bluuebunny/crossref_metadata_2025 huggingface dataset:
A new family of spatial 3-DOF parallel manipulators with two translational and one rotational DOFs
Authors: Liu Xin-Jun , Wang Jinsong , Wu Chao , Kim Jongwon
Published: May 2008

This paper proposes a new family of spatial 3-DOF (degree of freedom) parallel manipulators with two translational and one rotational DOFs. The manipulators in this family are the variations of the parallel manipulators, which are capable of very high rotational capability, introduced by X.-J. Liu, J. Wang, and G. Pritschow (“A new family of spatial 3-DoF fully parallel manipulators with high rotational capability,” Mech. Mach. Theory40(4), 475–494, 2005). However, compared with those old manipulators, the new parallel manipulators proposed here have the advantages of simpler kinematics and structure, easier manufacturing, and energy saving.
ANTIPODEAN ASSESSMENT
Authors: Mitchell Andrew S.
Published: May 2008

More than 10 years ago, the Australian government took the bold and unprecedented step of announcing that it would request evidence on comparative cost-effectiveness of new pharmaceutical products, assess this evidence, and then use it to guide systematically the decisions as to whether to subsidize these new products. This paper summarizes the Australian drug subsidy scheme and the activities involved in making this announcement work in practice, assesses the impact these activities have had on broader policy actions, and examines whether these have resulted in any worthwhile achievements.
SUMMARY REPORT OF THE ECHTA/ECAHI PROJECT
Authors: Jonsson Egon , Banta H. David , Henshall Chris , Sampietro-Colom Laura
Published: May 2008

Health technology assessment (HTA) seeks to inform health policy makers by using the best scientific evidence on the medical, social, economic, and ethical implications of investments in health care. Technology is broadly defined to include the drugs, devices, medical, and surgical procedures used in health care, as well as measures for prevention and rehabilitation of disease, and the organizational and support systems in which health care is provided.
HEALTH TECHNOLOGY ASSESSMENT IN POLICY AND PRACTICE
Authors: Henshall Chris , Koch Pedro , von Below Georg Carl , Boer Albert , Conde-Olasagasti José L. , Dillon Andrew , Gibis Bernhard , Grilli Roberto , Hardy Charlie , Liaropoulos Lycurgus , Martín-Moreno José M. , Roine Risto , Scherstén Tore , Søreide Odd , Züllig Maya
Published: May 2008

According to the HTA-Europe report, health technology assessment (HTA) has the potential to influence health policy in the fields of research and development, regulation of pharmaceuticals, devices, and services, quality assurance, reimbursement, education and training of healthcare providers, and consumer education (1). To identify and bridge the gaps between HTA production and implementation, the goal of Working Group 6 was to approach the use of HTA in policy and practice on the aggregate policy level as well as in the local context, such as in hospitals. Members of Working Group 6 included both users (e.g., members of decision-making bodies) and producers (e.g., members of HTA agencies) of HTA reports. The aim of the working group was to identify three types of information on HTA implementation and impact. These included identifying successful examples of the implementation of HTA results, examples of structures that require HTA information as part of the decision-making process, and finally, identifying groups and persons who use HTA frequently and are willing to share their experiences with other HTA users and producers.
PREVENTION COULD BE LESS COST-EFFECTIVE THAN CURE: THE CASE OF HEPATITIS C SCREENING POLICIES IN FRANCE
Authors: Loubière Sandrine , Rotily Michel , Moatti Jean-Paul
Published: May 2008

Objectives:To access the cost-effectiveness of French recommendations for hepatitis C virus (HCV) screening and the extent to which earlier identification of carriers may or not improve the cost-effectiveness of therapeutic strategies.

Methods:Cost-effectiveness analysis were performed using decision-tree analysis and a Markov model. Four alternative strategies were compared: no screening and no treatment; initiation of HCV treatment after the diagnosis of cirrhosis; and two alternative strategies refer to the current French policies of HCV testing, i.e., two enzyme immunoblot assay (EIA) tests in series, or a polymerase chain reaction (PCR) analysis after the first positive EIA test. Costs were computed from the viewpoint of the health care system. The analysis has been applied to populations particularly at risk of infection, as well as the general population.

Results:The “wait and treat cirrhosis” strategy was more cost-effective in the general population and in transfusion recipients. The incremental cost-effectiveness ratio of this strategy compared with baseline strategy was 3,476 of euros and €15,300 in respective cohorts. Considering the HCV screening strategy, the additional cost would be of €4,933 and €240,250 per additional year of life saved, respectively. In the intravenous drug user (IDU) population, the “two EIA” screening strategy was the more cost-effective alternative, with an additional cost of €3,825 per additional year of life saved.

Conclusions:HCV screening would be discarded for transfusion recipients but should be encouraged for IDUs and also for the general population, in which the additional cost of screening is an order of magnitude more acceptable.
COSTS OF INFORMAL CARE FOR PATIENTS IN ADVANCED HOME CARE: A POPULATION-BASED STUDY
Authors: Andersson Agneta , Carstensen John , Levin Lars-Åke , Emtinger Bengt Göran
Published: May 2008

Objectives:Several studies have sought to analyze the cost-effectiveness of advanced home care and home rehabilitation. However, the costs of informal care are rarely included in economic appraisals of home care. This study estimates the cost of informal care for patients treated in advanced home care and analyses some patient characteristics that influence informal care costs.

