bluuebunny/crossref_metadata_2025 huggingface dataset:
Homeopathy and complementary medicine in Tuscany, Italy: integration in the public health system
Authors: Rossi Elio , Baccetti Sonia , Firenzuoli Fabio , Belvedere Katia
Published: April 2008

The healthcare programmes of the Region of Tuscany, Italy have contained references to various types of non-conventional medicine since 1996, and the last three Regional Health Plans have includes a chapter on non-conventional medicine that arguably represent the greatest degree of integration of such therapies in the public health care system achieved thus far in Italy. The Plan aims to guarantee definitive integration in the Regional Health Service of types of non-conventional medicine which are supported by a sufficient level of scientific evidence to allow them to be defined as forms of complementary medicine (acupuncture, herbal medicine, homeopathy and manual medicine). Moreover, in 2007 the Regional council of Tuscany, for the first time in Italy, approved a regional law disciplining the pratice of complementary medicines on the part of doctors, dentists, Veterinarians and pharmacists.
Truth, proof and evidence
Authors: Swayne Jeremy
Published: April 2008

The study and practice of medicine, in its most personal and intimate functions, its most sophisticated scientific and technological manifestations, and its philosophical and ethical ramifications, are central to our understanding of the human condition. Homeopathic medicine: its insights, the questions that it begs, and the scientific and philosophical challenges it presents, has a significant contribution to make to this process.

To be actively and seriously engaged with homeopathy is an adventurous undertaking. It is to be engaged in exploring both human nature and the nature of the world we inhabit. And in that process we are also engaged in the pursuit of truth and the exploration of reality.

This paper deals first with the layout of the playing field on which homeopathy has to compete to be taken seriously. It then discusses three concepts: reality, truth and knowledge, which are objectives for which we strive and principles that guide us in that striving. In the third part it introduces the concept of ‘personal knowledge’ as an essential ingredient of scientific discovery and the pursuit of truth. And finally it proposes that the homeopathic community in general, and the Faculty of Homeopathy in particular, must expand its vision with a definition of a new paradigm, the new model of healthcare and medical science to which the vision aspires.
Effects of homeopathy in mice experimentally infected with Trypanosoma cruzi
Authors: Rodrigues de Almeida Luciana , Caroline de Oliveira Campos Mônica , Miraglia Herrera Heitor , Villano Bonamin Leoni , Henrique da Fonseca Adivaldo
Published: April 2008

Aim: The aim of this study was to evaluate the action of homeopathic treatment on mice experimentally infected with Trypanosoma cruzi.

Methods: Eighty adult male C57BL/6 inbred mice were randomly allocated to five groups treated with biotherapy (nosode) of T. cruzi 12dH (12×) pre- and post-infection; Phosphorus 12dH post-infection; infected control treated with control solution and uninfected control. The biotherapy was prepared by the Costa method from the blood of mice experimentally infected with the Y strain of T. cruzi. Phosphorus was used because of its clinical and reportorial similarity to Chagas disease. T. cruzi (104) sanguineous forms were inoculated intraperitoneally per animal. Parasitaemia was monitored, leukocyte and serological responses were evaluated at 0, 7, 14 and 42 days after infection. The prepatent and patent periods of parasitaemia, maximum of parasitaemia, day of maximum parasitaemia and mortality rates were compared between groups.

Results: A significantly shorter period of patent parasitaemia was observed in the group treated with the biotherapy before infection (p < 0.05) than in the other groups. This group also had the lowest parasitaemias values at 9, 13, 15 (p < 0.05), 17 (p < 0.05), 22, 24 and 28 days, a lower rate of mortality and a significant increase of lymphocytes compared to the infected control group. The Phosphorus group had the longest period of patent parasitaemia, higher maximum parasitaemia, and a significant reduction of lymphocyte numbers, but no mortality. The infected control group had the highest mortality rate (not statistically significant), and the highest IgG titres at 42 days post-infection (p < 0.05).

Conclusions: The results suggest that pre-treatment with biotherapy modulates host immune response to T. cruzi, mainly during the acute phase of the infection. Phosphorus shows an action on the pathogenicity by T. cruzi infection. Homeopathic treatment of T. cruzi infection should be further investigated.
Modern or post-modern? Local or non-local? A response to Leick
Authors: Walach Harald
Published: April 2008

Most debates in science and the humanities that cannot be settled are not about truth, nor about data, but about beliefs and world views. Philippe Leick's comment on entanglement models of homeopathy are a good example. Because of this, no argument, however, convincing to some, will settle that debate. The only thing that can resolve it is a large cultural shift. My own ideas about non-local models, for a whole category of possibly similar events of which homeopathy is but one example.
Putin as a flexible politician. Does he imitate Stalin?
Authors: Shlapentokh Vladimir
Published: April 2008

The article is about Putin's ‘Jewish anomaly’. Against all expectations, Putin during his tenure as president of the Russian Federation showed in various ways his concern about the life of Jews in his country.
Flow along a long thin cylinder
Authors: TUTTY O. R.
Published: April 2008

