Cost-Benefit Analysis of a Dosimetric Nebulizer Using Circulaire and aTraditional Vixone Nebulizer

Aerosol administration via small-volume nebulizers are still being used by selected patient-population. In the economic market, several nebulizer designs have become available, with each incorporating unique features that will potentially establish it as the preferred choice in aerosol delivery. With the continuous rising cost of health care services, clinicians are faced with the task of identifying opportunities for cost reduction in respiratory care. PURPOSE: The purpose of this study was to conduct a cost-benefit analysis of dosimetric nebulization using the Circulaire system and the traditional VixOne nebulizer. The desired outcome was to elevate awareness of the potential impact of the Circulaire, and how its adoption might reduce costs and enhance productivity in respiratory care. METHODS: A retrospective study using existing data collected from an urban tertiary adult hospital with a Level II Trauma Center was completed. DATA ANALYSIS: Descriptive statistics were run for each variable. The total cost of a full-time Registered Respiratory Therapist (RRT) with benefits per hour was calculated. The average number of RRTs per 12-hour shift, average number of nebulizer treatments by an RRT per 12-hour shift, average costs of traditional VixOne nebulizer and the Circulaire system were also calculated. RESULTS: Descriptive statistics indicated the annual cost of delivering aerosol therapy using the traditional VixOne nebulizer at 9-minutes treatment time to be $114,263.25 per year. The Circulaire was compared at two different treatment times of 5-minutes and 3-minutes, and the annual costs were$137,422.50 per year and $116,982.50 respectively. A sensitivity analysis was also conducted, and the treatment load was increased by 30%, with a reduction to 5 RRTs per shift. Data indicated an annual savings of 8% with the Circulaire at 5-minutes treatment time, and 21% with the Circulaire at 3-minutes treatment time. CONCLUSION: The use of the Circulaire system at 5-minutes or 3-minutes treatment time can reduce department expenditure by reducing labor costs

The critical success factors for stakeholder management in the restoration of built heritage assets in the UK

PurposeBuilt heritage or historic assets (BHAs) constructed in the pre-nineteenth century in the UK are perceived to have certain characteristics which instil cultural significance in them and have seen them become valuable to the economy of the country. The heritage sector makes significant contributions to the UK economy through provision of tourist attractive sites, construction and servicing of heritage assets, heritage conservation, research, and commercial activities carried out within and around heritage assets. These benefits have seen them draw considerable interests from diverse stakeholders within and outside the heritage sector. Hence, a lot of attention is drawn towards restoration of such assets, from stakeholders of different interests, ranging from advocacies for no alteration to complete alteration of the heritage assets. As with construction projects, conflict of interests amongst stakeholder affect the outcome of restoration projects and the purpose of this paper is to examine the critical success factors (CSFs) for managing the stakeholders to achieve the projects’ objectives. Design/methodology/approachThis paper examines the views and experiences of practitioners in the heritage sector who have been involved with BHA restoration projects. A total of 32 CSFs for stakeholder management, obtained through rigorous reviews of literature, were subjected to a severe scrutiny with eight restoration experts to determine the importance of the CSFs in restoration projects. The outcome of the exercise was a modified list of 20 CSFs which were further tested on 52 restoration practitioners in the United Kingdom (UK) using a structured questionnaire to determine the degree of importance of each of the CSFs in restoration projects and their relationships as perceived by the practitioners. FindingsThe results of the analyses performed on the data show that most of the CSFs were perceived by restoration practitioners as truly critical and vital for successful management of stakeholders in restoration of BHAs. The results also indicate that there is a strong consensus amongst a vast majority of practitioners on rankings of the CSFs. Practical implicationsThe identified CSFs could be used by the restoration practitioners as a “road map” for the development of appropriate solutions for successfully managing stakeholders associated with the promotion and BHAs restoration assets. Originality/valueAlthough CSFs for stakeholder management in construction have been studied by many scholars, no specific research could be identified prior to this study to have been done in defining the CSFs for stakeholder management in restoration projects. In this project, the authors have explored BHAs to identify and rank the CSFs for stakeholder management in restoration projects. Keywords: Built Heritage Assets, Stakeholder Management, Critical Success Factors, Restoration Projects, United Kingdom

