Greater Cost-effectiveness Research Articles

AB0906-HPR BENEFIT OF A NURSE-LED PROGRAM OF CARE FOR MANAGEMENT OF PATIENTS WITH ESTABLISHED RHEUMATOID ARTHRITIS: SYSTEMATIC LITERATURE REVIEW

Background:Nowadays, many countries experience an urgent demand for rheumatologists and greater cost-effectiveness. Thus, different alternatives to conventional outpatient physician-led follow-up have been investigated. The alternative of community-based service delivery systems is intended to meet emerging needs, reducing the costs of hospital care and morbidity. In patients with long-term conditions, such as Rheumatoid Arthritis (RA), nurses are seen as essential in the delivery of promotion in self-care and decision-making, favoring the empowerment of patients.Objectives:To systematically investigate if the nurse led-care management (NLCM) education programs are beneficial in patients with RA.Methods:This is a systematic literature research publication on the following bibliographic databases: Medline, Embase and the Cochrane Central register of Controlled Trials from the beginning until 2019.Results:From a yield of 116 studies, 44 were included in the review. After quality assessment and exclusion of the lowest-ranked studies, 19 studies were analyzed. Outcomes were organized into six themes (1) disease activity; (2) adherence; (3)satisfaction; (4)treatment compliance, (5) depression and (6)quality of life. All studies had significant results in at least one of the outcomes.Conclusion:According to our results, we can conclude that, clinicians could benefit from support conducted by nurse in the management of these patients in tasks such as metrology clinic, participation in enforcement, self-administration, the correct dosage and side effects of treatments, and link the patient and other professionals or entities. It would therefore be advisable to conduct further studies to draw more accurate and reliable conclusions in this context.

Effect of biological degradation by termites on the abnormal leakage of buried HDPE pipes

Buried high-density polyethylene (HDPE) pipes are widely utilized to transport gas and water due to its great shape flexibility, light weight and cost effectiveness. Because of the concentration of population and wealth, leakage accidents of buried HDPE pipelines would lead to catastrophic loss of life and property. Therefore, the comprehensive investigation and understanding of the mechanisms behind the unexpected failure of buried HDPE pipes is of great significance. In this paper, abnormal leakage occurred on the buried HDPE pipes in China. Multiple of holes and cracks were observed on the buried HDPE pipes during visual examination. Considering that no obvious third-party interference existed during the service period, systematic analyses on both mechanical properties and chemical structure were conducted to figure out the root cause of the failure. The results indicated that the abnormal leakage of the buried HDPE pipes resulted from the biological degradation by termites. Some countermeasures were also proposed to avoid the similar failure occurred again.

Expert endorsement and the legitimacy of public policy. Evidence from Covid19 mitigation strategies

During a pandemic, the government requires active compliance by citizens. While these demands can be enforced with rewards and punishments, legitimacy allows the government to achieve the same results with greater cost effectiveness. The way in which a government can acquire substantive legitimacy depends on how it communicates and justifies its decisions. In this article, we measure revealed legitimacy, via approval of three potential mitigation strategies against Covid19, when they are defended using expert endorsement, consultation by civil society, and mediation between opposing interests. Our methodological choice was to randomly assign participants to either a non-conflicting priming or to one that emphasizes the risks involved, (e.g. connection between health and economy, uncertainty, and economic costs). The data come from an online experiment we conducted as part of a longitudinal study in several countries. The countries included are Italy, Spain, and the United Kingdom. The results show that the support of experts in non-controversial domains is preferred (consensus of value, low uncertainty, diffuse rents). Contrary to our hypotheses, we found that citizen deliberation is not preferred under high epistemic uncertainty, and mediation is either indifferent or not preferred under conflict of value and conflict of interest.

Cost-effectiveness of base isolation for large transformers in areas of high seismic intensity

One of the most important components of an electrical substation is its power transformer, but this component is vulnerable to earthquakes. Several studies have demonstrated the good potential of base isolation to improve the seismic resistance of transformers. However, cost-effectiveness of a base isolation system is as important to the managers of a power grid as its isolation efficiency. Therefore, to investigate the cost-effectiveness of base isolation for large transformers, the framework of this two-part study comprised: (1) shaking table testing and (2) cost-effectiveness analysis. In the shaking table testing, the isolation efficiency of a friction pendulum system for a 220 kV transformer-bushing system was validated. In the cost-effectiveness analysis, the converter transformers of a typical substation were taken as examples to calculate the expected cost in a single earthquake event and the expected total life-cycle cost with/without the base isolation. The base isolation could impart considerable economic benefits in an extreme earthquake event and significantly reduce the risk of unacceptable earthquake-induced losses during the life period. Together, these two parts demonstrated the great cost-effectiveness of base isolation for large transformers in areas of high seismic intensity, underscoring the importance of further development and applications of this technology.

