A systematic review of cost-effectiveness analyses of complex wound interventions reveals optimal treatments for specific wound types.

BackgroundComplex wounds present a substantial economic burden on healthcare systems, costing billions of dollars annually in North America alone. The prevalence of complex wounds is a significant patient and societal healthcare concern and cost-effective wound care management remains unclear. This article summarizes the cost-effectiveness of interventions for complex wound care through a systematic review of the evidence base.MethodsWe searched multiple databases (MEDLINE, EMBASE, Cochrane Library) for cost-effectiveness studies that examined adults treated for complex wounds. Two reviewers independently screened the literature, abstracted data from full-text articles, and assessed methodological quality using the Drummond 10-item methodological quality tool. Incremental cost-effectiveness ratios were reported, or, if not reported, calculated and converted to United States Dollars for the year 2013.ResultsOverall, 59 cost-effectiveness analyses were included; 71% (42 out of 59) of the included studies scored 8 or more points on the Drummond 10-item checklist tool. Based on these, 22 interventions were found to be more effective and less costly (i.e., dominant) compared to the study comparators: 9 for diabetic ulcers, 8 for venous ulcers, 3 for pressure ulcers, 1 for mixed venous and venous/arterial ulcers, and 1 for mixed complex wound types.ConclusionsOur results can be used by decision-makers in maximizing the deployment of clinically effective and resource efficient wound care interventions. Our analysis also highlights specific treatments that are not cost-effective, thereby indicating areas of resource savings. Please see related article: http://dx.doi.org/10.1186/s12916-015-0288-5

The Oxford dodo. Seeing more than ever before : X-ray micro-CT scanning, specimen acquisition and provenance

The Oxford Dodo (Raphus cucullatus) has been in the collections of the University of Oxford since 1683, first in the Ashmolean Museum and latterly in Oxford University Museum of Natural History. Prior to this the specimen was part of the collections of the Tradescants, father and son, and likely acquired between 1634 and 1656, in the Musæum Tradescantianum in what is now Vauxhall, south London. It has been thought probable that this specimen was once the live bird recorded in London by Sir Hamon L’Estrange in around 1638, but X-ray CT scanning of the skull for anatomical investigation has cast doubt on the provenance of the Oxford Dodo. The 3D visualisation revealed 115 metal particles embedded within the bone of the skull, concentrated in the left side of the skull. All but five of the particles are less than 1 mm in diameter and their location leads to the conclusion that they represent lead shot consistent with the bird being shot from the rear right of the head, perhaps with a ventral component. This forensic discovery leaves the provenance of the Oxford specimen uncertain but illustrates the value of non-invasive visualisation techniques in determining the potentially complex histories of unique museum objects

Sensitivity to Sunburn Is Associated with Susceptibility to Ultraviolet Radiation–Induced Suppression of Cutaneous Cell–Mediated Immunity

Skin cancer incidence is highest in white-skinned people. Within this group, skin types I/II (sun sensitive/tan poorly) are at greater risk than skin types III/IV (sun tolerant/tan well). Studies in mice demonstrate that ultraviolet radiation (UVR)-induced suppression of cell-mediated immune function plays an important role in the development of skin cancer and induces a susceptibility to infectious disease. A similar role is suspected in humans, but we lack quantitative human data to make risk assessments of ambient solar exposure on human health. This study demonstrates that ambient levels of solar UVR, typically experienced within 1 h of exposure to noonday summer sunlight, can suppress contact hypersensitivity (CHS) responses in healthy white-skinned humans in vivo (n = 93). There was a linear relationship between increase in erythema and suppression of CHS (P < 0.001), and a moderate sunburn (two minimal erythema doses [2 MED]) was sufficient to suppress CHS in all volunteers by 93%. However, a single suberythemal exposure of either 0.25 or 0.5 MED suppressed CHS responses by 50 and 80%, respectively, in skin types I/II, whereas 1 MED only suppressed CHS by 40% in skin types III/IV. The two- to threefold greater sensitivity of skin types I/II for a given level of sunburn may play a role in their greater sensitivity to skin cancer

Removal of homeostatic cytokine sinks by lymphodepletion enhances the efficacy of adoptively transferred tumor-specific CD8(+) T cells

Depletion of immune elements before adoptive cell transfer (ACT) can dramatically improve the antitumor efficacy of transferred CD8(+) T cells, but the specific mechanisms that contribute to this enhanced immunity remain poorly defined. Elimination of CD4(+)CD25(+) regulatory T (T reg) cells has been proposed as a key mechanism by which lymphodepletion augments ACT-based immunotherapy. We found that even in the genetic absence of T reg cells, a nonmyeloablative regimen substantially augmented CD8(+) T cell reactivity to self-tissue and tumor. Surprisingly, enhanced antitumor efficacy and autoimmunity was caused by increased function rather than increased numbers of tumor-reactive T cells, as would be expected by homeostatic mechanisms. The γ (C) cytokines IL-7 and IL-15 were required for augmenting T cell functionality and antitumor activity. Removal of γ (C) cytokine–responsive endogenous cells using antibody or genetic means resulted in the enhanced antitumor responses similar to those seen after nonmyeloablative conditioning. These data indicate that lymphodepletion removes endogenous cellular elements that act as sinks for cytokines that are capable of augmenting the activity of self/tumor-reactive CD8(+) T cells. Thus, the restricted availability of homeostatic cytokines can be a contributing factor to peripheral tolerance, as well as a limiting resource for the effectiveness of tumor-specific T cells

