Additional Cost Burden Research Articles

Risk factors for hospital-acquired influenza A and patient characteristics: a matched case-control study

BackgroundWhile hospital-acquired influenza A results in an additional cost burden and considerable mortality in patients, its risk factors are unknown. We aimed to describe the characteristics of patients vulnerable to hospital-acquired influenza A and to identify its risk factors to assist clinicians control hospital-acquired infections and reduce the burden of treatment.MethodsA case-control study was conducted among hospitalized patients aged ≥18 years at a tertiary level teaching hospital during the 2018–2019 influenza A season. Patient data were retrieved from hospital-based electronic medical records. Hospital-acquired influenza A was defined as a case of influenza A diagnosed 7 days or more after admission, in a patient with no evidence of influenza A infection on admission. The controls without influenza A were selected among patients exposed to the same setting and time period. We identified risk factors using conditional logistic regression and described the characteristics of hospital-acquired influenza A by comparing the clinical data of infected patients and the controls.ResultsOf the 412 hospitalized patients with influenza A from all the departments in the study hospital, 93 (22.6%) cases were classified as hospital-acquired. The most common comorbidities of the 93 cases were hypertension (41.9%), coronary heart disease (21.5%), and cerebrovascular disease (20.4%). Before the onset of hospital-acquired influenza A, patients presented more lymphocytopenia (51.6% vs 35.5%, P = 0.027), hypoalbuminemia (78.5% vs 57.0%, P = 0.002), and pleural effusion (26.9% vs 9.7%, P = 0.002) than the matched controls. Infected patients also had longer hospital stays (18 days vs 14 days, P = 0.002), and higher mortality rates (10.8% vs 2.2%, P = 0.017) than the matched controls. Lymphocytopenia (odds ratio [OR]: 3.11; 95% confidence interval [CI]: 1.24–7.80; P = 0.016), hypoalbuminemia (OR: 2.24; 95% CI: 1.10–4.57; P = 0.027), and pleural effusion (OR: 3.09; 95% CI: 1.26–7.58; P = 0.014) were independently associated with hospital-acquired influenza A.ConclusionsLymphocytopenia, hypoalbuminemia and pleural effusion are independent risk factors that can help identify patients at high risk of hospital-acquired influenza A, which can extend hospital stay and is associated with a high mortality.

Health implications of economic growth: the role of air pollution

Economic growth comes with benefit and cost. The benefits include improved standard of living, better health care facilities and longer years of living as well as better chances of attaining higher education. There are also costs to economic growth. Economic growth entails increasing productive and consumption activities that can lead to health challenges, increase in income inequality, depletion of natural resources and increased environmental pollution, especially air pollution. Air pollution also indirectly affects income generation and savings for households. It places additional cost burden on governments. This paper thus evaluated the relationship that exists between economic growth and health performance in Nigeria vis-à-vis air pollution. The study used the PROCESS software to estimate the direct, indirect and total effects of economic growth on the health performance in Nigeria. The study found a direct and positive relationship exist between gross domestic product and life expectancy, variables used to capture both economic growth and health performance in Nigeria. It further found that the relationship could be indirectly effected with the use of a transmission mechanism, in this case-air pollution, to show that economic growth may not always lead to better health outcomes.

Accelerating SGD using flexible variance reduction on large-scale datasets

Stochastic gradient descent (SGD) is a popular optimization method widely used in machine learning, while the variance of gradient estimation leads to slow convergence. To accelerate the speed, many variance reduction methods have been proposed. However, most of these methods require additional memory cost or computational burden on full gradient, which results in low efficiency or even unavailable while applied to real-world applications with large-scale datasets. To handle this issue, we propose a new flexible variance reduction method for SGD, named FVR-SGD, which can reduce memory overhead and speed up the convergence using flexible subset without extra computation. We analyze the details of convergence property for our method, and linear convergence rate can be guaranteed while using flexible variance reduction. Some efficient variants for distributed environment and deep neural networks are also proposed in this paper. Several numerical experiments are conducted on a genre of real-world large-scale datasets. The experimental results demonstrated that FVR-SGD outperforms the currently popular algorithms. Specifically, the proposed method can achieve up to 40% reduction in the training time to solve the optimization problem of logistic regression, SVM and neural networks.

