Safety,efficiency and cost effectiveness of Bivalirudin:A systematic review

AIM To review the early and more recent studies of Bivalirudin, to assess the safety, effectiveness, and cost benefits of this drug.METHODS Literature search of MEDLINE and Pub Med databases from 1990 to 2017 using keywords as "bivalirubin" and "angiomax", combined with the words "safety", "effectiveness", "efficiency", "side effects", "toxicity", "adverse effect", and "adverse drug reaction".RESULTS A total of 66 publications were reviewed. The changes in clinical practice and differences in clinical protocols make it difficult to do direct comparisons of studies among each other. However, most trials showed decreased bleeding complications with bivalirudin, although ischemic complications and mortality were mostly comparable, with some favor towards bivalirudin.CONCLUSION Bivalirudin and heparin are both acceptable options according to current ACA/AHA guidelines. Authors conclude however, that that due to bivalirudin safer bleeding profile, it should be the preferred medication for anticoagulation.

Discharging patients home from the intensive care unit:A new trend

Discharging patients directly to home from the intensive care unit(ICU)is becoming a new trend.This review examines the feasibility,benefits,challenges,and considerations of directly discharging ICU patients.By analyzing available evidence and healthcare professionals'experiences,the review explores the potential impacts on patient outcomes and healthcare systems.The practice of direct discharge from the ICU presents both opportunities and complexities.While it can potentially reduce costs,enhance patient comfort,and mitigate complications linked to extended hospitalization,it necessitates meticulous patient selection and robust post-discharge support mechanisms.Implementing this strategy successfully mandates the availability of home-based care services and a careful assessment of the patient's readiness for the transition.Through critical evaluation of existing literature,this review underscores the significance of tailored patient selection criteria and comprehensive post-discharge support systems to ensure patient safety and optimal recovery.The insights provided contribute evidence-based recommendations for refining the direct discharge approach,fostering improved patient outcomes,heightened satisfaction,and streamlined healthcare processes.Ultimately,the review seeks to balance patientcentered care and effective resource utilization within ICU discharge strategies.

Cost Effective Optimal Task Scheduling Model in Hybrid Cloud Environment

In today’s world, Cloud Computing (CC) enables the users to accesscomputing resources and services over cloud without any need to own the infrastructure. Cloud Computing is a concept in which a network of devices, located inremote locations, is integrated to perform operations like data collection, processing, data profiling and data storage. In this context, resource allocation and taskscheduling are important processes which must be managed based on the requirements of a user. In order to allocate the resources effectively, hybrid cloud isemployed since it is a capable solution to process large-scale consumer applications in a pay-by-use manner. Hence, the model is to be designed as a profit-driven framework to reduce cost and make span. With this motivation, the currentresearch work develops a Cost-Effective Optimal Task Scheduling Model(CEOTS). A novel algorithm called Target-based Cost Derivation (TCD) modelis used in the proposed work for hybrid clouds. Moreover, the algorithm workson the basis of multi-intentional task completion process with optimal resourceallocation. The model was successfully simulated to validate its effectivenessbased on factors such as processing time, make span and efficient utilization ofvirtual machines. The results infer that the proposed model outperformed theexisting works and can be relied in future for real-time applications.

Decision-tree analysis for cost-effective management of solitary pulmonary nodules in China

