Cost effectiveness of antimicrobial catheters in the intensive care unit : Addressing uncertainty in the decision

Introduction: Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost-effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, antimicrobial-coated central venous catheters to use. We re-evaluated the cost-effectiveness of all commercially available antimicrobialcoated central venous catheters for prevention of catheter-related bloodstream infection in adult intensive care unit (ICU) patients. Methods: We used a Markov decision model to compare the cost-effectiveness of antimicrobial-coated central venous catheters relative to uncoated catheters. Four catheter types were evaluated; minocycline and rifampicin (MR)-coated catheters; silver, platinum and carbon (SPC)-impregnated catheters; and two chlorhexidine and silver sulfadiazine-coated catheters, one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per qualityadjusted life-year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses. Results: The baseline analysis, with no consideration of uncertainty, indicated all four types of antimicrobial-coated central venous catheters were cost-saving relative to uncoated catheters. Minocycline and rifampicin-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life-years, and cost-savings, AUD $130,289. After considering uncertainty in the current evidence, the minocycline and rifampicin-coated catheters returned the highest incremental monetary net benefits of $948 per catheter; but there was a 62% probability of error in this conclusion. Although the minocycline and rifampicin-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty. Conclusions: Current evidence suggests that the cost-effectiveness of using antimicrobial-coated central venous catheters within the ICU is highly uncertain. Policies to prevent catheter-related bloodstream infection amongst ICU patients should consider the cost-effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area.

Investigation of glutathione S-transferase zeta and the development of sporadic breast cancer

Background Certain genes from the glutathione S-transferase superfamily have been associated with several cancer types. It was the objective of this study to determine whether alleles of the glutathione S-transferase zeta 1 (GSTZ1) gene are associated with the development of sporadic breast cancer. Methods DNA samples obtained from a Caucasian population affected by breast cancer and a control population, matched for age and ethnicity, were genotyped for a polymorphism of the GSTZ1 gene. After PCR, alleles were identified by restriction enzyme digestion and results analysed by chi-square and CLUMP analysis. Results Chi-squared analysis gave a χ2 value of 4.77 (three degrees of freedom) with P = 0.19, and CLUMP analysis gave a T1 value of 9.02 with P = 0.45 for genotype frequencies and a T1 value of 4.77 with P = 0.19 for allele frequencies. Conclusion Statistical analysis indicates that there is no association of the GSTZ1 variant and hence the gene does not appear to play a significant role in the development of sporadic breast cancer.

Effect Of Administration Of Luteinizing-Hormone (Lh) And Deprivation Of Lh On The Proteins Of Smooth Endoplasmic-Reticulum Of Immature And Adult-Rat Leydig-Cells

Analysis of proteins of smooth endoplasmic reticulum (SER) of Leydig cells from immature and admit rats by two-dimensional polyacrylamide gel electrophoresis (SDS-PAGE) revealed the presence of several new proteins in the adult rats. Administration of human chorionic gonadotropin to immature rats for ten days also resulted in a significant increase as well as the appearance of several new proteins. The general pattern of SDS-PAGE analysis of the SER proteins of Leydig cells resembled that of the adult rat. SDS-PAGE analysis of the SER proteins of Leydig cells from adult rats following deprivation of endogenous luteinizing hormone by administration of antiserum to ovine luteinizing hormone resulted in a pattern which to certain extent resembled that of an immature I at. Western Blot analysis of luteinizing hormone antiserum treated rat Leydig cell proteins revealed a decrease in the 17-alpha-hydroxylase compared to the control. These results provide biochemical evidence for the suggestion that one of the main functions of luteinizing hormone is the control of biogenesis and/or turnover SER of Leydig cells in the rat.

Helix-sheet interconversion in a synthetic pore lining peptide derived from a designed ion channel

We have designed a four-helix protein that is expected to tetramerize in the membrane to form an ion channel with a structurally well defined pore. A synthetic peptide corresponding to the channel lining helix facilitates ion transport across liposomal membranes and largely helical in membranes. Detailed circular dichroism studies of the peptide in methanol, water and methanal-water mixtures reveal that it is helical in methanol, beta-structured in 97.5% water and a combination of these two structures at intermediate compositions of methanol and water. A fluorescence resonance energy transfer study of the peptide shows that the peptide is monomeric in methanol but undergoes extensive anti-parallel aggregation in aqueous solution.

How do proteins fold?

Understanding the mechanism by which an unfolded polypeptide chain folds to its unique, functional structure is a primary unsolved problem in biochemistry. Fundamental advances towards understanding how proteins fold have come from kinetic studies, Kinetic studies allow the dissection of the folding pathway of a protein into individual steps that are defined by partially-structured folding intermediates. Improvements in both the structural and temporal resolution of physical methods that are used to monitor the folding process, as well as the development of new methodologies, are now making it possible to obtain detailed structural information on protein folding pathways. The protein engineering methodology has been particularly useful in characterizing the structures of folding intermediates as well as the transition state of folding, Several characteristics of protein folding pathways have begun to emerge as general features for the folding of many different proteins. Progress in our understanding of how structure develops during folding is reviewed here.

