bluuebunny/crossref_metadata_2025 huggingface dataset:
Status of the development of ignition capsules in the U.S. effort to
achieve thermonuclear ignition on the national ignition facility
Authors: NOBILE A. , NIKROO A. , COOK R.C. , COOLEY J.C. , ALEXANDER D.J. , HACKENBERG R.E. , NECKER C.T. , DICKERSON R.M. , KILKENNY J.L. , BERNAT T.P. , CHEN K.C. , XU H. , STEPHENS R.B. , HUANG H. , HAAN S.W. , FORSMAN A.C. , ATHERTON L.J. , LETTS S.A. , BONO M.J. , WILSON D.C.
Published: April 2008

An important component of the U.S. effort to achieve thermonuclear
ignition in 2010 on the National Ignition Facility is the development of
high quality 2 mm diameter spherical capsules to function as the ablator
and contain the cryogenic DT fuel. Three ignition capsule designs have
been developed, and detailed fabrication specifications for each design
have been established and placed under change control. A research program
with activities coordinated mainly between Lawrence Livermore, General
Atomics and Los Alamos is underway to demonstrate fabrication of capsules
meeting specifications. The point design for ignition campaigns beginning
in 2010 is a Cu-doped Be capsule that has a radial gradient in Cu dopant
level in the capsule wall. This capsule is being produced by sputter
deposition of Be and Cu onto either a hollow glow discharge polymer (GDP)
spherical mandrel or a solid spherical mandrel, followed by removal of the
mandrel and polishing of the capsule. A key goal in the U.S. is to
demonstrate fabrication of this capsule by the end of 2006. Two other
ignition capsule designs are also being developed as contingencies to the
point design. One contingency design is a GDP capsule that has a radial Ge
dopant level in its wall. This capsule is produced by co-deposition of Ge
and GDP onto a PAMS mandrel followed by thermal removal of the mandrel.
The second contingency design is a uniform Cu-doped Be capsule that is
fabricated from high purity fine grain Be0.3at.%Cu alloy using a precision
machining route followed by polishing. Ignition targets to be fielded in
2010 will be filled with DT fuel through a small fill hole. Laser drilling
capability has been developed and used to drill approximately 5 μm
diameter holes through capsule walls for DT filling. Characterization
methods necessary for characterizing capsules are being developed.
Investigation of laser-produced chlorine plasma radiation for non-monochromatic X-ray scattering experiments
Authors: SCHOLLMEIER M. , PRIETO G. RODRÍGUEZ , ROSMEJ F.B. , SCHAUMANN G. , BLAZEVIC A. , ROSMEJ O.N. , ROTH M.
Published: April 2008

The chlorine Heαradiation of polyvinyl chloride (PVC) was investigated with respect to X-ray scattering experiments on dense plasmas. The X-ray source was a laser-produced plasma that was observed with a highly reflective highly oriented pyrolytic graphite (HOPG) crystal spectrometer as it is used in current x-ray scattering experiments on dense plasmas. The underlying dielectronic satellites of Heαcannot be resolved, therefore the plasma was observed at the same time with a focusing spectrometer with spatial resolution. To reconstruct the spectrum a simple model to calculate the spectral line emission based on dielectronic recombination and inner shell excitation of helium- and lithium-like ions was used. The analysis shows that chlorine dielectronic satellite emission is intense compared to Heαin laser-produced chlorine plasmas with a temperature of 300 eV in this wavelength range of Δλ = 0.07 Å (ΔE= 43 eV). The method proposed in this paper allows deducing experimentally the role of the underlying dielectronic satellites in the scatter spectrum measured with a HOPG crystal spectrometer. It is shown that the dielectronic satellites can be neglected when the scattering is measured with low spectral resolution in the non-collective regime. They are of major importance in the collective scatter regime where a high spectral resolution is necessary.
Health-care decision-making processes in Latin America: Problems and prospects for the use of economic evaluation
Authors: Iglesias Cynthia P. , Drummond Michael F. , Rovira Joan ,   for the NEVALAT Project Group
Published: April 2008

Objectives: The use of economic evaluation studies (EE) in the decision-making process within the health-care system of nine Latin American (LA) and three European countries was investigated. The aim was to identify the opportunities, obstacles, and changes needed to facilitate the introduction of EE as a formal tool in health-care decision-making processes in LA.

Methods: A comparative study was conducted based on existing literature and information provided through a questionnaire applied to decision makers in Argentina, Brazil, Colombia, Cuba, Mexico, Nicaragua, Peru, Portugal Spain, United Kingdom, Uruguay, and Venezuela. Systematic electronic searches of HEED, NHS EED, and LILACS were conducted to identify published economic evaluation studies in LA from 1982 onward.

Results: There is relatively little evidence of the conduct and use of EE within the health care systems in LA. Electronic searches retrieved 554 records; however, only 93 were EE. In the nine LA participating countries, broad allocation of health-care resources is primarily based on political criteria, historical records, geographical areas, and specific groups of patients and diseases. Public-health provision and inclusion of services in health-insurance package are responsibilities of the Ministry of Health. Decisions regarding the purchase of medicines are primarily made through public tenders, and mainly based on differences in clinical efficacy and the price of health technologies of interest.

