Health economics of targeted intraoperative radiotherapy (TARGIT-IORT) for early breast cancer: a cost-effectiveness analysis in the United Kingdom

Objective: The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks’ course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation. Setting TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy. Methods: Cost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer’s perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed. Main outcome measures: Quality-adjusted life-years (QALYs). Results: In the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGITIORT and EBRT costs for the time horizon of 10 years were £12 455 and £13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity analyses. Conclusions: TARGIT-IORT is a dominant strategy over EBRT, being less costly and producing higher QALY gain

Deviation from the Fourier law in room-temperature heat pulse experiments

We report heat pulse experiments at room temperature that cannot be described by Fourier's law. The experimental data is modelled properly by the Guyer--Krumhansl equation, in its over-diffusion regime. The phenomenon is due to conduction channels with differing conductivities, and parallel to the direction of the heat flux.Comment: 9 pages, 4 figure

Sexual dysfunction in women with PCOS:a case control study

STUDY QUESTIONWhat is the relationship of sex steroid levels with sexual function in women with and without polycystic ovary syndrome (PCOS)?SUMMARY ANSWERWomen with PCOS reported more sexual dysfunction and more sexual distress compared to those without PCOS, but only few and weak associations between androgen levels and sexual function were observed.WHAT IS KNOWN ALREADYThe literature shows that women with PCOS report lower levels of sexual function and sexual satisfactionand more sexual distress. Contributing factors seem to be obesity, alopecia, hirsutism, acne, infertility, anxiety, depression, and low self-esteem. In women with PCOS clinical and/or biochemical hyperandrogenism is common; its relationship with sexualfunction is, however, inconclusive.STUDY DESIGN, SIZE, DURATIONThis observational prospective case control study with 135 women (68 PCOS, 67 control) was conductedfrom March 2017 until March 2020.PARTICIPANTS/MATERIALS, SETTING, METHODSHeterosexual women with and without PCOS, aged 18–40 years, in a steady relationshipand without any comorbidities, underwent an extensive medical and endocrine screening using liquid chromatography-tandem mass spectrometry and validated sexual function questionnaires.MAIN RESULTS AND THE ROLE OF CHANCEWomen with PCOS reported significantly lower sexual function (Female Sexual Function Index (FSFI) P < 0.001, partial η2 = 0.104), higher levels of sexual distress (Female Sexual Distress Scale-Revised P < 0.001, partial η2 = 0.090), and they more often complied with the definition of sexual dysfunction (41.2% vs 11.9%, P < 0.001, Phi V = 0.331) and clinical sexual distress (51.5% vs 19.4%, P < 0.001, Phi V = 0.335). Regression analysis adjusted for confounders showed only few and weak associations between androgen levels and sexual function, with each model explaining a maximum of 15% sexual function. Following significant Group × Hormone interactions, analyses for both groups separately showed no significant associations in the PCOS group. The control group showed only weak negative associations between testosterone and FSFI pain (β = −6.022, P = 0.044, Adj R2 = 0.050), between FAI and FSFI orgasm (β = −3.360, P = 0.023, Adj R2 = 0.049) and between androstenedione and clinical sexual distress (β = −7.293, P = 0.036, exp(β) = 0.001).LIMITATIONS, REASONS FOR CAUTIONThe focus of the study on sexual functioning potentially creates selection bias. Possibly women with more severe sexual disturbances did or did not choose to participate. Differences between women with PCOS and controls in relationship duration and hormonal contraceptive use might have skewed the sexual function outcomes.WIDER IMPLICATIONS OF THE FINDINGSSexual function is impaired in women with PCOS. However, endocrine perturbations seem to have minimal direct impact on sexual function. Addressing sexuality and offering psychosexual counseling is important in the clinical care for women with PCOS

On redundant topological constraints

© 2015 Elsevier B.V. All rights reserved. Redundancy checking is an important task in the research of knowledge representation and reasoning. In this paper, we consider redundant qualitative constraints. For a set Γ of qualitative constraints, we say a constraint (xRy) in Γ is redundant if it is entailed by the rest of Γ. A prime subnetwork of Γ is a subset of Γ which contains no redundant constraints and has the same solution set as Γ. It is natural to ask how to compute such a prime subnetwork, and when it is unique. We show that this problem is in general intractable, but becomes tractable if Γ is over a tractable subalgebra S of a qualitative calculus. Furthermore, if S is a subalgebra of the Region Connection Calculus RCC8 in which weak composition distributes over nonempty intersections, then Γ has a unique prime subnetwork, which can be obtained in cubic time by removing all redundant constraints simultaneously from Γ. As a by-product, we show that any path-consistent network over such a distributive subalgebra is minimal and globally consistent in a qualitative sense. A thorough empirical analysis of the prime subnetwork upon real geographical data sets demonstrates the approach is able to identify significantly more redundant constraints than previously proposed algorithms, especially in constraint networks with larger proportions of partial overlap relations

Comparative vessel traits of Macaranga gigantea and Vatica dulitensis from Malaysian Borneo