Methods:During one week in October 1995, data were collected on all 451 patients in advanced home care in the Swedish county of Östergötland. Costs were calculated by using two models: one including leisure time, and one excluding leisure time. Multiple regression analysis was used to analyze factors associated with costs of informal care.

Results:Seventy percent of the patients in the study had informal care around the clock during the week investigated. The patients had, on average, five formal care visits per week, each of which lasted for almost half an hour. Thus, the cost of informal care constituted a considerable part of the cost of advanced home care. When the cost of leisure time was included, the cost of informal care was estimated at SEK 5,880 per week per patient, or twice as high as total formal caregiver costs. When leisure time was excluded, the cost of informal care was estimated at SEK 3,410 per week per patient, which is still 1.2 times higher than formal caregiver costs (estimated at SEK 2,810 per week per patient). Informal care costs were higher among patients who were men, who were younger, who had their own housing, and who were diagnosed with cancer.

Conclusions:Studies of advanced home care that exclude the cost of informal care substantially underestimate the costs to society, regardless of whether or not the leisure time of the caregiver is included in the calculations.
DO PARTICIPANTS UNDERSTAND A STATED PREFERENCE HEALTH SURVEY? A QUALITATIVE APPROACH TO ASSESSING VALIDITY
Authors: Kenny Patricia , Hall Jane , Viney Rosalie , Haas Marion
Published: May 2008

Objectives:Examine the validity of using a self-completed Stated Preference Discrete Choice Modeling (SPDCM) questionnaire to measure parents' preferences for vaccinating their children against varicella.

Methods:A qualitative approach was used to assess the way parents understood the technical information in the questionnaire and the factors they considered to be important to the immunization decision. After completion of the SPDCM questionnaire, thirty-four participants completed a semistructured interview by telephone. Interview transcripts were analyzed by using content analysis. Comparisons were then made with the SPDCM questionnaire results.

Results:The technical information used to describe the program attributes appeared to be used appropriately by participants, although their explanations indicated that their understanding did not always come from the questionnaire information. Only one participant appeared to misunderstand the stated preference task, and a small number thought that the complexity and length should be reduced. The results of analysis of the questionnaire data were supported by the qualitative study, with the notable features of the model being reflected in the views commonly expressed about the immunization decision. Several additional factors were identified as important to the choice, including beliefs about vaccination generally and perceptions of the seriousness of varicella.

Conclusions:Although more research is required to investigate the validity of SPDCM for the measurement of preferences in health care, this study supports the validity of its use in childhood immunization where parents are familiar with the decision context.
ECONOMIC EVALUATIONS IN ITALY: A REVIEW OF THE LITERATURE
Authors: Garattini Livio , De Compadri Paola , Clemente Rosamaria , Cornago Dante
Published: May 2008

Objectives: To review the economic evaluations (EEs) done in Italy by Italian authors, following a common scheme to allow some comparisons of the studies selected and with the international reviews.

Methods: We selected all the original studies published by Italian authors (in Italian or English) in national and international journals. The period considered was January 1994 to December 2001. Both full and partial economic evaluations were included. Three international databases were interrogated: MEDLINE, Embase, and HealthStar; further articles were added from the internal database of our center (CESAV), which also classifies Italian local publications and journals specialized in health economics.

Results: A total of ninety-nine studies were reviewed. More than half of the fifty-seven full EEs focused on drugs as type of intervention (n=38), followed by diagnostic screening (n=7). The NHS viewpoint was the most used (n=55 studies), followed by that of society (n=27) and hospitals (n=12). Sixty-eight studies only analyzed direct costs and twenty-nine included both direct and indirect costs. Twenty-five of the thirty-eight pharmacoeconomic full EEs were sponsored by companies. In sixteen of the twenty-five sponsored studies, the sponsor's products were the dominant alternative.

Conclusions: The review showed that, in Italy, like elsewhere, there is a gap between theory and practice in EEs, and sponsors can considerably affect the results of EEs.
ARE VACCINATION SITES IN BANGLADESH SCALE EFFICIENT?
Authors: Valdmanis Vivian , Walker Damian , Fox-Rushby Julia
Published: May 2008

Objectives:The overall aim of this study is to discern whether and to what degree vaccination sites exhibit constant returns to scale.

Methods:Data Envelopment Analysis is used to compare all the facilities in the sample in terms of input costs used to produce multiple outputs. The application considers the Expanded Program on Immunization (EPI), which operated in Dhaka City, Bangladesh, during 1999.

Results:A preponderance of EPI sites were determined to be operating at increasing returns to scale.

Conclusions:Our findings question the applicability of cost-effectiveness analyses that assume constant returns to scale.
SCREENING FOR COLORECTAL CANCER USING THE FECAL OCCULT BLOOD TEST: AN ACTUARIAL ASSESSMENT OF THE IMPACT OF A POPULATION-BASED SCREENING PROGRAM IN CANADA
Authors: Villeneuve Paul J. , Coombs Ann
Published: May 2008

Objectives:A series of randomized controlled trials have demonstrated that screening for colorectal cancer (CRC) using the fecal occult blood (FOB) test can decrease mortality from this disease. These findings were used to develop an actuarial model to estimate the impact that a FOB screening program for colorectal cancer would have on the Canadian population.