Triage 4.0: On Death Algorithms and Technological Selection. Is Today’s Data- Driven Medical System Still Compatible with the Constitution?

ABSTRACT Health data bear great promises for a healthier and happier life, but they also make us vulnerable. Making use of millions or billions of data points, Machine Learning (ML) and Artificial Intelligence (AI) are now creating new benefits. For sure, harvesting Big Data can have great potentials for the health system, too. It can support accurate diagnoses, better treatments and greater cost effectiveness. However, it can also have undesirable implications, often in the sense of undesired side effects, which may in fact be terrible. Examples for this, as discussed in this article, are discrimination, the mechanisation of death, and genetic, social, behavioural or technological selection, which may imply eugenic effects or social Darwinism. As many unintended effects become visible only after years, we still lack sufficient criteria, long-term experience and advanced methods to reliably exclude that things may go terribly wrong. Handing over decision-making, responsibility or control to machines, could be dangerous and irresponsible. It would also be in serious conflict with human rights and our constitution.

S EADS

Distributed software systems are increasingly developed and deployed today. Many of these systems are supposed to run continuously. Given their critical roles in our society and daily lives, assuring the quality of distributed systems is crucial. Analyzing runtime program dependencies has long been a fundamental technique underlying numerous tool support for software quality assurance. Yet conventional approaches to dynamic dependence analysis face severe scalability barriers when they are applied to real-world distributed systems, due to the unbounded executions to be analyzed in addition to common efficiency challenges suffered by dynamic analysis in general. In this article, we present S EADS , a distributed , online , and cost-effective dynamic dependence analysis framework that aims at scaling the analysis to real-world distributed systems. The analysis itself is distributed to exploit the distributed computing resources (e.g., a cluster) of the system under analysis; it works online to overcome the problem with unbounded execution traces while running continuously with the system being analyzed to provide timely querying of analysis results (i.e., runtime dependence set of any given query). Most importantly, given a user-specified time budget, the analysis automatically adjusts itself to better cost-effectiveness tradeoffs (than otherwise) while respecting the budget by changing various analysis parameters according to the time being spent by the dependence analysis. At the core of the automatic adjustment is our application of a reinforcement learning method for the decision making—deciding which configuration to adjust to according to the current configuration and its associated analysis cost with respect to the user budget. We have implemented S EADS for Java and applied it to eight real-world distributed systems with continuous executions. Our empirical results revealed the efficiency and scalability advantages of our framework over a conventional dynamic analysis, at least for dynamic dependence computation at method level. While we demonstrate it in the context of dynamic dependence analysis in this article, the methodology for achieving and maintaining scalability and greater cost-effectiveness against continuously running systems is more broadly applicable to other dynamic analyses.

Web-based Self-help Program for Adjustment Problems After an Accident (SelFIT): Protocol for a Randomized Controlled Trial.

