Increasingly, assessment of healthcare technologies and interventions requires the assessment of both costs and utilities. Health state utility values (HSUVs) are measured using a range of generic and condition-specific measures. While reviews have identified that generic measures of HSUVs may lack validity in adults with conditions that result in physical disability, there is little information available on the methods used to obtain HSUVs in children and adolescents with disabilities. The objectives of this systematic review are to describe the methods used to obtain HSUVs, including mode of administration and psychometric properties, and provide summary statistics for HSUVs among children and adolescents with disabilities. The following databases will be searched from inception for English-language studies of any design: PubMed, PsychInfo, Medline, Scopus, CINAHL Plus, Econlit and EMBASE databases. Two reviewers will independently screen titles, abstracts and full text articles for studies reporting HSUVs and/or data on the psychometric properties of preference-based measures for children and adolescents with disabilities aged up to 19 years. Two reviewers will independently extract data items including descriptors of the study methods and sample, instruments used to capture HSUVs, summary statistics for HSUVs and items relating to the quality of reporting. A descriptive summary of results from included studies and summary statistics for HSUVs will be presented. If sufficient data is identified, we will pool summary statistics for HSUVs according to the method used to obtain the HSUV using a random effects model. In addition, we will explore the determinants of the HSUVs using a meta-regression. Ethical approval will not be required as no original data will be collected as part of this review. The completed review will be submitted for publication in a peer-reviewed journal and presentation at conferences. CRD42018086574.
To describe the associations between socio-economic position and prevalent tuberculosis in the 2010 ZAMSTAR Tuberculosis Prevalence Survey, one of the first large tuberculosis prevalence surveys in Southern Africa in the HIV era. The main analyses used data on 34 446 individuals in Zambia and 30 017 individuals in South Africa with evaluable tuberculosis culture results. Logistic regression was used to estimate adjusted odds ratios for prevalent TB by two measures of socio-economic position: household wealth, derived from data on assets using principal components analysis, and individual educational attainment. Mediation analysis was used to evaluate potential mechanisms for the observed social gradients. The quartile with highest household wealth index in Zambia and South Africa had, respectively, 0.55 (95% CI 0.33-0.92) times and 0.70 (95% CI 0.54-0.93) times the adjusted odds of prevalent TB of the bottom quartile. College or university-educated individuals in Zambia and South Africa had, respectively, 0.25 (95% CI 0.12-0.54) and 0.42 (95% CI 0.25-0.70) times the adjusted odds of prevalent TB of individuals who had received only primary education. We found little evidence that these associations were mediated via several key proximal risk factors for TB, including HIV status. These data suggest that social determinants of TB remain important even in the context of generalised HIV epidemics.
The intestinal epithelium constitutes an innate barrier which, upon injury, undergoes self-repair processes known as restitution. Although bile acids are known as important regulators of epithelial function in health and disease, their effects on wound healing processes are not yet clear. Here we set out to investigate the effects of the colonic bile acids, deoxycholic acid (DCA) and ursodeoxycholic acid (UDCA), on epithelial restitution. Wound healing in T
The use of sexed semen in dairy and beef cattle production provides a number of benefits at both farm and industry levels. There is an increasing demand for dairy and beef products across the globe, which will necessitate a greater focus on improving production efficiency. In dairy farming, there is surplus production of unwanted male calves. Male dairy calves increase the risk of dystocia compared with heifer calves, and as an unwanted by-product of breeding with conventional semen, they have a low economic value. Incorporating sexed semen into the breeding programme can minimise the number of unwanted male dairy calves and reduce dystocia. Sexed semen can be used to generate herd replacements and additional heifers for herd expansion at a faster rate from within the herd, thereby minimising biosecurity risks associated with bringing in animals from different herds. Furthermore, the use of sexed semen can increase herd genetic gain compared with use of non-sorted semen. In dairy herds, a sustainable breeding strategy could combine usage of sexed semen to generate replacements only, and usage of beef semen on all dams that are not suitable for generating replacements. This results in increased genetic gain in dairy herd, increased value of beef output from the dairy herd, and reduced greenhouse gas emissions from beef. It is important to note, however, that even a small decrease in fertility of sexed semen relative to conventional semen can negate much of the economic benefit. A high fertility sexed semen product has the potential to accelerate herd expansion, minimise waste production, improve animal welfare and increase profitability compared with non-sorted conventional semen.
Pure graphene in the form of few-layer graphene (FLG) - 1 to 6 layers - is biocompatible and non-cytotoxic. This makes FLG an ideal material to incorporate into dental polymers to increase their strength and durability. It is well known that graphene has high mechanical strength and has been shown to enhance the mechanical, physical and chemical properties of biomaterials. However, for commercial applicability, methods to produce larger than lab-scale quantities of graphene are required. Here, we present a simple method to make large quantities of FLG starting with commercially available multi-layer graphene (MLG). This FLG material was then used to fabricate graphene dental-polymer composites. The resultant graphene-modified composites show that low concentrations of graphene (ca. 0.2 wt %) lead to enhanced performance improvement in physio-mechanical properties - the mean compressive strength increased by 27% and the mean compressive modulus increased by 22%. Herein we report a new, cheap and simple method to make large quantities of few-layer graphene which was then incorporated into a common dental polymer to fabricate graphene-composites which shows very promising mechanical properties.