Methods:The mortality experience of the year 2000 cohort of Canadians fifty to seventy-four years of age, with follow-up extending to 2010, was modelled according to three scenarios: no screening, annual screening, biennial screening. The primary screening tool was the FOB test using unrehydrated samples, with follow-up of positive test results using colonoscopy. The framework of the model was developed based on published findings from the relevant randomized controlled trials, available data, and a literature review that yielded parameter values for some model items.

Results:During the 10-year follow-up of the cohort, we estimated that 4,444 and 2,827 deaths would be averted with annual and biennial FOB screening, respectively. We estimated that for an annual FOB screening program, approximately 3,400 FOB tests would be required to prevent one death, whereas 2,700 tests would be required within a biennial program.

Conclusions:Our analysis documents the population health impact of using the FOB test to screen for CRC. Additional information on the natural history of the disease, and Canadian pilot data are needed to better model the effectiveness of population-based FOB screening programs.
Health technology assessment and its influence on health-care priority setting
Authors: Oliver Adam , Mossialos Elias , Robinson Ray
Published: May 2008

In this article, we review the development of health technology assessment (HTA) in England and Wales, France, The Netherlands, and Sweden, and we summarize the reaction to these developments from a variety of different disciplinary and stakeholder perspectives (political science, sociology, economics, ethics, public health, general practice, clinical medicine, patients, and the pharmaceutical industry). We conclude that translating HTA into policy is a highly complex business and that, despite the growth of HTA over the past two decades, its influence on policy making, and its perceived relevance for people from a broad range of different perspectives, remains marginal.
Overview of health technology assessment in France
Authors: Orvain Jacques , Xerri Bertrand , Matillon Yves
Published: May 2008

Health technology assessment (HTA) in France covers a variety of activities performed for different customers (e.g., health professionals in the field and policy makers in government) for the benefit of patients. To promote the improvement of quality in health care, France has set up a series of distinct agencies that report to the Ministry of Health but are also accountable to their other customers. We place particular emphasis on ANAES (National Agency for Accreditation and Evaluation in Health) whose main remit is HTA. We show how the diversity of HTA activities and their decentralization suggests tight collaboration among all the different bodies which perform HTA or are closely involved with HTA, and we provide examples of such collaboration.
Health technology assessment: a sociological commentary on reflexive innovation
Authors: Webster Andrew
Published: May 2008

This study provides a sociological commentary on the current debates within health technology assessment (HTA), specifically in response to the approaches taken in France, The Netherlands, Sweden, and the United Kingdom. It argues that HTA is part of a wider reflexive innovation system that seeks to order current and prospective technologies. The study discusses the socio-political process of HTA priority setting, the rhetorical role of HTA, the localised and contingent use of HTA, and the policy gap between guidelines and practice. It argues for the development of new types of methodologies for assessment and for a stronger social embedding of HTA practice.
View of health technology assessment from the swampy lowlands of general practice
Authors: Heath Iona
Published: May 2008

This article seeks to comment on the approaches to health technology assessment (HTA) outlined in the four main country studies in this volume. It is written from the perspective of a general practitioner working in an inner city area in the United Kingdom and argues that, from the point of view of the clinician, HTA delivers considerably less than it promises. The problems center on the inevitability of judgment by both politicians and clinicians and the conflicting foundations of these judgments. Within political decision-making, the needs of the population inevitably outweigh the needs of the individual; within clinical decision making, the opposite is the case. Attempting a scientific rationality, HTA struggles with the impossibility of holding the balance between the two. These difficulties are further compounded by the implications of ever-increasing expectations of perfect health and the effects of multinational commercial pressures.
Perspectives on health technology assessment: response from the patient's perspective
Authors: Coulter Angela
Published: May 2008

Health technology assessment (HTA) involves values and judgments, but there have been few attempts to seek the views of members of the public or to ensure that they have access to the results. Patients and citizens can make an important contribution to HTA by determining priorities for assessment, designing and conducting assessments and appraisals, receiving and using the findings, and engaging in debates about policy priorities and rationing. Those responsible for HTA should make greater efforts to involve the public and ensure that the findings are accessible to patients for use when making treatment choices.
Pharmaceutical industry's perspective on health technology assessment
Authors: Lothgren Mickael , Ratcliffe Mark
Published: May 2008

This article presents the pharmaceutical industry's perspective on health technology assessment (HTA) with specific comments on the HTA systems in England and Wales, France, The Netherlands, and Sweden. The comments are focused on the following main themes: (i) The contributions of the HTA system to overall efficiency in the health-care system, (ii) HTA as a cost-driver for industry, patients, government, and society, and (iii) The various implementation barriers that currently exist for a successful implementation of HTA results.
Systematic review of the effectiveness of home versus hospital or satellite unit hemodialysis for people with end-stage renal failure
Authors: Mowatt Graham , Vale Luke , MacLeod Alison
Published: May 2008

Background:Home hemodialysis offers potential advantages over hospital hemodialysis, including the opportunity for more frequent and/or longer dialysis sessions. Expanding home hemodialysis services may help cope with the increasing numbers of people requiring hemodialysis.

