pinecone/core-2020-05-10-deduplication huggingface dataset:
Measuring willingness-to-pay for risk reduction: an application of conjoint analysis

This study applies conjoint analysis (CA) to estimate the marginal willingness-to-pay (MWTP) of elderly individuals for a reduction of the risk of fracture of the femur. The good in question is a hypothetical hip protector which lowers the risk of a fracture by different amounts. Other attributes are ease of handling, wearing comfort, and out-of-pocket cost, which are traded off against risk reduction. In 500 face-to-face interviews, pensioners stated whether or not they would buy the product.\ud
Results suggest that MWTP for wearing comfort exceeds that for risk reduction. Indeed, willingness-to-pay for the product as a whole is negative, indicating that it should not be included as a mandatory benefit in health insurance
A Preliminary Investigation of The Effects of Restrictions on Medicaid Funding for Abortions on Female STD Rates

There is evidence in the economic literature that restrictions on Medicaid funding for abortion reduces the demand for abortion. The unresolved question is whether such restrictions also increase safe sex (that is, pregnancy avoidance) behavior among women. This study explores that issue using state-level gonorrhea rates among women for 1975-95. The rationale is that sexual behavior that leads to greater risk of accidental pregnancies is likely to be highly correlated with sexual behavior leading to greater risk of STD infection. Since gonorrhea has an incubation period of about a week, and is transmitted almost exclusively through sexual intercourse, a change in sexual behavior should soon be followed by a change in gonorrhea rates. The study used a partial adjustment model with lagged dependent variables estimated using Arellano-Bond’s GMM method. Results fail to find any statistically significant evidence that Medicaid funding restrictions are effective in reducing gonorrhea rates. This finding is robust to a variety of alternate specifications and tests. This suggests that restrictions on Medicaid funding for abortion fail to promote safe sex behavior among women.
Co-payments for prescription drugs and the demand for doctor visits - Evidence from a natural experiment

The German health care reform of 1997 provides a natural experiment for evaluating the price sensitivity of demand for physicians’ services. As a part of the reform, co-payments for prescription drugs were increased step up to 200%. However, certain groups of people were exempted from the increase, providing a natural control group against which the changed demand for physicians’ services of the treated, those subject to increased co-payments, can be assessed. The differences-in-differences estimates indicate that increased co-payments reduced the number of doctor visits by about 10% on an average
Health state values for the HUI 2 descriptive system: results from a UK survey

This paper reports the results of a study to estimate a statistical health state valuation model for a revised version of the Health Utilities Index Mark 2, using Standard Gamble health state preference data. A sample of 51 health states were valued by a sample of the 198 members of the UK general population. Models are estimated for predicting health state valuations for all 8,000 states defined by the revised HUI2.  The recommended model produces logical and significant coefficients for all levels of all dimensions in the HUI2. These coefficients appear to be robust across model specifications. This model performs well in predicting the observed health state values within the valuation sample and for a separate validation sample of health states. However, there are concerns over large prediction errors for two health states in the valuation sample. These problems must be balanced against concerns over the validity of using the VAS based health state valuation data of the original HUI2 valuation model.
Distinguishing Between Heterogeneity and Inefficiency: Stochastic Frontier Analysis of the World Health Organization’s Panel Data on National Health Care Systems

The most commonly used approaches to parametric (stochastic frontier) analysis of efficiency in panel data, notably the fixed and random effects models, fail to distinguish between cross individual heterogeneity and inefficiency. This blending of effects is particularly problematic in the World Health Organization’s (WHO) panel data set on health care delivery, which is a 191 country, five year panel. The wide variation in cultural and economic characteristics of the worldwide sample of countries produces a large amount of unmeasured heterogeneity in the data. Familiar approaches to inefficiency estimation mistakenly measure that heterogeneity as inefficiency. This study will examine a large number of recently developed alternative approaches to stochastic frontier analysis with panel data, and apply some of them to the WHO data. A more general, flexible model and several measured indicators of cross country heterogeneity are added to the analysis done by previous researchers. Results suggest that in these data, there is considerable evidence of heterogeneity that in other studies using the same data, has masqueraded as inefficiency. Our results differ substantially from those obtained by several earlier researchers
Surgical margins in head and neck cancer: A contemporary review