Conclusions: To expedite the process of incorporating EE as a formal tool to inform decision-making processes within the health-care systems in LA countries, two main conditions need to be fulfilled. First, adequate resources and skills need to be available to conduct EE of good quality. Second, decision-making procedures need to be modified to accommodate “evidence-based” approaches such as EE.
Measuring cost-effectiveness of secondary health care: Feasibility and potential utilization of results
Authors: Räsänen Pirjo , Sintonen Harri , Ryynänen Olli-Pekka , Blom Marja , Semberg-Konttinen Virpi , Roine Risto P.
Published: April 2008

Objectives:Whether cost-effectiveness of secondary health care can be measured in a simple, yet commensurate way was studied.

Methods:Approximately 4,900 patients' health-related quality of life scores before and after treatment were measured. Used were a combination of quality of life data with diagnostic and financial indicators routinely collected in the hospital.

Results:Seventy percent of patients returned the first questionnaire and the informed written consent to participate. Of these patients, 80 percent also returned the second questionnaire sent out 3 to 12 months after treatment, depending on clinical specialty and diagnostic category. The routine of sending out questionnaires could be automated in such a way that data collection required only a limited amount of extra work. Patients were generally satisfied with the fact that the hospital was interested in their well-being also after treatment. No physician offered the chance to participate refused data collection in the patient group he or she was responsible for. The attitudes of the nursing staff were generally positive toward data collection, although it caused some extra work for some of them. The possibility of relating already routinely collected financial performance indicators with a relevant measure of treatment effectiveness, opened prospects for refined analysis of cost-effectiveness of secondary health care.

Conclusions:Routine collection of health-related quality of life data as an indicator of treatment effectiveness is feasible, requires only a small amount of extra work, and is potentially very useful when combined with existing measures of hospital performance.
Economic evaluation of hemodialysis: Implications for technology assessment in Greece
Authors: Kaitelidou Daphne , Ziroyanis Panagiotis N. , Maniadakis Nikolaos , Liaropoulos Lycurgus L.
Published: April 2008

Objectives:Hemodialysis is a well-established treatment for 74 percent of end-stage renal disease (ESRD) patients in Greece. The purpose of this study is to provide an estimate of the direct cost of dialysis in a public hospital setting and an estimate of the loss of production for ESRD patients. The results will be useful for public health facility planning purposes.

Methods:A socioeconomic prevalence-based analysis was performed using micro-economic evaluation of health-care resources consumed to provide hemodialysis for ESRD patients in 2000. Lost productivity costs due to illness were estimated for the patient and family using the human capital approach and the friction method. Indirect morbidity costs due to absence from work and long-term were estimated, as well as mortality costs. Mean gross income was used for both patient and family.

Results:Total health-sector cost for hemodialysis in Greece exceeds €171 million, or €182 per session and €229 per inpatient day. There were 2,046 years lost due to mortality, and the potential productivity cost was estimated at €9.9 million, according to the human capital approach, and €303.000, according to the friction method. Total morbidity cost due to absence from work and early retirement was estimated at more than €273 million, according to the human capital approach, and €12.5, according to the friction method.

Conclusions:Providing hemodialysis care for 0.05 percent of the population suffering from ESRD absorbs approximately 2 percent of total health expenditure in Greece. In addition to the cost for the National Health System, production loss due to mortality and morbidity from the disease are also considerable. Promoting alternative technologies such as organ transplantation and home dialysis as well as improving hemodialysis efficiency through satellite units are strategies that may prove more cost-effective and psychologically advantageous for the patients.
Determinants of the diffusion of computed tomography and magnetic resonance imaging
Authors: Oh Eun-Hwan , Imanaka Yuichi , Evans Edward
Published: April 2008

Objectives:The aim of this study is to explain factors influential to the diffusion of computed tomography (CTs) and magnetic resonance imaging (MRIs).

Methods:Variables were identified from a review of the literature on the diffusion of health technologies. A formal process was applied to build a conceptual model of the mechanism that drives technology diffusion. Variables for the analysis were classified as predisposing, enabling, or reinforcing factors, in keeping with a model commonly used to explain the diffusion of health behaviors. Multiple regression analysis was conducted using year 2000 OECD data.

Results:The results of this study showed that total health expenditure per capita (p< .01, both CTs and MRIs) and flexible payment methods to hospitals (p< .05, both CTs and MRIs) were significantly associated with the diffusion of CTs and MRIs (adjusted R2= 0.477, 0.656, respectively).

