bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary prevention of cardiovascular disease: Cost-effectiveness comparison
Authors: Franco Oscar H. , der Kinderen Arno J. , De Laet Chris , Peeters Anna , Bonneux Luc 
Published: January 2007

Objectives: The aim of this study was to evaluate the cost-effectiveness of four risk-lowering interventions (smoking cessation, antihypertensives, aspirin, and statins) in primary prevention of cardiovascular disease.Methods: Using data from the Framingham Heart Study and the Framingham Offspring study, we built life tables to model the benefits of the selected interventions. Participants were classified by age and level of risk of coronary heart disease. The effects of risk reduction are obtained as numbers of death averted and life-years saved within a 10-year period. Estimates of risk reduction by the interventions were obtained from meta-analyses and costs from Dutch sources.Results: The most cost-effective is smoking cessation therapy, representing savings in all situations. Aspirin is the second most cost-effective (€2,263 to €16,949 per year of life saved) followed by antihypertensives. Statins are the least cost-effective (€73,971 to €190,276 per year of life saved).Conclusions: A cost-effective strategy should offer smoking cessation for smokers and aspirin for moderate and high levels of risk among men 45 years of age and older. Statin therapy is the most expensive option in primary prevention at levels of 10-year coronary heart disease risk below 30 percent and should not constitute the first choice of treatment in these populations.
Cost-effectiveness of an education and activation program for patients with acute and subacute shoulder complaints compared to usual care
Authors: De Bruijn Camiel , Goossens Marielle , de Bie Rob , Ament Andre , Geraets Jacques , Dinant Geert-Jan 
Published: January 2007

Objectives: Shoulder complaints (SCs) constitute the second largest group of musculoskeletal disorders after low back pain. The economic burden in terms of costs of healthcare use and costs due to work absenteeism underlines the need for a cost-effectiveness analysis of the interventions involved. The education and activation program (EAP) is a newly developed early intervention to prevent the development of chronic SCs. A cost-effectiveness analysis should provide more information on the effect of an EAP on total costs related to SCs.Methods: We conducted a cost-effectiveness analysis alongside a randomized clinical trial comparing the effectiveness of the EAP in addition to usual care (EAP group) with that of usual care alone (UC group) in terms of preventing chronicity in patients with acute SCs. The aim of the cost-effectiveness analysis was to compare the observed difference in costs with the clinical effectiveness (i.e., patient-perceived recovery after 26 weeks), using bootstraps.Results: The comparison of total costs between treatment groups showed no significant (p = .077) difference after 26 weeks. The majority (82 percent) of the cost-effect pairs after bootstrap analysis were located in the northeast quadrant, suggesting more effect but at higher costs.Conclusions: In view of the clinical relevance of the clinical outcomes and the considerable costs needed to achieve this, it can be concluded that the EAP is currently not cost-effective.
Cost-effectiveness of surveillance programs for families at high and moderate risk of hereditary non-polyposis colorectal cancer
Authors: Olsen Kim R. , Bojesen Stig E. , Gerdes Anne-Marie M. , Lindorff-Larsen Karen , Bernstein Inge T. 
Published: January 2007

Objectives:Surveillance programs are recommended to both families at high risk (Amsterdam-positive families with known- and unknown mutation) and moderate risk (families not fulfilling all Amsterdam criteria) of colorectal cancer (CRC). Cost-effectiveness has so far only been estimated for the group at high risk. The aim of the present study is to determine cost-effectiveness of surveillance programs where families at both high and moderate risk of HNPCC participate.Methods:A decision analytic model (Markov model) is developed to assess surveillance programs where families at high and moderate risk of HNPCC are offered surveillance from age 25 and age 45, respectively. The model includes costs for all families referred to genetic counseling, including genetic risk assessment, mutation analysis, and surveillance in relevant families with or without known mutation, plus the costs related to any surgical treatment. The risk of metachronous CRC is also modeled.Results:Incremental costs per life year gained are estimated to be €980 when families at both high and moderate risk of HNPCC undergo surveillance (€508 for high risk and €1600 for moderate risk) and €1947 when the moderate risk group is evaluated genetically but not offered surveillance. Sensitivity analysis showed these findings to be robust, although cost-effectiveness can be improved in cases of more conservative referrals to genetic counseling.Conclusions:The result for high risk families confirms the findings in similar studies. Somewhat surprisingly, cost-effectiveness improves when surveillance of the moderate risk groups are included in the decision model.
Exploration of the difference in results of economic submissions to the National Institute of Clinical Excellence by manufacturers and assessment groups
Authors: Chauhan Deven , Miners Alec H. , Fischer Alastair J. 
Published: January 2007