Two different approaches have been used to calculate turbulent flow along a long thin cylinder where the flow is aligned with the cylinder. A boundary-layer code is used to predict the mean flow for very long cylinders (length to radius ratio of up toO(106)), with the effects of the turbulence estimated through a turbulence model. Detailed comparison with experimental results shows that the mean properties of the flow are predicted within experimental accuracy. The boundary-layer model predicts that, sufficiently far downstream, the surface shear stress will be (almost) constant. This is consistent with experimental results from long cylinders in the form of sonar arrays. A periodic Navier–Stokes problem is formulated, and solutions generated for Reynolds number from 300 to 5×104. The results are in agreement with those from the boundary-layer model and experiments. Strongly turbulent flow occurs only near the surface of the cylinder, with relatively weak turbulence over most of the boundary layer. For a thick boundary layer with the boundary-layer thickness much larger than the cylinder radius, the mean flow is effectively constant near the surface, in both temporal and spatial frameworks, while the outer flow continues to develop in time or space. Calculations of the circumferentially averaged surface pressure spectrum show that, in physical terms, as the radius of the cylinder decreases, the surface noise from the turbulence increases, with the maximum noise at a Reynolds number ofO(103). An increase in noise with a decrease in radius (Reynolds number) is consistent with experimental results.
Normal-mode linear analysis and initial conditions of capillary jets
Authors: GARCÍA F. J. , GONZÁLEZ H.
Published: April 2008

The normal-mode linear analysis of an axisymmetric infinite capillary jet is generalized to account for arbitrary initial conditions. An exhaustive study of the dispersion relation reveals the parametric behaviour of all eigenvalues and their corresponding normal modes. The two capillary modes (dominant and subdominant) are found to be necessary and sufficient to describe any possible non-recirculating initial conditions. An infinite set of other modes accounts for initial conditions with recirculating velocity field. The predictions of the normal-mode analysis are contrasted against previous computations of the initial-value problem, previous experiments, and our own one-dimensional numerical simulations. Contrary to the claim of some authors, the normal-mode analysis accurately predicts the initial transient with non-exponential growth of the disturbance amplitude observed in previous works. Simple and accurate formulae for the duration of the initial transient are deduced, with emphasis on improving the growth-rate measurement.
Linked twist map formalism in two and three dimensions applied to mixing in tumbled granular flows
Authors: STURMAN R. , MEIER S. W. , OTTINO J. M. , WIGGINS S.
Published: April 2008

We study the mixing properties of two systems: (i) a half-filled quasi-two-dimensional circular drum whose rotation rate is switched between two values and which can be analysed in terms of the existing mathematical formalism of linked twist maps; and (ii) a half-filled three-dimensional spherical tumbler rotated about two orthogonal axes bisecting the equator and with a rotational protocol switching between two rates on each axis, a system which we call a three-dimensional linked twist map, and for which there is no existing mathematical formalism. The mathematics of the three-dimensional case is considerably more involved. Moreover, as opposed to the two-dimensional case where the mathematical foundations are firm, most of the necessary mathematical results for the case of three-dimensional linked twist maps remain to be developed though some analytical results, some expressible as theorems, are possible and are presented in this work. Companion experiments in two-dimensional and three-dimensional systems are presented to demonstrate the validity of the flow used to construct the maps. In the quasi-two-dimensional circular drum, bidisperse (size-varying or density-varying) mixtures segregate to form lobes of small or dense particles that coincide with the locations of islands in computational Poincaré sections generated from the flow model. In the 3d spherical tumbler, patterns formed by tracer particles reveal the dynamics predicted by the flow model.
Vortical structures in the turbulent boundary layer: a possible route to a universal representation
Authors: STANISLAS MICHEL , PERRET LAURENT , FOUCAUT JEAN-MARC
Published: April 2008

A study of streamwise oriented vortical structures embedded in turbulent boundary layers is performed by investigating an experimental database acquired by stereoscopic particle image velocimetry (SPIV) in a plane normal both to the mean flow and the wall. The characteristics of the experimental data allow us to focus on the spatial organization within the logarithmic region for Reynolds numbersReθup to 15000. On the basis of the now accepted hairpin model, relationships and interaction between streamwise vortices are first investigated via computation of two-point spatial correlations and the use of linear stochastic estimation (LSE). These analyses confirm that the shape of the most probable coherent structures corresponds to an asymmetric one-legged hairpin vortex. Moreover, two regions of different dynamics can be distinguished: the near-wall region belowy+=150, densely populated with strongly interacting vortices; and the region abovey+=150 where interactions between eddies happen less frequently. Characteristics of the detected eddies, such as probability density functions of their radius and intensity, are then studied. It appears that Reynolds number as well as wall-normal independences of these quantities are achieved when scaling with the local Kolmogorov scales. The most probable size of the detected vortices is found to be about 10 times the Kolmogorov length scale. These results lead us to revisit the equation for the mean square vorticity fluctuations, and to propose a new balance of this equation in the near-wall region. This analysis and the above results allow us to propose a new description of the near-wall region, leading to a new scaling which seems to have a good universality in the Reynolds-number range investigated. The possibility of reaching a universal scaling at high enough Reynolds number, based on the external velocity and the Kolmogorov length scale is suggested.
Shock tube flows past partially opened diaphragms
Authors: GAETANI PAOLO , GUARDONE ALBERTO , PERSICO GIACOMO
Published: April 2008

