Increase In Cost Research Articles

Fluoroscopically calibrated 3D-printed patient-specific instruments improve the accuracy of osteotomy during bone tumor resection adjacent to joints

BackgroundInadequate surface matching, variation in the guide design, and soft tissue on the skeletal surface may make it difficult to accurately place the 3D-printed patient-specific instrument (PSI) exactly to the designated site, leading to decreased accuracy, or even errors. Consequently, we developed a novel 3D-printed PSI with fluoroscopy-guided positioning markers to enhance the accuracy of osteotomies in joint-preserving surgery. The current study was to compare whether the fluoroscopically calibrated PSI (FCPSI) can achieve better accuracy compared with freehand resection and conventional PSI (CPSI) resection.MethodsSimulated joint-preserving surgery was conducted using nine synthetic left knee bone models. Osteotomies adjacent to the knee joint were designed to evaluate the accuracy at the epiphysis side. The experiment was divided into three groups: free-hand, conventional PSI (CPSI), and fluoroscopically Calibrated PSI (FCPSI). Post-resection CT scans were quantitatively analyzed. Analysis of variance (ANOVA) was used.ResultFCPSI improved the resection accuracy significantly. The mean location accuracy is 2.66 mm for FCPSI compared to 6.36 mm (P < 0.001) for freehand resection and 4.58 mm (P = 0.012) for CPSI. The mean average distance is 1.27 mm compared to 2.99 mm (p < 0.001) and 2.11 mm (p = 0.049). The mean absolute angle is 2.16° compared to 8.50° (p < 0.001) and 5.54° (p = 0.021). The mean depth angle is 1.41° compared to 8.10° (p < 0.001) and 5.32° (p = 0.012). However, there were no significant differences in the front angle compared to the freehand resection group (P = 0.055) and CPSI (P = 0.599) group. The location accuracy observed with FCPSI was maintained at 4 mm, while CPSI and freehand resection exhibited a maximum deviation of 8 mm.ConclusionThe fluoroscopically calibrated 3D-printed patient-specific instruments improve the accuracy of osteotomy during bone tumor resection adjacent to joint joints compared to conventional PSI and freehand resection. In conclusion, this novel 3D-printed PSI offers significant accuracy improvement in joint preserving surgery with a minimal increase in time and design costs.

Novel design of a CCHP system to boost nearly zero-carbon building concept

The accumulation of carbon dioxide in the atmosphere is responsible for global warming. To address this issue, this study develops and optimizes a novel and economically viable combined cooling, heating, and power (CCHP) system for an educational building with minimal CO2 emissions. The main components of the system include a gas turbine cycle, a molten carbonate fuel cell, a heating system, an electric chiller, and an absorption chiller. Optimization is conducted based on a 4E (energy, exergy, economic, and environmental) analysis using TRNSYS and MATLAB software. The optimized CCHP system has a unit product cost of $52.44/h with an overall exergy efficiency of 44.34 %, generating 0.39 kg of CO2/kWh. Furthermore, the objective of a nearly zero-carbon system is achieved by integrating carbon capture and storage (CCS) into the original CCHP system. A novel cryogenic carbon capture unit is implemented to capture CO2 from the flue gas. Integrating CCS reduces CO2 emissions by up to 91 %, presenting a cost-effective approach to carbon offset. Although there is a modest increase in operational costs ($53.46/h) and a slight decrease in exergy efficiency (43.3 %), these trade-offs are necessary to attain an environmentally responsible system. Overall, the optimized CCHP system with the integrated CCS shows potential as an energy-efficient solution for the selected educational building while reducing CO2 emissions.

Guideline Adherence as an Indicator of PET Scan Overuse in an Italian Teaching Hospital: An Observational Study.

