Evaluations of training and education interventions for improved infectious disease management in low-income and middle-income countries:a systematic literature review

OBJECTIVES: To identify most vital input and outcome parameters required for evaluations of training and education interventions aimed at addressing infectious diseases in low-income and middle-income countries. DESIGN: Systematic review. DATA SOURCES: PubMed/Medline, Web of Science and Scopus were searched for eligible studies between January 2000 and November 2021. STUDY SELECTION: Health economic and health-outcome studies on infectious diseases covering an education or training intervention in low-income and middle-income countries were included. RESULTS: A total of 59 eligible studies covering training or education interventions for infectious diseases were found; infectious diseases were categorised as acute febrile infections (AFI), non-AFI and other non-acute infections. With regard to input parameters, the costs (direct and indirect) were most often reported. As outcome parameters, five categories were most often reported including final health outcomes, intermediate health outcomes, cost outcomes, prescription outcomes and health economic outcomes. Studies showed a wide range of per category variables included and a general lack of uniformity across studies. CONCLUSIONS: Further standardisation is needed on the relevant input and outcome parameters in this field. A more standardised approach would improve generalisability and comparability of results and allow policy-makers to make better informed decisions on the most effective and cost-effective interventions

Cost Effectiveness of a CYP2C19 Genotype-Guided Strategy in Patients with Acute Myocardial Infarction:Results from the POPular Genetics Trial

INTRODUCTION: The POPular Genetics trial demonstrated that a CYP2C19 genotype-guided P2Y12 inhibitor strategy reduced bleeding rates compared with standard treatment with ticagrelor or prasugrel without increasing thrombotic event rates after primary percutaneous coronary intervention (PCI). OBJECTIVE: In this analysis, we aimed to evaluate the cost effectiveness of a genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel. METHODS: A 1-year decision tree based on the POPular Genetics trial in combination with a lifelong Markov model was developed to compare costs and quality-adjusted life-years (QALYs) between a genotype-guided and a standard P2Y12 inhibitor strategy in patients with myocardial infarction undergoing primary PCI. The cost-effectiveness analysis was conducted from a Dutch healthcare system perspective. Within-trial survival and utility data were combined with lifetime projections to evaluate lifetime cost effectiveness for a cohort of 1000 patients. Costs and utilities were discounted at 4 and 1.5%, respectively, according to Dutch guidelines for health economic studies. Besides deterministic and probabilistic sensitivity analyses, several scenario analyses were also conducted (different time horizons, different discount rates, equal prices for P2Y12 inhibitors, and equal distribution of thrombotic events between the two strategies). RESULTS: Base-case analysis with a hypothetical cohort of 1000 subjects demonstrated 8.98 QALYs gained and €725,550.69 in cost savings for the genotype-guided strategy (dominant). The deterministic and probabilistic sensitivity analysis confirmed the robustness of the model and the cost-effectiveness results. In scenario analyses, the genotype-guided strategy remained dominant. CONCLUSION: In patients undergoing primary PCI, a CYP2C19 genotype-guided strategy compared with standard treatment with ticagrelor or prasugrel resulted in QALYs gained and cost savings. TRIAL REGISTRATION: Clinicaltrials.gov number: NCT01761786, Netherlands trial register number: NL2872

Holes in wrist patches improve wearing comfort

Purpose: The purpose of this paper was to investigate whether small holes in an impermeable patch at the wrist improve perceived comfort during exercise. Design/methodology/approach: Nine male participants participated in this study. During the experiment, participants cycled 60 W in a hot room (35°C, 30 percent relative humidity) while an impermeable 20 cm2 patch was located on the ventral side of one wrist and at the same time a patch of identical shape with 5 mm diameter holes (17.7 percent uncovered) on the other wrist. The participants could not see the patches. Participants were forced to choose which patch they perceived as more comfortable. Chest and arm skin temperature, thermal comfort, thermal sensation and wetness perception were assessed. Findings: Participants preferred 5 mm holes over no holes (p=0.017). Chest skin temperature (p=0.018) but not arm skin temperature correlates with this preference. Thermal comfort, thermal sensation and wetness perception did not differ significantly between patches. It is concluded that patches with 5 mm holes are preferred over impermeable patches during work in the heat in particular when the torso skin is warm. Originality/value: The wrist is a preferred location for smart wearables. Generally, wrist bands are made of air-impermeable materials leading to sensation of wetness and discomfort. This study has shown that manufacturers should consider to make small holes in their wrist bands to optimize wearing comfort