Cost burden associated with advanced non-small cell lung cancer in Europe and influence of disease stage

BackgroundAlthough evidence suggests that stage of disease may influence costs associated with non-small cell lung cancer (NSCLC), there remains a relative paucity of data on the financial burden incurred directly by patients and their informal caregivers as they progress through the disease course. As part of a large, cross-sectional study of the “real-world” humanistic and financial burden of advanced NSCLC in Europe, an analysis was conducted to quantify the cost burden of disease from a patient and caregiver perspective, and to evaluate how stage of disease impacts these costs.MethodsFinancial data were collected (May 2015–June 2016) during a multinational (France, Germany, and Italy) cross-sectional study of adults with advanced NSCLC (stage IIIB–IV) and their informal (unpaid) caregivers. Data were obtained via medical chart reviews and patient/caregiver self-completion forms. Costs were annualized and unadjusted or adjusted for government financial support. Statistical significance was assessed using Mann-Whitney U tests.ResultsOne thousand thirty patients and 427 accompanying caregivers were recruited and asked to provide cost data. Mean total unadjusted direct and indirect out-of-pocket expenses were €5691 for patients and €4125 for caregivers; after adjusting for government financial support, values were €2644 and €3477. Mean wage losses were significantly higher for patients with stage IV vs IIIB NSCLC (€2282 vs €499; p = 0.0135) as were unadjusted direct out-of-pocket expenses (€4020 vs €1546; p = 0.0306). For caregivers, a similar but non-significant trend was observed. Mean total unadjusted direct and indirect out-of-pocket costs were numerically higher for stage IV vs IIIB NSCLC among patients (€5925 vs €3528) and caregivers (€4319 vs €2232); government financial support normalized patient costs, but they remained numerically higher for stage IV disease among caregivers.ConclusionsThe financial burden of advanced NSCLC is considerable and appears to be influenced by stage of disease, with direct and indirect costs increasing as the disease progresses. Government financial support programmes appear to mitigate additional cost burdens among patients, but not among caregivers.

물류환경변화에 따른 부산항 운영사 재구성효과에 관한 실증연구

The probability of T/S cargo volume to decrease is the most notable problem associated with inappropriate mix of terminal operators in Busan port. Other problems include, the deterioration of the national carriers’ competitiveness from non-operation of own terminal, excessively high proportion of financial operators in the engagement of operation which may result in their passiveness in timely investment, additional cost burden to carriers’ in the handling inter-terminal T/S cargo transportation and inefficiency in terminal operation by the multiplicity of operators proved to be same recognized as so through the analysis. Therefore, in order to provide solutions for the problems and to strengthen Busan port’s competitiveness, this research suggests the restructuring of operators mix as follows. To achieve sustainable growth of T/S cargo, global carriers’ participation in terminal operation should be of utmost priority. To enhance the operational efficiency, the operators should be integrated. Similarly, the integration of operators will play a key role in verifying that national carriers’ own terminal operation is an important factor in raising its competence. Finally, BPA’s active engagement in the entire operation of port is also critical in public-oriented operation of the port. Whereas in the interactive analysis by taking the merits of Busan port into consideraion, global carrier’s participation in operation, integration of operators and BPA’s engagement in operation proved to contribute to the increase of T/S cargo and strengthening of operational efficiencies of Busan port.

Monoclonal Antibody Consumption Pattern in a Sponsored Tertiary-Care Healthcare System in a Developing Country: A Five-Year Study From 2013 - 2017