Evidence of inappropriate overuse and underuse of medical procedures has been documented in modern healthcare systems around the world. Excessive use of health services can contribute to a rapid increase in healthcare costs and harm the patient physically and psychologically; conversely, underuse can lead to the inability to provide effective treatments when clinically indicated. The study's aim is twofold: a) to measure the appropriateness of PET prescription in a cohort of patients, offering empirical evidence of overuse of health care services; b) to evaluate how the overuse of PET could affect public health expenditure and, consequently, the system's financial sustainability. In this observational study, we have analyzed prospectively and retrospectively health patient records who underwent 18F-FDG PET/TC scan at the Nuclear Medicine Department of the University Hospital Mater Domini in Catanzaro (Italy) from 29/09/2022 to 10/02/2023. Patients' diagnostic questions have been defined as appropriate, not completely appropriate and completely inappropriate according to the 18F-FDG PET/CT recommendations defined by the "Conditions of Supply and Indications of Prescriptive Appropriateness of Italian NHS (National Health Systems)" published in the Official Gazette no. 15 of 20 January 2016 (Decree 9 December 2015) and by the AIMN (Italian Association of Nuclear Medicine) guidelines. We gathered data from 500 oncological patients (242 males and 258 females). The results show that 423/500 of patients' prescriptions were appropriate, while 77/500 of patients' prescriptions were completely inappropriate (63/77) or not completely appropriate (14/77). Analysis showed a not complete adherence to national guidelines and no shared decision-making approach.

A dimensional design of tractor seat based on Iranian anthropometric characteristics.

The dimensional seat design process should consider both the users' tasks and their physical characteristics. To use an approach for the design and evaluation of seat dimensions based on the anthropometric characteristics of the Iranian population and the requirements of tractor operators. Some existing equations relating the seat dimensions to anthropometric characteristics were modified according to logical justifications and international standards. A new mathematical-statistical method was used to extract the equations estimating the constant seat dimensions based on the theoretical maximizing of the accommodation level. In addition, an Overall Seat Accommodation Score (OSAS) was developed to represent the mean of seat dimensions accommodation level and dimensional accommodation equality, simultaneously. The dimensional seat design can be affected under different conditions of adjustability, esthetic, and space limitations. However, it was shown that it is possible to improve the design of tractor seats without any significant increase in the final cost and complexity. A new approach was used for tractor seats for a sample of Iranian operators and can be used for the design and evaluation of tractor seats for other target populations.

Antifouling macrocyclic-engineered PVDF membrane for the low-pressure separation of surfactant-stabilized oily wastewater

Fouling is a common phenomenon which affects the long-term efficacy of membranes in the practical treatment of oily wastewater. It often results in a dramatic decline in flux, and a consequent increase in maintenance and operational cost. To address this, various substrates have been incorporated during membrane fabrication to enhance the fouling resistance, and improve the separation efficiency. Herein, we report the fabrication of a novel symmetrical ball-copper phthalocyanine incorporated PVDF membrane (CuPc@PVDF) for the effective separation of surfactant-stabilized oil-in-water emulsions. The symmetrical ball-Cu phthalocyanine with four non-peripheral substituents synthesized ab-initio and characterized using UV–vis, FT-IR, 1H NMR, and MALDI-TOF spectroscopies was added to the casting solution during membrane fabrication resulting in the formation of highly hydrophilic and anti-fouling CuPc@PVDF membrane. In contrast to the PVDF membrane, having a water contact angle of 82.3° ± 0.7°, the CuPc@PVDF membrane demonstrated high hydrophilicity with a contact angle of 55.5° ± 0.5°, and pure water permeance up to 768 LMH at 3 bar. It further achieved 99.9 % rejection of oil with size in the range of 50–450 nm at 1 bar, and demonstrated high stability and excellent anti-fouling property during 10 cycles of continuous demulsification, with a flux recovery ratio (FRR) of 98.5 %, and extremely low irreversible flux of 1.5 %. Similarly, the CuPc@PVDF membrane exhibited high resistance to accelerated organic fouling, maintaining a steady flux and an FRR of 93.0 % during 1 hour of continuous operation with 10 ppm sodium alginate and Ca2+ ions. This study reports a novel strategy to enhance the fouling resistance of demulsification membranes, and could be further explored in the design of next generation of advanced membranes for the purification of oily wastewater.