Malignant Struma Ovarii: Case Report and a Review of the Literature

Struma ovarii is a rare tumor. Malignant change in this tumour is even rarer. While clinical presentation is protean, a preoperative diagnosis is equally difficult. Diagnosis is confirmed by histology. Treatment ofmalignant struma ovarii is by surgical resection of the tumor or total abdominal hysterectomy and bilateral salpingo-oophorectomy. A total thyroidectomy allows radioactive iodine ablation and the use of thyroglobulin as marker to monitor recurrence. However due to rarity of the disease, standard treatment is still controversial. We present a case of malignant struma ovarii, followed up for five years after treatment, and a review of the literature on the disease. The patient was treated with surgery and radiation. She is still free of disease after 5 years.Key Words: Malignant Struma Ovarii, Ovarian Teratoma, Papillary Thyroid Carcinom

Allocative Efficiency and Returns to Scale among Fadama II Broiler Farmers in Imo State, Nigeria

This study investigated the efficiency of resource use and Returns to Scale among broiler farmers in Imo State. Data were collected through a multi-stage sampling from 50 broiler farmers in the State with the aid of structured questionnaire. Data collected were analyzed using descriptive statistics, Efficiency Index, Elasticity of Production technique and the Ordinary Least Square Regression model. The results from this study showed that 68% of the respondents engaged in farming as their primary occupation with mean age of 47.1 years and mean farm size of 563 birds. The farmers made an average Net Revenue of N291,192.10 with 66Kobo Return on Investment. Medication (significant at 1%), farm size (significant at 5%), feed and other inputs (significant at 1%) were the major factors affecting broiler output. The farmers operated at increasing Returns to Scale with 1.1408 Elasticity of Production (EP). It was concluded that broiler enterprise among the Fadama II farmers in Imo State is profitable but there is inefficiency in resource allocation. It was therefore recommended that the farmers either keep labour constant and increase their farm size or keep the farm size constant and decrease their use of labour input for increased profitability of their enterprises. Keywords: Allocative efficiency, Returns to Scale, broiler production, Fadama II farmer

Examination Malpractice and Control in Public Secondary Schools in Anambra State, Nigeria: Implications for the Counsellor

This study set out to investigate examination malpractice and control among secondary school students in Anambra state, Nigeria. One thousand, five hundred (1,500) respondents were drawn from the population of staff and students using a multi-stage sampling procedure. Three research questions and one hypothesis guided the study. A 36 item structured questionnaire was used to collect data for the study. Data were analysed using mean and ‘t’ test statistics. The result shows that both teachers and students have knowledge of what examination malpractice is all about and possible ways of curbing it. Counsellors should internalize the results of this study and use them meaningfully for counselling on issues related to examination malpractice Key words: Examination, Malpractice, Control, Secondary Schoo

The Legal Regime of Bankruptcy and Winding up Proceedings as a Tool for Debt Recovery in Nigeria: An Appraisal

Nigeria does not have a comprehensive policy or law on bankruptcy. Individuals are declared bankrupt while corporate bodies are insolvent in the event of individuals’ inability to meet his/her total liability. A corporation may be wound up if it is unable to pay for its debt. Bankruptcy and insolvency are used in our legal theory. But the paper examines legislation on bankruptcy laws and its proceedings which have to be amended to meet the current global economic growth, so that investors may have confidence on our legal system in order to recover their debts in case of corporate insolvency or regulation legislated upon bankruptcy. Bankruptcy deals with the creditor and debtor when the debtor is unable to pay the debt of a creditor and declares bankrupt. The article recommends corporate insolvency leading to winding up and liquidation of a corporate entity and settlement of all other related issues including cross-border claims and counter claim settlement and cross-border corporate insolvency should be codified and our jurisdictions should allow the debtor and the creditor to renegotiate on the basis of their respective rights and obligations at any time using ADR mechanisms

The prevalence of human immunodeficiency virus infection among TB patients in Port Harcourt Nigeria

The joint statement by the American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America recommends that all patients with tuberculosis (TB) undergo testing for human immunodeficiency virus (HIV) infection after counseling. In this study, we investigated the prevalence of HIV infection among 120 patients diagnosed with microbiologically proven TB aged 18 to 54 years with a mean age of 39.5 years (standard deviation 6.75). The subjects studied were 36 male (30%) and 84 females (70%). Enzyme-linked immunosorbent assay methods were used to screen for HIV infection among the subjects. Of the 120 TB patients tested 30 (25%) were positive for HIV infection. The prevalence of HIV was higher in females 24 (80%) compared to males 6 (20%) and among singles (66.7%) compared to married subjects (33.3%) (χ2 = 83.5 and χ2 = 126.2, respectively P = 0.001). HIV-1 was the predominant viral subtype. HIV prevalence was significantly higher in subjects in the 38–47 year and 28–37 year age groups (both 40%) followed by the 18–28 year age group (20%) (χ2 = 42.6, P = 0.05). The mean CD4 lymphocyte count of the HIV-infected TB subjects was significantly lower (195 ± 40.5 cells/μL) compared to the non-HIV infected (288 ± 35.25 cells/μL P = 0.01). This study has shown a high prevalence of HIV among TB patients. Reactivation of TB among people living with HIV can be reduced by TB preventive therapy and by universal access to antiretroviral therapy

