the development of paper-based POC devices for diagnosis of dengue infections at the POC. [ABSTRACT FROM AUTHOR]

Chronic back pain is an extremely common health problem. The largest category for pain therapy costs includes nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids. However, there has been limited evidence outlining their effectiveness in terms of quality of life for the treatment of chronic back pain. The authors performed a comparative pharmacoeconomic analysis of chronic back pain patients using NSAIDs versus those using opioids alone or combination opioid analgesics. This pharmacoeconomic evaluation was conducted using the Medical Expenditure Panel Survey (MEPS). Adults ≥18 years with chronic back pain diagnosis were included in the study. Individuals using opioids were matched in 1:1 ratio with those using only NSAIDs using propensity scores. All direct medical costs were included, and utility scores from Short Form 6D (SF-6D) were used to calculate QALYs (quality-adjusted life years). Monte Carlo probabilistic simulation technique was employed to determine the cost-effectiveness acceptability curve. After matching, there were 1109 patients in each cohort. The total mean annual cost was found to be $6137.41 for NSAIDs and $8982.28 for opioids. The mean utility gain for NSAIDs was found to be 0.661, whereas for opioids it was 0.633. Probabilistic sensitivity analysis showed that at all willingness-to-pay thresholds, the probability of NSAIDs being cost-effective was higher than the probability of the opioids being cost-effective. The authors found NSAIDs to be a dominant strategy as compared with opioids. Considering the higher cost associated with opioids/combination opioid analgesics, it might be cost-effective if they are used in patients who did not respond to the NSAIDs. [ABSTRACT FROM PUBLISHER]

High operating costs challenge sustainability of successful US emergency department (ED) HIV screening programs. Free-standing registration kiosks could potentially reduce the marginal costs of ED HIV screening. We investigated incremental cost-effectiveness ratio (CER) per new HIV diagnosis for a kiosk-based approach for offering screening at ED registration versus a testing staff-based approach to offer testing at the bedside. A rapid oral-fluid HIV screening program, instituted in a US ED since 2005, had a rate of new HIV diagnosis 0.16% in 2012. A two-phase quasi experimental design, including a testing staff-based approach to offer testing at the bedside (Phase I, August and September 2011) and a kiosk-based approach to offer testing at ED registration (Phase II, December 2011 and January 2012), was performed. CER per new HIV diagnosis was defined as total cost of the screening program divided by number of newly diagnosed cases. Costs included screening program personnel (study coordinator, testing staff, and kiosk helpers), diagnostic assays (rapid and confirmatory tests), and kiosks (2 kiosks, software, and IT consulting fees). Sensitivity analyses were performed. Data from our dedicated testing staff (DTS) program (Phase I) resulted in an estimated 5434 patients tested in one year and 9 newly diagnosed HIV-infected patients (95% CI: 3, 18). Data from the kiosk program (Phase II), resulted in a projected 4571 ED patients tested in one year and 21 newly diagnosed HIV-infected patients (95% CI: 4, 70). The overall cost was $ 201,433 for the DTS program, versus $292,008 for the kiosk program. Incremental CER per new HIV diagnosis for kiosk-based approach was $7523 (range: $1780–90,025 by sensitivity analysis). Our pilot data demonstrated that the use of kiosks for HIV screening was potentially more cost-effective than a testing staff-based bedside approach. [ABSTRACT FROM PUBLISHER]

The aim of this study was to analyze and compare print and electronic book usage for equivalent core clinical titles at the University of South Alabama Biomedical Library collection from 2010 to 2014 to determine format preference and if it would be necessary to purchase identical books in both electronic and print formats. The purpose of purchasing print books that are also available in electronic format is to meet the preferences of some users who prefer to read print format. Usage of 60 core books both in print and electronic formats was compared. Usage statistics were generated from the library’s integrated library system for the print books—both those used in the library and checked out of the library. Electronic usage statistics of the same titles were generated from COUNTER reports; then titles in both formats were compared to determine format preference and whether it is cost-effective to purchase books in both print and electronic formats. [ABSTRACT FROM PUBLISHER]

