Disease Modification in Gout: A Qualitative Study of Gout Expert Rheumatologists

Objective To examine healthcare provider views of disease modification in gout to potentially derive a provisional set of domains for disease modification in gout. Methods We performed a qualitative nominal group (NG) study with 20 gout experts (15 were authors/expert panel members of the 2012 and/or 2020 ACR gout guidelines, and/or 2015 ACR/EULAR gout classification criteria) about what constitutes “disease modification” in gout – “What sorts of things do you think constitute a change in the course of disease in gout? (positive); What are all the ways in which gout as a disease can be modified?” Results Decrease in gout flares was rated #1 rank in all six NGs as indicative of disease modification in gout, followed by serum urate (SU) lowering, which was rated #1 rank in 1 of the 6 NGs (tied score with flares in one NG). Other components of gout disease modification were to improve quality of life/productivity; restore function; reduce/eliminate pain; reduce tophi burden; and joint preservation or resolution of joint damage. Potential additional components that were not ranked in the top 3 votes within each NG were: Decrease healthcare cost/utilization; cardiovascular/renal morbidity/mortality reduction; and stop urate crystals formation. Conclusion This qualitative study provides a provisional set of domains for disease modification in gout. Future studies for the development of thresholds for disease modification domains, and wider consensus on this definition are needed.

Influence of Stiffeners for Improving the Compressive Strength of Ventilated Corrugated Packages Using Finite Element Modelling Technique

The aim of this research is to optimize the corrugated fibreboard (CFB) boxes recommended by the Bureau of Indian Standards (BIS) for packaging apples and suggest improvements for the same with the help of finite element modelling technique. The motivation for the current study grew with the advent of the multipurpose use of corrugated fibreboard as a structural material, particularly for packaging boxes. A standard double walled (DW) panel box is considered for improvements in terms of ventilation slot configuration and reduction in material utilization for manufacturing through the implementation of a single walled (SW) panel box design. In order to maintain the structural integrity upon reduction in box construction material, the concept of stiffener has been introduced as a load-bearing enhancement feature. These enhancements will help establish a rationale and enable the corrugated fibreboard manufacturers and consumers to improve the understanding of the behaviour of such structures and help to check for the cost utilization, avoid overdesign and further mitigate the failures in practical applications. Full depth vertical rectangular slot was found to generate the least stresses and found to be suitable as ventilation slots. With the replacement with SW panel box, a saving in material consumption can be realized amounting to more than 34%. It was found that a 3-ply box configuration with a full-depth ventilation slot with panel stiffener can serve as a potential candidate for the replacement of the current box constituting of 5-ply panels recommended in the context of Indian standards.

Research on the Performance of Solar Aided Power Generation System Based on Annular Fresnel Solar Concentrator

A solar-aided power generation (SAPG) system effectively promotes the high efficiency and low cost utilization of solar energy. In this paper, the SAPG system is represented by conventional coal-fired units and an annular Fresnel solar concentrator (AFSC) system. The annular Fresnel solar concentrator system is adopted to generate solar steam to replace the extraction steam of the turbine. According to the steam–water matrix equation and improved Flugel formula, the variable conditions simulation and analysis of the thermo-economic index were proposed by Matlab. Furthermore, in order to obtain the range of small disturbance, the method of partial replacement is used, that is, the extraction steam of the turbine is replaced from 0 to 100% with a step size of 20%. In this work, a SAPG system is proposed and its thermo-economic index and small disturbance scope are analyzed. The results show that the SAPG system is energy-saving, and the application scope of small disturbance is related to the quantity of the extraction steam and evaluation index.

