Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 310.625
Filtrar
1.
Sci Total Environ ; 857(Pt 1): 159245, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36208742

RESUMO

Invasive species are one of the greatest threats to ecosystems, disrupting ecosystem function and leading to the collapse and extinction of native species. While populations of native fishes in the Everglades are tied to the system's natural hydrological dynamics, Asian Swamp Eels (Monopterus albus/javanensis) are drought-resistant fish first reported from Florida in 1997 and the Everglades in 2007. Using a 26-year dataset that included a 13-year baseline period prior to swamp eel arrival in Taylor Slough, we assessed population changes of common small fishes and decapods that are important prey for larger vertebrate predators. After invasion, populations of two crayfishes collapsed by >95 %, two fishes declined by >80 %, two fishes had intermediate declines of 44-66 %, and three species remained unchanged. Species most strongly reduced were those dependent on predator-free habitats at the onset of the wet season, indicating drought-resistant swamp eels have introduced novel predator effects and disrupted the hydrology-mediated production of aquatic animals that are prey for many larger predators. Ongoing Everglades restoration is designed to restore hydrological conditions that support production of crayfishes and fishes, and nesting wading birds reliant on them. Water management may have facilitated the invasion of swamp eels. Our results suggest that the continued spread of swamp eels may result in adverse consequences for Everglades trophic dynamics and potentially diminish benefits expected from the $20B+ restoration.


Assuntos
Conservação dos Recursos Naturais , Hidrologia , Espécies Introduzidas , Smegmamorpha , Áreas Alagadas , Animais , Astacoidea , Aves , Peixes , Comportamento Predatório , Smegmamorpha/fisiologia , Florida , Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/estatística & dados numéricos
2.
Waste Manag ; 155: 19-28, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36335772

RESUMO

The orbital debris population is rapidly growing, increasing the chance of a Kessler-style collision event. We report a novel method for the production of estimates for the total monetary value of all debris objects and total mass of all objects currently in orbit. The method was devised using debris object data from the European Space Agency's DISCOS dataset, classified via a decision tree. 'Reuse' and 'scrap material' scenarios were developed. A high-end estimate for reuse shows a net value of $1.2 trillion. Median and low-end net value estimates of $600 billion and $570 billion, respectively, are probably judicious. A scrap material scenario produced a high mass estimate of 19,124 tonnes, a median of 6,978 tonnes and a low estimate of 5,312 tonnes. Development of in-orbit services will be crucial to solve the orbital debris problem. A future circular economy for space may be financially viable, with potentially beneficial consequences for risk reduction; resource efficiency; additional high-value employment; and climate-change knowledge, science, monitoring and early warning data.


Assuntos
Meio Ambiente Extraterreno , Reciclagem , Gerenciamento de Resíduos , Reciclagem/economia , Reciclagem/estatística & dados numéricos , Gerenciamento de Resíduos/economia , Gerenciamento de Resíduos/estatística & dados numéricos
3.
Sci Total Environ ; 857(Pt 2): 159479, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36265628

RESUMO

Invasive alien mammals cause huge adverse ecological impact on human society and natural ecosystems. Although studies have estimated economic costs of mammal invasions at regional scales, there is lacking the large-scale comprehensive assessment of currency costs for this taxon. Here, we estimated the economic cost of invasive alien mammals on a global scale using the most comprehensive global database compiling economic costs of invasive species (InvaCost). From 1960 to 2021, mammal invasions caused costs (summing damage costs and management costs) of US$ 462.49 billion to the global economy, while the total amount of robust costs reached US$ 52.49 billion. The majority of the total economic costs corresponded to damage costs (90.27 %), while only 7.43 % were related to management cost. Economic costs showed an increasing trend over time. The distribution of costs was uneven among taxonomic groups and regions, with the global total cost highly biasing toward to 5 species (European rabbit, Domestic cat, Black rat, Wild boar and Coypu), and North America reporting much higher costs (60.78 % of total economic costs) than other regions. The total costs were borne by agriculture, environment, authorities stakeholders and other sectors. Geographic and taxonomic biases suggested that total economic costs caused by invasive alien mammals were underestimated. Integrated research efforts are needed to fill in knowledge gaps in the economic costs generated by mammal invasions and to identify the drivers of the economic costs.


