Insight into the rapid elimination of low-concentration antibiotics from natural waters using tandem multilevel reactive electrochemical membranes: Role of direct electron transfer and hydroxyl radical oxidation.

Herein, we reported a tandem multilevel reactive electrochemical membrane (REM) system was promising for the rapid and complete removal of trace antibiotics from natural waters. Results indicate that a four-stage REM module-in-series system achieved steady over 98% removal of model antibiotic norfloxacin (NOR, 100 µg·L-1) from wastewater treatment plant final effluent and surface water with a residence time of 5.4 s, and the electric energy consumption was only around 0.007-0.011 kWh·m-3. As for the oxidation mechanism, direct electron transfer (DET) oxidation process played an important role in NOR rapid oxidation, enabling the REM system to tolerate various •OH scavenges in natural waters, including natural organic matters, Cl- and HCO3-, even at very high concentration levels. Meanwhile, •OH-mediated indirect oxidation process promotes the oxidation and mineralization of NOR. Although the DET-dominated oxidation mechanism makes the REM system cannot achieve the complete mineralization of NOR with residence times of few seconds, the antibacterial activity from NOR was completely eliminated. This REM system featured effective removal performance of trace contaminants with low energy cost and was tolerant to complex waster matrix, suggesting that it could be a powerful supplementary step for wastewater/water treatment.

Comparing costs and cost-efficiency of platforms for micronutrient powder (MNP) delivery to children in rural Uganda.

Micronutrient powder (MNP) can reduce iron deficiency in young children, which has been well established in efficacy trials. However, the cost of different delivery platforms has not been determined. We calculated the cost and cost-efficiency of distributed MNP through community-based mechanisms and in health facilities in a primarily rural district in Uganda. An endline survey (n = 1072) identified reach and adherence. During the 9-month pilot, 37,458 (community platform) and 12,390 (facility platform) packets of MNP were distributed. Each packet consisted of 30 MNP sachets. In 2016, total costs were $277,082 (community platform, $0.24/sachet) and $221,568 (facility platform, $0.59/sachet). The cost per child reached was lower in the community platform ($53.24) than the facility platform ($65.97). The cost per child adhering to a protocol was $58.08 (community platform) and $72.69 (facility platform). The estimated cost of scaling up the community platform pilot to the district level over 3 years to cover approximately 17,890 children was $1.23 million (scale-up integrated into a partner agency program) to $1.62 million (government scale-up scenario). Unlike previous estimates, these included opportunity costs. Community-based MNP delivery costs were greater, yet more cost-efficient per child reached and adhering to protocol than facility-based delivery. However, total costs for untargeted MNP delivery under program settings are potentially prohibitive.

Trade-off analysis of cost and nutrient efficiency of coffee farms in vietnam: A more generalised approach.

Literature has documented significant trade-offs between economic and environmental performance in many areas of agricultural production. However, while it has focused on the trade-off for technically efficient farms there are differing types of trade-offs that exist for differing types of farms. The present paper addresses these gaps in the literature by proposing a more generalised approach to analysing cost and environmental trade-offs. There is also a lack of research on the nature of the trade-off in coffee farming. This is especially so in Vietnam where there is both significant overuse of nutrients and increasing autonomous adaption through voluntary participation in sustainability certification schemes. The proposed framework is employed to investigate a data set of 679 Vietnamese coffee farms. This study delivers several important findings. First, the proposed approach indicates four distinct groups of farms facing differing types of trade-offs with some farms not facing any trade-offs. Second, empirical results show that the average levels of technical, cost and environmental efficiency are relatively low. Third, sustainability certified farms are found to perform better than non-certified farms although the differences in performance diminish over time. Overall, the empirical results favour a heterogeneous and more integrated policy approach to improving the technical, cost and environmental efficiency of coffee farmers in Vietnam.

Complementary music therapy for cancer patients in at-home palliative care and their caregivers: protocol for a multicentre randomised controlled trial.

BACKGROUND: Patients with advanced cancer, receiving at-home palliative care, are subject to numerous symptoms that are changeable and often require attention, a stressful situation that also impacts on the family caregiver. It has been suggested that music therapy may benefit both the patient and the caregiver. We propose a study to analyse the efficacy and cost utility of a music intervention programme, applied as complementary therapy, for cancer patients in palliative care and for their at-home caregivers, compared to usual treatment. METHOD: A randomised, double-blind, multicentre clinical trial will be performed in cancer patients in at-home palliative care and their family caregivers. The study population will include two samples of 40 patients and two samples of 41 caregivers. Participants will be randomly assigned either to the intervention group or to the control group. The intervention group will receive a seven-day programme including music sessions, while the control group will receive seven sessions of (spoken word) therapeutic education. In this study, the primary outcome measure is the assessment of patients' symptoms, according to the Edmonton Symptom Assessment System, and of the overload experienced by family caregivers, measured by the Caregiver Strain Index. The secondary outcomes considered will be the participants' health-related quality of life, their satisfaction with the intervention, and an economic valuation. DISCUSSION: This study is expected to enhance our understanding of the efficacy and cost-utility of music therapy for cancer patients in palliative care and for their family caregivers. The results of this project are expected to be applicable and transferrable to usual clinical practice for patients in home palliative care and for their caregivers. The approach described can be incorporated as an additional therapeutic resource within comprehensive palliative care. To our knowledge, no previous high quality studies, based on a double-blind clinical trial, have been undertaken to evaluate the cost-effectiveness of music therapy. The cost-effectiveness of the project will provide information to support decision making, thereby improving the management of health resources and their use within the health system. TRIAL REGISTRATION: The COMTHECARE study is registered at Clinical Trials.gov, NCT04052074. Registered 9 August, 2019.