Unsteady compressible flows resulting from the incomplete burst of the shock tube diaphragm are investigated both experimentally and numerically for different initial pressure ratios and opening diameters. The intensity of the shock wave is found to be lower than that corresponding to a complete opening. A heuristic relation is proposed to compute the shock strength as a function of the relative area of the open portion of the diaphragm. Strong pressure oscillations past the shock front are also observed. These multi-dimensional disturbances are generated when the initially normal shock wave diffracts from the diaphragm edges and reflects on the shock tube walls, resulting in a complex unsteady flow field behind the leading shock wave. The limiting local frequency of the pressure oscillations is found to be very close to the ratio of acoustic wave speed in the perturbed region to the shock tube diameter. The power associated with these pressure oscillations decreases with increasing distance from the diaphragm since the diffracted and reflected shocks partially coalesce into a single normal shock front. A simple analytical model is devised to explain the reduction of the local frequency of the disturbances as the distance from the leading shock increases.
On the stability of ocean overflows
Authors: PRATT LARRY J. , HELFRICH KARL R. , LEEN DAVID
Published: April 2008

The stability of a hydraulically driven sill flow in a rotating channel with smoothly varying cross-section is considered. The smooth topography forces the thickness of the moving layer to vanish at its two edges. The basic flow is assumed to have zero potential vorticity, as is the case in elementary models of the hydraulic behaviour of deep ocean straits. Such flows are found to always satisfy Ripa's necessary condition for instability. Direct calculation of the linear growth rates and numerical simulation of finite-amplitude behaviour suggests that the flows are, in fact, always unstable. The growth rates and nonlinear evolution depend largely on the dimensionless channel curvature κ=2αg′/f2, where 2α is the dimensional curvature, g′ is the reduced gravity, and f is the Coriolis parameter. Very small positive (or negative) values of κ correspond to dynamically wide channels and are associated with strong instability and the breakup of the basic flow into a train of eddies. For moderate or large values of κ, the instability widens the flow and increases its potential vorticity but does not destroy its character as a coherent stream. Ripa's condition for stability suggests a theory for the final width and potential vorticity that works moderately well. The observed and predicted growth in these quantities are minimal for κ≥1, suggesting that the zero-potential-vorticity approximation holds when the channel is narrower than a Rossby radius based on the initial maximum depth. The instability results from a resonant interaction between two waves trapped on opposite edges of the stream. Interactions can occur between two Kelvin-like frontal waves, between two inertia–gravity waves, or between one wave of each type. The growing disturbance has zero energy and extracts zero energy from the mean. At the same time, there is an overall conversion of kinetic energy to potential energy for κ>0, with the reverse occurring for κ<0. When it acts on a hydraulically controlled basic state, the instability tends to eliminate the band of counterflow that is predicted by hydraulic theory and that confounds hydraulic-based estimates of volume fluxes in the field. Eddy generation downstream of the controlling sill occurs if the downstream value of κ is sufficiently small.
Transverse-jet shear-layer instabilities. Part 2. Linear analysis for large jet-to-crossflow velocity ratio
Authors: DE B. ALVES LEONARDO S. , KELLY ROBERT E. , KARAGOZIAN ANN R.
Published: April 2008

The dominant non-dimensional parameter for isodensity transverse jet flow is the mean jet-to-crossflow velocity ratio,R. In Part 1 (Megerianet al.,J. Fluid Mech., vol. 593, 2007, p. 93), experimental results are presented for the behaviour of transverse-jet near-field shear-layer instabilities for velocity ratios in the range 1 4, using two different base flows for the transverse jet. The first analysis assumes the flow field to be described by a modified version of the potential flow solution of Coelho & Hunt (J. Fluid Mech., vol. 200, 1989, p. 95), in which the jet is enclosed by a vortex sheet. The second analysis assumes a continuous velocity model based on the same inviscid base flow; this analysis is valid for the larger values of Strouhal number expected to be typical of the most unstable disturbances, and allows prediction of a maximum spatial growth rate for the disturbances. In both approaches, results are obtained by expanding in inverse powers ofRso that the free-jet results are obtained asR→∞. The results from both approaches agree in the moderately low-frequency regime. Maximum spatial growth rates and associated Strouhal numbers extracted from the second approach both increase with decreasing velocity ratioR, in agreement with the experimental results from Part 1 in the range 4<R≤10. The nominally axisymmetric mode is found to be the most unstable mode in the transverse-jet shear-layer near-field region, upstream of the end of the potential core. The overall agreement of theoretical and experimental results suggests that convective instability occurs in the transverse-jet shear layer for jet-to-crossflow velocity ratios above 4, and that the instability is strengthened asRis decreased.
Discrimination of lichen genera and species using element concentrations
Authors: BENNETT James P.
Published: April 2008

