A One Health Framework for the Evaluation of Rabies Control Programmes: A Case Study from Colombo City, Sri Lanka

<div><p>Background</p><p>One Health addresses complex challenges to promote the health of all species and the environment by integrating relevant sciences at systems level. Its application to zoonotic diseases is recommended, but few coherent frameworks exist that combine approaches from multiple disciplines. Rabies requires an interdisciplinary approach for effective and efficient management.</p><p>Methodology/Principal Findings</p><p>A framework is proposed to assess the value of rabies interventions holistically. The economic assessment compares additional monetary and non-monetary costs and benefits of an intervention taking into account epidemiological, animal welfare, societal impact and cost data. It is complemented by an ethical assessment. The framework is applied to Colombo City, Sri Lanka, where modified dog rabies intervention measures were implemented in 2007. The two options included for analysis were the control measures in place until 2006 (“baseline scenario”) and the new comprehensive intervention measures (“intervention”) for a four-year duration. Differences in control cost; monetary human health costs after exposure; Disability-Adjusted Life Years (DALYs) lost due to human rabies deaths and the psychological burden following a bite; negative impact on animal welfare; epidemiological indicators; social acceptance of dogs; and ethical considerations were estimated using a mixed method approach including primary and secondary data. Over the four years analysed, the intervention cost US $1.03 million more than the baseline scenario in 2011 prices (adjusted for inflation) and caused a reduction in dog rabies cases; 738 DALYs averted; an increase in acceptability among non-dog owners; a perception of positive changes in society including a decrease in the number of roaming dogs; and a net reduction in the impact on animal welfare from intermediate-high to low-intermediate.</p><p>Conclusions</p><p>The findings illustrate the multiple outcomes relevant to stakeholders and allow greater understanding of the value of the implemented rabies control measures, thereby providing a solid foundation for informed decision-making and sustainable control.</p></div

Identification of Lipid Biomarkers to Discriminate between the Different Production Systems for Asiago PDO Cheese

The lipid fraction of Asiago Protected Designation of Origin (PDO) cheese was analyzed to identify specific biomarkers of its main production systems through a canonical discriminant analysis. The three main production systems of the cheese were considered. Two were located in the upland (UL): pasture-based (P-UL) vs hay-based total mixed rations (H-UL). The third was located in the lowland (LL) and processed milk from cows fed maize silage-based rations (maize silage lowland: MS-LL). The discriminant analysis selected nine fatty acids and vitamin A as lipid biomarkers useful to separate the three production systems. High contents of conjugated linoleic acids, anteiso-C15:0, and vitamin A were discriminant factors for P-UL cheese. The separation between H-UL and MS-LL cheese was less marked with the former having the higher content of conjugated linoleic acids and some polyunsaturated n-6 fatty acids and with the latter being identified by cyclopropane fatty acid and C9:0

Public Health Impact and Cost-Effectiveness of Hepatitis A Vaccination in the United States: A Disease Transmission Dynamic Modeling Approach

Objective: To assess the population-level impact and costeffectiveness of hepatitis A vaccination programs in the United States. Methods: We developed an age-structured population model of hepatitis A transmission dynamics to evaluate two policies of administering a twodose hepatitis A vaccine to children aged 12 to 18 months: 1) universal routine vaccination as recommended by the Advisory Committee on Immunization Practices in 2006 and 2) Advisory Committee on Immunization Practices&apos;s previous regional policy of routine vaccination of children living in states with high hepatitis A incidence. Inputs were obtained from the published literature, public sources, and clinical trial data. The model was fitted to hepatitis A seroprevalence (National Health and Nutrition Examination Survey II and III) and reported incidence from the National Notifiable Diseases Surveillance System (1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995). We used a societal perspective and projected costs (in 2013 US $), qualityadjusted life-years, incremental cost-effectiveness ratio, and other outcomes over the period 2006 to 2106. Results: On average, universal routine hepatitis A vaccination prevented 259,776 additional infections, 167,094 outpatient visits, 4781 hospitalizations, and 228 deaths annually. Compared with the regional vaccination policy, universal routine hepatitis A vaccination was cost saving. In scenario analysis, universal vaccination prevented 94,957 infections, 46,179 outpatient visits, 1286 hospitalizations, and 15 deaths annually and had an incremental cost-effectiveness ratio of$21,223/quality-adjusted life-year when herd protection was ignored. Conclusions: Our model predicted that universal childhood hepatitis A vaccination led to significant reductions in hepatitis A mortality and morbidity. Consequently, universal vaccination was cost saving compared with a regional vaccination policy. Herd protection effects of hepatitis A vaccination programs had a significant impact on hepatitis A mortality, morbidity, and cost-effectiveness ratios

Medical Malpractice : How Legal Liability Affects Medical Decisions

In health care, overuse and underuse of medical treatments represent equally dangerous deviations from an optimal use equilibrium and arouses concerns about possible implications for patients\u2019 health, and for the healthcare system in terms of both costs and access to medical care. Medical liability plays a dominant role among the elements that can affect these deviations. Therefore, a remarkable economic literature studies how medical decisions are influenced by different levels of liability. In particular, identifying the relation between liability and treatments selection, as well as disentangling the effect of liability from other incentives that might be in place, is a task for sound empirical research. Several studies have already tried to tackle this issue, but much more needs to be done. In the present chapter, we offer an overview of the state of the art in the study of the relation between liability and treatments selection. First, we reason on the theoretical mechanisms underpinning the relationship under investigation by presenting the main empirical predictions of the related literature. Second, we provide a comprehensive summary of the existing empirical evidence and its main weaknesses. Finally, we conclude by offering guidelines for further research

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Not AvailableMain objective of this study was to optimize the analytical procedures, especially extraction and saponification method for the better analysis of β-carotene in milk fat. Saponification method with suitable potassium hydroxide (KOH) concentration, use of antioxidant, saponification time, and temperature was optimized to get best extraction procedure for β-carotene . Analysis of β-carotene was carried out by using reversed phase high performance liquid chromatography (RP-HPLC) using C18 column. Chromatographic conditions best tested for the study involves methanol: tetrahydrofuran: water (MeOH: THF: H2 O). The effect of time temperature combination at 45̊C/30 min with saturated ascorbic acid had a pronounced effect on the β-carotene extraction from milk fat. Study also reveals that a concentration level of 10M KOH was best suited for the extraction of unsaponifiable.Not Availabl