Conclusions:This study presents a systematically developed model of the mechanism governing technology diffusion. Important findings from the study show that purchasing power, represented by total health expenditure per capita and economic incentives to hospitals in the form of flexible payment methods, were positively correlated with diffusion. Another important achievement of our model is that it accounts for all thirty OECD member countries without excluding any as outliers. This study shows that variation across countries in the diffusion of medical technology can be explained well by a logical model with multiple variables, the results of which hold profound implications for health policy regarding the adoption of innovations.
International comparison of the definition and the practical application of health technology assessment
Authors: Draborg Eva , Gyrd-Hansen Dorte , Bo Poulsen Peter , Horder Mogens
Published: April 2008

Objectives:Health Technology Assessment (HTA) is defined as a policy research approach that examines the short- and long-term social consequences of the application or use of technology. Internationally different institutions have translated this definition to local contexts. In Denmark, HTA is comprehensive with focus on four aspects of the problem in question (technology [clinical evidence], economy, patient, and organization). The objective of this study is to study how the application of HTA differs across leading countries and to study the extent to which Danish HTA reports differ from foreign HTAs.

Methods:A sample of 433 HTA reports published in the period 1989–2002 by eleven leading institutions or agencies in Denmark and eight other countries were reviewed. We looked at the characteristics of the HTA with respect to focus on the four main aspects and the manner in which each aspect has been approached.

Results:The study shows health technology procedures to be the most common type of health technology assessed in HTAs and literature review to be the most often used method of analysis. Policy recommendations are only present in approximately half of the HTA reports.

Conclusions:In the HTAs one generally sees a great focus on the clinical aspect of health technologies, leaving the economic, the patient-related, and the organizational aspect much more unanalyzed. The Danish HTAs generally have a wider scope than HTAs produced in other countries and tend to focus more frequently on patient-related and organizational dimensions.
Meta-analysis when only the median survival times are known: A comparison with individual patient data results
Authors: Michiels Stefan , Piedbois Pascal , Burdett Sarah , Syz Nathalie , Stewart Lesley , Pignon Jean-Pierre
Published: April 2008

Background:The hazard ratio (HR) is the most appropriate measure for time to event outcomes such as survival. In systematic reviews, HRs can be calculated either from the raw trial data obtained as part of an individual patient data (IPD) meta-analysis or from the appropriate trial-level summary statistics. However, the information required for the latter are seldom reported in sufficient detail to allow reviewers to calculate HRs. In contrast, the median survival and survival rates at specific time points are frequently presented. We aimed to evaluate retrospectively the performance of meta-analyses using median survival times and survival rates by comparing them with meta-analyses using IPD to calculate HRs.

Methods:IPD from thirteen published meta-analyses (MAs) in cancers with high mortality rates were used. Median survival and survival rates were calculated from the IPD rather than taken from publications so that the same trials, patients, and extended follow-up are used in each analysis.

Results and Conclusions:We show that using median survival times or survival rates at a particular point in time are not reasonable surrogate measures for meta-analyses of survival outcomes and that, wherever possible, HRs should be calculated. Individual trial publications reporting on time to event outcomes, therefore, should provide more detailed statistical information, preferably logHRs and their variances, or their estimators.
Cost-effectiveness analysis of medical documentation alternatives
Authors: Kopach Renata , Sadat Somayeh , Gallaway Ian D. , Geiger Glen , Ungar Wendy J. , Coyte Peter C.
Published: April 2008

Objectives:The delay between patient discharge and the completion of the final discharge note have prompted hospitals to consider new information technologies. This study compared the relative cost-effectiveness of an automated medical documentation system to the current system in place at a Canadian hospital. There are significant expenditures associated with the choice of medical documentation system, yet the benefit to the patient population has not been studied.

Methods:A systematic review of the literature was carried out. Cost data for the current documentation system were obtained from the study hospital. The costs of purchasing the automated system were obtained from the manufacturer. Other resource cost implications of the automated system were estimated based on information obtained from the Centre for Applied Health Informatics at the study hospital. The outcome was determined to be the average time (days) between patient discharge and note completion. A cost-effectiveness analysis was conducted. Sensitivity analyses were used to determine the robustness of the results.

Results:The automated documentation system was associated with higher costs but better outcomes than the current system. The incremental cost-effectiveness ratio used for comparing the automated medical documentation system with the traditional system indicated that the incremental daily cost for decreasing a day in average note completion time per discharge note was 0.331 Canadian $/day over the study period (4 years).

Conclusions:Although the automated documentation system was more expensive than the current system, it also provided qualitative benefits that were not considered in the cost-effectiveness analysis.
Cost-effectiveness of Herceptin®: A standard cost model for breast-cancer treatment in a Belgian university hospital
Authors: Neyt Mattias J. , Albrecht Johan A. , Clarysse Bart , Cocquyt Véronique F.
Published: April 2008

Objectives: The objective of this study was to conduct a cost-effectiveness analysis of Herceptin® from the hospital's point of view. This new biotechnological pharmaceutical is a humanized monoclonal antibody that targets the HER2 receptor, an important anti-cancer target.

Methods: A cost model with standard diagnostic and treatment options for breast cancer was set up for a Belgian university hospital in close collaboration with its specialists. Direct and indirect costs were calculated for each diagnostic and treatment option using the micro-costing method. Effectiveness was estimated through a literature study. The model allowed us to take cost consequences in other stages of the model into account and to calculate changes in monthly treatment costs from different “starting points.” With an incremental cost-effectiveness analysis, differences in costs and effectiveness with and without Herceptin® were compared.

