Snakebite: An Exploratory Cost-Effectiveness Analysis of Adjunct Treatment Strategies.

The cost-effectiveness of the standard of care for snakebite treatment, antivenom, and supportive care has been established in various settings. In this study, based on data from South Indian private health-care providers, we address an additional question: "For what cost and effectiveness values would adding adjunct-based treatment strategies to the standard of care for venomous snakebites be cost-effective?" We modeled the cost and performance of potential interventions (e.g., pharmacologic or preventive) used adjunctively with antivenom and supportive care for the treatment of snakebite. Because these potential interventions are theoretical, we used a threshold cost-effectiveness approach to explore this forward-looking concept. We examined economic parameters at which these interventions could be cost-effective or even cost saving. A threshold analysis was used to examine the addition of new interventions to the standard of care. Incremental cost-effectiveness ratios were used to compare treatment strategies. One-way, scenario, and probabilistic sensitivity analyses were conducted to analyze parameter uncertainty and define cost and effectiveness thresholds. Our results suggest that even a 3% reduction in severe cases due to an adjunct strategy is likely to reduce the cost of overall treatment and have the greatest impact on cost-effectiveness. In this model, for example, an investment of $10 of intervention that reduces the incidence of severe cases by 3$75 per individual. These findings illustrate the striking degree to which an adjunct intervention could improve patient outcomes and be cost-effective or even cost saving

Online Onboarding: Corporate Governance Training In The COVID-19 Era

Onboarding new directors is critical in the best of circumstances. What should organizations do when training new board members must be completed online? COVID-19 has forced both ordinary and extraordinary business functions to be conducted primarily online, and online onboarding may be necessary or preferred in a number of business contexts. This Article first reviews the best practices in director onboarding and explains the functional goals of those practices. It then explains how to leverage the power of virtual data rooms and virtual conference software to successfully onboard new corporate directors with virtual meetings. These strategies apply to both for-profit and non-profit boards and can be employed to enhance any online meeting or conference where the goals include informing and engaging participants while encouraging them to socialize

Online Onboarding Corporate Governance Training In The COVID-19

[Excerpt] Director onboarding is the process by which an organization facilitates a new director stepping into the role. It is a means by which an incoming director becomes familiar with their new surroundings, the organization, their fellow board members, and other organization leaders. As such, it is an inherently personal experience that has always necessitated face-to-face interaction, whether it takes place in the boardroom and adjacent offices, company retreats, or happy hours. Until 2020, tried-and-true onboarding methods functioned effectively, and there was no reason to reimagine the onboarding process as a potentially virtual procedure. Unfortunately, the novel coronavirus brought about unprecedented and confusing circumstances, and organizations worldwide were forced to shift their entire business platforms online with little or no time to prepare

A 10-Year Prospective Evaluation of Balloon Tube Tamponade and Emergency Injection Sclerotherapy for Actively Bleeding Oesophageal Varices

During a 10 year study period 234 patients were admitted on 371 occasions with a total of 566 acute variceal bleeding episodes. Of these, 173 patients had 343 variceal bleeds which required balloon tamponade to achieve initial control of bleeding during 229 admissions and were then referred for emergency injection sclerotherapy. Sixty-eight percent of these patients had alcoholic cirrhosis and 42% were poor risk Grade C patients. Injection sclerotherapy was performed initially using the rigid Negus oesophagoscope under general anaesthesia and later using the fibreoptic endoscope under light sedation. Definitive control of variceal bleeding was achieved with sclerotherapy during 197 hospital admissions (92%). Of the 17 failures of emergency sclerotherapy, 4 patients died from uncontrolled bleeding and 13 patients underwent major surgical intervention. Definitive control of variceal bleeding was achieved with a single injection treatment in 138 hospital admissions (70%). Complications were mostly of a minor nature and occurred at a rate of 6% per injection treatment. The overall hospital admission mortality was 36%. The majority of patients died due to liver failure. The mortality in patients who required 4 injection treatments to control variceal bleeding was 71%. Injection sclerotherapy is proposed as the emergency treatment of choice for patients whose variceal bleeding continues or recurs after initial conservative management. Patients whose variceal bleeding is not controlled by 2 injection treatments require more major emergency surgery