Objectives:A recent study showed that estimates of cost-effectiveness submitted to National Institute for Health and Clinical Excellence (NICE) by manufacturers had significantly lower incremental cost-effectiveness ratios (ICERs) than those submitted by university-based Assessment Groups. This study extends that analysis.Methods:Data were abstracted from relevant NICE documentation for thirty-two of eighty-two possible appraisals.Results:The results from the analysis showed that sources of the difference in ICERs appear to be the effectiveness estimates relating to the comparator technology and the cost estimates relating to the technology under evaluation. That is, manufacturers estimated lower average benefits for the comparator technology and lower costs relating to the technology under evaluation compared with estimates submitted by the Assessment Groups.Conclusions:These findings may be particularly important, given the introduction of the “Single Technology Appraisal.” Considerable difficulties were encountered when undertaking this study, highlighting, above all else, the complexity of explaining why results from economic evaluations purporting to answer the same question diverge.
Association of study type, sample size, and follow-up length with type of recommendation produced by the National Institute for Health and Clinical Excellence Interventional Procedures Programme
Authors: Campbell William Bruce , Barnes Steven J. , Kirby Rebecca A. , Willett Sarah L. , Wortley Sally , Lyratzopoulos Georgios 
Published: January 2007

Objectives:The association between type and amount of clinical evidence and type of National Institute for Health and Clinical Excellence recommendations for interventional procedures was examined.Methods:The evidence about 736 studies (including 183,729 patients) relating to 130 different interventional procedures and about relevant recommendations was analyzed. Associations were examined between type of recommendation (“normal arrangements” or “cautionary guidance”) and evidence type, total number of treated patients, and mean follow-up length. Evidence type was categorized as (a) randomized, (b) nonrandomized controlled, and (c) case series/reports. The main outcome measures were frequency of evidence type, total number of patients treated, and mean follow-up length, by type of recommendation.Results:“Normal arrangements” recommendations were made for 70 (54 percent) procedures and “cautionary guidance” was issued for 60 (46 percent) procedures. Procedures supported by at least one randomized study (34 percent,n= 44) were more likely to receive a “normal arrangements” recommendation (relative risk 1.38,p= .063). Overall, there were 85 (12 percent), 135 (18 percent), and 516 (70 percent) studies in categories a–c, respectively. The number of treated patients was significantly larger among procedures with “normal arrangements” (median, 605; range, 26–6,842) than among those with “cautionary guidance” (median, 240; range, 1–3,261;p< .001) recommendation. Mean follow-up length was longer in studies relating to procedures with “normal arrangements” recommendation (median, 16.7; range, 0–84 months) compared with those with “cautionary guidance” (median, 14.6; range, 0–67 months;p= .160).Conclusions:Procedures supported by randomized studies, and with larger numbers of patients and longer follow-up length, were more likely to receive positive guidance. Future research and development on interventional procedures should aim to produce better and more relevant evidence to optimize the possibility of such procedures being accepted by policy makers.
An experimental study of the influence of individual participant characteristics on formal consensus development
Authors: Carpenter James , Hutchings Andrew , Raine Rosalind , Sanderson Colin 
Published: January 2007