Human genome studies and intellectual property rights: Whither national interests?

India has been acknowledged as a large reservoir of nature's random mutation, an original 'rich' source of knowledge in the context of international genome studies. Human genome knowledge and the possible understanding of the basis of uniqueness of each individual in chemical terms has presented a number of inescapable challenges to our own jurisprudence philosophies and our ethical sensibilities.

Problems with geoengineering schemes to combat climate change

The accelerated rate of increase in atmospheric CO2 concentration in recent years has revived the idea of stabilizing the global climate through geoengineering schemes. Majority of the proposed geoengineering schemes will attempt to reduce the amount of solar radiation absorbed by our planet. Climate modelling studies of these so called 'sunshade geoengineering schemes' show that global warming from increasing concentrations of CO2 can be mitigated by intentionally manipulating the amount of sunlight absorbed by the climate system. These studies also suggest that the residual changes could be large on regional scales, so that climate change may not be mitigated on a local basis. More recent modelling studies have shown that these schemes could lead to a slow-down in the global hydrological cycle. Other problems such as changes in the terrestrial carbon cycle and ocean acidification remain unsolved by sunshade geoengineering schemes. In this article, I review the proposed geoengineering schemes, results from climate models and discuss why geoengineering is not the best option to deal with climate change.

Structural characteristics of a giant tropical liana and its mode of canopy spread in an alien environment

To circumvent the practical difficulties in research on tropical rainforest lianas in their natural habitat due to prevailing weather conditions, dense camouflaging vegetation and problems in transporting equipment for experimental investigations, Entada pursaetha DC (syn. Entada scandens Benth., Leguminosae) was grown inside a research campus in a dry subtropical environment. A solitary genet has attained a gigantic size in 17 years, infesting crowns of semi-evergreen trees growing in an area roughly equivalent to 1.6 ha. It has used aerially formed, cable-like stolons for navigating and spreading its canopy across tree gaps. Some of its parts which had remained unseen in its natural habitat due to dense vegetation are described. The attained size of this liana in a climatically different environment raises the question as to why it is restricted to evergreen rainforests. Some research problems for which this liana will be useful are pointed out.

Genome sequencing of cells that live inside glass cages reveals their past history

One-quarter of the total primary production on earth is contributed by diatoms1. These are photosynthetic, unicellular algae with ornamented silica shells found in all aquatic and moist environments. They form the base of energy-efficient food webs that support all aquatic life forms. More than 250 genera of living diatoms, with as many as 100,000 species are known2. Fossil diatoms are known as early as the Cretaceous, 144–65 m.y. ago3. In India, deposits of diatoms occur in Rajasthan and are known as ‘multani mitti’. Multani mitti or Indian Fuller’s earth or diatomaceous earth as it is called in the West, is applied as a paste on the surface of the skin for 15–20 min and then washed-off. This leaves the skin feeling smooth, soft, moist and rejuvenated. Diatomaceous earth is now being used in the formulation of soaps, cleansing products, face powders and skincare preparations. Diatomaceous earth is a mineral material consisting mainly of siliceous fragments of various species of fossilized remains of diatoms.

Particle field imaging using digital in-line holography

Digital holography is the direct recording of holograms using a CCD camera and is an alternative to the use of a film or a plate. In this communication in-line digital holographic microscopy has been explored for its application in particle imaging in 3D. Holograms of particles of about 10 mu m size have been digitally reconstructed. Digital focusing was done to image the particles in different planes along the depth of focus. Digital holographic particle imaging results were compared with conventional optical microscope imaging. A methodology for dynamic analysis of microparticles in 3D using in-line digital holography has been proposed.

Towards rational synthesis of inorganic solids

There have been major advances in the past couple of years in the rational synthesis of inorganic solids: synthesis of mercury-based superconducting cuprates showing transition temperatures up to 150 K; ZrP2-xVxO7 solid solutions showing zero or negative thermal expansion; copper oxides possessing ladder structures such as La1-xSrxCuO2.5; synthesis of mesoporous oxide materials having adjustable pore size in the range 15-100 Angstrom; and synthesis of a molecular ferromagnet showing a critical temperature of 18.6 K. Despite great advances in probing the structures of solids and measurement of their physical properties, the design and synthesis of inorganic solids possessing desired structures and properties remain a challenge today. With the availability of a variety of mild chemistry-based approaches, kinetic control of synthetic pathways is becoming increasingly possible, which, it is hoped, will eventually make rational design of inorganic solids a reality.