Analyzing the cost-effectiveness of Lyme disease risk reduction approaches.

Lyme disease (LD) is endemic in many regions of the Northeastern United States. Given the elusive nature of the disease, a systematic approach to identify efficient interventions would be useful for policymakers in addressing LD. We used Markov modeling to investigate the efficiency of interventions. These interventions range from awareness-based to behavioral-based strategies. Targeting animal reservoirs of LD using fungal spray or bait boxes did not prove to be an effective intervention. Results of awareness-based interventions, including distribution of signage, fliers, and presentations, implementable in different geographical scales, suggest that policymakers should focus on these interventions, as they are both cost-effective and have the highest impact on lowering LD risk. Populations may lose focus of LD warnings over time, thus quick succession of these interventions is vital. Our modeling results identify the awareness-based intervention as the most cost-effective strategy to lower the number of LD cases. These results can aid in the establishment of effective LD risk reduction policy at various scales of implementation.

Nonaqueous Polymer Combustion Synthesis of Cubic Li7La3Zr2O12 Nanopowders.

Garnet-type lithium lanthanum zirconate (Li7La3Zr2O12, LLZO) shows great promise as a solid electrolyte for future solid-state lithium batteries as it possesses a uniquely beneficial combination of high ionic conductivity, electrochemical stability against metallic lithium, and generally low reactivity in ambient conditions. Conventionally synthesized by using solid-state reactions, LLZO powders have also been prepared by using variations of sol-gel or combustion synthesis with sacrificial organic templates or polymers containing metal nitrate precursors. Herein, a novel nonaqueous polymer (NAP) method using metalorganic precursors and poly(vinylpyrrolidone) is demonstrated to easily form LLZO nanopowders. Compared to similar techniques using aqueous solutions with metal nitrates, the NAP method confers greater control over synthesis conditions. Undoped cubic phase LLZO is obtained after calcination at 700-800 °C between 0 and 4 h, and the NAP process is easily extended to Ta-doped LLZO. To elucidate the general formation mechanism of nanosized LLZO in the NAP combustion synthesis, scanning transmission electron microscopy is used to perform energy dispersive X-ray and electron energy loss spectral imaging. The results show that in situ formation of a carbonaceous foam during combustion physically segregates pockets of reagents and is responsible for maintaining the small particle size of the as-synthesized material during combustion and crystallization. The room temperature ionic conductivity of nanosized Ta-doped LLZO synthesized by using the NAP method was studied under various sintering conditions, with ionic conductivities between 0.24 and 0.67 mS cm-1, activation energies between 0.34 and 0.42 eV, and relative densities in excess of 90% obtained by sintering at 1100 °C for between 6 and 15 h.

ACCESS to Better Health and Clear Skies: Telemedicine and Greenhouse Gas Reduction.

Introduction: This study estimates the reduction in greenhouse gas (GHG) emissions resulting from 2,020 neuro-emergent telemedicine consultations. We then estimate potential GHG reduction if the program was expanded nationwide. Materials and Methods: Travel distances in miles were calculated for each avoided patient transfer using hospital location data and ArcGIS® tools. Potential GHG reductions from program expansion were calculated based on state and national stroke Diagnosis-Related Groups (DRGs). Along with average flight distance from a rural hospital to closest level one trauma center. Results: Participation in the Access to Critical Cerebral Emergent Support Services (ACCESS) from May 2015 to July 2017 resulted in 2,020 consultations. Of these consultations, there was a 70% (1,414) reduction in patient transfers. Emission reduction totaled 618,772 kg of carbon dioxide equivalents (CO2e) (618.77 metric tons) or 0.306 metric tons of CO2e per patient. Expanding the program across New Mexico and similar U.S. areas resulted in potential reductions of 4,307 (IQR 3,386-5,274) and 213,279 (IQR 169,320-263,570) metric tons of CO2e. Conclusion: Transport accounts for 26% of global CO2 emissions and is one of the few industrial sectors where emissions are still growing. What makes this study more impactful is that aviation's emissions are not part of the Kyoto Protocol and little is being done in this sector. GHG reduction was not the main intention of the ACCESS program, but it has shown to be a significant by-product.

Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program.

AIMS: Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients. This study assessed the clinical and economic outcomes of the ACCESS program in providing services to rural New Mexico from a healthcare payer perspective. METHODS: A decision tree model was constructed using findings from the ACCESS program and existing literature, the likelihood that a patient will receive a tissue plasminogen activator (tPA), cost of care, and resulting quality adjusted life years (QALYs). Data from the ACCESS program includes emergency room patients in rural New Mexico from May 2015 to August 2016. Outcomes and costs have been estimated for patients who were taken to a hospital providing neurological telecare and patients who were not. RESULTS: The use of ACCESS decreased neuro-emergent stroke patient transfers from rural hospitals to urban settings from 85% to 5% (no tPA) and 90% to 23% (tPA), while stroke specialist reading of patient CT/MRI imaging within 3 h of onset of stroke symptoms increased from 2% to 22%. Results indicate that use of ACCESS has the potential to save $4,241 ($3,952-$4,438) per patient and increase QALYs by 0.20 (0.14-0.22). This increase in QALYs equates to ∼73 more days of life at full health. The cost savings and QALYs are expected to increase when moving from a 90-day model to a lifetime model. CONCLUSION: The analysis demonstrates potential savings and improved quality-of-life associated with the use of ACCESS for patients presenting to rural hospitals with acute ischemic stroke (AIS).