Methods:We sought comparative studies or systematic reviews of home versus hospital/satellite unit hemodialysis for people with end-stage renal failure (ESRF). Outcomes included quality of life and survival. We searched MEDLINE, EMBASE, HealthSTAR, CINAHL, PREMEDLINE, and BIOSIS. Two reviewers independently extracted data and assessed the quality of the studies included.

Results:Twenty-seven studies of variable quality were included. People on home hemodialysis generally experienced a better quality of life and lived longer than those on hospital hemodialysis. Their partners, however, found home hemodialysis more stressful. Four studies using a Cox proportional hazards model to compare home with hospital hemodialysis reported a lower mortality risk for home hemodialysis. Of two studies using a Cox model to compare home with satellite unit hemodialysis, one reported a similar mortality risk, whereas the other reported a lower mortality risk for home hemodialysis.

Conclusions:Home hemodialysis was generally associated with better outcomes than hospital hemodialysis and (more modestly so) satellite unit hemodialysis, in terms of quality of life, survival, and other measures of effectiveness. People on home hemodialysis, however, are a highly selected group. Home hemodialysis also provides the opportunity for more frequent and/or longer dialysis sessions than would otherwise be possible. It is difficult to disentangle the true effects of home hemodialysis from such influencing factors.
Management for severe Crohn's disease: A lifetime cost-utility analysis
Authors: Jaisson-Hot Isabelle , Flourié Bernard , Descos Louis , Colin Cyrille
Published: May 2008

Objectives:Infliximab is a costly therapy for active Crohn's disease resistant to corticosteroids and immunosuppressive medication. The purpose of this study was to examine whether a treatment including infliximab (episodic re-infusions for relapse or maintenance therapy every 8 weeks) was relevant compared with conventional management (surgery and medical treatment without infliximab) for nonfistulizing resistant Crohn's disease.

Methods:We performed a life-time cost-utility analysis with an analytic Markov decision model from the perspective of the third-party payer system. Utility measurement using Standard Gamble was used to adjust the survival time for each health state of the disease. Direct costs were estimated from standard management based on expert opinion. A sensitivity analysis was conducted to gauge the effects of uncertainty in the values assigned to variables.

Results:The incremental effectiveness with infliximab therapy is .761 Quality-Adjusted Life Years (QALYs) for an added cost ranging from 48,478.79 euros to 596,990.35 euros, depending on treatment procedure. The incremental cost utility ratio expressed in euros per QALYs saved varied from 63,700.82 euros (episodic re-infusions) to over 762,245.09 euros (maintenance therapy).

Conclusions:Infliximab therapy could be cost-effective in the case of relapse treatment only, whereas the marginal cost-utility ratio exceeds conventional benchmarks for maintenance therapy. This analysis will be supplemented by conducting further randomized controlled trials and prospective observational study, focused on the costs of illness (direct and indirect), patient preferences, the disease's clinical course, and infliximab safety.
Using decision modeling to determine pricing of new pharmaceuticals: The case of neurokinin-1 receptor antagonist antiemetics for cancer chemotherapy
Authors: Dranitsaris George , Leung Pauline
Published: May 2008

Objectives:Decision analysis is commonly used to perform economic evaluations of new pharmaceuticals. The outcomes of such studies are often reported as an incremental cost per quality-adjusted life year (QALY) gained with the new agent. Decision analysis can also be used in the context of estimating drug cost before market entry. The current study used neurokinin-1 (NK-1) receptor antagonists, a new class of antiemetics for cancer patients, as an example to illustrate the process using an incremental cost of $Can20,000 per QALY gained as the target threshold.

Methods:A decision model was developed to simulate the control of acute and delayed emesis after cisplatin-based chemotherapy. The model compared standard therapy with granisetron and dexamethasone to the same protocol with the addition of an NK-1 before chemotherapy and continued twice daily for five days. The rates of complete emesis control were abstracted from a double-blind randomized trial. Costs of standard antiemetics and therapy for breakthrough vomiting were obtained from hospital sources. Utility estimates characterized as quality-adjusted emesis-free days were determined by interviewing twenty-five oncology nurses and pharmacists by using the Time Trade-Off technique. These data were then used to estimate the unit cost of the new antiemetic using a target threshold of $Can20,000 per QALY gained.

Results:A cost of $Can6.60 per NK-1 dose would generate an incremental cost of $Can20,000 per QALY. The sensitivity analysis on the unit cost identified a range from $Can4.80 to $Can10.00 per dose. For the recommended five days of therapy, the total cost should be $Can66.00 ($Can48.00–$Can100.00) for optimal economic efficiency relative to Canada's publicly funded health-care system.

Conclusions:The use of decision modeling for estimating drug cost before product launch is a powerful technique to ensure value for money. Such information can be of value to both drug manufacturers and formulary committees, because it would facilitate negotiations for optimal pricing in a given jurisdiction.
Retrieval of missing data for meta-analysis: A practical example
Authors: Kelley George A. , Kelley Kristi S. , Vu Tran Zung
Published: May 2008

Objectives:To examine the feasibility of retrieving missing outcome data for summary meta-analyses using an example dealing with the effects of aerobic exercise on lipids and lipoproteins in adults.

