Cost-effectiveness analysis of sedatives in the management of neonates undergoing mechanical ventilation in the intensive care setting in Qatar

Background. Neonates with respiratory distress syndrome (RDS), admitted to the neonatal intensive care unit (NICU) at the Women’s Hospital (WH) in Qatar, often require mechanical ventilation (MV) to maintain ventilator synchrony. No economic evaluations of morphine or fentanyl as stands alone or in combination with midazolam for sedation in NICU exist in the literature. The objective of this study was to evaluate the clinical and economic impact of sedatives in mechanically ventilated neonates with RDS in the Qatari NICU. Methods. A comparative retrospective cost-effectiveness study sought to evaluate 126 critically ill neonates receiving morphine versus fentanyl, 64 patients receiving morphine monotherapy versus morphine plus midazolam, and 268 patients receiving fentanyl monotherapy versus fentanyl plus midazolam at WH in Hamad Medical Corporation (HMC), Qatar. Available medical records in the duration from October 2014 to January 2016 were utilized. Decision analytic models from the hospital perspective were designed to measure all the possible consequences of all comparisons. The primary endpoints were the successful drug sedation rate, based on the Premature Infant Pain Profile (PIPP) scoring scale, and the overall direct medical cost of therapy. Sample size calculations were to achieve results with 80% power and a significance level of 0.05. Sensitivity analyses were conducted to enhance the robustness and generalizability of the results. Results. Morphine monotherapy achieved sedation success in 68% of patients with an incremental cost-effectiveness ratio (ICER) of QAR 490.36 per additional sedation success compared to 43% with fentanyl. Morphine also produced better sedation in neonates with an ICER of QAR 21, 206.85 compared to its combination with midazolam (66% versus 34%). The fentanyl monotherapy dominated the combination of fentanyl and midazolam, with a net cost saving of QAR 43,811.83 per patient and a 51% successful sedation rate, compared to 33%. Here, the study group of fentanyl plus midazolam combination did not achieve the calculated sample size and, hence, the evaluation of this group is piloting in nature. Sensitivity analyses demonstrated robustness of all study conclusions. Conclusion. The current study is the first clinical and economic analysis of morphine, fentanyl, and midazolam in the NICU in literature, including in Qatar. Morphine monotherapy produced higher sedation levels over fentanyl monotherapy and the morphine plus midazolam combination but with higher costs. Fentanyl monotherapy had cost savings over its combination with midazolam, while its reported higher clinical effectiveness over the combination cannot be interpreted due to the limited sample size

Oil transmissions pipelines condition monitoring using wavelet analysis and ultrasonic techniques

Proper and sensitive monitoring capability to determine the condition of pipelines is desirable to predict leakage and other failure modes, such as flaws and cracks. Currently methods used for detecting pipeline damage rely on visual inspection or localized measurements and thus, can only be used for the detection of damage that is on or near the surface of the structure. This thesis offers reliable, inexpensive and non-destructive technique, based on ultrasonic measurements, to detect faults within Carbon steel pipes and to evaluate the severity of these faults. The proposed technique allows inspections in areas where conventionally used inspection techniques are costly and/or difficult to apply. This work started by developing 3D Finite Elements Modelling (FEM) to describe the dynamic behaviour of ultrasonic wave propagations into the pipe’s structure and to identify the resonance modes. Consequently, the effects of quantified seeded faults, a 1-mm diameter hole of different depths in the pipe wall, on these resonance modes were examined using the developed model. An experimental test rig was designed and implemented for verifying the outcomes of the finite element model. Conventional analysis techniques were applied to detect and evaluate the severity of those quantified faults. However, those signal processing methods were found ineffective for such analysis. Therefore, a more capable signal processing technique, using continuous wavelet techniques (CWT), was developed. The energy contents of certain frequency bands of the CWT were found to be in good agreement with the model predicted responses and show important information on pipe’s defects. The developed technique is found to be sensitive for minor pipe structural related deficiencies and offers a reliable and inexpensive tool for pipeline integrity management programs

Internet Banking and Customers’ Acceptance in Jordan: The Unified Model’s Perspective

Internet banking in Jordan has developed rapidly since the year 2001, as most Jordanian banks have adopted some form of Internet usage and launched websites to serve their customers. This study extends the Unified Theory of Acceptance and Use of Technology (UTAUT) by adding perceived facilitating conditions and personality dimensions, two factors that have been suggested as important determinants of technology adoption. The frame of the study was “counter bank customers” sampled in three banks from three major cities in Jordan. The results indicated partial support for the UTAUT with respect to the predictors’ effect on behavioral intentions. The extended model supported the influence of performance expectancy, social influence, self-efficacy, perceived trust, and locus of control on the individual’s intentions to use Internet banking. Implications for research and practice, limitations, future research, and conclusions are discussed

