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Advances in Physiology Education Sep 2021Exercise is thought to be an effective means to quick weight loss. However, few people have realistic exercise-induced weight loss expectations. Fewer understand how...
Exercise is thought to be an effective means to quick weight loss. However, few people have realistic exercise-induced weight loss expectations. Fewer understand how weight is "lost" and where the lost mass goes. Understanding that fat is "burned" with inhaled oxygen and most of the mass lost must be exhaled as carbon dioxide might help individuals create realistic weight loss expectations. The purpose of this laboratory activity is to ) provide students with a basic understanding of the role of oxygen in fuel metabolism during physical activity and its relationship to energy expenditure and mechanical work, and ) engage students with collection of their own data to determine a realistic timeframe for exercise-induced weight loss. In the prelaboratory, questions such as, "When you lose weight, where does it go?" are asked. A guided discussion helps students understand the basic biochemistry required for weight loss. For the activity, students complete walking or running exercise, recording the time and distance. The relationship of exercise to physics' concepts of mechanical work and energy utilization are discussed with the concept of "calorie burn" and its relationship to oxygen consumption. Students estimate oxygen consumed and calories burned during exercise using established metabolic equations. Finally, the amount of energy (i.e., calories) equivalent to 1 pound of fat is discussed. Students calculate how long he/she would have to exercise to burn 10 pounds (4.5 kg) of fat. A person of average size and fitness, needs 60+ h of exercise to burn 10 pounds of fat. Supplementary activities including a dramatic gummy bear oxidation and the use of a metabolic cart reinforces these concepts and validates the laboratory estimates.
Topics: Energy Metabolism; Female; Humans; Laboratories; Male; Obesity; Oxygen Consumption; Weight Loss
PubMed: 34379483
DOI: 10.1152/advan.00006.2021 -
Delaware Journal of Public Health Apr 2023
PubMed: 37122343
DOI: 10.32481/djph.2023.04.005 -
Chronic Respiratory Disease 2008Collective experience with pulmonary rehabilitation and disease management has shown that patients with lung diseases including COPD and restrictive lung diseases live a... (Review)
Review
Collective experience with pulmonary rehabilitation and disease management has shown that patients with lung diseases including COPD and restrictive lung diseases live a longer and more productive quality of life if they can remain active. Patients who require oxygen supplementation but can otherwise be active should have the most portable and non-encumbering systems possible. Oxygen conserving devices have made a high level of portability possible. Small gas, liquid and even some concentrators have replaced the 20 pound E cylinder with 4 and 5 pound systems. In a parallel physiological development, exercise plus oxygen increases the physiological benefits of exercise and thereby enhances the patient's ability to function in life. This paper examines available options and their mechanical and physiological foundations.
Topics: Catheterization; Equipment Design; Humans; Oxygen Inhalation Therapy
PubMed: 18539725
DOI: 10.1177/1479972308090691 -
International Wound Journal Feb 2009Judicious resource allocation to maximise benefits is essential to health care decision-making, particularly with increasingly expensive treatments and rising... (Review)
Review
Judicious resource allocation to maximise benefits is essential to health care decision-making, particularly with increasingly expensive treatments and rising populations. Accurate wound debridement is important, and while many methods exist, surgical debridement is currently the gold standard with material costs at approximately pound 140. Versajet, a hydrosurgical device, is suggested by some to have facilitated a paradigm shift in wound management by allowing debridement of undesirable tissue while accurately preserving viable structures. Its proponents claim that it minimises surgical duration, length of hospital admission, improves wound healing and may be deployed at the bedside or in the community. Consoles and single-use hand-units cost pound 6000- pound 7000 and pound 220- pound 240, respectively. Some propose that hydrosurgery may provide an efficacious, efficient and cost-effective alterative to surgical debridement. However, the evidence available is largely based on expert opinion. Methodological flaws of such descriptive studies include the lack of control groups, selection bias and lack of blinding. Hence, these claims need to be interpreted cautiously. This opinion review examines the available evidence as to whether Versajet hydrosurgery provides quality and cost-effective care.