Objectives:The aim of this study was to examine the influence of participants' characteristics on the results produced by formal consensus methods.Methods:The approach was an experimental study of 346 participants in 20 groups rating the appropriateness of four mental health interventions for the treatment of chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain. There were four factors in the design: systematic literature review provided or not, decisions made under realistic or “ideal” resource assumptions, clinically mixed (general practitioners and mental health professionals) or homogenous group (general practitioners only), convened or mail-only group. A group's rating was defined as the median of participants' ratings. The influence of participants' characteristics (age, sex, and specialty) was examined using multilevel models.Results:The largest differences were between the GPs and mental health professionals, both in their initial ratings of the different interventions, and in how much they altered their ratings between rounds. There were smaller but statistically significant (p<.05) differences between specialty and age groups in initial ratings for the treatment (by whatever means) of different conditions, and for certain conditions women increased their ratings more than men. Women rated intervention more favorably when assuming “ideal” rather than realistic levels of resources, but men did not.Conclusions:Our findings support the practice of treating professional specialty as an important determinant of the results in consensus panels.
Dialysis care, cardiovascular disease, and costs in end-stage renal disease in Brazil
Authors: Sesso Ricardo , da Silva Camilla Barbosa , Kowalski Sérgio C. , Manfredi Silvia R. , Canziani Maria E. , Draibe Sergio A. , Elgazzar Heba A. , Ferraz Marcos B. 
Published: January 2007

Objectives: This study evaluates the cost of dialysis care in Brazil, including costs of ambulatory care and hospital admissions due to all causes and cardiovascular events.Methods: Data were analyzed for 200 patients with end-stage renal disease (ESRD) on chronic hemodialysis in Brazil between 2001 and 2004. Main end points were all-cause mortality, all-cause hospital admissions, and cardiovascular events. Direct costs of dialysis treatment and complications were computed from the perspective of two payers, the Ministry of Health (MoH) and private health insurance (PHI).Results: Mean number of days of hospitalization was 12 per patient-year. There were 105 cardiovascular events; the most frequent events were coronary disease (n = 59, 56 percent) and congestive heart failure (n = 26, 25 percent). The rate of cardiovascular events was 193 per 1,000 patient-years. There were 43 deaths, and the death rate was 79 per 1,000 patient-years. Median cost per hospital admission was US$ 675 and US$ 932 from the perspective of the MoH and PHI. For admissions due to cardiovascular causes, the corresponding costs were US$ 1,639 and US$ 4,499, respectively. Mean global cost per patient-year for chronic hemodialysis therapy was US$ 7,980 and US$ 13,428 from the perspective of the MoH and PHI, respectively.Conclusions: Patients on chronic hemodialysis care incur significant healthcare resources due to the costs of dialysis and complications, notably cardiovascular disease. New disease management programs aimed at reducing cardiovascular morbidity and efficient use of resources are critical to ensuring the sustainability of treatments for ESRD in Brazil.
Benefits of and barriers to involving users in medical device technology development and evaluation
Authors: Shah Syed Ghulam Sarwar , Robinson Ian 
Published: January 2007

Objectives:This study investigated the benefits of and barriers to user involvement in medical device technology development and evaluation.Methods:A structured review of published literature in peer-reviewed journals was conducted.Results:This literature review revealed that the main benefits of user involvement were an increased access to user needs, experiences, and ideas; improvements in medical device designs and user interfaces; and an increase in the functionality, usability, and quality of the devices. On the other hand, resource issues, particularly those of time and money were found the key impediments to involving users in the development and evaluation of medical device technologies. This study also has categorized both the benefits of and barriers to user involvement.Conclusions:The involvement of users in medical device technology development and evaluation requires resources, which are limited; however, this involvement is essential from both users and manufacturers perspectives.
Density-dependent Lines of One- and Two-electron Ions in Diagnostics of Laboratory plasma. I. The rates of collision relaxation of excited levels
Authors: V P Shevelko  , I Yu Skobelev  , A V Vinogradov  
Published: January 2007