Methods:Missing lipid and/or lipoprotein data from a currently developed meta-analytic data base were requested by means of electronic mail from 39 of 174 (22.4 percent) eligible studies. Binary logistic regression was used to examine whether year of publication and country were significant predictors for whether data would be provided.

Results:Of the thirty-nine studies from which data were requested, usable data were received for thirteen (33.3 percent) of the studies. The addition of these previously missing data decreased the percentage of eligible studies that would have had to be excluded by 33.5 percent (from 22.4 percent to 14.9 percent). Neither year of publication nor country in which the study was conducted (United States versus other) were significant predictors of whether missing data would be provided or not (p>.05).

Conclusions:Moderate success was achieved in the acquisition of missing outcome data dealing with the effects of aerobic exercise on lipids and lipoproteins in adults. However, whether this level of response is true in other areas of research needs to be determined by additional research.
Empirical assessment of the impact of drug-eluting stents on the rate of use of coronary revascularization procedures
Authors: Grilli Roberto , Taroni Francesco
Published: May 2008

Objectives:To assess the impact of the availability of drug-eluting stents (DES) in April 2002 in Emilia-Romagna (a four-million resident Italian region), on the rate of use of revascularization procedures. DES are expected to influence the rate of use of coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI). However, to date, little empirical information is available on the actual impact of this innovation on clinical practice.

Methods:A time series regression analysis of the monthly number of procedures (PCI and CABG) performed between January 1998 and March 2003.

Results:DES availability was associated with statistically significant changes in the use of revascularization procedures, although the size of the effect was always small or moderate. PCI increased only by 0.36 more procedures per month (approximately four per year), whereas more evident was the concurrent reduction of isolated CABG (4.15 fewer per month, that is fifty fewer per year). Overall, considering all the surgical revascularizations (i.e., CAGB both isolated and associated with other interventions), there was a reduction of 2.52 procedures per month (thirty less per year).

Conclusions:Despite DES being at a very early stage of their diffusion process, our results indicate that they are already having an impact, although moderate, on the use of revascularization procedures. If these findings will be confirmed, they will have a substantial influence on the patterns of care for patients with coronary artery disease and relevant policy implications for health services.
Cost-effectiveness of interventions to reduce the thrombolytic delay for acute myocardial infarction
Authors: Kildemoes Helle Wallach , Kristiansen Ivar Sønbø
Published: May 2008

Objectives:The objective of the study was to estimate the costs and health benefits of a public awareness campaign aimed at shortening the delay for thrombolytic therapy in patients with acute myocardial infarction (AMI) and to estimate the incremental costs and benefits of an additional telemedicine program.

Methods and Results:By using trial data on the impact of a Swedish campaign, a model was developed to simulate the current distribution of thrombolytic delay in Denmark and the delay after a campaign. The reduction in delay was translated into reduced fatality assuming reductions from the campaign and additional effects of a telemedicine program. The costs of the campaign were based on trial data and Danish unit costs while telemedicine costs were taken from a Danish demonstration program. The analyses indicate that the awareness campaign will translate into five fewer fatal AMIs (sixty-two life years gained) and a cost per life year of DKK283,300, with both costs and benefits discounted at 5 percent. When combining the public campaign with prehospital telemedicine diagnostics, the incremental cost per life year gained was DKK854.700.

Conclusions:Programs aimed at reducing delay of thrombolysis in patients with AMI are likely to have a limited impact on AMI fatality. Information campaigns may have acceptable cost-effectiveness ratios, while telemedicine programs lead to threefold greater ratios. Whether such programs can be considered cost-effective will depend on how life year gains are valued by society.
Assessing the accuracy of forecasting: Applying standard diagnostic assessment tools to a health technology early warning system
Authors: Simpson Sue , Hyde Chris , Cook Alison , Packer Claire , Stevens Andrew
Published: May 2008

Objectives:Early warning systems are an integral part of many health technology assessment programs. Despite this finding, to date, there have been no quantitative evaluations of the accuracy of predictions made by these systems. We report a study evaluating the accuracy of predictions made by the main United Kingdom early warning system.

Methods:As prediction of impact is analogous to diagnosis, a method normally applied to determine the accuracy of diagnostic tests was used. The sensitivity, specificity, and predictive values of the National Horizon Scanning Centre's prediction methods were estimated with reference to an (imperfect) gold standard, that is, expert opinion of impact 3 to 5 years after prediction.

Results:The sensitivity of predictions was 71 percent (95 percent confidence interval [CI], 0.36–0.92), and the specificity was 73 percent (95 percent CI, 0.64–0.8). The negative predictive value was 98 percent (95 percent CI, 0.92–0.99), and the positive predictive value was 14 percent (95 percent CI, 0.06–0.3).

Conclusions:Forecasting is difficult, but the results suggest that this early warning system's predictions have an acceptable level of accuracy. However, there are caveats. The first is that early warning systems may themselves reduce the impact of a technology, as helping to control adoption and diffusion is their main purpose. The second is that the use of an imperfect gold standard may bias the results. As early warning systems are viewed as an increasingly important component of health technology assessment and decision making, their outcomes must be evaluated. The method used here should be investigated further and the accuracy of other early warning systems explored.
Readmission rate as an indicator of hospital performance: The case of Spain
Authors: Jiménez-Puente Alberto , García-Alegría Javier , Gómez-Aracena Jorge , Hidalgo-Rojas Luis , Lorenzo-Nogueiras Luisa , Perea-Milla-López Emilio , Fernández-Crehuet-Navajas Joaquín
Published: May 2008

Objectives:Hospital readmission rate is currently used as a quality of care indicator, although its validity has not been established. Our aims were to identify the frequency and characteristics of potential avoidable readmissions and to compare the assessment of quality of care derived from readmission rate with other measure of quality (judgment of experts).

