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Cost-effective Approach (cost-effective + approach)
Selected AbstractsHelicobacter pylori Culture from a Positive, Liquid-Based Urease Test for Routine Clinical Use: A Cost-Effective ApproachHELICOBACTER, Issue 1 2000Bernhard H. Jaup Background. The aim of our study was to test the feasibility of culturing Helicobacter pylori directly from biopsies aimed for rapid urease test in routine clinical practice. Materials and Methods. In 260 consecutive patients referred for gastroscopy because of dyspepsia one antral biopsy was routinely used for our "in house" rapid urease test (RUT). Positive biopsies were placed in a transport medium and sent to the laboratory. The biopsies were cultured and incubated at 37°C for 5,7 days. H. pylori was identified and routinely tested for antimicrobial resistance by using the E -test. Results. In 118 out of 260 patients (45%) the urease test turned positive and the growth of H. pylori was sufficient to allow testing of antimicrobial resistance. Conclusion.H. pylori could be cultured from almost all positive RUT specimens. A liquid RUT is thus more suitable for culture, saving additional biopsies. [source] DNAPL Characterization Methods and Approaches, Part 2: Cost ComparisonsGROUND WATER MONITORING & REMEDIATION, Issue 1 2002Mark L. Kram Contamination from the use of chlorinated solvents, often classified as dense nonaqueous phase liquids (DNAPLs) when in an undissolved state, pose environmental threats to ground water resources worldwide. DNAPL site characterization method performance comparisons are presented in a companion paper (Kram et al. 2001). This study compares the costs for implementing various characterization approaches using synthetic unit model scenarios (UMSs), each with particular physical characteristics. Unit costs and assumptions related to labor, equipment, and consumables are applied to determine costs associated with each approach for various UMSs. In general, the direct-push sensor systems provide cost-effective characterization information in soils that are penetrable with relatively shallow (less than 10 to 15 m) water tables. For sites with impenetrable lithology using direct-push techniques, the Ribbon NAPL Sampler Flexible Liner Underground Technologies Everting (FLUTe) membrane appears to be the most cost-effective approach. For all scenarios studied, partitioning interwell tracer tests (PITTs) are the most expensive approach due to the extensive pre-and post-PITT requirements. However, the PITT is capable of providing useful additional information, such as approximate DNAPL saturation, which is not generally available from any of the other approaches included in this comparison. [source] Systemic Immunization with Unadjuvanted Whole Helicobacter pylori Protects Mice Against Heterologous ChallengeHELICOBACTER, Issue 6 2008Stacey N. Harbour Abstract Background:, Adjuvant-free vaccines have many benefits, including decreased cost and toxicity. We examined the protective effect of systemic vaccination with adjuvant-free formalin-fixed Helicobacter pylori or bacterial lysate and the ability of this vaccine to induce protection against heterologous challenge. Materials and Methods:, Mice were vaccinated subcutaneously with H. pylori 11637 lysate or formalin-fixed bacteria, with or without ISCOMATRIXTM adjuvant, then orally challenged with H. pylori SS1. Serum was taken prior to challenge to examine specific antibody levels induced by the vaccinations, and protection was assessed by colony-forming assay. Results:, Vaccination with H. pylori 11637 lysate or formalin-fixed bacteria delivered systemically induced significantly higher levels of Helicobacter -specific serum IgG than the control, unvaccinated group and orally vaccinated group. After heterologous challenge with H. pylori SS1, all vaccinated groups had significantly lower levels of colonization compared with unvaccinated, control mice, regardless of the addition of adjuvant or route of delivery. Protection induced by systemic vaccination with whole bacterial preparations, without the addition of adjuvants, was only associated with a mild cellular infiltration into the gastric mucosa, with no evidence of atrophy. Conclusions:, Subcutaneous vaccination using unadjuvanted formalin-fixed H. pylori has the potential to be a simple, cost-effective approach to the development of a Helicobacter vaccine. Importantly, this vaccine was able to induce protection against heterologous challenge, a factor that would be crucial in any human Helicobacter vaccine. Further studies are required to determine mechanisms of protection and to improve protective ability. [source] New immunochemical fecal occult blood test with two-consecutive stool sample testing is a cost-effective approach for colon cancer screening: