New vaccine introductions (NVIs) raise issues of value for money (VfM) for self-financing middle-income countries like Egypt. We evaluate a pediatric pneumococcal conjugate vaccine (PCV) NVI in Egypt ...from health payer and societal perspectives, using cost-utility and cost-benefit analysis (CUA, CBA). We evaluate vaccinating 100 successive birth cohorts with the 13-valent PCV ("PCV13") and the 10-valent PCV ("PCV10") relative to no vaccination and each other. We quantify health effects with a disease incidence projection model and a multiple-cohort static disease model. Our CBA uses a health-augmented lifecycle model to generate willingness-to-pay for health gains from which we calculate rates of return (RoR). We obtain parameters from the published literature. We perform deterministic and probabilistic sensitivity analysis. Our base-case CUA finds incremental cost-effectiveness ratios (ICERs) for PCV13 and PCV10 relative to no program of $926 (95% confidence interval $512-$1,735) and $1,984 ($1,186-$3,805) per quality-adjusted life year (QALY), respectively; and for PCV13 relative to PCV10 of $174 ($88-$331) per QALY. Our base-case CBA finds RoRs to PCV13 and PCV10 relative to no program of 488% (188-993%) and 164% (33-336%), respectively, and to PCV13 relative to PCV10 of 3109% (1410-6602%). Both CUA and CBA find PCV13 to be good VfM relative to PCV10.
Spatiotemporal variations of ten physicochemical parameters in the water quality of Atoyac River basin, Central Mexico, were obtained from 22 sampling sites (66 samples in total) located all along ...the basin for three different seasons (dry, rainy and winter). Multivariate statistical techniques such as correlation matrix, factor analysis (FA) and cluster analysis (CA) were used as a tool to understand the process. Physicochemical parameters such as temperature (
T
), pH, conductivity (
λ
), dissolved oxygen (DO), spectral absorption coefficient (SAC), oxidation–reduction potential (ORP), turbidity, 5-day biochemical oxygen demand (BOD
5
), chemical oxygen demand (COD) and total suspended solids (TSS) were analyzed. Extremely high values of pH (10.24), conductivity (1870 µS/cm) and reduced redox potential (−370.1 mV) were observed in the dry season, whereas elevated TSS of 2996 mg/L was detected during the rainy season. The results elucidated high influence from the adjoining industrial, agricultural and urban zones, making the river unsuitable for life. FA generated varifactors, which accounted for cumulative % of 75.04 (dry), 76.22 (rainy) and 79.96 (winter) clearly grouping the external factors responsible for these significant values indicating the source of contamination. Cluster analysis facilitated the ease of classifying the sampling sites based on the similarities of physicochemical parameters. This study carried out in different seasons using multivariate statistical techniques would definitely prove to be an efficient tool for the restoration and establishing the real-time monitoring stations along this important river basin of Mexico.
Diabetes affects multiple systems in complex manners. Diabetic foot ulcers (DFUs) are a result of diabetes‐induced microarterial vessel disease and peripheral neuropathy. The presence of ...arteriosclerosis‐induced macroarterial disease can further complicate DFU pathophysiology. Recent studies suggest that mesenchymal stromal cell therapies can enhance tissue regeneration. This phase I study was designed to determine the safety and explore the efficacy of local injections of autologous adipose‐derived stromal vascular fraction (SVF) cells to treat nonhealing DFUs greater than 3 cm in diameter. Sixty‐three patients with type 2 diabetes with chronic DFU—all amputation candidates—were treated with 30 × 106 SVF cells injected in the ulcer bed and periphery and along the pedal arteries. Patients were seen at 6 and 12 months to evaluate ulcer closure. Doppler ultrasounds were performed in a subset of subjects to determine vascular structural parameters. No intervention‐related serious adverse events were reported. At 6 months, 51 subjects had 100% DFU closure, and 8 subjects had ≥75% closure. Three subjects had early amputations, and one subject died. At 12 months, 50 subjects had 100% DFU healing and 4 subjects had ≥85% healing. Five subjects died between the 6‐ and 12‐month follow‐up visits. No deaths were intervention related. Doppler studies in 11 subjects revealed increases in peak systolic velocity and pulsatility index in 33 of 33 arteries, consistent with enhanced distal arterial runoff. These results indicate that SVF can be safely used to treat chronic DFU, with evidence of efficacy (wound healing) and mechanisms of action that include vascular repair and/or angiogenesis.