Assuntos
Ecossistema , Espécies Introduzidas , Animais , Gatos , Coelhos , Agricultura , Espécies Introduzidas/economia , Mamíferos , América do Norte
7.
J Med Econ ; 25(1): 1218-1230, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36384429

RESUMO

AIM: Vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) all are options for drug-resistant epilepsy (DRE). However, little is known about how the choice of neurostimulation impacts subsequent healthcare costs. MATERIALS AND METHODS: We used a large US healthcare claims database to identify all patients with epilepsy who underwent neurostimulation between 2012 and 2019. Eligible patients were identified and stratified based on procedure received (VNS vs. RNS/DBS). VNS patients were matched by propensity scoring to RNS/DBS patients. Use and cost of healthcare resources and pharmacotherapy were ascertained over the 24-month period following neurostimulation, incorporating all-cause and epilepsy-related measures. Disease-related care was defined based on diagnoses of claims for medical care and relevant pharmacotherapies. RESULTS: Seven hundred and ninety-two patients met all selection criteria. VNS patients were younger, were prescribed a higher pre-index mean number of anti-seizure medications (ASMs), and had higher pre-index levels of use and cost of epilepsy-related healthcare services. We propensity matched 148 VNS patients to an equal number of RNS/DBS patients. One year following index date (inclusive), mean total all-cause healthcare costs were 50% lower among VNS patients than RNS/DBS patients, and mean epilepsy-related costs were 55% lower; corresponding decreases at the two-year mark were 41% and 48%, respectively. LIMITATIONS: Some clinical variables, such as seizure frequency and severity, quality of life, and functional status were unavailable in the database, precluding our ability to comprehensively assess differences between devices. Administrative claims data are subject to billing code errors, inaccuracies, and missing data, resulting in possible misclassification and/or unmeasured confounding. CONCLUSIONS: After matching, VNS was associated with significantly lower all-cause and epilepsy-related costs for the two-year period following implantation. All-cause and epilepsy-related costs remained statistically significantly lower for VNS even after costs of implantation were excluded.


For some people with epilepsy, medications do not work very well. For these people, other treatment options exist. One such treatment is neurostimulation. There are three types of neurostimulators­vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS). All three devices are known to reduce seizures in patients who have tried several medications. However, it is not known how these devices impact the costs of care. We compared the use and costs of medical care over 2 years between patients who got VNS and those who got RNS/DBS. Before comparing the groups, we made sure that they were balanced. Patients who got VNS were less likely than patients who got RNS/DBS to go to the hospital during the follow-up period. Patients who got VNS also had lower healthcare costs than patients who got RNS/DBS during follow-up. These differences were seen for all medical care costs. These differences also were seen in the costs of care for epilepsy. Our results suggest that the use of VNS is associated with fewer hospitalizations than RNS/DBS, and also that use of VNS is associated with lower healthcare costs than RNS/DBS.


Assuntos
Estimulação Encefálica Profunda , Epilepsia Resistente a Medicamentos , Custos de Cuidados de Saúde , Estimulação do Nervo Vago , Humanos , Estimulação Encefálica Profunda/economia , Epilepsia Resistente a Medicamentos/terapia , Serviços de Saúde , Qualidade de Vida , Estados Unidos , Estimulação do Nervo Vago/economia
8.
Clin Drug Investig ; 42(12): 1085-1092, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36316586