Introduction:Hidradenitis suppurativa (HS) presents the problem of a chronic, relapsing, painful, draining wound. There is a myriad of HS wound care management strategies implemented by clinicians and patients centered around which dressings to use. Many factors affect which HS wound care dressing is the most appropriate to use such as the type of HS wound, cost, ease of application, patient comfort, absorbency and odor management among many others. Aim:In this work, the authors aim to prepare a set of guidelines for optimal HS wound care dressing use based on a tier system, ideal characteristics of HS dressings and the type of HS lesion. The dressing recommendations focus on cost-effectiveness for patients, ease of accessibility and ultimately, improvement in the quality of life of patients suffering from HS. Methods:PubMed was utilized to search the terms ‘wound care + HS’; ‘non-surgical wound care + HS’; ‘optimal wound care + HS’; ‘HS wounds’; and ‘optimal wound dressings’. Results:Silver-impregnated foam is considered the most optimal HS wound care dressing because it contains nearly all characteristics of an ideal wound care dressing. Conclusion:However, silver-impreganted foam is expensive and difficult to access for patients, so lower-tier HS wound care dressings must be considered prior to utilizing this tier 4 dressing. [ABSTRACT FROM PUBLISHER]

A simple, cost-effective method for synthesis of indoloquinoxalines from isatin ando-phenylenediamine employing a catalytic amount of sulfamic acid at ambient temperature is reported. Moreover, the method is applicable for a variety of isatins, ninhydrin, 4-hydroxynaphthaquinone, and 1,2-diketones. The key features of the protocol include rapid reactions with good yields, simple workup procedure, and easy isolation of products. [ABSTRACT FROM PUBLISHER]

The overloading agricultural phosphorus inputs play significant roles in accelerating eutrophication of receiving waters. For the propose of phosphorus removal from agricultural runoff, a field-scale free surface flow constructed riparian wetland system, with cost-effective and easily maintainable design, was constructed for receiving runoff from a small agricultural watershed on the northeastern lakeside rural areas of Liangzi Lake, China. During the start-up period, the system potentially provided a buffering capacity in irrigative and rainy periods. Wetland vegetations grew relatively well during the observed period (1 August–30 October 2012). Furthermore, the growth of vegetations has assisted in transforming the constructed riparian wetland structure to fit well with the surrounding landscape. The reductions in average concentrations of PO4-P and total phosphorus (TP) during the start-up period were approximately 75.6% and 46.5%, respectively. Moreover, the influences of environmental conditions on PO4-P and TP removal and retention in the constructed riparian wetland system were also analyzed. The results indicated that water temperature, conductivity, dissolved oxygen, and pH were important factors controlling phosphorus redistribution in the studied system. Generally, the constructed riparian wetland system preformed satisfactory during the start-up period, and it might be a suitable wastewater treatment tool for farms in poor rural areas. [ABSTRACT FROM AUTHOR]

Hydroxythiophenols have provided access to a number of unique heterocycles. Historically, access to 3-hydroxythiophenol has been challenging because of inefficiencies and prohibitive cost. A straightforward and efficient route to 3-hydroxythiphenol has been devised. [ABSTRACT FROM PUBLISHER]

Formaldehyde was monitored in the workplace environment of an adhesive manufacturer producing formaldehyde and urea-formaldehyde resin using a cost-effective sol-gel-based sensor. The sensor was first evaluated by comparing its performance to the conventional 2,4-dinitrophynylhydrazine-devivatization method (2,4-DNPH) followed by high-performance liquid chromatography coupled to a UV detector. The formaldehyde concentrations obtained by both techniques were not significantly different. The cost-effective sol-gel-based sensor was then used for monitoring formaldehyde levels in the laboratories, production areas and storage room. Formaldehyde concentrations in this adhesive manufacturer workplace environment were lower than the limit value of, 0.75 ppm for an 8-h time weight average and 2 ppm for a short-term exposure (15 min). However, the cancer risk for employees who worked in the laboratories, (1.7±0.7)×10−4–(5±2)×10−4, were higher than the acceptable cancer risk recommended by the US EPA (10−6). Therefore, some precaution should be taken to reduce the risk, such as an increase of ventilation to dilute the levels of formaldehyde and use air cleaners to remove formaldehyde. [ABSTRACT FROM AUTHOR]

A simple and efficient synthesis of cuprous oxide and cupric oxide nanoparticles was carried out with controlled surface properties via soft chemistry approach. The monodisperse and versatile Cu2O and CuO nanoparticles were characterized with the help of FT-IR, UV-Vis, TGA/DSC, XRD, SEM-EDX, TEM, and BET. From the XRD analysis, the size of Cu2O and CuO nanoparticles were calculated as 31 nm and 32 nm, respectively, which is calculated with the help of Scherer equation, as supported by TEM. The morphology of the nanoparticles can be controlled by tuning the amount of KOH and nature of solvent. Chemie douce approach is a novel, cheap, and convenient technique suitable for industrial production. [ABSTRACT FROM AUTHOR]