Adequacy of DEA in Measuring the Efficiency of Public Sector Entities in Nigeria: A Comparative Analysis Approach

The study examined the efficiency of Decision- Making Units (DMUs) in the public sector entities in Nigeria. The study focused on the efficiency in the utilization of personnel cost releases to the federal educational and health institutions by the Federal Government of Nigeria. Secondary data were sourced from the Annual General Warrants from Audited financial statements of the Public Sector entities. Sampled size for the study comprised twenty-five (25) DMUs each from both sectors out of the major Federal Ministries from four (4) geo-political Zones and Abuja. Data were analyzed using Data Envelopment Analysis Model (DEA). The results of the average efficiency scores from both Charnes, Cooper and Rhodes Model (CCR) and Banker, Charnes and Cooper (BCC) on the DMUs showed that the sectors were marginally inefficient. The summary of the overall results therefore revealed that the DMUs under health sector performed averagely better than education sector in the utilization of personnel cost allocations. The study recommended that a central monitoring team be created jointly by the Federal Ministry of Finance and Accountant-General’s office to ensure full utilization of personnel cost releases to the DMUs. The study therefore concluded that only continuous assessment and periodic appraisal of the personnel cost utilization by the supervising ministries, can guarantee full efficiency in the utilization of personnel cost releases.

Lower Diagnostic Costs Associated with Early Deployment of Capsule Endoscopy in Non-Hematemesis Gastrointestinal Bleeding: a Cost-Utilization Analysis

Introduction: Often, the diagnostic workup of patients presenting with non-hematemesis gastrointestinal bleeding (NHGIB) is inconclusive. Consequently, the diagnostic evaluation may incur unnecessary health care costs and diagnostic times. The use of a cost decision-analytical model of the current diagnostic management strategy applied to patients presenting with NHGIB may reveal alternative strategies for the evaluation of NHGIB.Methods: Cost decision-analytical model that retrospectively follows the diagnostic course of 231 consecutive patients presenting with NHGIB to the emergency department (ED) of a tertiary medical center. We measured the effect (cost and relative times) of selecting a specific procedure, plus the effect of pursuing secondary procedures after non-diagnostic primary procedures. Results: A primary VCE had a diagnostic rate of 68% vs. 45% and 48% for a primary EGD and COLO, respectively. Combining the diagnostic rates for each primary procedure with the cost of performing subsequent procedures (after non-diagnostic primary procedures), demonstrates the primary use of VCE (n=9) results in a total cost of $12,146 vs. $12,746 and $13,162 for a primary EGD (n=47) and COLO (n=33), respectively. Similarly, the use of VCE as a primary diagnostic procedure in NHGIB patients admitted to the floor would take 74 unit hours to reach a diagnosis compared to 104 and 131 for EGD and COLO, respectively. Conclusion: Our model suggests initial use of VCE for the diagnosis of acute NHGIB, may reduce time to diagnosis and management costs.

Lower Diagnostic Costs Associated With Early Deployment of Capsule Endoscopy in Non-hematemesis Gastrointestinal Bleeding: A Cost-utilization Analysis

Introduction: Often, the diagnostic workup of patients presenting with non-hematemesis gastrointestinal bleeding (NHGIB) is inconclusive. Consequently, the diagnostic evaluation may incur unnecessary health care costs and diagnostic times. The use of a cost decision-analytical model of the current diagnostic management strategy applied to patients presenting with NHGIB may reveal alternative strategies for the evaluation of NHGIB.Methods: Cost decision-analytical model that retrospectively follows the diagnostic course of 231 consecutive patients presenting with NHGIB to the emergency department (ED) of a tertiary medical center. We measured the effect (cost and relative times) of selecting a specific procedure, plus the effect of pursuing secondary procedures after non-diagnostic primary procedures.Results: A primary VCE had a diagnostic rate of 68% vs. 45% and 48% for a primary EGD and COLO, respectively. Combining the diagnostic rates for each primary procedure with the cost of performing subsequent procedures (after non-diagnostic primary procedures), demonstrates the primary use of VCE (n=9) results in a total cost of $12,146 vs. $12,746 and $13,162 for a primary EGD (n=47) and COLO (n=33), respectively. Similarly, the use of VCE as a primary diagnostic procedure in NHGIB patients admitted to the floor would take 74 unit hours to reach a diagnosis compared to 104 and 131 for EGD and COLO, respectively.Conclusion: Our model suggests initial use of VCE for the diagnosis of acute NHGIB, may reduce time to diagnosis and management costs.