Results of a prospective multicenter study in Chinese patientsINTERNATIONAL JOURNAL OF CANCER, Issue 12 2006Shirong Li Abstract The purpose of the study is to evaluate a new immunochemical fecal occult blood test method (Hemosure IFOBT), and compare it to the Guaiac-based chemical method (CFOBT) for colorectal cancer detection. A hypothetical sequential method (SFOBT), in which IFOBT was used only as a confirmatory test for CFOBT, was also evaluated. A total of 324 patients were recruited from 5 major hospitals in Beijing, China. For each patient, 3 consecutive stool samples were collected for simultaneous CFOBT and IFOBT tests, followed by colonoscopic examination. We compared the sensitivity and specificity of the 3 methods (CFOBT, IFOBT and SFOBT) in two settings, with the first 2 consecutive samples versus all 3 samples. Although the sensitivity for the detection of cancer and large (>20 mm) or multiple adenoma was similar for all 3 methods in the three-sample setting, in the two-sample setting IFOBT had higher sensitivity than SFOBT for detecting cancer (87.8% vs. 75.5%, respectively, p < 0.05) and large (>20 mm) or multiple adenomas (65.4% vs. 42.3%, respectively, p < 0.05). The IFOBT also had a higher specificity than the CFOBT (89.2% vs. 75.5%, respectively, p < 0.01) in "normal" individuals defined by colonoscopy in the three-sample setting. Comparing two-sample setting to the three-sample setting, both CFOBT and SFOBT showed significant loss of sensitivity for the detection of cancer as well as adenoma, whereas the sensitivity for IFOBT did not change significantly. Overall, IFOBT with two-sample testing showed compatible sensitivity and specificity to the three-sample testing, and had a lower relative cost per cancer detected than the three-sample testing. In conclusion, the new Hemosure IFOBT with two consecutive stool samples appears to be the most cost-effective approach for colon cancer screening. © 2006 Wiley-Liss, Inc. [source] Typing of Listeria monocytogenes strains isolated in Italy by inlA gene characterization and evaluation of a new cost-effective approach to antisera selection for serotypingJOURNAL OF APPLIED MICROBIOLOGY, Issue 5 2010M. Tamburro Abstract Aims:, In this study, 105 Listeria monocytogenes strains isolated from humans, foods and environmental samples were characterized using several typing methods. Moreover, serotyping procedure was evaluated, and a cost-effective methodological approach based on preliminary PCRs screening was proposed. Methods and Results:, The isolates were analysed by conventional serotyping, multiplex-PCRs for serogroup and lineage identification and PCR,RFLP of inlA gene to identify potentially noninvasive L. monocytogenes. Among the strains, only the serotypes 1/2a, 1/2c, 1/2b, 4b and 3a were identified. The isolates were classified into serogroups I (58·10%), II (22·85%), III (12·38%) and IV (6·67%). Among clinical strains, lineage I was more represented (68·75%) than lineage II; whereas, lineage II was more associated with food (90·24%) and environmental (85·72%) isolates. Most of food (89·02%) and environmental (85·71%) isolates were classified into truncated InlA profiles, whereas the 93·75% of clinical strains were associated with a complete form of the protein. Conclusion:, Molecular techniques were sensitive and specific for classifying strains into serogroup and lineage and in agreement with the serotyping. Moreover, a preliminary PCRs-based screening was proposed to select only the necessary antisera by a flow chart; this methodological approach allows cost saving up to 42%. Our results further suggest the role of InlA protein in human listeriosis, particularly in immunocompetent individuals, and a correlation between truncated protein and serotype. Significance and Impact of the Study:, This study further validates molecular methods for L. monocytogenes analysis and proposed a new cost-effective approach for serotyping. It could help to improve a national surveillance network for L. monocytogenes infections in Italy. [source] An economic evaluation of different sinus lift techniquesJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 8 2010Stefan Listl Listl S, Faggion CM. An economic evaluation of different sinus lift techniques. J Clin Periodontol 2010; 37: 777-787 doi: 10.1111/j.1600-051X.2010.01577.x. Abstract Purpose: To identify the most cost-effective approach to sinus lifting on the basis of currently available evidence. Methods: We incorporate the costs and clinical outcomes of nine different sinus lift techniques within a decision tree model in which costs are based on insurance regulations in Germany and health outcomes follow two recent meta-analyses. The most cost-effective treatment option is identified on the basis of the maximum net benefit criterion. Uncertainties