Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 407.952
Filtrar
1.
Siglo cero (Madr.) ; 54(4): 49-64, oct.-dic. 2024. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-EMG-558

RESUMO

El paradigma de apoyos y el de calidad de vida se han transformado en guías fundamentales para los avances en el ámbito de la discapacidad intelectual (DI). Con base en una muestra de 93 personas adultas con DI, se analiza, desde un enfoque cuantitativo no experimental, la relación entre la calidad de vida y las necesidades de apoyo, aplicando la escala INICO-FEAPS y la escala de Intensidad de Apoyos (SIS) para cada constructo. Los principales resultados evidencian que existe una relación fuerte e indirecta entre calidad de vida y necesidades de apoyos, y también la relevancia de analizar dichos resultados desde variables como grado de discapacidad, sexo o nivel socioeconómico. La discusión permite inferir la necesidad de discutir nuevas estrategias en torno a categorías como el grado de discapacidad, la autodeterminación e inclusión social, como elementos facilitadores de la calidad de vida y apoyos desde un enfoque integral que contribuya al desarrollo de estrategias de programas sociales para la población con DI. (AU)


The support paradigm and the quality of life paradigm have become fundamental guides for progress in the field of Intellectual Disability (ID). Based on a sample of 93 adults with ID, the relationship between Quality of Life and Support Needs is analyzed from a non-experimental quantitative approach, applying the INICO-FEAPS scale and the SIS Support Intensity scale for each construct. The main results show that there is a strong and indirect relationship between quality of life and support needs, and the relevance of analyzing these results from variables such as the degree of disability, sex or socioeconomic level. The discussion allows us to infer the need to discuss new strategies around categories such as the degree of disability, self-determination and social inclusion, as facilitating elements of quality of life and supporting a comprehensive approach that contributes to the development of social program strategies for the population with ID. (AU)


Assuntos
Humanos , Adulto Jovem , Adulto , Deficiência Intelectual , Qualidade de Vida , Pessoas com Deficiência , Chile , Amostragem
2.
J Chem Phys ; 160(9)2024 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-38426525

RESUMO

Vapor-liquid equilibria and thermodynamic properties of saturated argon and krypton were calculated by semi-classical Monte Carlo simulations with the NpT + test particle method using ab initio potentials for the two-body and nonadditive three-body interactions. The NpT + test particle method was extended to the calculation of second-order thermodynamic properties, such as the isochoric and isobaric heat capacities or the speed of sound, of the saturated liquid and vapor by using our recently developed approach for the systematic calculation of arbitrary thermodynamic properties in the isothermal-isobaric ensemble. Generally, the results for all simulated properties agree well with experimental data and the current reference equations of state for argon and krypton. In particular, the results for the vapor pressure and for the density and speed of sound of the saturated liquid and vapor agree with the most accurate experimental data for both noble gases almost within the uncertainty of these data, a level of agreement unprecedented for many-particle simulations. This study demonstrates that the vapor-liquid equilibrium and thermodynamic properties at saturation of a pure fluid can be predicted by Monte Carlo simulations with high accuracy when the intermolecular interactions are described by state-of-the-art ab initio pair and nonadditive three-body potentials and quantum effects are accounted for.

3.
Adv Mater ; : e2311591, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38426690

RESUMO

2D van der Waals (vdW) magnets open landmark horizons in the development of innovative spintronic device architectures. However, their fabrication with large scale poses challenges due to high synthesis temperatures (>500 °C) and difficulties in integrating them with standard complementary metal-oxide semiconductor (CMOS) technology on amorphous substrates such as silicon oxide (SiO2 ) and silicon nitride (SiNx ). Here, a seeded growth technique for crystallizing CrTe2 films on amorphous SiNx /Si and SiO2 /Si substrates with a low thermal budget is presented. This fabrication process optimizes large-scale, granular atomic layers on amorphous substrates, yielding a substantial coercivity of 11.5 kilo-oersted, attributed to weak intergranular exchange coupling. Field-driven Néel-type stripe domain dynamics explain the amplified coercivity. Moreover, the granular CrTe2 devices on Si wafers display significantly enhanced magnetoresistance, more than doubling that of single-crystalline counterparts. Current-assisted magnetization switching, enabled by a substantial spin-orbit torque with a large spin Hall angle (85) and spin Hall conductivity (1.02 × 107 ℏ/2e Ω⁻¹ m⁻¹), is also demonstrated. These observations underscore the proficiency in manipulating crystallinity within integrated 2D magnetic films on Si wafers, paving the way for large-scale batch manufacturing of practical magnetoelectronic and spintronic devices, heralding a new era of technological innovation.