Background: Monoclonal antibodies are increasingly being employed in oncology, toxicology, infectious diseases and rheumatology owing to unmatched efficacy and safety; nevertheless, their usage in developing countries is restricted due to high cost to the exchequer. The newer production line of monoclonal antibodies comes forth with improved efficacy and safety of the current generation monoclonal antibodies and has led to a meteoric growth in their utility. Methods: We performed a comparative analysis of consumption pattern of monoclonal antibodies in a sponsored tertiary-care healthcare system during 2013 - 2017. The humanized anti-IgE monoclonal antibody, omalizumab, was compared with various groups of drugs used for the treatment of bronchial asthma such as combination of long-acting β-agonists and inhaled corticosteroids, short-acting β-agonists and anticholinergics, and inhaled corticosteroids and leukotriene receptor antagonists. Results: The consumption pattern revealed a three-fold increase in the number of monoclonal antibodies during 2016 - 2017 compared to the three-year period from 2013 to 2015. Omalizumab incurred the highest cost burden relative to other medicines used in bronchial asthma. The comparative analysis of usage pattern of monoclonal antibodies, immunomodulators, anti-HIV drugs and all insulin preparations demonstrates annually rising cost burden of monoclonal antibodies. Conclusions: The study showed an increasing trend of healthcare costs and proportionately increasing use of monoclonal antibodies, which add to the quality of care through increased efficacy and safety. We need to accept the fact that quality comes with an additional cost burden, and costs can be optimized with economy of scale.

A comparative study to assess the awareness of antibiotic resistance amongst first and second year medical undergraduate students in a medical college

Background: With the rising instances of antibiotic resistance and decline in the discovery of newer antibiotics, it is high time to prevent the emergence of antibiotic resistance. One of the best measures regarding the above problem is education and creating awareness regarding antibiotic resistance, and that too primarily among healthcare professionals. The initiation should start at the basic level and that too in the early days of medical profession, so that there is greater awareness and strong foundation for antibiotic prescribing pattern. The present study is taken up to compare awareness among 1st year and 2nd year medical students in a private medical college with 2nd year medical students having prior education regarding antibiotics resistance and first year students representing general public without any education regarding antibiotics resistance.Methods: This study was a comparative, cross-sectional, questionnaire based study. The questionnaire was validated for face validity and content validity from subject experts. The two groups selected were 1st year and 2nd year medical undergraduates. Data was analysed using simple descriptive statistics.Results: 136 students from 1st year and 88 students from 2nd year participated in the study. In both the groups studied, majority of the respondents completed the full course of antibiotics. 77% of 1st year and all 2nd year students were aware of the antibiotic resistance. 99% of 2nd year students and only 49% of the 1st year students were aware of the reasons for it (p<0.01). Awareness regarding prophylactic usage of antibiotics, usage for simple common cold and usage of higher antibiotics for mid infection leading to Antibiotic Resistance was significantly less among first year students. 2nd year students were well aware of consequences of antibiotic resistance like ineffective treatment, prolongation of illness, emergence of bacterial resistance and additional cost burden than 1st year students. Awareness regarding other aspects of antibiotic resistance was not significant between two groups.Conclusions: Stressing upon awareness and education regarding antibiotic resistance in the early days of medical curriculum will help in change of behaviour and habits of antibiotic usage and rational prescribing of antibiotics by the future doctors.

Universal Versus Conditional Third Day Follow-Up Visit for Children With Nonsevere Unclassified Fever at the Community Level in Ethiopia: Protocol for a Cluster Randomized Noninferiority Trial.

BackgroundUnder the World Health Organization’s integrated community case management strategy, febrile children seen by community health workers (on day 1) without a diagnosable illness and without danger signs are advised to return on day 3, regardless of symptom resolution. This advice might be unnecessary and place additional time and cost burdens on caregivers and community health workers. However, the safety of not following up with respect to children with unclassified fever is unknown.ObjectiveThe objective of this study is to establish the safety of conditional follow-up of nonsevere unclassified fever, that is, nonsevere illness with fever, no malaria, pneumonia, diarrhea, or danger signs, compared with universal follow-up on day 3, through a 2-arm cluster randomized controlled noninferiority trial.MethodsThe study is being conducted in 3 districts in southwest Ethiopia. A total of 25 health facilities are randomized to one of the 2 intervention arms; all 144 health posts and 284 community health workers are included. All enrolled children are followed-up after 1 week (on day 8) for re-assessment. If still sick on day 8, additional follow-up takes place after 2 weeks (day 15) and 1 month (day 29). To demonstrate that there is no significant increase in the percentage of children deteriorating clinically, the sample size needed for a noninferiority margin of 4%, a power of 80%, an alpha of 5%, and a design effect of 3 is 4284 children with unclassified fever. Main outcome is treatment failure on day 8, defined as death, hospitalization, one or more danger signs, or persistent fever.ResultsThe project was funded in 2015 and enrollment was completed 2016. Data analysis is currently under way, and the first results are expected to be submitted for publication in 2018.ConclusionsThis study addresses the question as to whether there is any benefit in recommending universal follow-up among children seen for nonsevere unclassified fever, or whether parents can be counseled to return in the event of persistent fever, using a cluster randomized controlled trial design embedded in a national program. Outcomes will be relevant for policy makers and are important for the evaluation of current and future World Health Organization guidelines for the management of children with fever.Trial RegistrationClinicalTrials.gov NCT02926625; https://clinicaltrials.gov/ct2/show/NCT02926625 (Archived by WebCite at http://www.webcitation.org/6xrQWn50t)