BackgroundAccidents and the resulting injuries are among the world’s biggest health care issues, often causing long-term effects on psychological and physical health. With regard to psychological consequences, accidents can cause a wide range of burdens including adjustment problems. Although adjustment problems are among the most frequent mental health problems, there are few specific interventions available. The newly developed program SelFIT (German acronym: Selber wieder fit nach einem Unfall; “fit again after an accident”) aims to remedy this situation by offering a low-threshold, web-based self-help intervention for psychological distress after an accident.ObjectiveThe overall aim is to evaluate the efficacy and cost-effectiveness of the SelFIT program plus care as usual (CAU) compared to only CAU. Furthermore, the program’s user-friendliness, acceptance, and adherence are assessed. We expect that the use of SelFIT will be associated with a greater reduction in psychological distress, greater improvement in mental and physical well-being, and greater cost-effectiveness compared to CAU.MethodsAdults (n=240) experiencing adjustment problems due to an accident they had between 2 weeks and 2 years before entering the study will be randomized into either the intervention or control group. Participants in the intervention group receive direct access to SelFIT. The control group receives access to the program after 12 weeks. There are 6 measurement points for both groups (baseline as well as after 4, 8, 12, 24, and 36 weeks). The main outcome is a reduction in anxiety, depression, and stress symptoms that indicate adjustment problems. Secondary outcomes include well-being, optimism, embitterment, self-esteem, self-efficacy, emotion regulation, pain, costs of health care consumption, and productivity loss, as well as the program’s adherence, acceptance, and user-friendliness.ResultsRecruitment began in December 2019 and will continue at least until January 2021, with the option to extend this for another 6 months until July 2021. As of July 2020, 324 people have shown interest in participating, and 48 people have given their informed consent.ConclusionsTo the best of our knowledge, this is the first study examining a web-based self-help program designed to treat adjustment problems resulting from an accident. If effective, the program could complement the still limited offerings for secondary and tertiary prevention of psychological distress after an accident.Trial RegistrationClinicalTrials.gov NCT03785912; https://clinicaltrials.gov/ct2/show/NCT03785912International Registered Report Identifier (IRRID)DERR1-10.2196/21200

Impact of wound duration on diabetic foot ulcer healing: evaluation of a new sucrose octasulfate wound dressing.

A common and frequent complication of diabetes is diabetic foot ulcers (DFU), which can have high treatment costs and severe adverse events. This study aims to evaluate the effects of wound duration on wound healing and the impact on costs, including treatment with a new sucrose octasulfate dressing compared with a control dressing. Based on the Explorer study (a two-armed randomised double-blind clinical trial), a cost-effectiveness analysis compared four different patient groups distinguished by their wound duration and additionally two DFU treatment options: a sucrose octasulfate dressing and a neutral dressing (as control). Clinical outcomes and total direct costs of wound dressings were evaluated over 20 weeks from the perspective of the Social Health Insurance in Germany. Simulation of long-term outcomes and costs were demonstrated by a five cycle Markov model. The results show total wound healing rates between 71% and 14.8%, and direct treatment costs for DFU in the range of €2482-3278 (sucrose octasulfate dressing) and €2768-3194 (control dressing). Patients with a wound duration of ≤2 months revealed the highest wound healing rates for both the sucrose octasulfate dressing and control dressing (71% and 41%, respectively) and had the lowest direct treatment costs of €2482 and €2768, respectively. The 100-week Markov model amplified the results. Patients with ≤2 months' wound duration achieved wound healing rates of 98% and 88%, respectively and costs of €3450 and €6054, respectively (CE=€3520, €6864). Sensitivity analysis revealed that the dressing changes per week were the most significant uncertainty factor. Based on the findings of this study, early treatment of DFU with a sucrose octasulfate dressing is recommended from a health economic view due to lower treatment costs, greater cost-effectiveness and higher wound healing rates.

언어네트워크 분석을 활용한 핫플레이스 이미지 연구

Recently, people are active in sharing their experiences with visiting trendy places on Social Network Service (SNS). Such places are expressed as ‘hot place’, and the unique atmosphere of hot places including restaurants have become a major reason to visit. This study used semantic network analysis to examine the images of hot places mentioned in social media focusing on restaurants by limiting the spatial scope to Seoul Metropolitan City. This study used the Textom for Text Mining using data from blogs of NAVER and DAUM, news articles of Google, Facebook, and Twitter. To examine the seasonal effect, data from two seasons (summer and winter) were collected and analyzed accordingly. This study verified the images of hot places by conducting the centrality analysis using the UCINET, and classified similar keywords into clusters through the structural equivalence analysis. The results showed that Seongsu-dong, Hongdae, Ikseon-dong, and Eulji-ro were mentioned the most as hot places of Seoul region. The keywords such as ‘cafe’ and ‘date’ were mostly searched. The images of places were verified as follows: Seongsu-dong as industrial interior design and remodeling factories, Hongdae as a place with great clubs and cost effectiveness, Ikseon-dong as new-tro using Hanok, and Eulji-ro as a place coexisting with the past and present. It has been found that the image of a region is variously recognized, and the image of a restaurant food and the image of a place do not necessarily match. The findings could serve as useful information for restaurant start-ups and local marketing.