4.
Spine Deform ; 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38427155

RESUMO

PURPOSE: This study aims to evaluate the cost-utility of intraoperative tranexamic acid (TXA) in adult spinal deformity (ASD) patients undergoing long posterior (≥ 5 vertebral levels) spinal fusion. METHODS: A decision-analysis model was built for a hypothetical 60-year-old adult patient with spinal deformity undergoing long posterior spinal fusion. A comprehensive review of the literature was performed to obtain event probabilities, costs and health utilities at each node. Health utilities were utilized to calculate Quality-Adjusted Life Years (QALYs). A base-case analysis was carried out to obtain the incremental cost and effectiveness of intraoperative TXA. Probabilistic sensitivity analysis was performed to evaluate uncertainty in our model and obtain mean incremental costs, effectiveness, and net monetary benefits. One-way sensitivity analyses were also performed to identify the variables with the most impact on our model. RESULTS: Use of intraoperative TXA was the favored strategy in 88% of the iterations. The mean incremental utility ratio for using intraoperative TXA demonstrated higher benefit and lower cost while being lower than the willingness-to-pay threshold set at $50,000 per quality adjusted life years. Use of intraoperative TXA was associated with a mean incremental net monetary benefit (INMB) of $3743 (95% CI 3492-3995). One-way sensitivity analysis reported cost of blood transfusions due to post-operative anemia to be a major driver of cost-utility analysis. CONCLUSION: Use of intraoperative TXAs is a cost-effective strategy to reduce overall perioperative costs related to post-operative blood transfusions. Administration of intraoperative TXA should be considered for long fusions in ASD population when not explicitly contra-indicated due to patient factors.

5.
Artigo em Inglês | MEDLINE | ID: mdl-38427217

RESUMO

BACKGROUND AND OBJECTIVE: Imaging with low or no benefit for the patient undermines the quality of care and amounts to vast opportunity costs. More than 3.6 billion imaging examinations are performed annually, and about 20-50% of these are of low value. This study aimed to synthesize knowledge of the costs of low-value imaging worldwide. METHODS: This systematic review was based on the PRISMA statement. The database search was developed in Medline and further adapted to Embase-Ovid, Cochrane Library, and Scopus. Primary empirical studies assessing the costs of low-value diagnostic imaging were included if published between 2012 and March 2022. Studies designed as randomized controlled trials, non-randomized trials, cohort studies, cross-sectional studies, descriptive studies, cost analysis, cost-effectiveness analysis, and mixed-methods studies were eligible. The analysis was descriptive. RESULTS: Of 5,567 records identified, 106 were included. Most of the studies included were conducted in the USA (n = 76), and a hospital or medical center was the most common setting (n = 82). Thirty-eight of the included studies calculated the costs of multiple imaging modalities; in studies with only one imaging modality included, conventional radiography was the most common (n = 32). Aggregated costs for low-value examinations amounts to billions of dollars per year globally. Initiatives to reduce low-value imaging may reduce costs by up to 95% without harming patients. CONCLUSIONS: This study is the first systematic review of the cost of low-value imaging worldwide, documenting a high potential for cost reduction. Given the universal challenges with resource allocation, the large amount used for low-value imaging represents a vast opportunity cost and offers great potential to improve the quality and efficiency of care.

