Systematic review of cost effectiveness studies of telemedicine interventions

ObjectivesTo systematically review cost benefit studies of telemedicine.DesignSystematic review of English language, peer reviewed journal articles.Results557 articles without cost data categorised by topic. 55 articles with data initially categorised by cost variables employed in the study and conclusions. Only 24/55 (44%) studies met quality criteria justifying inclusion in a quality review. 20/24 (83%) restricted to simple cost comparisons. No study used cost utility analysis, the conventional means of establishing the “value for money” that a therapeutic intervention represents. Only 7/24 (29%) studies attempted to explore the level of utilisation that would be needed for telemedicine services to compare favourably with traditionally organised health care. None addressed this question in sufficient detail to adequately answer it. 15/24 (62.5%) of articles reviewed here provided no details of sensitivity analysis, a method all economic analyses should incorporate.ConclusionThere is no good evidence that telemedicine is a cost effective means of delivering health care.

What is already known on this topic

The use of telemedicine has garnered much attention in the past decadeHundreds of articles have been published claiming that telemedicine is cost effectiveHowever, missing from the literature is a synthesis or meta-analysis of these publications

What this study adds

A comprehensive literature search of cost related articles on telemedicine identified more than 600 articles, but only 9% contained any cost benefit dataOnly 4% of these articles met quality criteria justifying inclusion in a formalised quality review, and most of these were small scale, short term, pragmatic evaluations with few generalisable conclusionsThere is little published evidence to confirm whether or not telemedicine is a cost effective alternative to standard healthcare delivery     

Comparison of endotoxin exposure assessment by bioaerosol impinger and filter-sampling methods

Environmental assessment data collected in two prior occupational hygiene studies of swine barns and sawmills allowed the comparison of concurrent, triplicate, side-by-side endotoxin measurements using air sampling filters and bioaerosol impingers. Endotoxin concentrations in impinger solutions and filter eluates were assayed using the Limulus amebocyte lysate assay. In sawmills, impinger sampling yielded significantly higher endotoxin concentration measurements and lower variances than filter sampling with IOM inhalable dust samplers. Analysis of variance for repeated measures showed that this association remained after controlling for other factors such as replicate, sawmill, sawmill operation, wood type, and interaction terms. Endotoxin concentrations in the swine barns were 10-fold higher on average than in sawmills. These samples demonstrated comparable endotoxin concentration estimates for impinger and filter methods although the variability was lower using the impinger method. In both occupational settings, side-by-side replicates were more uniform for the impinger samples than for the filter samples. This study demonstrates that impinger sampling is an acceptable method for quantitation of area endotoxin concentrations. Further, when sampling is performed with impingers for airborne microorganism quantitation, these same impinger solutions can yield valid endotoxin exposure estimates, negating the need for additional filter sampling.     

Reproduction in free-ranging Propithecus verreauxi: Estrus and the relationship between multiple partner matings and fertilization

Female sifaka mate selectively with one or more resident and/or non-resident males during the breeding season. Various adaptive explanations have been advanced to explain why female primates mate with multiple males including that 1) females seek to confuse paternity and thereby forestall male infanticide and/or ensure male infant care or 2) females seek to ensure fertilization. Assessing the power of fertilization insurance to explain mating patterns in females requires information on the temporal relationship between mating and ovarian hormones. The hormonal correlates of reproduction and mating in free-ranging Propithecus verreauxi were investigated using excreted steroids as indices of reproductive state. Solid-phase extraction and radioimmunoassay techniques were used to measure unconjugated estradiol (E₃) and progesterone (P₄) in 485 desiccated fecal samples collected from five female sifaka before and during the breeding season at Beza Mahafaly, Madagascar. Results suggest that behavioral estrus was characterized by 10- to 15-day elevations in E₂; hormonal activity was observed to be similar to pseudo-estrus reported for other lemur species; apparent conception was associated with sustained P₄ elevations beginning 1 to 3 days post-estrus with gestational phase elevations of E₂ beginning 42 to 45 days post-conception; and mating with multiple partners appeared not to be a prerequisite to fertilization, as conception resulted from both monoandrous and polyandrous matings. These preliminary data suggest that fertilization insurance is not adequate to explain polyandrous mating in sifaka at Beza Mahafaly. © 1996 Wiley-Liss, Inc.     

Orchid phylogenomics and multiple drivers of their extraordinary diversification

Orchids are the most diverse family of angiosperms, with over 25 000 species, more than mammals, birds and reptiles combined. Tests of hypotheses to account for such diversity have been stymied by the lack of a fully resolved broad-scale phylogeny. Here, we provide such a phylogeny, based on 75 chloroplast genes for 39 species representing all orchid subfamilies and 16 of 17 tribes, time-calibrated against 17 angiosperm fossils. A supermatrix analysis places an additional 144 species based on three plastid genes. Orchids appear to have arisen roughly 112 million years ago (Mya); the subfamilies Orchidoideae and Epidendroideae diverged from each other at the end of the Cretaceous; and the eight tribes and three previously unplaced subtribes of the upper epidendroids diverged rapidly from each other between 37.9 and 30.8 Mya. Orchids appear to have undergone one significant acceleration of net species diversification in the orchidoids, and two accelerations and one deceleration in the upper epidendroids. Consistent with theory, such accelerations were correlated with the evolution of pollinia, the epiphytic habit, CAM photosynthesis, tropical distribution (especially in extensive cordilleras), and pollination via Lepidoptera or euglossine bees. Deceit pollination appears to have elevated the number of orchid species by one-half but not via acceleration of the rate of net diversification. The highest rate of net species diversification within the orchids (0.382 sp sp⁻¹ My⁻¹) is 6.8 times that at the Asparagales crown.     