Optimal management of gastrojejunal tube in the ENFit era — Interventions that changed practice

BackgroundWe experienced a high incidence of jejunal tube (JEJ) displacement in children who underwent percutaneous endoscopic transgastric jejunostomy (PEGJ), ever since the introduction of ENFit connector (2017). MethodsTwo interventions were introduced in 2018 — fixative suture to PEGJ ENFit connector, and conversion to balloon transgastric–jejunal feeding device (Balloon GJ) whenever possible. Children receiving PEGJ and Balloon GJ in 2.8 years were categorized into 3 eras: 2016 (pre-ENFit), 2017 (ENFit) and 2018 (interventional), for comparison of complications and sequelae. Kaplan–Meier survival curves with log-rank test (P < 0.05) were applied. Results100 children underwent 323 JEJ insertions — PEGJ (n = 237), Balloon GJ (n = 86). Complications occurred in 188 JEJs (58%), more frequently with PEGJ than Balloon GJ (69% vs. 29%, P < 0.0005). PEGJ had higher complication/1000-tube-days (6 vs. 0, P < 0.0005). In 2018, complication rate reduced from 76% to 30% (P < 0.0005) owing to effectiveness of PEGJ connector suture application (P = 0.019), and increased utilization of Balloon GJ (16% to 44%, P = 0.005). Balloon GJ showed better JEJ survival (P = 0.019), less morbidity (emergency attendance, X-ray) and greater cost-effectiveness than PEGJ. ConclusionsBalloon GJ had better overall outcomes than PEGJ. Suture application to connector successfully reduced JEJ internal displacement in PEGJ; however, conversion to Balloon GJ should be strongly considered. Level of evidenceII

Efficient removal of methylene blue by low-cost and biodegradable highly effective adsorbents based on biomass in the fixed bed column

The adsorptive ability of sustainable biomass (spent coffee ground (SC) and water hyacinth (WH)) and activated biochar derived from WH to remove methylene blue (MB) from aqueous solution was evaluated under continuous fixed-bed column. Morphological structure and functional groups of WH and SC were determined by SEM and FTIR, respectively. The SEM showed the presence of porous structure of WH, whilst FTIR confirmed the presence of more hydroxyl groups at the WH surface, resulting in higher MB adsorption. A series of column experiments were performed with varying bed height and initial MB concentration. To determine the breakthrough curves and characteristic parameters for process design, Yoon-Nelson, Thomas and modified Dose-Response models were applied to experimental breakthrough data. The MB adsorption was dependent on the bed height and initial MB concentration. An increase in bed height resulted in improved adsorption capacity. With increasing initial MB concentration, the adsorption capacity decreased. The maximum adsorption capacity (Q0) of ∼391 mg/g by WH (at 0.75 cm bed height and 300 mg/L initial MB concentration) and ∼393 mg/g by its activated biochar (at 2 cm bed height and 200 mg/L initial MB concentration) was observed. The results showed that WH gave comparable MB adsorption capacity with a greater cost-effectiveness.

Phase Diagram Predictive Model for a Ternary Mixture of Calcium, Sodium, and Potassium Nitrate

The development of heat transfer fluids (HTF) and heat storage materials (HSM) is crucial to design concentrating solar plant (CSP). Binary alkaline nitrate mixtures are currently used as sensible thermal energy storage materials. However, multi-component nitrate/nitrite systems were proposed as possible better candidates. In particular, ternaries mixtures containing sodium, potassium, and calcium are extremely promising as thermal fluids, given their reduced toxicity and greater cost-effectiveness. Nevertheless, very few data are present in the scientific literature regarding the correspondent phase diagram, and only the properties of specific compositions are reported. For this reason, a regular solution model was developed and employed in this work, and validated by comparing the simulation results with experimentally obtained phase change values. In particular, given that the common calorimetric techniques are impracticable for detecting the transition temperatures of calcium containing nitrate mixtur...