Plasma devices with inertial plasma confinement such as laser produced plasmas, exploding wires, plasma focus, etc., which have been rapidly developed during recent years, appear to be very intensive sources of spectral line radiation in far UV and X-ray regions. Analysis of this radiation provides a good tool for plasma diagnostics with very high electron densities up to 1022cm-3. In this work, consisting of two parts, we consider the mechanism of the formation of spectral lines in hot and dense plasma. The key point for density diagnostics is the fact that for some ion levels the rate of collisional relaxation has the same order of magnitude as the radiative decay. Thus the intensities of spectral lines arising from these levels show a strong dependence on electron density which makes diagnostics possible.In the first paper, emphasis is laid on the calculation of rates of transition between close ion levels induced by electron or ion impact, which usually gives the main contribution to the collisional relaxation constants. The influence of plasma polarization effects on the collision frequency in a dense plasma is also considered.In a second paper, the formation of spectral lines of hydrogen-like, helium-like and oxygen-like ions will be considered for electron density 1018cm-3⩽N⩽ 1024cm-3and the ion charge 10 ⩽Z⩽ 19.
Auger Electron Spectra of Sodium Bound to Keratin and other Biological Materials
Authors: Astrid Höglund  , Erik Odeblad  
Published: January 2007

It is expected that keratin, the protective protein of the skin, has capability to bind materials for which it is exposed e.g. inorganic ions. To test this hypothesis for sodium ions we studied the Na Auger 1
D line in NaCl-keratin combinations. The keratin methylene C-1s line served as an internal reference and the shift, S, to the Na 1
D line was measured. It was found that S was dependent on P, the molar fraction of NaCl (on a NaCl-peptide bond basis). The experimental values suggest that S depends on P according to the eq.:
S = 13.0-3.2√P

with S expressed in eV. This result indicates the following: (1) There exists some kind of bonding, or association, between NaCl and keratin. (2) NaCl seems to be associated to the peptide regions of the protein. (3) The bonding is second order in the sense that (probably) two moles of bonds occur per mole NaCl. (4) Possible models can be presented for the mechanisms involved and it is tentatively suggested that electrostatic bonding occurs between Na+ and the carbonyl oxygen and, under certain circumstances, between Cl- and the nitrogen of the peptide bond. Besides keratin, a number of other biochemicals and cervical mucus were studied. Cervical mucus associates, according to our experimental findings, sodium chloride, probably in a similar fashion. This has diagnostic interest in human fertility problems. It is not yet known which of the constituents in the cervical mucus that is mainly responsible for the bonding, and this and several other related questions are the subject of continued studies.
Sieving by large integers and covering systems of congruences
Authors: Filaseta Michael , Ford Kevin , Konyagin Sergei , Pomerance Carl , Yu Gang 
Published: January 2007

An old question of Erdős asks if there exists, for each number

N
N

, a finite set

S
S

of integers greater than

N
N

and residue classes

r
(
n
)

(

mod

n
)

r(n)~(\textrm {mod}~n)

for

n
∈
S

n\in S

whose union is

Z

\mathbb Z

. We prove that if

∑

n
∈
S

1

/

n

\sum _{n\in S}1/n

is bounded for such a covering of the integers, then the least member of

S
S

is also bounded, thus confirming a conjecture of Erdős and Selfridge. We also prove a conjecture of Erdős and Graham, that, for each fixed number

K
>
1

K>1

, the complement in

Z

\mathbb Z

of any union of residue classes

r
(
n
)

(

mod

n
)

r(n)~(\textrm {mod}~n)

, for distinct

n
∈
(
N
,
K
N
]

n\in (N,KN]

, has density at least

d
K

d_K

for

N
N

sufficiently large. Here

d
K

d_K

is a positive number depending only on

K
K

. Either of these new results implies another conjecture of Erdős and Graham, that if

S
S

is a finite set of moduli greater than

N
N

, with a choice for residue classes

r
(
n
)

(

mod

n
)

r(n)~(\textrm {mod}~n)

for

n
∈
S

n\in S

which covers

Z

\mathbb Z

, then the largest member of

S
S

cannot be

O
(
N
)

O(N)

. We further obtain stronger forms of these results and establish other information, including an improvement of a related theorem of Haight.
Specific expression of hepatocyte nuclear factor‐1β in the ovarian clear cell adenocarcinoma and its application to cytological diagnosis
Authors: Higashiguchi Atsushi , Yamada Taketo , Susumu Nobuyuki , Mori Taisuke , Suzuki Atsushi , Aoki Daisuke , Sakamoto Michiie 
Published: January 2007