Delabeling of allergy to beta-lactam antibiotics in hospitalized patients: a prospective study evaluating cost savings.

Patients with a penicillin allergy label are at risk of an associated increase in adverse antibiotic events and hospitalization costs. We aimed to study the economic savings derived from the correct diagnosis and delabeling inpatients with suspected beta-lactam allergy, considering the acquisition cost of antimicrobials prescribed during a patient's hospital stay. We prospectively evaluated patients admitted to the University Hospital of Salamanca who had been labeled as allergic to beta-lactams and performed a delabeling study. Subsequently, cost differences between antibiotics administered before and after the allergy study and those derived from those patients who received alternative antibiotics during admission and those who switched to beta-lactams after the allergy study were calculated. One hundred seventy-seven inpatients labeled as allergic to beta-lactams underwent a delabeling study; 34 (19.2%) were confirmed to have allergy to beta-lactams. Of the total number of patients, 136 (76.8%) received antibiotics during their hospitalization, involving a mean (SD) cost of €203.07 (318.42) and a median (IQR) cost of €88.97 (48.86-233.56). After delabeling in 85 (62.5%) patients, the antibiotic treatment was changed to beta-lactams. In this group of patients, the mean cost (SD) decreased from €188.91 (351.09) before the change to 91.31 (136.07) afterward, and the median cost (IQR) decreased from €72.92 (45.82-211.99) to €19.24 (11.66-168). The reduction was significant compared to the median cost of patients whose treatment was not changed to beta-lactams (p<0.001). Delabeling hospitalized patients represents a cost-saving measure for treating patients labeled as allergic to beta-lactams.

Associations of preoperative anaemia with healthcare resource use and outcomes after colorectal surgery: a population-based cohort study

BackgroundPreoperative anaemia is common in patient undergoing colorectal surgery. Understanding the population-level costs of preoperative anaemia will inform development and evaluation of anaemia management at health system levels. MethodsThis was a population-based cohort study using linked, routinely collected data, including residents from Ontario, Canada, aged ≥18 yr who underwent an elective colorectal resection between 2012 and 2022. Primary exposure was preoperative anaemia (haemoglobin <130 g L−1 in males; <120 g L−1 in females). Primary outcome was 30-day costs in 2022 Canadian dollars (CAD), from the perspective of a publicly funded healthcare system. Secondary outcomes included red blood cell transfusion, major adverse events (MAEs), length of stay (LOS), days alive at home (DAH), and readmissions. ResultsWe included 54,286 patients, with mean 65.3 (range 18–102) years of age and 49.0% females, among which 21 264 (39.2%) had preoperative anaemia. There was an absolute adjusted cost increase of $2671 per person at 30 days after surgery attributable to preoperative anaemia (ratio of means [RoM] 1.05, 95% confidence interval [CI] 1.04–1.06). Compared with the control group, 30-day risks of transfusion (odds ratio [OR] 4.34, 95% CI 4.04–4.66), MAEs (OR 1.14, 95% CI 1.03–1.27), LOS (RoM 1.08, 95% CI 1.07–1.10), and readmissions (OR 1.16, 95% CI 1.08–1.24) were higher in the anaemia group, with reduced DAH (RoM 0.95, 95% CI 0.95–0.96). ConclusionsApproximately $2671 CAD per person in 30-day health system costs are attributable to preoperative anaemia after colorectal surgery in Ontario, Canada.

Cost-effectiveness analysis of durvalumab, tremelimumab, and etoposide-platinum in first-line treatment of extensive-stage small cell lung cancer.