Scintigraphic evaluation of esophageal motility and gastroesophageal reflux in patients presenting with upper respiratory tract symptoms

Purpose of Study:The purpose is to evaluate the findings and utility of esophageal transit scintigraphy (ETS) and gastroesophageal reflux scintigraphy (GES) in patients presenting with upper respiratory tract (URT) symptoms suspected to be due to gastroesophageal reflux (GER) disease.Materials and Methods:Thirty patients aged between 19 and 60 years underwent nasopharyngolaryngoscopy (NPL), ETS, and GES. Correlation between GER, esophageal motility, and NPL was evaluated. Inclusion criteria include patients with recurrent URT symptoms such as chronic dry cough/hoarseness of voice and itching/foreign body sensation in throat. Those with typical gastrointestinal (GI) symptoms of GER, URT symptoms relieved by antibiotics, surgical intervention in abdomen, cardiac/hepatobiliary diseases, etc. were excluded from the study.Results:Significant correlation was found between GER and NPL in 28/30 patients. More the grade of reflux, more severe was the NPL findings. Two patients with Grade II reflux had normal NPL suggesting structural inflammatory changes due to acidic pH of refluxate which have not yet manifested or symptoms could be due to nonacid refluxate. Incidence of esophageal motility disorder was statistically significant in patients with GER disease (GERD). Patients who had symptoms, but no demonstrable GER showed delayed ET in supine position suggesting the presence of esophageal motility disorder even before GERD.Conclusion:GES demonstrated GER in patients presenting with URT symptoms without typical GI symptoms. ETS showed coexistence of esophageal motility disorder in most patients presenting with URT symptoms even without an associated reflux disease. We hypothesize that primary abnormal esophageal motility leads to delayed esophageal clearance and consequently to URT symptoms. Addition of ETS to GES is easily feasible with no significant additional cost, time, or radiation burden.

Poor recovery of households from out-of-pocket payment for assisted reproductive technology.

How do households recover financially from direct out-of-pocket payment for government subsidized ART? After a mean of 3.8 years, there was poor recovery from initiated financial coping strategies with the poorest households being disproportionatley affected. Out-of-pocket payment for health services can create financial burdens for households and inequities in access to care. A previous study conducted at a public-academic institution in South Africa documented that patient co-payment for one cycle of ART resulted in catastrophic expenditure for one in five households, and more frequently among the poorest, requiring diverse financial coping strategies to offset costs. An observational follow-up study was conducted ~4 years later to assess financial recovery among the 135 couples who had participated in this previous study. Data were collected over 12 months from 73 informants. The study was conducted at a level three referral hospital in the public-academic health sector of South Africa. At this institution ART is subsidized but requires patient co-payments. A purpose-built questionnaire capturing socio-economic information and recovery from financial coping strategies which had been activated was administered to all informants. Financial recovery was defined as the resolution of strategies initiated for the specific purpose of covering the original ART cycle. Results were analysed by strategy and household with the latter including analysis by tertiles based on socio-economic status at the time of the original expenditure. In addition to descriptive statistics, the Pearson Chi squared test was used to determine differences between socioeconomic tertiles and associations between recovery and other variables. The participation rate in this follow-up study was 54.1% with equal representation from the three socio-economic tertiles. The average duration of follow-up was 46.1 months (±9.78 SD) and respondents' mean age was 42 years (range 31-52). The recovery rate was below 50% for four of five strategies evaluated: 23.1% of households had re-purchased a sold asset; 23.5% had normalized a previous reduction in household spending, 33.8% had regained their savings, and 48.7% were no longer bolstering income through additional work. Two-thirds of households (60.0%) had repaid all loans and debts. The poorest households showed lower rates of recovery when compared to households in the richest tertile. Complete recovery from all strategies initiated was reported by only 10 households (13.7%): 1 of 19 in the lowest tertile, 3 of 30 in the middle and by 6 of 24 households in the richest tertile (P > 0.05). No association was found between the degree of financial recovery and additional cost burdens incurred, including related to babies born; or between the degree of recovery and ongoing pursuit of ART. The sample size was limited. The participation rate was just over 50%. Results were dependent on participants' narrative and recall. The willingness of patients to pay for ART does not necessarily imply the ability to pay. As a result, the lack of comprehensive third-party funding for ART can create immediate and long-term financial hardship which is more pronounced among poorer households. While more data on the impact of out-of-pocket payment for ART are needed to illustrate the problem in other low resource settings, the results from South Africa provide useful information for similar developing countries. The current absence of more extensive data should therefore not be a barrier to the promotion of financial risk protection for infertile couples, especially the poorest, in need of ART. The study was supported by a Masters Student Grant from the Faculty of Health Sciences, University of Cape Town. The authors had no competing interests. Not applicable.