Experimental analysis and evaluation of wide residual networks based agricultural disease identification in smart agriculture system

Specialised pest and disease control in the agricultural crops industry have been a high-priority issue. Due to great cost-effectiveness and efficient automation, computer vision (CV)–based automatic pest or disease identification techniques are widely utilised in the smart agricultural systems. As rapid development of artificial intelligence, in the field of computer vision–based agricultural pest identification, an increasing number of scholars have begun to move their attentions from traditional machine learning models to deep learning techniques. However, so far, deep learning techniques still have been suffering from many problems such as limited data samples, cost-effectiveness of network structure, and high image quality requirements. These issues greatly limit the potential utilisation of deep-learning techniques into smart agricultural systems. This paper aims at investigating utilization of one new deep-learning model WRN (wide residual networks) into CV-based automatic disease identification problem. We first built up a large-scale agricultural disease images dataset containing over 36,000 pieces of diseases, which includes typical types of disease in tomato, potato, grape, corn and apple. Then, we analysed and evaluated wide residual networks algorithm using the Tesla K80 graphics processor (GPU) in the TensorFlow deep-learning framework. A set of comprehensive experimental protocols have been designed in comparing with GoogLeNet Inception V4 regarding several benchmarks. The experimental results indicate that (1) under WRN architecture, Softmax loss function gives a faster convergence and improved accuracy than GoogLeNet inception V4 network. (2) While WRN shows a good effect for identification of agricultural diseases, its effectiveness has a strong need on the number of training samples of dataset like at least 36 k images in our experiment. (3) The overall performance is better than 800 sheets. The disease identification results show that the WRN model can be applied to the identification of agricultural diseases.

Enhanced erythritol production by a Snf1-deficient Yarrowia lipolytica strain under nitrogen-enriched fermentation condition

Erythritol is a new polyol used as a bulk sweetener in food industries, and the bioconversion of agricultural or industrial wastes to erythritol by Yarrowia lipolytica at high productivity is of great cost-effectiveness. In the Yarrowia-erythritol procedure, erythritol synthesis is triggered only under nitrogen starvation condition (or a high carbon-to-nitrogen ratio, C/N), causing an inefficient product yield and the unavailability of nitrogen-rich wastes. Sucrose non-fermenting protein kinase (Snf1) plays an important role in the nitrogen starvation-triggered process. In this study, a Snf1-deficient strain Y. lipolytica M53-S was obtained, and the calculated carbon source uptake (Qs) and erythritol formation (QEry) rates were respectively increased by 46% and 49% when a lower C/N ratio of 20/1 was imposed on M53-S cells than that during nitrogen limitation (C/N=250/1). Moreover, loss of Snf1 abolished the reliance on high osmotic pressure and supplemental nutrition. Results of qRT-PCR suggested that the metabolic enzymes in M53-S were u P-R egulated at transcriptional level under low C/N ratio. The increased enzyme activitiesf also suggested a carbon overflow into the erythritol biosynthetic pathway. During the scaled-up fermentation process, 72.5g/L of erythritol was produced by M53-S within a greatly shortened period. This work confirms the critical role of Snf1 in coupling between nitrogen starvation and product synthesis, which also presents a new perspective in developing a cost-effective process for efficient production of secondary metabolites from nitrogen-rich wastes.

Cost-effectiveness analysis of different types of payments for ecosystem services: A case in the urban wetland ecosystem

Payments for Ecosystem Services (PES) have emerged as a popular conservation tool, yet evaluation among different PES programs strategies remains piecemeal. We prospectively compare cost-effectiveness of general PES, collective payments for ecosystem services (CPES) and the transition from PES to Land Purchases or Easements (LPE). We analyze the economic cost using statistics data and literature data, and analyze the transaction cost with the ordinal variable. We develop the Emergy Analysis method with the InVEST Habitat Quality model, and utilize it to analyze and map the ecological effectiveness. This paper gives an example to assessing the cost-effectiveness of different PES programs. Based on the analysis, LPE strategy led to improved ecological effectiveness, lower cost and greater cost-effectiveness. The collective PES has lower cost than general PES. However, they demonstrate equal ecological effectiveness. Based on these outcomes, we analyze the factors that influence PES programs’ cost-effectiveness, including collective or group, market-based mechanism, economic incentive, transaction cost, contract scale etc. We conclude that minimal number of intermediaries, community/collective support and involvement constitute the key factors in improving the cost-effectiveness of ecological programs. However, we acknowledge the need for further studies on the subject.