Adequate resection margins are critical to the treatment decisions and prognosis of patients with head and neck squamous cell carcinoma (HNSCC). However, there are numerous controversies regarding reporting and interpretation of the status of resection margins. Fundamental issues relating to the basic definition of margin adequacy, uniform reporting standards for margins, optimal method of specimen dissection, and the role of intraoperative frozen section evaluation, all require further clarification and standardization. Future horizons for margin surveillance offer the possible use of novel methods such as “molecular margins” and contact microscopic endoscopy, However, the limitations of these approaches need to be understood. The goal of this review was to evaluate these issues to define a more rational, standardized approach for achieving resection margin adequacy for patients with HNSCC undergoing curative resection. © 2012 Wiley Periodicals, Inc. Head Neck, 201
Infrahyoid fascio-myocutaneous flap as an alternative to free radial forearm flap in head and neck reconstruction.

The use of microvascular free flaps is currently the favored method for the reconstruction of defects after resection of head and neck cancer. The flap most commonly used for head and neck reconstruction is the free radial forearm flap, but the less popular infrahyoid flap represents a good alternative in selected cases. This flap has proven to be helpful in the reconstruction of a wide range of moderate-sized head and neck defects.We reviewed a series of 13 patients with defects resulting from cancer of the head and neck, who underwent infrahyoid flap reconstruction as an alternative to free radial forearm flap. The series includes 12 squamous cell carcinomas arising from the oral cavity and oropharynx, and 1 Merkel cell carcinoma of the submental skin. In the harvesting of the flap, the technical modifications recently suggested by Dolivet et al were used in all cases. Furthermore, another technical change has been introduced so creating a new infrahyoid facio-myocutaneous flap (IHFMCF). The surgical technique is described in detail.No total or partial flap necrosis was experienced. All reconstructions healed quickly without wound complications and with good functional results. The healing process in the donor site was excellent in every case with good aesthetic results.The IHFMCF is a versatile, reliable, and convenient flap suitable for repairing small and medium-sized defects of the oral cavity and oropharynx and obviates the need for a microvascular reconstruction
Submucosal purse-string suture as a treatment of leakage around the indwelling voice prosthesis

Abstract 

Background. 
Leakage around the indwelling voice prosthesis is an annoying complication of tracheoesophageal speech. 

Methods. 
Twenty patients, who experienced peripheral leakage of the tracheoesophageal fistula, were treated with a purse-string suture. Our aim was to get the patients free of leakage without losing their voice prosthesis. The technique was considered successful if this objective was reached and unsuccessful if eventually closure of the fistula was required. 

Results. 
Immediately after the procedure, no patients showed residual leakage. At 1 month, 2 patients experienced recurrent leakage. At a mean follow-up of 19.4 months, the method was successful in 16 patients and unsuccessful in 4 patients. 

Conclusions. 
If peripheral leakage is not amenable to simple downsizing of the indwelling voice prosthesis, we feel the purse-string suture is the first-choice treatment because of its safety, efficiency, low cost, and ease of application. © 2007 Wiley Periodicals, Inc. Head Neck, 2007status: publishe
Supracricoid partial laryngectomy as salvage surgery for radiation therapy failure.

The main concern in the treatment of laryngeal carcinomas is tumor control with preservation of laryngeal functions. We believe that salvage supracricoid partial laryngectomy (SPL) should be carefully considered in selected cases of radiotherapy failure, because it can offer the possibility of achieving adequate tumor control with preservation of laryngeal functions.A series of 31 patients who underwent an SPL as salvage procedure after radiotherapy failure was reviewed.Locoregional control rate was 75\%, with 60\% 5-year overall survival; no patients were lost to follow-up, and a death-from-disease rate of 19.35\% was recorded. Restoration of laryngeal functions was achieved in 89.29\% of the patients. No statistically significant differences were found in locoregional control regarding anterior commissure involvement, elective neck dissection versus wait-and-see policy, pathologic positive neck disease, and restage I-II versus restage III-IV.The oncologic and functional results indicate the consistency of salvage SPL, proposing this type of operation as a serious alternative to total laryngectomy in carefully selected cases
Three-dimensional photogrammetry for surgical planning of tissue expansion in hemifacial microsomia