Minimally invasive vs open nephrectomy in the modern era: does approach matter?

To evaluate if the widespread adoption of a minimally invasive approach to radical nephrectomy has affected short- and long-term patient outcomes in the modern era. A retrospective cohort study of patients who underwent radical nephrectomy from 2001 to 2012 was conducted using the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) Program and Medicare insurance program database. Patients who underwent open surgery were compared to those who underwent minimally invasive surgery using propensity score matching. 10,739 (85.9%) underwent open surgery and 1776 (14.1%) underwent minimally invasive surgery. Minimally invasive surgery increased from 18.4% from 2001-2004 to 43.5% from 2009 to 2012. After median follow-up of 57.1months, minimally invasive radical nephrectomy conferred long-term oncologic efficacy in terms of overall (HR 0.84; 95% CI 0.75-0.95) survival and cancer-specific (HR 0.68; 95% CI 0.54-0.86) survival compared to open radical nephrectomy. Minimally invasive surgery was associated with lower risk of inpatient death [risk ratio (RR) 0.45 with 95% CI: (0.20-0.99), p=0.04], deep vein thrombosis [RR: 0.35 (0.18-0.69), p=0.002], respiratory complications [RR: 0.73 (0.60-0.89), p=0.001], infectious complications [RR: 0.35 (0.14-0.90), p=0.02], acute kidney injury [RR: 0.66 (0.52-0.84), p<0.001], sepsis [RR: 0.55 (0.31-0.98), p=0.04], prolonged length of stay (18.6 vs 30.0%, p<0.001), and ICU admission (19.7 vs 26.3%, p<0.001). Costs were similar between the two approaches (30-day costs $15,882 vs $15,564; p=0.70). After widespread adoption of minimally invasive approaches to radical nephrectomy across the United States, oncologic standards remain preserved with improved perioperative outcomes at no additional cost burden.

Is it important to analyse serum liver enzymes in patients with established metabolic syndrome? A Pilot study to tie the knot