6.
Infect Dis Ther ; 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38427290

RESUMO

INTRODUCTION: The first direct-acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection were reimbursed via Australia's Pharmaceutical Benefits Scheme (PBS) in March 2016. This was based on the recommendation from the Pharmaceutical Benefits Advisory Committee (PBAC) that the regimens would be acceptably cost-effective at an incremental cost-effectiveness ratio (ICER) no greater than $15,000/quality-adjusted life-year (QALY). Since the initial PBS listings for DAA therapies and subsequent listings of newer DAA treatments such as glecaprevir/pibrentasvir (Maviret®), the demographics and some of the disease characteristics of currently treated patients have markedly changed. This analysis aims to reassess the cost-effectiveness of glecaprevir/pibrentasvir, accounting for the changes to the HCV population currently seeking treatment and incorporating retreatment in first-line failures and the treatment of new infections in previously treated individuals. METHODS: To assess the cost-effectiveness 7 years after initial listing of DAAs, an update was made to the Markov model used to achieve PBS reimbursement for Viekira-Pak® in May 2016. Amendments to the Viekira-Pak® model include: changes to baseline age and fibrosis distribution of treated patients, and inclusion of retreatment of first-line failures [those not achieving a sustained virologic response (SVR12)] and reinfected individuals. Treatment-related inputs including SVR12 response rates, adverse events, treatment-related disutility, and discontinuations were sourced from pivotal glecaprevir/pibrentasvir clinical trials. RESULTS: Using the published price of glecaprevir/pibrentasvir, the ICER is below $15,000/QALY. CONCLUSIONS: Despite changes in demographics and disease characteristics of treated patients, and changes to the model structure to reflect retreatment in clinical practice in Australia, DAAs remain cost-effective in 2023.

7.
Cogn Emot ; : 1-7, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-38427425

RESUMO

To find a target in visual search, it is often necessary to filter out task-irrelevant distractors. People find the process of distractor filtering effortful, exerting physical effort to reduce the number of distractors that need to be filtered on a given search trial. Working memory demands are sufficiently costly that people are sometimes willing to accept aversive heat stimulation in exchange for the ability to avoid performing a working memory task. The present study examines whether filtering distractors in visual search is similarly costly. The findings reveal that individuals are sometimes willing to accept an electric shock in exchange for the ability to skip a single trial of visual search, increasingly so as the demands of distractor filtering increase. This was true even when acceptance of shock resulted in no overall time savings, although acceptance of shock was overall infrequent and influenced by a plurality of factors, including boredom and curiosity. These findings have implications for our understanding of the mental burden of distractor filtering and why people seek to avoid cognitive effort more broadly.

8.
Am J Transplant ; 24(2S1): S10-S18, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38431357

RESUMO

The OPTN/SRTR 2022 Annual Data Report presents the status of the solid organ transplant system in the United States from 2011 through 2022. Organ-specific chapters are presented for kidney, pancreas, liver, intestine, heart, and lung transplant. Each organ-specific chapter is organized to present waitlist information, donor information (both deceased and living, as appropriate), transplant information, and patient outcomes. Data pertaining to pediatric patients are generally presented separately from the adult data. In addition to the organ-specific chapters, the reader will find chapters dedicated to deceased organ donation, vascularized composite allografts, and the COVID-19 pandemic. The data presented in the Annual Data Report are descriptive in nature. In other words, most tables and figures present raw data without statistical adjustment for possible confounding or changes over time. Therefore, the reader should keep in mind the observational nature of the data when attempting to draw inferences before trying to ascribe a cause to any observed patterns or trends. This introduction provides a brief overview of trends in waitlist and transplant activity from 2012 through 2022. More detailed descriptions can be found in the respective organ-specific chapters.


Assuntos
Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Adulto , Humanos , Criança , Estados Unidos , Pandemias , Sobrevivência de Enxerto , Alocação de Recursos , Listas de Espera
9.
Plast Surg (Oakv) ; 32(1): 11-18, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38433808

