Developing a framework to assess the costeffectiveness of COMPARE - a global platform for the exchange of sequence-based pathogen data.

Analysing the genomic data of pathogens with the help of next-generation sequencing (NGS) is an increasingly important part of disease outbreak investigations and helps guide responses. While this technology has already been successfully employed to elucidate and control disease outbreaks, wider implementation of NGS also depends on its cost-effectiveness. COMPARE - short for 'Collaborative Management Platform for detection and Analyses of (Re-) emerging and foodborne outbreaks' - is a major project, funded by the European Union, to develop a global platform for sharing and analysing NGS data and thereby improve the rapid identification, containment and mitigation of emerging infectious diseases and foodborne outbreaks. This article introduces the project and presents the results of a review of the literature, composed of previous relevant cost-benefit and cost-effectiveness analyses. The authors also outline the implications for a methodological framework to assess the costeffectiveness of COMPARE and similar systems.

L'analyse des données sur le génome des agents pathogènes grâce au séquençage de nouvelle génération (SNG) joue un rôle de plus en plus important dans les enquêtes sur les foyers de maladies et contribue à l'élaboration de stratégies de réponse. Si cette technologie a été utilisée avec succès pour élucider la cause des certains foyers et pour les contrôler, une application plus large du SNG dépend également de sa rentabilité. La plate-forme COMPARE (plate-forme de gestion collaborative pour la détection et l'analyse des foyers émergents et ré-émergents et des toxi-infections alimentaires) est un projet de grande envergure financé par l'Union européenne, visant à mettre en place une plate-forme mondiale d'échanges et d'analyse des données de séquençage de nouvelle génération et à améliorer ainsi l'identification précoce, le confinement et l'atténuation des maladies infectieuses émergentes et des foyers de toxiinfections alimentaires. Les auteurs présentent le projet ainsi que les résultats d'une étude bibliographique intégrant des analyses pertinentes coûts­avantages et coûts­efficacité réalisées dans le passé. Ils soulignent également les enseignements de ces analyses pour l'élaboration d'un cadre méthodologique d'évaluation de la relation coûts­efficacité applicable au système COMPARE et à d'autres systèmes similaires.

El análisis de datos genómicos de los patógenos con ayuda de técnicas de secuenciación de próxima generación es un componente cada vez más importante de la investigación de brotes infecciosos, que resulta de utilidad para guiar las medidas de respuesta. Aunque estas técnicas ya se han utilizado con éxito para elucidar y combatir brotes de enfermedad, su aplicación generalizada también dependerá de la relación costo-eficacia que ofrezcan. COMPARE (acrónimo inglés de «plataforma de gestión colectiva para la detección y análisis de brotes (re)emergentes y de transmisión alimentaria¼) es un vasto proyecto financiado por la Unión Europea que apunta a instituir un dispositivo mundial de intercambio y análisis de datos de secuenciación de próxima generación y lograr así más eficacia en la rápida identificación, contención y mitigación de brotes de transmisión alimentaria y de enfermedades infecciosas emergentes. Los autores exponen el proyecto y presentan los resultados de un repaso bibliográfico de anteriores análisis de las relaciones costo-beneficio y costo-eficacia de estas técnicas. Además, explican brevemente lo que puede aportar un marco metodológico para evaluar la relación costo-eficacia del sistema COMPARE y de otros sistemas similares.

Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients.

BACKGROUND: Flexible, fibreoptic bronchoscopy (FFB) and bronchoalveolar lavage (BAL) have been used for diagnostic purposes in critically ill ventilated patients. The additional diagnostic value compared to tracheal aspirations in ventilator-associated pneumonia (VAP) has been questioned. Nevertheless, BAL can provide extra information for the differential diagnosis of respiratory disease and good antibiotic stewardship. These benefits should outweigh potential hazards caused by the invasiveness of this diagnostic technique. The focus of the present study was on the clinical course and complications of patients following BAL procedures up to 24 h. METHODS: Hundred sixty-four FFB guided BAL procedures for suspected pneumonia were analysed in an observational study. The clinical course of patients was monitored by respiratory and haemodynamic data before BAL, 1 and 24 h after BAL. Complications were defined and registered. Factors associated with complications were analysed by logistic regression. CLINICAL COURSE: a decrease in average pO2/FiO2 ratio 1 h after BAL from 29 kPa (218 mmHg) to 25 kPa (189 mmHg) (p < 0.05) was observed which fully recovered within 24 h. Respiratory complications: the incidence of procedure related hypo-oxygenation (SaO2 ≤ 88 %) and/or bronchospasm was 9 %; a decrease of >25 % PaO2/FiO2 ratio 1 h after BAL was found in 29 % of patients; no bleeding or pneumothorax were registered. Haemodynamic complications: there were no cases of hypertension and cardiac rhythm disturbances; haemodynamic instability within the first 24 h after BAL was recorded in 22 %; this was correlated with a cardiovascular diagnosis at admission (OR 2.9; 95 % CI 1.2 - 6.7) and the presence of cardiovascular co-morbidity (OR 3.5; 95 % CI 1.5 - 8.3). The incidence of bacteraemia was 7 %. There was no case of procedure related death. DISCUSSION: Frequently occurring haemodynamic and respiratory instability but no cases of cardiac rhythm disturbances, bleeding, pneumothorax or procedure related death were attributable to diagnostic FFB and BAL. The procedures should be conducted under careful supervision by experienced physicians. Only a randomized controlled trial that compares diagnostic FFB and BAL with a non-invasive strategy could ultimately establish the safety profile and clinical utility of these procedures in critically ill ventilated patients.

Water quality management in the coastal city in the period of considerable water consumption decrease.

Gdansk water supply system belongs among the oldest in Continental Europe. In 1992 one of the first joint-venture water companies was established in the city. Under a contract concluded between the firm and the municipality, the company was obliged to secure quick and considerable improvement of drinking water quality. At the same time a considerable water consumption decrease was observed. The drop entails new environmental, technical and economic problems. The biggest threat to the supplies of safe and good quality water is the phenomenon of secondary pollution of water resulting from the overdimensioning of the water supply network. Positive aspects of water consumption decrease are related to the opportunity of more rational and sustainable water resources management. The solutions adopted in Gdansk can serve as a starting point for working out the best model for water quality management in the coastal cities.

Pediatricians' pet peeves about mental health referrals.

This chapter has described a number of problems encountered by pediatricians when referring their patients for mental health services; these are related to access to care, quality of providers and service, attitudes of patients and providers, and lack of adequate communication. We have discussed some of the reasons for these difficulties, provided information that may assist pediatricians in making referrals to appropriate mental health providers, and offered suggestions to facilitate the referral process. We have highlighted the utility of developing and maintaining a relationship with mental health referral sources, and noted a number of advantages of including mental health providers in pediatric practices.