RESUMO

BACKGROUND: Gene therapy is known to be unaffordable to those who need it the most; however, evidence on the financial impact is limited. OBJECTIVE: This study aimed to estimate the budget impact and affordability of the gene therapy idecabtagene vicleucel for the treatment of adult patients with relapsed or refractory multiple myeloma (rrMM) in the US over a 3-year period from the payer healthcare perspective. METHOD: A budget impact model was developed to estimate the budget impact to the US healthcare plan compared with bortezomib-based maintenance therapy. The target population size was based on a hypothetical 1-million-member plan over a 3-year time horizon with and without idecabtagene vicleucel adoption. The cost of drug acquisition, drug administration, and grade 3-4 adverse events (AEs) were calculated for both scenarios. The budget impact of idecabtagene vicleucel was calculated as the difference in costs for these two scenarios. Costs were extracted from IBM-Micromedex Red Book, Centers for Medicare and Medicaid Services, and the literature. A one-way sensitivity analysis was performed to ensure robustness. RESULTS: An estimated 22 patients with rrMM each year would be eligible for idecabtagene vicleucel. The model projected the annual cost per patient in the first year as $19,449 and $517,528.13 for bortezomib and idecabtagene vicleucel, respectively. Introducing idecabtagene vicleucel was predicted to increase the total budget by $13.4, $13.6, and $14 million in the first, second, and third years. There would be an additional $1.1128, $1.1252, and $1.1486 per member per month (PMPM) when using idecabtagene vicleucel over bortezomib. CONCLUSION: This study suggests that the high cost of the gene therapy idecabtagene vicleucel is justifiable due to the low number of rrMM patients.


Assuntos
Antineoplásicos Imunológicos , Mieloma Múltiplo , Adulto , Humanos , Bortezomib/economia , Bortezomib/uso terapêutico , Orçamentos , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/economia , Estados Unidos , Antineoplásicos Imunológicos/economia , Antineoplásicos Imunológicos/uso terapêutico
12.
Health Promot Int ; 37(6)2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36377702

RESUMO

Mass media campaigns can change attitudes and behaviours to improve population health. However, a key challenge is achieving share of voice in a complex and cluttered media environment. The aim of this study was to compare advertising expenditure on public health campaigns for obesity prevention (and related healthy eating and physical activity campaigns) with competing commercial categories of (a) sugary drinks, (b) artificially sweetened drinks and (c) diet/weight loss products and programmes. These commercial products may either undermine or dilute public health messages by directly contributing to poor health or confusing the public about the best ways to sustain a healthy lifestyle. Monthly estimates of advertising expenditure in Australian media (television, outdoor, cinema, radio, newspapers, magazines and digital) were obtained from Nielsen Media for 2016-18. Eligible public health advertising expenditure for the entire period (total AUD$27M) was vastly outweighed by the commercial categories of sugary drinks (AUD$129M) and diet/weight loss products and services (AUD$122M). Artificially sweetened drinks accounted for an additional AUD$23M of expenditure. These results highlight the need to rebalance the ratio of advertising to support public health in Australia through increased funding for obesity prevention and related campaigns, and critically, through government regulation to limit competing commercial advertising.


Assuntos
Publicidade , Obesidade , Saúde Pública , Humanos , Publicidade/economia , Austrália , Gastos em Saúde , Obesidade/prevenção & controle , Televisão , Redução de Peso
16.
Nature ; 611(7936): 570-577, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36352231

RESUMO

Expanding our global testing capacity is critical to preventing and containing pandemics1-9. Accordingly, accessible and adaptable automated platforms that in decentralized settings perform nucleic acid amplification tests resource-efficiently are required10-14. Pooled testing can be extremely efficient if the pooling strategy is based on local viral prevalence15-20; however, it requires automation, small sample volume handling and feedback not available in current bulky, capital-intensive liquid handling technologies21-29. Here we use a swarm of millimetre-sized magnets as mobile robotic agents ('ferrobots') for precise and robust handling of magnetized sample droplets and high-fidelity delivery of flexible workflows based on nucleic acid amplification tests to overcome these limitations. Within a palm-sized printed circuit board-based programmable platform, we demonstrated the myriad of laboratory-equivalent operations involved in pooled testing. These operations were guided by an introduced square matrix pooled testing algorithm to identify the samples from infected patients, while maximizing the testing efficiency. We applied this automated technology for the loop-mediated isothermal amplification and detection of the SARS-CoV-2 virus in clinical samples, in which the test results completely matched those obtained off-chip. This technology is easily manufacturable and distributable, and its adoption for viral testing could lead to a 10-300-fold reduction in reagent costs (depending on the viral prevalence) and three orders of magnitude reduction in instrumentation cost. Therefore, it is a promising solution to expand our testing capacity for pandemic preparedness and to reimagine the automated clinical laboratory of the future.