Experimental Investigation on the Flexural Capacity of Reinforced Concrete Beams with Treated Wastewater and Recycled Concrete Aggregates

Eco-friendly concrete is the most recommended sustainable option to reduce the excessive diminution of concrete natural resources and the high generation of greenhouse gas emissions. Therefore, the present study explores the feasibility of employing treated wastewater (TWW), recycled concrete aggregates (RCA), and fly ash (FA) in concrete mixes. A total of 4 reinforced concrete (RC) beams were investigated under 4-point bending setup with three parameters investigated; namely, mixing water (fresh water and TWW), coarse aggregates (gabbro and RCA), and cementitious binders (cement and FA). The experimental results revealed that the beams' ductility was decreased by 9% and 16% with TWW and RCA, respectively. Moreover, the flexural performance of the TWW-RC beams was decreased by 14%, whereas RCA-RC beams showed comparable flexural strength to its counterpart with natural aggregates. In addition, the utilization of FA at a 20% replacement ratio enhanced the flexural strength by 5% to 7%

Combined effects of treated domestic wastewater, fly ash, and calcium nitrite toward concrete sustainability

The drastic increase in freshwater and ordinary Portland cement (OPC) consumption poses severe environmental and economic challenges worldwide. This study; therefore, explores the mechanical and durability properties of concrete incorporating treated domestic wastewater (TWW), class F fly ash (FA), and calcium nitrite-based corrosion inhibitor (CN). OPC paste and mortar with TWW were first prepared and compared with the permissible limits specified in ASTM C1602/C1602M ? 18 provisions. After that, ten concrete mixes were prepared with different ratios of TWW (0%, 25%, 50%, and 100%), FA (0%, 20%, and 35%), and CN (0% and 3%) and tested for fresh slump and density, compressive and flexural strengths, electrical resistivity, porosity, and chloride permeability. All concrete specimens were cured with fresh water. Concrete hardened properties were tested at 7, 28, and 90 days. Test results revealed that TWW slightly decreased concrete compressive and flexural strengths by 5%-12%, whereas it dramatically increased the porosity and chloride permeability by about 40%. It was also shown that the addition of FA significantly decreased the chloride permeability of TWW concrete by 55%-71%. The optimum FA replacement ratio was observed at 20 wt%. The addition of CN was shown to deteriorate the strength and durability properties of freshwater concrete by 10%-39%. However, combining TWW and CN has improved concrete resistivity, porosity, chloride permeability by 32%, 28%, and 32%, respectively. The optimum concrete properties were obtained using 20 wt% FA and 0% CN. The obtained results were analytically supported by scanning electron microscopy (SEM), energy-dispersive X-ray microanalysis (EDX), and X-ray diffraction (XRD) tests. Moreover, Pearson correlation and linear regressions were performed on the experimental data.This publication was made possible by GSRA grant GSRA6-1-0509-19022 from the Qatar National Research Fund (QNRF, a member of Qatar Foundation ). The authors would like also to thank the Central Laboratories Unit (CLU) at Qatar University for the scanning electron microscopy and energy-dispersive X-ray microanalysis images. Also, the financial support from Qatar University through grant no. QUST-1-CENG-2021-20 is acknowledged. Open Access funding provided by the Qatar National Library. The findings achieved herein are solely the responsibility of the authors.Scopu

M-Service Quality of Telecom Companies in Qatar

Today, although mobile applications make our lives easier, the service quality provided by such applications has become a vital element in increasing customer satisfaction. This research paper aims to identify the significant mobile service quality factors (Application Design, Ease of Use, Information Content, Reliability, Responsiveness, Empathy, Security and Prices and offers) that influence customer satisfaction and loyalty in Qatar’s telecommunications sector. To answer the research question and test the hypotheses that form the study model, data were collected through an online questionnaire of 195 random customers who use Ooredoo or Vodafone mobile applications in Qatar. The proposed model was evaluated using partial least squares structural equation modeling (PLS-SEM). The results show that Ease of Use, Information Content, Responsiveness, and Security are the most significant factors that affect M-Customer Satisfaction. Also, there is a strong relationship between M-customer Satisfaction and M-loyalty. On the contrary, Application Design, Reliability, Empathy, and Prices and offers did not affect M-customer satisfaction. Thus, the managers in telecommunication companies should adopt a strategy that focuses on the M-service quality factors that most influence M-customer satisfaction to increase customer satisfaction rates and loyalty to their products and services. It will also help reduce overall costs by delivering those products and services to a higher proportion of customers through the mobile application rather than physical branches. This paper also helps the researchers use the proposed model in future research to understand these relationships in other countries better

