Literature-based Analysis Research Articles

161 Optimizing Clinical Assessment and Diagnostic Evaluation in Patients With Chronic Constipation Based on Systematic Analysis of 97 Articles in the Literature

INTRODUCTION: There is still controversy surrounding the use of symptoms, history, and tests for diagnosis of rectal evacuation disorders (RED) and slow transit constipation (STC). We performed a comprehensive literature-based analysis to ascertain pooled prevalence, sensitivity (SN), specificity (SP), and likelihood ratios (LR) for clinical parameters to determine pre- and post-test probabilities of diagnosing RED and STC without RED. METHODS: Using MEDLINE and PUBMED, we examined systematic and clinical reviews, meta-analyses, primers, guidelines, and consensus statements since 1999 to determine the diagnostic utility of history, symptoms, and testing for RED and STC. Studies were included if binary data were available to assess true/false positives or negatives to pool and calculate SN/SP/LR. Given there are no “gold standard” diagnostic criteria for RED or STC, designation of “true” RED or STC was based on confirmation by at least one objective anorectal or colonic transit test. Controls varied across studies; all had normal anorectal and/or transit tests by the specific protocol used in each study. We assessed STC alone (associated with normal anorectal testing). RESULTS: We reviewed 97 articles involving studies from many different countries, and 63 articles for RED and 61 articles for STC met inclusion/exclusion criteria. The prevalence of disease phenotypes among 4160 patients with chronic constipation based on objective testing was RED alone 23.3%, normal transit constipation (NTC) alone 31.9%, STC alone 16.2%, and RED + STC 14.3%. To diagnose RED (Figure 1, Table 1), the most clinically significant symptoms included hard/lumpy stools (+LR 269.6, n = 1583) and urinary symptoms (100% specificity, n = 58). The strongest digital rectal exam (DRE) findings were poor anal relaxation (+LR 5.3, n = 529) or increased anal squeeze (+LR 8.4, n = 395). The most predictive anorectal tests were balloon expulsion time >120 s (+LR 5.5, n = 551) and rectoanal pressure gradient < −40 mmHg with high anal pressure on straining on anorectal manometry (100% specificity, n = 101). For STC alone, the most predictive symptom was a call to stool (+LR 10.5, n = 75). Patients without abdominal distension/fullness/bloating were less likely to have RED (−LR 0.2, n = 324) or STC alone (−LR 0.2, n = 93). CONCLUSION: Symptom assessments and DREs are critical in the evaluation for RED and STC. RED is highly prevalent in patients presenting with chronic idiopathic constipation.

Medical 3D Printing Cost-Savings in Orthopedic and Maxillofacial Surgery: Cost Analysis of Operating Room Time Saved with 3D Printed Anatomic Models and Surgical Guides

Three-dimensional (3D) printed anatomic models and surgical guides have been shown to reduce operative time. The purpose of this study was to generate an economic analysis of the cost-saving potential of 3D printed anatomic models and surgical guides in orthopedic and maxillofacial surgical applications. A targeted literature search identified operating room cost-per-minute and studies that quantified time saved using 3D printed constructs. Studies that reported operative time differences due to 3D printed anatomic models or surgical guides were reviewed and cataloged. A mean of $62 per operating room minute (range of $22-$133 per minute) was used as the reference standard for operating room time cost. Different financial scenarios were modeled with the provided cost-per-minute of operating room time (using high, mean, and low values) and mean time saved using 3D printed constructs. Seven studies using 3D printed anatomic models in surgical care demonstrated a mean 62 minutes ($3720/case saved from reduced time) of time saved, and 25 studies of 3D printed surgical guides demonstrated a mean 23 minutes time saved ($1488/case saved from reduced time). An estimated 63 models or guides per year (or 1.2/week) were predicted to be the minimum number to breakeven and account for annual fixed costs. Based on the literature-based financial analyses, medical 3D printing appears to reduce operating room costs secondary to shortening procedure times. While resource-intensive, 3D printed constructs used in patients' operative care provides considerable downstream value to health systems.