RESUMO

Introduction: Reduction mammoplasty (RM) is one of the most common operations performed in plastic surgery. While US national surgical expenditures have risen in recent years, studies have reported decreasing reimbursement rates for plastic surgeons. The purpose of this study is to characterize the trends in charges and payments for a common plastic surgery operation, ambulatory RM, for facilities and physicians. Methods: A Medicare patient records database was used to capture hospital, surgeon, and anesthesiologist charges and payments for ambulatory RM from 2005 to 2014. Values were adjusted for inflation. A ratio of hospital to surgeon charges and payments were calculated: charge multiplier (CM) and payment multiplier (PM), respectively. Charges, payments, Charlson comorbidity index, CM, and PM values were analyzed for trends. Results: This study included 1001 patients. During the study period, the facility charge for RM per patient increased from $8477 to $11,102 (31% increase; p < .0005), and the surgeon charge increased from $7088 to $7199 (2% increase; p = .0009). Facility payments increased from $3661 to $3930 (7% increase; p < .0005), and surgeon payments decreased from $1178 to $1002 (15% decrease; p < .0005). CM increased from 1.2 to 1.54, and PM increased from 3.11 to 3.92. Conclusions: Charges and payments to facilities for ambulatory RM increased disproportionately to that of surgeons, likely due in part to rising administrative costs in health care delivery. This may disincentivize plastic surgeons from offering RM at hospital-based surgical centers, limiting patient access to this operation.


Introduction: La mammoplastie de réduction (MR) est l'une des interventions les plus courantes pratiquées en chirurgie plastique. Alors que les dépenses chirurgicales aux États-Unis ont augmenté au niveau national au cours des dernières années, les études ont signalé une diminution des taux de remboursement pour les chirurgiens plasticiens. L'objectif de cette étude est de définir les tendances dans les frais et paiements pour une intervention courante de chirurgie plastique, une MR ambulatoire, pour les établissements et pour les médecins. Méthodes: Une base de données des dossiers de patients Medicare a été utilisée pour collecter les frais pour les hôpitaux, les chirurgiens et les anesthésiologistes ainsi que les paiements pour MR ambulatoires de 2005 à 2014. Les valeurs ont été ajustées pour tenir compte de l'inflation. Des ratios des frais hôpital/chirurgien et des paiements ont été calculés : respectivement, un facteur de multiplication des frais (MF) et des paiements (MP). Les tendances de la valeur des frais, des paiements, de l'indice de comorbidité de Charlson, du MF et du MP ont été analysées. Résultats: Cette étude a inclus 1001 patients. Au cours de la période de l'étude, les frais pour MR par patient à la charge de l'établissement ont augmenté de 8 477 $ à 11 102 $, soit une augmentation de 31 % (P < 0,0005) et les frais du chirurgien sont passés de 7 088 $ à 7 199 $, soit une augmentation de 2 % (P = 0,0009). Les paiements de l'établissement ont augmenté de 3 661 $ à 3 930 $, soit une augmentation de 7 % (P < 0,0005) et les paiements du chirurgien ont diminué de 1 178 $ à 1 002 $, soit une diminution de 15 % (P < 0,0005). Le facteur MF est passé de 1,2 à 1,54 et le facteur MP est passé de 3,11 à 3,92. Conclusions: Les frais et paiements aux établissements pour MR ambulatoire ont augmenté de manière disproportionnée par rapport à ceux des chirurgiens, probablement en partie à cause de l'augmentation des coûts administratifs croissants de l'administration des soins. Cela pourrait inciter les chirurgiens plasticiens à ne plus offrir de MR dans les centres chirurgicaux hospitaliers et pourrait donc limiter l'accès des patients à cette opération.

10.
Plast Surg (Oakv) ; 32(1): 70-77, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38433805

RESUMO

Background: This study aimed to explore a low-cost solution for virtual surgical planning/3D printed surgical guides in a training hospital, assessing the impact on intraoperative time and bleeding. Material and Methods: We included a total of 13 patients. 8 who underwent maxillofacial reconstruction surgery with fibula-free flap utilizing virtual surgical planning/3D printed guides (VP/SG), and 5 using conventional surgery (CS) from 2017 to 2020. The surgical time, bleeding, length of hospital stay, and comorbidities were collected and compared in two groups. We recorded the average cost for the complete surgical planning and 3D printed guides. We applied a qualitative survey to the surgeons involved in the surgical procedures. Results The mean surgical time in the VP/SG group was 8.16 ± 2.7, compared to the CS group 12.5 ± 3.8, showing a 4.34 hours difference with statistical significance (p = 0.033). Patients from the CS group had a higher bleeding volume of 921 ± 467.6 mL VS 760 ± 633.8 mL in the VP/SG group. The average cost for the complete surgical planning and 3D printed guides was 914.44 ± 46.39 USD. All the surgeons who answered the survey preferred to perform the procedure utilizing the virtual planning/3D printed guides. Conclusions Virtual planning and 3D printed surgical guides have the potential to reduce operation time in maxillofacial reconstruction.