Results: Over the complete treatment period from diagnosis until the metastatic phase, monthly costs for the hospital rose from €85.07 to €90.35 for stage I diagnosed breast cancer when adding Herceptin® to the model. In the metastatic phase alone, these costs rose from €1,132.33 to €1,256.23. With Herceptin®, we found an extra cost of €3,981.44 per extra life-month.

Conclusions: This cost-effectiveness ratio was rather high, because Herceptin® was quite expensive and the product was additive in its current use and did not replace existing treatments. Future research will concentrate on alternative applications of Herceptin® based on ongoing Herceptin® trials and expert opinions.
Cost–benefit evaluation of routine influenza immunization in people 65–74 years of age
Authors: Allsup S. , Gosney M. , Haycox A. , Regan M.
Published: April 2008

Objectives: This study aimed to determine
the cost-effectiveness ofinfluenza vaccination in people 65–74
years of age in the absence of comorbidity.
Routine examination of the newborn: The EMREN study. Evaluation of an extension of the midwife role including a randomized controlled trial of appropriately trained midwives and pediatric senior house officers
Authors: Townsend J. , Wolke D. , Hayes J. , Davé S. , Rogers C. , Bloomfield L. , Quist-Therson E. , Tomlin M. , Messer D.
Published: April 2008

Objectives: This study assesses the
implications and cost-effectiveness of extending the role of midwives to
include the routine (24-hour) examination of the healthy newborn usually
carried out by junior doctors.
Impact of screening on future health-promoting behaviors and health beliefs: A systematic review
Authors: Bankhead C. R. , Brett J. , Bukach C. , Webster P. , Stewart-Brown S. , Munafo M. , Austoker J.
Published: April 2008

Objectives: A systematic review was
performed to examine the effects of cholesterol, breast cancer, and
cervical cancer screening on actual or intended health-promoting
behaviors and health-related beliefs.
Systematic review and modeling of the investigation of acute and chronic chest pain presenting in primary care
Authors: Mant J. , McManus R. J. , Oakes R. A. L. , Delaney B. C. , Barton P. M. , Deeks J. J. , Hammersley L. , Davies R. C. , Davies M. K. , Hobbs F. D. R.
Published: April 2008

Objectives: The objectives were to
ascertain the value of a range of methods—including clinical
features, resting and exercise electrocardiography, and rapid access
chest pain clinics (RACPCs)—used in the diagnosis and early
management of acute coronary syndrome (ACS), suspected acute myocardial
infarction (MI), and exertional angina.
Clinical-effectiveness and cost-effectiveness of neonatal screening for inborn errors of metabolism using tandem mass spectrometry: A systematic review
Authors: Pandor A. , Eastham J. , Beverley C. , Chilcott J. , Paisley S.
Published: April 2008

Objectives: The clinical- and
cost-effectiveness of tandem mass spectrometry (MS)-based neonatal
screening for inborn errors of metabolism (IEM) were evaluated.
Evidence-Based Practice Center network and health technology assessment in the United States: Bridging the cultural gap
Authors: Sarría-Santamera Antonio , Matchar David B. , Westermann-Clark Emma V. , Patwardhan Meenal B.
Published: April 2008

Objectives:The purpose of this study was to identify the Evidence-Based Practice Center (EPC) network participants' perceptions of the characteristics of the EPC process and the relationship of the process to the success of EPC reports.

Methods:Semistructured interviews were conducted with the three groups involved in the EPC: EPC staff, Agency for Healthcare Research and Quality (AHRQ) staff, and representatives of partner organizations.

Results:The analysis of the coded transcripts revealed three related major themes, which form the conceptual basis for the interpretation presented here: the definition of a successful report, the determinants of a successful report, and the role of AHRQ in the process.

Conclusions:A successful report is a report that is used. The ultimate success of the core health technology assessment objective, moving from research to policy, depends on balancing two values: excellence and relevance. Our findings are consistent with the “two communities thesis,” which postulates the existence of two camps that confer different values to excellence and relevance, with resulting tension. A promising model for approaching this tension is integration or collaboration, which requires linking researchers and policy makers, promoting productive dialogues about the formulation and timing of analysis, and early consideration of how the resulting analysis will be used. This effort suggests that actively blurring the frontiers between these two groups will enhance their interaction. Furthermore, enhancing the role of the AHRQ as scientific broker will maximize the potential of the EPC network.
Randomized trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: Cost-effectiveness analysis
Authors: Manca Andrea , Epstein David M. , Torgerson David J. , Klaber Moffett Jennifer A. , Coulton Simon , Farrin Amanda J. , Hahn Seokyung , Jackson David A. , Richmond Stewart J.
Published: April 2008

Objectives:To assess the cost-effectiveness ofbrief physiotherapyintervention versususual physiotherapymanagement in patients with neck pain of musculoskeletal origin in the community setting.