Water Vulnerability in Arctic Households: A Literature-based Analysis

There is an urgent need to understand the contextual factors that influence water vulnerability of households in the Arctic. To evaluate the existing knowledge of Arctic household water vulnerability, this paper presents the results of a narrative review with a systematic search. The review identified 112 documents, including peer-reviewed articles, reviews, book chapters, proceedings papers, and meeting abstracts. The documents were analyzed for the main factors affecting water vulnerability in Arctic households, which fell into two categories: biophysical factors and anthropogenic factors. Within the biophysical category, the majority of documents noted climate change impacts on freshwater supplies and water systems, followed by attention to extreme weather and the seasonality of water supplies. Within the anthropogenic category, the vast majority highlighted infrastructure as the primary issue affecting water access, followed by economic, governance, socio-cultural, and demographic factors. Through these diverse influencing factors, this review situates the discussion of household water vulnerability in the Arctic in a more nuanced light. The categories illuminate patterns between factors, which can worsen, assuage, or mitigate water vulnerability. The complex relationships between these factors influence the degree and nature of water vulnerability in Arctic households. In order to successfully address household water vulnerability in the Arctic, these factors and their dynamic relationships must be considered in freshwater policy and management frameworks.

Engendering High Performing Employees through Business Analytics, Organisational Social Capital Building (OSCB) and Employee Engagement: A Theoretical Review

Abstract Contemporary HR entails the use, and the combination of modified HR practices and functions to ensure the integration of individual trust with organizational trust leading to accumulating and harnessing employee commitment, identification, and spirit of collectivism that are necessary for the achievement of organizational outcomes. Intensified discussions about the ever-increasing role HR practitioners have to play in harnessing, the inherent, capital in human social interactions provided the stimulus and inspiration for this research paper. More so, as contemporary HR, requires the bringing forth of a highly engaged organization workforce, sustainably. This paper approaches its aim in three strands: first, the paper explores the, hitherto unknown, symbiotic relationship that exists between business analytics (BA), organisational social capital (OSC), employee engagement (EE) and high performing employees (HPE). Secondly, it examines the causal role of BA in organisations social capital building (OSCB) initiatives; the multiplier effect of OSCB on EE and consequently high performing employees. Thirdly, this paper, theoretically, identified the specific area of BA that has a direct impact on OSCB, EE, and HPE, and suggest practical implications of how BA can enhance organisation performance via OSCB and EE. The paper employs literature-based analyses, and from these conceptual, theoretical and practical arguments are established.

Does the hospitality industry need or deserve talent?

PurposeThis paper aims to confront the most challenging issues that the hospitality industry faces. This relates to the recruitment and retention of talented future leaders. This is a long-standing issue but one that is increasing in importance as industry changes, combined with external pressures within the labour market (demographic and competitive), act to restructure the recruitment landscape in many countries.Design/methodology/approachThis paper provides a literature-based analysis that addresses two key questions relating to the hospitality industry and talent – does the sector need talent and, controversially, does it deserve talent? The literature has been addressed on the basis of the author’s in-depth knowledge and the use of a wide range of pertinent search terms relating to the core themes of hospitality and talent management.FindingsThe paper assesses evidence with respect to both questions, framed as propositions, and concludes that the current talent pipelines, upon which hospitality substantially depends, may not be fit for purpose, and that the wider workplace culture within hospitality is not compatible with the attraction of the best into the industry.Research limitations/implicationsThe paper challenges the established practice, both within the hospitality industry, in terms of its workplace environment, and in the way its educational partners (hospitality management schools) prepare young people for the industry. The outcomes of the analysis do not provide much by way of succour to either.Practical implicationsImplicit in this paper is a call to key stakeholders (industry and education) in the search for future leaders of the hospitality industry to address and review both the industry workplace, to make it more attractive and rewarding for young graduates, and the educational model that still dominates hospitality management programmes in preparing them for careers.Social implicationsCareers in hospitality will remain “Cinderella” options for young graduates until action is taken by stakeholders to reposition the nature of the careers on offer and the focus of the programmes available in preparation for them.Originality/valueThe approach taken is the presentation of widely recognised themes in an original format.

How well do software assistants for minimally invasive partial nephrectomy meet surgeon information needs? A cognitive task analysis and literature review study.