AIM: To analyze the cost-effectiveness of the diagnosis of solitary pulmonary nodule(SPN) in China. METHODS: Decision analysis models were constructed to assess the cost-effectiveness of four strategies for the management of SPN: computed tomography(CT) alone, CT plus CT-guided automated cutting needle biopsy(ACNB), CT plus positron emission tomography/computed tomography(PET/CT), CT plus diffusionweighted magnetic resonance imaging(DWI) plus PET/CT. RESULTS: The prevalence of lung cancer among SPN discovered in the clinical setting was approximately 50%. The CT plus ACNB strategy had higher diagnostic accuracies(87% vs 81%), with a cost saving of $1945 RMB per patient, and reducing unnecessary thoracotomy by 16.5%; this was associated with a 4.5% missed diagnosis rate. CT plus DWI plus PET/CT strategy also had higher accuracies(95% vs 81%), with a cost saving of $590 RMB per patient, and reducing unneces-sary thoracotomy by 13.5%; this was accompanied by 0.3% missed diagnosis rate. CT plus PET strategy is cost effective at a prevalence rate of 0-34%, but there was a larger prevalence range of lung cancer for CT plus ACNB strategy(from 0 to 0.6) and CT plus DWI plus PET/CT strategy(from 0 to 0.64). CONCLUSION: CT plus DWI plus PET/CT strategy was cost-effective, and had a higher accuracy accompanied by a lower missed diagnosis rate than CT plus ACNB strategy.

Ammonia Emissions in EuropemCosts, Regulation and Targets with Focus on Denmark

The NEC （National Emission Ceiling） directive has set targets for the 2010 ammonia emissions from a number of European countries. The target will be reached by most EU-countries and the total emission for EU-27 has been reduced by 22% from 1990 to 2007. Denmark is one of the countries with the largest reductions since 1990 and the article aims at the measures and costs involved. The conclusion is that the costs have been under 3ε per kg NH3-N. Measures in several countries are under 5ε per kg NH3-N, which is a likely minimum for the benefits of reducing NH3-N. The findings suggest that the same measures might be cheaper in the Netherlands and Denmark than in the UK and the USA due to technology advances and stricter regulations in the past. The new Danish application procedure, when increasing the animal production, has tried to make the acceptance procedure quicker and dynamic ensuring that new technology is adopted quicker and that the farm has the right location. It is concluded that the new application process so far has not lived up to the high expectations at the outset. Despite this, the paper concludes that Denmark is likely to reduce emission by 50% from 1990 to 2020 and reach the likely 2020 NEC ceiling.

Open Partial Nephrectomy: One Night Length of Stay Is Safe and Cost Effective

Objective: To review our open partial nephrectomy (OPN) experience and compare to known robotic partial nephrectomy (RPN) data to determine whether length of stay (LOS) and morbidity are significant drivers in the surgical approach employed for partial nephrectomy. Methods: We reviewed our OPN experience during the last 3 years examining age, tumor size, LOS, pathology, blood loss, complications, recurences, and deaths. Results: Seventy-five patients underwent OPN during this period. Mean age was 59 years, tumor size 2.8 cm, percent malignant 75%, estimated blood loss 350 cc. With a median follow-up of 18 months, there was one urinoma managed by drain-age, one pseudo aneurysm that required embolization and one pulmonary embolism that required anticoagulation. There were no readmissions, no tumor recurences, and no deaths. Our major complication rate was 4% as compared to other trials that re-ported major complication rates between 1% - 9% for RPN and between 3% - 24% for OPN. In the first half of the experience (n = 37), median LOS was 57 hours. Using a pathway encouraging early ambulation and smaller incisions in the second half of the experience (n = 38), median LOS was 35 hours. This is much shorter than reported RPN LOS of 62 - 67 hours and OPN LOS of 108 - 142 hours. Conclusion: OPN can be performed safely and effectively with one night hospital stay. This provides a more cost-effective approach to partial nephrectomy with similar or better complication rates and calls into question the main value drivers of RPN.

Optimization of a High Throughput, Cost Effective, and All-stage DNA Extraction Protocol for Sorghum （Sorghum bicolor）

The extraction of DNA for molecular analyses is often a limiting factor in terms of cost, time, and availability of skilled labor Here the authors describe a simple extraction protocol for obtaining DNA from field and greenhouse grown plants. This method was optimized for sampling mature wild sorghum populations in remote areas of Ethiopia and young greenhouse grown seedlings for genetic studies using microsatellite loci. Initially, the leaf squashes are made on Whatman FTA plant saver cards or small cards of Whatman chromatography paper. After several washes, sufficient DNA to run up to 70 PCR amplifications is eluted from a 6 mm disk. Both types of cards were equally effective for collecting genomic DNA from young and mature sorghum plants for PCR-based analyses. The use of this technology for extracting genomic DNA from seedlings and/or mature plants in situ is particularly attractive for sampling at sites that are far from the laboratory where samples are ultimately analyzed. Moreover, highly skilled personnel are not required to collect DNA samples using this protocol. The Whatman FTA card is more expensive than the Wbatman chromatography paper. Therefore, without compromising efficiency, the lower cost chromatography paper can be used for DNA extraction, especially for institutions in developing countries.