Uptake and metabolism of nucleosides by embryos of the sea urchin Strongylocentrotus purpuratus

Uptake and metabolism of thymidine and adenosine have been studied in embryos of the sea urchin Strongylocentrotus purpuratus. Uptake of these nucleosides is found to be mutually competitive, with the Km for uptake of thymidine similar to its Ki for inhibition of adenosine uptake and vice versa. The metabolic studies show that adenosine is rapidly and completely phosphorylated upon entry, even at high exogenous concentrations which saturate the uptake mechanism. In contrast, at concentrations which saturate nucleoside uptake, thymidine becomes appreciably catabolized (up to 60%) to thymine and beta-amino-isobutyric acid in addition to its phosphorylation to thymine nucleotides. Negligible amounts of endogenous thymidine appear to remain unmetabolized following uptake in these embryos. The data provide strong in vivo evidence for separate metabolic pathways for thymidine and adenosine which have not previously been described in this organism. The observation of mutual competition during uptake, together with different routes of metabolism for these nucleosides, would suggest that the rate-limiting step in the uptake process is transport rather than metabolism. The specificity of this transport system for its nucleoside substrate has been examined in some detail in the present report. All naturally occurring nucleosides but only a limited number of nucleoside analogs are recognized by this membrane carrier. Neither purine nor pyrimidine bases are substrates for this transport system. Previous work by this laboratory has demonstrated the strict Na+-dependence of this carrier, its high affinity for nucleoside substrate, and its activation at fertilization. These observations and the substrate specificity studies of the present work together describe a unique transport system for nucleosides in sea urchin embryos which is quite different from those previously described in mammalian cells.     

The cosmopolitan maternal heritage of the Thoroughbred racehorse breed shows a significant contribution from British and Irish native mares

The paternal origins of Thoroughbred racehorses trace back to a handful of Middle Eastern stallions, imported to the British Isles during the seventeenth century. Yet, few details of the foundation mares were recorded, in many cases not even their names (several different maternal lineages trace back to 'A Royal Mare'). This has fuelled intense speculation over their origins. We examined mitochondrial DNA from 1929 horses to determine the origin of Thoroughbred foundation mares. There is no evidence to support exclusive Arab maternal origins as some historical records have suggested, or a significant importation of Oriental mares (the term used in historic records to refer to Middle East and western Asian breeds including Arab, Akhal-Teke, Barb and Caspian). Instead, we show that Thoroughbred foundation mares had a cosmopolitan European heritage with a far greater contribution from British and Irish Native mares than previously recognized.     

Temperature effects on the hydrodynamic radius of the intrinsically disordered N‐terminal region of the p53 protein

Intrinsically disordered proteins (IDPs) are often characterized in terms of the hydrodynamic radius, R_h. The R_h of IDPs are known to depend on fractional proline content and net charge, where increased numbers of proline residues and increased net charge cause larger R_h. Though sequence and charge effects on the R_h of IDPs have been studied, the temperature sensitivity has been noted only briefly. Reported here are R_h measurements in the temperature range of 5–75°C for the intrinsically disordered N‐terminal region of the p53 protein, p53(1–93). Of note, the R_h of this protein fragment was highly sensitive to temperature, decreasing from 35 Å at 5°C to 26 Å at 75°C. Computer generated simulations of conformationally dynamic and disordered polypeptide chains were performed to provide a hypothesis for the heat‐induced compaction of p53(1–93) structure, which was opposite to the heat‐induced increase in R_h observed for a model folded protein. The simulations demonstrated that heat caused R_h to trend toward statistical coil values for both proteins, indicating that the effects of heat on p53(1–93) structure could be interpreted as thermal denaturation. The simulation data also predicted that proline content contributed minimally to the native R_h of p53(1–93), which was confirmed by measuring R_h for a substitution variant that had all 22 proline residues changed for glycine. Proteins 2014; 82:668–678. © 2013 Wiley Periodicals, Inc.     

Symbiont-mediated RNA interference in insects

RNA interference (RNAi) methods for insects are often limited by problems with double-stranded (ds) RNA delivery, which restricts reverse genetics studies and the development of RNAi-based biocides. We therefore delegated to insect symbiotic bacteria the task of: (i) constitutive dsRNA synthesis and (ii) trauma-free delivery. RNaseIII-deficient, dsRNA-expressing bacterial strains were created from the symbionts of two very diverse pest species: a long-lived blood-sucking bug, Rhodnius prolixus, and a short-lived globally invasive polyphagous agricultural pest, western flower thrips (Frankliniella occidentalis). When ingested, the manipulated bacteria colonized the insects, successfully competed with the wild-type microflora, and sustainably mediated systemic knockdown phenotypes that were horizontally transmissible. This represents a significant advance in the ability to deliver RNAi, potentially to a large range of non-model insects.