IntroductionIntraoperative software assistance is gaining increasing importance in laparoscopic and robot-assisted surgery. Within the user-centred development process of such systems, the first question to be asked is: What information does the surgeon need and when does he or she need it? In this article, we present an approach to investigate these surgeon information needs for minimally invasive partial nephrectomy and compare these needs to the relevant surgical computer assistance literature.Materials and methodsFirst, we conducted a literature-based hierarchical task analysis of the surgical procedure. This task analysis was taken as a basis for a qualitative in-depth interview study with nine experienced surgical urologists. The study employed a cognitive task analysis method to elicit surgeons' information needs during minimally invasive partial nephrectomy. Finally, a systematic literature search was conducted to review proposed software assistance solutions for minimally invasive partial nephrectomy. The review focused on what information the solutions present to the surgeon and what phase of the surgery they aim to support.ResultsThe task analysis yielded a workflow description for minimally invasive partial nephrectomy. During the subsequent interview study, we identified three challenging phases of the procedure, which may particularly benefit from software assistance. These phases are I. Hilar and vascular management, II. Tumour excision, and III. Repair of the renal defects. Between these phases, 25 individual challenges were found which define the surgeon information needs. The literature review identified 34 relevant publications, all of which aim to support the surgeon in hilar and vascular management (phase I) or tumour excision (phase II).ConclusionThe work presented in this article identified unmet surgeon information needs in minimally invasive partial nephrectomy. Namely, our results suggest that future solutions should address the repair of renal defects (phase III) or put more focus on the renal collecting system as a critical anatomical structure.

Decolonizing the Ethics of Intellectual Freedom: Exploring a New Intersectional Framework for Allyship and Ethical Practice

The intersection between Indigenous allyship, intellectual freedom, and social responsibility is understudied in LIS literature. This conceptual paper employs literature-based critical analysis to explore the tension between these concepts and torwards the theoretical basis for a new interdisciplinary model for ethical information practice. The model draws on foundational aspects of human rights scholarship, human resources literature, philosophy, and uncertainty as a critical tradition for librarianship.

Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis

There is a scarcity of published data on the global prevalence of obstructive sleep apnoea, a disorder associated with major neurocognitive and cardiovascular sequelae. We used publicly available data and contacted key opinion leaders to estimate the global prevalence of obstructive sleep apnoea. We searched PubMed and Embase to identify published studies reporting the prevalence of obstructive sleep apnoea based on objective testing methods. A conversion algorithm was created for studies that did not use the American Academy of Sleep Medicine (AASM) 2012 scoring criteria to identify obstructive sleep apnoea, allowing determination of an equivalent apnoea-hypopnoea index (AHI) for publications that used different criteria. The presence of symptoms was not specifically analysed because of scarce information about symptoms in the reference studies and population data. Prevalence estimates for obstructive sleep apnoea across studies using different diagnostic criteria were standardised with a newly developed algorithm. Countries without obstructive sleep apnoea prevalence data were matched to a similar country with available prevalence data; population similarity was based on the population body-mass index, race, and geographical proximity. The primary outcome was prevalence of obstructive sleep apnoea based on AASM 2012 diagnostic criteria in individuals aged 30-69 years (as this age group generally had available data in the published studies and related to information from the UN for all countries). Reliable prevalence data for obstructive sleep apnoea were available for 16 countries, from 17 studies. Using AASM 2012 diagnostic criteria and AHI threshold values of five or more events per h and 15 or more events per h, we estimated that 936 million (95% CI 903-970) adults aged 30-69 years (men and women) have mild to severe obstructive sleep apnoea and 425 million (399-450) adults aged 30-69 years have moderate to severe obstructive sleep apnoea globally. The number of affected individuals was highest in China, followed by the USA, Brazil, and India. To our knowledge, this is the first study to report global prevalence of obstructive sleep apnoea; with almost 1 billion people affected, and with prevalence exceeding 50% in some countries, effective diagnostic and treatment strategies are needed to minimise the negative health impacts and to maximise cost-effectiveness. ResMed.

