Cost-minimization analysis of oral versus intravenous antibiotic treatment for Klebsiella pneumoniae liver abscess

A cost-minimization analysis was conducted for Klebsiella pneumoniae liver abscess (KLA) patients enrolled in a randomized controlled trial which found oral ciprofloxacin to be non-inferior to intravenous (IV) ceftriaxone in terms of clinical outcomes. Healthcare service utilization and cost data were obtained from medical records and estimated from self-reported patient surveys in a non-inferiority trial of oral ciprofloxacin versus IV ceftriaxone administered to 152 hospitalized adults with KLA in Singapore between November 2013 and October 2017. Total costs were evaluated by category and payer, and compared between oral and IV antibiotic groups over the trial period of 12 weeks. Among the subset of 139 patients for whom cost data were collected, average total cost over 12 weeks was $16,378 (95$14,620-$18,136) for the oral ciprofloxacin group and$20,569 (95% CI, $18,296-$22,842) for the IV ceftriaxone group, largely driven by lower average outpatient costs, as the average number of outpatient visits was halved for the oral ciprofloxacin group. There were no other statistically significant differences, either in inpatient costs or in other informal healthcare costs. Oral ciprofloxacin is less costly than IV ceftriaxone in the treatment of Klebsiella liver abscess, largely driven by reduced outpatient service costs.Trial registration: ClinicalTrials.gov Identifier NCT01723150 (7/11/2012)

Contesting the Dominant Discourse of Child Sexual Abuse: Sexual Subjects, Agency, and Ethics

Responding to previous scholars’ call to explore the complexities of child sexual abuse (CSA), this article presents narratives of CSA and scrutinizes a binary construction underpinning this discourse of CSA, namely, the positioning of children as powerless and adults as powerful. The narratives belong to three Indonesian young people who have had sexual interactions with adults when they were children. The findings demonstrate how this binary positioning has been both drawn upon and resisted in the ways participants understand their sexual experiences. This article contributes to the existing literature by providing analyses of some vignettes of everyday experiences of how children might be constituted as sexual subjects, including their capability to exercise agency, perform resistance, and negotiate ethics. The implications of the findings are discussed in relation to how the recognition of children as sexual subjects and their sexual agency might be beneficial for parents, educators, and counselors

The Guinea Pig as a model for sporadic Alzheimer's Disease (AD): the impact of cholesterol intake on expression of AD-related genes

Extent: 12p.We investigated the guinea pig, Cavia porcellus, as a model for Alzheimer’s disease (AD), both in terms of the conservation of genes involved in AD and the regulatory responses of these to a known AD risk factor - high cholesterol intake. Unlike rats and mice, guinea pigs possess an Aβ peptide sequence identical to human Aβ. Consistent with the commonality between cardiovascular and AD risk factors in humans, we saw that a high cholesterol diet leads to up-regulation of BACE1 (β-secretase) transcription and down-regulation of ADAM10 (α-secretase) transcription which should increase release of Aβ from APP. Significantly, guinea pigs possess isoforms of AD-related genes found in humans but not present in mice or rats. For example, we discovered that the truncated PS2V isoform of human PSEN2, that is found at raised levels in AD brains and that increases γ-secretase activity and Aβ synthesis, is not uniquely human or aberrant as previously believed. We show that PS2V formation is up-regulated by hypoxia and a high-cholesterol diet while, consistent with observations in humans, Aβ concentrations are raised in some brain regions but not others. Also like humans, but unlike mice, the guinea pig gene encoding tau, MAPT, encodes isoforms with both three and four microtubule binding domains, and cholesterol alters the ratio of these isoforms. We conclude that AD-related genes are highly conserved and more similar to human than the rat or mouse. Guinea pigs represent a superior rodent model for analysis of the impact of dietary factors such as cholesterol on the regulation of AD-related genes.Mathew J. Sharman, Seyyed H. Moussavi Nik, Mengqi M. Chen, Daniel Ong, Linda Wijaya, Simon M. Laws, Kevin Taddei, Morgan Newman, Michael Lardelli, Ralph N. Martins, Giuseppe Verdil

Genomic and epigenomic EBF1 alterations modulate TERT expression in gastric cancer