Assuntos
Automação , Teste para COVID-19 , Imãs , Técnicas de Diagnóstico Molecular , Técnicas de Amplificação de Ácido Nucleico , Robótica , SARS-CoV-2 , Humanos , COVID-19/diagnóstico , COVID-19/virologia , Teste para COVID-19/métodos , Técnicas de Diagnóstico Molecular/economia , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificação de Ácido Nucleico/economia , Técnicas de Amplificação de Ácido Nucleico/métodos , Pandemias/prevenção & controle , RNA Viral/análise , RNA Viral/genética , SARS-CoV-2/genética , SARS-CoV-2/isolamento & purificação , Sensibilidade e Especificidade , Algoritmos , Automação/economia , Automação/métodos , Robótica/métodos , Indicadores e Reagentes/economia
17.
Nature ; 611(7935): 332-345, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36329272

RESUMO

Despite notable scientific and medical advances, broader political, socioeconomic and behavioural factors continue to undercut the response to the COVID-19 pandemic1,2. Here we convened, as part of this Delphi study, a diverse, multidisciplinary panel of 386 academic, health, non-governmental organization, government and other experts in COVID-19 response from 112 countries and territories to recommend specific actions to end this persistent global threat to public health. The panel developed a set of 41 consensus statements and 57 recommendations to governments, health systems, industry and other key stakeholders across six domains: communication; health systems; vaccination; prevention; treatment and care; and inequities. In the wake of nearly three years of fragmented global and national responses, it is instructive to note that three of the highest-ranked recommendations call for the adoption of whole-of-society and whole-of-government approaches1, while maintaining proven prevention measures using a vaccines-plus approach2 that employs a range of public health and financial support measures to complement vaccination. Other recommendations with at least 99% combined agreement advise governments and other stakeholders to improve communication, rebuild public trust and engage communities3 in the management of pandemic responses. The findings of the study, which have been further endorsed by 184 organizations globally, include points of unanimous agreement, as well as six recommendations with >5% disagreement, that provide health and social policy actions to address inadequacies in the pandemic response and help to bring this public health threat to an end.


Assuntos
COVID-19 , Técnica Delfos , Cooperação Internacional , Saúde Pública , Humanos , COVID-19/economia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Governo , Pandemias/economia , Pandemias/prevenção & controle , Saúde Pública/economia , Saúde Pública/métodos , Organizações , Vacinas contra COVID-19 , Comunicação , Educação em Saúde , Política de Saúde , Opinião Pública
18.
BMC Pediatr ; 22(1): 648, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36348320