Abstract 673: Impact of PD-L1 feedback modulation on the sensitivity of anti-PD-1/PD-L1

Abstract The long-term benefits of anti-PD-1/PD-L1 are limited in most cancer patients. Resistance and insensitivity are major challenges of this therapeutic class. Feedback regulation of PD-L1 could serve as a mechanism of drug resistant, especially negative feedback loops where inhibition of PD-L1 may lead to up-regulation of its own expression and function. In this study, computational models were established to investigate PD-L1 feedback modulations to facilitate discovery of biomarkers for drug sensitivity and to inform design of drug combination studies. As of October 2018, over 10,000 publications on cancer and immunosuppressive factors (e.g. PD-1, PD-L1, CTLA4, IDO1, TIM-3, LAG3, TIGIT) were found in PubMed. About 2500 abstracts of these articles were downloaded and systematically analyzed through natural language processing and text mining. Information on gene/drug, pathway/disease along with results from cell/animal/clinical studies were extracted, standardized and integrated into a directed graph-based database. Algorithms were designed to construct networks and identify PD-L1 feedback loops (FBLs). Fisher's Exact tests were performed to evaluate the significance of factors involved in (+) and (-)FBLs. The computationally generated PD-L1 feedback network comprises 102 nodes, 216 interactions with 1080 possible FBLs (502 positive vs 578 negative). In particular, up-regulation of IL10, pEGFR, SRC, HIF1A, ISX, NF-kappaB, pSMAD2/SMAD2, IFN-gamma were strongly associated with up-regulation of PD-L1 upon inhibition of PD-1/PD-L1 (p<0.0001, (-)FBLs). Interestingly, TIM-3, a potential IO target and commonly up-regulated by anti-PD-1/PD-L1, is involved in both (+) and (-)FBLs. Inhibition of TIM-3 (e.g. anti-TIM-3) could decrease IL-10 in Tregs and enhance efficacy of anti-PD-1/PD-L1, but meanwhile, anti-TIM-3 could activate NF-kappaB, IRF7 and STAT1, leading to up-regulation of PD-L1 expression and potential resistance to anti-PD-1/PD-L1. In conclusion, the literature-based network analysis proved to be effective to identify potential regulatory pathways driving resistance to immunotherapies, to prioritize the selection of biomarkers, and to assess risk of drug combinations. Particularly, through the analysis of feedback regulations of PD-L1, novel therapeutic approaches to boost efficacy of anti-PD-1/PD-L1 could be postulated. Targeting genes involved in both (+) and (-)FBLs of PD-L1, such as TIM-3, needs to be carefully evaluated. Citation Format: Jian Zhu, Rebecca L. Zhu. Impact of PD-L1 feedback modulation on the sensitivity of anti-PD-1/PD-L1 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 673.

Motor cortex stimulation: a systematic literature-based analysis of effectiveness and case series experience

BackgroundAim to quantitatively analyze the clinical effectiveness for motor cortex stimulation (MCS) to refractory pain.MethodsThe literatures were systematically searched in database of Cocharane library, Embase and PubMed, using relevant strategies. Data were extracted from eligible articles and pooled as mean with standard deviation (SD). Comparative analysis was measured by non-parametric t test and linear regression model.ResultsThe pooled effect estimate from 12 trials (n = 198) elucidated that MCS shown the positive effect on refractory pain, and the total percentage improvement was 35.2% in post-stroke pain and 46.5% in trigeminal neuropathic pain. There is no statistical differences between stroke involved thalamus or non-thalamus. The improvement of plexus avulsion (29.8%) and phantom pain (34.1%) was similar. The highest improvement rate was seen in post-radicular plexopathy (65.1%) and MCS may aggravate the pain induced by spinal cord injury, confirmed by small sample size. Concurrently, Both the duration of disease (r = 0.233, p = 0.019*) and the time of follow-up (r = 0.196, p = 0.016*) had small predicative value, while age (p = 0.125) had no correlation to post-operative pain relief.ConclusionsMCS is conducive to the patients with refractory pain. The duration of disease and the time of follow-up can be regarded as predictive factor. Meanwhile, further studies are needed to reveal the mechanism of MCS and to reevaluate the cost-benefit aspect with better-designed clinical trials.