Supernova Remnant in a Stratified Medium: Explicit, Analytical Approximations for Adiabatic Expansion and Radiative Cooling

We propose simple, explicit, analytical approximations for the kinematics of an adiabatic blast wave propagating in an exponentially stratified ambient medium, and for the onset of radiative cooling, which ends the adiabatic era. Our method, based on the Kompaneets implicit solution and the Kahn approximation for the radiative cooling coefficient, gives straightforward estimates for the size, expansion velocity, and progression of cooling times over the surface, when applied to supernova remnants (SNRs). The remnant shape is remarkably close to spherical for moderate density gradients, but even a small gradient in ambient density causes the cooling time to vary substantially over the remnant's surface, so that for a considerable period there will be a cold dense expanding shell covering only a part of the remnant. Our approximation provides an effective tool for identifying the approximate parameters when planning 2-dimensional numerical models of SNRs, the example of W44 being given in a subsequent paper.Comment: ApJ accepted, 11 pages, 2 figures embedded, aas style with ecmatex.sty and lscape.sty package

Digital Correlation of Ion and Optical Microscopic Images: Application to the Study of Thyroglobulin Chemical Modification

A method has been developed in order to digitally correlate ion and optical microscopic images of the same sample areas. Serial cross-sections of human thyroid tissue were analyzed by secondary ion mass microscopy and by light microscopy. The resulting chemical and immunochemical map images were superimposed and correlated by means of a two-pass registration algorithm which allows to correct for geometrical distortions introduced by the ion microscope. Results are presented for the study of thyroglobulin chemical modification in pathological thyroid tissue that demonstrates heterogeneous molecular activity

A DMRG Study of Low-Energy Excitations and Low-Temperature Properties of Alternating Spin Systems

We use the density matrix renormalization group (DMRG) method to study the ground and low-lying excited states of three kinds of uniform and dimerized alternating spin chains. The DMRG procedure is also employed to obtain low-temperature thermodynamic properties of these systems. We consider a 2N site system with spins $s_1$ and $s_2$ alternating from site to site and interacting via a Heisenberg antiferromagnetic exchange. The three systems studied correspond to $(s_1 ,s_2 )$ being equal to $(1,1/2),(3/2,1/2)$ and $(3/2,1)$; all of them have very similar properties. The ground state is found to be ferrimagnetic with total spin $s_G =N(s_1 - s_2)$. We find that there is a gapless excitation to a state with spin $s_G -1$, and a gapped excitation to a state with spin $s_G +1$. Surprisingly, the correlation length in the ground state is found to be very small for this gapless system. The DMRG analysis shows that the chain is susceptible to a conditional spin-Peierls instability. Furthermore, our studies of the magnetization, magnetic susceptibility $\chi$ and specific heat show strong magnetic-field dependences. The product $\chi T$ shows a minimum as a function of temperature T at low magnetic fields; the minimum vanishes at high magnetic fields. This low-field behavior is in agreement with earlier experimental observations. The specific heat shows a maximum as a function of temperature, and the height of the maximum increases sharply at high magnetic fields. Although all the three systems show qualitatively similar behavior, there are some notable quantitative differences between the systems in which the site spin difference, $|s_1 - s_2|$, is large and small respectively.Comment: 16 LaTeX pages, 13 postscript figure

Evidence for a fundamental stellar upper mass limit from clustered star formation

The observed masses of the most massive stars do not surpass about 150Msun. This may either be a fundamental upper mass limit which is defined by the physics of massive stars and/or their formation, or it may simply reflect the increasing sparsity of such very massive stars so that observing even higher-mass stars becomes unlikely in the Galaxy and the Magellanic Clouds. It is shown here that if the stellar initial mass function (IMF) is a power-law with a Salpeter exponent (alpha=2.35) for massive stars then the richest very young cluster R136 seen in the Large Magellanic Cloud (LMC) should contain stars with masses larger than 750Msun. If, however, the IMF is formulated by consistently incorporating a fundamental upper mass limit then the observed upper mass limit is arrived at readily even if the IMF is invariant. An explicit turn-down or cutoff of the IMF near 150Msun is not required; our formulation of the problem contains this implicitly. We are therefore led to conclude that a fundamental maximum stellar mass near 150Msun exists, unless the true IMF has alpha>2.8.Comment: MNRAS, accepted, 6 page