Surgical Versus Percutaneous Occlusion of Ostium Secundum Atrial Septal Defects Results and Cost-Effective Considerations in a Low-Income Country

ObjectivesWe compared the effectiveness and cost of percutaneous occlusion using an Amplatzer septal occluder (ASO) (AGA Medical Corp., Golden Valley, Minnesota) device compared with surgical closure of an ostium secundum atrial septal defect (ASD II) in Guatemala.BackgroundThe percutaneous occlusion of ASD II in first-world nations seems to offer better clinical results and lower cost compared with surgical closure.MethodsWe reviewed the clinical course of 111 patients referred to our institution for closure of isolated ASD II. Successful closure was assessed immediately after the procedures and at 12 months. Actual hospital costs were calculated for every patient who underwent either of the two procedures.ResultsEighty-three patients with ASD II (75%) were selected for percutaneous occlusion with the ASO device, and the remaining 28 patients (25%) underwent surgical closure. In the device group, in 72 patients (86.7%) devices were successfully deployed. At immediate and 12-month follow-up, the complete closure rate was 87.5% (63 of 72 patients) and 97.2% (70 of 71 patients), respectively. In the surgical group, all patients had successful closure immediately after the procedure and at 12 months. Surgical closure offered a 27% cost savings in comparison with percutaneous occlusion (U.S. $3,329.50 ±$411.30 and U.S. $4,521.03 ±$429.71; p < 0.001, respectively). Cost of the device (U.S. $2,930.00) proved to be the main cause for this difference.ConclusionsWe confirmed the clinical advantages of percutaneous occlusion over surgical closure of ASD II. However, percutaneous occlusion costs were higher compared with surgical closure. In Guatemala, where health care resources are limited, ASD II closure with the ASO device did not prove to be cost-effective

The Viability of Long-Haul, Low Cost Business Models

Recent events have confirmed the concerns that many within the aviation industry have held about the viability of the low cost business model for long-haul operations. This paper begins by reviewing the operating cost differences between low cost carriers (LCC) and legacy airlines in different regions of the world. This is followed by a summary of the various cost advantages of low cost carriers operating in short-haul markets. The main focus of the work, however, is a cost simulation involving the use of a Boeing 767-300 by both a LCC and a legacy carrier under varying operating assumptions. The research demonstrates that in none of the cases cited is the LCC cost advantage greater than 10%

In vitro fibre fermentation of feed ingredients with varying fermentable carbohydrate and protein levels and protein synthesis by colonic bacteria isolated from pigs

An in vitro experiment was carried out using the gas technique to study the fermentation characteristics of different feed ingredients differing in their fermentable carbohydrate and protein composition by colonic bacteria isolated from pigs. The effect on in vitro bacterial protein synthesis was also evaluated. The ingredients used were wheat bran (WB), wood cellulose (Solka-floc®, SF), peas, pea hulls (PH), pea inner fibre (PIF), sugar beet pulp (SBP), flax seed meal (FSM) and corn distillers dried grains with solubles (DDGS). The samples were pre-treated with pepsin and pancreatin and the hydrolyzed substrates were then incubated with pig faeces in a buffered mineral solution. The nitrogen source in the buffer solution (NH4HCO3) was replaced by an equimolar quantity of 15N-labeled NH4Cl, used for the determination of the rate of bacterial protein synthesis. Gas production, proportional to the amount of fermented carbohydrate, was recorded for 48 h and modelled. The fermented product was subjected to short-chain fatty acids (SCFA) analysis. The source of fibre affected the in vitro dry matter degradability (IVDMD), the fermentation kinetics and the gas production profile (P0.05) in SCFA production after the fermentation of SF, P, PH, PIF and SBP (ranging from 3.8 to 4.5 mmol/g DM incubated) while WB and FSM yielded lowest (P<0.05) SCFA. The bacterial nitrogen incorporation (BNI), both at T/2 and after 48 h of fermentation was the highest (P<0.001) for PIF (18.5 and 15.6 mg/g DM incubated, respectively) and the lowest for DDGS and WB. In conclusion, peas and pea fibres had higher rates of fermentability, produced more SCFA and had high bacterial protein synthesis capacity. They thus have the potential to be included in pig diets as a source of fermentable fibre to modulate the gut environment and reduce nitrogen excretion