Transcriptional reactivation of telomerase catalytic subunit (TERT) is a frequent hallmark of cancer, occurring in 90% of human malignancies. However, specific mechanisms driving TERT reactivation remain obscure for many tumor types and in particular gastric cancer (GC), a leading cause of global cancer mortality. Here, through comprehensive genomic and epigenomic analysis of primary GCs and GC cell lines, we identified the transcription factor early B cell factor 1 (EBF1) as a TERT transcriptional repressor and inactivation of EBF1 function as a major cause of TERT upregulation. Abolishment of EBF1 function occurs through 3 distinct (epi)genomic mechanisms. First, EBF1 is epigenetically silenced via DNA methyltransferase, polycomb-repressive complex 2 (PRC2), and histone deacetylase activity in GCs. Second, recurrent, somatic, and heterozygous EBF1 DNA–binding domain mutations result in the production of dominant-negative EBF1 isoforms. Third, more rarely, genomic deletions and rearrangements proximal to the TERT promoter remobilize or abolish EBF1-binding sites, derepressing TERT and leading to high TERT expression. EBF1 is also functionally required for various malignant phenotypes in vitro and in vivo, highlighting its importance for GC development. These results indicate that multimodal genomic and epigenomic alterations underpin TERT reactivation in GC, converging on transcriptional repressors such as EBF1

COLLABORATIVE GOVERNANCE TO EVOLVE SMART CITY IN LOCAL GOVERNMENTS

The smart-city is innovation concept providing effective and efficient public services, through innovation and the use of information technology infrastructure. There needs to be a collaboration between local governments, private agencies, and other community groups to develop this concept. However, the collaboration model seems to be very rarely studied in smart city envolve in local government. This paper uses a descriptive qualitative method, with a positivist approach. The results of the study explained that the Government of Baubau City was developing an online application for Information Management and Documentation Officers, that application provides information about which a number of data on finance, market prices, spatial data, and other public information were presented to support government transparency. Besides having developed links that the public can access various information on policies, programs, news, government activities, including online-based reporting systems, including development planning program (MUSREMBANG) now can be online. It's just that the implementation process is still oriented to the local government, while the private sector and the community have not fully contributed so that this service has not been optimal in providing effective and efficient services. The biggest challenges in implementing this are limited human resources and telecommunications infrastructure that is not yet optimal. Keywords: Collaborative Governance, Smart-city, Local Governmen

Beyond the Standardized Assessment of Mathematical Problem Solving Competencies: From Products to Processes

National and international standardised assessments of mathematical competencies challenge students to solve stimulating non-routine problems but, in some sense, they appear to have several limitations exactly in assessing students’ problem solving competencies. In particular, the use of multiple choice or short answer items focuses the assessment on the student’s choice (the product) rather than on how and why the student made that choice (the reasoning, that is, the process). The emersion of the processes appears to be a crucial need for teachers and researchers in order to understand what is involved in students’ answers. In this chapter, we will describe a protocol (developed within an Italian research project) for getting data to understand – at a micro level – the educational macro phenomena illustrated by standardised assessment quantitative results. This approach – that involves educational researchers and mathematics teachers – makes it possible to foster the development of a critical and productive approach to standardised tests, transforming them in an educational opportunity for teachers and researchers

Reconciling forest conservation and logging in Indonesian Borneo

Combining protected areas with natural forest timber concessions may sustain larger forest landscapes than is possible via protected areas alone. However, the role of timber concessions in maintaining natural forest remains poorly characterized.An estimated 57% (303,525 km2) of Kalimantan's land area (532,100 km2) was covered by natural forest in 2000. About 14,212 km2 (4.7%) had been cleared by 2010. Forests in oil palm concessions had been reduced by 5,600 km2 (14.1%), while the figures for timber concessions are 1,336 km2 (1.5%), and for protected forests are 1,122 km2 (1.2%). These deforestation rates explain little about the relative performance of the different land use categories under equivalent conversion risks due to the confounding effects of location.An estimated 25% of lands allocated for timber harvesting in 2000 had their status changed to industrial plantation concessions in 2010. Based on a sample of 3,391 forest plots (1×1 km; 100 ha), and matching statistical analyses, 2000-2010 deforestation was on average 17.6 ha lower (95% C.I.: -22.3 ha--12.9 ha) in timber concession plots than in oil palm concession plots. When location effects were accounted for, deforestation rates in timber concessions and protected areas were not significantly different (Mean difference: 0.35 ha; 95% C.I.: -0.002 ha-0.7 ha).Natural forest timber concessions in Kalimantan had similar ability as protected areas to maintain forest cover during 2000-2010, provided the former were not reclassified to industrial plantation concessions. Our study indicates the desirability of the Government of Indonesia designating its natural forest timber concessions as protected areas under the IUCN Protected Area Category VI to protect them from reclassification