Comparing mass screening techniques for gastric cancer in Japan

AIM： To discuss the efficacy of endoscopic mass screening for gastric cancer.METHODS： The data used in this study were the results of mass screening programs for gastric cancer in Niigata City from 2002 to 2004. The number of participants was 35089 in 2002, 34557 in 2003 and 36600 in 2004. The finding ratio referred to the final diagnosis of gastric cancer after a double check of endoscopic files and histological findings. The costs of identifying one case of gastric cancer were calculated based on the total expense for each screening program and additional close examinations. RESULTS： From the analysis of individual screening program with endoscopy, individual screening program with X-ray （ISX） and mass screening program with photofluorography （MSP） in reference to the finding ratio of gastric cancer, endoscopic examination was the best for detecting early gastric cancer, the finding ratio was 0.87% in 2004, approximately 2.7 and 4.6 times higher than those of the ISX and MSP groups. In addition, this novel method was the cheapest means regarding the cost of identifying one case of gastric cancer, which was estimated to be 1608000 Japanese yen in 2004. CONCLUSION： Endoscopic mass screening is a promising method and can be effectively applied if a sufficient number of skilled endoscopists become available to staff the system and if city offices support it.

Laboratory model study of newly deposited dredger fills using improved multiple-vacuum preloading technique

Problems continue to be encountered concerning the traditional vacuum preloading method in field during the treatment of newly deposited dredger fills.In this paper,an improved multiple-vacuum preloading method was developed to consolidate newly dredger fills that are hydraulically placed in seawater for land reclamation in Lingang Industrial Zone of Tianjin City,China.With this multiplevacuum preloading method,the newly deposited dredger fills could be treated effectively by adopting a novel moisture separator and a rapid improvement technique without sand cushion.A series of model tests was conducted in the laboratory for comparing the results from the multiple-vacuum preloading method and the traditional one.Ten piezometers and settlement plates were installed to measure the variations in excess pore water pressures and moisture content,and vane shear strength was measured at different positions.The testing results indicate that water dischargeetime curves obtained by the traditional vacuum preloading method can be divided into three phases:rapid growth phase,slow growth phase,and steady phase.According to the process of fluid flow concentrated along tiny ripples and building of larger channels inside soils during the whole vacuum loading process,the fluctuations of pore water pressure during each loading step are divided into three phases:steady phase,rapid dissipation phase,and slow dissipation phase.An optimal loading pattern which could have a best treatment effect was proposed for calculating the water discharge and pore water pressure of soil using the improved multiple-vacuum preloading method.For the newly deposited dredger fills at Lingang Industrial Zone of Tianjin City,the best loading step was 20 kPa and the loading of 40-50 k Pa produced the highest drainage consolidation.The measured moisture content and vane shear strength were discussed in terms of the effect of reinforcement,both of which indicate that the multiple-vacuum preloading method has a better treatment effect not only in decreasing the moisture content and increasing the bearing capacity,but also in increasing the process uniformity at different depths of foundation.

Decision modelling for economic evaluation of liver transplantation

As the gap between a shortage of organs and the im-mense demand for liver grafts persists, every available donor liver needs to be optimized for utility, urgency and equity. To overcome this challenge, decision modelling might allow us to gather evidence from previous studies as well as compare the costs and consequences of alternative options. For public health policy and clinical intervention assessment, it is a potentially powerful tool. The most commonly used types of decision analytical models include decision trees, the Markov model, microsimulation, discrete event simulation and the system dynamic model. Analytic models could support decision makers in the field of liver transplantation when facing specifc problems by synthesizing evidence, comprising all relevant options, generalizing results to other contexts, extending the time horizon and exploring the uncertainty. For modeling studies of economic evaluation for transplantation, understanding the current nature of the disease is crucial, as well as the selection of appropriate modelling techniques. The quality and availability of data is another key element for the selection and development of decision analytical models. In addition, good practice guidelines should be complied, which is important for standardization and comparability between economic outputs.

