Development of unit cost for the health services offered at King FAHD Central hospital Jazan,Saudi Arabia

BackgroundEfficiency remains one of the most important drivers of decision making in health care system. Fund allocators need to receive structured information about the cost healthcare services from hospitals for better decisions related to resource allocation and budgeting. The objective of the study was to estimate the unit cost for health services offered to inpatients in King Fahd Central hospital (KFCH) Jazan during the financial year 2018.MethodsWe applied a retrospective approach using a top-down costing method to estimate the cost of health care services. Clinical and Administrative departments divided into cost centres, and the unit cost was calculated by dividing the total cost of final care cost centres into the total number of patients discharged in one year. The average cost of inpatient services was calculated based on the average cost of each ward and the number of patients treated.ResultsThe average cost per patient stayed in KFCH was SAR 19,034, with the highest cost of SAR 108,561 for patients in the Orthopedic ward. The average cost of the patient in the Surgery ward, Plastic surgery, Neurosurgery, Medical ward, Pediatric ward and Gynecology ward was SAR 33,033, SAR 29,425, SAR 23,444, SAR 20,450, SAR 9579 and SAR 8636 respectively.ConclusionThis study provides necessary information about the cost of health care services in a tertiary care setting. This information can be used as a primary tool and reference for further studies in other regions of the country. Hence, this data can help to provide a better understanding of tertiary hospital costing in the region to achieve the privatization objective.     

NETosis occurs independently of neutrophil serine proteases

Neutrophils are primary host innate immune cells defending against pathogens. One proposed mechanism by which neutrophils prevent the spread of pathogens is NETosis, the extrusion of cellular DNA resulting in neutrophil extracellular traps (NETs). The protease neutrophil elastase (NE) has been implicated in the formation of NETs through proteolysis of nuclear proteins leading to chromatin decondensation. In addition to NE, neutrophils contain three other serine proteases that could compensate if the activity of NE was neutralized. However, whether they do play such a role is unknown. Thus, we deployed recently described specific inhibitors against all four of the neutrophil serine proteases (NSPs). Using specific antibodies to the NSPs along with our labeled inhibitors, we show that catalytic activity of these enzymes is not required for the formation of NETs. Moreover, the NSPs that decorate NETs are in an inactive conformation and thus cannot participate in further catalytic events. These results indicate that NSPs play no role in either NETosis or arming NETs with proteolytic activity.     

The small molecule SI113 hinders epithelial-to-mesenchymal transition and subverts cytoskeletal organization in human cancer cells

The small molecule SI113 is an inhibitor of the kinase activity of SGK1, a key biological regulator acting on the PI3K/mTOR signal transduction pathway. Several studies demonstrate that this compound is able to strongly restrain cancer growth in vitro and in vivo, alone or in associative antineoplastic treatments, being able to elicit an autophagic response, either cytotoxic or cytoprotective. To elucidate more exhaustively the molecular mechanisms targeted by SI113, we performed activity-based protein profiling (ABPP) proteomic analysis using a kinase enrichment procedure. This technique allowed the identification via mass spectrometry of novel targets of this compound, most of them involved in functions concerning cell motility and cytoskeletal architecture. Using a glioblastoma multiforme, hepatocarcinoma and colorectal carcinoma cell line, we recognized an inhibitory effect of SI113 on cell migration, invading, and epithelial-to-mesenchymal transition. In addition, these cancer cells, when exposed to this compound, showed a remarkable subversion of the cytoskeletal architecture characterized by F-actin destabilization, phospho-FAK delocalization, and tubulin depolimerization. These results were definitely concordant in attributing to SI113 a key role in hindering cancer cell malignancy and, due to its negligible in vivo toxicity, can sustain performing a Phase I clinical trial to employ this drug in associative cancer therapy.     

Life Cycle costing as part of design for environment environmental business cases