Ascitic cytological diagnosis is critical, but ovarian adenocarcinoma cells and reactive mesothelial cells can be difficult to distinguish because they usually have atypical cell nuclei and increased nuclear/cytoplasmic ratios. Previous studies using DNA microarrays have demonstrated that hepatocyte nuclear factor‐1β (HNF‐1β) is expressed specifically in clear cell adenocarcinoma (CCC). Thus, in the present study, we investigated the usefulness of HNF‐1β as an immunocytochemical diagnostic marker of CCC in ascitic specimens. We first confirmed that HNF‐1β expression levels were significantly higher in CCC than in non‐CCC (i.e. serous adenocarcinoma, mucinous adenocarcinoma and endometrioid adenocarcinoma) in 55 surgical specimens at both the mRNA (P < 0.05) and protein (P < 0.05) levels by real‐time polymerase chain reaction and immunohistochemistry, respectively. Immunocytochemistry of 60 cytological specimens showed significant positivity in CCC cases whereas all non‐CCC cells, except for three endometrioid adenocaricnoma cases, and mesothelial cells in the background stained negatively for anti‐HNF‐1β antibody (P < 0.05). The sensitivity and specificity were calculated to be 0.955 and 0.921, respectively. Immmunostaining patterns of HNF‐1β on cytological specimens were similar to those observed on histopathological ovarian specimens from the same patients. Double immunohistochemical staining using anti‐HNF‐1β antibody and HBME‐1, a mesothelium‐specific monoclonal antibody, confirmed that anti‐HNF‐1β antibody distinguished CCC cells and mesothelial cells. In conclusion, our findings indicate the specific expression of HNF‐1β in ovarian CCC and possible clinical applications of HNF‐1β immunocytochemical staining for the differential cytopathological diagnosis of CCC from non‐CCC, as well as from mesothelial cells using cytological specimens from ovarian carcinoma patients. (Cancer Sci 2007; 98: 387–391)
Technetium‐99m sestamibi scintigraphy is sensitive and specific for the staging and the follow‐up of patients with multiple myeloma: a multicentre study on 397 scans
Authors: Mele Anna , Offidani Massimo , Visani Giuseppe , Marconi Monica , Cambioli Filippo , Nonni Marco , Catarini Massimo , Brianzoni Ernesto , Berbellini Alfonso , Ascoli Giorgio , Brunori Marino , Agostini Vanessa , Corvatta Laura , Isidori Alessandro , Spinelli Aureliano , Gradari Marinella , Leoni Pietro 
Published: January 2007

SummaryWe evaluated the additional benefit of Technetium99‐sestamibi (99mTc‐MIBI) scanning in comparison with standard X‐ray techniques for multiple myeloma patients either at diagnosis or during follow‐up. Between February 2001 and January 2005, 397 whole body scans were acquired. On 229 scans performed at diagnosis, 146 (64%) were positive and 81 cases have discordant X‐ray results. The sensitivity of 99mTc‐MIBI and X‐ray were 77% and 45% respectively. As a result of 99mTc‐MIBI, 40% of asymptomatic myeloma patients were up‐staged. The positivity of 99mTc‐MIBI correlated significantly with all of the most relevant clinical and biological parameters. Multivariate analysis selected only high reactive C protein (P = 0·0005), bone marrow infiltration (P = 0·02) and bone pain (P = 0·002) as factors affecting 99mTc‐MIBI pattern. In 22 patients with solitary myeloma, 99mTc‐MIBI was positive in 86% of cases and detected more disease sites than X‐ray. Among 168 scans performed during follow‐up, 99mTc‐MIBI presented high specificity in patients showing a complete response (CR; 86%), and correlated with myeloma activity and with response to therapy. At multivariate analysis, a positive pattern correlated with bone marrow infiltration (P = 0·002) and disease status other than CR (P = 0·03). We conclude that 99mTc‐MIBI scanning is an additional diagnostic tool with a high specificity for the staging and the follow‐up of multiple myeloma patients.