Plan de negocio para una plataforma tecnol?gica de intermediaci?n de compras en los mercados de abastos de Lima Metropolitana

La plataforma tecnol?gica llamada Mi Mercado, es una aplicaci?n de intermediaci?n que permite realizar las compras de productos de primera necesidad en los mercados de abastos sin la necesidad de salir de sus hogares, comparando rese?as de experiencia de compra de otros usuarios y evaluar distintas propuestas de venta de los proveedores, para garantizar el precio justo, el tiempo de entrega y la calidad esperada. De tal manera que los consumidores puedan provisionarse de sus productos sin exponerse a contagios innecesarios, ni a la inseguridad ciudadana, a trav?s de una plataforma tecnol?gica de f?cil uso, r?pida, segura y eficiente, que les permita aprovechar el tiempo ganado en destinarlo a la familia o en otras actividades de inter?s. Parte de la propuesta incluye lograr que los proveedores de productos puedan tener un canal adicional de ventas, que les permita mejorar el posicionamiento de su negocio, controlar su flujo de dinero y proyectar su inventario. Seg?n los expertos entrevistados en nuestro an?lisis cualitativo, no se encontraron competidores directos que abarquen a nuestros dos clientes y cuenten con la misma propuesta personalizada que ofrecemos, por lo que mantenemos una ventaja consistente frente a los nuevos competidores que se encuentran surgiendo

Charge-state-enhanced ion sputtering of metallic gold nanoislands

Experimental results on the charge-state-dependent sputtering of metallic gold nanoislands are presented. Irradiations with slow highly charged ions of metallic targets were previously considered to show no charge state dependent effects on ion-induced material modification, since these materials possess enough free electrons to dissipate the deposited potential energy before electron-phonon coupling can set in. By reducing the size of the target material down to the nanometer regime and thus enabling a geometric energy confinement, a possibility is demonstrated to erode metallic surfaces by charge state related effects in contrast to regular kinetic sputtering

Properties of a Gamma-Ray Burst Host Galaxy at z ~ 5

We describe the properties of the host galaxy of the gamma-ray burst GRB 060510B based on a spectrum of the burst afterglow obtained with the Gemini North 8 m telescope. The galaxy lies at a redshift of z = 4.941, making it the fourth highest spectroscopically identified burst host. However, it is the second highest redshift galaxy for which the quality of the spectrum permits a detailed metallicity analysis. The neutral hydrogen column density has a logarithmic value of 21.0-21.2 cm-2, and the weak metal lines of Ni, S, and Fe show that the metallicity is in excess of a tenth of solar, which is far above the metallicities in damped Lya absorbers at high redshift. The tightest constraint is from the Fe lines, which place [Fe/H] in excess of -0.8. We argue that the results suggest that metallicity bias could be a serious obstacle to inferring star formation from the GRB population, and we consider how future higher quality measurements could be used to resolve this issue

Application of ultrafast gold luminescence to measuring the instrument response function for multispectral multiphoton fluorescence lifetime imaging

When performing multiphoton fluorescence lifetime imaging in multiple spectral emission channels, an instrument response function must be acquired in each channel if accurate measurements of complex fluorescence decays are to be performed. Although this can be achieved using the reference reconvolution technique, it is difficult to identify suitable fluorophores with a mono-exponential fluorescence decay across a broad emission spectrum. We present a solution to this problem by measuring the IRF using the ultrafast luminescence from gold nanorods. We show that ultrafast gold nanorod luminescence allows the IRF to be directly obtained in multiple spectral channels simultaneously across a wide spectral range. We validate this approach by presenting an analysis of multispectral autofluorescence FLIM data obtained from human skin ex vivo

A Comprehensive Study of GRB 070125, A Most Energetic Gamma-Ray Burst

We present a comprehensive multiwavelength analysis of the bright, long-duration gamma-ray burst GRB 070125, comprised of observations in gamma-ray, X-ray, optical, millimeter, and centimeter wave bands. Simultaneous fits to the optical and X-ray light curves favor a break on day 3.78, which we interpret as the jet break from a collimated outflow. Independent fits to optical and X-ray bands give similar results in the optical bands but shift the jet break to around day 10 in the X-ray light curve. We show that for the physical parameters derived for GRB 070125, inverse Compton scattering effects are important throughout the afterglow evolution. While inverse Compton scattering does not affect radio and optical bands, it may be a promising candidate to delay the jet break in the X-ray band. Radio light curves show rapid flux variations, which are interpreted as due to interstellar scintillation and used to derive an upper limit of 2.4 × 10 17 cm on the radius of the fireball in the lateral expansion phase of the jet. Radio light curves and spectra suggest a high synchrotron self-absorption frequency indicative of the afterglow shock wave moving in a dense medium. Our broadband modeling favors a constant density profile for the circumburst medium over a windlike profile (R -2). However, keeping in mind the uncertainty of the parameters, it is difficult to unambiguously distinguish between the two density profiles. Our broadband fits suggest that GRB 070125 is a burst with high radiative efficiency (>60%).R. A. C. was supported in part by NASA grant NNG06GJ33G