Long-term third-party assessment of results after continent cutaneous diversion with Lundiana pouch

2017 ◽  
Vol 120 (4) ◽  
pp. 530-536 ◽  
Author(s):  
Fredrik Liedberg ◽  
Sigurdur Gudjonsson ◽  
Abai Xu ◽  
Pär-Ola Bendahl ◽  
Thomas Davidsson ◽  
...  
2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Takahiro Kinoshita ◽  
Kensuke Moriwaki ◽  
Nao Hanaki ◽  
Tetsuhisa Kitamura ◽  
Kazuma Yamakawa ◽  
...  

Abstract Background Hybrid emergency room (ER) systems, consisting of an angiography-computed tomography (CT) machine in a trauma resuscitation room, are reported to be effective for reducing death from exsanguination in trauma patients. We aimed to investigate the cost-effectiveness of a hybrid ER system in severe trauma patients without severe traumatic brain injury (TBI). Methods We conducted a cost-utility analysis comparing the hybrid ER system to the conventional ER system from the perspective of the third-party healthcare payer in Japan. A short-term decision tree and a long-term Markov model using a lifetime time horizon were constructed to estimate quality-adjusted life years (QALYs) and associated lifetime healthcare costs. Short-term mortality and healthcare costs were derived from medical records and claims data in a tertiary care hospital with a hybrid ER. Long-term mortality and utilities were extrapolated from the literature. The willingness-to-pay threshold was set at $47,619 per QALY gained and the discount rate was 2%. Deterministic and probabilistic sensitivity analyses were conducted. Results The hybrid ER system was associated with a gain of 1.03 QALYs and an increment of $33,591 lifetime costs compared to the conventional ER system, resulting in an ICER of $32,522 per QALY gained. The ICER was lower than the willingness-to-pay threshold if the odds ratio of 28-day mortality was < 0.66. Probabilistic sensitivity analysis indicated that the hybrid ER system was cost-effective with a 79.3% probability. Conclusion The present study suggested that the hybrid ER system is a likely cost-effective strategy for treating severe trauma patients without severe TBI.


Animals ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 830
Author(s):  
Temple Grandin

In the U.S., the most severe animal welfare problems caused by COViD-19 were in the pork industry. Thousands of pigs had to be destroyed on the farm due to reduced slaughter capacity caused by ill workers. In the future, both short-term and long-term remedies will be needed. In the short-term, a portable electrocution unit that uses scientifically validated electrical parameters for inducing instantaneous unconsciousness, would be preferable to some of the poor killing methods. A second alternative would be converting the slaughter houses to carcass production. This would require fewer people to process the same number of pigs. The pandemic revealed the fragility of large centralized supply chains. A more distributed supply chain with smaller abattoirs would be more robust and less prone to disruption, but the cost of pork would be greater. Small abattoirs can coexist with large slaughter facilities if they process pigs for specialized premium markets such as high welfare pork. The pandemic also had a detrimental effect on animal welfare inspection and third party auditing programs run by large meat buyers. Most in-person audits in the slaughter plants were cancelled and audits were done by video. Video audits should never completely replace in-person audits.


2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Katie Dunkley ◽  
Jo Cable ◽  
Sarah E. Perkins

AbstractMutualistic interactions play a major role in shaping the Earth’s biodiversity, yet the consistent drivers governing these beneficial interactions are unknown. Using a long-term (8 year, including > 256 h behavioural observations) dataset of the interaction patterns of a service-resource mutualism (the cleaner-client interaction), we identified consistent and dynamic predictors of mutualistic outcomes. We showed that cleaning was consistently more frequent when the presence of third-party species and client partner abundance locally increased (creating choice options), whilst partner identity regulated client behaviours. Eight of our 12 predictors of cleaner and client behaviour played a dynamic role in predicting both the quality (duration) and quantity (frequency) of interactions, and we suggest that the environmental context acting on these predictors at a specific time point will indirectly regulate their role in cleaner-client interaction patterns: context-dependency can hence regulate mutualisms both directly and indirectly. Together our study highlights that consistency in cleaner-client mutualisms relies strongly on the local, rather than wider community—with biodiversity loss threatening all environments this presents a worrying future for the pervasiveness of mutualisms.