Durvalumab plus etoposide-platinum (DEP) showed sustained overall survival improvements in patients with extensive-stage small-cell lung cancer (ES-SCLC) compared to etoposide-platinum (EP), but adding tremelimumab to DEP (DTEP) did not significantly improve outcomes. A third-party payer perspective is taken here to evaluate the cost-effectiveness of DTEP, DEP, and EP for ES-SCLC. The cost-effectiveness was evaluated by partitioning survival models into 3 mutually exclusive health states. In this model, clinical characteristics and outcomes were obtained from the CASPIAN. Model robustness was evaluated through 1-way deterministic and probabilistic sensitivity analyses. Outcome measurements included costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratio, life-years, incremental net health benefit, and incremental net monetary benefit. The analysis was conducted with a 10-year lifetime horizon in a United States setting. Compared with EP, DEP, and DTEP were associated with an increment of 0.480 and 0.313 life-years, and an increment of 0.247 and 0.165 QALYs, as well as a $139,788 and $170,331 increase in cost per patient. The corresponding ICERs were $565,807/QALY and $1033,456/QALY, respectively. The incremental net health benefit and incremental net monetary benefit of DEP or DTEP were -0.685 QALYs and -$102,729, or -0.971 QALYs and -$145,608 at a willingness to pay threshold of $150,000/QALY, respectively. Compared with DTEP, DEP was dominated. DTEP and DEP were 100% unlikely to be cost-effective if the willingness to pay threshold was $150,000/QALY. DEP was cost-effective compared to EP when durvalumab was priced below $0.994/mg. Compared with EP, DEP, and DTEP were unlikely to be considered cost-effective across all subgroups. DEP and DTEP were not cost-effective options in the first-line treatment for ES-SCLC compared with EP, from the third-party payer perspective in the United States. Compared with DTEP, DEP was dominated.

Physicochemical Properties and Cost of Production of Cow Milk Shrikhand Blended with Calcutta Betel Vine (Piper betel) Extract

The present investigation entitled “Preparation of cow milk shrikhand blended with calcutta betel vine (Piper betel) leaves extract” was conducted at Section of Animal Husbandry and Dairy Science, Nagpur. An effort was made to find out the physicochemical properties and calculate the cost structure. Some of the findings emerged from the present investigation are summarized as follows. Concerning the chemical composition of Calcutta betel vine leaves extract added in shrikhand, it was observed that the fat, protein and titratable acidity content were slightly decreased with addition of different levels of Calcutta betel vine leaves extract. The moisture, ash and pH of shrikhand was significantly increased. The total solids and solids not fat content of shrikhand was decreased with increase the level of Calcutta betel vine leaves extract. As regards to the cost of production per kg shrikhand was lowest in T1 (Rs. 238.23 kg-1) and highest in T5 (Rs.294.81 kg-1). Which indicates that, increase in the level of Calcutta betel vine leaves extract showed increase in cost of production for preparation of shrikhand. The present study concluded that acceptable quality shrikhand can be prepared by adding 6 % Calcutta betel vine leaves extract.

Synthesis cost-optimal targeted mutant protein libraries

Protein variant libraries produced by site-directed mutagenesis are a useful tool utilized by protein engineers to explore variants with potentially improved properties, such as activity and stability. These libraries are commonly built by selecting residue positions and alternative beneficial mutations for each position. All possible combinations are then constructed and screened, by incorporating degenerate codons at mutation sites. These degenerate codons often encode additional unwanted amino acids or even STOP codons. Our study aims to take advantage of annealing based recombination of oligonucleotides during synthesis and utilize multiple degenerate codons per mutation site to produce targeted protein libraries devoid of unwanted variants. Toward this goal we created an algorithm to calculate the minimum number of degenerate codons necessary to specify any given amino acid set, and a dynamic programming method that uses this algorithm to optimally partition a DNA target sequence with degeneracies into overlapping oligonucleotides, such that the total cost of synthesis of the target mutant protein library is minimized. Computational experiments show that, for a modest increase in DNA synthesis costs, beneficial variant yields in produced mutant libraries are increased by orders of magnitude, an effect particularly pronounced in large combinatorial libraries.