Background: Metabolic Syndrome (MetS) is one of theemerging health problems which is the major area of concern as it is not only a potential risk factor for some many diseases but it also affecting globally. It is a common multi-factorial disorder of metabolic derangements and prominent etiological factors for the development and progression of atherosclerotic vascular disease and type 2 diabetes. The relation between elevated serum gamma-glutamyltranferase and metabolic syndrome, however, have been not well explored in a developing country like India. Aims and Objectives: The current study was designed to estimate the levels of alanine transaminase (ALT), aspartate transaminase (AST), and gamma-glutamyltransferase (GGT) in metabolic syndrome patients with age-sex matched healthy controls. Furthermore the relation of liver function status with the various biochemical parameters of metabolic syndrome was explored.Materials and Methods: In this present only patients of metabolic syndrome were selected based on inclusion and exclusion criteria of selecting cases. All the biochemical parameters were analysed using standard methods. Data collected were analysed using Statistical Package for the Social Sciences (version 20.0). P value (p&lt;0.05) was considered to be significant.Results: Of the 200 cases and controlsselected, the differences in serum GGT (p&lt;0.001) and ALT (p=0.048) were statistically significant. In case of male subjects,study and controls groups were compared only for serum GGT level (p=0.032) and in case of female subjects, studyand controls were compared for serum ALT (p=0.027) and serum GGT level (p&lt;0.001)and the differences were found to be highly significant. When male and female subjects of study group were compared, significant differences were observed in their serum ALT and GGT levels.Conclusion: Patients suspected of metabolic syndrome must also get their liver profile enzymes analysed as liver functionis also affected with metabolic syndrome and it could be an additional risk factor additive of metabolic syndrome. Early detection and management can be preventive and can have a better treatment modalities is managing patients with metabolic syndrome. It not only prevent disease progression but also prevents additional cost burden beard by the patients.Asian Journal of Medical Sciences Vol.8(3) 2017 35-40

Ultrasonographic United Stiffness Score System: Resolving the Discrepancy between Acoustic Radiation Force Impulse and Real-time Elastography in Evaluating the Thyroid Nodules Stiffness

Objective: The aim of this study was to assess the ultrasonographic united stiffness score system (UUSSS) in diagnosing thyroid nodules, and retrospectively analyze the discrepancy between acoustic radiation force impulse (ARFI) and real-time elastography (RTE). Methods: 170 conventional ultrasound (US) proven thyroid nodules in 70 patients were included and all were examined by RTE and ARFI. RTE and ARFI were first analyzed respectively, comparing with pathological findings. Then nodules have discrepancy between ARFI and RTE were retrospectively analyzed by UUSSS. Results: The AUC (area under curve) of ARFI combined RTE in 170 nodules was 0.87 (sensitivity=79.4% (54/68), specificity=84.3% (86/102), PPV=77.1% (54/70), NPV=86.0% (86/100), accuracy for ARFI were 82.4% (140/170), relatively to RTE was 0.83, 80.9%, 65.7%, 61.1%, 83.8%, 71.8%.The AUC of UUSSS was 0.876 (sensitivity=83.8% (57/68), specificity=87.3% (89/102), PPV=81.4% (57/70), NPV=89.0% (89/100), accuracy for UUSSS was 85.9% (146/170). The difference between area under UUSSS and RTE ROC curves was statistically significant (p<0.05), but was insignificant between UUSSS and ARFI (p=0.2245). There were 47 thyroid nodules had discrepancy in assessing the stiffness between ARFI and RTE. In these nodules, the accuracy of UUSSS was 83.0% (39/47), there were significant difference compare to RTE (20/47) (p=0.000), and ARFI (27/47) (p=0.012). Conclusions: UUSSS is useful to increase the diagnostic accuracy compare to independent RTE and ARFI, especially for those had discrepancy between ARFI and RTE. UUSSS is easy and convenient to re-evaluate stiffness on RTE and ARFI basis, and it place no additional cost burden.

West Nile Virus preparedness plan to ensure safe blood components in Switzerland: a risk‐based approach

BackgroundIn 2012, the Swiss Transfusion SRC founded a working group to develop a WNV preparedness plan for Switzerland in order to deal with expanding spread of WNV epidemics in Europe.Materials and MethodsThe risk estimates were computed for various presumptive incidence scenarios and brought into relation to cost estimates for the introduction of a routine WNV‐NAT screening programme. The costs to prevent one case per year and the number of donations which need to be tested to detect a WNV‐RNA‐positive donation were calculated.ResultsWith a theoretical postulated incidence of one West Nile virus meningoencephalitis (WNVME) case in Switzerland per year, approximately one WNV‐RNA‐positive case would be detected every 11 years. With 100 WNVME cases per year, approximately 8·8 donations would be detected every year. The additional cost burden of introducing WNV‐NAT in Switzerland is 2·6 million euros per year. Costs to prevent one case per year are thus between 27 million and 0·28 million euros, depending on the incidence assumption.Due to the geographical situation in Switzerland, it was decided to determine two potential risk regions, the southern part of the country and the remaining northern part. In addition, two risk levels and respective measures were defined.ConclusionsThe risk for WNV transmission through blood products is low even when 100 autochthonous WNV cases would be detected. With this in mind, the blood transfusion services and the national health authorities established a cost‐efficient WNV preparedness plan to prevent WNV transfusion–transmission and maintain self‐sufficiency in the blood supply.