regarding health outcomes are incorporated via probabilistic sensitivity analysis based on Monte-Carlo simulation. Results: When there are no financial restrictions, the optimum treatment strategy is the lateral approach with autogenous particulate bone and a resorbable membrane. When, however, monetary resources for sinus-floor elevation are scarce, the most cost-effective option is the transalveolar technique without bone grafting. Only if relatively high costs can be afforded or if initial bone height at implant site is below 5 mm is the maximum net benefit achieved by lateral approaches. Conclusions: On the basis of currently available evidence, the transalveolar technique is advisable when monetary resources for sinus-floor elevation are scarce and initial bone height is sufficiently high. Lateral approaches are primarily recommended for lower pre-operative bone heights. [source] Increasing trend of acute hepatitis A in north India: Need for identification of high-risk population for vaccinationJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2006Zahid Hussain Abstract Background and Aims:, Hepatitis A (HAV) is endemic in India and most of the population is infected asymptomatically in early childhood with lifelong immunity. Because of altered epidemiology and decreasing endemicity, the pattern of acute HAV infection is changing from asymptomatic childhood infection to an increased incidence of symptomatic disease in the 18,40 age group. The aims of the present study were to assess whether the proportion of adults with acute HAV infection has been increasing over the years and to analyze the seroprevalence of immunoglobulin G (IgG) anti-HAV antibodies in young adults above the age of 15 years as well as in cases of chronic liver disease. Methods:, Sera collected from 3495 patients with acute (1932) and chronic (1563) liver disease attending the Medical Outpatient Department of Lok Nayak Hospital during the previous five years (1999,2003) were tested for various serological markers of acute (HBsAg, HBcIgM, anti-HCV, HEV-IgM, and HAV-IgM) and chronic (HBsAg, HBcIgG, HBeAg, and anti-HCV) hepatitis. In addition, 500 normal healthy attendants of the patients above the age of 15 years were tested for IgG anti-HAV as controls. Results:, Of 1932 patients with acute viral hepatitis, 221 (11.4%) were positive for immunoglobulin M (IgM) anti-HAV. The patients who were IgM anti-HAV negative included hepatitis B (321 patients), C (39 patients), E (507 patients) and unclassified (844 patients). Although the frequency of HAV infection among children had increased (10.6% to 22.0%) in the 5-year period, the frequency of HAV infection among adults had also increased (3.4% to 12.3%) during the same period. A total of 300 patients with chronic liver diseases that were etiologically related to hepatitis B (169), C (73) or dual infection (10) and alcoholic liver injury (48) were tested for the presence of IgG anti-HAV antibody; 98% (294/300) were positive for the antibody. Conclusions:, Although universal vaccination against HAV is not currently indicated, selective vaccination of the high-risk population, based on their serological evidence of HAV antibody, would be a rational and cost-effective approach. [source] Four-Year Cost-Utility Analyses of Sealed and Nonsealed First Permanent Molars in Iowa Medicaid-Enrolled ChildrenJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 4 2007Patita Bhuridej DDS Abstract Objectives: Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective. Methods: Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999. Previously published utilities were used to weight the different health states. The weighted sum of outcomes [Quality-Adjusted Tooth-Years (QATYs)] was the measure of effectiveness. Costs and QATYs were discounted to the time of the child's sixth birthday. Results: For all first molars, the cost of treatment associated with sealed teeth was higher but the utility was also slightly higher over the 4-year period. The relative incremental cost per 0.19 QATY ratio [changing the health state from a restored tooth (utility=0.81) to a nonrestored tooth (utility =1)] by sealing the molar ranged from $36.7 to $83.5 per 0.19 QATY. The incremental cost/QATY ratio was lower for sealing lower utilizers and for mandibular versus maxillary molars. Conclusions: Sealants improved overall utility of first permanent molars after 4 years. The 4-year cost/QATY ratio of sealing the first permanent molar varied by arch and type of utilizers. Sealing first permanent molars in lower dental utilizers is the most cost-effective approach for prioritizing limited resources. [source] Evaluation of available indices for inherently safer design optionsPROCESS SAFETY PROGRESS, Issue 2 2003Faisal I. Khan Inherent safety is a proactive approach for loss prevention