A Pharmacoeconomic Analysis to Determine the Relative Cost-effectiveness of Timolol 0.5%, Brinzolamide 1% and Brimonidine 0.2% Eye Drops in Treatment of Primary Open Angle Glaucoma/Ocular Hypertension

Aim: A pharmacoeconomic analysis to determine the relative cost-effectiveness of timolol 0.5%, brinzolamide 1% and brimonidine 0.2% eye drops in treatment of Primary Open Angle Glaucoma (POAG)/ocular hypertension (OHT). Settings and Design: Comparative, open, randomized, parallel group prospective study. Materials and Methods: 60 patients of POAG or ocular hypertension were included in this study. Time period of study was 6 weeks. 60 eyes of 60 patients were included in the study. Patients were divided randomly into 3 groups of 20 each. Patients in group A, B and C received timolol, brinzolamide and brimonidine respectively. One drop of each medication was instilled twice a day at 9 am and 9 pm daily for 6 weeks. IOP was measured on day 0 at 9 am (before administration of drugs) and then at 11 am, to get baseline IOP. IOP was again measured on subsequent visits at 9 am and 11 am. Treatment outcome was number of mm Hg fall in IOP induced by the study drug. The daily cost of each drug was calculated by maximum retail price and the average number of drops per bottle. The cost‑effectiveness was then calculated as the cost of drug/mm Hg fall in IOP. Statistics: Paired ‘t’ test was used to analyze the parameters within the group. Independent samples t‑test was used to compare the efficacy of drugs with each other. Results: The % reduction of brimonidine, timolol and brinzolamide at end of 6 weeks was 21.43 ± 3.06%, 24.87 ± 2.46% and 18.78 ± 1.73% respectively. Timolol was superior in efficacy to other two drugs. The difference was statistically significant between the efficacy of timolol and brinzolamide (p < 0.001) as well as timolol and brimonidine (p = 0.003). There was no statistical significant difference in the efficacy of brimonidine when compared to brinzolamide (p=0.26). Timolol (5.87 ± 0.83 Rs/mm lowering after 6 weeks) was found to be most cost-effective followed by brimonidine (46.83 ± 7.37) and then brinzolamide (60.49 ± 6.77) in lowering IOP. Conclusion: All three drugs under the present study are useful in the treatment of POAG/OHT, but timolol is a better choice than other two drugs because of greater reduction in IOP and greater cost-effectiveness.

PCN70 COST-EFFECTIVENESS OF ADHERENCE AND PERSISTENCE INTERVENTIONS FOR ADJUVANT TAMOXIFEN THERAPY

Adjuvant tamoxifen therapy reduces the risk of breast cancer recurrence and mortality. Poor adherence and persistence to therapy adversely impact patient outcomes. This study evaluates the cost-effectiveness of adherence and persistence interventions for patients on adjuvant tamoxifen therapy as compared to usual care from a payer’s perspective. A five-state Markov model was developed to evaluate four hypothetical interventions. The Restart-Stopped intervention targets women who have discontinued tamoxifen and increases the proportion that restart therapy. The Never-Stop intervention targets all women on therapy and decreases discontinuation. The High-to-High intervention focuses on maintaining the current adherence level among women with high adherence (proportion of days covered ≥80%). The Low-to-High intervention focuses only on women with low adherence, and increases the proportion who become highly adherent. Annual cycles and a five-year time horizon were used. Model inputs were obtained from the literature. Relative improvement in adherence or persistence was varied and the associated program cost was estimated for assessing incremental cost-effectiveness at a willingness-to-pay (WTP) threshold of $100,000/QALY. Cost and benefits across all interventions were compared at a 5% relative increase in adherence or decrease in discontinuation over the 5-year time horizon. The Restart-Stopped intervention was cost-effective at a per-patient per-year (PPPY) cost of $445 and saved 4 lives/1,000. The Never-Stop intervention was cost-effective at $177 PPPY and saved 5 lives/1,000. The High-to-High intervention was cost-effective at $290 PPPY and saved 6 lives/1,000. Lastly, the Low-to-High intervention was cost-effective at $545 PPY and saved 4 lives/1,000. At a 5% effectiveness level, persistence interventions focusing on decreasing discontinuation and adherence interventions targeting patients with high-adherence resulted in more lives saved and met the willingness to pay threshold at a lower cost. Interventions targeting persistence have the greatest potential to improve life expectancy with greater cost-effectiveness.

Intensivist staffing and outcome in the ICU: daytime, nighttime, 24/7?