Contexte : Cette étude visait à explorer une solution peu coûteuse pour la planification chirurgicale virtuelle/l'impression 3D de guides chirurgicaux dans un hôpital d'enseignement, en évaluant leur impact sur le temps peropératoire et le saignement. Matériel et méthodes : Nous avons inclus un total de 13 patients; 8 patients ont subi une chirurgie de reconstruction faciale avec lambeau libre de péroné (fibula) utilisant une planification chirurgicale virtuelle/des guides imprimés en 3D (VP/SG) et 5 patients ont subi une chirurgie conventionnelle (CS) entre 2017 et 2020. Le temps opératoire, le saignement, la durée de l'hospitalisation et les comorbidités ont été consignés et comparés entre les deux groupes. Nous avons enregistré le coût moyen pour la planification chirurgicale complète et les guides imprimés en 3D. Nous avons appliqué une enquête qualitative aux chirurgiens impliqués dans les procédures chirurgicales. Résultats : Le temps opératoire moyen dans le groupe VP/SG a été de 8,16 ± 2,7, comparativement à 12,5 ± 3,8 dans le groupe CS, soit une différence de 4,4 heures avec une signification statistique (P = 0033). Des patients du groupe CS ont perdu un plus grand volume de sang que les patients du groupe VP/SG (respectivement, 921 ± 467.6 mL contre 760 ± 633.8 mL). Le coût moyen de la planification chirurgicale complète et des guides imprimés en 3D a été de 914,44 ± 46,39 US$. Tous les chirurgiens ayant répondu à l'enquête ont préféré utiliser la planification virtuelle/les guides imprimés en 3D pour la réalisation de la procédure. Conclusions : La planification virtuelle et les guides chirurgicaux imprimés en 3D ont le potentiel de réduire les temps opératoires pour la reconstruction maxillo-faciale.

11.
Heliyon ; 10(4): e26450, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38434036

RESUMO

In the realm of significant technological research and innovation within the marine economy, enterprises and academic research institutions often grapple with a lack of innovation motivation due to financial constraints. This paper introduces the factor of "capital constraints" into the marine innovation chain, establishing a technological innovation chain within the marine economy. Utilizing a three-party evolutionary game model, the study delves into the strategy selection and evolution of financial institutions, marine enterprises, and academic research institutions. In contrast to previous studies, this paper categorizes technological innovation cooperation into two types: "cooperative tackling type" and "market-oriented promotion type." Additionally, it posits that collaboration between academic research institutions and marine enterprises establishes an implicit guarantee relationship, facilitating access to higher loan amounts for both parties. The research reveals that the behavior of governments and marine enterprises is influenced by the initial willingness of participants. Higher basic benefits of cooperation and innovation between academic research institutions and marine enterprises lead to a quicker attainment of an evolutionary stable state. Moreover, in collaborations between marine enterprises and research institutions, an excessively high proportion of funds occupied by marine enterprises proves disadvantageous. The paper suggests that pure market-oriented promotion innovation cooperation could serve as a supplementary approach to traditional cooperation and innovation. Finally, numerical examples are presented to elucidate the outcomes of the theoretical model, accompanied by policy suggestions.

12.
Heliyon ; 10(4): e26487, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38434022

RESUMO

In this work, we formulated and investigated an optimal control problem of the melioidosis epidemic to explain the effectiveness of time-dependent control functions in controlling the spread of the epidemic. The basic reproduction number (R0c) with control measures is obtained, using the next-generation matrix approach and the impact of the controls on R0c is illustrated numerically. The optimal control problem is analyzed using Pontryagin's maximum principle to derive the optimality system. The optimality system is simulated using the forward-backward sweep method based on the fourth-order Runge-Kutta method in the MATLAB program to illustrate the impact of all the possible combinations of the control interventions on the transmission dynamics of the disease. The numerical results indicate that among strategies considered, strategy C is shown to be the most effective in reducing the number of infectious classes compared to both strategy A and strategy B. Furthermore, we carried out a cost-effectiveness analysis to determine the most cost-effective strategy and the result indicated that the strategy B (treatment control strategy) should be recommended to mitigate the spread and impact of the disease regarding the costs of the strategies.

