A cost-benefit analisys of chagas disease control

Chagas disease transmission can be effetively interrupted by insecticidal control of its triatomine bug vectors. We present here a simple model comparing the costs and benefits of such a programme, designed to eliminate domestic populations of Triatoma infestans throughout its known area of distribution over the seven southernmost countries of Latin America. The model has been simplified to require only four financial estimates relating to the unit cost of housing spraying and benefits due to avoidance of premature death in the acute phase of the disease, avoidance of supportive treatment and care in the chronic phase of the disease, and avoidance of corrective digestive and cardiac surgery. Exceptfor these direct medical costs, al other potential benefits have been ignored. Nevertheless, the model shows that the direct financial benefits of such a programme would far outweigh the costs, and the project would support a remarkably high internal rate of return under the least optimistic estimates.

Violent adolescents and their educational environment : a multilevel analysis ; et, Youths carrying a weapon or using a weapon in a fight : what makes the difference ?

Rapport de synthèse : Cette recherche s'intéresse (1) au port et à l'utilisation d'armes chez les adolescents ainsi que (2) aux rôles des facteurs environnementaux et individuels dans la violence juvénile. Les données étaient tirés de SMASH 2002 (Swiss multicenter adolescent survey on health 2002), étude dans laquelle un échantillon représentatif de 7548 étudiants et apprentis âgés entre 16 et 20 ans vivant en Suisse ont été interrogés Dans une première étude, les adolescents ayant porté une arme (couteau, masse, coup de poing américain, pistolet/autre arme à feu, spray) durant l'année précédant l'enquête étaient comparés avec ceux n'ayant pas porté d'arme. Ensuite, dans le sous-échantillon de porteurs d'armes, ceux ayant uniquement porté l'arme étaient comparés avec ceux ayant utilisé une arme dans une bagarre. Des facteurs individuels, familiaux, scolaires et sociaux ont été étudiés à l'aide d'analyses bivariées et multivariées. 13.7% des jeunes vivant en Suisse ont porté une arme dans l'année précédant l'enquête. 6.2% des filles porteuses d'armes et 19.9% des garçons porteurs d'armes ont fait usage de l'arme dans une bagarre. Chez les garçons et chez les filles, les porteurs d'armes étaient plus souvent délinquants et victimes de violence physique. Les garçons porteurs d'armes étaient plus souvent des apprentis, à la recherche de sensations fortes, porteurs de tatouages, avaient une mauvaise relation avec leurs parents, étaient dans des bagarres sous l'influence de substances, et avaient des relations sexuelles à risque. En comparaison avec les porteuses d'armes, les filles utilisatrices d'armes étaient plus souvent fumeuses quotidiennes. Les garçons ayant utilisé leur arme étaient plus souvent nés à l'étranger, vivaient dans un milieu urbain, étaient des apprentis, avaient un mauvais contexte scolaire, avaient des relations sexuelles à risque et étaient impliqués dans des bagarres sous l'influence de substances. Nos résultats montrent que porter une arme est un comportement relativement fréquent chez les adolescents vivant en Suisse et qu'une proportion non négligeable de ces porteurs d'armes ont utilisé l'arme dans une bagarre. De ce fait, une discussion sur le port d'arme devrait être incluse dans l'entretien clinique ainsi que dans les programmes de prévention visant les adolescents. Dans une deuxième étude, la violence juvénile était définie comme présente si l'adolescent avait commis au moins un des quatre délits suivants durant l'année précédant l'enquête: attaquer un adulte, arracher ou voler quelque chose, porter une arme ou utiliser une arme dans une bagarre. Des niveaux écologiques étaient testés et résultaient en un modèle à trois niveaux pour les garçons (niveau individuel, niveau classe et niveau école) et, à cause d'une faible prévalence de la violence chez les filles, en un modèle à un niveau (individuel) pour les filles. Des variables dépendantes étaient attribuées à chaque niveau, en se basant sur la littérature. Le modèle multiniveaux des garçons montrait que le niveau école (10%) et le niveau classe (24%) comptaient pour plus d'un tiers de la variance inter-individuelle dans le comportement violent. Les facteurs associés à ce comportement chez les filles étaient être victime de violence physique et la recherche de sensations fortes. Pour les garçons, les facteurs explicatifs de la violence étaient pratiquer des relations sexuelles à risque, être à la recherche de sensations fortes, être victime de violence physique, avoir une mauvaise relation avec les parents, être déprimé et vivre dans une famille monoparentale au niveau individuel, la violence et les actes antisociaux au niveau de la classe et être apprenti au niveau de l'école. Des interventions au niveau de la classe ainsi qu'un règlement explicit en ce qui concerne la violence et d'autres comportements à risque dans des écoles devraient être prioritaires pour la prévention de la violence chez les adolescents. En outre, la prévention devrait tenir compte des différences entre les sexes.

