Development of Deflection Prediction Model for Interlocking Concrete Block Pavements

Interlocking concrete block pavement (ICBP) is one of the pavement types adopted worldwide, as it is economical and exhibits improved structural performance. The primary objective of the present study was to develop a deflection prediction model for ICBP considering the most influential parameters using the plate load test. The finite element method (FEM) based software PLAXIS was also employed to predict the plate load deflection to reduce laboratory cost and time. Statistical analysis was carried out to assure the identical deflection values between the laboratory plate load test and FEM analysis. Sensitivity analysis was performed to finalize the most significant parameters for developing the deflection prediction model using the Design Expert software. Two deflection models were predicted for zigzag shape blocks with two laying patterns: stretcher and herringbone. The model was developed in SPSS software by performing 1,680 trial experiments. The results from ANOVA statistical analysis proved that the developed model possessed a significant fit for a 95% confidence level. The predicted deflection model was validated using field deflection measurements obtained from four different roads using Benkelman beam deflection (BBD) and light weight deflectometer (LWD). Statistical two-tailed test results proved that the predicted deflection model was compatible with the observed field deflection value.

Comparison of targeted metagenomics and IS-Pro methods for analysing the lung microbiome

Background Targeted metagenomics and IS-Pro method are two of the many methods that have been used to study the microbiome. The two methods target different regions of the 16 S rRNA gene. The aim of this study was to compare targeted metagenomics and IS-Pro methods for the ability to discern the microbial composition of the lung microbiome of COPD patients. Methods Spontaneously expectorated sputum specimens were collected from COPD patients. Bacterial DNA was extracted and used for targeted metagenomics and IS-Pro method. The analysis was performed using QIIME2 (targeted metagenomics) and IS-Pro software (IS-Pro method). Additionally, a laboratory cost per isolate and time analysis was performed for each method. Results Statistically significant differences were observed in alpha diversity when targeted metagenomics and IS-Pro methods’ data were compared using the Shannon diversity measure (p-value = 0.0006) but not with the Simpson diversity measure (p-value = 0.84). Distinct clusters with no overlap between the two technologies were observed for beta diversity. Targeted metagenomics had a lower relative abundance of phyla, such as the Proteobacteria, and higher relative abundance of phyla, such as Firmicutes when compared to the IS-Pro method. Haemophilus, Prevotella and Streptococcus were most prevalent genera across both methods. Targeted metagenomics classified 23 % (144/631) of OTUs to a species level, whereas IS-Pro method classified 86 % (55/64) of OTUs to a species level. However, unclassified OTUs accounted for a higher relative abundance when using the IS-Pro method (35 %) compared to targeted metagenomics (5 %). The two methods performed comparably in terms of cost and time; however, the IS-Pro method was more user-friendly. Conclusions It is essential to understand the value of different methods for characterisation of the microbiome. Targeted metagenomics and IS-Pro methods showed differences in ability in identifying and characterising OTUs, diversity and microbial composition of the lung microbiome. The IS-Pro method might miss relevant species and could inflate the abundance of Proteobacteria. However, the IS-Pro kit identified most of the important lung pathogens, such as Burkholderia and Pseudomonas and may work in a more diagnostics-orientated setting. Both methods were comparable in terms of cost and time; however, the IS-Pro method was easier to use.

FACTORS ASSOCIATED WITH THALASSAEMIA CARRIER AMONG FORM FOUR STUDENTS IN KEDAH, MALAYSIA

Thalassaemia and abnormal haemoglobins are the most common genetic disorder worldwide. School-based screening thalassaemia program for form four students was introduced with the objective to screen for the thalassaemia status. There is paucity in the data in Kedah on distribution of thalassaemia carrier and the associated factors. Hence this study aims to identify the factors associated with being a thalassaemia carrier and to describe the laboratory cost for the thalassaemia screening. This study used secondary data from the school-based thalassaemia screening in 2018 obtained from Kedah State Health Department. Results showed the prevalence of thalassaemia carrier among form four students in Kedah was 10.91%. Multivariate logistic regression showed that students from Baling, Padang Terap and Yan were 1.40, 1.34 and 1.23 times more likely to be a thalassaemia carrier respectively compared to Kota Setar (aOR Baling 1.40;95% CI 1.21,1.64; aOR Padang Terap 1.34;95% CI 1.11,1.61 and aOR Yan 1.23;95% CI 1.03,1.47). Malay and Siamese students were five times more likely be thalassaemia carriers compared to Indian (aOR Malay 5.16;95%CI 3.42,7.79, aOR Siamese 5.63;95%CI 3.19,9.97). Meanwhile, Chinese students had 2.61 higher odds to be a thalassaemia carrier compared to Indian (aOR Chinese 2.61;95%CI 1.65,4.12). The laboratory cost for the thalassaemia screening ranged from RM2.14 to RM142.14 per participant. As for conclusion, this study reported high prevalence (10.91%) of thalassaemia carriers in Kedah. Our study also confirmed that the district and the ethnicity significantly influenced the thalassaemia carrier status. The identified factors should inform future thalassaemia campaign to prevent higher prevalence of thalassaemia patients.