Tui Na (or Tuina) Massage: A Minireview of Pertinent Literature, 1970-2017

Background: Tuina massage is a traditional method used effectively in the treatment of various ailments in China since ancient time, and currently it is used around the world. Objective: This minireview aims to describe several aspects of Tuina massage an integral part of Traditional Chinese Medicine in order to fill up the knowledge gap concerning traditional practitioners in Saudi Arabia. Methods: Electronic searches of databases using Boolean operators and keywords were conducted to retrieve data published in English and Chinese literature. Thousands of articles were identified and screened by two independent reviewers using exclusion and inclusion criteria, and 56 articles were finally included in this study. Results: Tuina has a very rich history in Chinese culture since antiquity. With continuous advancements in research, training, regulation and clinical practice, Tuina massage became popular worldwide and now used either alone or in conjunction with other complementary and alternative medicine or conventional therapies in diverse diseases associated with pain and other symptoms with good outcome. Although Tuina has good safety profile with level of evidence (LOE) of I to III, well defined indications and contraindications, a variety of minor adverse effects together with some major complications including deaths have been reported in the literature. Besides continuous training of Tuina practitioners, Tuina massage practice needs regulatory measures and guidelines for avoiding complications and improving the clinical outcome of patients. Conclusion: Evidently, Chinese Tuina massage supported by theory, mechanisms, procedure and included randomized clinical trials snapshots, systematic reviews and meta-analysis with LOE of I to III is reported to be effective in several conditions. Further, rigorous randomized controlled studies with active comparators including other traditional modality or conventional medications or placebo with intensified quality control measures are required to provide further robust evidence-based data to support its efficacy in chronic diseases associated with pain and disabilities

A Timeline of Oculocutaneous Albinism

The purpose of this research timeline is to synthesize the natural history of Oculocutaneous Albinism (OCA), discover gaps in knowledge, as well as understand the genes and mutations that incite the disease. It is through methods of literature-based research that we found the earliest recognition of OCA and investigated it up to its most current state of research. The rate of research remains steady and continuous with the focus varying widely; either by examining more of the genes involved in the disease or by taking more in-depth looks at mutational analyses of genes that are already observed to be linked to the disease. OCA is a group of autosomal recessive disorders characterized by decreased or absent pigmentation in the hair, skin, and eyes. The genotypes and phenotypes of OCA vary in the population and are broken down into a clinical spectrum which consists of OCA1A, being the most severe, in addition to the milder forms which consist of OCA1B, OCA2, OCA3, and OCA4, which show mild pigment accumulation over time. The majority of these forms are caused by mutations in the TYR gene, which is responsible for the production of melanin, as well as the OCA2 gene, which is responsible for the transport of melanin within a melanocyte. The significance of this research timeline is to look at the natural history of OCA in hopes to understand the mechanism of the disease and look at the current research status of the disease.https://digitalscholarship.unlv.edu/durep_posters/1000/thumbnail.jp

Cost-Effectiveness Analysis of Out-Of-Hospital versus In-Hospital Extracorporeal Cardiopulmonary Resuscitation for Out-Hospital Refractory Cardiac Arrest

It has been speculated that out-of-hospital cardiac arrest (OHCA) patients’ survival might be improved by implementing extracorporeal cardiopulmonary resuscitation (ECPR) before arrival to hospital. Therefore, we sought to assess the cost-effectiveness of OH-ECPR versus in-hospital (IH)-ECPR in OHCA patients in Qatar. From the hospital perspective, a conventional decision-analytic model was constructed to follow up the clinical and economic consequences of OH-ECPR versus IH-ECPR in a simulated OHCA population over one year. The primary outcome was the survival at discharge after arrest as well as the overall direct healthcare costs of managing OHCA patients. The robustness of this model was evaluated via sensitivity analyses. The OH-ECPR yielded 16% survival at discharge after arrest compared to 7% with IH-ECPR, [risk ratio (RR)=0.91; 95% CI 0.79 to 1.06; P = 0.26]. Incorporating the uncertainty associated with this survival rate, and based on the estimated willingness to pay threshold in Qatar, the OH-ECPR was cost-effective with an incremental cost-effectiveness ratio of QAR 464,589 (USD 127,634). Sensitivity and uncertainty analyses confirmed the robustness of the study outcome. This is the first cost-effectiveness evaluation of OH-ECPR versus IH-ECPR in OHCA patients. OH-ECPR is potentially an economically acceptable resuscitative strategy in Qatar.Open access funding was provided by the Qatar National Library