The importance of organic chemistry in the classification of lichens is well established, but inorganic chemistry has been largely overlooked. Six lichen species were studied over a period of 23 years that were growing in 11 protected areas of the northern Great Lakes ecoregion, which were not greatly influenced by anthropogenic particulates or gaseous air pollutants. The elemental data from these studies were aggregated in order to test the hypothesis that differences among species in tissue element concentrations were large enough to discriminate between taxa faithfully. Concentrations of 16 chemical elements that were found in tissue samples from Cladonia rangiferina, Evernia mesomorpha, Flavopunctelia flaventior, Hypogymnia physodes, Parmelia sulcata, and Punctelia rudecta were analyzed statistically using multivariate discriminant functions and CART analyses, as well as t-tests. Genera and species were clearly separated in element space, and elemental discriminant functions were able to classify 91–100 of the samples correctly into species. At the broadest level, a Zn concentration of 51 ppm in tissues of four of the lichen species effectively discriminated foliose from fruticose species. Similarly, a S concentration of 680 ppm discriminated C. rangiferina and E. mesomorpha, and a Ca concentration of 10 436 ppm discriminated H. physodes from P. sulcata. For the three parmelioid species, a Ca concentration >32 837 ppm discriminated Punctelia rudecta from the other two species, while a Zn concentration of 56 ppm discriminated Parmelia sulcata from F. flaventior. Foliose species also had higher concentrations than did fruticose species of all elements except Na. Elemental signatures for each of the six species were developed using standardized means. Twenty-four mechanisms explaining the differences among species are summarized. Finally, the relationships of four species based on element concentrations, using additive-trees clustering of a Euclidean-distance matrix, produced identical relationships as did analyses based on secondary product chemistry that used additive-trees clustering of a Jaccard similarity matrix. At least for these six species, element composition has taxonomic significance, and may be useful for discriminating other taxa.
Leptogium loriforme P. M. Jørg. & Kashiw., a new hairy species from Papua New Guinea
Authors: JØRGENSEN Per M. , KASHIWADANI H.
Published: April 2008

A new species of the Leptogium trichophorum group is described from Mt. Albert Edward in Papua New Guinea. A key to the related species, which are all found in SE Asia, is given. The new species appears to be rather local, and may prove to be endemic.
Caloplaca concreticola (Teloschistaceae), a new species from anthropogenic substrata in Eastern Europe
Authors: VONDRÁK Jan , KHODOSOVTSEV Alexander , ŘÍHA Pavel
Published: April 2008

Caloplaca concreticola is described here as new. It is a morphologically well-characterized, sorediate species of the subgenus Pyrenodesmia, that comprises a part of the ‘‘black-fruited’’ taxa with an absence of anthraquinones in their apothecia. Currently it is known only from concrete and always occurs close to water (mainly on the walls of water channels). Analysis of nuclear ribosomal ITS sequence data of the new species, together with most European species of the subgenus, supports the recognition of the new species as a monophyletic taxon within the Pyrenodesmia clade.
Epiphytic lichens indicate recent increase in air pollution in the Mongolian capital Ulan Bator
Authors: Hauck Markus
Published: April 2008

Mongolia is one of the least densely populated countries of the world with 2·6 million
people occupying an area of 1·5 million km2. A high proportion of the population and economy is concentrated in the capital Ulan Bator, which has 1 million inhabitants. Ulan Bator is characterized by its high elevation (1350 m), low precipitation (300 mm), high annual sunshine duration, and its location in a basin. The city is surrounded by mountain ranges to the north and to the south. Furthermore, it is the coldest capital of the world with an annual mean temperature of −3·7°C (Hilbig et al. 2004). Outside Ulan Bator and a few industrial areas, including a large copper plant near the second-largest city Erdenet, Mongolia’s air is extremely pure (ADB 2006). Therefore, Mongolia’s forests, which cover 10% of the country (Erdenechuluun 2006) harbour a rich epiphytic lichen vegetation (Cogt 1995). Most of these woodlands are conifer stands that form the southernmost range of the continuous Siberian taiga forests (Gunin et al. 1999). Eighty percent of the forest area of Mongolia is covered by Larix sibirica (Savin et al. 1978), while other important tree species in the taiga include Pinus sibirica, P. sylvestris, Picea obovata, Abies sibirica, and Betula platyphylla (Hilbig 1995; Dulamsuren et al. 2005). Dominant epiphytic lichen species in the larch-dominated taiga include Bryoria fuscescens, B. nadvornikiana, Evernia mesomorpha, Flavopunctelia soredica, Hypogymnia bitteri, H. physodes, Lecanora symmicta, Melanohalea septentrionalis, Parmelia sulcata, Usnea sp., and Vulpicida pinastri (Biazrov 1974; Hauck et al. 2007).
Association between methodological characteristics and outcome in health technology assessments which included case series
Authors: Stein Ken , Dalziel Kim , Garside Ruth , Castelnuovo Emanuela , Round Ali
Published: April 2008

Objectives:Case series constitute a weak form of evidence for effectiveness of health technologies. However, for a variety of reasons, such studies may be included in health technology assessments. There are no clear criteria for assessing the quality of case series. We carried out an empirical investigation of the association between outcome frequency and methodological characteristics in a sample of health technology assessments.