Methods:A cost-effectiveness analysis was conducted alongside a multicenter pragmatic randomized controlled clinical trial. Individuals 18 years of age and older with neck pain of more than 2 weeks were recruited from physiotherapy departments with referrals from general practitioners (GPs) in the East Yorkshire and North Lincolnshire regions in the United Kingdom. A total of 139 patients were allocated to the brief intervention, and 129 to the usual physiotherapy. Resource use data were prospectively collected on the number of physiotherapy sessions, hospital stay, specialist, and GP visits. Quality-adjusted life years (QALYs) were estimated using EQ-5D data collected at baseline, 3 and 12 months from the start of the treatment. The economic evaluation was conducted from the U.K. National Health System perspective.

Results:On average, brief intervention produced lower costs (£−68; 95 percent confidence interval [CI], £−103 to £−35) and marginally lower QALYs (−0.001; 95 percent CI, −0.030 to 0.028) compared with usual physiotherapy, resulting in an incremental cost per QALY of £68,000 for usual physiotherapy. These results are sensitive to patients' treatment preferences.

Conclusions:Usual physiotherapy may not be good value for money for the average individual in this trial but could be a cost-effective strategy for those who are indifferent toward which treatment they receive.
Cost-effectiveness of a supplementary class-based exercise program in the treatment of knee osteoarthritis
Authors: Richardson Gerry , Hawkins Neil , McCarthy Christopher James , Mills Pauline Mary , Pullen Rachel , Roberts Christopher , Silman Alan , Oldham Jacqueline Ann
Published: April 2008

Objectives:The aim of this study was to assess the cost-effectiveness of a class-based exercise program supplementing a home-based program when compared with a home-based program alone. In addition, we estimated the probability that the supplementary class program is cost-effective over a range of values of a decision maker's willingness to pay for an additional quality-adjusted life-year (QALY).

Methods:The resource use and effectiveness data were collected as part of the clinical trial detailed elsewhere. Unit costs were estimated from published sources. The net benefit approach to cost-effectiveness analysis is used to estimate the probability of the intervention being cost-effective.

Results:The addition of a supplementary class-based group results in an increase in QALYs and lower costs. For all plausible values of a decision maker's willingness to pay for a QALY, the supplementary class group is likely to be cost-effective.

Conclusions:The addition of a class-based exercise program is likely to be cost-effective and, on current evidence, should be implemented.
Evaluating telemedicine: A focus on patient pathways
Authors: Coughlan Jane , Eatock Julie , Eldabi Tillal
Published: April 2008

Evaluations of telemedicine have sought to assess various measures of effectiveness (e.g., diagnostic accuracy), efficiency (e.g., cost), and engagement (e.g., patient satisfaction) to determine its success. Few studies, however, have looked at evaluating the organizational impact of telemedicine, which involves technology and process changes that affect the way that it is used and accepted by patients and clinicians alike. This study reviews and discusses the conceptual issues in telemedicine research and proposes a fresh approach for evaluating telemedicine. First, we advance a patient pathway perspective, as most of the existing studies view telemedicine as a support to a singular rather than multiple aspects of a health care process. Second, to conceptualize patient pathways and understand how telemedicine impacts upon them, we propose simulation as a tool to enhance understanding of the traditional and telemedicine patient pathway.
Joint project of the international network of agencies for health technology assessment—Part 1: Survey results on diffusion, assessment, and clinical use of positron emission tomography
Authors: Hastings John , Adams Elizabeth J.
Published: April 2008

Objectives: The International Network of Agencies for Health Technology Assessment (INAHTA) has been tracking activities associated with the clinical use of positron emission tomography (PET) in its members' healthcare systems since 1997 and published its first Joint Project report on PET in 1999. Part 1 of this Joint Project report presents survey results on diffusion, assessment activities, and policy for clinical use related to PET among INAHTA members since 1999.

Methods: INAHTA members were surveyed in 2003–2004.

Results: Twenty-seven INAHTA agencies (69 percent response rate) from nineteen countries responded to the survey. Dedicated PET systems are the most universally installed systems to date. Mobile scanners and modified gamma cameras are used occasionally as lower cost alternatives, and interest in PET–computed tomography hybrid models is rising despite limited assessment of impact on service planning. PET was used and assessed most commonly for managing patients with cancer. All respondents reported having some form of public funding for clinical PET frequently linked to data collection for the purpose of gathering evidence to refine clinical use and guide resource allocation toward indications that maximize clinical and cost-effectiveness.

Conclusions: The use of HTA within a continuous quality improvement framework can help optimize scarce resources for evaluation and use of high cost diagnostic technologies such as PET, particularly where potential clinical or cost-effectiveness is considerable but conclusive evidence is lacking.
Integration of health technology assessment recommendations into organizational and clinical practice: A case study in Catalonia
Authors: Gagnon Marie-Pierre , Sánchez Emília , Pons Joan M. V.
Published: April 2008

Objectives:Evaluating the impact of recommendations based upon health technology assessment (HTA) represents a challenge for both HTA agencies and healthcare policy makers. This research sought to understand factors affecting the uptake of HTA recommendations to support decision making with respect to the introduction of three health technologies.