13.
Front Physiol ; 15: 1356787, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38434139

RESUMO

Exposure of experimental rodents to controlled cycles of light, food, and temperature is important when investigating alterations in circadian cycles that profoundly influence health and disease. However, applying such stimuli simultaneously is difficult in practice. We aimed to design, build, test, and open-source describe a simple device that subjects a conventional mouse cage to independent cycles of physiologically relevant environmental variables. The device is based on a box enclosing the rodent cage to modify the light, feeding, and temperature environments. The device provides temperature-controlled air conditioning (heating or cooling) by a Peltier module and includes programmable feeding and illumination. All functions are set by a user-friendly front panel for independent cycle programming. Bench testing with a model simulating the CO2 production of mice in the cage showed: a) suitable air renewal (by measuring actual ambient CO2), b) controlled realistic illumination at the mouse enclosure (measured by a photometer), c) stable temperature control, and d) correct cycling of light, feeding, and temperature. The cost of all the supplies (retail purchased by e-commerce) was <300 US$. Detailed technical information is open-source provided, allowing for any user to reliably reproduce or modify the device. This approach can considerably facilitate circadian research since using one of the described low-cost devices for any mouse group with a given light-food-temperature paradigm allows for all the experiments to be performed simultaneously, thereby requiring no changes in the light/temperature of a general-use laboratory.

14.
Heliyon ; 10(5): e26512, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38434319

RESUMO

This paper proposes a nonlinear threshold cointegration framework to study how energy prices affect Malaysia's nominal exchange rate, considering the money supply, income, and interest rate. The study employs a threshold cointegration approach utilizing threshold autoregressive and momentum threshold autoregressive models. The momentum threshold vector error correction model determines the short-run adjustment of exchange rate deviation from the long-run equilibrium level. The findings reveal that the nonlinear adjustment process to capture the short-run deviation in the long-run equilibrium path is primarily influenced by energy prices, money supply, and interest rates. These results highlight the importance of considering the impact of energy prices on exchange rate policies when formulating and implementing economic policies in Malaysia. The findings can also be valuable for decision-makers to comprehend the future dynamics of exchange rates and make well-informed decisions.

15.
Heliyon ; 10(5): e26546, 2024 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-38434396

RESUMO

Despite China's heavy investment in sports infrastructure development in the last decades, the financial resources utilization efficiency (FRUE), regional technological gap (TGR), and total factor productivity change (TFPC) in sports infrastructure development are undiscovered and worth investigating. To this end, this study employed DEA-SBM, Meta-frontier analysis, and Malmquist productivity index on the data set of 31 Chinese provinces and 3 regions for the years 2014-2021 to gauge the FRUE, TGR, and TFPC in sports infrastructure development. The results indicate that the average FRUE is 0.4859, with a growth potential of 51.41% in financial resource utilization efficiency for sports infrastructure development. Further Eastern region is more efficient as compared to the Central and western regions. Beijing, Shanghai, Tibet, Hainan, and Guangdong are top performers in FRUE. Further, the value of TGR in the East is 0.9787 which is higher than in Central (0.4977), and Western (0.5821) regions. It indicates that the eastern region contains superior production technology in the development of the sports infrastructure in China. Moreover, the average TFPC value is 1.035 witnessed a 3.5% growth, primarily determined by technological change (TC). As TC = 1.0273 is higher than efficiency change EC = 0.997. The eastern region has a higher average TFPC of 1.048, indicating higher total factor productivity growth in sports infrastructure development. Beijing, Liaoning, Tianjin, Shanghai, and Zhejiang are the top performers in the TFP growth over the study period. Finally, the Kruskal-Wallis test proved the statistically significant difference in three regions of China for FRUE, TGR, and TFPC in sports infrastructure development.