Counting the costs of accreditation in acute care: an activity-based costing approach

ObjectivesTo assess the costs of hospital accreditation in Australia.DesignMixed methods design incorporating: stakeholder analysis; survey design and implementation; activity-based costs analysis; and expert panel review.SettingAcute care hospitals accredited by the...

151 Preventing Sudden Cardiac Death in the Young: Results form a Population-Based Screening Program in the UK: Abstract 151 Table 1

Purpose Sudden cardiac death (SCD) in the young is commonly attributed to inherited cardiac conditions, a considerable proportion of which can be detected during life. To prevent such tragedies, learned sporting and scientific bodies recommend pre-participation screening in young athletes. However, most SCDs in the young are likely to occur in non-competitive athletes. The aim of this study was to report the results of a population screening program in the UK. Methods During 2012, 12000 individuals, aged between 14 and 35 years, were screened, irrespective of athletic activity. Screening was performed at a cost of £35/individual and comprised of a health questionnaire, 12-lead ECG and consultation with a cardiologist. Individuals with abnormalities underwent a transthoracic echocardiogram on the day or were referred for further evaluation. Follow-up data were obtained through self-reported patient questionnaires. Results Of the 12,000 individuals screened (which included 13% elite athletes), 9.4% underwent echocardiography on the day. Ultimately, 323 (2.7%) individuals were referred for further assessment, 231 responded to the questionnaire and 189 had completed their follow-up investigations. Individuals were subjected to an average of 1.6 further investigations (ECHO 31%, 24-hour ECG monitor 30%, exercise test 22%, MRI 12%, other 5%). A cardiac pathology or findings necessitating regular follow-up were identified in 31 (16%) of the 189 individuals (Table 1). Conclusion Our results indicate that a large-scale population screening program based to similar methodology to the European Society of Cardiology recommendations is feasible. Our low referral rate indicates that young individuals with potentially sinister conditions can be identified at a relative low additional cost and investigation burden to the National health system.

Estimated impacts of the sulphur directive on the Nordic industry

The International Maritime Organization and the European Parliament (EP) have stated that ships must lower sulphur emissions significantly in a specific region in Northern Europe, that is, in the Sulphur Emission Control Area (SECA), where sulphur content in bunkers is not allowed to exceed 0.1 percent. The Nordic companies have been examined somewhat marginally from the point of view of the SECA-directive, and how it will affect the cost-efficiency of the industry. The research data contains information about export to four large European countries that form the biggest markets in Europe for the case mill. The transport costs (freight costs per ton) were taken from the mill database on the customer level. The actual and forecasted mill data was copied into Excel spreadsheets for analysis. Results of this case study strongly indicate that the sulphur directive has direct impacts to the economy of the Nordic bulk industry. When the bunker fuel prices increase from the year 2015 onward, it reflects directly to sea freight prices in the SECA-region. This will noticeably increase the total transportation costs per ton. The sulphur directive will be an additional cost burden for the Nordic industry, which in turn is something that from 2015 onward local European paper mills and other manufacturing industries will benefit from. The sulphur directive will probably indicate that from 2015 onward Central European paper mills and other manufacturing industries will benefit from outside the traditional business environment. The impacts of the sulphur directive will vary heavily from market to market and transportation costs from Finland to Europe can increase by average more than 20 percent in €/t; this can also be an underestimation. Profitability can drop by tens of percentage due to more expensive logistics. Logistics costs’ percentage in turnover will increase in the Nordic countries, but existing low oil price (2015) will mitigate the expected price increase of the MDO in the near future.