Topics: Cost-Benefit Analysis; Debridement; Equipment Design; Humans; Quality of Health Care; Wounds and Injuries
PubMed: 19291112
DOI: 10.1111/j.1742-481X.2008.00560.x -
Journal of Dairy Science May 2022An estimated 40% of food produced in the United States is wasted, which poses a significant barrier to achieving a sustainable future-so much so that the United Nations... (Review)
Review
An estimated 40% of food produced in the United States is wasted, which poses a significant barrier to achieving a sustainable future-so much so that the United Nations Sustainable Development Goal no. 12, to "ensure sustainable consumption and production patterns," includes a goal to "halve per capita global food waste at the retail and consumer level, and reduce food losses along the production and supply chains by 2030." Annually, consumers waste approximately 90 billion pounds of food, equating to roughly 1 pound per person per day. More specifically, consumer waste is the largest contributor to the food waste problem when compared with other steps along the supply chain, such as production, post-harvest handling and storage, processing, and distribution. Furthermore, American families discard approximately 25% of the food and beverages they buy. When considering the type of waste coming from households, fresh fruits and vegetables rank highest at 22%, with dairy products, at 19%, following in close second. A variety of factors contribute to why consumers waste so much food. For dairy, commonly referenced reasons are related to the misunderstanding of date labels, poor planning of purchases, spoilage before consuming products, and improper storage. This wasted food accumulates in landfills and produces methane when decomposing, resulting in environmental consequences related to ozone depletion and climate change. Milk can have negative environmental impacts when disposed of down the drain. This review will discuss the food waste problem, causes, and potential solutions at the consumer level, with particular focus on dairy waste. An individual plus policy, system, and environment approach will also be integrated to provide a well-rounded view of the issue.
Topics: Animals; Fruit; Humans; Milk; Policy; Refuse Disposal; United States; Vegetables
PubMed: 35307180
DOI: 10.3168/jds.2021-20994 -
Health Technology Assessment... Sep 2009This paper presents a summary of the evidence review group's critical review of the evidence for the clinical effectiveness and cost-effectiveness of rituximab for the... (Review)
Review
This paper presents a summary of the evidence review group's critical review of the evidence for the clinical effectiveness and cost-effectiveness of rituximab for the treatment of severe rheumatoid arthritis (RA) following failure of previous therapy, including one or more tumour necrosis factor-alpha inhibitors (TNFi), compared with current standards of care, based upon the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The submission's clinical evidence came from one randomised, placebo-controlled, double-blind trial (REFLEX--Random Evaluation of Long-term Efficacy of Rituximab in Rheumatoid Arthritis) comparing rituximab plus methotrexate (MTX) with placebo plus MTX in 517 patients with long-standing refractory RA. Rituximab plus MTX was more effective than placebo plus MTX across a range of primary and secondary outcome measures, e.g. American College of Rheumatology (ACR) responses, Health Assessment Questionnaire (HAQ). However, this evidence cannot be used directly to address the manufacturer's analysis of the decision problem because, in the REFLEX trial, rituximab was not compared with a relevant comparator (e.g. leflunomide or second or third TNFi). Long-term efficacy data for retreatment with rituximab are favourable, with an estimated mean time to retreatment of 307 days (n = 164). Evidence from a further five trials is presented as the basis for indirect comparisons with other disease-modifying antirheumatic drugs (DMARDs); however, it is not clear that all relevant clinical studies have been included in the indirect comparison exercise, the rationale for the choice of indirect comparison method adopted is unclear and the indirect comparison method used to adjust the ACR responses only uses a single value for the reference placebo. The submitted microsimulation Markov model was based upon the REFLEX trial. For the 'NICE-recommended' scenario and the 'sequential TNFi' scenario, the original submission reports incremental cost-effectiveness ratios (ICERs) of 14,690 pounds and 11,601 pounds per quality-adjusted life-year (QALY) gained respectively. After model assumptions were adjusted to more realistic estimates by the ERG, the ICERs for the NICE-recommended scenario and the sequential use of TNFi range from 37,002 pounds to 80,198 pounds per QALY gained and from 28,553 pounds to 65,558 pounds per QALY gained respectively. The guidance issued by NICE in August 2007 states that rituximab in combination with methotrexate is recommended as an option for the treatment of adults with severe active rheumatoid arthritis who have had an inadequate response to or intolerance of other DMARDs including treatment with at least one TNFi therapy.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antirheumatic Agents; Arthritis, Rheumatoid; Cost-Benefit Analysis; Humans; Quality-Adjusted Life Years; Randomized Controlled Trials as Topic; Rituximab
PubMed: 19804686
DOI: 10.3310/hta13suppl2/04 -
Health Technology Assessment... 2003To establish the clinical and cost-effectiveness of amantadine, oseltamivir and zanamivir compared to standard care for the treatment and prevention of influenza. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To establish the clinical and cost-effectiveness of amantadine, oseltamivir and zanamivir compared to standard care for the treatment and prevention of influenza.