Background: We aim to illustrate the applications of 3-dimensional (3-D) photogrammetry for surgical planning and longitudinal assessment of the volumetric changes in hemifacial microsomia. Methods. A 3-D photogrammetric system was employed for planning soft tissue expansion and transplantation of a vascularized scapular flap for a patient with hemifacial microsomia. The facial deficiency was calculated by superimposing a mirror of the normal side on the preoperative image. Postsurgical volumetric changes were monitored by serial superimposition of 3-D images. Results. A total of 31 cm3 of tissue expansion was achieved within a period of 4 weeks. A scapular free flap measuring 8 cm × 5 cm was transplanted to augment the facial deficiency. Postsurgical shrinkage of the flap was observed mainly in the first 3 months and it was minimal thereafter. Conclusion. 3-D photogrammetry can be used as a noninvasive objective tool for assessing facial deformity, planning, and postoperative follow-up of surgical correction of facial asymmetry. © 2009 Wiley Periodicals, Inc.postprin
Preoperative predictors of sternotomy need in mediastinal goiter management

BACKGROUND: The objective of this study was to identify the preoperative risk factors for patients in need of a sternotomy in the management of mediastinal goiters in order to provide better preoperative planning and patient consent.\ud
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METHODS: We analyzed 98 patients who underwent surgery for mediastinal goiters (goiters extending below the thoracic inlet > or =3 cm with the neck in hyperextension) between 1995 and 2008. Twelve (12.2%) of the patients required a sternotomy. The patients' features were analyzed by the surgical approach performed. Logistic regression analysis was used to study which variables were influencing the surgical strategy. The receiver operating characteristic (ROC) curves were designed when appropriate.\ud
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RESULTS: The analysis disclosed the following risk factors: radiologic extension of mediastinal goiters below the aortic arch (odds ratio [OR] = 32.87; 95% confidence interval [CI] = 4.04-267.12; p < .0001); posterior mediastinum involvement for mediastinal goiters with subaortic extension (OR = 7.2; 95% CI = 1.52-34.14; p = .0244); history of mediastinal goiters before surgery (for mediastinal goiters aged >160 months: OR = 22.8; 95% CI = 5.28-98.53; p < .0001).\ud
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CONCLUSIONS: Sternotomy need for mediastinal goiter removal can be predicted; in such cases surgeons should not hesitate to perform it for minimizing complications
Association between bisphosphonates and jaw osteonecrosis: a study in Wistar rats

BACKGROUND: This work aimed at determining whether bisphosphonate therapy produces a sufficient condition for jaw osteonecrosis after tooth extraction. METHODS: Rats were allocated into 3 groups: (1) 11 rats treated with alendronate, (2) 10 rats treated with zoledronic acid, and (3) 10 control rats. The animals were subjected to tooth extractions, and at the end of bisphosphonate therapy, they were humanely killed. Histologic sections of the surgical site were processed and analyzed. RESULTS: The zoledronic acid group showed higher incidences of osteonecrosis, inflammatory infiltrate, and microorganisms. There was no significant difference for epithelial or connective tissue, root fragments, vital bone, and positive staining for vascular endothelial growth factor (VEGF) among the groups. CONCLUSION: Zoledronic acid is associated with jaw osteonecrosis, whereas alendronate did not produce a condition sufficient for osteonecrosis after tooth extraction. Neither zoledronic acid nor alendronate was associated with a reduced immunohistochemical expression of VEGF in vital bone at the tooth extraction site
First report on the reliability and validity of speech handicap index in native English-speaking patients with head and neck cancer

