The clinical effectiveness and cost-effectiveness of ablative therapies in the management of liver metastases: systematic review and economic evaluation

Background: Many deaths from cancer are caused by metastatic burden. Prognosis and survival rates vary, but survival beyond 5 years of patients with untreated metastatic disease in the liver is rare. Treatment for liver metastases has largely been surgical resection, but this is feasible in only approximately 20–30% of people. Non-surgical alternatives to treat some liver metastases can include various forms of ablative therapies and other targeted treatments.Objectives: To evaluate the clinical effectiveness and cost-effectiveness of the different ablative and minimally invasive therapies for treating liver metastases.Data sources: Electronic databases including MEDLINE, EMBASE and The Cochrane Library were searched from 1990 to September 2011. Experts were consulted and bibliographies checked.Review methods: Systematic reviews of the literature were undertaken to appraise the clinical effectiveness and cost-effectiveness of ablative therapies and minimally invasive therapies used for people with liver metastases. Studies were any prospective study with sample size greater than 100 participants. A probabilistic model was developed for the economic evaluation of the technologies where data permitted.Results: The evidence assessing the clinical effectiveness and cost-effectiveness of ablative and other minimally invasive therapies was limited. Nine studies of ablative therapies were included in the review; each had methodological shortcomings and few had a comparator group. One randomised controlled trial (RCT) of microwave ablation versus surgical resection was identified and showed no improvement in outcomes compared with resection. In two prospective case series studies that investigated the use of laser ablation, mean survival ranged from 41 to 58 months. One cohort study compared radiofrequency ablation with surgical resection and five case series studies also investigated the use of radiofrequency ablation. Across these studies the median survival ranged from 44 to 52 months. Seven studies of minimally invasive therapies were included in the review. Two RCTs compared chemoembolisation with chemotherapy only. Overall survival was not compared between groups and methodological shortcomings mean that conclusions are difficult to make. Two case series studies of laser ablation following chemoembolisation were also included; however, these provide little evidence of the use of these technologies in combination. Three RCTs of radioembolisation were included. Significant improvements in tumour response and time to disease progression were demonstrated; however, benefits in terms of survival were equivocal. An exploratory survival model was developed using data from the review of clinical effectiveness. The model includes separate analyses of microwave ablation compared with surgery and radiofrequency ablation compared with surgery and one of radioembolisation in conjunction with hepatic artery chemotherapy compared with hepatic artery chemotherapy alone. Microwave ablation was associated with an incremental cost-effectiveness ratio (ICER) of £3664 per quality-adjusted life-year (QALY) gained, with microwave ablation being associated with reduced cost but also with poorer outcome than surgery. Radiofrequency ablation compared with surgical resection for solitary metastases < 3 cm was associated with an ICER of –£266,767 per QALY gained, indicating that radiofrequency ablation dominates surgical resection. Radiofrequency ablation compared with surgical resection for solitary metastases ? 3 cm resulted in poorer outcomes at lower costs and a resultant ICER of £2538 per QALY gained. Radioembolisation plus hepatic artery chemotherapy compared with hepatic artery chemotherapy was associated with an ICER of £37,303 per QALY gained.Conclusions: There is currently limited high-quality research evidence upon which to base any firm decisions regarding ablative therapies for liver metastases. Further trials should compare ablative therapies with surgery, in particular. A RCT would provide the most appropriate design for undertaking any further evaluation and should include a full economic evaluation, but the group to be randomised needs careful selection.Source of funding: Funding for this study was provided by the Health Technology Assessment programme of the National Institute for Health Research

A Multivariate Homogeneously Weighted Moving Average Control Chart

This paper presents a multivariate homogeneously weighted moving average (MHWMA) control chart for monitoring a process mean vector. The MHWMA control chart statistic gives a specific weight to the current observation, and the remaining weight is evenly distributed among the previous observations. We present the design procedure and compare the average run length (ARL) performance of the proposed chart with multivariate Chi-square, multivariate EWMA, and multivariate cumulative sum control charts. The ARL comparison indicates superior performance of the MHWMA chart over its competitors, particularly for the detection of small shifts in the process mean vector. Examples are also provided to show the application of the proposed chart. - 2013 IEEE.Scopu

Pitting damage levels estimation for planetary gear sets based on model simulation and grey relational analysis

The planetary gearbox is a critical mechanism in helicopter transmission systems. Tooth failures in planetary gear sets will cause great risk to helicopter operations. A gear pitting damage level estimation methodology has been devised in this paper by integrating a physical model for simulation signal generation, a three-step statistic algorithm for feature selection and damage level estimation for grey relational analysis. The proposed method was calibrated firstly with fault seeded test data and then validated with the data of other tests from a planetary gear set. The estimation results of test data coincide with the actual test records, showing the effectiveness and accuracy of the method in providing a novel way to model based methods and feature selection and weighting methods for more accurate health monitoring and condition prediction