Methods:Using a multidimensional framework, based upon a combination of theoretical models, a case study was conducted. A total of twenty-eight semistructured interviews were done with physicians from fifteen hospitals and other stakeholders in Catalonia. Interview content was analyzed iteratively and classified according to theoretical dimensions and contextual factors.

Results:At the sociopolitical level, factors related to the organization and financing of the health system were found to affect the utilization of HTA recommendations. At the healthcare organization level, existing collaborations between the hospital and the HTA agency favored the integration of recommendations into practices. Formalism in the organization also influenced the utilization of HTA recommendations. At the professional level, the high degree of autonomy of specialists, the importance of peers and collegial control, and the definition of professional roles and responsibilities influenced physicians' willingness to integrate HTA recommendations into their practice.

Conclusions:This study offers a comprehensive framework to understand the complex dynamics that affect adoption of health technologies in organizational and professional practices. The findings suggest some avenues to promote the integration of HTA recommendations into practices and, thus, increase the utilization of scientific evidence to support decision making in health care.
Early assessment of the likely cost-effectiveness of a new technology: A Markov model with probabilistic sensitivity analysis of computer-assisted total knee replacement
Authors: Dong Hengjin , Buxton Martin
Published: April 2008

Objectives:The objective of this study is to apply a Markov model to compare cost-effectiveness of total knee replacement (TKR) using computer-assisted surgery (CAS) with that of TKR using a conventional manual method in the absence of formal clinical trial evidence.

Methods:A structured search was carried out to identify evidence relating to the clinical outcome, cost, and effectiveness of TKR. Nine Markov states were identified based on the progress of the disease after TKR. Effectiveness was expressed by quality-adjusted life years (QALYs). The simulation was carried out initially for 120 cycles of a month each, starting with 1,000 TKRs. A discount rate of 3.5 percent was used for both cost and effectiveness in the incremental cost-effectiveness analysis. Then, a probabilistic sensitivity analysis was carried out using a Monte Carlo approach with 10,000 iterations.

Results:Computer-assisted TKR was a long-term cost-effective technology, but the QALYs gained were small. After the first 2 years, the incremental cost per QALY of computer-assisted TKR was dominant because of cheaper and more QALYs. The incremental cost-effectiveness ratio (ICER) was sensitive to the “effect of CAS,” to the CAS extra cost, and to the utility of the state “Normal health after primary TKR,” but it was not sensitive to utilities of other Markov states. Both probabilistic and deterministic analyses produced similar cumulative serious or minor complication rates and complex or simple revision rates. They also produced similar ICERs.

Conclusions:Compared with conventional TKR, computer-assisted TKR is a cost-saving technology in the long-term and may offer small additional QALYs. The “effect of CAS” is to reduce revision rates and complications through more accurate and precise alignment, and although the conclusions from the model, even when allowing for a full probabilistic analysis of uncertainty, are clear, the “effect of CAS” on the rate of revisions awaits long-term clinical evidence.
Overview of systematic reviews on invasive treatment of stable coronary artery disease
Authors: Kuukasjärvi Pekka , Malmivaara Antti , Halinen Matti , Hartikainen Juha , Keto Pekka E. , Talvensaari Taisto , Tierala Ilkka , Mäkelä Marjukka
Published: April 2008

Objectives: The aim of the study was to evaluate the validity of the systematic reviews as a source of best evidence and to present and interpret the evidence of the systematic reviews on effectiveness of surgery and percutaneous interventions for stable coronary artery disease.

Methods: Electronic databases were searched without language restriction from January 1966 to March 2004. The databases used included the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, DARE, the Health Technology Assessment Database, MEDLINE(R), MEDLINE(R) In-Process & Other Non-Indexed Citations. We included systematic reviews of randomized clinical trials on patients with stable coronary heart disease undergoing percutaneous coronary intervention or coronary artery bypass surgery in comparison with medical treatment or a comparison between invasive techniques. At least one of the following outcomes had to be reported: death, myocardial infarction, angina pectoris, revascularization. The methodological quality was assessed using a modified version of the scale devised by Oxman and Guyatt (1991). A standardized data-extraction form was used. The method used to evaluate clinical relevance was carried out with updated method guidelines from the Cochrane Back Research Group. Quantitative synthesis of the effectiveness data is presented.

Results: We found nineteen systematic reviews. The median score of validity was 13 points (range, 6–17 points), with a maximum of 18 points. vCoronary artery bypass surgery gives better relief of angina, and the need for repeated procedures is reduced after bypass surgery compared with percutaneous interventions. There is inconsistent evidence as to whether bypass surgery improves survival compared with percutaneous intervention. A smaller need for repeated procedures exists after bare metal stent and even more so after drug-eluting stent placement than after percutaneous intervention without stent placement. However, according to the current evidence, these treatment alternatives do not differ in terms of mortality or myocardial infarction.