IPO suspensions and labor employment decisions: Evidence from China

The Chinese regulator occasionally suspends all initial public offerings (IPOs) to maintain stability in the capital markets and facilitate capital market reform. These suspensions temporarily prevent firms that have obtained IPO approval from going public. We hypothesize that this suspension-induced listing delay influences firms’ labor employment decisions. Consistent with this argument, we find that a suspension-induced listing delay is associated with an increase in labor costs, both in terms of total and average employee payments. This positive relationship is more pronounced for human capital-intensive firms and non-state-owned enterprises. We also find that there is an increase in employment and employee turnover for firms facing suspension-induced listing delays. Moreover, IPO suspensions result in lower labor productivity and firm performance. Overall, our results indicate that government policy uncertainty leads firms to incur high labor costs and reduces capital allocation efficiency.

On development of lattice-Boltzmann method based multi phase flow solver

A numerical methodology based on lattice Boltzmann and level set function is presented to simulate the two-phase flows with stringent density and viscosity ratio. Two different strategies - single grid (SGLBLS) and dual grid (DGLBLS) are used. For accurate computation of interfacial forces in DGLBLS, the level set equations are solved on a uniform grid which is twice that for lattice-Boltzmann equations. The code validation and performance of SGLBLS and DGLBLS is carried on three different problems: Young’s Laplace law, 2D rising bubble and Rayleigh–Taylor instability. The results show that the representation of the interface is more accurate in DGLBLS with significantly less mass error - establishing it as an accurate method to handle stringent density and viscosity ratio. The comparison between DGLBLS and SGLBLS shows that the DGLBLS leads to a large improvement in the accuracy of the results with only slight increase in the computational cost.

A Critical Review on Immobilized Sucrose Isomerase and Cells for Producing Isomaltulose.

Isomaltulose is a novel sweetener and is considered healthier than the common sugars, such as sucrose or glucose. It has been internationally recognized as a safe food product and holds vast potential in pharmaceutical and food industries. Sucrose isomerase is commonly used to produce isomaltulose from the substrate sucrose in vitro and in vivo. However, free cells/enzymes were often mixed with the product, making recycling difficult and leading to a significant increase in production costs. Immobilized cells/enzymes have the following advantages including easy separation from products, high stability, and reusability, which can significantly reduce production costs. They are more suitable than free ones for industrial production. Recently, immobilized cells/enzymes have been encapsulated using composite materials to enhance their mechanical strength and reusability and reduce leakage. This review summarizes the advancements made in immobilized cells/enzymes for isomaltulose production in terms of refining traditional approaches and innovating in materials and methods. Moreover, innovations in immobilized enzyme methods include cross-linked enzyme aggregates, nanoflowers, inclusion bodies, and directed affinity immobilization. Material innovations involve nanomaterials, graphene oxide, and so on. These innovations circumvent challenges like the utilization of toxic cross-linking agents and enzyme leakage encountered in traditional methods, thus contributing to enhanced enzyme stability.

Enhancing strategic deployment of baiting transects for invasive species control – a case study for feral pig baiting in north-eastern Australia