FGD investments as part of energy policy: A case study for Turkey

Coal-fired power plants take a significant share in electricity production at present. Therefore, emission reduction, especially sulfur dioxide (SO2) is essential. Thus, the coal-fired power plants are built with “Flue Gas Desulfurization (FGD)” units. Turkey has retrofitted exiting thermal power plants with new FGD units. Turkey's installed electricity generation capacity was 49,524MW in 2010. The coal-fired thermal plants made up 26% of this capacity. However, only 4107MW of lignite fired power plants are equipped with the retrofit FGD units. In this paper, the additional cost burden of the retrofitted FGD units to the national electricity generation is thoroughly evaluated using the technical and economic parameters. The share of the FGD investments is vital for the domestic energy investments and electric power sector. The FGD unit cost may increase the investment rate up to 17%. The proposed indicators are presented to introduce effectiveness for FGD investments in the energy sector. The parameters and indicators of the FGD investments in Turkey are depending on the new air pollution control legislations. The relationship between the rise of the FGD investments and the national macroeconomic indicators such as economic growth, state debt, and foreign investment rate in Turkey are shown with actual data.

Attributable Burden of Hospital-OnsetClostridium difficileInfection: A Propensity Score Matching Study

To determine the attributable in-hospital mortality, length of stay (LOS), and cost of hospital-onset Clostridium difficile infection (HO-CDI). Propensity score matching. Six Pennsylvania hospitals (2 academic centers, 1 community teaching facility, and 3 community nonteaching facilities) contributing data to a clinical research database. Adult inpatients between 2007 and 2008. We defined HO-CDI in adult inpatients as a positive C. difficile toxin assay result from a specimen collected more than 48 hours after admission and more than 8 weeks following any previous positive result. We developed an HO-CDI propensity model and matched cases with noncases by propensity score at a 1∶3 ratio. We further restricted matching within the same hospital, within the same principal disease group, and within a similar length of lead time from admission to onset of HO-CDI. Among 77,257 discharges, 282 HO-CDI cases were identified. The propensity score-matched rate was 90%. Compared with matched noncases, HO-CDI patients had higher mortality (11.8% vs. 7.3%; P < .05), longer LOS (median [interquartile range (IQR)], 12 [9-21] vs. 11 [8-17] days; P < .01), and higher cost (median [IQR], $20,804 [$11,059-$38,429] vs. $16,634 [$9,413-$30,319]; P < .01). The attributable effect of HO-CDI was 4.5% (95% confidence interval [CI], 0.2%-8.7%; P < .05) for mortality, 2.3 days (95% CI, 0.9-3.8; P < .01) for LOS, and $6,117 (95% CI, $1,659-$10,574; P < .01) for cost. Patients with HO-CDI incur additional attributable mortality, LOS, and cost burden compared with patients with similar primary clinical condition, exposure risk, lead time of hospitalization, and baseline characteristics.

Valuation of pollinator forage services provided by Eucalyptus cladocalyx

We assess the monetary value of forage provisioning services for honeybees as provided by an alien tree species in the Western Cape province of South Africa. Although Eucalyptus cladocalyx is not an officially declared invader, it is cleared on a regular basis along with other invasive Eucalyptus species such as Eucalyptus camaldulensis, and Eucalyptus conferruminata (which have been prioritised for eradication in South Africa). We present some of the trade-offs associated with the clearing of E. cladocalyx by means of a practical example that illustrates a situation where the benefits of the species to certain stakeholders could support the containment of the species in demarcated areas, while allowing clearing outside such areas.Given the absence of market prices for such forage provisioning services, the replacement cost is used to present the value of the loss in forage as provided by E. cladocalyx if the alien tree species is cleared along with invasive alien tree species. Two replacement scenarios formed the basis for our calculations. The first scenario was an artificial diet as replacement for the forage provisioning service, which yielded a direct cost estimate of US$7.5m per year. The second was based on a Fynbos cultivation/restoration initiative aimed at substituting the forage provisioning service of E. cladocalyx, which yielded a direct cost of US$20.2m per year. These figures provide estimates of the potential additional cost burden on the beekeeping industry if E. cladocalyx is completely eradicated from the Western Cape. The cost estimates should be balanced against the negative impacts of E. cladocalyx on ecosystem services in order to make an informed decision with regard to appropriate management strategies for this species. The findings therefore serve as useful inputs to balance trade-offs for alien species that are considered as beneficial to some, but harmful to other.