11 research outputs found

    Rapid Molecular Testing for TB to Guide Respiratory Isolation in the U.S.: A Cost-Benefit Analysis

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    BACKGROUND: Respiratory isolation of inpatients during evaluation for TB is a slow and costly process in low-burden settings. Xpert MTB/RIF (Xpert) is a novel molecular test for tuberculosis (TB) that is faster and more sensitive but substantially more expensive than smear microscopy. No previous studies have examined the costs of molecular testing as a replacement for smear microscopy in this setting. METHODS: We conducted an incremental cost–benefit analysis comparing the use of a single negative Xpert versus two negative sputum smears to release consecutive adult inpatients with presumed TB from respiratory isolation at an urban public hospital in the United States. We estimated all health-system costs and patient outcomes related to Xpert implementation, diagnostic evaluation, isolation, hospitalization, and treatment. We performed sensitivity and probabilistic uncertainty analyses to determine at what threshold the Xpert strategy would become cost-saving. RESULTS: Among a hypothetical cohort of 234 individuals undergoing evaluation for presumed active TB annually, 6.4% had culture-positive TB. Compared to smear microscopy, Xpert reduced isolation bed utilization from an average of 2.7 to 1.4 days per patient, leading to a 48% reduction in total annual isolation bed usage from 632 to 328 bed-days. Xpert saved an average of 2,278(952,278 (95% uncertainty range 1582–4570) per admission, or $533,520 per year, compared with smear microscopy. CONCLUSIONS: Molecular testing for TB could provide substantial savings to hospitals in high-income countries by reducing respiratory isolation usage and overall length of stay

    4 Rhizaria: Phytomyxea

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    The selenium jevels of mothers and their neonates using hair, breast milk, meconium, and maternal and umbilical cord blood in van basin

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    The objective of the present study is to calculate linear regressions between a mother and her child with respect to their selenium concentration (ng/g) in the following traits: maternal blood and umbilical cord blood, maternal and child hair, maternal milk and child umbilical cord blood, maternal milk and meconium, maternal blood plasma, and child meconium. The data were collected at Research Hospital of the University of Yüzüncü Yıl from 30 pairs of mothers and their newborn baby. The mean maternal serum Se level in 30 mothers was 68.52 ± 3.57 ng/g and cord plasma level was 119.90 ± 18.08 ng/g. The Se concentration in maternal and neonatal hair was 330.84 ± 39.03 and 1,124.76 ± 186.84 ng/g, respectively. The Se concentration of maternal milk at day 14 after delivery was determined as 68.63 ± 7.78 ng/g (n = 13) and the concentration of Se was 418.90 ± 45.49 ng/g (n = 22) for meconium of neonatal. There was no significant difference between maternal blood and milk Se levels. However, hair Se concentration was significantly higher than milk and maternal blood Se level. For each trait comparison, the average absolute difference in log10-transformed Se concentration was calculated between a mother and her child. The observed average absolute difference was compared with a test distribution of 1,000 resampled bootstrap averages where the number of samples was maintained but the relationship between a mother and her child was randomized among samples (α = 0.05).H. Sağmanlıgil Özdemir, F. Karadas, A. C. Pappas, P. Cassey, G. Oto and O. Tunce

    Zinc and Reproduction: Effects of Deficiency on Foetal and Postnatal Development

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    Functional ecology of wild bees in cities: towards a better understanding of trait-urbanization relationships

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