Activation of a dendritic cell-T cell axis by Ad5 immune complexes creates an improved environment for replication of HIV in T cells.

The STEP HIV vaccine trial, which evaluated a replication-defective adenovirus type 5 (Ad5) vector vaccine, was recently stopped. The reasons for this included lack of efficacy of the vaccine and a twofold increase in the incidence of HIV acquisition among vaccinated recipients with increased Ad5-neutralizing antibody titers compared with placebo recipients. To model the events that might be occurring in vivo, the effect on dendritic cells (DCs) of Ad5 vector alone or treated with neutralizing antiserum (Ad5 immune complexes [IC]) was compared. Ad5 IC induced more notable DC maturation, as indicated by increased CD86 expression, decreased endocytosis, and production of tumor necrosis factor and type I interferons. We found that DC stimulation by Ad5 IC was mediated by the Fcgamma receptor IIa and Toll-like receptor 9 interactions. DCs treated with Ad5 IC also induced significantly higher stimulation of Ad5-specific CD8 T cells equipped with cytolytic machinery. In contrast to Ad5 vectors alone, Ad5 IC caused significantly enhanced HIV infection in DC-T cell cocultures. The present results indicate that Ad5 IC activates a DC-T cell axis that, together with the possible persistence of the Ad5 vaccine in seropositive individuals, may set up a permissive environment for HIV-1 infection, which could account for the increased acquisition of HIV-1 infection among Ad5 seropositive vaccine recipients.

Agency cost of government ownership: a study of voluntary audit comitte formation in China

In this paper, we investigate the agency costs of government ownership and their impact on corporate governance and firm value. China is used as a laboratory because of the prevalent state shareholdings in exchange-listed firms. In this context, we specifically consider the trade-offs involved in the voluntary formation of an audit committee when the controlling shareholder is the state. The decision to improve corporate governance (in this case, introduce an audit committee) is shown to be value relevant and a function of existing agency relationships and non-trivial implementation costs. Our findings are robust to the level of pyramid groups, the ownership-control wedge, and financial leverage. The research adds to the debate regarding the effect of government shareholdings on corporate culture and performance - a topic that hastaken on renewed importance in recent times.

Comparative cost-effectiveness analyses of cardiovascular magnetic resonance and coronary angiography combined with fractional flow reserve for the diagnosis of coronary artery disease.

BACKGROUND: According to recent guidelines, patients with coronary artery disease (CAD) should undergo revascularization if significant myocardial ischemia is present. Both, cardiovascular magnetic resonance (CMR) and fractional flow reserve (FFR) allow for a reliable ischemia assessment and in combination with anatomical information provided by invasive coronary angiography (CXA), such a work-up sets the basis for a decision to revascularize or not. The cost-effectiveness ratio of these two strategies is compared. METHODS: Strategy 1) CMR to assess ischemia followed by CXA in ischemia-positive patients (CMR + CXA), Strategy 2) CXA followed by FFR in angiographically positive stenoses (CXA + FFR). The costs, evaluated from the third party payer perspective in Switzerland, Germany, the United Kingdom (UK), and the United States (US), included public prices of the different outpatient procedures and costs induced by procedural complications and by diagnostic errors. The effectiveness criterion was the correct identification of hemodynamically significant coronary lesion(s) (= significant CAD) complemented by full anatomical information. Test performances were derived from the published literature. Cost-effectiveness ratios for both strategies were compared for hypothetical cohorts with different pretest likelihood of significant CAD. RESULTS: CMR + CXA and CXA + FFR were equally cost-effective at a pretest likelihood of CAD of 62% in Switzerland, 65% in Germany, 83% in the UK, and 82% in the US with costs of CHF 5'794, euro 1'517, £ 2'680, and $ 2'179 per patient correctly diagnosed. Below these thresholds, CMR + CXA showed lower costs per patient correctly diagnosed than CXA + FFR. CONCLUSIONS: The CMR + CXA strategy is more cost-effective than CXA + FFR below a CAD prevalence of 62%, 65%, 83%, and 82% for the Swiss, the German, the UK, and the US health care systems, respectively. These findings may help to optimize resource utilization in the diagnosis of CAD.