This article is a perspective on what research skills new associates in legal practice need. Knowledge of print and electronic resources and cost-effective search strategies are the main focus of the article. A checklist of research skills is included along with recommendations on what law schools and law firm librarians can do to assist law students and new attorneys in learning these skills. [ABSTRACT FROM AUTHOR]

Impact evaluations, whether of aid, development interventions or policy interventions, help hold donors and policy makers accountable for promises made and provide a means to legitimise recommendations for future interventions. Quantitative approaches are the order of the day but do not fully capture the complex and nuanced characteristics of communities important to understand the full effects of interventions and/or identify required interventions. This article describes a cost-effective approach to capturing large volumes of qualitative data in anecdotal form that can help inform interventions and approaches to research. Data collected by using the technique in a poor, urban, mixed race settlement in South Africa are reviewed and used to provide recommendations on research in poverty. For reasons consistent with the theoretical framework explained, recommendations are limited to three: consider carefully intergenerational dynamics when researching poor areas; be responsible about differences in value scales; and be conscious of how differently the researched see the world. A discussion using the method in mixed methods research is provided. [ABSTRACT FROM AUTHOR]

Disproportionately large numbers of high risk clients from Multiple Problem Families (MPFs) utilize a disproportionately large percentage of Medicaid, Health and Human Services. Clients from these families are involved in domestic violence, addiction, child abuse and neglect. They are over represented on the caseloads of state protective service agencies. The approach outlined in this paper is based on social attachment theory models. It stresses the use of long-term, home-based therapy, and community support agencies to establish and maintain safe secure attachment for these fragile families. The therapeutic goals are to foster attachments that lead to increased mentalisation, and to decrease the crisis-driven behavior that often results in high cost utilization of state services.Aplacement prevention model, outlined as an alternative "mentalising social system" approach, is proposed for treating disruptive MPF children. Family oriented, in-home, community-based treatment is found to be more cost effective and therapeutically helpful for these children than costly inpatient psychiatric admission followed by residential care. [ABSTRACT FROM AUTHOR]

This first international review of the evidence that needle syringe programs reduce HIV infection among injecting drug users found that conservative interpretation of the published data fulfills six of the nine Bradford Hill criteria (strength of association, replication of findings, temporal sequence, biological plausibility, coherence of evidence, and reasoning by analogy) and all six additional criteria (cost-effectiveness, absence of negative consequences, feasibility of implementation, expansion and coverage, unanticipated benefits, and application to special populations). The Bradford Hill criteria are often used to evaluate public health interventions. The principal finding of this review was that there is compelling evidence of effectiveness, safety, and cost-effectiveness, consistent with seven previous reviews conducted by or on behalf of U.S. government agencies. Authorities in countries affected or threatened by HIV infection among injecting drug users should carefully consider this convincing evidence now available for needle syringe programs with a view to establishing or expanding needle syringe programs to scale. [ABSTRACT FROM AUTHOR]

Background : Psoriasis is difficult at times to treat and treatment failures are not uncommon regardless of approach. With the advent of expensive biologic therapies for psoriasis there is increasing discussion on the cost efficacy of a given systemic or biologic agent. An alternative and overlooked aspect of cost efficacy is the cost that accrues from treatment failures. Methods : We review the literature and develop a model to analyze the cost-effectiveness and the cost of treatment failures per success for various systemic psoriasis agents using a 12-week treatment period. Results : For continuous-dose agents, the cost-effectiveness results are: methotrexate $623, acitretin $2729, cyclosporine $2969, nUVB $3692, PUVA $4668, etanercept $16 312, and efalizumab $17 196. The cost of expected treatment failures to achieve one success for the same agents were: methotrexate $187, cyclosporine $505, PUVA $767, nUVB $1034, acitretin $1310, etanercept $8319, and efalizumab $12 897. Conclusions : Methotrexate appears to be the most cost-effective agent for the treatment of severe psoriasis. However, greater efficacy can be achieved with cyclosporine and PUVA, albeit at a greater cost. Because of the high cost of treatment failures, access to a wide array of therapies and combination regimens should not be discouraged by physicians or insurers. [ABSTRACT FROM AUTHOR]