DATA SOURCES
Electronic databases. Reference lists of identified articles and key publications. Relevant trials.
REVIEW METHODS
A systematic review and meta-analysis of the randomised evidence was undertaken to investigate the effectiveness of oseltamivir and zanamivir compared to standard care for treatment and prophylaxis use for influenza A and B. An additional systematic review of the effectiveness of amantadine for treatment and prophylaxis use for influenza A in children and the elderly was also undertaken. Economic decision models were constructed to examine the cost-effectiveness and cost-utility of the alternative strategies for treating and preventing influenza A and/or B. This was informed by the systematic reviews outlined above and additional sources of information where required.
RESULTS
The systematic review of the treatment of influenza found that oseltamivir reduced the median duration of symptoms in the influenza positive group by 1.38 days for the otherwise healthy adult population, 0.5 day for the high-risk population, and 1.5 days for the children population. This compared to 1.26 days, 1.99 days, and 1.3 for the similar groups for inhaled zanamivir. The systematic review of the prevention of influenza found that the relative risk reduction for oseltamivir was between approximately 75 and 90% and approximately 70 and 90% for inhaled zanamivir depending on the strategy adopted and the population under consideration. For the economic model a base case was constructed that focussed primarily on the health benefits generated by shortening the period of influenza illness. This base case found that, compared to standard care, the estimated cost per quality-adjusted life year ranged from pound 6190 to pound 31,529 for healthy adults, from pound 4535 to pound 22,502 for the 'high-risk' group, from pound 6117 to pound 30,825 for children, and from pound 5057 to pound 21,781 for the residential care elderly population. The base case model included valuations of the health effects of pneumonia (and otitis media in the children's model) based on observed rates in the trials. However it does not include the cost of hospitalisations as only very limited data was available for the effects of antivirals on hospitalisation rates. As for mortality rates, deaths from influenza were rare in trials of neuraminidase inhibitors (NIs). Therefore, suitable data on mortality were not available from these sources. As avoided hospitalisation costs and avoided mortality are potentially important we also carried out sensitivity analysis that involved extrapolating the observed reductions in pneumonias in the NI trials to hospitalisations and deaths. In all four models the cost-effectiveness of NIs is substantially improved by this extrapolation. For prophylaxis, antiviral drugs were compared with vaccination as preventative strategies. In all cases the cost-effectiveness ratios for vaccination were either low or cost-saving. In the base case the cost-effectiveness of antivirals was relatively unfavourable, there were scenarios relating to the elderly residential care model where antivirals as an additional strategy could be cost-effective.
CONCLUSIONS
The cost-effectiveness varies markedly between the intervention strategies and target populations. The estimate of cost effectiveness is also sensitive to variations in certain key parameters of the model, for example the proportion of all influenza-like illnesses that are influenza. The effectiveness literature that was used to inform the economic decision model spans many decades and hence great caution should be exercised when interpreting the results of indirect intervention comparisons from the model. Further randomised trials making direct comparisons would be valuable to verify the model's findings.
Topics: Antiviral Agents; Cost-Benefit Analysis; Decision Support Techniques; Humans; Influenza Vaccines; Influenza, Human; Quality-Adjusted Life Years; Treatment Outcome
PubMed: 14609480
DOI: 10.3310/hta7350 -
The Journal of Thoracic and... Feb 2021
Topics: Humans; Quadricuspid Aortic Valve
PubMed: 32089347
DOI: 10.1016/j.jtcvs.2020.01.040 -
Netherlands Heart Journal : Monthly... Jan 2024
PubMed: 38085508
DOI: 10.1007/s12471-023-01839-3