Transcriptomic analysis of human dermal fibroblast cells reveals potential mechanisms underlying the protective effects of visible red light against damage from ultraviolet B light

BackgroundUltraviolet B (UVB) radiation is a major cause of skin photodamage, including the damage associated with photodermatoses, aging, and cancer. Although many studies have shown that red light has photoprotective effects on skin, the mechanisms underlying these effects are still poorly understood. ObjectiveThe aim of this study was to identify the photoprotective effects of visible red light against UVB-induced skin damage in normal human dermal fibroblast cells using a transcriptomic approach. MethodsNext-generation sequencing-based transcriptomic analyses were used to profile transcriptomic alterations and identify genes that are differentially expressed by visible red light and by UVB exposure. To understand the biological networks among identified genes, a literature-based biological pathway analysis was performed. Quantitative real-time polymerase chain reaction assays were used for mRNA-level validation of selected key genes. ResultsWe observed that visible red light contributes to skin cell protection against UVB by modulating gene expression that enhances the adaptive response to redox and inflammatory balancing and by upregulating genes involved in DNA excision repair processes. We also identified that several key genes in the red light-induced biological network were differentially regulated. ConclusionsVisible red light enhanced the UVB-protective effects in normal human skin cells via the transcriptomic modulation of genes involved in cell-protective processes. Our findings from this next-generation sequencing analysis may lead to a better understanding of the cytoprotective effects of visible red light and provide direction for further molecular or mechanistic studies.

Lactate Activates the E2F Pathway to Promote Cell Motility by Up-Regulating Microtubule Modulating Genes.

Excess lactate production due to enhanced aerobic glycolysis is characteristic of malignant cancers, which is also intimately associated with poor cancer prognoses. Although tumor-associated lactate contributes to all major steps in carcinogenesis, its action mechanism remains obscure. To understand the molecular mechanism of the lactate-induced tumor metastatic process, we identified an array of lactate-responsive genes via transcriptome analysis of a metformin-induced hyper-glycolytic liver cancer model. Gene set enrichment analysis suggested E2F-RB pathway as the dominant regulator of the lactate-induced gene expression. We experimentally verified that lactate indeed activates E2F-mediated transcription by promoting E2F1 protein accumulation through a posttranscriptional mechanism. Literature-based analysis of target pathways potentially modulated by 136 top-ranked genes indicated that genes functioning in cell-cell or cell-matrix communications dominate the lactate-induced gene expression. Especially, those regulating microtubule functions, including a group of kinesin family members, were significantly up-regulated in lactate- and E2F1-dependent manners. Depletion of E2F1 or kinesins (KIF2C, KIF18B, KIF20A) led to deformation of microtubule structures, impairing cell motility as much as the deficit in lactate production. These results indicate that E2F pathway activation by tumor-associated lactate and subsequent transcriptional activation of microtubule functions play crucial roles in tumor metastasis, providing mechanistic clues to cell motility-directed anti-cancer strategies.

On the centrality of peripheral research and the dangers of tight boundary gatekeeping

Drawing on a literature-based analysis and our own experiences in doing work at the periphery of accounting research, this essay aims to reflect on the processes by which accounting research boundaries are socially constructed, henceforth demarcating a division between center and peripheral research. Recognizing that serious indications of tight boundary gatekeeping are on the rise in the accounting research domain, we highlight the extent of negative consequences ensuing from this kind of behavior. We also maintain how, collectively speaking, we may gain from developing more receptive attitudes toward the peripheral. Along with several other writers, we view work at the periphery of an area’s research boundaries as having significant potential for the development of new ideas and innovations. However, an excessively protective center may prevent these ideas and innovations from being brought into the field of visibility, especially when the center is inclined to issue stringent reviews and this degree of stringency, somehow, reverberates in peripheral journals’ reviewing practices. We believe that the longer-term sustainability of accounting research requires the incremental development of spaces of receptivity toward the unexpected and peripheral.