Up to the 18th century, the prevailing view of reproduction, or 'generation' as it was referred to, was that organisms develop from miniatures of themselves, termed preformation. The alternative theory, epigenesis, proposed that the structure of an animal emerges gradually from a relatively formless egg. The teachings of the Ancient Greeks who argued either that both sexes each contributed 'semen' to form the embryo, or held a more male-centred view that the female merely provided fertile ground for the male seed to grow, dominated thinking until the 17th century, when the combined work of numerous scholars led to the theory that all female organisms, including humans, produced eggs. The sequence of events leading to the commercial use of artificial insemination (AI) date back to the discovery of sperm in 1678, although it took almost 100 years to demonstrate that sperm were the agents of fertilisation and a further 100 years for the detailed events associated with fertilisation to be elucidated. The first successful AI, carried out in the dog, dates back to 1780 while it was not until the early to mid-1900s that practical methods for AI were described in Russia. Inspired by the Russian success, the first AI cooperative was established in Denmark in 1936 and later in the United States in 1938. The next major advances involved development of semen extenders, addition of antibiotics to semen, and the discovery in 1949 that glycerol protected sperm during cryopreservation. Almost four decades later, the flow cytometric separation of X- and Y-bearing sperm opened a new chapter in the application of AI for cattle breeding. As we look forward today, developments in imaging sperm and breakthroughs in gene editing and stem cell technology are opening up new possibilities to manipulate reproduction in a way never thought possible by the pioneers of the past. This review highlights some of the main milestones and individuals in the history of sperm biology and the development of technologies associated with AI in cattle.
Substrate selection is one of the key technical issues for constructed wetlands (CWs), which works for wastewater treatment based mainly on the biofilm principle. In recent years, many alternative substrates have been studied and applied in CWs, and a review is conducive to providing updated information on CW R&D. Based on the intensive research work especially over the last 10 years on the development of emerged substrates (except for the three conventional substrates of soil, sand, and gravel) in CWs, this review was made. The substrates are categorized depending on their main roles in pollutant removal as ion-exchange substrates, P-sorption substrates, and electron donor substrates. Among these, reuse of various waste products as substrates was suggested due to their competitive pollutant removal efficiency and minimized waste disposal. Regarding substrate development, future research on avoiding substrate clogging to extend their lifetime in CWs is needed.
Improvements in living standards result in a growing demand for food with high quality attributes including freshness, nutrition and safety. However, current industrial processing methods rely on traditional thermal and chemical methods, such as sterilization and solvent extraction, which could induce negative effects on food quality and safety. The electric fields (EFs) involving pulsed electric fields (PEFs) and high voltage electric fields (HVEFs) have been studied and developed for assisting and enhancing various food processes. In this review, the principles and applications of pulsed and high voltage electric fields are described in details for a range of food processes, including microbial inactivation, component extraction, and winemaking, thawing and drying, freezing and enzymatic inactivation. Moreover, the advantages and limitations of electric field related technologies are discussed to foresee future developments in the food industry. This review demonstrates that electric field technology has a great potential to enhance food processing by supplementing or replacing the conventional methods employed in different food manufacturing processes. Successful industrial applications of electric field treatments have been achieved in some areas such as microbial inactivation and extraction. However, investigations of HVEFs are still in an early stage and translating the technology into industrial applications need further research efforts.
Hepatitis C (HCV) infection is highly prevalent among people who inject drugs (PWID). Many PWID are unaware of their infection and few have received HCV treatment. Recent developments in treatment offer cure rates >90%. However, the potential of these treatments will only be realised if HCV identification among PWID with linkage to treatment is optimised. This paper describes the Hepcare Europe project, a collaboration between five institutions across four member states (Ireland, UK, Spain, Romania), to develop, implement and evaluate interventions to improve the identification, evaluation and treatment of HCV among PWID. A service innovation project and a mixed-methods, pre-post intervention study, Hepcare will design and deliver interventions in Dublin, London, Seville and Bucharest to enhance PWID engagement and retention in the cascade of HCV care. The feasibility, acceptability, potential efficacy and cost-effectiveness of these interventions to improve care processes and outcomes among PWID will be evaluated. Hepcare has the potential to make an important impact on patient care for marginalised populations who might otherwise go undiagnosed and untreated. Lessons learned from the study can be incorporated into national and European guidelines and strategies for HCV.
In this article, we review the literature on quantitative sensory testing of deep somatic pain by means of computerized cuff pressure algometry (CPA) in search of pressure-related safety guidelines for wearable soft exoskeleton and robotics design. Most pressure-related safety thresholds to date are based on interface pressures and skin perfusion, although clinical research suggests the deep somatic tissues to be the most sensitive to excessive loading. With CPA, pain is induced in deeper layers of soft tissue at the limbs. The results indicate that circumferential compression leads to discomfort at ∼16-34 kPa, becomes painful at ∼20-27 kPa, and can become unbearable even below 40 kPa.