Conclusions: We found some high-quality systematic reviews. There was evidence on the potential of invasive treatments to provide symptomatic relief. Surgery seems to provide a longer-lasting effect than percutaneous interventions with bare metal stents or without stents. Evidence in favor of drug-eluting stents so far is based on short-term follow-up and mostly on patients with single-vessel disease.
Alan Williams (1927–2005) and his contribution to health technology assessment
Authors: Drummond Michael
Published: April 2008

We should be careful when making claims that a given individual had a major impact on a given field. After all, much research is undertaken in teams and good ideas are quickly transferred and developed. There are, however, several reasons to suggest that Alan Williams made a major impact and that the field may have developed differently had he never become a health economist. I give five reasons below.
Bernard S. Bloom (1940–2006)
Authors: Fendrik Mark
Published: April 2008

The Journal has lost a loyal friend and trusted advisor when former board member Bernard S. Bloom, PhD, died at his home in Society Hill, Pennsylvania. A gifted economist, Bernie's contribution to the healthcare field was immeasurable and left an indelible impression on students and peers alike.
TESTING FOR LONG MEMORY IN VOLATILITY
Authors: Hurvich Clifford M. , Soulier Philippe
Published: April 2008

We consider the asymptotic behavior of log-periodogram regression
estimators of the memory parameter in long-memory stochastic
volatility models, under the null hypothesis of short memory
in volatility. We show that in this situation, if the periodogram
is computed from the log squared returns, then the estimator
is asymptotically normal, with the same asymptotic mean and
variance that would hold if the series were Gaussian. In
particular, for the widely used GPH estimator
[d with circumflex above]GPH under the null hypothesis,
the asymptotic mean of
m1/2[d with circumflex above]GPH
is zero and the asymptotic variance is π2/24 where
m is the number of Fourier frequencies used in the regression.
This justifies an ordinary Wald test for long memory in volatility based
on the log periodogram of the log squared returns.
REGRESSION THEORY FOR NEARLY COINTEGRATED TIME SERIES
Authors: Jansson Michael , Haldrup Niels
Published: April 2008

This paper proposes a notion of near cointegration and generalizes
several existing results from the cointegration literature to
the case of near cointegration. In particular, the properties
of conventional cointegration methods under near cointegration
are characterized, thereby investigating the robustness of
cointegration methods. In addition, we obtain local asymptotic
power functions of five cointegration tests that take cointegration
as the null hypothesis.
ON THE PROPERTIES OF SOME TESTS FOR COMMON STOCHASTIC TRENDS
Authors: Breitung Jörg , Trenkler Carsten
Published: April 2008

We study the asymptotic properties of the tests suggested by
Choi and Ahn (1995, Econometric Theory 11, 952–983)
in the case of a (nearly) improper normalization of the
cointegration vectors. To overcome the size problems in such
situations we suggest a test statistic that is based on the
eigenvalues of a canonical correlation analysis. Using Monte
Carlo simulations, the small sample properties of our test are
compared to various other test statistics recently suggested
in the literature.
MINIMUM DISTANCE ESTIMATION OF NONSTATIONARY TIME SERIES MODELS
Authors: Moon Hyungsik Roger , Schorfheide Frank
Published: April 2008

This paper analyzes the limit distribution of minimum distance
(MD) estimators for nonstationary time series models that involve
nonlinear parameter restrictions. A rotation for the restricted
parameter space is constructed to separate the components of
the MD estimator that converge at different rates. We derive
regularity conditions for the restriction function that are
easier to verify than the stochastic equicontinuity conditions
that arise from direct estimation of the restricted parameters.
The sequence of matrices that is used to weigh the discrepancy
between the unrestricted estimates and the restriction function
is allowed to have a stochastic limit. For MD estimators based
on unrestricted estimators with a mixed normal asymptotic
distribution the optimal weight matrix is derived and a
goodness-of-fit test is proposed. Our estimation theory is
illustrated in the context of a permanent-income model and a
present-value model.
OVERVIEW OF VOLUME 20
Authors: Grabe William
Published: April 2008

The twentieth volume of ARAL, as an anniversary edition, explores the evolving discipline of applied linguistics from a variety of perspectives. Rather than ask fifteen authors to provide general positions on the status of applied linguistics, the invitation to contribute to ARAL 20 asked authors to consider the status of applied linguistics from the perspective of their own fields of study and major topical issues. Contributors received a small set of questions asking them to situate their own fields of study within a framework informed by applied linguistics. For example, contributors were asked 1) how their own research sub-fields were located within applied linguistics, 2) how applied linguistics will make the strongest contributions in the coming decade---from the perspective of their own sub-fields, and 3) what obstacles confront their sub-fields and applied linguistics more generally. Some of the authors have addressed these issues explicitly while others have recognized more implicitly the frame of reference that is provided by applied linguistics.
LANGUAGE TEACHER EDUCATION
Authors: Crandall JoAnn (Jodi)
Published: April 2008

