A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting

Background & aims: There is limited information about the economic impact of nutritional support despite its known clinical benefits. This systematic review examined the cost and cost effectiveness of using standard (non-disease specific) oral nutritional supplements (ONS) administered in the hospital setting only. Methods: A systematic literature search of multiple databases, data synthesis and analysis were undertaken according to recommended procedures. Results: Nine publications comprising four full text papers, two abstracts and three reports, one of which contained 11 cost analyses of controlled cohort studies, were identified. Most of these were based on retrospective analyses of randomised controlled trials designed to assess clinically relevant outcomes. The sample sizes of patients with surgical, orthopaedic and medical problems and combinations of these varied from 40 to 1.16 million. Of 14 cost analyses comparing ONS with no ONS (or routine care), 12 favoured the ONS group, and among those with quantitative data (12 studies) the mean cost saving was 12.2%. In a meta-analysis of five abdominal surgical studies in the UK, the mean net cost saving was $746 per patient (se$338; P = 0.027). Cost savings were typically associated with significantly improved outcomes, demonstrated through the following meta-analyses: reduced mortality (Risk ratio 0.650, P < 0.05; N = 5 studies), reduced complications (by 35% of the total; P < 0.001, N = 7 studies) and reduced length of hospital stay (by ~2 days, P < 0.05; N = 5 surgical studies) corresponding to ~13.0% reduction in hospital stay. Two studies also found ONS to be cost effective, one by avoiding development of pressure ulcers and releasing hospital beds, and the other by gaining quality adjusted life years. Conclusion: This review suggests that standard ONS in the hospital setting produce a cost saving and are cost effective. The evidence base could be further strengthened by prospective studies in which the primary outcome measures are economic

A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings

Background & aims: Despite the clinical benefits of using standard (non-disease specific) oral nutritional supplements (ONS) in the community and care homes, there is uncertainty about their economic consequences. Methods: A systematic review was undertaken according to recommended procedures to assess whether ONS can produce cost savings and cost-effective outcomes. Results: 19 publications with and without a hospital component were identified: 9 full text papers, 9 abstracts, and 1 report with retrospective analyses of 6 randomised controlled trials. From these publications a total of 31 cost and 4 cost-effectiveness analyses were identified. Most were retrospective analyses based on clinical data from randomised controlled trials (RCTs). In 9 studies/economic models involving ONS use for 0.05; 5 studies). In RCTs, ONS accounted for less than 5% of the total costs and the investment in the community produced a cost saving in hospital. Meta-analysis indicated that ONS reduced hospitalisation significantly (16.5%; P < 0.001; 9 comparisons) and mortality non-significantly (Relative risk 0.86 (95% CI, 0.61, 1.22); 8 comparisons). Many clinically relevant outcomes favouring ONS were reported: improved quality of life, reduced infections, reduced minor post-operative complications, reduced falls, and functional limitations. Of the cost-effectiveness analyses involving quality adjusted life years or functional limitations, most favoured the ONS group. The care home studies (4 cost analyses; 2 cost-effectiveness analyses) had differing aims, designs and conclusions. Conclusions: Overall, the reviewed studies, mostly based on retrospective cost analyses, indicate that ONS use in the community produce an overall cost advantage or near neutral balance, often in association with clinically relevant outcomes, suggesting cost effectiveness. There is a need for prospective studies designed to examine primary economic outcomes

Task oriented nonlinear control laws for telerobotic assembly operations

The goal of this research is to achieve very intelligent telerobotic controllers which are capable of receiving high-level commands from the human operator and implementing them in an adaptive manner in the object/task/manipulator workspace. Initiatives by the authors at Integrated Systems, Inc. to identify and develop the key technologies necessary to create such a flexible, highly programmable, telerobotic controller are presented. The focus of the discussion is on the modeling of insertion tasks in three dimensions and nonlinear implicit force feedback control laws which incorporate tool/workspace constraints. Preliminary experiments with dual arm beam assembly in 2-D are presented

Mechanical Systems: Symmetry and Reduction

Reduction theory is concerned with mechanical systems with symmetries. It constructs a lower dimensional reduced space in which associated conservation laws are taken out and symmetries are \factored out" and studies the relation between the dynamics of the given system with the dynamics on the reduced space. This subject is important in many areas, such as stability of relative equilibria, geometric phases and integrable systems

