Cost Effectiveness of a Community-Delivered Consultation to Improve Infant Sleep Problems and Maternal Well-Being

© 2018 Objectives: To evaluate the cost effectiveness of a community-delivered consultation aimed at improving infant sleep and maternal well-being. Methods: A decision-analytic model was developed that compared the costs and benefits of an infant sleep consultation with usual care. The effectiveness of the consultation was based on clinical evidence, and improvements in maternal quality of life were estimated by mapping the Edinburgh Postnatal Depression Scale scores to published utility scores. Cost effectiveness was calculated as the incremental cost per quality-adjusted life-year gained (QALY). Results: The statistically significant improvements in mean Edinburgh Postnatal Depression Scale scores at 4- and 16-month follow-ups were used to estimate the benefit in terms of QALYs. The modeled results demonstrated that the infant sleep consultation is low-cost (A$436), more effective in terms of QALYs gained (0.017), and cost-effective. The estimated incremental cost-effectiveness ratio was A$ 4031/QALY gained. The main drivers of the model were the use of early parenting centers and nurse training costs. Conclusions: Community-based nurse-delivered infant sleep consultations aid infant sleep, improve maternal quality of life, and are cost-effective compared with usual care and lead to improvements in quality of life through a reduction in postnatal depression

Studi Pembuatan Bahan Alternatif Plastik Biodegradable dari Pati Ubi Jalar dengan Plasticizer Gliserol dengan Metode Melt Intercalation

Masalah lingkungan dari pembuangan limbah plastik turunan minyak bumi telah menjadi isu penting karena sifatnya yang sulit diuraikan. Oleh karena itu, upaya telah dilakukan untuk mempercepat tingkat degradasi material polimer dengan mengganti beberapa atau seluruh polimer sintetis dengan polimer alami. Pati merupakan salah satu polimer alami yang dapat digunakan untuk produksi material biodegradable karena sifatnya yang mudah terdegradasi, melimpah, dan terjangkau namun memiliki kekurangan seperti kuatnya perilaku hidrofilik dan sifat mekanis yang lebih buruk. Untuk meningkatkan kekuatan mekanis pada pati, sejumlah kecil pegisi (filler) berupa bahan penguat biasanya ditambahkan ke dalam matriks polimer. Oleh karena itu, bioplastik disiapkan dengan pencampuran pati ubi jalar sebagai matriks, gliserol sebagai pemlastis, dan kitosan sebagai pengisi (filler) melalui metode melt intercalation. Variasi konsentrasi gliserol dan kitosan mempengaruhi sifat mekanis dan biodegradabilitas bioplastik. Ketika gliserol divariasikan dari 0,5% menjadi 1,5% kekuatan tarik menurun dari 19,23 MPa menjadi 8,83 Mpa, sedangkan niali elongasi meningkat dari 0% menjadi 39,16%. Sebaliknya pada saat variasi konsentrasi Kitosan dari 1% menjadi 2% kekuatan tarik meningkat dari 4,90 MPa menjadi 5,60 MPa, dan pada saat konsentrasi kitosan 3% nilai kuat tarik menurun menjadi 4,22 MPa, sedangkan nilai elongasi mengalami penurunan yaitu 32,62%, 16,60% dan 8,35%. Biodegradabilitas bioplastik dengan variasi plasticizer gliserol mencapai 2,50 % dalam waktu 8 hari. Sedangkan bioplastik pada variasi konsentrasi kitosan mempunyai biodegradabilitas 1,63% dalam waktu 8 hari

Symptoms and Surgical Management of a Distal Choledochal Cyst in a Patient with Pancreas Divisum: Case Report and Review of the Literature

We report the case of a 63-year-old woman who presented with the rare finding of a distal choledochocele in a pancreas divisum with recurrent abdominal pain and episodes of pancreatitis. She underwent successful resection with choledochectomy, papillectomy and reconstruction with a hepatico-jejunostomy and reinsertion of the uncinate pancreatic duct into the same jejunal loop. Comparable literature findings are discussed with regard to the presented case

Dietary and Behavioral Interventions Protect against Age Related Activation of Caspase Cascades in the Canine Brain

Lifestyle interventions such as diet, exercise, and cognitive training represent a quietly emerging revolution in the modern approach to counteracting age-related declines in brain health. Previous studies in our laboratory have shown that long-term dietary supplementation with antioxidants and mitochondrial cofactors (AOX) or behavioral enrichment with social, cognitive, and exercise components (ENR), can effectively improve cognitive performance and reduce brain pathology of aged canines, including oxidative damage and Aβ accumulation. In this study, we build on and extend our previous findings by investigating if the interventions reduce caspase activation and ceramide accumulation in the aged frontal cortex, since caspase activation and ceramide accumulation are common convergence points for oxidative damage and Aβ, among other factors associated with the aged and AD brain. Aged beagles were placed into one of four treatment groups: CON – control environment/control diet, AOX– control environment/antioxidant diet, ENR – enriched environment/control diet, AOX/ENR– enriched environment/antioxidant diet for 2.8 years. Following behavioral testing, brains were removed and frontal cortices were analyzed to monitor levels of active caspase 3, active caspase 9 and their respective cleavage products such as tau and semaphorin7a, and ceramides. Our results show that levels of activated caspase-3 were reduced by ENR and AOX interventions with the largest reduction occurring with combined AOX/ENR group. Further, reductions in caspase-3 correlated with reduced errors in a reversal learning task, which depends on frontal cortex function. In addition, animals treated with an AOX arm showed reduced numbers of cells expressing active caspase 9 or its cleavage product semaphorin 7A, while ENR (but not AOX) reduced ceramide levels. Overall, these data demonstrate that lifestyle interventions curtail activation of pro-degenerative pathways to improve cellular health and are the first to show that lifestyle interventions can regulate caspase pathways in a higher animal model of aging

A fibril-specific, conformation-dependent antibody recognizes a subset of Aβ plaques in Alzheimer disease, Down syndrome and Tg2576 transgenic mouse brain

Beta-amyloid (Aβ) is thought to be a key contributor to the pathogenesis of Alzheimer disease (AD) in the general population and in adults with Down syndrome (DS). Different assembly states of Aβ have been identified that may be neurotoxic. Aβ oligomers can assemble into soluble prefibrillar oligomers, soluble fibrillar oligomers and insoluble fibrils. Using a novel antibody, OC, recognizing fibrils and soluble fibrillar oligomers, we characterized fibrillar Aβ deposits in AD and DS cases. We further compared human specimens to those obtained from the Tg2576 mouse model of AD. Our results show that accumulation of fibrillar immunoreactivity is significantly increased in AD relative to nondemented aged subjects and those with select cognitive impairments (p < 0.0001). Further, there was a significant correlation between the extent of frontal cortex fibrillar deposit accumulation and dementia severity (MMSE r = −0.72). In DS, we observe an early age of onset and age-dependent accumulation of fibrillar OC immunoreactivity with little pathology in similarly aged non-DS individuals. Tg2576 mice show fibrillar accumulation that can be detected as young as 6 months. Interestingly, fibril-specific immunoreactivity was observed in diffuse, thioflavine S-negative Aβ deposits in addition to more mature neuritic plaques. These results suggest that fibrillar deposits are associated with disease in both AD and in adults with DS and their distribution within early Aβ pathology associated with diffuse plaques and correlation with MMSE suggest that these deposits may not be as benign as previously thought