Foley catheter vs. oral misoprostol to induce labour among hypertensive women in India: a cost-consequence analysis alongside a clinical trial.

OBJECTIVE: To determine the effectiveness and economic impact of two methods for induction of labour in hypertensive women, in low-resource settings. DESIGN: Cost-consequence analysis of a previously reported multicentre, parallel, open-label randomised trial. SETTING & POPULATION: A total of 602 women with a live fetus, aged ≥18 years requiring delivery for pre-eclampsia or hypertension, in two public hospitals in Nagpur, India. METHODS: We performed a formal economic evaluation alongside the INFORM clinical trial. Women were randomised to receive transcervical Foley catheterisation or oral misoprostol 25 mcg. Healthcare expenditure was calculated using a provider-side microcosting approach. MAIN OUTCOME MEASURES: Rates of vaginal this delivery within 24 hours of induction, healthcare expenditure per completed treatment episode. RESULTS: Induction with oral misoprostol resulted in a (mean difference) $20.6USD reduction in healthcare expenditure [95% CI (-) $123.59 (-) $72.49], and improved achievement of vaginal delivery within 24 hours of induction, mean difference 10% [95% CI (-2 to 17.9%), P = 0.016]. Oxytocin administration time was reduced by 135.3 minutes [95% CI (84.4-186.2 minutes), P < 0.01] and caesarean sections by 9.1% [95% CI (1.1-17%), P = 0.025] for those receiving oral misoprostol. Following probabilistic sensitivity analysis, oral misoprostol was cost-saving in 63% of 5,000 bootstrap replications and achieved superior rates of vaginal delivery, delivery within 24 hours of induction and vaginal delivery within 24 hours of induction in 98.7%, 90.7%, and 99.4% of bootstrap simulations. Based on univariate threshold analysis, the unit price of oral misoprostol 25 mcg could feasibly increase 31-fold from $0.24 to $7.50 per 25 mcg tablet and remain cost-saving. CONCLUSION: Compared to Foley catheterisation for the induction of high-risk hypertensive women, oral misoprostol improves rates of vaginal delivery within 24 hours of induction and may also reduce costs. Additional research performed in other low-resource settings is required to determine their relative cost-effectiveness. TWEETABLE ABSTRACT: Oral misoprostol less costly and more effective than Foley catheter for labour induction in hypertension.

Use of personal measurements for ozone exposure assessment: a pilot study.

During summer 1991, we collected indoor, outdoor, and personal ozone concentration data as well as time-activity data in State College, Pennsylvania. These concentrations were measured for 23 children and their homes using passive ozone samplers. Outdoor concentrations were also measured at a stationary ambient monitoring site. Results from this pilot study demonstrate that fixed-site ambient measurements may not adequately represent individual exposures. Outdoor ozone concentrations showed substantial spatial variation between rural and residential regions. Ignoring this spatial variation by using fixed-site measurements to estimate personal exposures can result in an error as high as 127%. In addition, evidence from our pilot study indicates that ozone concentrations of a single indoor microenvironment may not represent those of other indoor microenvironments. Personal exposures were significantly correlated with both indoor (r = 0.55) and outdoor (r = 0.41) concentrations measured at home sites. Multiple regression analyses identified indoor ozone concentrations as the most important predictors of personal exposures. However, models based on time-weighted indoor and outdoor concentrations explained only 40% of the variability in personal exposures. When the model included observations for only those participants who spent the majority of their day in or near their homes, an R2 of 0.76 resulted when estimates were regressed on measured personal exposures. It is evident that contributions from diverse indoor and outdoor microenvironments must be considered to estimate personal ozone exposures accurately.

Use of bioindicators and passive sampling devices to evaluate ambient ozone concentrations in north central Pennsylvania.

Ambient concentrations of tropospheric ozone and ozone-induced injury to black cherry (Prunus serotina) and common milkweed (Asclepias syriaca) were determined in north central Pennsylvania from 29 May to 5 September 2000 and from 28 May to 18 September 2001. Ogawa passive ozone samplers were utilized within openings at 15 forested sites of which six were co-located with TECO model 49 continuous ozone monitors. A significant positive correlation was observed between the Ogawa passive samplers and the TECO model 49 continuous ozone monitors for the 2000 (r=0.959) and 2001 (r=0.979) seasons. In addition, a significant positive correlation existed in 2000 and 2001 between ozone concentration and elevation (r=0.720) and (r=0.802), respectively. Classic ozone-induced symptoms were observed on black cherry and common milkweed. In 2000, initial injury was observed in early June, whereas for the 2001 season, initial injury was initially observed in late June. During both seasons, injury was noted at most sites by mid- to late-July. Soil moisture potential was measured for the 2001 season and a significant positive relationship (P<0.001) showed that injury to black cherry was a function of cumulative ozone concentrations and available soil moisture.

A 13-week comparison of passive and continuous ozone monitors at forested sites in north-central Pennsylvania.

