Economic evaluation of a community health worker model for tuberculosis care in Ho Chi Minh City, Viet Nam: a mixed-methods Social Return on Investment Analysis.

BACKGROUND: There is extensive evidence for the cost-effectiveness of programmatic and additional tuberculosis (TB) interventions, but no studies have employed the social return on investment (SROI) methodology. We conducted a SROI analysis to measure the benefits of a community health worker (CHW) model for active TB case finding and patient-centered care. METHODS: This mixed-method study took place alongside a TB intervention implemented in Ho Chi Minh City, Viet Nam, between October-2017 - September-2019. The valuation encompassed beneficiary, health system and societal perspectives over a 5-year time-horizon. We conducted a rapid literature review, two focus group discussions and 14 in-depth interviews to identify and validate pertinent stakeholders and material value drivers. We compiled quantitative data from the TB program's and the intervention's surveillance systems, ecological databases, scientific publications, project accounts and 11 beneficiary surveys. We mapped, quantified and monetized value drivers to derive a crude financial benefit, which was adjusted for four counterfactuals. We calculated a SROI based on the net present value (NPV) of benefits and investments using a discounted cash flow model with a discount rate of 3.5%. A scenario analysis assessed SROI at varying discount rates of 0-10%. RESULTS: The mathematical model yielded NPVs of US$235,511 in investments and US$8,497,183 in benefits. This suggested a return of US$36.08 for each dollar invested, ranging from US$31.66-US39.00 for varying discount rate scenarios. CONCLUSIONS: The evaluated CHW-based TB intervention generated substantial individual and societal benefits. The SROI methodology may be an alternative for the economic evaluation of healthcare interventions.

Field assessment of coconut-based activated carbon systems for the treatment of herbicide contamination.

Once released into the environment, herbicides can move through soil or surface water to streams and groundwater. Filters containing adsorbent media placed in fields may be an effective solution to herbicide loss in the environment. However, to date, no study has investigated the use of adsorbent materials in intervention systems at field-scale, nor has any study investigated their optimal configuration. Therefore, the aim of this paper was to examine the efficacy of low-cost, coconut-based activated carbon (CAC) intervention systems, placed in streams and tributaries, for herbicide removal. Two configurations of interventions were investigated in two agricultural catchments and one urban area in Ireland: (1) filter bags and (2) filter bags fitted into polyethylene pipes. Herbicide sampling was conducted using Chemcatcher® passive sampling devices in order to identify trends in herbicide exceedances at the sites, and to quantifiably assess, compare, and contrast the efficiency of the two intervention configurations. While the Chemcatcher® passive sampling devices are capable of analysing eighteen different acid herbicides, only six different acid herbicides (2,4-D, clopyralid, fluroxypyr, MCPA, mecoprop and triclopyr) were ever detected within the three catchment areas, which were also the only acid herbicides used therein. The CAC was capable of complete herbicide removal, when the water flow was slow (0.5-1 m3 s-1), and the interventions spanned the width and depth of the waterway. Overall, the reduction in herbicide concentrations was better for the filter pipes than for the filter bags, with a 48% reduction in detections and a 37% reduction in exceedances across all the sampling sites for the filter pipe interventions compared to a 13% reduction in the number of detections and a 24% reduction in exceedances across all sampling sites for the filter bag interventions (p < 0.05). This study demonstrates, for the first time, that CAC may be an effective in situ remediation strategy to manage herbicide exceedances close to the source, thereby reducing the impact on environmental and public health.

Multiagency safeguarding arrangements during and beyond the Covid-19 pandemic: Identifying shared learning.

Measures to combat transmission of the coronavirus presented unprecedented challenges for safeguarding and child protection practice, including through withdrawal of routine opportunities to observe and engage with children and families and disruption of systems for inter-agency communication and coordination. This article reports on a two-stage study designed to identify shared learning from adaptations to professional practice in response to the measures. Interviews with 67 London-based senior safeguarding leads from seven professional groups undertaken during the summer of 2020 informed an England-wide survey to similar groups in February-March 2021. SPSS was used to analyse 417 responses, which were supplemented by answers to open questions. Findings are reported using the six practice themes which the Child Safeguarding Practice Review Panel expects to inform shared learning to improve safeguarding at national and local levels. The study revealed the formidable barriers facing professionals in understanding the changing environments in which children were living and in identifying and assessing new or altered risks due to the pandemic; steps taken to respond to changing risks and to keep in touch and re-engage families; strategies to support critical thinking and challenge among professionals working under unprecedented pressure; and opportunities for enhanced multiagency working and inter-agency collaboration.

Niraparib Shows Superior Tissue Distribution and Efficacy in a Prostate Cancer Bone Metastasis Model Compared with Other PARP Inhibitors.

Patients with prostate cancer whose tumors bear deleterious mutations in DNA-repair pathways often respond to PARP inhibitors. Studies were conducted to compare the activity of several PARP inhibitors in vitro and their tissue exposure and in vivo efficacy in mice bearing PC-3M-luc-C6 prostate tumors grown subcutaneously or in bone. Niraparib, olaparib, rucaparib, and talazoparib were compared in proliferation assays, using several prostate tumor cell lines and in a cell-free PARP-trapping assay. PC-3M-luc-C6 cells were approximately 12- to 20-fold more sensitive to PARP inhibition than other prostate tumor lines, suggesting that these cells bear a DNA damage repair defect. The tissue exposure and efficacy of these PARP inhibitors were evaluated in vivo in PC-3M-luc-C6 subcutaneous and bone metastasis tumor models. A steady-state pharmacokinetic study in PC-3M-luc-C6 tumor-bearing mice showed that all of the PARP inhibitors had favorable subcutaneous tumor exposure, but niraparib was differentiated by superior bone marrow exposure compared with the other drugs. In a PC-3M-luc-C6 subcutaneous tumor efficacy study, niraparib, olaparib, and talazoparib inhibited tumor growth and increased survival to a similar degree. In contrast, in the PC-3M-luc-C6 bone metastasis model, niraparib showed the most potent inhibition of bone tumor growth compared with the other therapies (67% vs. 40%-45% on day 17), and the best survival improvement over vehicle control [hazard ratio (HR), 0.28 vs. HR, 0.46-0.59] and over other therapies (HR, 1.68-2.16). These results show that niraparib has superior bone marrow exposure and greater inhibition of tumor growth in bone, compared with olaparib, rucaparib, and talazoparib.

An assessment of potential pesticide transmission, considering the combined impact of soil texture and pesticide properties: A meta-analysis.

Pesticides are widely employed as a cost-effective means of reducing the impacts of undesirable plants and animals. The aim of this paper is to develop a risk ranking of transmission of key pesticides through soil to waterways, taking into account physico-chemical properties of the pesticides (soil half-life and water solubility), soil permeability, and the relationship between adsorption of pesticides and soil texture. This may be used as a screening tool for land managers, as it allows assessment of the potential transmission risks associated with the use of specified pesticides across a spectrum of soil textures. The twenty-eight pesticides examined were differentiated into three groups: herbicides, fungicides and insecticides. The highest risk of pesticide transmission through soils to waterways is associated with soils containing <20% clay or >45% sand. In a small number of cases, the resulting transmission risk is not influenced by soil texture alone. For example, for Phenmedipham, the transmission risk is higher for clay soils than for silt loam. The data generated in this paper may also be used in the identification of critical area sources, which have a high likelihood of pesticide transmission to waterways. Furthermore, they have the potential to be applied to GIS mapping, where the potential transmission risk values of the pesticides can be layered directly onto various soil textures.