Methods:Systematic reviews of functional endoscopic sinus surgery for nasal polyps, spinal cord stimulation for chronic back pain, and percutaneous transluminal coronary angioplasty and coronary artery bypass grafting for chronic stable angina were identified as containing more than forty case series. Data were extracted by one reviewer and checked by a second on population characteristics, outcomes, and the following methodological features: sample size, prospective/retrospective approach, consecutive recruitment, multi- or single-center organization, length of follow-up, independence of outcome measurement, and date of publication. Association between methodological features and outcome were explored in univariate and multivariate analyses using parametric and nonparametric tests and robust regression or analysis of variance/analysis of covariance, as appropriate.

Results:Included reviews contained between forty-two and seventy-six case series studies, involving 5 to 172,283 participants. Reporting of methodological features was poor and limited the analyses. In general, we found little evidence of any association between methodological characteristics and outcome. Sample size is used as an inclusion criterion in many reviews of case series but was consistently shown to have no relationship to outcome in all analyses. A prospective approach was not associated with outcome. Insufficient data were available to explore consecutive recruitment. Mixed results were shown for length of follow-up, independence of outcome measurement, and publication date.

Conclusion:We found little evidence to support the use of many of the factors included in tools used for quality assessment of case series. Importantly, we found no relationship between study size and outcome across the four examples studied. Isolated examples of a potentially important relationship between other methodological factors and outcome were shown, for example, blinding of outcome measurement, but these examples were not shown consistently across the small number of examples studied. Further research into the determinants of quality in case series studies is required to support health technology assessment.
Self-reports of health-care utilization: Diary or questionnaire?
Authors: van den Brink Mandy , van den Hout Wilbert B. , Stiggelbout Anne M. , Putter Hein , van de Velde Cornelis J. H. , Kievit Job
Published: April 2008

Objectives:The feasibility and convergent validity of a cost diary and a cost questionnaire was investigated.

Methods:Data were obtained as part of a cost-utility analysis alongside a multicenter clinical trial in patients with resectable rectal cancer. A sample of 107 patients from 30 hospitals was asked to keep a weekly diary during the first 3 months after surgery, and a monthly diary from 3 to 12 months after surgery. A second sample of seventy-two patients from twenty-eight hospitals in the trial received a questionnaire at 3, 6, and 12 months after surgery, referring to the previous 3 or 6 months. Format and items of the questions were similar and included a wide range of medical and nonmedical items and costs after hospitalization for surgery.

Results:Small differences were found with respect to nonresponse (range, 79 to 86 percent) and missing questions (range, 1 to 6 percent between the diary and questionnaire). For most estimates of volumes of care and of costs, the diary and questionnaire did not differ significantly. Total 3-month nonhospital costs were €1,860, €1,280, and €1,050 in the diary sample and €1,860, €1,090, and €840 in the questionnaire sample at 3, 6, and 12 months after surgery, respectively (p=.50). However, with respect to open questions, the diary sample tended to report significantly more care.

Conclusions:For the assessment of health-care utilization in economic evaluations alongside clinical trials, a cost questionnaire with structured closed questions may replace a cost diary for recall periods up to 6 months.
Toward a procedure for integrating moral issues in health technology assessment
Authors: Hofmann Bjørn
Published: April 2008

Objectives:Although ethics has been on the agenda in health technology assessment (HTA) since its inception, the integration of moral issues is still not standard and is performed in a vast variety of ways. Therefore, there is a need for a procedure for integrating moral issues in HTA.

Methods:Literature review of existing approaches together with application of various theories in moral philosophy and axiology.

Results:The article develops a set of questions that addresses a wide range of moral issues related to the assessment and implementation of health technology. The issues include general moral issues and moral issues related to stakeholders, methodology, characteristics of technology, and to the HTA process itself. The questions form a kind of checklist for use in HTAs.

Conclusions:The presented approach for integrating moral issues in HTA has a broad theoretical foundation and has shown to be useful in practice. Integrating ethical issues in HTAs can be of great importance with respect to the dissemination of HTA results and in efficient health policy making.
Technology assessment in dentistry: A comparison of the longevity and cost-effectiveness of inlays
Authors: Gandjour Afschin , Kerschbaum Thomas , Reis Andreas , Lauterbach Karl Wilhelm
Published: April 2008

Objectives:An example of technology assessment in dental care by evaluating the (cost-)effectiveness of types of three-surface inlays (gold, laboratory-fabricated ceramic, and chairside CAD/CAM ceramic) is provided.

Methods:MEDLINE, EMBASE, and the Cochrane Library were searched for studies published between 1966 and June 2003 that reported annual survival probabilities and annual observations. The longevity of different types of inlays was measured by the number of failure-free years. Annual survival rates from different studies were pooled by weighing the rates of each study by the inverse of the variance of the effect estimate. A cost-effectiveness analysis from the perspective of German private health insurers was performed using billing charges.

Results:Three, five, and two case series on laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively, were included. Over a 9-year observation period, the number of undiscounted failure-free years was 8.62 (95 percent confidence interval, 8.40–8.85), 8.65 (8.58–8.73), and 8.76 (8.72–8.80) for laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays, respectively. Laboratory-fabricated ceramic inlays were the most expensive.