Hybrid business models for ‘Organ-on-a-Chip’ technology: The best of both worlds

Current in vitro and in vivo preclinical models often have limited predictive value for translation to the clinical setting. The emerging ‘Organ-on-a-Chip’ (OOC) technology provides a better resemblance to the human physiology through combining 3D configuration of human-derived cells with microfluidic techniques, potentially improving translation. However, due to the disruptive nature of the OOC technology, it is unclear how to best achieve a product-market fit. Data on currently employed business models was collected by 14 semi-structured interviews with representatives from OOC companies. Customer needs were collected by means of an online questionnaire among 62 (potential) end-users. Both companies and customers preferred the Hybrid business model, in which both products and services were offered. Customized services were only moderately preferred over standard services, limiting the potential for price premiums. Razor blade business models facilitate investments in laboratory equipment while locking in the purchase of disposable OOC devices. Current and future generations of in vitro technologies would benefit from combining the best of product and service business models into the Hybrid business model. Downward price pressures are expected to lead to ever-lower pricing and to facilitate more predictive, high throughput screening with a high societal impact on the longer term

Hybrid business models for ‘Organ-on-a-Chip’ technology:the best of both worlds

\u3cp\u3eCurrent in vitro and in vivo preclinical models often have limited predictive value for translation to the clinical setting. The emerging ‘Organ-on-a-Chip’ (OOC) technology provides a better resemblance to the human physiology through combining 3D configuration of human-derived cells with microfluidic techniques, potentially improving translation. However, due to the disruptive nature of the OOC technology, it is unclear how to best achieve a product-market fit. Data on currently employed business models was collected by 14 semi-structured interviews with representatives from OOC companies. Customer needs were collected by means of an online questionnaire among 62 (potential) end-users. Both companies and customers preferred the Hybrid business model, in which both products and services were offered. Customized services were only moderately preferred over standard services, limiting the potential for price premiums. Razor blade business models facilitate investments in laboratory equipment while locking in the purchase of disposable OOC devices. Current and future generations of in vitro technologies would benefit from combining the best of product and service business models into the Hybrid business model. Downward price pressures are expected to lead to ever-lower pricing and to facilitate more predictive, high throughput screening with a high societal impact on the longer term.\u3c/p\u3

Co-benefits of black carbon mitigation for climate and air quality

Mitigation of black carbon (BC) aerosol emissions can potentially contribute to both reducing air pollution and climate change, although mixed results have been reported regarding the latter. A detailed quantification of the synergy between global air quality and climate policy is still lacking. This study contributes with an integrated assessment model-based scenario analysis of BC-focused mitigation strategies aimed at maximizing air quality and climate benefits. The impacts of these policy strategies have been examined under different socioeconomic conditions, climate ambitions, and BC mitigation strategies. The study finds that measures targeting BC emissions (including reduction of co-emitted organic carbon, sulfur dioxide, and nitrogen dioxides) result in significant decline in premature mortality due to ambient air pollution, in the order of 4 to 12 million avoided deaths between 2015 and 2030. Under certain circumstances, BC mitigation can also reduce climate change, i.e., mainly by lowering BC emissions in the residential sector and in high BC emission scenarios. Still, the effect of BC mitigation on global mean temperature is found to be modest at best (with a maximum short-term GMT decrease of 0.02 °C in 2030) and could even lead to warming (with a maximum increase of 0.05 °C in case of a health-focused strategy, where all aerosols are strongly reduced). At the same time, strong climate policy would improve air quality (the opposite relation) through reduced fossil fuel use, leading to an estimated 2 to 5 million avoided deaths in the period up to2030. By combining both air quality and climate goals, net health benefits can be maximized

Co-benefits of black carbon mitigation for climate and air quality

Mitigation of black carbon (BC) aerosol emissions can potentially contribute to both reducing air pollution and climate change, although mixed results have been reported regarding the latter. A detailed quantification of the synergy between global air quality and climate policy is still lacking. This study contributes with an integrated assessment model-based scenario analysis of BC-focused mitigation strategies aimed at maximizing air quality and climate benefits. The impacts of these policy strategies have been examined under different socioeconomic conditions, climate ambitions, and BC mitigation strategies. The study finds that measures targeting BC emissions (including reduction of co-emitted organic carbon, sulfur dioxide, and nitrogen dioxides) result in significant decline in premature mortality due to ambient air pollution, in the order of 4 to 12 million avoided deaths between 2015 and 2030. Under certain circumstances, BC mitigation can also reduce climate change, i.e., mainly by lowering BC emissions in the residential sector and in high BC emission scenarios. Still, the effect of BC mitigation on global mean temperature is found to be modest at best (with a maximum short-term GMT decrease of 0.02 °C in 2030) and could even lead to warming (with a maximum increase of 0.05 °C in case of a health-focused strategy, where all aerosols are strongly reduced). At the same time, strong climate policy would improve air quality (the opposite relation) through reduced fossil fuel use, leading to an estimated 2 to 5 million avoided deaths in the period up to2030. By combining both air quality and climate goals, net health benefits can be maximized