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Tenecteplase improved functional outcomes and reduced the requirement for endovascular thrombectomy in ischemic stroke patients with large vessel occlusion in the EXTEND-IA TNK randomized trial. We assessed the cost-effectiveness of tenecteplase versus alteplase in this trial.
Post hoc within-trial economic analysis included costs of index emergency department and inpatient stroke hospitalization, rehabilitation/subacute care, and rehospitalization due to stroke within 90 days. Sources for cost included key study site complemented by published literature and government websites. Quality-adjusted life-years were estimated using utility scores derived from the modified Rankin Scale score at 90 days. Long-term modeled cost-effectiveness analysis used a Markov model with 7 health states corresponding to 7 modified Rankin Scale scores. Probabilistic sensitivity analyses were performed.
Within the 202 patients in the randomized controlled trial, total cost was nonsignificantly lower in the tenecteplase-treate short and long term. Registration URL https//www.clinicaltrials.gov. Unique identifier NCT02388061.
Both within-trial and long-term economic analyses showed that tenecteplase was highly likely to be cost-effective for patients with acute stroke before thrombectomy. Recommending the use of tenecteplase over alteplase could lead to a cost saving to the healthcare system both in the short and long term. Registration URL https//www.clinicaltrials.gov. Unique identifier NCT02388061.Waste solar photovoltaic (PV) panels are considered as one of the fastest-growing future waste streams under the category of large electronic waste (e-waste). The lifespan of solar panels varies from 20 to 30 years, and an appropriate reverse logistics network design is essential to manage the waste stream efficiently once their lifetime expires. Mixed-integer programming-based RL model is proposed in this paper for New South Wales, Australia that minimizes the overall cost by identifying optimal locations and sizing of the collection points while determining optimal capacities for recycling facilities. Using the historical data (2001-2017) on the installed capacity of solar panels in the state, the potential waste generation (at council-level) is estimated and optimized solutions are proposed for the year 2047. The results of the study show that the highest waste solar PV will be generated at Murrumbidgee, Berrigan, Balranald, and Bogan councils. Out of 129 councils in the state, the model identifies 78 optimized-locations of the collection points that would be required in the councils. In the councils of Newcastle, Narrandera and Wagga Wagga, three major recycling facilities would need to be established. This is the first systematic attempt in designing an optimized RL network in Australia focusing on waste solar PV. Policy-makers will find this research highly valuable in decision-making on local recycling infrastructure development.
Ureteral stents are placed to relieve ureteral obstruction in various endourological surgery. As soon as it is inserted it is rapidly colonized by host of microorganism. Culture and sensitivity pattern of these growing microorganism on the stent may provide us an insight to treat postoperative urosepsis in high risk patients with indwelling DJ stents.
Prospective study between September 2018 and August 2019 with enrollment of 100 patients to determine the ability of urine culture (UC) to predict stent culture (SC) status, to identify associated infectious pathogens with their antibiotic sensitivity patterns and to evaluate the association between SC and post-endourological intervention sepsis.
Colonization of bacteria on stent culture (SC) was identified in 53 out of 100 patients (53%). Most of the organism grown on SC were multidrug resistant and they were resistant to most commonly prescribed antibiotics like fluroquinolones, cephalosporins, and aminoglycosides .These organisms were only sensitive to newer antibiotics. Indwelling time of ureteral stent was directly proportional with SC positivity (
< 0.05). Association of Urine culture at DJ Removal and DJ stent culture was not statistically significant.
Very low rates of colonization within 6 weeks after the insertion of stents. Sterile culture of urine does not rule out colonization of the stent. Most of the urinary pathogens as well as the organisms grown on DJ stent are resistant to fluroquinolones and cephalosporins.
Very low rates of colonization within 6 weeks after the insertion of stents. Sterile culture of urine does not rule out colonization of the stent. learn more Most of the urinary pathogens as well as the organisms grown on DJ stent are resistant to fluroquinolones and cephalosporins.Urbanization is perhaps the most significant and rapid cause of demographic change in human societies, with more than half the world's population now living in cities. Urban lifestyles have been associated with increased risk for mental disorders, greater stress responses, and lower trust. However, it is not known whether a general tendency towards prosocial behaviour varies across the urban-rural gradient, or whether other factors such as neighbourhood wealth might be more predictive of variation in prosocial behaviour. Here, we present findings from three real-world experiments conducted in 37 different neighbourhoods, in 12 cities and 12 towns and villages across the UK. We measured whether people (i) posted a lost letter; (ii) returned a dropped item; and (iii) stopped to let someone cross the road in each neighbourhood. We expected to find that people were less willing to help a stranger in more urban locations, with increased diffusion of responsibility and perceived anonymity in cities being measured as variables that might drive this effect. Our data did not support this hypothesis. There was no effect of either urbanicity or population density on people's willingness to help a stranger. Instead, the neighbourhood level of deprivation explained most of the variance in helping behaviour with help being offered less frequently in more deprived neighbourhoods. These findings highlight the importance of socio-economic factors, rather than urbanicity per se, in shaping variation in prosocial behaviour in humans.
