37 research outputs found
Contrasting effects of nitric oxide and corticotropin- releasing factor within the dorsal periaqueductal gray on defensive behavior and nociception in mice
Social–environmental drivers inform strategic management of coral reefs in the Anthropocene
Without drastic efforts to reduce carbon emissions and mitigate globalized stressors, tropical coral reefs are in jeopardy. Strategic conservation and management requires identification of the environmental and socioeconomic factors driving the persistence of scleractinian coral assemblages—the foundation species of coral reef ecosystems. Here, we compiled coral abundance data from 2,584 Indo-Pacific reefs to evaluate the influence of 21 climate, social and environmental drivers on the ecology of reef coral assemblages. Higher abundances of framework-building corals were typically associated with: weaker thermal disturbances and longer intervals for potential recovery; slower human population growth; reduced access by human settlements and markets; and less nearby agriculture. We therefore propose a framework of three management strategies (protect, recover or transform) by considering: (1) if reefs were above or below a proposed threshold of >10% cover of the coral taxa important for structural complexity and carbonate production; and (2) reef exposure to severe thermal stress during the 2014–2017 global coral bleaching event. Our findings can guide urgent management efforts for coral reefs, by identifying key threats across multiple scales and strategic policy priorities that might sustain a network of functioning reefs in the Indo-Pacific to avoid ecosystem collapse
Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts: an economic decision model
Objectives: To estimate the costs of commonly used
treatments for cutaneous warts, as well as their health
benefits and risk. To create an economic decision model
to evaluate the cost-effectiveness of these treatments,
and, as a result, assess whether a randomised controlled
trial (RCT) would be feasible and cost-effective.
Data sources: Focus groups, structured interviews
and observation of practice. Postal survey sent to 723
patients. A recently updated Cochrane systematic
review and published cost and prescribing data.
Review methods: Primary and secondary data
collection methods were used to inform the
development of an economic decision model. Data from
the postal survey provided estimates of the
effectiveness of wart treatments in a primary care
setting. These estimates were compared with outcomes
reported in the Cochrane review of wart treatment,
which were largely obtained from RCTs conducted in
secondary care. A decision model was developed
including a variety of over-the-counter (OTC) and GPprescribed
treatments. The model simulated 10,000
patients and adopted a societal perspective.
Results: OTC treatments were used by a substantial
number of patients (57%) before attending the GP
surgery. By far the most commonly used OTC
preparation was salicylic acid (SA). The results of the
economic model suggested that of the treatments
prescribed by a GP, the most cost-effective treatment
was SA, with an incremental cost-effectiveness ratio
(ICER) of 2.20 £/% cured. The ICERs for cryotherapy
varied widely (from 1.95 to 7.06 £/% cured) depending
on the frequency of applications and the mode of
delivery. The most cost-effective mode of delivery was
through nurse-led cryotherapy clinics (ICER =
1.95 £/% cured) and this could be a cost-effective
alternative to GP-prescribed SA. Overall, the OTC
therapies were the most cost-effective treatment
options. ICERs ranged from 0.22 £/% cured for OTC
duct tape and 0.76 £/% cured for OTC cryotherapy to
1.12 £/% cured for OTC SA. However, evidence in
support of OTC duct tape and OTC cryotherapy is
very limited. Side-effects were commonly reported for
both SA and cryotherapy, particularly a burning
sensation, pain and blistering.
Conclusions: Cryotherapy delivered by a doctor is an
expensive option for the treatment of warts in primary
care. Alternative options such as GP-prescribed SA and
nurse-led cryotherapy clinics provide more costeffective
alternatives, but are still expensive compared
with self-treatment. Given the minor nature of most
cutaneous warts, coupled with the fact that the
majority spontaneously resolve in time, it may be
concluded that a shift towards self-treatment is
warranted. Although both duct tape and OTC
cryotherapy appear promising new self-treatment
options from both a cost and an effectiveness
perspective, more research is required to confirm the
efficacy of these two methods of wart treatment. If
these treatments are shown to be as cost-effective as
or more cost-effective than conventional treatments,
then a shift in service delivery away from primary care
towards more OTC treatment is likely. A public
awareness campaign would be useful to educate
patients about the self-limiting nature of warts and the
possible alternative OTC treatment options available.
Two future RCTs are recommended for consideration:
a trial of SA compared with nurse-led cryotherapy in
primary care, and a trial of home treatments. Greater
understanding of the efficacy of these home treatments
will give doctors a wider choice of treatment options,
and may help to reduce the overall demand for
cryotherapy in primary care
Effectiveness and cost-effectiveness of salicylic acid and cryotherapy for cutaneous warts: an economic decision model
Objectives: To estimate the costs of commonly used
treatments for cutaneous warts, as well as their health
benefits and risk. To create an economic decision model
to evaluate the cost-effectiveness of these treatments,
and, as a result, assess whether a randomised controlled
trial (RCT) would be feasible and cost-effective.
Data sources: Focus groups, structured interviews
and observation of practice. Postal survey sent to 723
patients. A recently updated Cochrane systematic
review and published cost and prescribing data.
