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Aims. To investigate the costs and cost-effectiveness of a short message service (SMS) intervention to prevent the onset of type 2 diabetes mellitus (T2DM) in subjects with impaired glucose tolerance (IGT). Methods. A Markov model was developed to simulate the cost and effectiveness outcomes of the SMS intervention and usual clinical practice from the health provider's perspective. The direct programme costs and the two-year SMS intervention costs were evaluated in subjects with IGT. All costs were expressed in 2011 US dollars. The incremental cost-effectiveness ratio was calculated as cost per T2DM onset prevented, cost per life year gained, and cost per quality adjusted life year (QALY) gained. Results. Within the two-year trial period, the net intervention cost of the SMS group was $42.03 per subject. The SMS intervention managed to reduce 5.05% onset of diabetes, resulting in saving $118.39 per subject over two years. In the lifetime model, the SMS intervention dominated the control by gaining an additional 0.071 QALY and saving $1020.35 per person. The SMS intervention remained dominant in all sensitivity analyses. Conclusions. The SMS intervention for IGT subjects had the superiority of lower monetary cost and a considerable improvement in preventing or delaying the T2DM onset. This trial is registered with ClinicalTrials.gov NCT01556880.

Air-conditioning system plays a significant role in providing users a thermally comfortable indoor environment, which is a necessity in modern buildings. In order to save the vast energy consumed by air-conditioning system, the building envelopes in envelope-load dominated buildings should be well designed such that the unwanted heat gain and loss with environment can be minimized. In this paper, a new design of concrete wall panel that enhances thermal insulation of buildings by adding a gypsum layer inside concrete is presented. Experiments have been conducted for monitoring the temperature variation in both proposed sandwich wall panel and conventional concrete wall panel under a heat radiation source. For further understanding the thermal effect of such sandwich wall panel design from building scale, two three-story building models adopting different wall panel designs are constructed for evaluating the temperature distribution of entire buildings using finite element method. Both the experimental and simulation results have shown that the gypsum layer improves the thermal insulation performance by retarding the heat transfer across the building envelopes.

Network analysis of transcriptional signature typically relies on direct interaction between two highly expressed genes. However, this approach misses indirect and biological relevant interactions through a third factor (hub). Here we determine whether a hub-based network analysis can select an improved signature subset that correlates with a biological change in a stronger manner than the original signature. We have previously reported an interferon-related transcriptional signature (THP1r2Mtb-induced) from Mycobacterium tuberculosis (M. tb)-infected THP-1 human macrophage. We selected hub-connected THP1r2Mtb-induced genes into the refined network signature TMtb-iNet and grouped the excluded genes into the excluded signature TMtb-iEx. TMtb-iNet retained the enrichment of binding sites of interferon-related transcription factors and contained relatively more interferon-related interacting genes when compared to THP1r2Mtb-induced signature. TMtb-iNet correlated as strongly as THP1r2Mtb-induced signature on a public transcriptional dataset of patients with pulmonary tuberculosis (PTB). TMtb-iNet correlated more strongly in CD4(+) and CD8(+) T cells from PTB patients than THP1r2Mtb-induced signature and TMtb-iEx. When TMtb-iNet was applied to data during clinical therapy of tuberculosis, it resulted in the most pronounced response and the weakest correlation. Correlation on dataset from patients with AIDS or malaria was stronger for TMtb-iNet, indicating an involvement of TMtb-iNet in these chronic human infections. Collectively, the significance of this work is twofold: (1) we disseminate a hub-based approach in generating a biologically meaningful and clinically useful signature; (2) using this approach we introduce a new network-based signature and demonstrate its promising applications in understanding host responses to infections.

Induction of necrotic death in macrophages is a primary virulence determinant of Mycobacterium tuberculosis. The ESX-1 secretion system and its substrate ESAT-6 are required for M. tuberculosis to induce necrosis, but host factors that mediate the ESAT-6-promoted necrosis remain unknown. Here we report that ESAT-6-promoted necrotic death in THP-1 human macrophages is dependent on the NLRP3 inflammasome, as shown by RNA interference and pharmacological inhibitions. Phagosomes containing ESAT-6-expressing M. tuberculosis recruit markers previously associated with damaged phagosomal membrane, such as galectin-3 and ubiquitinated protein aggregates. In addition, ESAT-6 promoted lysosomal permeabilization by M. tuberculosis. ESAT-6 mutants defective for ubiquitination were unable to trigger NLRP3 activation and necrotic death. Furthermore, Syk tyrosine kinase, recently implicated in NLRP3 activation during fungal and malarial infections, was necessary for mediating the ESAT-6-promoted necrosis and NLRP3 activation. Our results thus link phagosomal damage and Syk activity to NLRP3-mediated necrotic death triggered by M. tuberculosis ESAT-6 during infection., (© 2011 Blackwell Publishing Ltd.)

Objective: We aimed to determine any beneficial effect from targeted surveillance, cohort nursing, and restricted health care worker access in controlling MRSA infection in patients undergoing surgery for head and neck cancer., Study Design: Historical cohort study., Subjects and Methods: In phase 1 data were gathered on MRSA-positive cases admitted from February 1, 2006 to February 28, 2007. In phase 2, from July 1, 2007 to January 31, 2008, eligible patients underwent screening swabs, cohort nursing, and restricted access., Results: In the first phase, 24 patients developed MRSA infection out of a total of 84 eligible admissions. There were 31 eligible admissions during phase 2. None of them had known risk factors for MRSA as per Scottish Infection Standards and Strategy Group (SISS) guidelines. All screened patients were noncarriers of MRSA. Three patients out of this group subsequently developed MRSA during their hospital stay. There was a statistically significant drop in MRSA to 9.6 percent (3/31) during this phase compared to 28.5 percent (24/84) in phase 1., Conclusion: Head and neck cancer patients are at high risk of acquiring MRSA infection. Their targeted surveillance is unlikely to influence their MRSA infection rate. However, cohort nursing with restricted health care worker access may help control MRSA infection in them.