Potentially inappropriate testing for vitamin D deficiency: a cross-sectional study in Switzerland

Background There is consensus that vitamin D supplementation is often indicated but population-based screening by laboratory testing for vitamin D deficiency is inadequate. Testing should be restricted to people at high risk of severe deficiency. This study describes the current lab testing for vitamin D deficiency in the adult population of Switzerland. Methods We assessed Swiss health insurance data (SWICA) for incidence of lab testing for vitamin D levels, comparing the years 2015 and 2018. Claims were analyzed for associations between lab testing and age, sex, medical indications, insurance status and geographic location in multivariable regression analyses. We also estimated the costs of vitamin D testing. Results Data from 200,043 and 200,046 persons for 2015 and 2018, respectively, were analyzed. Vitamin D level was tested in 14% of the sample population in 2015 and 20% in 2018. Testing increased by 69% for individuals aged 26–30. Testing was associated with being middle-aged to young senior citizens, female, medical indications (pregnancy, renal disease, osteoporosis, hyperparathyroidism, HIV, glucocorticoid intake), more chronic conditions, having a mandatory insurance with a low deductible, additional insurance coverage, and living in urban areas. We estimate that the total laboratory cost to mandatory insurance was about 90 million Swiss francs in 2018. Conclusions Despite recommendations for routine vitamin D supplementation, vitamin D testing of low risk individuals is common and increasing in Switzerland.

Analisis Efektivitas Biaya Terapi Antihipertensi Kombinasi Tetap Di Satu Rumah Sakit Jakarta Selatan

The majority of alternative antihypertensive therapies require pharmacoeconomic studies, particularly Cost Effectiveness Analysis, which is useful in balancing patients’ expenditure by determining alternative treatments that represented the most plausible health outcomes with a more reasonable budget. The objective of this study was to compare the cost effectiveness using antihypertensive fixed dose combinations (FDC) of Valsartan-Amlodipine + Furosemide and FDC of Valsartan-HCT + Amlodipin. This research applied the descriptive analytical cross-sectional method and conducted data collection retrospectively from the medical record of hypertensive patients. Meanwhile, the medication cost breakdown was obtained from Outpatient Financial Department of a Type B Hospital in south Jakarta for the period of January - June 2018. Total sample were 74 patients, consisted of 37 patients who used FDC of Valsartan-Amlodipin + Furosemide, and 37 patients who used FDC of Valsartan-HCT + Amlodipin. The parameters of this research were direct medication cost (consisted of examination cost, laboratory cost and medicines cost), indirect medication cost (consisted accommodation cost and lost productivity cost), while the effectiveness used the MAP average (Mean Arterial Pressure). The result of this research showed that the biggest medication effectiveness to lower the blood pressure is FDC of Valsartan-Amlodipin + Furosemide, with 32 patients had the average MAP 101,29 mmHg, while the FDC of Valsartan-HCT + Amlodipin with 29 patients had the average MAP 103,59 mmHg. The cost effectiveness based on ACER value of FDC of Valsartan –HCT + Amlodipin and FDC Valsartan-HCT + Amlodipin sequentially is Rp 3.922.040/MAP and Rp 4.458.034/MAP. In conclusion, the FDC of Valsartan-Amlodipin + Furosemide was more cost-effective.

Cost-effectiveness Analysis of Per-abdominal and Laparoscopic Cholecystectomy

Cholelithiasis is one of the major problems which need cholecystectomy. Laparoscopic cholecystectomy is a newer technique. But there is a need to evaluate the cost-effectiveness of per-abdominal and laparoscopic method from patients perspective. The study was performed to assess the cost-effectiveness of per-abdominal and laparoscopic cholecystectomy. Materials and Methods: This cross sectional study in two sample situations was conducted among 90 purposively selected cholecystectomy patients of which 60 patients underwent laparoscopic cholecystectomy (LC) and 30 patients underwent per-abdominal cholecystectomy (PAC) from three tertiary level government hospitals of Dhaka, Bangladesh at the time of their discharge through face to face interview using a semi-structured questionnaire and checklist. The study found average age 45.33(13.63) and 41.75(13.39) years in PAC and LC respectively. Average monthly income was less in the PAC group Tk.23200.00(12374.61) than LC Tk.24925.00(12166.86). Average duration of suffering from cholelithiasis was 9.50(8.68) months in PAC group and 12.43(17.49) months in LC group. Average hospital stay was 13.97(6.88) days in PAC group while it was 12.02(6.66) days in LC group. Average treatment cost was little higher Tk.21927.407795.89 in LC group than Tk.21466.306261.42 in the PAC group. Both direct cost and indirect cost were also higher in LC group (Tk.18668.305965.67 and Tk.3661.324229.85) than in PAC group (Tk.18228.004624.75 and Tk.3350.004124.58). But these differences were not statistically significant. In both groups treatment cost significantly increased with duration of hospitalization (correlation, p<0.01). Cure rate was significantly high in LC group (94.4%) than in PAC group (86.7%) (χ2, p<0.05). This study revealed LC method is cost-effective than PAC method. Total treatment cost in LC can be reduced by minimizing hospital cost, laboratory cost and securing the income of the patients which enhance the economic load.