Language teacher education programs are likely to be housed in departments of applied linguistics, education, or languages and literature: These three disciplines provide the knowledge base and opportunities for developing skills and dispositions for both prospective and experienced teachers. Until recently, applied linguistics (psycholinguistics, sociolinguistics, discourse analysis, language description, and language teaching and testing methodology) formed the core of language teacher education, not unexpected, since language teaching has historically been the primary focus of applied linguistics (Bardovi-Harlig and Hartford 1997, Crandall 1995; 1996). However, during the last decade, general educational theory and practice have exerted a much more powerful influence on the direction of the education of both preservice and inservice language teacher education, resulting in a greater focus on: 1) practical experiences such as observations, practice teaching, and opportunities for curriculum and materials development (Crandall 1994, Johnson 1996b, Pennington 1990, Richards 1990, Richards and Crookes 1988); 2) classroom-centered or teacher research (Allwright and Bailey 1991, Chaudron 1988, Edge and Richards 1993, Nunan 1989, van Lier 1988); and 3) teacher beliefs and teacher cognition in language teacher education (Freeman 1996; 1998, Freeman and Johnson 1998a, Richards and Nunan 1990). In fact, the last decade can be viewed as a search for a theory of language teaching and, by extension, of language teacher education at both the micro and macro levels (Freeman and Johnson 1998b, Johnson 1996a, Larsen-Freeman 1990, Richards 1990). Language teacher education is a microcosm of teacher education, and many of the trends in current language teacher education derive from theory and practice in general teacher education. These trends include at least four major shifts.
DESIGN AND PRACTICE: ENACTING FUNCTIONAL LINGUISTICS
Authors: Martin James R.
Published: April 2008

I have tried to practice linguistics as a form of social action, a practice which Halliday (e.g., 1985) has suggested cannot be other than ideologically committed. This practice dissolves the linguistics vs. applied linguistic opposition which has evolved in response to the hegemony of American formalism—whose idealizing reductivity comes nowhere near serving the needs of language users and their aids around the world. In its stead, linguistics as social action engages theory with practice in a dialectic whereby theory informs practice which, in turn, rebounds on theory, recursively, as more effective ways of intervening in various processes of semogenesis are designed (Martin 1997; 1998a). My own experience of this engagement has been mainly in the field of literacy, especially of writing development in primary and secondary school. Accordingly, I'll draw on this experience to address the sub-field ‘Writing and Literacy,’ writing as a linguist working across what is generally read and has been increasingly institutionalized as an applied vs. theoretical frontier.
LANGUAGE POLICY AND PLANNING
Authors: Takala Sauli , Sajavaara Kari
Published: April 2008

The field of language policy and planning is clearly a sub-field within applied linguistics. It generally does not draw heavily on formal linguistics, except for aspects of corpus and status planning. However, it does draw extensively from a range of disciplines in order to plan, implement, and evaluate language policies that respond to the needs of stake holders of various types. Despite continuous development of the field, aspects of language policy and planning need to be developed further. One of the key areas where policy can be enhanced considerably is in the area of policy and planning evaluation. This direction of inquiry is also relevant to a number of other areas within applied linguistics.
ASSESSMENT AND TESTING
Authors: Clapham Caroline
Published: April 2008

In this brief article, I discuss the relationship between language testing and the other sub-disciplines of applied linguistics and also the relationship, as I see it, between testing and assessment. The article starts with a brief exploration of the term ‘applied linguistics’ and then goes on to discuss the role of language testing within this discipline, the relationship between testing and teaching, and the relationship between testing and assessment. The second part of the article mentions some areas of current concern to testers and discusses in more detail recent advances in the areas of performance testing, alternative assessment, and computer assessment. One of my aims in this article is to argue that the skills involved in language testing are necessary not only for those constructing all kinds of language proficiency assessments, but also for those other applied linguists who use tests or other elicitation techniques to help them gather language data for research.
STILL WRESTLING WITH ‘CONTEXT’ IN INTERLANGUAGE THEORY
Authors: Tarone Elaine
Published: April 2008

One of the most intractable issues in the field of second-language acquisition (SLA) research has been the attempt to identify the role of social context in influencing (or not) the process of acquisition of a second language. The central question has been whether a theory of SLA must account only for the psycholinguistic processes involved in acquiring an interlanguage (IL), or, alternatively, whether social and sociolinguistic factors influence those psycho-linguistic processes to such an extent that they too must be included in such a theory. It seems very clear that SLA is a psycholinguistic process. But to what extent are those psycholinguistic processes affected by social context? In 1985, Selinker and Douglas proposed a construct of ‘discourse domains’ to show how social and psycholinguistic processes might be included in a theory of inter-language; Young (1999) reviews that proposal and a recent attempt to test it, concluding that the results are still uncertain. After 15 years, this is still a lively issue in the field of SLA. Indeed, it is becoming a source of increasing conflict both within the field of SLA and within such areas of applied linguistics as second/foreign language teaching and second/foreign language teacher training. In this article, I will briefly summarize the problem, and review and summarize the current evidence being brought to bear upon this issue in the SLA research literature.