The linkage between knowledge management practices and organization based projects for better learning outcome

PurposeThe purpose of this paper is to provide a framework to understand and reflect upon issues, which can help in producing better industry-ready students graduating from business schools.Design/methodology/approachThe paper examines research conducted in the area of knowledge management (KM) and proposes a conceptual framework that can be used by academic institutions to engage students and prepare them for industry needs so that they are better industry-ready graduates. A case study based approach has been adopted in this study.FindingsIn line with the literature-based analysis, a framework for better industry ready students has been proposed, illustrating the linkage between KM, learning from organization-based projects, industry feedback and inputs from international accreditation bodies in higher education.Originality/valueThis paper has provided a comprehensive framework that contributes to the understanding and refining the academic processes in a business school setting with the help of learning from academic KM process. Such a framework has not been previously developed by previous researchers.

A review of climatic and vegetation surveys in urban environment with laser scanning: A literature-based analysis

Laser scanning is a promising relatively new technology of land surveying and has different contributions to research areas and practical applications. We performed a review based on query terms in the Scopus database. We determined the number of papers where the laser scanning was the technique of the survey and refined the results with the aerial (ALS) and terrestrial (TLS) laser scanning methods, and the urban and vegetation searching terms. Results showed that geosciences had a 30-40% ratio within the scientific papers using LiDAR. TLS had larger relevance related to ALS considering the total number of research papers, urban application and vegetation analysis in urban environment. We analysed the current status of the technology and discussed the underlying possible causes.

Etiologies of simultaneous cerebral infarcts in multiple arterial territories: A simple literature-based pooled analysis.

Acute multiple infarcts in multiple cerebral circulations are thought to suggest the presence of cardioembolic sources. However, several studies have shown other etiologies for simultaneous cerebral infarcts in multiple arterial territories. We conducted a systematic review of the literature using PubMed, Scopus, Embase, Clinicaltrial.gov, WHO International Clinical Trials Registry Platform (ICTRP), and Cochrane library. Studies reporting multiple acute strokes in more than one arterial territory based on diffusion-weighted imaging (DWI) findings were reviewed and included. Studies were excluded if they had limited inclusion criteria, performed limited subgroup analysis, did not use diffusion weighted imaging (DWI), and were not published in English. Out of 15056 stroke patients from 21 studies included in this study, 1914 (13%) patients had acute multiple infarcts in multiple cerebral circulations. One hundred and ninety-nine patients were excluded as their workup and diagnosis were not reported. Out of 1715 patients, 472 (27.6%) patients had an undetermined etiology. Cardioembolism was the most common cause of stroke in multiple arterial territories [37.2%, 95% confidence interval (CI): 36-40%] followed by large artery atherosclerosis including aortic arch atheroma (25.7%, 95% CI: 21-25%). Hematological disorders were found to be the cause of cerebral infarcts in 36 (2.1%, 95% CI: 2-4%) patients. Other etiologies for stroke in multiple arterial territories were small vessel pathologies and intracranial small vessel atherosclerosis (1.8%), inflammatory disorders such as vasculitis and infection (0.2%), and iatrogenic causes (0.1%). Acute multiple infarcts in multiple cerebral circulations occur among 13% of stroke patients. Although cardioembolism is the most common cause, there are several other etiologies that require a different workup and secondary prevention strategy.

Research on the Development of China’s Logistics

The purpose of this paper is to explore the current state of China’s logistics development and the future development. In order to fulfill the research objective, a literature-based survey and content analysis is used to investigate the development level of China’s logistics research, also, second-hand data based statistical analysis is used as the main method to study the development of Chinese logistics in this paper. While every effort has been made to ensure that the most up-to-date data is available in the analysis, this is not always possible due to the obvious reasons for data scarcity and data integrity. Despite the improvements and progress made by the government and other agencies, the current logistics infrastructure, especially the transportation network, customs procedures and warehousing facilities are still lacking. Future developments are also highlighted to portray an accurate assessment of China’s logistics situation. This is the latest comprehensive research on the development of China’s logistics in the known scope. It provides an opportunity for companies that want to enter the Chinese market to understand the development of China’s logistics.

