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A simulation model for determination of the economic production rate of the auto analyzer system.

1. The problem is considered of determining the appropriate rate of operation of an Auto Analyzer System. A computer model is presented which simulates the operation of the system, so as to describe the frequency of such events as repeated samples. 2. Estimates may be obtained of average total running costs, incorporating those of consumables and technician time and the rate which minimises the average cost, subject to stated test quality constraints, may then be calculated.

Autoanalysis

An economic evaluation of present and proposed methods of compensating hearing loss.

The basis for compensation of industrial hearing loss in the Province of Ontario is described, and contrasted with schemes utilized in other parts of Canada, United Kingdom, Australia, and the United States. Changes are suggested for the method used to derive the percentage of permanent disability related to hearing loss. A randomly selected population of claimants for industrial hearing loss have been used to model the economic effect of such changes, which are discussed.

Audiometry

Enteropathogenicity testing of Treponema hyodysenteriae in ligated colonic loops of swine.

Multiple, ligated loops of swine colon were used as an in vivo model in which to test enteropathogenicity of isolates of Treponema hyodysenteriae. Gross and microscopic lesions observed in 21 of 22 colonic loops in pigs killed 48 to 72 hours after inoculation with isolates known to be enteropathogenic were characteristic of swine dysentery. These lesions were not observed in 12 loops exposed to uninoculated media or in 12 loops inoculated with nonpathogenic isolates of T hyodysenteriae. The swine-loop technique provides a relatively rapid, economical, reliable model in which to test enteropathogenicity of T hyodysenteriae isolates.

Animals

Estrone disrupts early reproductive development in juvenile male Siniperca chuatsi and is associated with brain and gonadal responses.

Whether estrone (E1)-associated disruption of early reproductive development in fish is accompanied by brain responses in addition to direct gonadal effects remains unclear. Here, juvenile Siniperca chuatsi, a non-model but economically important freshwater species, were exposed for 60 d to 0, 0.01, 0.1, and 1.0 μg/L E1, spanning environmentally reported and elevated concentrations. By integrating waterborne concentration monitoring, histopathology, transcriptomics, and quantitative real-time PCR (qPCR) validation, we evaluated E1-associated changes in brain and gonadal tissues during early reproductive development. Waterborne E1 concentrations remained generally stable throughout the exposure period. At the highest tested concentration (1.0 μg/L), E1 caused neuronal vacuolation and pyknosis in the hypothalamic region and induced distinct ovarian-like structures in the gonads of genetic males. In the brain, cyp19a1, crhr1, and adcy2a were significantly upregulated, whereas egr1 was significantly downregulated, indicating transcriptional changes in genes associated with local estrogen conversion, stress-response/cAMP signaling, and neuronal activity-related regulation within a broader injury/stress-response background. In the gonad, RNA-seq analysis showed significant downregulation of star2, hsd3b1, cyp17a1, and cyp11b and significant upregulation of hsd17b1, suggesting alterations in steroidogenesis-related gene expression at the transcriptomic level. qPCR analysis of selected gonadal candidate genes showed expression directions generally consistent with the RNA-seq results, and these molecular patterns were consistent with the feminized histological phenotype. Together, these results indicate that E1 can disrupt early reproductive development in juvenile S. chuatsi and support a cautious working model in which E1 exposure is accompanied by concurrent brain and gonadal responses. This study provides new evidence for understanding the toxic effects and ecological risk implications of natural estrogen E1 during early fish development.

Animals

Cost-effectiveness of alternative cascade screening strategies for familial hypercholesterolemia with realistic cascade screening acceptance rates and use of novel treatment.

BACKGROUND AND AIMS: Cascade screening (CS) for familial hypercholesterolemia (FH) has been found to be cost-effective in many published studies. However, most existing studies (i) ignored or overstated first-degree relative (FDR) participation rate (as 60-100 %), (ii) did not consider novel and expensive therapies, e.g. PCSK9 inhibitors (PCSK9i), and (iii) were conducted outside of Asia. This study, conducted in Singapore, where FDR participation rate is about 25 % among probands who have known pathogenic variants, aims to identify drivers of cost-effectiveness of CS protocols for FH. METHODS: Four CS protocols, which vary in the application of genetic tests, were examined using a hybrid decision tree-Markov model. Sensitivity analyses were conducted to identify drivers of cost-effectiveness. RESULTS: Cascade acceptance rates are key drivers of cost-effectiveness. Other drivers include age of proband, prevalence of FH among probands, health-related quality of life loss with cardiovascular disease, timeliness of starting treatment post-screening, treatment effectiveness, cost of PCSK9i and discount rate for cost and QALY. With cascade acceptance rates observed in Singapore, among various screening protocols examined, probabilities of being cost-effective ranged from 86 % to 95 % when no access to PCSK9i and ranged from 75 % to 98 % when PCSK9i are provided. The most cost-effective protocol differs depending on cascade acceptance rates and whether PCSK9i is provided. CONCLUSION: For better cost-effectiveness of CS for FH, health systems need to look for ways to improve proband's willingness to share contact of their relatives and relatives' willingness to be screened and to lower the cost of novel treatment. Other ways to improve cost-effectiveness include to select age groups for proband screening, improve screening detection rate among probands, and start timely treatment post-screening.

