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Health problems can lead to costs in the education sector. However, these costs are rarely incorporated in health economic evaluations due to the lack of reference unit costs (RUCs), cost per unit of service, of education services and of validated methods to obtain them. In this study, a standardized unit cost calculation tool developed in the PECUNIA project, the PECUNIA RUC Template for services, was applied to calculate the RUCs of selected education services in five European countries. The RUCs of special education services and of educational therapy were calculated using the information collected via an exploratory gray literature search and contact with service providers. The RUCs of special education services ranged from €55 to €189 per school day. The RUCs of educational therapy ranged from €6 to €25 per contact and from €5 to €35 per day. Variation was observed in the type of input data and measurement unit, among other. The tool helped reduce variability in the RUCs related to costing methodology and gain insights into other aspects that contribute to the variability (e.g. data availability). Further research and efforts to generate high quality input data are required to reduce the variability of the RUCs. [ABSTRACT FROM AUTHOR]

Introduction: Severe infections require early optimization of antibiotic therapy. Since 2016, antibiotic susceptibility results with minimum inhibitory concentrations (MIC) direct from positive blood cultures are available in less than 8 h using a new diagnostic system. The aim of this study is to investigate the economic effects of a rapid availability of antibiotic susceptibility in Germany and to validate these theoretical results in a German hospital., Materials and Methods: In the context of a literature search, the clinical and economic benefit of an adequate therapy as well as the rate of the initially inadequate antibiotic therapy (IIAT) were determined for sepsis and bloodstream infections. In addition to the weighted average of the pooled studies, the case numbers in Germany (data year 2015) of all DRGs for sepsis patients with coded pathogen and ICU stay were integrated into a theoretical economic model that was subsequently validated in a German hospital., Results: The analysis of 14 studies with a total of 6408 patients showed an average weighted rate of 27.3% IIAT. From a total of 8 studies (n = 2988), an average weighted length of stay (LOS) saving of 4.7 days was determined with adequate initial therapy compared to an IIAT. In the theoretical model, an average of € 1539 per case could be saved with a possible LOS reduction of 3.7 days. A conservative scenario with an IIAT of 20% and LOS reduction of 2.5 days still resulted in an average saving of € 201 per case. In the hospital-individual model, 68% of 146 cases had a positive blood culture. In 61% of the examined cases an adjustment of the therapy would have been necessary (35% IIAT, 26% de-escalation). After deducting the cost of the test for 60 patients, the total potential savings amounted to € 122,112, which is over 2000 € per patient., Conclusion: A fast adequate antibiotic therapy was economically advantageous both in the economic model and in the real-life evaluation. The optimization of antibiotic therapy by early pathogen detection and MIC-based susceptibilities represents a possibility to achieve savings despite the high costs for diagnostics in the clinic. Particularly noteworthy is the optimization through de-escalation. The potential for each hospital should be identified through systematic case studies.

Objectives: We sought to objectively assess our outcomes after laparoscopic diaphragmatic plication for symptomatic hemidiaphragmatic paralysis or eventration using a respiratory quality-of-life questionnaire and pulmonary function tests., Methods: We performed a retrospective review of all symptomatic patients with hemidiaphragmatic paralysis or eventration who underwent laparoscopic diaphragmatic plication from March 1, 2005, through August 31, 2008. Patients with primary neuromuscular disorders were excluded from our analysis. We collected St George's Respiratory Questionnaire scores (a respiratory quality-of-life questionnaire) and pulmonary function test results preoperatively and at 1 month and 1 year postoperatively. A 2-sided significance level of .05 was used for all statistical testing., Results: During the study period, 25 patients underwent laparoscopic diaphragmatic plication (9 right-sided and 16 left-sided plications); 1 patient required conversion to a thoracotomy. St George's Respiratory Questionnaire total scores (59.3 +/- 26.8) improved by more than 20 points on average (a reduction of > or = 4 points after an intervention is considered a clinically significant improvement). This improvement was statistically significant at 1 month (36.6 +/- 15.9, P = .001) and maintained significance at 1 year (30.8 +/- 18.8, P = .009). Similarly, percent predicted maximum forced inspiratory flow (93.2% +/- 34.1%) was significantly improved 1 month after plication (113.9% +/- 31.8%, P = .01) and maintained significance at 1 year (111.5% +/- 30.9%, P = .02)., Conclusions: Our objective evaluation of laparoscopic diaphragmatic plication for hemidiaphragmatic paralysis or eventration demonstrated significant short-term and midterm improvements in respiratory quality of life and pulmonary function test results. This approach represents a potential paradigm shift in the surgical management of hemidiaphragmatic paralysis or eventration., (Copyright 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)