Many hospitals, particularly large academic centers, have begun to provide 24-h in-house intensive care attending coverage. Proposed advantages for this model include improved patient care, greater provider, nursing and patient satisfaction, better communication, and greater cost-effectiveness. This review will evaluate current evidence with respect to 24/7 coverage, including patient outcomes, cost-effectiveness, and impact on training/education. Evidence surrounding 24-h intensivist staffing has been mixed. Although a subset of studies suggest a possible benefit to 24-h intensivist coverage, recent prospective studies have shown no difference in major patient outcomes, including mortality and ICU length of stay between patients in ICUs with and those without 24-h intensivist coverage. Although some studies cite increased caregiver and patient satisfaction, outcome studies find no consistent effect on patient-centered outcomes such as mortality or length of stay. Downsides to in-house nighttime attending staffing include physician burnout, adverse effects on physician health, decreased trainee autonomy, and effects on trainee specialty choices because of undesirable lifestyle considerations. Tele-ICU and other novel approaches may allow for attending supervision without physical presence.

Carbon-supported ultrafine Pt nanoparticles modified with trace amounts of cobalt as enhanced oxygen reduction reaction catalysts for proton exchange membrane fuel cells

To accelerate the kinetics of the oxygen reduction reaction (ORR) in proton exchange membrane fuel cells, ultrafine Pt nanoparticles modified with trace amounts of cobalt were fabricated and decorated on carbon black through a strategy involving modified glycol reduction and chemical etching. The obtained Pt36Co/C catalyst exhibits a much larger electrochemical surface area (ECSA) and an improved ORR electrocatalytic activity compared to commercial Pt/C. Moreover, an electrode prepared with Pt36Co/C was further evaluated under H2-air single cell test conditions, and exhibited a maximum specific power density of 10.27 W mgPt−1, which is 1.61 times higher than that of a conventional Pt/C electrode and also competitive with most state-of-the-art Pt-based architectures. In addition, the changes in ECSA, power density, and reacting resistance during the accelerated degradation process further demonstrate the enhanced durability of the Pt36Co/C electrode. The superior performance observed in this work can be attributed to the synergy between the ultrasmall size and homogeneous distribution of catalyst nanoparticles, bimetallic ligand and electronic effects, and the dissolution of unstable Co with the rearrangement of surface structure brought about by acid etching. Furthermore, the accessible raw materials and simplified operating procedures involved in the fabrication process would result in great cost-effectiveness for practical applications of PEMFCs.

Recruitment Strategies for a Randomised Controlled Trial Comparing Fast Versus Slow Weight Loss in Postmenopausal Women with Obesity-The TEMPO Diet Trial.

Current research around effective recruitment strategies for clinical trials of dietary obesity treatments have largely focused on younger adults, and thus may not be applicable to older populations. The TEMPO Diet Trial (Type of Energy Manipulation for Promoting optimal metabolic health and body composition in Obesity) is a randomised controlled trial comparing the long-term effects of fast versus slow weight loss on body composition and cardio-metabolic health in postmenopausal women with obesity. This paper addresses the recruitment strategies used to enrol participants into this trial and evaluates their relative effectiveness. 101 post-menopausal women aged 45–65 years, with a body mass index of 30–40 kg/m2 were recruited and randomised to either fast or slow weight loss. Multiple strategies were used to recruit participants. The total time cost (labour) and monetary cost per randomised participant from each recruitment strategy was estimated, with lower values indicating greater cost-effectiveness and higher values indicating poorer cost-effectiveness. The most cost-effective recruitment strategy was word of mouth, followed (at equal second place) by free publicity on TV and radio, and printed advertorials, albeit these avenues only yielded 26/101 participants. Intermediate cost-effective recruitment strategies were flyer distribution at community events, hospitals and a local tertiary education campus, internet-based strategies, and clinical trial databases and intranets, which recruited a further 40/101 participants. The least cost-effective recruitment strategy was flyer distribution to local health service centres and residential mailboxes, and referrals from healthcare professionals were not effective. Recruiting for clinical trials involving postmenopausal women could benefit from a combination of recruitment strategies, with an emphasis on word of mouth and free publicity via radio, TV, and print media, as well as strategic placement of flyers, supplemented with internet-based strategies, databases and intranets if a greater yield of participants is needed.