during process plant design. It has been proven that, considering the lifetime costs of a process and its operation, an inherent safety approach can lead to a cost-optimal option. Application of inherent safety at the early stages of process design yields the best results with respect to process selection, conceptual design, and engineering design. However, in spite of being an attractive and cost-effective approach to loss prevention, it is not widely used. Reasons have been suggested for this lack of widespread use, but the lack of systematic tools to apply inherent safety principles is perhaps the most important one. A detailed study was conducted to analyze the performance of available hazard indices with reference to various inherent safety principles (guidewords). The performance of four main indices (Dow, Mond, Inherent Safety, and Safety Weighted Hazard [SweHI] indices) was studied for five inherent safety guidewords. None of the indexing procedures can capture all of the inherent safety guidewords, although the SWeHI and Dow Index were found to be robust on many accounts. It is recommended that a new specific index be developed for inherently safer design evaluation. The SWeHI and Dow indexing procedures may be a good basis on which to build. [source] Cost-effectiveness of Weight Watchers and the Lighten Up to a Healthy Lifestyle programAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Linda Cobiac Abstract Objective: Intensive weight loss programs that incorporate dietary counselling and exercise advice are popular and are supported by evidence of immediate weight loss benefits. We evaluate the cost-effectiveness of two weight loss programs, Lighten Up to a Healthy Lifestyle and Weight Watchers. Methods: Health gains from prevention of chronic disease are modelled over the lifetime of the Australian population. These results are combined with estimates of intervention costs and cost offsets (due to reduced rates of lifestyle-related diseases) to determine the dollars per disability-adjusted life year (DALY) averted by each intervention program, from an Australian health sector perspective. Results: Both weight loss programs produced small improvements in population health compared to current practice. The time and travel associated with attending group-counselling sessions, however, was costly for patients, and overall the cost-effectiveness ratios for Lighten Up ($130,000/DALY) and Weight Watchers ($140,000/DALY) were high. Conclusion: Based on current evidence, these intensive behavioural counselling interventions are not very cost-effective strategies for reducing obesity, and the potential benefits for population health are small. Implications: It will be critical to consider other strategies (e.g. changing the ,obesogenic' environment) or explore alternative methods of intervention delivery (e.g. Internet) to see if they offer a more cost-effective approach by effectively reaching a high number of people at a low cost. [source] Interferon regulatory factor-1 acts as a powerful adjuvant in tat DNA based vaccination,JOURNAL OF CELLULAR PHYSIOLOGY, Issue 3 2010Arianna Castaldello Genetic vaccines are safe cost-effective approaches to immunization but DNA immunization is an inefficient process. There is, therefore, a pressing need for adjuvants capable of enhancing the immunogenicity and effectiveness of these vaccines. This is particularly important for diseases for which successful vaccines are still lacking, such as cancer and infectious diseases including HIV-1/AIDS. Here we report an approach to enhance the immunogenicity of DNA vaccines involving the use of transcription factors of the Interferon regulatory factor (IRF) family, specifically IRF-1, IRF-3, and IRF-7 using the tat gene as model antigen. Balb/c mice were immunized by three intramuscular inoculations, using a DNA prime-protein boost protocol, with a DNA encoding tat of HIV-1 and the indicated IRFs and immune responses were compared to those induced by vaccination with tat DNA alone. In vivo administration of plasmid DNA encoding IRF-1, or a mutated version of IRF-1 deleted of the DNA-binding domain, enhanced Tat-specific immune responses and shifted them towards a predominant T helper 1-type immune response with increased IFN-, production and cytotoxic T lymphocytes responses. Conversely, the use of IRF-3 or IRF-7 did not affect the tat -induced responses. These findings define IRF-1 and its mutated form as efficacious T helper 1-inducing adjuvants in the context of tat- based vaccination and also providing a new promising candidate for genetic vaccine development. J. Cell. Physiol. 