Experimental design and outcomes.
The confluence of technological advances in optics and the need of a deeper understanding of cellular processes have boosted the development of diverse optical microrheometric techniques. These ...experimental methods have allowed a better understanding of not only the viscoelastic behaviour of cells, but also different intracellular processes. In this work, the fundamentals of the most commonly used optical microrheometric techniques and their more relevant applications in the biological field are expounded for a non-specialist public. In particular, the promising and emerging use of upconverting luminescent particles as probes in this field is highlighted, as they could be the cornerstone of the development of new methods or the improvement of already existing microrheometric techniques.
•The use of light for the characterization of the intracellular rheological status.•Optical microrheology techniques for less-invasive high-resolution measurements.•Advanced optical microrheometric techniques based on upconverting materials.
The COVID-19 pandemic demonstrates the importance of valuing vaccines from a broad societal perspective (SP), as opposed to a narrower health-payer perspective (HPP). COVID-19's catastrophic global ...impacts extend not only to its health-related effects, but also to the profound macroeconomic losses caused by lockdowns required for disease control, leading to the worst global economic crisis in a century. COVID-19 vaccination (CV) has been the central policy tool for resolving this economic crisis, and it has been hypothesized that this macroeconomic benefit alone justifies the cost of CV many times over. Yet HPP-based vaccine valuations are wholly insensitive to this enormous benefit, not allowing it to influence the allocation of given health budgets nor the determination of the magnitudes of such budgets, thereby risking inadequate societal spending on CV. HPP allocates given health budgets to maximize only health, giving no weight to macroeconomic outcomes, causing allocative inefficiency by not allowing welfare-improving trade-offs of health for wealth. HPP assumes health budgets are optimal, not scrutinizing whether their scale adequately reflects the macroeconomic benefits of health spending, thereby risking productive inefficiency by foregoing health spending increases such as on CV that could raise both population-level health and wealth. These allocative and productive inefficiencies in turn distort for-profit R&D incentives, risking dynamic inefficiency. And since the socio-economic and health burdens of COVID-19 are disproportionately borne by the worse off, HPP's failure to promote optimal levels of societal investment in CV may disproportionately burden the worse off as well, exacerbating inequality. Vaccine valuations from the societal perspective allow the allocation and determination of health budgets to reflect macroeconomic and distributional values, thereby promoting allocative, productive, and dynamic efficiency, as well as equity. These considerations of efficiency and equity support evaluating CV, and to ensure a level playing field, all vaccines, from a societal perspective.
In the US, RSV imposes significant burdens on infants, households, and the health system. Yet the only licensed immunization is accessible to only certain risk groups comprising 2% of the infant ...population, leaving the remaining 98% unprotected. An effective immunization for all infants is a significant public health priority. One possible solution is the FDA-approved monoclonal antibody nirsevimab, which recent evidence suggests is safe and effective in preventing RSV in all infants, and which is currently being considered for inclusion in the pediatric immunization schedule and the federal Vaccines for Children (VFC) program. But the question arises whether
immunization products like nirsevimab ought to be eligible for the VFC, which nominally and traditionally centers on vaccines providing
immunity. Addressing this is urgent because VFC inclusion will be decided on imminently. I argue there are strong policy grounds, i.e., reasons grounded in the ultimate health system goals of maximizing population health or social welfare subject to resource constraints, not to exclude passive immunization from VFC eligibility. Active and passive immunizations both provide adaptive immunity and can therefore produce qualitatively similar effects on risks of infection, disease, and transmission; on disease severity and duration; and on health, welfare, and health resource use. The distinction between active and passive immunization does not intrinsically matter since what matters for the attainment of health system goals is the extent of immunity conferred, not whether immunity is active or passive. Nor can passivity be considered a useful proxy for conferring a lesser extent of immunity, since no such proxy is needed (existing valuation methods can cope with variations in product attributes), and it is a poor proxy (passive immunizations can be better for individuals with impaired immune systems and can have comparable effectiveness durations and economic value as vaccines).