Review methods: Primary and secondary data
collection methods were used to inform the
development of an economic decision model. Data from
the postal survey provided estimates of the
effectiveness of wart treatments in a primary care
setting. These estimates were compared with outcomes
reported in the Cochrane review of wart treatment,
which were largely obtained from RCTs conducted in
secondary care. A decision model was developed
including a variety of over-the-counter (OTC) and GPprescribed
treatments. The model simulated 10,000
patients and adopted a societal perspective.
Results: OTC treatments were used by a substantial
number of patients (57%) before attending the GP
surgery. By far the most commonly used OTC
preparation was salicylic acid (SA). The results of the
economic model suggested that of the treatments
prescribed by a GP, the most cost-effective treatment
was SA, with an incremental cost-effectiveness ratio
(ICER) of 2.20 £/% cured. The ICERs for cryotherapy
varied widely (from 1.95 to 7.06 £/% cured) depending
on the frequency of applications and the mode of
delivery. The most cost-effective mode of delivery was
through nurse-led cryotherapy clinics (ICER =
1.95 £/% cured) and this could be a cost-effective
alternative to GP-prescribed SA. Overall, the OTC
therapies were the most cost-effective treatment
options. ICERs ranged from 0.22 £/% cured for OTC
duct tape and 0.76 £/% cured for OTC cryotherapy to
1.12 £/% cured for OTC SA. However, evidence in
support of OTC duct tape and OTC cryotherapy is
very limited. Side-effects were commonly reported for
both SA and cryotherapy, particularly a burning
sensation, pain and blistering.
Conclusions: Cryotherapy delivered by a doctor is an
expensive option for the treatment of warts in primary
care. Alternative options such as GP-prescribed SA and
nurse-led cryotherapy clinics provide more costeffective
alternatives, but are still expensive compared
with self-treatment. Given the minor nature of most
cutaneous warts, coupled with the fact that the
majority spontaneously resolve in time, it may be
concluded that a shift towards self-treatment is
warranted. Although both duct tape and OTC
cryotherapy appear promising new self-treatment
options from both a cost and an effectiveness
perspective, more research is required to confirm the
efficacy of these two methods of wart treatment. If
these treatments are shown to be as cost-effective as
or more cost-effective than conventional treatments,
then a shift in service delivery away from primary care
towards more OTC treatment is likely. A public\ud
awareness campaign would be useful to educate
patients about the self-limiting nature of warts and the
possible alternative OTC treatment options available.
Two future RCTs are recommended for consideration:
a trial of SA compared with nurse-led cryotherapy in
primary care, and a trial of home treatments. Greater
understanding of the efficacy of these home treatments
will give doctors a wider choice of treatment options,
and may help to reduce the overall demand for
cryotherapy in primary care
Sociocultural factors, female students body internalization, food choices and eating patterns
Selective Unilateral Spinal Anaesthesia for Outpatient Knee Arthroscopy Using Real-Time Monitoring of Lower Limb Sympathetic Tone
Hernioplastia diafragmática em cão com pericárdio bovino conservado em solução supersaturada de açúcar Diaphragmatic hernioplasty in dogs with bovine pericardium preserved in supersaturated sugar solution
Foram utilizados sete cães adultos, três machos e quatro fêmeas, sem raça definida, com pesos entre 10 e 22kg, para avaliação do processo cicatricial do músculo diafragma, na presença do implante de pericárdio bovino conservado em solução supersaturada de açúcar a 300%. Foi criado um defeito na porção muscular do hemidiafragma esquerdo de dimensões 8,0×5,0cm. Após a toracotomia no oitavo espaço intercostal esquerdo, o implante heterógeno foi fixado com fio poliamida nº 3-0 por meio de sutura simples contínua. Decorrido o período pré-estabelecido de pós-operatório, os animais foram submetidos a exames radiográficos simples e contrastado e a estudos macroscópico e histológico. Na avaliação radiográfica, foi verificada presença das silhuetas diafragmática e cardíaca, sem evidências de vísceras abdominais no interior do tórax. Macroscopicamente, notou-se a formação de tecido conjuntivo fibroso semi-transparente que ocluia o defeito diafragmático. O segmento de pericárdio bovino conservado em solução supersaturada de açúcar a 300%, em temperatura ambiente, é substituído por uma fina camada de tecido conjuntivo fibroso e promove a restauração do defeito no músculo diafragma de cão.<br>Seven adult mongrel dogs, three males and four females, weighting between 10 and 22kg were used to evaluate the diaphragmatic muscle healing process. A defect of 8.0×5.5cm was created at the muscular portion of the left hemidiaphragm, through a thoracotomy at the eighth left intercostal space. A segment of bovine pericardium, preserved in 300% sugar solution, was implanted in the diaphragmatic defect. The heterologous implant was sutured with 3.0 polyamide using simple continuous suture. After the observation period, radiologic analysis and macroscopic and histopathologic evaluations were performed. Upon radiographic examination, there was no evidence of interruption of diaphragmatic outline or increased radiopacity at the implantation site. Histologically, fine connective tissue occluded the diaphragmatic defect. Bovine pericardium preserved in 300% supersaturated sugar solution at room temperature is replaced by a fine layer of connective fibrous tissue and promote repair of large diaphragmatic defects in dogs