Background  In developing products various requirements have to be integrated including functionality, quality, affordability as well as environmental aspects. Often conflicting requirements have to be fulfilled. Therefore, multi-dimensional decision support approaches are necessary. Methods  Here, one approach is to relate the conflicting requirements to each other. Life Cycle Costing (LCC) has the potential to support the trade-off between some environmental targets and overall affordability targets by including all monetary flows along the product life cycle (going beyond the well-known costs of ownership by integrating also long-term use and end-of-life costs). Those solutions can be identified that (a) have the highest efficiencies (where do we get most environmental improvements per Ϊ and (b) have the highest affordability for the customer along the life cycle. Furthermore, on-costs in the design phase can be justified in terms of future savings either for the customer or for the recycling of the products. These represent real business cases for environmental actions. Three types of environmental business cases can be differentiated. Results and Discussion  This paper presents various examples where LCC is integrated into product design. However, there are a number of open issues in the implementation of LCC within real product development including data availability and uncertainty (future costs/ savings), level of discounting, accounting and compensation. Various internal case studies done in the last years showed that already few changes in the costs structure can significantly affect the identi-fied future costs. Recommendation and Outlook  Uncertainties in LCC are higher than in LCA and highest when applied in the stage of product develop-ment, i.e. used to support DfE action. As a consequence, the result-ing figures can only be seen as directional. Therefore, the use of LCC in Design for Environment cannot be recommended without major restrictions in terms of guidance, experience/training. The link-age between LCC and DfE can either be established via (1) experts supporting design teams or (2) as part of a DfE tool. The DfE tool has to include detailed guidance for interpretation, and its application should be based on a solid training for DfE engineers.     

Life Cycle Approach in the Procurement Process: The Case of Defence Materiel (9 pp)

Goal, Scope and Background Procurement in public and non-public organisations has the potential to influence product development towards more environmentally friendly products. This article focuses on public procurement with procurement in Swedish defence as a special case. In 2003, public procurement in Sweden was 28% of the GDP. In the Swedish defence sector the amount was 2% of the GDP. The total emissions from the sector were of the same order of magnitude as from waste treatment (2% of Sweden's emissions). According to an appropriation letter from the Ministry of Defence in 1998, the Swedish Armed Forces (SAF) and the Swedish Defence Materiel Administration (FMV) are required to take environmental issues into consideration during the entire process of acquiring defence materiel. Environmental aspects are considered today, but without a life-cycle perspective. - The aims of this article are to recommend suitable tools for taking environmental concerns into account, considering a product's life-cycle, in the procurement process for defence materiel in Sweden; to make suggestions for how these tools could be used in the acquisition process; and to evaluate these suggestions through interviews with actors in the acquisition process. The procurement process does not include aspects specific to Swedish defence, and it is therefore likely to be comparable to processes in other countries. Methods The method involved a study of current literature and interviews with various actors in the acquisition process. The life cycle methods considered were quantitative Life Cycle Assessments, a simplified LCA-method called the MECO method and Life Cycle Costing (LCC). Results and Discussion Methodology recommendations for quantitative LCA and simplified LCA are presented in the article, as well as suggestions on how to integrate LCA methods in the acquisition process. We identified four areas for use for LCA in the acquisition process: to learn about environmental aspects of the product; to fulfil requirements from customers; to set environmental requirements and to choose between alternatives. Therefore, tools such as LCAs are useful in several steps in the acquisition process. Conclusion From the interviews, it became clear that the actors in the acquisition process think that environmental aspects should be included early in the process. The actors are interested in using LCA methods, but there is a need for an initiative from one or several of them if the method is to be used regularly in the process. Environmental and acquisition issues are handled with very little interaction in the controlling and ordering organisation. An integration of environmental and acquisition parts in these organisations is probably needed in order to integrate environmental aspects in general and life-cycle thinking in particular. Other difficulties identified are costs and time constraints. Recommendation and Perspective In order to include the most significant aspects when procuring materiel, it is important to consider the whole life-cycle of the products. Our major recommendation is that the defence sector should work systematically through different product groups. For each product group, quantitative, traditional LCAs or simplified LCAs (in this case modified MECOs) should be performed for reference products within each product group. The results should be an identification of critical aspects in the life-cycles of the products. The studies will also form a database that can be used when making new LCAs. This knowledge should then be used when writing specifications of what to procure and setting criteria for procurement. The reports should be publicly available to allow reviews and discussions of results. To make the work more cost-effective, international co-operation should be sought. In addition, LCAs can also be performed as an integrated part of the acquisition process in specific cases.     

Life Cycle Tools within Ford of Europe's Product Sustainability Index. Case Study Ford S-MAX & Ford Galaxy (8 pp)