224: 702,709, 2010. © 2010 Wiley-Liss, Inc. [source] Hydrogen generation from photoelectrochemical water splitting based on nanomaterialsLASER & PHOTONICS REVIEWS, Issue 4 2010Y. Li Abstract Hydrogen is potentially one of the most attractive and environmentally friendly fuels for energy applications. Safe and efficient generation, storage, and utilization of hydrogen present major challenges in its widespread use. Hydrogen generation from water splitting represents a holy grail in energy science and technology, as water is the most abundant hydrogen source on the Earth. Among different methods, hydrogen generation from photoelectrochemical (PEC) water splitting using semiconductors as photoelectrodes is one of the most scalable and cost-effective approaches. Compared to bulk materials, nanostructured semiconductors offer potential advantages in PEC application due to their large surface area and size-dependent properties, such as increased absorption coefficient, increased band-gap energy, and reduced carrier-scattering rate. This article provides a brief overview of some recent research activities in the area of hydrogen generation from PEC water splitting based on nanostructured semiconductor materials, with a particular emphasis on metal oxides. Both scientific and technical issues are critically analyzed and reviewed. [source] The future of IPM: whither or wither?AUSTRALIAN JOURNAL OF ENTOMOLOGY, Issue 2 2009Myron P Zalucki Abstract The acronym IPM (integrated pest management) has been around for over 50 years and now not only supposedly guides research and extension in pest management but also markets pesticides, is claimed to be undertaken by many growers, and even resonates with public perceptions and politicians. Whether or not IPM programs are sustainable in the longer term under the conflicting stresses and strains of the modern agricultural environment is debatable. We analyse three case studies of IPM development in Australia: citrus IPM in central Queensland, Brassica IPM in southeast Queensland and Helicoverpa management in cotton in eastern Australia. Many management practices for these pests have changed over time. In the more stable citrus system classical biological control along with changed practices (reduced pesticide use) have effectively controlled imported scale insect pests. In Brassicas and cotton, IPM is predominantly of the sample and spray variety where, increasingly, less broad-spectrum insecticides are used and, in cotton, Helicoverpa management includes the deployment of transgenic plants. We question whether or not IPM principles are always consistent with market forces and whether or not the approach is universally applicable for all pest insects when implemented at the small (field or farm) scale. Farmers will adopt cost-effective approaches that minimise their financial risks. For Australia as a whole over the last 30 years insecticide input costs per hectare have increased faster than the price index, reflecting more costly insecticides, changes to the combinations of crops grown and an increase in the overall area of crops cultivated together with possible concomitant changes in pest abundance. Any pest crisis will ensure rapid changes in practice and adoption of technologies, in order to mitigate the short-term financial stresses caused. However, regression to former practices tends to follow (e.g. in Brassica crops). In most cases, we cannot objectively test if changed management practices are responsible for changes in pest abundance, as is often claimed, or if the latter is simply a consequence of the weather and/or related large-scale landscape features (e.g. area of host plants). We argue that for many systems the future of pest management practice will require a change to landscape or area-wide approaches. We suspect, given how entrenched the acronym has become, whatever the nature of the approach it will be called IPM. [source] Studies in haemoglobin E beta-thalassaemiaBRITISH JOURNAL OF HAEMATOLOGY, Issue 3 2008Nancy F. Olivieri Summary Haemoglobin E ,-thalassaemia is the commonest form of severe thalassaemia in many Asian countries, but little is known about its natural history, the reasons for its clinical diversity, or its optimal management. Despite its frequency, haemoglobin E ,-thalassaemia is often managed in an ill-defined and haphazard way, usually by demand transfusion. We studied a cohort of Sri Lankan patients with haemoglobin E ,-thalassaemia over 5 years, and identi,ed several genetic and environmental factors possibly contributing to the phenotypic diversity of the disorder. These included modi,ers of haemoglobin F production, malaria and age-related changes in adaptation to anaemia. Our ,ndings suggest that in many patients, haemoglobin E ,-thalassaemia can be managed without transfusion, even with low haemoglobin levels. Age-related changes in the pattern of adaptation to anaemia suggest that more cost-effective approaches to management should be explored. [source] | |||||||||||||