Challenges and Opportunities for Developing Countries from Medical Tourism

Wikipedia defines “Medical Tourism” as the act of traveling to other countries to obtain medical, dental and surgical care. Rapid expansion of facilities for patients abroad has helped to spur this industry’s growth. Regardless of the destination, U.S. citizens are increasingly embracing the benefits of medical tourism due to dramatically rising U.S. healthcare costs. Medical care in countries such as India, Mexico, Thailand and Singapore can cost as little as ten percent of the cost of comparable care in the U.S. for some procedures. Statistical analysis revealed the costs to be significantly lower for many of these countries. Currently, patients from U.S., Canada, Europe, Australia and the Middle East appear to be traveling to destinations in Asia such as India and in Central America such as Mexico for medical care. Medical tourism can offer opportunities to developing countries to make improvements in their country and the host country can enjoy the economic benefit from medical tourism. However, there are also some challenges they may face from medical tourism. This paper discusses the opportunities and the challenges resulting from medical tourism for developing countries

The role of hole transport between dyes in solid-state dye-sensitized solar cells

In dye-sensitized solar cells (DSSCs) photogenerated positive charges are normally considered to be carried away from the dyes by a separate phase of hole-transporting material (HTM). We show that there can also be significant transport within the dye monolayer itself before the hole reaches the HTM. We quantify the fraction of dye regeneration in solid-state DSSCs that can be attributed to this process. By using cyclic voltammetry and transient anisotropy spectroscopy, we demonstrate that the rate of interdye hole transport is prevented both on micrometer and nanometer length scales by reducing the dye loading on the TiO₂ surface. The dye regeneration yield is quantified for films with high and low dye loadings (with and without hole percolation in the dye monolayer) infiltrated with varying levels of HTM. Interdye hole transport can account for >50% of the overall dye regeneration with low HTM pore filling. This is reduced to about 5% when the infiltration of the HTM in the pores is optimized in 2 μm thick films. Finally, we use hole transport in the dye monolayer to characterize the spatial distribution of the HTM phase in the pores of the dyed mesoporous TiO₂

Cost-effectiveness of community versus hospital eye service follow-up for patients with quiescent treated age-related macular degeneration alongside the ECHoES randomised trial

Objectives To assess the cost-effectiveness of optometrist-led follow-up monitoring reviews for patients with quiescent neovascular age-related macular degeneration (nAMD) in community settings (including high street opticians) compared with ophthalmologist-led reviews in hospitals. Design A model based cost-effectiveness analysis with a 4-week time horizon, based on a ‘virtual’ non-inferiority randomised trial designed to emulate a parallel group design. Setting A virtual internet-based clinical assessment, conducted at community optometry practices, and hospital ophthalmology clinics. Participants Ophthalmologists with experience in the age-related macular degeneration service; fully qualified optometrists not participating in nAMD shared care schemes. Interventions The participating optometrists and ophthalmologists classified lesions from vignettes and were asked to judge whether any retreatment was required. Vignettes comprised clinical information, colour fundus photographs and optical coherence tomography images. Participants’ classifications were validated against experts’ classifications (reference standard). Resource use and cost information were attributed to these retreatment decisions. Main Outcome Measures Correct classification of whether further treatment is needed, compared with a reference standard. Results The mean cost per assessment, including the subsequent care pathway, was £411 for optometrists and £397 for ophthalmologists: a cost difference of £13 (95% CI: -£18, £45). Optometrists were non-inferior to ophthalmologists with respect to the overall percentage of lesions correctly assessed (difference: -1.0%; 95% CI: -4.5%, 2.5%). Conclusions In the base case analysis, the slightly larger number of incorrect retreatment decisions by optometrists led to marginally and non-significantly higher costs. Sensitivity analyses that reflected different practices across eye hospitals indicate that shared care pathways between optometrists and ophthalmologists can be identified which may reduce demands on scant hospital resources, although in light of the uncertainty around differences in outcome and cost it remains unclear whether the differences between the two care pathways are significant in economic terms. </p

Family history is neglected in the work-up of patients with colorectal cancer: a quality assessment using cancer registry data

In the diagnostic work-up of hereditary non-polyposis colorectal cancer (HNPCC, Lynch syndrome), high-risk patients can be identified using information from the family history on cancer (‘Amsterdam criteria’ and ‘Bethesda guidelines’). To investigate to what extent the medical specialists apply these criteria to patients with colorectal carcinoma and a suspicion of HNPCC, we collected information on diagnostic work-up of 224 patients of seven hospitals in the region of the Comprehensive Cancer Centre West in Leiden, The Netherlands. These patients were diagnosed with colorectal cancer between 1999 and 2001 and satisfied at least one of the Bethesda guidelines. A complete family history was recorded for 38 of the 244 patients (16%). Patients with a complete family history were more likely to be referred to the Clinical Genetic Centre than those with an incomplete or absent family history (53% vs. 13% and 4%, respectively; P < 0.0001), and more likely to be analyzed for microsatellite instability (MSI), which is a characteristic of HNPCC (34% vs. 6% and 1%, respectively; P < 0.0001). We conclude that the family history is neglected in the majority of patients with colorectal cancer and MSI-analysis is only performed in a small proportion of the patients that meet the guidelines for this analysis

Solvent effects on the harvesting of stratum corneum from hairless mouse skin through adhesive tape stripping in vitro

125 [mu]l of a propylene glycol/ethanol/water vehicle were applied for various lengths of time to 1.77 cm2 area of excised hairless mouse skin sections held in in vitro diffusion cells. After removal from the cell, each skin section was stripped repeatedly with a non-hygroscopic polypropylene tape. The amount of tissue removed in each strip was determined after allowing the volatile solvents to evaporate. Weights were corrected for residual propylene glycol and water, the amounts of which were determined radioisotopically. More tissue was harvested in the first and second strips from skin conditioned with the vehicle for more than 12 h. The effect of vehicle treatment on stripping properties precludes one from determining drug and vehicle concentration gradients in the stratum corneum at different treatment times by direct comparison of corresponding strips. While it does not appear that a penetrant's deposition as a function of time can be followed easily and directly by stripping and then quantifying the drug (or solvent) in the respective layers, the stripping technique may still be useful in separating stratum corneum (or epidermis) from dermis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29469/1/0000555.pd

Thermal degradation of lead halide perovskite surfaces

Commercial use of lead halide perovskites requires improved ther mal stability and therefore a better understanding of their degrada tion mechanisms. The thermal degradation of three clean perovskite single crystal surfaces MAPbI3, MAPbBr3, FAPbBr3 was investigated using synchrotron based photoelectron spectroscopy. Central find ings are that the halide has a large impact on thermal stability and that the degradation of formamidnium results in the formation of a new organic species at the FAPbBr3 crystal surfac