Evidence for the world as an external memory: A trade-off between internal and external visual memory storage.

We use visual working memory (VWM) to maintain the visual features of objects in our world. Although the capacity of VWM is limited, it is unlikely that this limit will pose a problem in daily life, as visual information can be supplemented with input from our external visual world by using eye movements. In the current study, we influenced the trade-off between eye movements and VWM utilization by introducing a cost to a saccade. Higher costs were created by adding a delay in stimulus availability to a copying task. We show that increased saccade cost results in less saccades towards the model and an increased dwell time on the model. These results suggest a shift from making eye movements towards taxing internal VWM. Our findings reveal that the trade-off between executing eye-movements and building an internal representation of our world is based on an adaptive mechanism, governed by cost-efficiency.

Instruments to assess the patient comfort during hospitalization: a psychometric review protocol.

AIM: The aim of this study was to analyse the psychometric properties, outcomes and utility of instruments measuring the patient comfort during hospitalization. BACKGROUND: While there are numerous systematic reviews assessing the psychometric properties of healthcare instruments, none of them is devoted to evaluate the psychometric properties of instruments measuring comfort, which is considered an indicator of quality in health care and is associated to quicker discharges, increased patient satisfaction and stronger cost-benefit ratios for the institution. DESIGN: Psychometric Systematic review. METHODS: Searches will be performed on MEDLINE, CINAHL, PsycINFO, Web of Knowledge, ProQuest Thesis&Dissertations and grey literature and will be focused on questionnaires measuring patient comfort as a holistic experience in any healthcare setting. The assessment will take into account the theoretical model on which the instruments are built, evaluate the psychometric properties of each study according to the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) and will include the assessment of the quality of instruments outcomes and their cost-efficiency, acceptability and educational impact. The review protocol was registered in PROSPERO, CRD42016036290 and was supported by the Grant PSI2014-52962-P, Spanish Ministry of Economy and Competitiveness (July, 2015). DISCUSSION: The results of our psychometric review will categorise the instruments measuring the patient comfort according to their psychometric properties, methodological quality, outcomes and utility, to improve the quality of health care provided and the institution's benefits.

Comparison of the costs of care during acute illness by two community children's nursing teams.

OBJECTIVE: To compare the costs associated with care by two community children's nursing teams (CCNT). DESIGN: A case study incorporating questionnaire survey, analysis of routinely collected data and analysis of costs in the north-west England. PATIENTS: Children with acute illness referred for CCNT care. INTERVENTIONS: Two CCNT provided care for 273 children during acute illness in order to reduce the number and duration of hospital admissions. MAIN OUTCOME MEASURES: Costs of CCNT, other services and costs to families. RESULTS: The objectives of both CCNT included shortening and avoiding hospitalisations. Most (45 (58%) in case A and 150 (77%) in case B) children were referred for infections. There were differences in the proportion of children who had been hospitalised (45 (57.7%) and 78 (40%)), the mean number of services used before referral to CCNT (1.6 and 2.2) and the staffing profile of the CCNT. There was a statistically significant difference in the overall mean cost to the NHS of CCNT care (£146 and £238, 95% CI for difference of means 7 to 184), associated with higher proportions of children having telephone-only contact (two (3%) and 46 (24%)) and children using almost twice as many other health services during care by one CCNT (means 0.27 and 0.51). CONCLUSIONS: Costs of CCNT care can vary widely when all health service use is taken into account. Differences in the way CCNT are integrated with the urgent care system, and the way in which CCNT care is organised, could contribute to variations in costs.

Avaliação de tecnologia em saúde: II. A análise de custo-efetividade / Health technology assessment: II. Cost effectiveness analysis

O advento de novas tecnologias na saúde causou impacto nos indicadores clínicos e econômicos. Os métodos de pesquisa que incorporam conceitos da economia da saúde e epidemiologia clínica permitem avaliar a eficiência de novas tecnologias, por exemplo, através da análise de custo-efetividade. Este é um instrumento de análise de valor das intervenções em saúde. A metodologia, análise de custo-efetividade, é condição determinante da moderna prática de cuidados à saúde, pois as opções terapêuticas hoje disponíveis no Sistema Único de Saúde (SUS) ou no sistema de saúde suplementar do Brasil passam necessariamente por tal análise, logo o sistema de saúde bem como os profissionais da saúde são levados a reexaminar os benefícios e custos de suas ações para assegurar que haja incorporação das tecnologias mais eficientes. Neste segundo artigo sobre avaliação de tecnologia em saúde reviram-se os conceitos de análise de custo-efetividade, os passos envolvidos na sua execução e o método para a análise crítica dos resultados.

New health technologies have made an impact in clinical and economic outcomes. Therefore, research methodologies that allow to evaluate the efficiency of these new technologies such as cost-effectiveness analysis are necessary. Cost-effectiveness analysis assess the value of health care interventions or drugs, the technology. Cost-effectiveness analysis is also deemed a determinant of modern health care practice, because the therapeutic options available at public (SUS) or private health care system must go through a formal health technology assessment in Brazil; thus, both the health care system and the health care professionals have to reevaluate the clinical consequences and costs of their actions to assure that the most efficient technologies are the one used in the practice. In this second article about health technology assessment we review the concepts of cost-effectiveness analysis, the steps involved in performing such analysis, and the criteria most frequently used to critically review the results.