Background\ud
Posttreatment speech problems are seen in nearly half of patients with head and neck cancer. Although there are many voice-specific scales, surprisingly there is no speech-specific questionnaire for English-speaking patients with head and neck cancer. The aim of this study was to validate the Speech Handicap Index (SHI) as the first speech-specific questionnaire in the English language.\ud
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Method\ud
In all, 55 consecutive patients in follow-up for oral and oropharyngeal cancer completed the SHI and University of Washington Quality of Life Questionnaire (UWQOL V.04). Thirty-two patients completed both questionnaires again 4 weeks later to address test-retest reliability.\ud
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Results\ud
Internal consistency, test-retest reliability, construct validity, and group validity of the SHI were found to be highly significant (p < .01) using Cronbach's alpha, Spearman's correlation coefficient (r), and Mann-Whitney U tests.\ud
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Conclusions\ud
The SHI is a precise, highly reliable, and valid speech assessment tool for patients with head and neck cancer. Further dedicated studies using the SHI in patients with head and neck cancer would be useful. © 2010 Wiley Periodicals, Inc. Head Neck, 201
Long-term follow-up of 44 patients with adenocarcinoma of the nasal cavity and sinuses primarily treated with endoscopic resection followed by radiotherapy

BACKGROUND: Endoscopic resection followed by radiotherapy as primary treatment for adenocarcinoma of the sinuses is emerging as an alternative to open resection. METHODS: A total of 44 patients primarily treated by an endoscopic approach followed by radiotherapy from 1992 to 2004 seen at our ENT-Department were analyzed for outcome and prognostic factors. RESULTS: Median follow-up was 61 months. Median follow-up of the patients alive at the end of the follow-up period was 100 months. For the 5-year follow-up, the overall survival, disease-specific survival, and recurrence-free survival were 63% (±7% SE), 82% (±6), and 60% (±8%), respectively. The overall survival, disease-specific survival, and recurrence-free survival after 100 months of follow-up were 53% (±8%), 72% (±9%), and 54% (±9%), respectively. Four factors significantly influenced the disease-specific survival. CONCLUSION: This study of a homogeneous cohort of patients with sinonasal adenocarcinoma treated by endoscopic resection and radiotherapy confirms that endoscopic resection is a valid alternative to open resection. © 2010 Wiley Periodicals, Inc. Head Neck, 2010.status: publishe
Limitations and complications of endoscopic surgery for treatment of sinonasal inverted papilloma: a re-assessment after 212 cases.

BACKGROUND: \ud
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The purpose of this study was to define the optimal surgical strategy for sinonasal inverted papilloma in relation to the site of origin and tumor extent.\ud
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METHODS: \ud
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Retrospective analysis of patients affected by inverted papilloma treated by purely endoscopic or combined approaches at the Department of Otorhinolaryngology of the University of Brescia and Pavia-Varese from November 1991 to December 2007.\ud
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RESULTS: \ud
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Two hundred twelve patients were considered eligible for this study. An exclusive endoscopic approach was performed in 198 patients (93.4%); the remaining 14 patients (6.6%) underwent an endoscopic approach combined with an osteoplastic frontal flap. Follow-up ranged from 24 to 192 months (mean, 53.8 months). A single recurrence was observed in 12 patients (5.7%). Twenty complications (9.4%) were observed.\ud
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CONCLUSION: \ud
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Endoscopic surgery is the first choice in the treatment of inverted papilloma; only lesions with extensive involvement of frontal sinus and/or supraorbital cell may require a combined approach. A minimum follow-up of 5 years is recommended
Current trends in initial management of hypopharyngeal cancer: The declining use of open surgery

Squamous cell carcinoma of the hypopharynx represents a distinct clinical entity. Most patients present with significant comorbidities and advanced‐stage disease. The overall survival is relatively poor because of high rates of regional and distant metastasis at presentation or early in the course of the disease. A multidisciplinary approach is crucial in the overall management of these patients to achieve the best results and maintain or improve functional results. Traditionally, operable hypopharyngeal cancer has been treated by total (occasionally partial) laryngectomy and partial or circumferential pharyngectomy, followed by reconstruction and postoperative radiotherapy in most cases.  Efforts to preserve speech and swallowing function in the surgical treatment of hypopharyngeal (and laryngeal) cancer have resulted in a declining use of total laryngopharyngectomy and improved reconstructive efforts, including microvascular free tissue transfer. There are many surgical, as well as nonsurgical, options available for organ and function preservation, which report equally effective tumor control and survival. The selection of appropriate treatment is of crucial importance in the achievement of optimal results for these patients. In this article, several aspects of surgical and nonsurgical approaches in the treatment of hypopharyngeal cancer are discussed. Future studies must be carefully designed within clearly defined populations and use uniform terminology and standardized functional assessment and declare appropriate patient or disease endpoints. These studies should focus on improvement of resultsx, without increasing patient morbidity. In this respect, technical improvements in radiotherapy such as intensity‐modulated radiotherapy, advances in supportive care, and incorporation of newer systemic agents such as targeted therapy, are relevant developments. © 2010 Wiley Periodicals, Inc. Head Neck, 201
Novel neoadjuvant immunotherapy regimen safety and survival in head and neck squamous cell cancer