2021 ◽  
Vol 58 (3) ◽  
Author(s):  
Torbjörn Bildtgård ◽  
Marianne Winqvist ◽  
Peter Öberg

The increasing prevalence of ageing stepfamilies and the potential of stepchildren to act as a source of support for older parents have increased the interest in long-term intergenerational step relationships. Applying a life-course perspective combined with Simmel’s theorizing on social dynamics, this exploratory study aims to investigate the preconditions for cohesion in long-term intergenerational step relationships. The study is based on interviews with 13 older parents, aged 66–79, who have raised both biological children and stepchildren. Retrospective life-course interviews were used to capture the development of step relationships over time. Interviews were analysed following the principles of analytical induction. The results reveal four central third-party relationships that are important for cohesion in intergenerational step relationships over time, involving: (1) the intimate partner; (2) the non-residential parent; (3) the bridge child; and (4) the stepchild-in-law. The findings have led to the conclusion that if we are to understand the unique conditions for cohesion in long-term intergenerational step relationships, we cannot simply compare biological parent–child dyads with step dyads, because the step relationship is essentially a mediated relationship.


2021 ◽  
Vol 12 (1) ◽  
pp. 135-146
Author(s):  
E.A. Ejem ◽  
C.M. Uka ◽  
D.N. Dike ◽  
C.C. Ikeogu ◽  
C.C. Igboanusi ◽  
...  

Abstract This paper is focused on solving the evaluation and selection of 3PL’s by applying multi-criteria decision-making methods. Nigerian Breweries, Nigerian Bottling Company (NBC), AG Leventis, Kobo logistics, and Flour Mills of Nigeria (FMN) were understudied. The main criteria on which evaluation is based were established: Cost, Service level, Financial Capability, Reputation and Long-term relationship. A combination of two quantitative models was adopted in the study. Relevant data were collected through an oral interview with managers and key decision-makers at the companies. SWARA was first applied to the collated data to determine the relative weights of the criteria. Afterwards, the TOPSIS was applied to the weights developed using SWARA and on the performance of the selected service providers. After the analysis, the best service provider was identified as supplier 2 while the worst was supplier 5.


2012 ◽  
Vol 8 (2) ◽  
pp. 34-38
Author(s):  
Mark T. Kozlowski

The 2012 primary season has been one of the most volatile in recent memory, with the Republican Party struggling to settle on a candidate. The campaign has also vaulted some previously obscure politicians to national prominence, only to relegate them again to obscurity. Ron Paul has demonstrated perhaps the most dramatic transformation, from a lone voice who was once largely ignored to one of the last four candidates for the nomination, who has performed quite creditably in several primaries. In this article, I examine how much influence Paul is going to have in the short term, up to and including the Republican National Convention. I also examine how lasting his influence will be over the long term, and whether or not he will mount a third-party bid in 2012.


Author(s):  
Elizabeth Fife ◽  
Laura Hosman

This paper analyses the recent phenomenon of private/public partnerships (PPPs) in the ICT sector of the developing world. The partners may come to these projects with divergent motivations: profit on the one hand and the provision of public services on the other, but at the end of the day, the interests of the partners that are symbiotic can – and indeed should – be aligned to ensure successful long-term projects. To investigate what can be done to promote successful and sustainable PPPs, this paper extends the traditional two-actor analysis to include both a third-party non-profit-oriented facilitating organization and the technology recipients that are the targets of these projects. Following an overview of the current state of PPPs in the developing world, the paper provides two case studies, based in Vietnam, where all four of the above-mentioned stakeholders were involved. The cases reveal important success factors that can be applied to future PPPs in the ICT sector.


Vascular ◽  
2013 ◽  
Vol 21 (3) ◽  
pp. 149-156 ◽  
Author(s):  
Bauer E Sumpio

There are many stakeholders in the vascular marketplace from clinicians to hospitals, third party payers, medical device manufacturers and the government. Economic stress, threats of policy reform and changing health-care delivery are adding to the challenges faced by vascular surgeons. Use of Porter's Five Forces analysis to identify the sources of competition, the strength and likelihood of that competition existing, and barriers to competition that affect vascular surgery will help our specialty understand both the strength of our current competition and the strength of a position that our specialty will need to move to. By understanding the nature of the Porter's Five Forces as it applies to vascular surgery, and by appreciating their relative importance, our society would be in a stronger position to defend itself against threats and perhaps influence the forces with a long-term strategy. Porter's generic strategies attempt to create effective links for business with customers and suppliers and create barriers to new entrants and substitute products. It brings an initial perspective that is convenient to adapt to vascular surgery in order to reveal opportunities. Vascular surgery is uniquely situated to pursue both a differentiation and high value leadership strategy.


Sign in / Sign up

Export Citation Format

Share Document