Methods:Design: cross-sectional observational study; Setting: acute care hospital located in Marbella, South of Spain; Study participants: random sample of patients readmitted at the hospital within six months from discharge (n=363); Interventions: review of clinical records by a pair of observers to assess the causes of readmissions and their potential avoidability; Main measures: logistic regression analysis to identify the variables from the databases of hospital discharges which are related to avoidability of readmissions. Determination of sensitivity and specificity of different definitions of readmission rate to detect avoidable situations.

Results:Nineteen percent of readmissions were considered potentially avoidable. Variables related to readmission avoidability were (i) time elapsed between index admission and readmission and (ii) difference in diagnoses of both episodes. None of the definitions of readmission rate used in this study provided adequate values of sensitivity and specificity in the identification of potentially avoidable readmissions.

Conclusions:Most readmissions in our hospital were unavoidable. Thus, readmission rate might not be considered a valid indicator of quality of care.
Outcomes of evidence-based clinical practice guidelines: A systematic review
Authors: Bahtsevani Christel , Udén Giggi , Willman Ania
Published: May 2008

Objectives: This study aimed to investigate whether evidence-based clinical practice in health care improves outcomes for patients, personnel, and/or organizations.

Methods: A systematic review of studies was conducted with various quantitative and qualitative methods up to the Spring of 2002. Protocols were used in quality assessment. Data synthesis is descriptive in a narrative form.

Results: Of 305 assessed articles, eight studies were included. The outcomes in the included studies were related to the experiences of patients and personnel and to organization concerning changed patient care and resource utilization. Because the included studies are heterogeneous in design, focus of research area, and scientific quality, the scientific foundation for the findings is weak. There is some support that evidence-based clinical practice guidelines, when put to use, improve outcomes (i) for patients—less likelihood of showing worsening of skin condition and disruption of skin condition improves more rapidly for infants; (ii) for personnel—support in daily work situation; and (iii) for organizations—decreased admission rates and length of stay, less resource utilization and reduced costs.

Conclusions: There is a need for further research as the findings are based on a rather limited number of studies. There is a tendency toward support for the idea that outcomes improve for patients, personnel, or organizations if clinical practice in health care is evidence-based, that is, if evidence-based clinical practice guidelines are used, although these findings could be specific to the settings and context of the studies reported in this systematic review.
Cost comparison of two surgical strategies in the treatment of breast cancer: Sentinel lymph node biopsy versus axillary lymph node dissection
Authors: Perrier Lionel , Nessah Karima , Morelle Magali , Mignotte Hervé , Carrère Marie-Odile , Brémond Alain
Published: May 2008

Objectives: The feasibility and accuracy of sentinel lymph node biopsy (SLNB) in the treatment of breast cancer is widely acknowledged today. The aim of our study was to compare the hospital-related costs of this strategy with those of conventional axillary lymph node dissection (ALND).

Methods: A retrospective study was carried out to determine the total direct medical costs for each of the two medical strategies. Two patient samples (n=43 for ALND; n=48 for SLNB) were selected at random among breast cancer patients at the Centre Léon Bérard, a comprehensive cancer treatment center in Lyon, France. Costs related to ALND carried out after SLNB (either immediately or at a later date) were included in SLNB costs (n=18 of 48 patients).

Results: Total direct medical costs were significantly different in the two groups (median 1,965.86€ versus 1,429.93€, p=0.0076, Mann-Whitney U-test). The total cost for SLNB decreased even further for patients who underwent SLNB alone (median, 1,301€). Despite the high cost of anatomic pathology examinations and nuclear medicine (both favorable to ALND), the difference in direct medical costs for the two strategies was primarily due to the length of hospitalization, which differs significantly depending on the technique used (9-day median for ALND versus 3 days for SLNB, p<0.0001).

Conclusions: A lower morbidity rate is favorable to the generalization of SLNB, when the patient's clinical state allows for it. From an economic point of view, SLNB also seems to be preferred, particularly because our results confirm those found in two published studies concerning the cost of SLNB.
Cost-effectiveness analysis of a complementary health intervention: The case of smoking relapse prevention
Authors: Chirikos Thomas N. , Herzog Thaddeus A. , Meade Cathy D. , Webb Monica S. , Brandon Thomas H.
Published: May 2008

Objectives:We assess the cost-effectiveness of smoking relapse prevention interventions designed to keep quitters from resuming the use of cigarettes. Because relapse prevention is complementary to smoking cessation efforts, the appropriate test of its cost-effectiveness is whether it reduces the incremental cost-effectiveness ratio (ICER) of smoking cessation. The major goal of the study is to carry out such a test.

Methods:Data from a randomized trial that ascertained the effectiveness of alternative modes of smoking relapse prevention are combined with ICER estimates of smoking cessation to assess whether relapse prevention is cost-effective.

