Cost-benefit analysis of introducing next-generation sequencing (metagenomic) pathogen testing in the setting of pyrexia of unknown origin

Pyrexia of unknown origin (PUO) is defined as a temperature of >38.3°C that lasts for >3 weeks, where no cause can be found despite appropriate investigation. Existing protocols for the work-up of PUO can be extensive and costly, motivating the application of recent advances in molecular diagnostics to pathogen testing. There have been many reports describing various analytical methods and performance of metagenomic pathogen testing in clinical samples but the economics of it has been less well studied. This study pragmatically evaluates the feasibility of introducing metagenomic testing in this setting by assessing the relative cost of clinically-relevant strategies employing this investigative tool under various cost and performance scenarios using Singapore as a demonstration case, and assessing the price and performance benchmarks, which would need to be achieved for metagenomic testing to be potentially considered financially viable relative to the current diagnostic standard. This study has some important limitations: we examined only impact of introducing the metagenomic test to the overall diagnostic cost and excluded costs associated with hospitalization and makes assumptions about the performance of the routine diagnostic tests, limiting the cost of metagenomic test, and the lack of further work-up after positive pathogen detection by the metagenomic test. However, these assumptions were necessary to keep the model within reasonable limits. In spite of these, the simplified presentation lends itself to the illustration of the key insights of our paper. In general, we find the use of metagenomic testing as second-line investigation is effectively dominated, and that use of metagenomic testing at first-line would typically require higher rates of detection or lower cost than currently available in order to be justifiable purely as a cost-saving measure. We conclude that current conditions do not warrant a widespread rush to deploy metagenomic testing to resolve any and all uncertainty, but rather as a front-line technology that should be used in specific contexts, as a supplement to rather than a replacement for careful clinical judgement

Antiparasitic potential of chromatographic fractions of nephrolepis biserrata and liquid chromatography-quadrupole time-of-flight-mass spectrometry analysis

Marine aquaculture development is recently impeded by parasitic leech Zeylanicobdella arugamensis (Hirudinea, Piscicolidae) in Sabah, Malaysia. The parasitic leech infests a variety of cultured fishes in aquaculture facilities. In this study, we evaluated the antiparasitic activity of the chromatographic fractions of the medicinal plant Nephrolepis biserrata methanol extract against Z. arugamensis and highlighted the potential metabolites responsible for the antiparasitic properties through liquid chromatography (LC)–quadrupole time-of-flight (QTOF)–mass spectrometry (MS) analysis. Out of seven fractions obtained through flash column chromatography techniques, three fractions demonstrated antiparasitic properties. Significant parasitic mortality was indicated by fraction 3 at a concentration of 2.50 mg/mL, all the leeches were killed in a time limit of 1.92 ± 0.59 min. followed by fraction 4 (14 mg/mL) in 34.57 ± 3.39 and fraction 5 (15.3 mg/mL) in 36.82 ± 4.53 min. LC-QTOF-MS analysis indicated the presence of secondary metabolites including phytosphingosine (6), pyrethrosin (1), haplophytine (9), ivalin (2), warburganal (3), isodomedin (4) and pheophorbide a (16), representing sphingoid, alkaloid, terpenoid, phenolic and flavonoid groups. Thus, our study indicated that the chromatographic fractions of N. biserrata demonstrated significant antiparasitic activity against the marine parasitic leeches due to the presence of potent antiparasitic bioactive compounds

The need for an appropriate environmental education

Since the formulation of the National Environmental Policy and the establishment of the ministry of Science, Technology and Environment in the mid 1970s, there has been an upsurge of interest in the environment and environmental problems. The question is whether the formal education system has responded well to this emerging concern. It is recognised that a great deal of environmental learning takes place outside the formal education process and the best locations and opportunities for environmental education are found in the community. The focus of this paper is to evaluate the state of environmental education in the school system and to identify areas of curriculum needs which can help us develop a more meaningful environmental education programme. The existing curriculum activities for environmental education for primary and secondary levels are briefly reviewed and some observations are made regarding the implementation of environmental education by teachers. The infusion of elements of environmental education into the different disciplines particularly into the science subjects can be described as incidental. The findings of three research studies are elaborated to provide some objective evidence about student learnings about environment as well as perceptions of science teachers about the social relevance of the science curricula. Ba$ed on these findings some constraints to the development of environmental education are inferred. Five curriculum issues representing the areas of need for environmental education in school are selected for discussion and these include: nature of environmental education, selection of content, curriculum design strategies, teaching-learning methodologies and evaluation. The discussion highlights the need to have a clear conceptualisation of the nature and goals of environmental education and their implications for the process of developing environmental education includes 'what it is, how do we select the content for it, how do we organise the content, what are the appropriate teaching methodologies how do we assess its learnings

Dyadic approach to supervised community rehabilitation participation in an Asian setting post-stroke: Exploring the role of caregiver and patient characteristics in a prospective cohort study

10.1136/bmjopen-2019-036631BMJ Open104e03663

Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors

10.1186/s12913-018-3696-3BMC health services research18188

Can caregivers report their care recipients' post-stroke hospitalizations and outpatient visits accurately? Findings of an Asian prospective stroke cohort 11 Medical and Health Sciences 1117 Public Health and Health Services

10.1186/s12913-018-3634-4BMC Health Services Research18181