Background: This study was conducted to establish an objective approach to evaluate symptoms and sweat production in patients with primary palmoplantar hyperhidrosis (PPH) and assess their response to bilateral thoracoscopic sympathectomy (BTS)., Methods: We conducted two institutional review board-approved studies. We performed a one-time evaluation of healthy volunteers (controls) with three questionnaires (Hyperhidrosis Disease Severity Scale, Dermatology Life Quality Index, and Short Form-36) and measurement of transepidermal water loss (TEWL; g/m(2)/h). We evaluated PPH patients with these same tools before and 1 month after BTS and compared them with controls., Results: We evaluated 35 controls (mean age, 23.0 +/- 3.3 years) and 45 PPH patients (mean age, 26.5 +/- 12.3 years); 18 PPH patients underwent BTS and the 1-month postoperative evaluation. Hyperhidrosis Disease Severity Scale and Dermatology Life Quality Index scores were higher in PPH patients than in controls (p < 0.0001), but normalized after BTS. Short Form-36 scale scores were lower in PPH patients than in controls (p < 0.05), but improved significantly after BTS. Compared with controls, preoperative TEWL values were significantly higher in PPH patients (palmar: 142.7 +/- 43.6 PPH vs 115.8 +/- 48.7 controls, p = 0.011; plantar: 87.5 +/- 28.8 PPH vs 57.7 +/- 24.7 controls, p < 0.0001). After BTS, palmar TEWL values were significantly lower (49.1 +/- 29.8, p < 0.0001). Plantar TEWL did not change significantly (77.6 +/- 46.6, p = 0.52)., Conclusions: PPH patients should be objectively evaluated with standardized quality of life measures and TEWL measurements before and after treatment. We believe that this objective practical approach provides a benchmark for clinical practice and research.

Background: Isolated rib lesions detected on bone scanning can pose a diagnostic challenge, particularly in patients with a known primary cancer. The purpose of our study was to assess the diagnostic value of radionuclide-guided rib biopsy with an intraoperative gamma probe., Methods: We conducted a retrospective chart review of 10 patients who underwent an intraoperative gamma probe-guided rib biopsy. Rib defects were identified by radionuclide bone scan. Patients received an intravenous dose of technetium 99m methylene diphosphonate within 6 hours before surgery. The approximate location of the rib defect was scanned with a hand-held gamma probe intraoperatively; an excisional rib biopsy was performed in the area with the highest tracer activity., Results: Median age was 54 years (range, 40 to 83) and median body mass index was 32.5 (range, 23 to 52). Seven patients had a known primary extraosseous cancer and 3 patients had no history of cancer. Seven patients had pain at the time of initial evaluation. The median operative time was 45 minutes, median operative blood loss was 25 mL, and median length of stay was 1 day. Complications occurred in 2 patients: a pneumothorax that did not require treatment and a delayed hemothorax that required tube thoracostomy. Rib biopsy was accurate in all 10 patients; metastatic disease was found in 5 of 7 cancer patients. Pain improved or resolved in 4 patients., Conclusions: The evaluation of isolated rib lesions using radionuclide-guided rib biopsy with an intraoperative hand-held gamma probe is accurate and potentially therapeutic. Thoracic surgeons and oncologists should be aware of this approach.

