ABSTRACT
BACKGROUND: To assess the financial impact of incorporating a new (reciprocal) technology into endodontic treatments in the public health system (SUS). METHODS: This was a economic evaluation study (comparing the 3 different endodontic instrumentation techniques-manual, rotary and reciprocating), allocative efficiency analysis to optimize existing resources in the SUS, and financial contribution impact analysis of incorporation of a new technology. Thirty-one (31) 12 years-old volunteers were evaluated. RESULTS: The incremental cost-effectiveness ratio (ICER) was calculated at R$1.34/min, - R$0.60/min and BRL 0.10/min for the single-rooted, bi-rooted and tri-rooted teeth, respectively, when the rotary technique was compared with the manual type. In turn, the ICER was R$ 21.04/min, - R$ 0.73/min and - R$ 2.81/min for the 3 types of teeth, respectively, when the reciprocating technique was compared with the manual type. The incremental financial impact of replacing manual endodontic with rotary endodontic treatments would be - R$ 2060963.66 in the case of single-rooted teeth, but the number of treatments would also be reduced (- 19,379). In the case of two-rooted teeth, the incremental financial impact would be BRL 34921540.62 with the possibility of performing an additional 204,110 treatments. In turn, BRL 11523561.50 represented the incremental financial impact for teeth with 3 or more roots and with an increase of 72,545 procedures. When we analyzed the incremental financial impact of replacing manual endodontic with reciprocating endodontic treatments, it would be - R$ 730227.80 in the case of single-rooted teeth, allowing for an additional 2538 treatments. In turn, R$ 21674853.00 represented the incremental financial impact for bi-radicular teeth, with an increase of 121,700 procedures. In the case of two-rooted teeth, the incremental financial impact would be BRL 13591742.90 with the possibility of performing an additional 40,670 treatments. CONCLUSIONS: The reciprocating technique could improve access to endodontic treatment in the SUS as it allowed a simultaneous reduction in clinical time and associated costs. However, the higher number of endodontic treatments performed would have a financial impact.
Subject(s)
Root Canal Preparation , Tooth Root , Child , Cost-Benefit Analysis , HumansABSTRACT
Resumen Introducción. La eutanasia fue despenalizada en Colombia mediante la Sentencia C-239/97 y reglamentada por la Resolución 1216 de 2015 del Ministerio de Salud y Protección Social. Se investigó en algunos medios de circulación nacional la posición a favor, neutra y en contra sobre la eutanasia y su carga argumentativa entre los años 1997 y 2015. Objetivos. Determinar la posición de algunos medios de comunicación frente a la eutanasia durante 1997-2015 y analizar su contenido argumentativo. Materiales y métodos. Tras una búsqueda en las versiones virtual e impresa de los periódicos El Tiempo y El Espectador y la Revista Semana, se realizó una clasificación y análisis de contenido de los artículos sobre la eutanasia con apoyo del programa ATLAS.ti, versión 8. Resultados. De 257 artículos recuperados, 190 incluyeron el término eutanasia en relación con el final de la vida y la salud. El 45% fueron neutros y de carácter informativo y el 78.9% no mencionó los cuidados paliativos. La carga argumentativa a favor recayó sobre contenidos de dignidad, sufrimiento y regulación. Conclusiones. Los artículos presentaron posiciones opuestas con errores de contenido y superficialidad en el tratamiento del concepto. La postura prevalente fue neutra seguida de la posición a favor. Se evidencia escasa participación de la comunidad médica y casi ninguna mención de los cuidados paliativos.
Abstract Introduction: Euthanasia was decriminalized in Colombia by means of Sentence C-239/97 and regulated through Resolution 1216 of2015 of the Ministry of Health and Social Protection. Some Colombian media were consulted to identify whether their position was in favor, neutral or against euthanasia and their reasons during the period 19972015. Objectives: To establish the position of some media regarding euthanasia during 1997-2015 and analyze their reasoning. Materials and methods: After conducting a search in the digital and printed versions of El Tiempo, El Espectador and Revista Semana, a classification and content analysis of the articles on euthanasia was carried out using the software ATLAS.ti, version 8. Results: From 257 articles retrieved, 190 included the term euthanasia in the context of health and end of life. 45% of the articles were neutral and informative and 78.9% did not mention palliative care. Favorable opinions were related to contents about dignity, suffering and regulation. Conclusions: The articles presented contrasting positions with content mistakes and superficial discussions on the issue. The prevailing position was neutral followed by favorable. There was little involvement of the medical community and almost no mention of palliative care.
ABSTRACT
The ability of methanotrophs to rapidly respond to intentional or accidental stress conditions caused by operational failures or process fluctuations is of utmost importance to guarantee the robustness of CH4 abatement biotechnologies. In this study, the performance of a continuous and two feast-famine (5:5 days feast-famine cycles) stirred tank reactors treating diluted CH4 emissions (4-5% v/v) was comparatively assessed for 149 days. The robustness of the three bioreactors towards a 5 days CH4 deprivation episode was thoroughly evaluated at a molecular level (pmoA gene expression level) and correlated to macroscopic process performance. The bioreactors recovered their steady-state abatement performance (in terms of CH4 elimination capacity and CO2 production rate) within 1.5-2â¯h following CH4 supply resumption concomitantly with a maximum in pmoA gene expression, regardless of the previous operational mode. However, while methanotrophs from the continuous unit maintained higher basal levels of pmoA expression as a strategy for a rapid CH4 metabolism initiation, the strategy of the feast-famine adapted-methanotrophs consisted on a more accurate regulation of their pmoA transcripts levels along with a higher and/or more rapid induction of the pmoA gene by CH4 availability.