Context Baits are used to deliver lethal or other substances in wildlife management programs across the globe. Successful baiting campaigns are contingent upon the availability of baits to target animals. Bait density is often increased in an attempt to improve bait encounter probabilities. However, this comes with a concomitant increase in cost and may result in significant bait wastage if deployed in areas of low target species activity. Aims The aim of this study was to assess the effectiveness, efficiency and cost of different bait transect methods in intersecting home and core ranges of feral pigs as a case study to determine optimal spacing and placement of baiting transects. Methods The authors simulated a variety of systematically spaced aerial transects, watercourse-aligned aerial transects and ground transects along property boundaries and farm tracks, and compared them with home and core ranges of feral pigs, at two study sites in Queensland, Australia. Transect effectiveness at intersecting pig ranges was determined through beta-regression and estimated marginal means (emmeans); efficiency was considered as emmeans per unit of transect length. Key results The study found that systematically spaced aerial transects at 4 km intervals were the most efficient means of intersecting both home and core ranges of feral pigs. Additionally, no alternate transect method, either aerial or ground, provided significantly greater effectiveness at intersecting feral pig home and core ranges at these study sites. Ground transects along farm tracks and property boundaries were also between 113% and 192% more expensive than aerial transects at 4 km spaced intervals for either fixed-wing or rotary aircraft. Conclusion Systematically spaced aerial transects at 4 km intervals are among the most effective and are the most efficient means of intersecting feral pig ranges at the study sites examined. Implications Our methodology offers a blueprint for both vaccination and toxin baiting programs to assess and compare bait transect placements. More specifically for feral pig control, aerial transects with 4 km systematic spacing provide an effective and efficient means for intersecting feral pig ranges. Furthermore, additional data on bait encounter and interaction probabilities are required to determine transect effectiveness at bait uptake by the target species.

Trend in basic oral treatment needs in relation to taxation of sweets, ice cream, and sugar-sweetened beverages in Finland: a registry-based study.

The aims were to explore the trend in basic oral treatment needs and total operating cost of public dental services (PDS) in relation to total excise tax revenue generated from sugary products during 2011-2020 and to evaluate the impact of tax policy in excise tax revenue of sugary products and average sugar consumption. The study comprised longitudinal data retrieved from Finnish registries during the years 2011-2020. Basic oral treatment needs, and total operating cost of PDS, total excise tax revenue generated from sugary products and average sugar consumed (kg per capita) during the years 2011-2020 were obtained. Simplified panel analyses and sensitivity analyses were used to evaluate the effects of explanatory variables on outcomes. Results: An approximate one EUR 1,000,000 increase in total excise tax revenue generated from sugary products corresponds to a 0.4% increase in total operating cost of PDS. There was a significant positive trend in total operating cost of PDS in Finland over the study period. Similarly, an approximate one EUR 1,000,000 rise in total excise tax revenue corresponds to a 0.2% increase in basic oral treatment needs. Additionally, there was a statistically significant difference in the average excise tax revenue for sugary products between the periods before and after 2017. No change in average sugar consumption was observed despite implementing the new sugar policy. Therefore, it may be worthwhile to reconsider the excise tax on sweets and ice cream as it will significantly increase the total national revenues.

Pharmacoeconomic aspects of drug provision of patients with diabetes mellitus in the Novosibirsk Region

Aim to conduct a pharmacoeconomic assessment of drug provision for patients with diabetes mellitus in the Novosibirsk Region in the context of federal and regional segments for the period 2019-2021.&#x0D; Material and methods. An array of data on drug provision for diabetic patients in the Novosibirsk region for the period 2019-2021 was subjected to analysis. In the process of research were used methods: logical analysis, content analysis, ABC analysis, XYZ analysis.&#x0D; Results. The pharmacoeconomic assessment of drug provision for diabetic patients allows us to conclude that in the period 2019-2021 the load on the regional segment of the drug provision system steadily increased. At the same time, the share of costs for drug provision of diabetic patients in the federal segment continues to grow, despite the decrease in the number of covered prescriptions, which can be explained by the constant increase in the average cost of a prescription.&#x0D; The results of assessing the consumption of medicines and medical devices using a matrix model based on an integrated ABC/XYZ analysis showed an increasing need for additional medicines for the treatment of complications and concomitant diseases in diabetic patients. A greater increase in prescriptions of additional medicines and expenses for them in the period 2019-2021 observed in the regional segment.&#x0D; Conclusion. The results can be used to make managerial decisions in the field of optimizing the organization of drug provision for diabetic patients.