Humans

Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis.

BACKGROUND AND AIMS: Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives. METHODS: We constructed and validated a multi-state microsimulation Markov model for a population of 10,000 individuals aged between 40 and 69 years without CVD, selected randomly from the UK Biobank. The model evaluated Lp(a) testing in individuals not initially classified as high-risk based on age, diabetes status, or the SCORE-2 algorithm. Those with an Lp(a) level ≥105 nmol/L (50 mg/dL) were treated as high risk (initiation of a statin plus blood pressure lowering). The Lp(a) testing intervention was compared to standard of care. The primary analyses were conducted from the Australian and UK healthcare perspectives in 2023AUD/GBP. A cost adaptation method estimated cost-effectiveness in multiple European countries, Canada, and the USA. RESULTS: Among 10,000 individuals, 1,807 had their treatment modified from Lp(a) testing. This led to 217 and 255 quality-adjusted life years gained in Australia and the UK, respectively, with corresponding incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving). From a societal perspective, Lp(a) testing saved $85 and £263 per person in Australia and the UK, respectively. Lp(a) testing was cost-saving among all countries tested in the cost adaptation analysis. CONCLUSIONS: Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD.

Humans

Acute and chronic pancreatitis in the rat caused by a closed duodenal loop.

A closed duodenal loop was created by the obstruction of the duodenum on either side of the common bile duct. Acute haemorrhagic pancreatitis developed within 24 h with interlobular oedema, marked acinar cell necrosis, intra-abdominal fat necrosis and ascites. Plasma amylase activity was greatly increased together with a marked decrease in albumin. There was a temporary abnormality of liver function tests due to obstruction of bile. When the duodenal obstruction was released and the animals allowed to survive there was at 3 weeks a marked reduction in the pancreatic acinar cells with fibrosis and areas of necrosis and chronic inflammatory cell infiltration. Plasma amylase activity was normal but there was an increase in total plasma protein at 3 weeks. This technique of a closed duodenal loop in the rat gives a simple, reliable and economic experimental model for studies on acute and chronic fibrotic pancreatitis.

Acute Disease

Human rights, health, and capital accumulation in the Third World.

This article examines the relationship between human rights and the pattern of capital accumulation in the Third World. The repressive authoritarian State increasingly constitutes the means for enforcing the intensive exploitation of labor in Third World industrial enclaves and commercial agriculture. While the development of center capitalism has evolved toward "the Welfare State" and a framework of liberal sociodemocracy, the "peripheral State" is generally characterized by nondemocratic forms of government. This bipolarity in the state structure between center and periphery is functionally related to the international division of labor and the unity of production and circulation on a world level. The programs and policies of the center Welfare State (health, education, social security, etc.) constitute an input of "human capital" into the high-technology center labor process. Moreover, welfare programs in center countries activate the process of circulation by sustaining high levels of consumer demand. In underdeveloped countries, the underlying vacuum in the social sectors and the important allocations to military expenditure support the requirements of the peripheral labor process. Programs in health in the center and periphery are related to the bipolarity (qualification/dequalification) in the international division of labor. The social and economic functions of health programs are intimately related to the organic structure of the State and the mechanics whereby the State allocates its financial surplus in support of both capitalist production and circulation.

Africa

Securing funding.

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Audiovisual Aids

The impact of occupational licensure of clinical laboratory personnel.

This paper develops a model of the economic impact of occupational licensure. The model is then used to estimate the effects of occupational licensure on wages and the division of labor in clinical laboratories and to generate a low-bound estimate of the welfare impact of licensure. Estimates are based on cross-section and time-series data on areas with and without licensure of laboratory personnel. Recent licensure laws have no effect on wages or employment, but older, more stringent laws sharply increase the wages and employment of skilled personnel in laboratories.

Allied Health Personnel

Synaptic depression at a synapse in Aplysia californica: analysis in terms of a material flow model of neurotransmitter.

When a pair of stimuli separated by an appropriate interval is given to the right visceropleural connective of Aplysia californica the amplitude of the second EPSP elicited in cell R15 is usually smaller than the amplitude of the first EPSP. In the present paper we show that this phenomenon, synaptic depression, can be analyzed in terms of the material flow model of neurotransmitter economics developed in our preceding publications. We specifically show how changes in the 4 model parameters; A, the available pool of transmitter; F, the fraction of the available pool released by a presynaptic action potential; M, the rate of transmitter mobilization into the available pool; and D, the rate constant of demobilization of transmitter from the available pool, all effect synaptic depression. In addition, we show how transient changes in F and M, that are observed immediately and for seconds after a stimulus, influence the time course of synaptic depression. Using this analysis we then tested our previous inferences about changes in the model parameters produced either by pharmacological manipulations or repetitive stimulation, by comparing the observed effects of these manipulations on synaptic depression with the theoretical predictions. The theoretical and experimental findings agreed, thereby strengthening both our previous conclusions of the mode of action of these manipulations and the model itself.

Animals