Ogawa passive O3 samplers were used in a 13-week study (June 1-September 1, 1999) involving 11 forested and mountaintop sites in north-central Pennsylvania. Four of the sites were collocated with TECO model 49 O3 analyzers. A significant correlation (p < 0.0001) was found for 24-hr average weekly O3 concentrations between the two methodologies at the four sites with collocated monitors. As expected, there were positive relationships between increasing elevation of the sites and increasing O3 concentrations. No O3 exposure patterns were found on a west-to-east or south-to-north basis; however, the area known for lower O3 exposures within a smaller subsection of the study area showed consistently lower O3 exposures. Preliminary results regarding relationships of symptom responses within O3-sensitive bioindicators are also presented with black cherry (Prunus serotina, Ehrh.) and common milkweed (Asclepias syriaca, L.) showing clear evidence of increasing injury with increasing O3 exposures. Due to the extremely dry conditions encountered in north-central Pennsylvania during the 1999 growing season, O3-induced symptoms were sporadic and quite delayed until late-season rains during the latter portion of the observation period.

Passive ozone network of Dallas: a modeling opportunity with community involvement. 2.

Attaining the current lower tropospheric U.S. ozone standards continues to be a difficult task for many areas in the U.S. Concentrations of ozone above the standards negatively affects human health, agricultural crops, forests, and other ecosystem elements. This paper describes year two (1999) of a regional networking of passive and continuous ozone monitoring sites in the Dallas-Fort Worth (DFW) Metroplex region. The objectives of the second year of study were to (1) validate conclusions of the 1998 Passive Ozone Network of Dallas (POND) I study, (2) define the value of taking 12-h diurnal samples in addition to 24-h samples, and (3) add to the scientific knowledge base of rural/urban ozone comparison studies. Results of the POND II (1999) study demonstrated that ozone concentrations exceeding the new 8-h ozone standard could be recorded at least 130 km, or 80 miles, from the DFW Metroplex core in more rural areas. In addition, results of the POND II study indicated that ozone concentrations exceeding the 8-h standard probably occurred in areas recording a 12-h daytime ozone concentration above 60 parts per billion (ppb). The 12-h passive ozone data from POND II also suggests the relative magnitude of anthropogenic pollution influence could be assessed for rural passive ozone sites. The data from the POND II study provide modelers a rich database for future photochemical subgrid development for the DFW ozone nonattainment area. Indeed, the POND database provides a great amount of additional ozone ambient data covering 26 8-h and 13 1-h ozone standard exceedance days over an approximate 25000 km2 region. These data should help decrease uncertainties derived from future DFW ozone model exercises.

Collection of nonpolar organic compounds from ambient air using polyurethane foam-granular adsorbent sandwich cartridges.

Glass cartridges containing 6-10 g of Tenax-GC or 15 g of XAD-2 resin packed between two slices of polyurethane foam (PUF) were used in a General Metal Works PS-1 high-volume sampler to collect chlorobenzenes (CBs) containing three to six chlorine atoms, hexachlorocyclohexanes (HCHs), and two-ring aromatic hydrocarbons from 35-385 m3 of air. Laboratory experiments were run by vaporizing known quantities of analytes into a clean airstream for sampling by the PS-1 system at 20 degrees C. Collection efficiencies, determined from mass balance of the quantities introduced and recovered, ranged from 70 to 120% for individual compounds and averaged 93% overall. Penetration of analytes to backup adsorbent traps showed an inverse correlation to vapor pressure. The method was used to collect the above compounds from urban and rural air.

Passive ozone network of Dallas: a modeling opportunity with community involvement. 1.

Despite tremendous efforts toward regulating and controlling tropospheric ozone (O3) formation, a large portion of the U.S. population presently lives in environments where air quality exceeds both 1- and 8-h National Ambient Air Quality Standards (NAAQS) set for O3. High O3 concentrations annually cost the United States billions of dollars in excessive human health costs, reduced crop yields, and ecological damage. This paper describes a regional networking of O3 monitoring sites, operated by the public, that used simplified passive sampling devices (PSDs). In collaboration with EPA Region 6, a lay network (i.e., Passive Ozone Network of Dallas, acronym POND), consisting of 30 PSD sites in the Dallas-Fort Worth (DFW) Metroplex, a region representing 16 counties, successfully measured daily ozone during 8 weeks of the 1998 high ozone season. It was demonstrated that the concerned public, when properly trained, could successfully operate a large PSD network that requires daily sample handling and weekly mailing procedures, even from remote sites. Data treatment of the 2880 POND measurements included (i) high correlations with collocated continuous monitoring data [r range = 0.95-0.97], (ii) daily O3 contour mapping of the 24,000 km2 area, and (iii) a ranking of O3 severity in 12 peri-urban counties for guidance in sitting additional monitors. With a new 8-h NAAQS standard now in place, a cost-effective network such as POND could aid regional airshed models in generating meaningful guidance for O3 state implementation plans (SIPs) by providing input that is representative of both rural and urban sites.