Objective: This study examines a sample of alcohol user treatment outcome studies to determine the amount of attention given to three areas of concern and cost-effectiveness in treatment research: patient diagnosis, use of self-help groups (e.g., Alcoholics Anonymous [AA]), and use of maintenance care services (also known as a “aftercare”). METHOD: A preliminary sample of 40 studies was coded for the degree of specific information provided to each of the three areas of interest. RESULTS: Eight studies in the sample did not mention the diagnostic criteria used to determine patient addiction, 18 did not mention use, referral, or recommendation of AA, and 20 did not mention use, referral, or recommendation of maintenance care services. CONCLUSIONS: As cost-effective additions to primary treatment, AA and maintenance care services deserve greater attention in the treatment of “substance abuse disorders.” Researchers should also pay greater attention to patient diagnosis as an integral part of patient care. Finally, journal editors should institute minimum requirements for published reports ensuring that sufficient information on patient care is provided. [ABSTRACT FROM AUTHOR]

Laparoscopy has become the preferred operative treatment for the removal of gallbladders containing symptomatic stones. Both length of stay and total unit cost has declined, through the use of the laparoscopic cholecystectomy procedure. However, the total cost of treating gallstones has increased. Consensus practice guidelines would indicate that there should be no increase in the number of gallbladder surgeries performed, as the indications for a closed cholecystectomy should be the same as those for open procedures. To correct for the variation in incidence of surgery, I propose a decision flow tree to control the rate of laparoscopic cholecystectomy within a provider organization. I also propose further studies of ablative methods versus surgical procedures to determine the cost effectiveness of expanding indications for laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

This manuscript evaluates the various available pharmacologic agents and combinations of these agents in the management of type 2 diabetes mellitus in the elderly. Currently the incidence of type 2 diabetes in the elderly is on the rise. While goals of glycemic control may be similar in the elderly to the younger type 2 patients, nuances in the pharmacology of the four groups of oral agents and in insulin products may make some regimens preferable in the elderly population. The positive benefits of euglycemic control in all patients with diabetes has been conclusively demonstrated. Currently in the United States sulfonylureas, alpha-glucosidase inhibitors, biguanides, thiazolidinediones, and various insulin products are available for management of hyperglycemia. When choosing an agent the practitioner must consider efficacy of the medication (blood glucose lowering potential), current and goal blood glucose and glycosylated hemoglobin levels, contraindications, side effects, and effect on other metabolic parameters such as insulin concentration, lipids, and body weight. Additionally in the elderly, remaining life expectancy, presence of diabetic complications, presence of coexisting medical or neuropsychiatric disorders, and the patient's willingness and ability to comply with the proposed diabetes treatment plan must be considered when developing treatment goals and therapeutic regimens. While cost of medication must be considered, it is incidental (less than 2%) when compared to the overall cost of diabetes. As stated above strict glycemic control reduces complications. Therefore, using the most cost-effective approach, the practitioner should choose the regimen that has the best effect on glycemia, as well as weight, insulin concentration, and plasma lipids, without causing undo side effects. In the long run, this approach will be cost effective with a resultant reduction in morbidity and mortality. [ABSTRACT FROM PUBLISHER]

Background: The amount a government should be willing to invest in adopting new medical treatments has long been under debate. With many countries using formal cost-effectiveness (C/E) thresholds when examining potential new treatments and ever-growing medical costs, accurately setting the level of a C/E threshold can be essential for an efficient healthcare system. Objectives: The aim of this systematic review is to describe the prominent approaches to setting a C/E threshold, compile available national-level C/E threshold data and willingness-to-pay (WTP) data, and to discern whether associations exist between these values, gross domestic product (GDP) and health-adjusted life expectancy (HALE). This review further examines current obstacles faced with the presently available data. Methods: A systematic review was performed to collect articles which have studied national C/E thresholds and willingness-to-pay (WTP) per quality-adjusted life year (QALY) in the general population. Associations between GDP, HALE, WTP, and C/E thresholds were analyzed with correlations. Results: Seventeen countries were identified from nine unique sources to have formal C/E thresholds within our inclusion criteria. Thirteen countries from nine sources were identified to have WTP per QALY data within our inclusion criteria. Two possible associations were identified: C/E thresholds with HALE (quadratic correlation of 0.63), and C/E thresholds with GDP per capita (polynomial correlation of 0.84). However, these results are based on few observations and therefore firm conclusions cannot be made. Conclusions: Most national C/E thresholds identified in our review fall within the WHO's recommended range of one-to-three times GDP per capita. However, the quality and quantity of data available regarding national average WTP per QALY, opportunity costs, and C/E thresholds is poor in comparison to the importance of adequate investment in healthcare. There exists an obvious risk that countries might either over- or underinvest in healthcare if they base their decision-making process on erroneous presumptions or non-evidence-based methodologies. The commonly referred to value of 100,000$ USD per QALY may potentially have some basis. [ABSTRACT FROM AUTHOR]