The COVID-19 pandemic has impacted health systems and health programs across the world. For tuberculosis (TB), it is predicted to set back progress by at least twelve years. Public private mix (PPM) is a collaborative approach to engage private providers in quality TB care. It has made a vital contribution to reach End TB targets with a ten-fold rise in TB notifications from private providers between 2012 and 2019. This is due in large part to the efforts of intermediary agencies, which aggregate demand from private providers. The COVID-19 pandemic has put these gains at risk over the past year. In this rapid assessment, representatives of 15 intermediary agencies from seven countries that are considered the highest priority for TB PPM (the Big Seven) share their views on the impact of COVID-19 on their programs, the private providers operating under their PPM schemes, and their private TB clients. All intermediaries reported a drop in TB testing and notifications, and the closure of some private practices. While travel restrictions and the fear of contracting COVID were the main contributing factors, there were also unanticipated expenses for private providers, which were transferred to patients via increased prices. Intermediaries also had their routine activities disrupted and had to shift tasks and budgets to meet the new needs. However, the intermediaries and their partners rapidly adapted, including an increased use of digital tools, patient-centric services, and ancillary support for private providers. Despite many setbacks, the COVID-19 pandemic has underlined the importance of effective private sector engagement. The robust approach to fight COVID-19 has shown the possibilities for ending TB with a similar approach, augmented by the digital revolution around treatment and diagnostics and the push to decentralize health services.

Aims:The electrosurgical technology category is used widely, with a diverse spectrum of devices designed for different surgical needs. Historically, hospitals are supplied with electrosurgical devices from several manufacturers, and those devices are often evaluated separately; it may be more efficient to evaluate the category holistically. This study assessed the health economic impact of adopting an electrosurgical device-category from a single manufacturer. Methods: A budget impact model was developed from a U.S. hospital perspective. The uptake of electrosurgical devices from EES (Ethicon Electrosurgery), including ultrasonic, advanced bipolar, smoke evacuators, and reusable dispersive electrodes were compared with similar MED (Medical Energy Devices) from multiple manufacturers. It was assumed that an average hospital performed 10,000 annual procedures 80% of which involved electrosurgery. Current utilization assumed 100% MED use, including advanced energy, conventional smoke mitigation options (e.g. ventilation, masks), and single-use disposable dispersive electrode devices. Future utilization assumed 100% EES use, including advanced energy devices, smoke evacuators (i.e. 80% uptake), and reusable dispersive electrodes. Surgical specialties included colorectal, bariatric, gynecology, thoracic and general surgery. Systematic reviews, network meta-analyses, and meta-regressions informed operating room (OR) time, hospital stay, and transfusion model inputs. Costs were assigned to model parameters, and price parity was assumed for advanced energy devices. The costs of disposables for dispersive electrodes and smokeevacuators were included. Results: The base-case analysis, which assessed the adoption of EES instead of MED for an average U.S. hospital predicted an annual savings of $824,760 ($101 per procedure). Savings were attributable to associated reductions with EES in OR time, days of hospital stay, and volume of disposable electrodes. Sensitivity analyses were consistent with these base-case findings. Conclusions: Category-wide adoption of electrosurgical devices from a single manufacturer demonstrated economic advantages compared with disaggregated product uptake. Future research should focus on informing comparisons of innovative electrosurgical devices.

A simple tube suction test has been developed by the Finnish National Road Administration for evaluating unstabilized granular base material. The test consists of monitoring the capillary rise of moisture within a 150-mm-diameter by 200-mm-high cylinder of compacted aggregate. A probe is used to measure the dielectric constant at the surface of the sample. The dielectric constant is a measure of the free, or unbound, water within the aggregate sample. It is this unbound water that is thought to be directly related to the strength of the material and its ability to withstand repeated freeze-thaw cycling. Measurements of dielectric constants are made over a period of 10 days. The poorest performing materials are those that rapidly reach saturation and exhibit high surface dielectric values. A study was conducted on four marginal aggregates from Alaska, Nevada, New Mexico, and Texas. These aggregates have been reported to be poor performers in their environments. Each aggregate failed the tube suction test. A mineralogical evaluation was performed to identify the mineral composition of each aggregate and to explain their high affinity for moisture. Subsequently the aggregates were treated with a concentrated liquid stabilizer. Upon treatment the aggregates showed improved performance in the tube suction test. The Alaska, Nevada, and New Mexico aggregates were then used in construction projects. Initial performance reports have been promising. The tube suction test described in this research has the potential to identify moisture-susceptible aggregates and to serve as a guide in selecting the optimal stabilizer type and amount.

A structural evaluation was performed on 25 base recycling projects in the Bryan District of the Texas Department of Transportation. The recycled layers were stabilized with cement or lime. On higher volume roadways, an unstabilized flexible base was placed over the stabilized layer, followed by a two-course surface treatment. On other pavements, the two-course surface treatment was placed directly on the stabilized layer. Testing was performed using the Dynaflect, falling weight deflectometer, dynamic cone penetrometer, and ground-penetrating radar. A correlation was generated between backcalculated layer moduli and percentage of stabilizer. Tentative moduli values, for thickness designs, were proposed. In the first year, 23 of 25 sections were judged to be performing well, with little or no surface distress. However in the next year, after a severe summer, only 17 were judged to be performing well. The major distress found was severe localized longitudinal cracking, which originated in the subgrade. The shrink-and-swell potential of the subgrade soil appears to be the major factor controlling pavement performance. Sections constructed on soils with a plasticity index of more than 35 did not perform well. The severity of the surface cracking was also related to the following secondary factors: ( a) the summer droughts of 1996 and 1998, ( b) presence of trees near the edge of the pavement, ( c) side slope conditions, and ( d) strength of the stabilized layer. The base recycling technique applied by the Bryan District appears to work well if the subgrade soils have low to moderate plasticity indices. This technique is not recommended for sections constructed on high plasticity index subgrades.