Background, Aim and Scope Sustainability is a well recognised goal which is difficult to manage due to its complexity. As part of a series of sustainability management tools, a Product Sustainability Index (PSI) is translating the sustainability aspects to the organization of vehicle product development of Ford of Europe, thus allocating ownership and responsibility to that function. PSI is limiting the scope to those key environmental, social and economic characteristics of passenger vehicles that are controllable by the product development organisation. Materials and Methods: The PSI considers environmental, economic and social aspects based on externally reviewed life cycle environmental and cost aspects (Life Cycle Assessment, Cost of ownership / Life Cycle Costing), externally certified aspects (allergy-tested interior) and related aspects as sustainable materials, safety, mobility capability and noise. After the kick-off of their product development in 2002, the new Ford S-MAX and Ford Galaxy are serving as a pilot for this tool. These products are launched in Europe in 2006. The tracking of PSI performance has been done by engineers of the Vehicle Integration department within the product development organization. The method has been translated in an easy spreadsheet tool. Engineers have been trained within one hour trainings. The application of PSI by vehicle integration followed the principle to reduce the need for any incremental time or additional data to a minimum. PSI is adopted to the existing decision-making process. End of 2005, an internal expert conducted a Life Cycle Assessment and Life Cycle Costing (LCC) study for verification purposes using commercial software. This study and the PSI have been scrutinized by an external review panel according to ISO14040 and, by taking into consideration the on-going SETAC, work in the field of LCC. Results: The results of the Life Cycle based indicators of PSI as calculated by non-experts are fully in line with those of the more detailed expert study. The difference is below 2%. The new Ford Galaxy and Ford S-MAX shows significantly improved performance regarding the life cycle air quality, use of sustainable materials, restricted substances and safety compared to the previous model Galaxy. The affordability (Life Cycle Cost of Ownership) has also been improved when looking at the same engine types. Looking at gasoline versus diesel options, the detailed study shows under what conditions the diesel options are environmentally preferable and less costly (mileage, fuel prices, etc.). Discussion: The robustness of results has been verified in various ways. Based also on Sensitivity and Monte-Carlo Analysis, case study-specific requirements have been deduced defining criteria for a significant environmental improvement between the various vehicles. Only if the differences of LCIA results between two vehicles are larger than a certain threshold are the above-mentioned results robust. Conclusions: In general terms, an approach has been implemented and externally reviewed that allows non-experts to manage key environmental, social and economic aspects in the product development, also on a vehicle level. This allows mainstream functions to take ownership of sustainability and assigns accountability to those who can really decide on changes affecting the sustainability performance. In the case of Ford S-MAX and Galaxy, indicators from all three dimensions of sustainability (environment, social and economic) have been improved compared to the old Ford Galaxy. Recommendations and Perspectives: Based on this positive experience, it is recommended to make, in large or multinational organizations, the core business functions directly responsible and accountable for managing their own part of environmental, social and economic aspects of sustainability. Staff functions should be limited to starting the process with methodological and training support and making sure that the contributions of the different main functions fit together.     

Hybrid LCC of Appliances with Different Energy Efficiency (10 pp)

Goal, Scope and Background This paper is concerned with a life cycle assessment (LCA) and life cycle costing (LCC) by the use of the waste input-output (WIO) quantity- and price model of air conditioners with different energy efficiency at the use phase (high-end, low-end and average models) that were available in Japan as of winter 2002. The functional unit is an air conditioner of the 2.5kW type that is used for 10 years, and then subjected to an end-of-life (EoL) process that is consistent with the Japanese law on the recycling of appliances. Methods This is the first simultaneous application of the WIO methodology to an LCA and LCC over the entire life-cycle of a product including the use phase, and represents a methodological extension (in the sense of considering the use phase) and integration (in the sense of a simultaneous application) of previous studies by us (Kondo and Nakamura, Int. J. LCA, 2004, Nakamura and Kondo, Ecol. Econ., 2005, in press). The main body of data is provided by the WIO table for the year 2000, an update of the previous table for 1995 that was used in the above WIO studies. Compared with the WIO table for 1995 that consisted of only about 80 industry sectors, the current one consists of about 400 industry sectors, and includes air conditioner as a separate sector. The data on the purchase price and efficiency of air conditioners indicate wide variations: the cheapest one (the low-end model) costs half of the most expensive one (the high-end model), but its efficiency is about half of the latter. Results and Discussion When the cost in the use and EoL phases is included, the low-end model becomes the most expensive one, and the high-end model with the highest purchase cost the least expensive. This reversal of the relative cost levels is attributed to the difference in the efficiency in the use phase. A sensitivity analysis indicates that a reduction of the electricity price in the use phase by about 40% does not alter the significant superiority of the high-end model over the low-end model. In spite of the largest amount of input in the production phase, the high-end model performs the best in terms of both global warming potential (GWP) and landfill, while the low-end model performs the worst. The use phase generates the largest amount of waste for landfill across the three models, the largest component of which is flyash generated from coal firing power plants. A possible internalization of externality in the form of carbon tax was found to work in favor of the high-end model. The cost advantage of the high-end model, however, is sensitive to the rate of discounting of future costs: discounting at 15% diminishes its advantage over the low-end model. Recommendation and Perspective The results indicate the effectiveness of the pricing based on the life cycle cost for achieving sustainability, that is, for promoting the shift of the demand away from appliances with low environmental performance to the one with higher environmental performance. Acceptance by society of pricing based on life cycle costing would require, among other things, an economy-wide standardization of the LCC concept (in a manner analogous to ISO-LCA) that can be used complementary to ISO-LCA.     