Decision Making on a Software Upgrade or Decommission with Data Mining and Machine Learning Techniques in Information Technology Industry

The Organizations have been investing more in Technology and Infrastructure spends like software upgrades, software renewals, software replacements, platform migrations etc., apart from investment in Business, People, and Processes. In this context, it is not an easy task for stakeholders to decide whether to go for a software upgrade or to replace it with another software. There is no unified approach or solution to consolidate data and relationships of Information Technology Assets, Software Upgrades, Software costs, Software defects, Software Performance Metrics, Security issues, IT system versions, service level objectives etc. Due to this, the decision making of software upgrades and software decommissioning is a tedious process and takes more time and effort. There is a need to build a solution that can integrate and validate the information like software assets, software upgrade success and failure likelihoods, cost benefit analysis of Cloud Computing, software metrics for fault prediction, software maintainability prediction results, Digital Transformation readiness and other related factors. There is an opportunity to apply Machine Learning techniques in defining and deriving the success likelihoods on the following data: Systems and data integration, software assets compatibility, operational service level agreement breaches, quality assurance metrics, security issues, number of open defects, number of defect fixes, number of priority incidents, mean time to resolve critical incidents, expected cost increase in software maintenance, potential cost reduction with the software or hardware replacement etc. This Research Proposal outlines the above mentioned to build a recommendation system aka decision tree namely Software Upgrades or Decommissions Life Cycle.

Moderate low-cost modifications in diet prevent a substantial number of deaths and mitigate environmental impacts in Brazil.

This study aimed to estimate the health, economic, and environmental impacts of moderate simulated interventions on dietary intake in Brazil. Data on food price and consumption were obtained from three nationwide surveys. Baseline dietary intake was estimated for 33,859 individuals aged 25years and older. Counterfactual intakes were based on six hypothetical intervention scenarios, by changing the weekly frequency and serving size in low or high consumers of fruit and vegetables (FV), milk, whole grains, red and processed meats, and sugar-sweetened beverages. For each scenario, we estimated the attributable number of deaths and disability-adjusted life years (DALY), monetary cost, environmental impacts (14 midpoint indicators), and environmentally-mediated health impacts. Compared with the baseline intake and cost, the most expensive intervention (+ 8.3%) was to increase FV intake (+ 125g), resulting in a 1.2% reduction in all-cause mortality (16,307 deaths/year). The cheapest (- 9.9%) was to reduce red and processed meat intake (- 40g), resulting in a 1.1% reduction in all-cause mortality (14,272 deaths/year). The combined intervention was, on average, 3.7% cheaper than the baseline cost, resulting in an increase in diet cost for 30% of the population (45-22% in the lower- and higher-income groups); all-cause mortality would be reduced by 3.8% (49,488 deaths/year). Interventions targeting red and processed meats would reduce emissions and resource use by 35-55%, in addition to reducing 2300 DALYs/year. A meaningful number of deaths can be avoided and environmental impacts reduced through moderate and potentially affordable diet modifications.

Role of Prophylactic Negative Pressure Dressings in Determining the Surgical Site Infection (SSI) on Closed Laparotomy Wounds in Abdominal Surgery: Randomized Controlled Open Label Trial: Vacuum Assisted Closure (VAC) Trial in a Tertiary Care Setup