Nonparametric monitoring of sunspot number observations: a case study

Solar activity is an important driver of long-term climate trends and must be accounted for in climate models. Unfortunately, direct measurements of this quantity over long periods do not exist. The only observation related to solar activity whose records reach back to the seventeenth century are sunspots. Surprisingly, determining the number of sunspots consistently over time has remained until today a challenging statistical problem. It arises from the need of consolidating data from multiple observing stations around the world in a context of low signal-to-noise ratios, non-stationarity, missing data, non-standard distributions and many kinds of errors. The data from some stations experience therefore severe and various deviations over time. In this paper, we propose the first systematic and thorough statistical approach for monitoring these complex and important series. It consists of three steps essential for successful treatment of the data: smoothing on multiple timescales, monitoring using block bootstrap calibrated CUSUM charts and classifying of out-of-control situations by support vector techniques. This approach allows us to detect a wide range of anomalies (such as sudden jumps or more progressive drifts), unseen in previous analyses. It helps us to identify the causes of major deviations, which are often observer or equipment related. Their detection and identification will contribute to improve future observations. Their elimination or correction in past data will lead to a more precise reconstruction of the world reference index for solar activity: the International Sunspot Number.Comment: 27 pages (without appendices), 6 figure

Quantile Function for Rayleigh and Scaled Half Logistic: Application in Missing Data

In this research paper quantile Functions for Scaled half logistic and Rayleigh distributions has been constructed. Data generated through the quantile Functions and then different limits for the full and missing data set have been developed with scale parameter. A number of such mean control limits could be constructed through purposed method but for analysis purpose few of them have discussed. The missing data limits broadened than the full data in each case, which was expected to be. The average run length (ARL) was also calculated for different sample sizes (50,100,150). The general decreasing behavior of ARL according to increasing shifts was observed that shows a worthy sign, for two distributions, as the probability of detecting an out of control signal increased due to decrease in ARL

МОНИТОРИНГ СТАБИЛЬНОСТИ ТЕХНОЛОГИЧЕСКОГО ПРОЦЕССА ИЗГОТОВЛЕНИЯ ЭЛЕКТРОИЗОЛЯЦИОННЫХ СИСТЕМ ТЯГОВЫХ ЭЛЕКТРИЧЕСКИХ МАШИН

Introduction. Electrical insulation systems make up about 0.03 % of the traction electric machines (TEM) mass, but they are of exceptional importance and affect the design capabilities and manufacturing techniques of electric machines, ultimately - on their specific weight and overall dimensions, on the reliability and durability of the TEM. Purpose. The monitoring of the stability of the manufacturing process of electrical insulating systems of the TEM based on the insulation resistance measurements. Methodology. The analysis of the manufacturing process is carried out for three versions of the case of insulation of the magnetic system of the DC traction electric motor. Practical value. Construction and analysis of special graphs (charts) of individual values and cumulative sums of insulation resistance, sliding range MR allow to find out whether the technological process of manufacturing electric insulating systems of traction electric machines is in a statistically controllable state.Показано, что сопротивление изоляции может служить информативным параметром стабильности технологического процесса изготовления электроизоляционных систем тяговых электрических машин. Установлено, что сопротивление изоляции находится в пределах ±3σ относительно среднего значения каждой выборки трех вариантов исполнения электроизоляционной системы. Представлены контрольные карты индивидуальных значений и кумулятивных сумм сопротивления изоляции магнитной системы тяговых электродвигателей постоянного тока

A Functional Data Analysis Approach for the Detection of Air Pollution Episodes and Outliers: A Case Study in Dublin, Ireland

Ground level concentrations of nitrogen oxide (NOx) can act as an indicator of air quality in the urban environment. In cities with relatively good air quality, and where NOx concentrations rarely exceed legal limits, adverse health effects on the population may still occur. Therefore, detecting small deviations in air quality and deriving methods of controlling air pollution are challenging. This study presents different data analytical methods which can be used to monitor and effectively evaluate policies or measures to reduce nitrogen oxide (NOx) emissions through the detection of pollution episodes and the removal of outliers. This method helps to identify the sources of pollution more effectively, and enhances the value of monitoring data and exceedances of limit values. It will detect outliers, changes and trend deviations in NO2 concentrations at ground level, and consists of four main steps: classical statistical description techniques, statistical process control techniques, functional analysis and a functional control process. To demonstrate the effectiveness of the outlier detection methodology proposed, it was applied to a complete one-year NO2 dataset for a sub-urban site in Dublin, Ireland in 2013. The findings demonstrate how the functional data approach improves the classical techniques for detecting outliers, and in addition, how this new methodology can facilitate a more thorough approach to defining effect air pollution control measures