Results:The trial produced convincing evidence that relapse prevention yields statistically significant reductions in the proportion of quitters who are smoking at 24 months postquit. The intervention effects are substantial enough to raise the denominator terms of the smoking cessation ICER and, thereby, offset the amount relapse prevention adds to cost numerator terms. In this sense, smoking relapse prevention tends to pay for itself.

Conclusions:Smoking relapse prevention is a highly cost-effective addition to current efforts to curb cigarette consumption. Complementary health interventions of this sort should be assessed by different methods than those commonly found in the cost-effectiveness literature.
Information technology law and health systems in the European Union
Authors: Mossialos Elias , Thomson Sarah , Ter Linden Annemarie
Published: May 2008

Objectives:This study aims to examine the impact of European Union (EU) law relating to information technology (IT) on health systems.

Methods:The study identifies EU directives relating to IT, analyzes them in terms of their impact on the use of IT in health systems, and outlines their implications for health technology assessment (HTA). Analysis is based on a review of literature identified through relevant databases and Internet searches.

Results:Developments in IT have serious implications for EU health systems, presenting policy makers with new challenges. The European Commission has adopted a range of legal measures to protect consumers in the “information society” However, as few of them are health-specific, it is not evident that they have implications for health, health systems, or HTA, and they may not be effective in protecting consumers in the health sector.

Conclusions:In light of the growing importance of IT in the health sector, legal and nonlegal measures need to be further developed at EU and international level. Where possible, future initiatives should pay attention to the particular characteristics of health goods and services and health systems. Although definitions of HTA usually recognize the importance of evaluating both the indirect, unintended consequences of health technologies and the legal aspects of their application, it seems that, in practice, HTA often overlooks or underestimates legislative matters. Those involved in HTA should be aware of the legal implications of using IT to provide health goods and services and compile, store, transfer, and disseminate health information electronically.
Packing-dimension profiles and fractional Brownian motion
Authors: KHOSHNEVISAN DAVAR , XIAO YIMIN
Published: May 2008

In order to compute the packing dimension of orthogonal projections Falconer and Howroyd [3] have introduced a family of packing dimension profiles Dims that are parametrized by real numbers s > 0. Subsequently, Howroyd [5] introduced alternate s-dimensional packing dimension profiles P-Dims by using Caratheodory-type packing measures, and proved, among many other things, that P-DimsE = DimsE for all integers s > 0 and all analytic sets E ⊆ RN.

The aim of this paper is to prove that P-DimsE = DimsE for all real numbers s > 0 and analytic sets E ⊆ RN. This answers a question of Howroyd [5, p. 159]. Our proof hinges on establishing a new property of fractional Brownian motion.
On the size of linearization domains
Authors: BUFF XAVIER , PETERSEN CARSTEN L.
Published: May 2008

Assume $f{:}\,U\subset \C\to \C$ is a holomorphic map fixing 0 with derivative λ, where 0 < |λ| ≤ 1. If λ is not a root of unity, there is a formal power series φf(z) = z + ${\cal O}$(z2) such that φf(λ z) = f(φf(z)). This power series is unique and we denote by Rconv(f) ∈ [0,+∞] its radius of convergence. We denote by Rgeom(f) the largest radius r ∈ [0, Rconv(f)] such that φf(D(0,r)) ⊂ U. In this paper, we present new elementary techniques for studying the maps f ↦ Rconv(f) and f ↦ Rgeom(f). Contrary to previous approaches, our techniques do not involve studying the arithmetical properties of rotation numbers.
Wiener amalgams, Hardy spaces and summability of Fourier series
Authors: WEISZ FERENC
Published: May 2008

A general summability method, the so called θ-summability is considered for multi-dimensional Fourier series, where θ is in the Wiener algebraW(C,ℓ1)($\mathbb{R}$d). It is based on the use of Wiener amalgam spaces, weighted Feichtinger's algebra, Herz and Hardy spaces. Under some conditions on θ, it is proved that the maximal operator of the θ-means is bounded from theHpHardy space toLp(orHp). This implies some norm and almost everywhere convergence results for the θ-means. Large number of special cases of the θ-summation are considered.
Cohomological invariants of odd degree Jordan algebras
Authors: MacDONALD MARK L.
Published: May 2008

In this paper we determine all possible cohomological invariants ofAut(J)-torsors in Galois cohomology with mod 2 coefficients (characteristic of the base field not 2), forJa split central simple Jordan algebra of odd degreen≥ 3. This has already been done forJof orthogonal and exceptional type, and we extend these results to unitary and symplectic type. We will use our results to compute the essential dimensions of some groups, for example we show that ed(PSp2n) =n+ 1 fornodd.
Agricultural carbon sequestration, poverty, and sustainability
Authors: ANTLE JOHN M. , STOORVOGEL JETSE J.
Published: May 2008