Conclusions:While laboratory-fabricated ceramic, chairside CAD/CAM ceramic, and gold inlays had a strikingly similar failure-free survival rate, laboratory-fabricated ceramic inlays had the highest costs and, thus, were less cost-effective than chairside CAD/CAM ceramic and gold inlays.
Spinal cord stimulation for failed back surgery syndrome: A decision-analytic model and cost-effectiveness analysis
Authors: Taylor Rebecca J. , Taylor Rod S.
Published: April 2008

Objectives:The aim of this study was to develop a decision-analytic model to assess the cost-effectiveness of spinal cord stimulation (SCS), relative to nonsurgical conventional medical management (CMM), for patients with failed back surgery syndrome (FBSS).

Methods:A decision tree and Markov model were developed to synthesize evidence on both health-care costs and outcomes for patients with FBSS. Outcome data of SCS and CMM were sourced from 2-year follow-up data of two randomized controlled trials (RCTs). Treatment effects were measured as levels of pain relief. Short- and long-term health-care costs were obtained from a detailed Canadian costing study in FBSS patients. Results are presented as incremental cost per quality adjusted life year (QALY) and expressed in 2003 Euros. Costs were discounted at 6 percent and outcomes at 1.5 percent.

Results:Over the lifetime of the patient, SCS was dominant (i.e., SCS is cost-saving and gives more health gain relative to CMM); a finding that was robust across sensitivity analyses. At a 2-year time horizon, SCS gave more health gain but at an increased cost relative to CMM. Given the uncertainty in effectiveness and cost parameters, the 2-year cost-effectiveness of SCS ranged from €30,370 in the base case to €63,511 in the worst-case scenario.

Conclusions:SCS was found to be both more effective and less costly than CMM, over the lifetime of a patient. In the short-term, although SCS is potentially cost-effective, the model results are highly sensitive to the choice of input parameters. Further empirical data are required to improve the precision in the estimation of short-term cost-effectiveness.
Diffusion of published cost-utility analyses in the field of health policy and practice
Authors: Sonnad Seema S. , Greenberg Dan , Rosen Allison B. , Neumann Peter J.
Published: April 2008

Objectives:The diffusion of cost-utility analyses (CUAs) through the medical literature was examined, documenting visible patterns and determining how they correspond with expectations about the diffusion of process innovations.

Methods:This study used 539 CUAs from a registry. It includes data elements comprising year of publication, the research center in which the study was performed, the clinical area covered by the CUA, and the specific journal. Finally, each paper was assigned to a journal type that could be one of the three categories: health services research, general medicine, or clinical specialty.

Results:When the average number of publications is plotted against time, the plot reveals an S-shaped curve. It appears that, whereas CUAs initially were published more frequently in general medical or health services research journals, there was a clear increase in the diffusion of CUA into subspecialty journals over time. The concentration ratio for research centers as measured by the Herfindhal–Hirschman Index decreased over time.

Conclusions:The spread of CUA through the medical literature follows patterns identified for the diffusion of other new technologies and processes. Future research should focus on what impact this spread has had on the practice of medicine and formulation of health policy.
When analyses are invalidated by erroneous assumptions
Authors: Terkelsen Christian Juhl , Lassen Jens Flensted , Nørgaard Bjarne Linde , Nielsen Torsten Toftegaard , Andersen Henning Rud
Published: April 2008

In a recent publication in the “International Journal of Technology Assessment in Health Care” (7), Kildemoes and Kristiansen claim to address “Cost-effectiveness of interventions to reduce the thrombolytic delay for acute myocardial infarction.” Their study is based on a “Master of Public Health Assessment” thesis published by Kildemoes in the year 2001 (6). Three years ago, the author was informed that several of her assumptions were incorrect. In this letter, we will address six of the erroneous assumptions made by Kildemoes and Kristiansen.
Response to an optimistic viewpoint
Authors: Kildemoes Helle Wallach , Kristiansen Ivar Sønbø
Published: April 2008

We appreciate the interests in our work and observe that we agree that earlier thrombolysis for AMI can reduce the AMI case fatality. The question is how much and at what price. There are no data available to directly address this issue, and we developed a simulation model to quantify costs and health consequences of less thrombolytic delay by using public awareness campaigns, telemedicine, or a combination of the two. Inevitably, such a model needs to be based on several uncertain parameter values. We performed a range of sensitivity analyses so readers of the analysis could see the effect of replacing our base case values with others that the reader might consider more appropriate. Due to space restrictions, we had to omit a table with sensitivity analyses that would have addressed several of the concerns Terkelsen and coworkers have.
Response to commentaries by Kildemoes and Kristiansen
Authors: Terkelsen Christian Juhl
Published: April 2008