Background  Cellular immune suppression is observed in head and neck squamous cell cancer (HNSCC) and contributes to poor prognosis. Restoration of immune homeostasis may require primary cell‐derived cytokines at physiologic doses. An immunotherapy regimen containing a biologic, with multiple‐active cytokine components, and administered with cytoxan, zinc, and indomethacin was developed to modulate cellular immunity.    Methods  Study methods were designed to determine the safety and efficacy of a 21‐day neoadjuvant immunotherapy regimen in a phase 2 trial that enrolled 27 therapy‐naïve patients with stage II to IVa HNSCC. Methods included safety, clinical and radiologic tumor response, disease‐free survival (DFS), overall survival (OS), and tumor lymphocytic infiltrate (LI) data collection.    Results  Acute toxicity was minimal. Patients completed neoadjuvant treatment without surgical delay. By independent radiographic review, 83% had stable disease during treatment. OS was 92%, 73%, and 69% at 12, 24, and 36 months, respectively. Histologic analysis suggested correlation between survival and tumor LI.    Conclusion  Immunotherapy regimen was tolerated. Survival results are encouraging. © 2011 Wiley Periodicals, Inc. Head Neck, 201
Frequency of cells expressing CD44, a Head and Neck cancer stem cell marker: Correlation with tumor aggressiveness

Background  We previously identified by flow cytometry a Lineage‐CD44+ (Lin‐CD44+) subpopulation of cells with cancer stem cell properties in head and neck squamous cell carcinoma (HNSCC). We now correlate clinical and histologic factors with Lin‐CD44+ cell frequency.    Methods  The study included 31 patients with HNSCC, of whom 87% had stage IV disease. The frequency of Lin‐CD44+ cells and the success of xenografting patient tumors in mice were correlated with clinical and pathologic data.    Results  The mean frequency of Lin‐CD44+ cells was 25% (0.4%–81%). It was 36% in patients who had recurrence versus 15% for those without recurrence ( p  = .04). Successful xenograft implantation occurred in 53%. Seventy‐five percent of patients with successful xenografts had recurrence versus 21% of patients with unsuccessful xenografts ( p  = .003).    Conclusions  Successful xenograft implantation and a high frequency of Lin‐CD44+ cells correlate with known poor prognostic factors such as advanced T classification and recurrence. These findings may support the stem cell concept in HNSCC. © 2011 Wiley Periodicals, Inc. Head Neck, 201
Sternocleidomastoid muscle flap in preventing Frey's syndrome after parotidectomy: A systematic review

Background  Parotidectomy is a common procedure and Frey's syndrome (gustatory sweating) is a common side effect. The current literature was assessed concerning the effectiveness of the sternocleidomastoid muscle (SCM) flap to prevent Frey's syndrome after parotidectomy.    Methods  A bibliography search was conducted for studies published between 1966 and 2010 and included randomized controlled trials (RCTs) or cohort studies with patients undergoing parotidectomy with facial nerve preservation. The outcome measures of particular interest were the incidence of Frey's syndrome and cosmetic impairment.    Results  In all, 12 studies were selected (1 meta‐analysis of all interventions to prevent Frey's syndrome, 2 RCTs, and 9 cohort studies). The trials were too heterogeneous to perform a meta‐analysis on the effect of the SCM flap. The results reported by the authors of each study suggest an objective decrease in Frey's syndrome when the SCM flap was used, but there was no difference in the patients' subjective reporting of symptoms. However, this conclusion is prone to the biases inherent in these studies, and thus overall it is impossible to make any recommendation.    Conclusion  Current reported evidence is inconclusive as to the use of SCM muscle flap as an intervention to prevent Frey's syndrome following parotid surgery. © 2011 Wiley Periodicals, Inc. Head Neck, 201