A substitute to xylene in deparaffinization and clearing prior to coverslipping in histopathology

INTRODUCTION: Deparaffinization and clearing prior to coverslipping are important steps in all staining methods in histopathology. Xylene is the most commonly used agent worldwide. However, xylene is toxic. We evaluated safer alternative dewaxing and clearing agents prior to coverslipping in a histopathology laboratory. MATERIALS AND METHODS: Thirteen different fresh surgical tissues were cut into two halves. One half processed using xylene and the other half processed using UltraClear™. Five groups were designed. For each Group of A, B, C, and D, 100 slides were cut from xylene-processed blocks. For Group E, 100 slides were cut from UltraClear™-processed blocks. Group A is the standard method. Group B evaluates UltraClear™ as a dewaxing agent only. Group C evaluates UltraClear™ as a clearing agent prior to coverslipping only. Group D evaluates UltraClear™ as both dewaxing and clearing agents prior to coverslipping. Group E evaluates UltraClear™ as both dewaxing and clearing agents prior to coverslipping. Six parameters were evaluated: nuclear staining, cytoplasmic staining, cell morphology, clarity of staining, uniformity of staining, and cost. RESULTS: Groups B, C, and D showed 79% (P = 0.054), 83% (P = 0.221), and 80% (P = 0.079) adequacy when compared with Group A (89%), respectively. However, Group E showed only 76% (P = 0.016) adequacy. UltraClear™ is more expensive than xylene. CONCLUSION: UltraClear™ is a promising dewaxing agent. It is also a good clearing agent for use prior to coverslipping in histopathology laboratory. Cost-benefit balance between safety of laboratory workers, good quality staining, and cost-effective strategy needs to be further studied.

Retrospective evaluation of a local protocol used to enhance laboratory savings through minimizing the performance of alkaline phosphatase isoenzyme analysis

Background Alkaline phosphatase isoenzyme analysis is an expensive and time-consuming laboratory test. We evaluated the effect of a locally derived screening algorithm for alkaline phosphatase isoenzyme requests on the number of alkaline phosphatase isoenzyme analyses performed, laboratory cost and patient care. Method A total of 110 alkaline phosphatase isoenzyme analysis requests from the year 2015 were reviewed and subsequent alkaline phosphatase concentrations were monitored over a two-year period, to determine if the decision of performing/not performing alkaline phosphatase isoenzyme analysis, based on the algorithm, had an impact on patient care and laboratory cost. All alkaline phosphatase isoenzyme analysis requests with two consecutive elevated alkaline phosphatase concentrations (>upper limit of reference interval) were screened and, subject to the gamma glutamyl transferase being within the reference interval, either Bone alkaline phosphatase or 25 hydroxyvitamin D was measured depending on the age of the patient. Results Compliance with this algorithm led to the normalization of subsequent serum alkaline phosphatase in 97% of patients without requiring alkaline phosphatase isoenzyme analysis. The cost of performing Bone alkaline phosphatase and 25 hydroxyvitamin D in-house was £778.50, while the cost of performing alkaline phosphatase isoenzyme analysis would have been £3040. This resulted in a laboratory saving of £2261.50. Conclusions Implementation of this algorithm led to a significant reduction in alkaline phosphatase isoenzyme analysis, without compromising patient care. Total savings could be increased if 25 hydroxyvitamin D was used as a first-line test, for all patients with an elevated alkaline phosphatase and a normal gamma glutamyl transferase regardless of age. This algorithm is cost-effective and can be implemented in laboratories with 25 hydroxyvitamin D assay.

Duplicate Type and Screen Testing: Waste in the Clinical Laboratory

Context.— In the United States, approximately $65 billion dollars is spent per year on clinical laboratory testing, of which 20% to 30% of all testing is deemed inappropriate. There have been multiple studies in the field of transfusion medicine regarding evidence-based transfusion practices, but limited data exist regarding inappropriate pretransfusion testing and its financial and clinical implications. Objective.— To assess duplicative testing practices in the transfusion medicine service. Design.— A 24-month retrospective review was performed at a 1025-bed tertiary care center, identifying all duplicate type and screen (TS) tests performed within 72 hours of the previous TS. Duplicative testing was classified as appropriate or inappropriate by predetermined criteria. The level of underordering was analyzed through a query of the electronic event reporting system. A cost analysis was performed to determine the financial impact of inappropriate duplicative TS. Results.— The mean rate of inappropriate, duplicative TS orders was 4.13% (standard deviation ± 4.09%). Rates of inappropriate ordering ranged from 0.01% to 15.5% depending on the clinical service and did not correlate with volume of tests ordered. There were 8 reported cases of delayed blood delivery due to lack of a valid TS during the study period, demonstrating that underordering is also a harmful practice. The laboratory cost of inappropriate testing for the study period was $80,434, and phlebotomy costs were $45,469. Conclusions.— Our study demonstrates that inappropriate TS ordering is costly, both financially and clinically. By evaluating the percentage of inappropriate TS tests by clinical services, we have identified services that may benefit from additional education and technologic intervention.