§1.1. Recent data documents that not a “majority” but only 40% of Danish patients arrive at the hospital within 30 minutes of ambulance call (7;8). §1.2. The Dutch study confirmed that, even in areas with 13 minutes transport time to the hospital, comparable to the Danish scenery, a prehospital thrombolytic strategy reduced treatment delay by nearly 1 hour (5). §1.3. We appreciate that the authors confirm our viewpoint, that is, quoting that “the mortality reduction more than doubles up,” “if hospital delay is totally eliminated (corresponding to a delay reduction of 1 hour).” In the future, patients should be diagnosed before hospital admission and either treated before hospital admission with thrombolysis or transferred directly to interventional center for primary PCI. In both settings, the delay at the local hospital, averaging 1 hour, would be eliminated (1;8). §2.0. Kildemoes and Kristiansen may have misunderstood our arguments regarding the Boersma formula. We recommend that they read our previous viewpoint (9). We have no reason to believe that distribution of patient delay in Denmark differs significantly from other countries. Moreover, we are surprised that the case fatality estimates implemented by Kildemoes and Kristiansen differs significantly from findings in a recent Danish Health Technology Assessment and findings in previous meta-analyses (2;4;6). §3.1. For 7 years, the present group of authors have worked with telemedicine in the prehospital evaluation of patients. Our close collaborators, the ambulance operators and the company delivering telemedicine equipment, have confirmed our cost data, whereas they disagree with the cost data implemented by Kildemoes and Kristiansen. §3.2. Equipment for twelve-lead ECG acquisition is necessary when implementing prehospital diagnosis, irrespective of whether the diagnoses are established by telemedicine, by paramedics, or by physicians. §5. A 1-hour reduction in treatment delay is achievable by a prehospital diagnostic strategy, both in the setting of prehospital thrombolysis and in the setting of prehospital referral to interventional centers for primary PCI (6;8). This reduction in treatment delay should have a major impact on AMI fatality (also in Denmark; 3;6).
Health-care management and the culture of assessment: An urgent liaison?
Authors: Granados Alicia
Published: April 2008

Effectiveness in health-care management has been defined as the relationship between what a manager achieves in terms of performance and what he or she is expected to achieve; that is, effectiveness is the extent to and means by which an organization carries out its defined functions (6). The implicit, albeit core functions of hospitals and primary care centers in providing patient access, professional and center responsiveness, effective and safe services, and improved health outcomes, have increasingly been blurred by other more explicit objectives, such as cost-containment and process reengineering. Indiscriminate cost-cutting and “reengineering mania” have become popular among health-care policy-makers all over the world. Such strategies have even been adopted by countries (including Spain) whose health-care expenditures have for decades ranked below the European average (9). However, the effects of these widespread trends have never been properly assessed. They seem to impose a common threat on professional job satisfaction, and in Europe, there are more impatient patients on the waiting list than ever (8)
Differences in Comprehensive System Rorschach Variables Between Groups Differing in Therapy Suitability
Authors: Nygren Marianne
Published: April 2008

Dans les deux études présentées ici, nous avons fait des prédictions conceptuelles sur l'aptitude de patients à suivre une psychothérapie d'orientation dynamique à partir de variables Rorschach. Dans la première étude, nous avons sélectionné rationnellement des variables prédictives Rorschach (SI) (Exner, 1991, 1993) pour trois groupes de patients de divers diagnostics (n = 30, 43, 25). Les groupes ont été comparés à l'aide de l'ANOVA non paramétrique de Kruskall-Wallis puis nous avons procédé à des comparaisons par paire entre les groupes avec le test U de Mann-Whitney. Dans l'étude II, on a prédit des différences de scores entre deux désordres de personnalité (n = 35 et 25) et testés à l'aide du U de Mann-Whitney. Les résultats de ces deux études on confirmé les prédictions pour le EA, les blends, l'activité d'organisation (Zf), le mouvement humain de forme ordinaire (Mo), la dimension formelle (FD), le mouvement agressif (AG) et de coopération (COP) comme de bonne indication pour une psychothérapie d'orientation dynamique. De même, nous avons trouvé comme indicateurs négatifs le pourcentage des réponses purement formelles (F%), un score D > 0 et un indice d'incompétence sociale positif (CDI > 3). Les prédictions portant sur la couleur dominée par le forme (FC), l'estompage de diffusion non dominé par la forme (YF, Y), le mouvement d'objet (m), la somme pondérée des cotations spéciales critiques (WSum6), la distorsion formelle (X–%), l'espace blanc (S), les reflets (Fr, rF) et les réponses personnalisées (PER) n'ont pas été confirmées.
Discrepancies Between the Rorschach Inkblot Method and Self-Report Measures of Personality
Authors: Petot Jean-Michel , Djurić Jočić Dragana
Published: April 2008

Because the quasi-absence of correlation between Rorschach variables and the dimensions described in academic psychology of personality is now a well-established fact, this paper reviews the main reasons which could account for this puzzling discrepancies. Some of these reasons are methodological or statistical ones, and they are linked to formal properties of variables to be correlated: raw scores, ratios, or percentages, or broader constructs operationalized by specific pattern of scores and ratios. It is emphasized that some difficulties are related to the excessive number of variables addressed in studies lacking theoretical hypotheses, as to the categorical nature of many Rorschach variables, which opposes the dimensional nature of the constructs of academic personality psychology. More fundamentally, it is suggested that, as exemplified by introversion and introversiveness, psychological realities assessed by the Rorschach differ from those conceptualized by personality psychology not only by their content but also by their structure. Finally, the authors discuss the hypothesis suggested by Ganellen and Meyer: the correlation between the Rorschach and self-report measures would be moderated by the patients’ response style or test-taking attitude; the absence of correlation in the studied samples would conceal strong positive correlations among subjects with the same attitude toward both tests, and strong negative correlations among subjects with test-taking attitude different toward each kind of instrument. It is suggested that this hypothesis is promising, but it will be illuminating only when a reliable and specific marker of attitude will be identified. To conclude, it is remembered that while these discrepancies between the two kinds of tests raise some problems at the theoretical level, at a clinical level they convey much valuable information about patient’s self-representation and defence mechanisms.
Correlation of the Rorschach Method and the NEO PI-R Questionnaire
Authors: Djurić Jočić Dragana
Published: April 2008