Trade-offs in wood anatomical characteristics reflect different strategies used by trees to deal with water transport in response to variation in environmental conditions. To study vascular strategies for Bornean rainforest trees, we compared water transport-related anatomical characteristics in branch wood between the common tree species Vatica dulitensis (Dipterocarpaceae) from old-growth forest and the common pioneer tree species Macaranga gigantea (Euphorbiaceae) from selectively logged forest. We hypothesised that the vessel traits of the pioneer species would reflect the need to capture and transport resources to support its fast growth rate (resource-acquisitive strategy), while the species of the old-growth forest would display more conservative vessel traits (resource-conservative strategy). We found that M. gigantea had significantly greater vessel area, hydraulically weighted diameter, vessel area to number ratio, and potential hydraulic conductivity than V. dulitensis. These results suggest that vessel traits of the common old-growth species would ensure high hydraulic safety during occasional drought when soil moisture is limited, while the common species of selectively logged forest possesses an efficient water transport system but its vessels would confer lower hydraulic safety during drought conditions. These contrasting vascular strategies highlight the potential for divergent responses of species of Bornean forest trees to future climatic extremes

Au/Zn Contacts to rho-InP: Electrical and Metallurgical Characteristics and the Relationship Between Them

The metallurgical and electrical behavior of Au/Zn contacting metallization on p-type InP was investigated as a function of the Zn content in the metallization. It was found that ohmic behavior can be achieved with Zn concentrations as small as 0.05 atomic percent Zn. For Zn concentrations between 0.1 and 36 at. percent, the contact resistivity rho(sub c) was found to be independent of the Zn content. For low Zn concentrations the realization of ohmic behavior was found to require the growth of the compound Au2P3 at the metal-InP interface. The magnitude of rho(sub c) is shown to be very sensitive to the growth rate of the interfacial Au2P3 layer. The possibility of exploiting this sensitivity to provide low resistance contacts while avoiding the semiconductor structural damage that is normally attendant to contact formation is discussed

The BIM2LCA approach: An industry foundation classes (IFC)-based interface to integrate life cycle assessment in integral planning

An increasing degree of digitalization in construction planning offers significant potential for building life cycle assessment (LCA) to reduce access barriers, as well as the assessment effort itself. To realize the widespread application of LCA tools and their potential to effectively minimize life cycle impacts, an open approach is required that allows for flexible application of comprehensive LCA studies and early integration in planning processes. The authors present an approach for LCA integration in all phases of digital planning which aims at a DGNB (Deutsche Gesellschaft für nachhaltiges Bauen) certification based on the open Building Information Modeling (BIM) standard Industry Foundation Classes (IFC). The approach takes into account varying levels of development and resulting data availability during integral planning phases, as well as resulting LCA application contexts. It goes beyond existing strategies and allows one to consider both BIM and LCA software through a workflow based on a single data format. The assessment framework is operationalized through standardized interface development and technical realization following the information delivery manual (IDM) process standardized for IFC interfaces. The Extensible Markup Language (XML) schema, as a specific implementation for certification, provides the target system for LCA data requirements and is generalized to a planning phase specific IDM base table. The technical realization based on respective model view definitions and distributed data suggests a pathway to the standardization of LCA-IFC integration based on an open approach. The overall approach exemplarily applies to the “LERNZENTRUM” at the Karlsruhe Institute of Technology (KIT) campus. We conclude that an open BIM approach for LCA integration in model-based planning is feasible, but requires several adjustments in IFC, LCA, and planning practice. Adding a lifecycle element to the IFC to connect BIM and LCA provides comprehensive feedback for informed decision making based on environmental impact

Discussing sexual health in spinal care

Abstract BACKGROUND: The possible detrimental effects of spinal disease on sexual health are widely recognized; however, it is not known to what extent neurosurgeons discuss this topic with their patients. The aim of this study is to identify knowledge, attitude and practice patterns of neurosurgeons counseling their patients about sexual health. METHODS: All members of the Dutch Association of Neurosurgery (neurosurgeons and residents) were sent a questionnaire addressing their attitudes, knowledge and practice patterns regarding discussing sexual health. RESULTS: Response rate was 62 % with 89 questionnaires suitable for analysis. The majority of participants (83 %) were male; mean age, 42.4 years. The mean experience in neurosurgical practice was 9 years. Respondents assumed that in 34 % of their patients, sexual health was affected due to spinal disease. The majority of respondents (64 %) stated that responsibility for discussing sexual health lies (partly) with the neurosurgeon; however, 73 % indicated to (almost) never do this. The main reasons for not discussing sexual health were patients' old age (42 %), lack of knowledge (38 %) and lack of patients' initiative to bring up the subject (36 %). Twenty-six percent indicated lack of time as a reason. There was no evidence for gender or doctor's age discordance as important barriers. Fifty percent of participants wished to gain more knowledge on discussing sexual health with patients. CONCLUSION: This study shows that despite high prevalence of sexual dysfunction (SD) in spinal patients, counseling about sexual health is not often done in neurosurgical care. More training on sexual health counseling early in the residency program seems critical. By initiating the discussion, clinicians who deal with spinal patients have the potential to detect sexual dysfunction (SD) and to refer adequately when necessary, thereby improving overall quality of life of their patients. KEYWORDS: Cauda equina syndrome; Counseling; Patient care; Sexual dysfunction; Spinal cord injury GynecologyCervix cance