This paper explores the potential impacts of payments for agricultural soil carbon sequestration on poverty of farm households and on the sustainability of agricultural systems, using economic theory combined with evidence from three case studies in Kenya, Peru, and Senegal. The case studies indicate that the likely impact of carbon contracts will be to raise rural incomes and reduce the rate of soil carbon loss. In some cases, carbon contracts may be able to stabilize soil carbon stocks at a higher level than would otherwise be economically feasible. These findings suggest that carbon payments could have a positive impact on the sustainability of production systems while also reducing poverty. The analysis indicates that payments for environmental services are most likely to have a positive impact when they are implemented in an enabling economic and institutional environment.
Contracting caravans: partnership and profit in nineteenth- and early twentieth-century trans-Saharan trade
Authors: Lydon Ghislaine
Published: May 2008

Organizing trans-Saharan camel caravans was a complicated business requiring skills, stamina, resources, and human capital. This article focuses on the contractual world of caravanning in the nineteenth and early twentieth century based on interviews with retired caravanners, original trade records, and legal sources mined in private family archives. It surveys the different contractual agreements that featured commonly in this ‘paper economy’, which was based on a reliance on literacy and Islamic law. It is argued that contracts were key instruments for accounting and accountability even between traders with kinship ties and other sources of solidarity, and that they were often the only channel for women to engage in long-distance trade via proxy.
Glaubhaftigkeitsbegutachtung bei Persönlichkeitsstörungen
Authors: Steller Max , Böhm Claudia
Published: May 2008

Die Beurteilung von belastenden Aussagen von Zeugen mit Persönlichkeitsstörungen rückt zunehmend in den Fokus der Aufmerksamkeit der aussagepsychologischen Begutachtung. Relevante Probleme im Begutachtungsprozess und auftretende Fragestellungen werden erörtert und Konsequenzen für die juristische Praxis diskutiert.
ADHS, Antisoziale Persönlichkeitsstörung und Delinquenz 1Prof. Dr. med. Dr. jur. R. Luthe zum 75. Geburtstag gewidmet
Authors: Rösler Michael , Retz Wolfgang
Published: May 2008

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) kann im Erwachsenenalter mit erheblichen Einschränkungen im Lebensalltag vergesellschaftet sein. In Straftäterpopulationen kommt ADHS sowohl bei Männern wie auch Frauen überdurchschnittlich häufig vor. In der Regel ist dabei ADHS mit einer Conduct Disorder (CD) assoziiert. Bei der Kombination ADHS mit CD handelt es sich um Personen, bei denen in der Kindheit und Jugend delinquente Verhaltensstile zu beobachten sind. Bei diesem Personenkreis, nicht aber bei isolierter ADHS, besteht ein hohes Risiko für die Entwicklung einer Antisozialen Persönlichkeitsstörung (ASP) oder von anhaltendem kriminellem Verhalten im Erwachsenenalter. Etwa die Hälfte aller Kinder mit ADHS entwickelt eine CD. Eine ASP tritt später in 20–25 % der Fälle ein. Auf welche Weise ADHS mit CD oder ASP pathogenetisch assoziiert ist, konnte bisher nicht eindeutig geklärt werden. Gemeinsame genetische Faktoren, Gen × Gen Interaktionen sowie Gen × Umwelt Interaktionen sind wahrscheinlich. Straftäter mit ADHS beginnen in jüngerem Alter mit delinquenten Verhaltensstilen und sind häufiger Rezidivtäter als Täter ohne ADHS. Die Prävalenz von ADHS ist nicht in allen Tätergruppen gleichmäßig erhöht. Bei Betrügern ist die ADHS Prävalenz normal. Signifikant mehr ADHS findet man bei Sexualstraftätern (ca. 30 %) und bei Personen, die reaktive Gewalttaten verübt haben. Bei proaktiver Gewalttätigkeit ist die Prävalenz für ADHS eher niedrig. Auch unter den BTM Delinquenten findet man eine relativ hohe ADHS Prävalenz. Die im Rahmen der ADHS auftretende Antisozialität lässt keine wesentlichen Querverbindungen zur Kerngruppe der Psychopathen nach Hare erkennen und kann damit als eigenständige Subgruppe innerhalb der ASP angesehen werden.
Gewalterfahrungen von Jugendlichen
Authors: Koglin Ute , Petermann Franz
Published: May 2008

Die Sicherheitswahrnehmung und Gewalterfahrungen von Jugendlichen wurden im Zusammenhang mit externalisierenden und internalisierenden Verhaltensproblemen bei Jugendlichen untersucht. Dabei wurden Selbstwirksamkeit und Vertrauen in einen Lehrer als Ressourcen einbezogen, die mit einer besseren psychosozialen Entwicklung einhergehen. Die Stichprobe setzte sich aus 225 Schülern aus Bremer Schulen zusammen, die die achte bis zehnte Jahrgangsstufe besuchten. Eine hohe Selbstwirksamkeit geht mit mehr prosozialem Verhalten und weniger internalisierenden und externalisierenden Verhaltensproblemen einher, während Opfererfahrungen und eine geringe Sicherheit in der Schule mit mehr Symptomen in Zusammenhang stehen. Das Vertrauen in einen Lehrer stand jedoch nicht mit einer besseren Anpassung in Verbindung, sondern mit mehr internalisierenden Problemen und Problemen mit Gleichaltrigen. Selbstwirksamkeit moderiert den Zusammenhang zwischen Schulsicherheit und Verhaltensproblemen. Schüler mit einer geringen Selbstwirksamkeit, die sich an der Schule sicher fühlen, haben weniger Verhaltensprobleme.