On Filippov solutions of discontinuous DAEs of index 1

We study discontinuous differential-algebraic equations (DDAEs) with a co-dimension 1 discontinuity manifold Σ. Our main objectives are to give sufficient conditions that allow to extend the DAE along Σ and, when this is possible, to define sliding motion (the sliding DAE) on Σ, extending Filippov construction to this DAE case. Our approach is to consider discontinuous ODEs associated to the DDAE and apply Filippov theory to the discontinuous ODEs, defining sliding/crossing solutions of the DDAE to be those inherited by the sliding/crossing solutions of the associated discontinuous ODEs. We will see that, in general, the sliding DAE on Σ is not defined unambiguously. When possible, we will consider in greater details two different methods based on Filippov's methodology to arrive at the sliding DAE. We will call these the direct approach and the Singular Perturbation Approach and we will explore advantages and disadvantages of each of them. We illustrate our development with numerical examples

Strategies for Prevention of Pertussis

Introdução: Nos últimos 30 anos, em vários países, tem sido relatado um aumento da incidência de tosse convulsa, sobretudo em adolescentes e adultos, apesar das altas taxas de cobertura de imunização primária. Objectivos: Rever aspectos da epidemiologia da tosse convulsa, descrever algumas estratégias de controlo, com ênfase nas que incluem a utilização de vacinas com menores quantidades do toxóide diftérico e de alguns componentes pertussis (dTpa), e a avaliação da eficácia e efectividade destas vacinas. Métodos: Selecção de artigos relevantes, através da base de dados PubMed e sítios de acesso livre da internet, publicados entre 1991 e 2011. Resultados: As alterações do padrão epidemiológico são atribuídas, principalmente, à diminuição da imunidade ao longo dos anos, após a vacinação ou infecção natural. Os adolescentes e adultos foram identificados como importantes fontes de transmissão da doença para lactentes muito jovens que, uma vez não imunizados ou parcialmente imunizados, são mais vulneráveis às complicações relacionadas com a doença e apresentam maior mortalidade. A vacina (dTpa), formulada para o uso em adolescentes e adultos é segura e eficaz. A sua utilização também reduz a transmissão da tosse convulsa para os grupos etários com alto risco de complicações. Conclusão: A disponibilidade da dTpa oferece novas oportunidades para reduzir o impacto da tosse convulsa. A modificação das estratégias preventivas pode levar a um melhor controlo global da doença

Topic Segmentation: How Much Can We Do by Counting Words and Sequences of Words

In this paper, we present an innovative topic segmentation system based on a new informative similarity measure that takes into account word co-occurrence in order to avoid the accessibility to existing linguistic resources such as electronic dictionaries or lexico-semantic databases such as thesauri or ontology. Topic segmentation is the task of breaking documents into topically coherent multi-paragraph subparts. Topic segmentation has extensively been used in information retrieval and text summarization. In particular, our architecture proposes a language-independent topic segmentation system that solves three main problems evidenced by previous research: systems based uniquely on lexical repetition that show reliability problems, systems based on lexical cohesion using existing linguistic resources that are usually available only for dominating languages and as a consequence do not apply to less favored languages and finally systems that need previously existing harvesting training data. For that purpose, we only use statistics on words and sequences of words based on a set of texts. This solution provides a flexible solution that may narrow the gap between dominating languages and less favored languages thus allowing equivalent access to information

Effect of castration age on carcass traits and meat quality of Simmental bulls

RiassuntoEffetto dell'eta di castrazione su caratteristiche della carcassa e qualita della carne di tori Pezzati Rossi. Il posticipo dell'eta di castrazione sembra limitare la riduzione delle performance produttive, mantenendo gli effetti positivi sulla qualita della carne. In proposito, su 24 tori di razza Pezzata Rossa, lo studio ha valutato l'effetto della castrazione a 10 o 12 mesi (Anticipata vs. Tardiva; periodo di ingrasso: 191 vs. 151 giorni) sulle caratteristiche qualitative della carcassa e del Longissimus thoracis. Sulla carne sono state analizzate composizione chimica, colore, tenerezza e gusto, con tecniche strumentali e sensoriali. La castrazione anticipata comporta l'ottenimento di carne a piu elevato tenore lipidico che migliora la tenerezza, aumenta la luminosita e riduce le perdite di cottura. Nel caso degli animali castrati tardivamente, la minor marezzatura sembra invece favorire la produzione di carne con un piu elevato valore dell'indice del rosso e dal gusto piu apprezzato alla valu..