Yakimbo

Treball de recerca realitzat per alumnes d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. Aquest treball és una creació d’un projecte empresarial, és a dir, una planificació estratègica que té per objectiu analitzar la viabilitat, examinar els objectius i descobrir els inconvenients del mateix. Aquest projecte final està enfocat al turisme i consisteix en crear una agència de viatges. S’ha decidit crear una agència de viatges de baix cost destinada principalment als joves, ja que aquest sector de població busca una manera de viatjar econòmica que combini diversió i cultura. El treball es basa en la recerca i aplicació de la informació sobre la idea inicial. En primer lloc, per tal de realitzar-lo s’ha fet un projecte d’empresa, un estudi de mercat i de l’entorn amb les seves corresponents enquestes i un pla de marketing. En segon lloc, s’ha realitzat una definició del mercat i la comunicació, una determinació dels preus i organització de les vendes així com una identificació i organització de l’empresa i els seus productes. Per últim, s’ha fet un estudi econòmic i financer del projecte i, les conclusions extretes d’aquest, diuen que el nostre projecte serà viable i tindrà un èxit tècnic.

Development of an optimized methodology for tensile testing of carbon steels in hydrogen environment

The study was performed at OCAS, the Steel Research Centre of ArcelorMittal for the Industry market. The major aim of this research was to obtain an optimized tensile testing methodology with in-situ H-charging to reveal the hydrogen embrittlement in various high strength steels. The second aim of this study has been the mechanical characterization of the hydrogen effect on hight strength carbon steels with varying microstructure, i.e. ferrite-martensite and ferrite-bainite grades. The optimal parameters for H-charging - which influence the tensile test results (sample geometry type of electrolyte, charging methods effect of steel type, etc.) - were defined and applied to Slow Strain Rate testing, Incremental Step Loading and Constant Load Testing. To better understand the initiation and propagation of cracks during tensile testing with in-situ H-charging, and to make the correlation with crystallographic orientation, some materials have been analyzed in the SEM in combination with the EBSD technique. The introduction of a notch on the tensile samples permits to reach a significantly improved reproducibility of the results. Comparing the various steel grades reveals that Dual Phase (ferrite-martensite) steels are more sensitive to hydrogen induced cracking than the FB (ferritic-bainitic) ones. This higher sensitivity to hydrogen was found back in the reduced failure times, increased creep rates and enhanced crack initiation (SEM) for the Dual Phase steels in comparison with the FB steels.

Auditoria ambiental de l'edifici de l'Àrea de Territori, Medi Ambient, Paisatge i Espai Urbà de l'Ajuntament de Sitges

Aquest projecte realitza una auditoria ambiental de l’edifici de l’Àrea de Territori, Medi Ambient, Paisatge i Espai Urbà de l’Ajuntament de Sitges, com a primer pas per a la implantació d’un sistema de gestió ambiental (SGA), en acord amb el Reglament (CE) nº 761/2001, i la posterior obtenció d’un certificat de gestió i auditories ambientals (EMAS). L’auditoria s’inicia amb la identificació dels aspectes ambientals de l’edifici, mitjançant la recopilació de dades sobre consums energètics i hídrics, la estimació de la generació de residus i enquestes de mobilitat als treballadors. Aquestes dades són utilitzades per determinar els aspectes ambientals significatius i posteriorment, exposar una sèrie de propostes de millora per tal de corregir-los o minimitzar-los, com ara sistemes d’estalvi d’aigua, d’enllumenat, de producció d’electricitat i l’educació ambiental dels treballadors. Per a la implantació d’un SGA en la situació actual de l’edifici, es necessària, entre altres coses, la implantació d’un sistema de registre que arxivi els consums d’aigua, energia i generació de residus, per tal de dur un control de les despeses de cadascun dels vectors. A més, caldrà implementar un Programa de bones pràctiques ambientals en l’oficina per tal de reduir el consum elèctric, d’aigua i generació de residus, i la seva classificació per part dels treballadors.

Less frequent dosing of erythropoiesis stimulating agents in patients undergoing dialysis: a European multicentre cost study.