Endoscopic management of occluded biliary uncovered metal stents:A multicenter experience

AIM:To compare diverse endoscopic interventions in the management of occluded uncovered self-expanding metal stents(SEMSs) that had been placed for palliative treatment of unresectable malignant biliary obstruction.METHODS:A retrospective review was undertaken in 4 tertiary endoscopic centers to determine optimal management of different types of occluded SEMSs.The technical success of performed treatment in occluded SEMSs,the patency of the stent,the need for re-intervention and the financial costs of each treatment were analyzed.RESULTS:Fifty four patients were included in the analysis;21 received Hanaro,19 Wallstent and 14 Flexus.For the relief of obstruction,a plastic stent was inserted in 24 patients,a second SEMS in 25 and mechanical cleaning was performed in 5 patients.The overall median second patency rates between second SEMSs and plastic stents did not differ(133 d for SEMSs vs 106 d for plastic stents;P = 0.856).Similarly,no difference was found between the overall survival of SEMS and plastic stent groups,and no procedure-related complications occurred.Incremental cost analysis showed that successive plastic stenting was a cost-saving strategy at least in Greece.CONCLUSION:Insertion of uncovered SEMSs or plastic stents is a safe and effective treatment for occluded uncovered SEMSs;insertion of plastic stents appears to be the most cost-effective strategy.

Barium meal follow through with pneumocolon:Screening test for chronic bowel pain

AIM： To study the sensitivity, specificity and cost effectiveness of barium meal follow through with pneumocolon （BMFTP） used as a screening modality for patients with chronic abdominal pain of luminal origin in developing countries. METHODS： Fifty patients attending the Gastroenterology Unit, SMS Hospital, whose clinical evaluation revealed chronic abdominal pain of bowel origin were included in the study. After routine testing, BMFT, BMFTP, contrast enhanced computed tomography （CECT） of the abdomen, barium enema and colonoscopy were performed. The sensitivity, specificity and cost effectiveness of these imaging modalities in the detection of small and/or large bowel lesions were compared. RESULTS： Out of fifty patients, structural pathology was found in ten. Nine out of these ten patients had small bowel involvement while seven had colonic involvement alone or in combination with small bowel involvement. The sensitivity of BMFTP was 100% compared to 88.89% with BMFT when detecting small bowel involvement （BMFTP detected one additional patient with ileocecal involvement）. The sensitivity and specificity of BMFTP for the detection of colonic pathology were 85.71% and 95.35% （41/43）, respectively. Screening a patient with chronic abdominal pain （bowel origin） using a combination of BMFT and barium enema cost significantly more than BMFTP while their sensitivity was almost comparable. CONCLUSION： BMFTP should be included in the investigative workup of patients with chronic abdominal pain of luminal origin, where either multiple sites （small and large intestine） of involvement are suspected or the site is unclear on clinical grounds. BMFTP is an economical, quick and comfortable procedure which obviates the need for colonoscopy in the majority of patients.

Perspectives of newborn hearing screening in resource constrained settings

Newborn hearing screening is an effective strategy for early identification of hearing loss in the newborn which result in early intervention and best outcome.However implementing universal screening strategy is a challenge in many resource constrained settings.There are various limitations towards successful implementation of hearing screening program in the developing countries.The cost effectiveness of the screening program also needs to be considered in a resource constrained settings.We attempt to provide a viewpoint that can be potentially helpful for the successful implementation of hearing screening in a resource constrained settings of the developing countries.