Financial inclusion and economic growth of Nigeria (the microfinance option)

The main focus of this study is to establish the relationship between financial inclusion and economic growth with particular reference of microfinance option for the period 1992 to 2013. Using Ordinary Least Square method and employing the Johansen Cointegration tests the study revealed that the activities of microfinance as one of the financial inclusion strategy significantly contribute to economic growth. While total loans and advances of microfinance banks significantly contribute to economic growth, total deposits inversely affect economic growth. The study also established the presence of long-run relationship between the variables considered (GDP, total loans and advances, total deposits, investments and number of microfinance banks) The study reveals that the growth and development of a nation is significantly dependent on the expansion of banking and financial services to the currently financially-excluded class of citizens of the country, as they possess untapped and unexplored valuable potentials that will be of tremendous to the country. In view of the benefits inherent in financial inclusion, this study recommends that microfinance banks should concentrate efforts on low cost deposits which are in line with their operations than competing with the conventional banks in mobilizing fixed deposits that has higher cost attached to it. Financial education is also recommended to enlighten the public on benefits of a financial superstructure

Pattern of second primary malignancies in thyroid cancer patients

Many factors, including relatively young age of thyroid cancer diagnoses and improved survival, have led to increased concerns about the occurrence of second primary malignancies. This paper describes the pattern of occurrence of second primary malignancies in patients who were treated for malignant thyroid neoplasms in an Indian hospital. There were 21 affected patients of the approximately 4500 seen over 25 years. Most of the second primary cancers are solid tumors, and when nonthyroid cancers are the second tumors, ductal carcinoma of the female breast is the most common. Most of these tumors have very short detection intervals (including synchronous occurrences), suggesting that therapy with internal radiation was not contributory to the tumor development. Whenthyroid malignancies were the second primary cancers, they usually follow radiotherapy to the head and neck region for treatment of the first primary tumor and tend to be of aggressive histologic types than the common welldifferentiated thyroid carcinomas.Key words: Radiation, radiotherapy, second malignancies, thyroid cance

Ultrasound Findings in the Gallbladder of Sickle‑Cell Patients: A Cross‑Sectional Study in Enugu, Nigeria

Background: Sickle‑cell disease (SCD) causes chronic and recurrent hemolysis which is a recognized risk factor for gallbladder (GB) disease. The prevalence of GB disease in SCD is high and increases with age. Cholelithiasis and cholecystitis are relatively common GB diseases in SCD. They are important causes of acute abdominal pain in SCD and also increase morbidity. Ultrasound is a cheap and noninvasive means of evaluating the GB; it has a high degree of accuracy and is widely available. Aims: The aim of this study is to sonographically evaluate the GB of SCD patients in steady state at the University of Nigeria Teaching Hospital (UNTH), Ituku‑Ozalla, Enugu, and to determine the prevalence of specific GB diseases in SCD patients. Materials and Methods: A prospective cross‑sectional study of 130 known SCD patients attending sickle‑cell clinics at UNTH and 130 controls. Ultrasound of the GB was done after at least 6 h fast, using a Dp2200 mindray mobile ultrasound machine equipped with a 2.5–5 MHz convex probe. The data were analyzed using the SPSS software version 16. Results: The GBs of 130 consecutive SCD participants and 130 control group were sonographically evaluated. The prevalence of cholelithiasis in SCD was 10.8%, whereas the prevalence of cholelithiasis in the control group was 3.1%. No other GB diseases were seen. The mean dimensions of theGB for the study group were length (65.78 ± 9.85 mm), width (29.15 ± 6.01 mm), depth (25.58 ± 5.81 mm), wall thickness (1.59 ± 0.74 mm), and volume (26.52 ± 11.18 cm3). Conclusion: The prevalence of cholelithiasis in sickle cell disease in southeast Nigeria is 10.8% while the prevalence of cholelithiasis in the control population is 3.1%. Keywords: Cholecystitis, cholelithiasis, gallbladder, sickle cell disease, ultrasoun