16.
Can J Gastroenterol Hepatol ; 2024: 5573068, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38434933

RESUMO

Background: Data on the economic burden of chronic hepatitis C (CHC) among immigrants are limited. Our objective was to estimate the CHC-attributable mortality and healthcare costs among immigrants in Ontario, Canada. Methods: We conducted a population-based matched cohort study among immigrants diagnosed with CHC between May 31, 2003, and December 31, 2018, using linked health administrative data. Immigrants with CHC (exposed) were matched 1 : 1 to immigrants without CHC (unexposed) using a combination of hard (index date, sex, and age) and propensity-score matching. Net costs (2020 Canadian dollars) collected from the healthcare payer perspective were calculated using a phase-of-care approach and used to estimate long-term costs adjusted for survival. Results: We matched 5,575 exposed individuals with unexposed controls, achieving a balanced match. The mean age was 47 years, and 52% was male. On average, 10.5% of exposed and 3.5% of unexposed individuals died 15 years postindex (relative risk = 2.9; 95% confidence interval (CI): 2.6-3.5). The net 30-day costs per person were $88 (95% CI: 55 to 122) for the prediagnosis, $324 (95% CI: 291 to 356) for the initial phase, $1,016 (95% CI: 900 to 1,132) for the late phase, and $975 (95% CI: -25 to 1,974) for the terminal phase. The mean net healthcare cost adjusted for survival at 15 years was $90,448. Conclusions: Compared to unexposed immigrants, immigrants infected with CHC have higher mortality rates and greater healthcare costs. These findings will support the planning of HCV elimination efforts among key risk groups in the province.


Assuntos
Emigrantes e Imigrantes , Hepatite C , Masculino , Humanos , Pessoa de Meia-Idade , Estudos de Coortes , Hepacivirus , Custos de Cuidados de Saúde , Ontário/epidemiologia
17.
Ecol Evol ; 14(3): e11081, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38435022

RESUMO

The Type VI Secretion System (T6SS) is a widespread and highly effective mechanism of microbial warfare; it confers the ability to efficiently kill susceptible cells within close proximity. Due to its large physical size, complexity, and ballistic basis for intoxication, it has widely been assumed to incur significant growth costs in the absence of improved competitive outcomes. In this study, we precisely examine the fitness costs of constitutive T6SS firing in the bacterium Vibrio cholerae. We find that, contrary to expectations, constitutive expression of the T6SS has a negligible impact on growth, reducing growth fitness by 0.025 ± 0.5% (95% CI) relative to a T6SS- control. Mathematical modeling of microbial populations demonstrates that, due to clonal interference, constitutive expression of the T6SS will often be neutral, with little impact on evolutionary outcomes. Our findings underscore the importance of precisely measuring the fitness costs of microbial social behaviors and help explain the prevalence of the T6SS across Gram-negative bacteria.

18.
Shoulder Elbow ; 16(1): 59-67, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38435039

RESUMO

Purpose: Arthroscopic Bankart repair (ABR) may be more effective than nonoperative management for patients with anterior shoulder instability following first-time dislocation. The purpose of the study was to determine the most cost-effective treatment strategy by evaluating the incremental cost-effectiveness ratio (ICER) for ABR versus nonoperative treatment. Methods: This cost-effectiveness study utilized a Markov decision chain and Monte Carlo simulation. Probabilities, health utility values, and outcome data regarding ABR and nonoperative management of first-time shoulder instability derived from level I/II evidence. Costs were tabulated from Centers for Medicaid & Medicare Services. Probabilistic sensitivity analysis was performed using >100,000 repetitions of the Monte Carlo simulation. A willingness-to-pay (WTP) threshold was set at $50,000. Results: The expected cost for operative management higher than nonoperative management ($32,765 vs $29,343). However, ABR (5.48 quality-adjusted life years (QALYs)) was the more effective treatment strategy compared to nonoperative management (4.61 QALYs). The ICER for ABR was $3943. Probabilistic sensitivity analysis showed that ABR was the most cost-effective strategy in 100% of simulations. Discussion: ABR is more cost-effective than nonoperative management for first-time anterior shoulder dislocation. The threshold analysis demonstrated that when accounting for WTP, ABR was found to be the more cost-effective strategy.

