Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost

Eflornithine is a cost-effective alternative to melarsoprol for the treatment of second-stage human West African trypanosomiasis in Caxito, Angola.

OBJECTIVE: To compare the cost-effectiveness of eflornithine and melarsoprol in the treatment of human African trypanosomiasis. METHOD: We used data from a Médecins Sans Frontières treatment project in Caxito, Angola to do a formal cost-effectiveness analysis, comparing the efficiency of an eflornithine-based approach with melarsoprol. Endpoints calculated were: cost per death avoided; incremental cost per additional life saved; cost per years of life lost (YLL) averted; incremental cost per YLL averted. Sensitivity analysis was done for all parameters for which uncertainty existed over the plausible range. We did an analysis with and without cost of trypanocidal drugs included. RESULTS: Effectiveness was 95.6% for melarsoprol and 98.7% for eflornithine. Cost/patient was 504.6 for melarsoprol and 552.3 for eflornithine, cost per life saved was 527.5 USD for melarsoprol and 559.8 USD for eflornithine without cost of trypanocidal drugs but it increases to 600.4 USD and 844.6 USD per patient saved and 627.6 USD and 856.1 USD per life saved when cost of trypanocidal drugs are included. Incremental cost-effectiveness ratio is 1596 USD per additional life saved and 58 USD per additional life year saved in the baseline scenario without cost of trypanocidal drugs but it increases to 8169 USD per additional life saved and 299 USD per additional life year saved if costs of trypanocidal drugs are included. CONCLUSION: Eflornithine saves more lives than melarsoprol, but melarsoprol is slightly more cost-effective. Switching from melarsoprol to eflornithine can be considered as a cost-effective option according to the WHO choice criteria

Plug-and-play Solvability of the Power Flow Equations for Interconnected DC Microgrids with Constant Power Loads

In this paper we study the DC power flow equations of a purely resistive DC power grid which consists of interconnected DC microgrids with constant-power loads. We present a condition on the power grid which guarantees the existence of a solution to the power flow equations. In addition, we present a condition for any microgrid in island mode which guarantees that the power grid remains feasible upon interconnection. These conditions provide a method to determine if a power grid remains feasible after the interconnection with a specific microgrid with constant-power loads. Although the presented condition are more conservative than existing conditions in the literature, its novelty lies in its plug-and-play property. That is, the condition gives a restriction on the to-be-connected microgrid, but does not impose more restrictions on the rest of the power grid.Comment: 8 pages, 2 figures, submitted to IEEE Conference on Decision and Control 201

Forward-Backward Asymmetry as a Discovery Tool for Z' Bosons at the LHC

The Forward-Backward Asymmetry (AFB) in Z' physics is commonly only perceived as the observable which possibly allows one to interpret a Z' signal by distinguishing different models of such (heavy) spin-1 bosons. In this paper, we examine the potential of AFB in setting bounds on or even discovering a Z' boson at the Large Hadron Collider (LHC) and show that it might be a powerful tool for this purpose. We analyse two different scenarios: Z' bosons with a narrow and wide width, respectively. We find that, in the first case, the significance of the AFB search can be comparable with that of the bump search usually adopted by the experimental collaborations; however, being a ratio of (differential) cross sections the AFB has the advantage of reducing systematical errors. In the second case, the AFB search can win over the bump search in terms of event shape, as the structure of the AFB distribution as a function of the invariant mass of the reconstructed Z'boson could nail down the new broad resonance much better than the event counting strategy usually adopted in such cases.Comment: 27 pages, 17 figure

A power consensus algorithm for DC microgrids

A novel power consensus algorithm for DC microgrids is proposed and analyzed. DC microgrids are networks composed of DC sources, loads, and interconnecting lines. They are represented by differential-algebraic equations connected over an undirected weighted graph that models the electrical circuit. A second graph represents the communication network over which the source nodes exchange information about the instantaneous powers, which is used to adjust the injected current accordingly. This give rise to a nonlinear consensus-like system of differential-algebraic equations that is analyzed via Lyapunov functions inspired by the physics of the system. We establish convergence to the set of equilibria consisting of weighted consensus power vectors as well as preservation of the weighted geometric mean of the source voltages. The results apply to networks with constant impedance, constant current and constant power loads.Comment: Abridged version submitted to the 20th IFAC World Congress, Toulouse, Franc

Informing investment to reduce inequalities: a modelling approach

Background: Reducing health inequalities is an important policy objective but there is limited quantitative information about the impact of specific interventions. Objectives: To provide estimates of the impact of a range of interventions on health and health inequalities. Materials and methods: Literature reviews were conducted to identify the best evidence linking interventions to mortality and hospital admissions. We examined interventions across the determinants of health: a ‘living wage’; changes to benefits, taxation and employment; active travel; tobacco taxation; smoking cessation, alcohol brief interventions, and weight management services. A model was developed to estimate mortality and years of life lost (YLL) in intervention and comparison populations over a 20-year time period following interventions delivered only in the first year. We estimated changes in inequalities using the relative index of inequality (RII). Results: Introduction of a ‘living wage’ generated the largest beneficial health impact, with modest reductions in health inequalities. Benefits increases had modest positive impacts on health and health inequalities. Income tax increases had negative impacts on population health but reduced inequalities, while council tax increases worsened both health and health inequalities. Active travel increases had minimally positive effects on population health but widened health inequalities. Increases in employment reduced inequalities only when targeted to the most deprived groups. Tobacco taxation had modestly positive impacts on health but little impact on health inequalities. Alcohol brief interventions had modestly positive impacts on health and health inequalities only when strongly socially targeted, while smoking cessation and weight-reduction programmes had minimal impacts on health and health inequalities even when socially targeted. Conclusions: Interventions have markedly different effects on mortality, hospitalisations and inequalities. The most effective (and likely cost-effective) interventions for reducing inequalities were regulatory and tax options. Interventions focused on individual agency were much less likely to impact on inequalities, even when targeted at the most deprived communities