Analysis of Listeriosis Transmission Dynamics with Optimal Control

Listeriosis is an illness caused by the germ Listeria monocytogenes. Generally, humans are infected with listeriosis after eating contaminated food. Listeriosis mostly affects people with weakened immune systems, pregnant women and newborns. In this paper, a model describing the dynamics of Listeriosis is developed and analysed using ordinary differential equations. The model was analysed both quantitatively and qualitatively for its local and global stability, basic reproductive number and parameter contributions to the basic reproductive number to understand the impact of each parameter on the disease spread. The Listeriosis model has been extended to include time dependent control variables such as treatment of both humans and animals, vaccination and education of humans. Pontryagin’s Maximum Principle was introduced to obtain the best optimal control strategies required for curbing Listeriosis infections. Numerical simulation was performed and the results displayed graphically and discussed. Cost effectiveness analysis was conducted using the intervention averted ratio (IAR) concepts and it was revealed that the most effective intervention strategy is the treatment of infected humans and animals.

Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant diagnosis(EID),economic evaluations are needed to inform program design and implementation.This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases(Embase,MEDLINE and EconLit)and grey literature for economic analyses of HIV EID in low-and middle-income countries published between January 2008 and June 2021.We extracted data on unit costs,cost savings,and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats.We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records,we included 29 studies:17 cost analyses and 12 model-based cost-effectiveness analyses.Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests.All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective.Most studies reported costs of EID testing strategies;however,few studies assessed the same intervention or reported costs in the same way,making comparison of costs across studies challenging.Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV,while not directly comparable across studies,covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving.Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.

Effect of Roselle calyces extract on the chemical and sensory properties of functional cupcakes

Roselle calyces(RC)are a major crop for export and used to make a common drink in Egypt.Dried RC are commercially available and appreciated to obtain concentrated extracts which might be used in the food and pharmaceutical industries for color and heath benefits.The objective of this research was to determine the chemical and the sensory properties of cupcakes formulated with Roselle calyces extract(RCE).Proximate analysis,anthocyanins,ascorbic acid,titrable acidity,%retaining of anthocyanins,color and sensory evaluations were done.RC cupcakes had high sensory scores(P<0.05)compared to control cupcakes.The parameter a*was significantly red in the RC cupcakes compared to control cupcakes along with 77%retaining of anthocyanins.The consumption of 100 g of the RC cupcakes would provide 465 mg/100 g dry matter anthocyanin that is more than 2 folds of the minimum average of the daily intake of anthocyanins for Americans,along∼1/3 of the daily dietary fiber intake to achieve fiber adequacy according to the Scientific Advisory Committee on Nutrition.RC cupcake can be a functional food and would have a“clean”label with cost effective advantage.

Serum SCCA-IgM as a predictor of hepatocellular carcinoma in patients with liver cirrhosis

Aberrant Squamous Cell Carcinoma Antigen (SCCA) expression is an early hepatocarcinogenetic event and circulating SCCA-IgM complexes are elevated in most HCC patients. We evaluated whether serum SCCA-IgM levels can identify HCV +ve cirrhotic patients at low HCC risk. In this retrospective study we enrolled 29 cirrhotic patients in whom serum SCCA-IgM was measured 8 - 69 months (median 31) before HCC diagnosis, and 28 cirrhotic patients who remained HCC- free, with SCCA-IgM measured 15 - 68 months (median 48) before the study end. The best discriminating value of SCCA-IgM was calculated and tested in predicting HCC diagnosis within 12, 24 and 36 months. Sensitivity analysis, considering different HCC incidence, was conducted to identify the patient subgroup with an annual cancer risk below the threshold of a cost-effective semiannual surveillance with ultrasound. Cumulative HCC incidence at 12, 24 and 36 months was 7.0%, 15.7% and 26.3%, respectively. SCCA-IgM levels were higher in HCC than in cirrhotic patients [median: 381 (95% C.I.: 50 - 5289) vs. 100 (70 - 493) AU/mL, P = 0.005]. The SCCA-IgM value ≤ 200 AU/mL accurately identified patients at low risk of HCC development in the subsequent year (sensitivity 75%, specificity 62%, positive predictive value 13% and negative predictive value 97%). Considering an annual HCC incidence ≤ 3%, patients with SCCA-IgM ≤ 200 AU/mL (60% of the whole patients) had an HCC risk below the accepted threshold of a cost-effective surveillance (1.5%). In conclusion, provided that our provocative results are confirmed in larger studies, SCCA-IgM serum measurement could permit implementation of a two step (with different costs) surveillance: an initial serological surveillance, based on the annual monitoring of this biomarker, and the conventional surveillance by semiannual US when SCCA-IgM becomes >200 AU/mL. This could improve the cost/effectiveness of surveillance of HCV infected patients at risk of HCC.