Regulatory Analysis of Mark-up Structure in Medicine Prices by the Pharmaceutical Industry in South Africa

Access to medicines depends on a number of interconnected factors: Medicine prices, one of the most common factors can be affected by the manufacturer’s selling prices, duties, taxes, patent legislation and mark-ups along the supply channel. The South African government has passed price legislation prohibiting discounts and rebates in the pharmaceutical sector by setting a single exit price for all manufacturers and a fee-for service logistics fee for wholesalers, distributors and dispensing fee for retailers as compensation. In this study the South African mark-up structure related to medicine prices is going to be analysed because of its tribulations in implementing a transparent wholesale reform and the fact that it was once classified under the nine countries from the WHO African Region for analysis of data from their Medicines Prices Surveys. This Literature based-analysis study made use of articles, journals for assessing and identifying the denominators responsible for high mark-ups on medications. Documentation pharmaceutical policy papers and publications, researches performed using PubMed and WHO/HAI medicine price database were also used to assess those areas and come up with possible strategies to reduce high price of medication and improve access of healthcare by the public. In private sectors, regulating mark-ups is more complex and weaker than in the public sector which is a reason for higher medicine costs. Policy development need to be reviewed in terms of pricing policies and regulation of mark-ups so that people of South Africa receive the medicine they need at a cost that they and the system as a whole can afford. This structure can help to raise further awareness and prompt the government to evaluate the regulation on entry point drug developers.

Cost-effectiveness of a combined intervention of long lasting insecticidal nets and indoor residual spraying compared with each intervention alone for malaria prevention in Ethiopia

BackgroundThe effectiveness of long lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), for malaria prevention, have been established in several studies. However, the available evidence about the additional resources required for a combined implementation (LLIN + IRS) with respect to the added protection afforded is limited. Therefore, the aim of this study was to compare the cost-effectiveness of combined implementation of LLINs and IRS, compared with LLINs alone, IRS alone, and routine practice in Ethiopia.MethodsThe study was performed alongside a cluster randomized controlled trial of malaria prevention conducted in Adami Tullu district, in Ethiopia, from 2014 to 2016. In addition, literature-based cost-effectiveness analysis—using effectiveness information from a systematic review of published articles was conducted. Costing of the interventions were done from the providers’ perspective. The health-effect was measured using disability adjusted life years (DALYs) averted, and combined with cost information using a Markov life-cycle model. In the base-case analysis, health-effects were based on the current trial, and in addition, a scenario analysis was performed based on a literature survey.ResultsThe current trial-based analysis showed that routine practice is not less effective and therefore dominates both the combined intervention and singleton intervention due to lower costs. The literature-based analysis had shown that combined intervention had an incremental cost-effectiveness ratio of USD 1403 per DALY averted, and USD 207 per DALY averted was estimated for LLIN alone. In order for the ICER for the combined intervention to be within a range of 1 GDP per capita per DALY averted, the annual malaria incidence in the area should be at least 13%, and the protective-effectiveness of combined implementation should be at least 53%.ConclusionsBased on the current trial-based analysis, LLINs and IRS are not cost-effective compared to routine practice. However, based on the literature-based analysis, LLIN alone is likely to be cost-effective compared to 3 times GDP per capita per DALY averted. The annual malaria probability and protective-effectiveness of combined intervention are key determinants of the cost-effectiveness of the interventions.Trial registration PACTR201411000882128 (Registered 8 September 2014). http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201411000882128

Industry 4.0 and Sustainability Implications: A Scenario-Based Analysis of the Impacts and Challenges

The new evolution of the production and industrial process called Industry 4.0, and its related technologies such as the Internet of Things, big data analytics, and cyber–physical systems, among others, still have an unknown potential impact on sustainability and the environment. In this paper, we conduct a literature-based analysis to discuss the sustainability impact and challenges of Industry 4.0 from four different scenarios: deployment, operation and technologies, integration and compliance with the sustainable development goals, and long-run scenarios. From these scenarios, our analysis resulted in positive or negative impacts related to the basic production inputs and outputs flows: raw material, energy and information consumption and product and waste disposal. As the main results, we identified both positive and negative expected impacts, with some predominance of positives that can be considered positive secondary effects derived from Industry 4.0 activities. However, only through integrating Industry 4.0 with the sustainable development goals in an eco-innovation platform, can it really ensure environmental performance. It is expected that this work can contribute to helping stakeholders, practitioners and governments to advance solutions to deal with the outcomes emerging through the massive adoption of those technologies, as well as supporting the expected positive impacts through policies and financial initiatives.