19.
Front Public Health ; 12: 1213318, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38435286

RESUMO

Background: The ALTA-1 L trial and EXP-3B arm of NCT01970865 trial found that both brigatinib and lorlatinib showed durable and robust responses in treating ALK-positive non-small cell lung cancer (NSCLC) patients. However, brigatinib and lorlatinib treatments are costly and need indefinite administration until the disease progression. Thus, it remains uncertain whether using brigatinib followed by lorlatinib before chemotherapy is cost-effective compared to reserving these two drugs until progression after chemotherapy. Methods: We used a Markov model to assess clinical outcomes and healthcare costs of treating ALK-positive NSCLC individuals with brigatinib followed by lorlatinib before chemotherapy versus a strategy of reserving these drugs until progression after chemotherapy. Transition probabilities were estimated using parametric survival modeling based on multiple clinical trials. The drug acquisition costs, adverse events costs, administration costs were extracted from published studies before and publicly available data. We calculated lifetime direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios from the perspective of a United States payer. Results: Our base-case analysis indicated that the incremental cost-effectiveness ratios of using first-line brigatinib followed by lorlatinib compared with second-line brigatinib followed by lorlatinib is $-400,722.09/QALY which meant that second-line brigatinib followed by lorlatinib had less costs and better outcomes. Univariate sensitivity analysis indicated the results were most sensitive to the cost of brigatinib. Probability sensitivity analysis revealed that using brigatinib followed by lorlatinib before chemotherapy had a 0% probability of cost-effectiveness versus delaying these two drugs until progression after chemotherapy at a willingness-to-pay threshold of $150,000 per QALY. Sensitivity analyses conducted revealed the robustness of this result, as incremental cost-effectiveness ratios never exceeded the willingness-to-pay threshold. Conclusion: Using brigatinib as first-line treatment followed by lorlatinib for ALK-positive NSCLC may not be cost-effective given current pricing from the perspective of a United States payer. Delaying brigatinib followed by lorlatinib until subsequent lines of treatment may be a reasonable strategy that could limit healthcare costs without affecting clinical outcomes. More mature data are needed to better estimate cost-effectiveness in this setting.


Assuntos
Aminopiridinas , Carcinoma Pulmonar de Células não Pequenas , Lactamas , Neoplasias Pulmonares , Compostos Organofosforados , Pirazóis , Pirimidinas , Humanos , Carcinoma Pulmonar de Células não Pequenas/tratamento farmacológico , Análise Custo-Benefício , Neoplasias Pulmonares/tratamento farmacológico , Lactamas Macrocíclicas , Receptores Proteína Tirosina Quinases
20.
Front Public Health ; 12: 1301825, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38435289

RESUMO

Introduction: Despite the improvements in European health systems, a large number of premature deaths are attributable to treatable mortality. Men make up the majority of these deaths, with a significant gap existing between women and men's treatable mortality rate in the EU. Aim: This study aims to identify the healthcare-related factors, including health expenditures, human and physical resources, and hospital services use associated with treatable mortality in women and men across European countries during the period 2011-2019. Methods: We use Eurostat data for 28 EU countries in the period 2011-2019. We estimate a panel data linear regression with country fixed effects and quantile linear regression for men and women. Results: The results found (i) differences in drivers for male and female treatable mortality, but common drivers hold the same direction for both sexes; (ii) favorable drivers are GDP per capita, health expenditures, number of physicians per capita, and (only for men) the average length of a hospital stay, (iii) unfavorable drivers are nurses and beds per capita, although nurses are not significant for explaining female mortality. Conclusion: Policy recommendations may arise that involve an improvement in hospital bed management and the design of more specific policies aimed at healthcare professionals.


Assuntos
Gastos em Saúde , Pessoal de Saúde , Humanos , Feminino , Masculino , Europa (Continente)/epidemiologia , Tempo de Internação , Modelos Lineares
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...