The aim of the study was to determine the convergent value of two instruments for personality evaluation. The conceptual and empiric correlation of two indicators of the projective method and self-report questionnaire were studied. The Rorschach method as interpreted by the Comprehensive System is considered atheoretical, while the NEO PI-R questionnaire is based on the Five-Factor Model of personality. Therefore, the correlation between the Rorschach method and Five-Factor personality theory has been investigated indirectly. The sample comprised 200 psychiatric patients, 100 nonpsychotic patients (mostly anxious-depressive) and 100 psychotic patients (mostly schizophrenic). Analysis of the results used correlation analysis, factorial analysis, canonical correlation analysis, canonical analysis of covariance, and asymmetric redundancy analysis. Identification of aberrant objects was applied for qualitative interpretation of the results. The obtained results have shown that, although numerous conceptual similarities between indicators of the two instruments have been recognized, their convergent validity is low. Possible causes of the low convergent validity and recommendations for further studies are proposed.
The Rorschach Ink-Blot Test as an Instrument for Evaluating Quality of Life in Breast-Cancer Victims
Authors: Marchioro G. , Barbato F. , Azzarello G. , Vinante O.
Published: April 2008

Background. The psychological discomfort associated to breast-cancer diagnosis and related treatments is universally recognized. However homogeneous modalities of intervention are lacking. The questionnaires are the most employed tools to analyze pre-morbidity personality traits and the quality of life of cancer patients, but they lack valid indicators of the patients' overall quality of life. On the other hand, counseling along with administered psychological tests allows listening and mutual relationship between patient and examiner. The aim of this study was to evaluate the impact of the Rorschach test, a multidimensional method of collecting data on personality functioning, as an instrument to assess mood disorders, object relation, self-image and quality of life in breast cancer patients. Methods. 135 consecutive women affected by operable breast cancer underwent psychological counseling and the Rorschach test within 2–4 weeks after surgery. Results of the test were interpreted according to the structural and experiential approaches. The discrimination between “compact” and “noncompact” tables makes it possible to study the changes of patients identity during the illness, while the Experienced Stimulation and Experience Actual indices, providing information about the patient's coping to therapeutic approach, were calculated according to the Exner system. The records from a sample of 60 healthy women, equally distributed in three age groups (< 50, 50–59, > 60) coming from the same Italian region (regional sample) and the results from 736 nonpatient Italian subjects (national sample) were used as controls. Results. Quantitative results were comparable within groups, except for parameters of cognitive characteristics regulating the approach to reality (G, G+, F+, Anat, Ban). No patient fulfilled the parameter configuration corresponding to depressive disorder, but alexithymia with a state reaction interpreted as an adjustment disorder with depressive mood was recorded. This trait was correlated with lower educational levels and increasing age.
Extraversion in Differential Psychology and Experience Balance in the Rorschach
Authors: del Pilar Gregorio E. H.
Published: April 2008

Durante muchos años, la opinión de expertos en Rorschach sobre las conexiones entre extraversión (E) y tipo vivencial (EB) han presentado un amplio rango, desde la consideración de que ambas variables eran prácticamente idénticas hasta la negación de cualquier relación entre ellas. Los resultados de estudios empíricos no han sido menos divergentes: los trabajos basados en los correlatos psicológicos de EB parecen haber confirmado la semejanza con los componentes de E. Por otro lado, los estudios que han investigado directamente la correlación entre ambos conceptos han obtenidos casi unánimemente resultados no significativos. Se planteó este trabajo para abordar nuevamente el tema administrando a 129 estudiantes universitarios bilingües filipinos la escala de Eysenck (EPQ-R), la versión filipina del NEO-PI-R y el Rorschach. Las correlaciones obtenidas entre EB y las dos escalas E fueron de 0.22 (p < .05) y 0.29 (p < .01). Descartando un valor extremo, estas correlaciones alcanzan 0.33 y 0.41 respectivamente (p < .001 para ambas). Los aspectos de E más relacionados con EB fueron calidez, gregarismo, emociones positivas y actividad. Tanto estos componentes de E como la E total correlacionan positivamente con las respuestas de Color y negativamente con las de Movimiento. Sin embargo, la fórmula EB presenta correlaciones con E a niveles más elevados que solo las respuestas de Color o sólo las de Movimiento. Se sugieren nuevas posibilidades de conceptualización sobre EB basadas en estas correlaciones con E.