RESUMO

AIM: Teaching Basic Life Support (BLS) in schools is a key initiative to improve the survival rates after out-of-hospital cardiac arrest. Low-cost training materials can reach a wider population. Our aim was to compare the effectiveness of using teaching cards with the traditional instructor-led and combined methods on BLS skills and attitude and to evaluate the long-term effects after two months. METHODS: A quasi-experimental combination design study. Two hundred sixty-three schoolchildren aged 6 to 10 years were assigned to three groups with different methods to teach BLS: teaching card group (n = 100), traditional instructor-led teaching group (n = 91), combined teaching group (n = 72). BLS skills and attitude were measured and compared before the training (T0), after the training (T1), and two months later (T2). RESULTS: BLS skills improved in every group at T1 compared to T0 (p < 0.001) and remained higher at T2 than at T0 in almost all cases (p < 0.001). Skill performance was similar in most of the skills between the three groups at T1. The best skill scores acquired were calling the ambulance and the correct hand position by chest compression. Positioning the head during check the breathing was more effective in the traditional group (48.4%) and combined group (61.1%) than in the teaching card group (19.0%) (p < 0.001) at T1. However, some skills improved significantly in the teaching card group at T2: check breathing for 10 s (p = 0.016); positioning the head by check breathing (p < 0.001); and positioning the head by ventilation (p = 0.011). Attitude did not change significantly in any of the groups (p > 0.05). Furthermore, the level of attitude was inferior in the teaching card group compared with the traditional (p = 0.005), and the combined groups (p = 0.049). CONCLUSION: Using low-cost materials for teaching BLS for young schoolchildren can improve their skills, however, could not improve attitudes. Teaching cards were not inferior compared to traditional and combined methods in some skills but inferior in others. Therefore, hands-on training opportunity is still important. Teaching cards are useful for long-term learning. To learn correctly the whole sequence of BLS is difficult for 6 to 10 years-old children, however, they are able to learn more BLS-related skills separately.


Assuntos
Recursos Audiovisuais , Reanimação Cardiopulmonar , Instituições Acadêmicas , Criança , Humanos , Atitude , Reanimação Cardiopulmonar/educação , Avaliação Educacional , Aprendizagem , Ensino , Recursos Audiovisuais/economia
19.
Science ; 378(6620): 586, 2022 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-36356146

RESUMO

Long-term study in China shows yields hold up and farmers save money and time.


Assuntos
Produção Agrícola , Produtos Agrícolas , Oryza , Humanos , China , Fazendeiros , Produção Agrícola/economia
20.
J Am Heart Assoc ; 11(22): e026620, 2022 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-36370005

RESUMO

Background Pharmacologic treatment for pulmonary arterial hypertension (PAH) improves exercise capacity, functional class, and hemodynamic indexes. However, monthly prescription costs often exceed $4000. We examined associations between (1) medication copayment and (2) annual household income with adherence to pulmonary vasodilator therapy among individuals with PAH. Methods and Results We used administrative claims data from an insured population in the United States to identify individuals diagnosed with PAH between 2015 and 2020. All individuals had ≥1 medication claim for endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, prostanoids or prostacyclin receptor agonists, or the soluble guanylate cyclase stimulator riociguat. We defined copayments as low, medium, or high, as determined by their distributions for each medication class. Annual household income was categorized as <$40 000, $40 000 to $74 999, and ≥$75 000. The primary outcome was medication adherence, defined by proportion of days covered ≥80%. We studied 4025 adults (aged 65.9±13.3 years; 71.2% women). Compared with those with annual household income ≥$75 000, individuals in the <$40 000 and $40 000 to $74 999 categories had no significant differences in medication adherence. Compared with those with low copayments, individuals with high copayments had decreased adherence to prostanoids (odds ratio [OR], 0.36 [95% CI, 0.20-0.65]; P<0.001) and combination therapy with endothelin receptor antagonist and phosphodiesterase type-5 inhibitor (OR, 0.61 [95% CI, 0.38-0.97]; P=0.03). Conclusions We identified associations between copayment and adherence to prostanoids and combination therapy among individuals with PAH. Copayment may be a structural barrier to medication adherence and merits inclusion in studies examining access to pharmacotherapy among individuals with PAH.


Assuntos
Gastos em Saúde , Adesão à Medicação , Hipertensão Arterial Pulmonar , Feminino , Humanos , Masculino , Antagonistas dos Receptores de Endotelina/economia , Antagonistas dos Receptores de Endotelina/uso terapêutico , Inibidores da Fosfodiesterase 5/economia , Inibidores da Fosfodiesterase 5/uso terapêutico , Prostaglandinas , Hipertensão Arterial Pulmonar/tratamento farmacológico , Hipertensão Arterial Pulmonar/economia , Estados Unidos , Pessoa de Meia-Idade , Idoso , Renda
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...