生物多样性价值的经济学处理：一些理论障碍及其克服

本文首先对国际生态经济学界围绕“世界生态系统功能价值计量”的方法学论争进行短简的评价,接着阐述了生物多样性价值的新的概念框架,并据此就生物多样性价值计量中尚未得到关注的问题（生物多样性价值的可计算性,价值计量方法的恰当性,价值分量的可加性和可解析性,价值误差测算）提出解决思路,本文最后讨论了两个保护经济学问题方法学构架,其一是生物多样性破坏的经济损失计算,其二是生物多样性保护工程的成本－效益体质与成本－效果分析。     

Quantitative Metaproteomics and Activity-based Protein Profiling of Patient Fecal Microbiome Identifies Host and Microbial Serine-type Endopeptidase Activity Associated With Ulcerative Colitis

The gut microbiota plays an important yet incompletely understood role in the induction and propagation of ulcerative colitis (UC). Organism-level efforts to identify UC-associated microbes have revealed the importance of community structure, but less is known about the molecular effectors of disease. We performed 16S rRNA gene sequencing in parallel with label-free data-dependent LC-MS/MS proteomics to characterize the stool microbiomes of healthy (n = 8) and UC (n = 10) patients. Comparisons of taxonomic composition between techniques revealed major differences in community structure partially attributable to the additional detection of host, fungal, viral, and food peptides by metaproteomics. Differential expression analysis of metaproteomic data identified 176 significantly enriched protein groups between healthy and UC patients. Gene ontology analysis revealed several enriched functions with serine-type endopeptidase activity overrepresented in UC patients. Using a biotinylated fluorophosphonate probe and streptavidin-based enrichment, we show that serine endopeptidases are active in patient fecal samples and that additional putative serine hydrolases are detectable by this approach compared with unenriched profiling. Finally, as metaproteomic databases expand, they are expected to asymptotically approach completeness. Using ComPIL and de novo peptide sequencing, we estimate the size of the probable peptide space unidentified (“dark peptidome”) by our large database approach to establish a rough benchmark for database sufficiency. Despite high variability inherent in patient samples, our analysis yielded a catalog of differentially enriched proteins between healthy and UC fecal proteomes. This catalog provides a clinically relevant jumping-off point for further molecular-level studies aimed at identifying the microbial underpinnings of UC.     

Biochemical and Structural Characterization of TesA,a Major Thioesterase Required for Outer-Envelope Lipid Biosynthesis in Mycobacterium tuberculosis

With the high number of patients infected by tuberculosis and the sharp increase of drug-resistant tuberculosis cases, developing new drugs to fight this disease has become increasingly urgent. In this context, analogs of the naturally occurring enolphosphates Cyclipostins and Cyclophostin (CyC analogs) offer new therapeutic opportunities. The CyC analogs display potent activity both in vitro and in infected macrophages against several pathogenic mycobacteria including Mycobacterium tuberculosis and Mycobacterium abscessus. Interestingly, these CyC inhibitors target several enzymes with active-site serine or cysteine residues that play key roles in mycobacterial lipid and cell wall metabolism. Among them, TesA, a putative thioesterase involved in the synthesis of phthiocerol dimycocerosates (PDIMs) and phenolic glycolipids (PGLs), has been identified. These two lipids (PDIM and PGL) are non-covalently bound to the outer cell wall in several human pathogenic mycobacteria and are important virulence factors. Herein, we used biochemical and structural approaches to validate TesA as an effective pharmacological target of the CyC analogs. We confirmed both thioesterase and esterase activities of TesA, and showed that the most active inhibitor CyC₁₇ binds covalently to the catalytic Ser104 residue leading to a total loss of enzyme activity. These data were supported by the X-ray structure, obtained at a 2.6-Å resolution, of a complex in which CyC₁₇ is bound to TesA. Our study provides evidence that CyC₁₇ inhibits the activity of TesA, thus paving the way to a new strategy for impairing the PDIM and PGL biosynthesis, potentially decreasing the virulence of associated mycobacterial species.