OBJECTIVE: To calculate the variable costs involved with the process of delivering erythropoiesis stimulating agents (ESA) in European dialysis practices. METHODS: A conceptual model was developed to classify the processes and sub-processes followed in the pharmacy (ordering from supplier, receiving/storing/delivering ESA to the dialysis unit), dialysis unit (dose determination, ordering, receipt, registration, storage, administration, registration) and waste disposal unit. Time and material costs were recorded. Labour costs were derived from actual local wages while material costs came from the facilities' accounting records. Activities associated with ESA administration were listed and each activity evaluated to determine if dosing frequency affected the amount of resources required. RESULTS: A total of 21 centres in 8 European countries supplied data for 142 patients (mean) per hospital (range 42-648). Patients received various ESA regimens (thrice-weekly, twice-weekly, once-weekly, once every 2 weeks and once-monthly). Administering ESA every 2 weeks, the mean costs per patient per year for each process and the estimates of the percentage reduction in costs obtainable, respectively, were: pharmacy labour (10.1 euro, 39%); dialysis unit labour (66.0 euro, 65%); dialysis unit materials (4.11 euro, 61%) and waste unit materials (0.43 euro, 49%). LIMITATION: Impact on financial costs was not measured. CONCLUSION: ESA administration has quantifiable labour and material costs which are affected by dosing frequency.

Prediction of the economic cost of individual long-term care in the Spanish population

Pensions together with savings and investments during active life are key elements of retirement planning. Motivation for personal choices about the standard of living, bequest and the replacement ratio of pension with respect to last salary income must be considered. This research contributes to the financial planning by helping to quantify long-term care economic needs. We estimate life expectancy from retirement age onwards. The economic cost of care per unit of service is linked to the expected time of needed care and the intensity of required services. The expected individual cost of long-term care from an onset of dependence is estimated separately for men and women. Assumptions on the mortality of the dependent people compared to the general population are introduced. Parameters defining eligibility for various forms of coverage by the universal public social care of the welfare system are addressed. The impact of the intensity of social services on individual predictions is assessed, and a partial coverage by standard private insurance products is also explored. Data were collected by the Spanish Institute of Statistics in two surveys conducted on the general Spanish population in 1999 and in 2008. Official mortality records and life table trends were used to create realistic scenarios for longevity. We find empirical evidence that the public long-term care system in Spain effectively mitigates the risk of incurring huge lifetime costs. We also find that the most vulnerable categories are citizens with moderate disabilities that do not qualify to obtain public social care support. In the Spanish case, the trends between 1999 and 2008 need to be further explored.

Cost evaluation of cardiovascular magnetic resonance versus coronary angiography for the diagnostic work-up of coronary artery disease: Application of the European Cardiovascular Magnetic Resonance registry data to the German, United Kingdom, Swiss, and United States health care systems.

ABSTRACT: BACKGROUND: Cardiovascular magnetic resonance (CMR) has favorable characteristics for diagnostic evaluation and risk stratification of patients with known or suspected CAD. CMR utilization in CAD detection is growing fast. However, data on its cost-effectiveness are scarce. The goal of this study is to compare the costs of two strategies for detection of significant coronary artery stenoses in patients with suspected coronary artery disease (CAD): 1) Performing CMR first to assess myocardial ischemia and/or infarct scar before referring positive patients (defined as presence of ischemia and/or infarct scar to coronary angiography (CXA) versus 2) a hypothetical CXA performed in all patients as a single test to detect CAD. METHODS: A subgroup of the European CMR pilot registry was used including 2,717 consecutive patients who underwent stress-CMR. From these patients, 21% were positive for CAD (ischemia and/or infarct scar), 73% negative, and 6% uncertain and underwent additional testing. The diagnostic costs were evaluated using invoicing costs of each test performed. Costs analysis was performed from a health care payer perspective in German, United Kingdom, Swiss, and United States health care settings. RESULTS: In the public sectors of the German, United Kingdom, and Swiss health care systems, cost savings from the CMR-driven strategy were 50%, 25% and 23%, respectively, versus outpatient CXA. If CXA was carried out as an inpatient procedure, cost savings were 46%, 50% and 48%, respectively. In the United States context, cost savings were 51% when compared with inpatient CXA, but higher for CMR by 8% versus outpatient CXA. CONCLUSION: This analysis suggests that from an economic perspective, the use of CMR should be encouraged as a management option for patients with suspected CAD.

Bacillus sphaericus mosquito pathogens in the aquatic environment

The fate of Bacillus sphaericus spores in the aquatic environment was investigated by suspending spores in dialysis bags in fresh and seawater. Spore viability was lost more rapidly in seawater. Neither B. sphaericus nor B. thuringiensis israelensis (B.t.i.) spores mixed with pond sediment appeared to attach to the sediment. However, rapid decrease in B.t.i. toxicity suggested attachment of parasporal bodies to sediment. B. sphaericus toxin settled more slowly and less completely. B. sphaericus spores fed to larvae of four aquatic invertebrates were mostly eliminated from the animal gut in less than one week. An exception was the cranefly (Tipula abdominalis) where spores persisted in the posterior gut for up to five weeks.