The murein (peptidoglycan) sacculus is an essential polymer embedded in the bacterial envelope. The Escherichia coli class B penicillin-binding protein (PBP) 3 is a murein transpeptidase and essential for cell division. In an affinity chromatography experiment, the bifunctional transglycosylase-transpeptidase murein synthase PBP1B was retained by PBP3-sepharose when a membrane fraction of E. coli was applied. The direct protein-protein interaction between purified PBP3 and PBP1B was characterized in vitro by surface plasmon resonance. The interaction was confirmed in vivo employing two different methods: by a bacterial two-hybrid system, and by cross-linking/co-immunoprecipitation. In the bacterial two-hybrid system, a truncated PBP3 comprising the N-terminal 56 amino acids interacted with PBP1B. Both synthases could be cross-linked in vivo in wild-type cells and in cells lacking FtsW or FtsN. PBP1B localized diffusely and in foci at the septation site and also at the side wall. Statistical analysis of the immunofluorescence signals revealed that the localization of PBP1B at the septation site depended on the physical presence of PBP3, but not on the activity of PBP3. These studies have demonstrated, for the first time, a direct interaction between a class B PBP (PBP3) and a class A PBP (PBP1B) in vitro and in vivo, indicating that different murein synthases might act in concert to enlarge the murein sacculus during cell division.

PBP1B is a major bifunctional murein (peptidoglycan) synthase catalyzing transglycosylation and transpeptidation reactions in Escherichia coli. PBP1B has been shown to form dimers in vivo. The K(D) value for PBP1B dimerization was determined by surface plasmon resonance. The effect of the dimerization of PBP1B on its activities was studied with a newly developed in vitro murein synthesis assay with radioactively labeled lipid II precursor as substrate. Under conditions at which PBP1B dimerizes, the enzyme synthesized murein with long glycan strands (>25 disaccharide units) and with almost 50% of the peptides being part of cross-links. PBP1B was also capable of synthesizing trimeric muropeptide structures. Tri-, tetra-, and pentapeptide compounds could serve as acceptors in the PBP1B-catalyzed transpeptidation reaction.

Many VISA (vancomycin intermediately resistant Staphylococcus aureus) strains are characterized by increased cell wall biosynthesis and decreased cross-linking of the peptide side chains, leading to accumulation of free D-alanyl-D-alanine termini in the peptidoglycan, which act as false target sites for vancomycin. A spontaneous mutant of methicillin-resistant VISA strain SA137/93A (vancomycin MIC [E-test], 8 micro g/ml), called SA137/93G, showed increased resistance to vancomycin (MIC [E-test], 12 micro g/ml). Analysis of the resistance profile of the mutant revealed a loss of beta-lactam resistance with a concomitant increase in resistance to glycopeptides. In both strains, cell wall thickness was 1.4-fold greater than that of control isolates. However, cross-linking of the cell wall was drastically lower in SA137/93A than in SA137/93G. The sensitivity of strain SA137/93G to beta-lactams was due to loss of the beta-lactamase plasmid and a deletion that comprises 32.5 kb of the methicillin resistance cassette SCCmec, as well as 65.4 kb of chromosomal DNA. A spontaneous mutant of SA137/93G with higher sensitivity to vancomycin displayed a cell wall profile similar, in some respects, to that of an fmhB mutant. Results described here and elsewhere show that the only feature common to all VISA strains is a thickened cell wall, which may play a central role in the vancomycin resistance mechanism.

In a previous study, we used the genome of serogroup B Meningococcus to identify novel vaccine candidates. One of these molecules, GNA33, is well conserved among Meningococcus B strains, other Meningococcus serogroups and Gonococcus and induces bactericidal antibodies as a result of being a mimetic antigen of the PorA epitope P1.2. GNA33 encodes a 48-kDa lipoprotein that is 34.5% identical with membrane-bound lytic transglycosylase A (MltA) from Escherichia coli. In this study, we expressed GNA33, i.e. Meningococcus MltA, as a lipoprotein in E. coli. The lipoprotein nature of recombinant MltA was demonstrated by incorporation of [3H]palmitate. MltA lipoprotein was purified to homogeneity from E. coli membranes by cation-exchange chromatography. Muramidase activity was confirmed when MltA was shown to degrade insoluble murein sacculi and unsubstituted glycan strands. HPLC analysis demonstrated the formation of 1,6-anhydrodisaccharide tripeptide and tetrapeptide reaction products, confirming that the protein is a lytic transglycosylase. Optimal muramidase activity was observed at pH 5.5 and 37 degrees C and enhanced by Mg2+, Mn2+ and Ca2+. The addition of Ni2+ and EDTA had no significant effect on activity, whereas Zn2+ inhibited activity. Triton X-100 stimulated activity 5.1-fold. Affinity chromatography indicated that MltA interacts with penicillin-binding protein 2 from Meningococcus B, and, like MltA from E. coli, may form part of a multienzyme complex.