The Cost-effectiveness and Risk Analysis of Dynamic Conflict Decision Making

This paper introduces the technique of cost effectiveness and risk analysis employed in decision making appraisal to the major processes of analysis of the dynamic conflict decision making modelling, and have obtained conflict state transfer, conflict decision making selection, cost effectiveness and risk computation appraisal model of enforcement under different patterns. This work has made the dynamic conflict decision modelling analysis more comprehensive, accurate and effective.

Environmental Mapping of Potential Habitats for Anthropod Vectors of Trypanosomiasis in Northern Nigeria

This paper presents analysis of a cost effective methodology using remotely sensed data analysed within a geographical systems (GIS) environment for mapping out potential habitats of anthropod vectors responsible for trypanosomiasis in northern Nigeria. These geographical locations are areas with high population of livestock in Nigeria. Animal Trypanosomiasis is considered as an arthropod-borne viral disease which is endemic in about 37 countries of the sub-Saharan Africa and in particular northern Nigeria. This anthropod-borne viral disease remains a threat to both humans and livestock in many communities, and the outbreak of such diseases is shown to relate to fluctuations in the changing climate mostly experienced whenever there are changes in global precipitation which also relates to changes in sea surface temperatures otherwise known as “El Niňo Southern Oscillations” (ENSO). Monthly Satellite imageries in the form of Normalised Difference Vegetation Index (NDVI) at 250 meters spatial resolution obtained from NASA-MODIS/CMD were subjected to principal component analysis utilizing the standardized principal components within a GIS environment and supplemented with Digital Elevation Model (DEM) data in the analysis. Results from the maps showed that pockets of probable habitats of these anthropod vectors responsible for trypanosomiasis mostly located around forest islands characterized by dry woodland and savanna, and in some cases around gallery forests and few lowland and riverine areas. This study provides baseline information for policy makers in Nigeria and other stakeholders as a cost effective measure for mapping potential habitats for anthropod vectors responsible for trypanosomiasis in Northern Nigeria. Further studies are encouraged so as to clearly understand the magnitude and actual locations of the habitat of this vector and find ways of targeting their locations for minimizing or even eradicating these vectors.

Cost-effectiveness of one-stage versus two-stage breast reconstruction in the United Kingdom

Aim:Permanent expanders allow for breast reconstruction as a single stage.These prostheses are more expensive than conventional tissue expanders,but this excess cost is markedly offset as only one operation is required.However,if the revision rate is sufficiently high,then this effect is negated.We aim to compare costs of one-stage vs.two-stage reconstruction at a single center,taking into account explantation and unexpected admissions following complications.Methods:A retrospective review was carried out on all patients who underwent one-stage and two-stage reconstruction over a 5-year period by a single surgeon.A cost analysis was performed taking into account,explantation and additional admissions.Results:One hundred and forty-three one-stage and 45 two-stage procedures were included.The explantation rate for one-stage procedures is 36%,at a mean of 12.9 months postimplantation,the majority of which were exchanged for silicone implants to improve cosmesis.Four(9%)of the two-stage procedures were explanted a mean of 18 months postreconstruction.Overall,one-stage reconstructions were significantly more expensive than the two-stage group(P=0.016).Conclusion:There are many benefits of one-stage breast reconstruction.However,it does not appear to be cost-effective when additional admissions for explantation surgery are taken into account.