Background: Surgical site infections (SSIs) continue to pose a significant challenge in postoperative care, particularly in abdominal surgeries, due to their prevalence and the associated increase in morbidity, mortality, and healthcare costs. Despite advancements in surgical techniques and aseptic measures, the incidence of SSIs remains high, underscoring the need for innovative preventive strategies. Objective: This study aims to evaluate the efficacy of vacuum-assisted closure (VAC) dressings compared to standard dressing methods in reducing the incidence of surgical site infections in patients undergoing closed laparotomy wounds in abdominal surgeries. Methods: A randomized controlled trial was conducted over six months at Civil Hospital Karachi, involving 116 patients undergoing abdominal surgeries. Participants were randomly assigned to receive either the VAC dressing or standard dressing postoperatively. The primary outcome measured was the incidence of SSIs within 30 days post-surgery, evaluated using the CDC classification and Southampton wound grading system. Data were analyzed using SPSS version 25.0, employing descriptive statistics, independent t-tests, and Chi-square tests for continuous and categorical variables, respectively. Results: The VAC group demonstrated a significantly lower incidence of SSIs (13.8%) compared to the non-VAC group (96.6%), with statistical significance (p &lt; 0.001). Age and BMI showed significant differences between the groups; patients in the VAC group were younger (mean age 30.84 ± 10.71 years) and had a lower BMI (mean 19.69 ± 4.16 kg/m²) compared to the non-VAC group (mean age 37.31 ± 12.83 years, mean BMI 22.07 ± 4.41 kg/m²). The duration of surgery and length of incision did not significantly differ between the groups. Conclusion: The use of vacuum-assisted closure dressings significantly reduces the incidence of surgical site infections in abdominal surgery patients, offering a superior alternative to standard dressings. This method not only enhances patient outcomes but could also lead to a reduction in healthcare costs by minimizing complications associated with SSIs.

Costs and acceptability of simplified monitoring in HIV-suppressed patients switching to dual therapy: the SIMPL'HIV open-label, factorial randomised controlled trial.

Clinical and laboratory monitoring of patients on antiretroviral therapy is an integral part of HIV care and determines whether treatment needs enhanced adherence or modification of the drug regimen. However, different monitoring and treatment strategies carry different costs and health consequences. The SIMPL'HIV study was a randomised trial that assessed the non-inferiority of dual maintenance therapy. The co-primary outcome was a comparison of costs over 48 weeks of dual therapy with standard antiretroviral therapy and the costs associated with a simplified HIV care approach (patient-centred monitoring [PCM]) versus standard, tri-monthly routine monitoring. Costs included outpatient medical consultations (HIV/non-HIV consultations), non-medical consultations, antiretroviral therapy, laboratory tests and hospitalisation costs. PCM participants had restricted immunological and blood safety monitoring at weeks 0 and 48, and they were offered the choice to complete their remaining study visits via a telephone call, have medications delivered to a specified address, and to have blood tests performed at a location of their choice. We analysed the costs of both strategies using invoices for medical consultations issued by the hospital where the patient was followed, as well as those obtained from health insurance companies. Secondary outcomes included differences between monitoring arms for renal function, lipids and glucose values, and weight over 48 weeks. Patient satisfaction with treatment and monitoring was also assessed using visual analogue scales. Of 93 participants randomised to dolutegravir plus emtricitabine and 94 individuals to combination antiretroviral therapy (median nadir CD4 count, 246 cells/mm3; median age, 48 years; female, 17%),patient-centred monitoring generated no substantial reductions or increases in total costs (US$ -421 per year [95% CI -2292 to 1451];p= 0.658). However, dual therapy was significantly less expensive (US$ -2620.4 [95% CI -2864.3 to -2331.4]) compared to standard triple-drug antiretroviral therapy costs. Approximately 50% of participants selected one monitoring option, one-third chose two, and a few opted for three. The preferred option was telephone calls, followed by drug delivery. The number of additional visits outside the study schedule did not differ by type of monitoring. Patient satisfaction related to treatment and monitoring was high at baseline, with no significant increase at week 48. Patient-centred monitoring did not reduce costs compared to standard monitoring in individuals switching to dual therapy or those continuing combined antiretroviral therapy. In this representative sample of patients with suppressed HIV, antiretroviral therapy was the primary factor driving costs, which may be reduced by using generic drugs to mitigate the high cost of lifelong HIV treatment. ClinicalTrials.govNCT03160105.