Thirty-eight sediment samples were collected from the inter-tidal beaches of Huatulco located in the Pacific coast of Southern Mexico. They were analyzed for leachable trace metals (LTMs) (As, Cd, ...Co, Cr, Cu, Hg, Mn, Ni, Pb, Zn, Fe) to evaluate the metal concentration caused by the Easter week tourist activities period and before that. Concentration pattern of LTMs indicates that Fe (avg. 7482 mg kg
−1
), Mn (avg. 69.24 mg kg
−1
), Cr (avg. 89.25 mg kg
−1
) are enriched, which is also supported by the correlation of other metals. Geoaccumulation (
I
geo
) and enrichment factor (EF) calculations infer that higher values of Fe, Mn, Cr, and As are not anthropogenic and it is possibly the result of mineralogical assemblage. Comparison of LTMs with other geographical regions and eco-toxicological values deduced from sediment quality guidelines (SQGs) emphasize that As, Cr, Cd, Mn, and Ni are in higher concentrations and the bio-available elements should be monitored.
We analyzed the total (Zn, Pb, Ni, Hg, Cr, Cd, Cu, As) and partially leachable metals (PLMs) in 25 ash and soil samples from recent (2012–2013) eruptions of the Popocatépetl Volcano in Central ...Mexico. More recent ash and soil samples from volcanic activity in 2012–2013 had higher metal concentrations than older samples from eruptions in 1997 suggesting that the naturally highly volatile and mobile metals leach into nearby fresh water sources. The higher proportions of As (74.72 %), Zn (44.64 %), Cu (42.50 %), and Hg (32.86 %) reflect not only their considerable mobility but also the fact that they are dissolved and accumulated quickly following an eruption. Comparison of our concentration patterns with sediment quality guidelines indicates that the Cu, Cd, Cr, Hg, Ni, and Pb concentrations are higher than permissible limits; this situation must be monitored closely as these concentrations may reach lethal levels in the future.
Metallic porous materials are designed to allow the ingrowth of living tissue inside the pores and to improve the mechanical anchorage of the implant. In the present work, tantalum and ...nickel–titanium porous materials have been characterized. The tantalum foams were produced by vapour chemical deposition (CVD/CVI) and the NiTi foams by self-propagating high temperature synthesis (SHS). The former exhibited an open porosity ranging between 65 and 73% and for the latter it ranged between 63 and 68%. The pore sizes were between 370 and 440
μm for tantalum and between 350 and 370
μm for nickel–titanium. The Young's modulus in compression of the foams studied, especially for tantalum, were very similar to those of cancellous bone. This similitude may be relevant in order to minimize the stress shielding effect in the load transfer from the implant to bone. The strength values for NiTi foam are higher than for tantalum, especially of the strain to fracture which is about 23% for NiTi and only 8% for tantalum. The fatigue endurance limit set at 10
8 cycles is about 7.5
MPa for NiTi and 13.2
MPa for tantalum. The failure mechanisms have been studied by scanning electron microscopy.
Bamboo is the building material of the past and future. It offers numerous properties that make it versatile for various applications, including construction. Its impressive strength-to-weight ratio ...enables it to bear substantial loads and stresses, while its good elasticity allows efficient energy absorption. However, its mechanical properties can vary based on factors such as species, age, locations, methods, and treatment. Treating bamboo is essential to enhance its properties and durability. The literature provides various natural and chemical treatments that enhance some of the properties but also reported drawbacks regarding higher temperature, content, and duration. This paper reviewed 57 articles from the Scopus database, specifically focusing on article–document-type publications from the years 2003 to 2023. Additional references were also incorporated to address concerns in properties, treatment, and standards to provide systematic understanding. With extensive assessment of the articles, the following gaps and concerns were observed, and recommendations for further study and assessment were made: the bamboo’s properties, the development of centralized guidelines and procedures for the preparation and processing; the exploration of alternative materials to reinforce bamboo without compromising its ductility; and the development of joint connections, and testing of mechanical properties considering seismic, wind and vibration. For treatment methods, the standardization of procedures using natural, chemical, or a combination. Lastly, for bamboo codes and standards, the assessment of existing codes and standards for testing the mechanical properties of bamboo, highlighting the potential limitations and areas, uniformity, and differences with all existing similar standards. By filling these gaps, it can support the reliability and robustness of bamboo as a sustainable material, fostering its promotion and adoption in the construction industry.
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