244 research outputs found

    Recombinant Factor VIII versus plasma derived Factor VIII in the management of haemophilia A: an examination of the costs and consequences

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    The effect of cultural and environmental factors on potato seed tuber morphology and subsequent sprout and stem development

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    Seed crops of the variety Estima were grown in each of 2 years using two planting dates, two harvest dates, two plant densities and two irrigation regimes to produce seed tubers which had experienced different cultural and environmental conditions. The effects of these treatments on tuber characteristics, sprout production and stem development in the ware crop were then determined in subsequent experiments using storage regimes of 3 and 10 °C. Time of planting the seed crop affected numbers of eyes, sprouts and above ground stems in the subsequent ware crop because environmental conditions around the time of tuber initiation appeared to alter tuber shape. Cooler, wetter conditions in the 7 days after tuber initiation were associated with tubers which were longer, heavier and had more eyes, sprouts and above ground stems. In contrast, the time of harvesting the seed crop did not affect tuber shape or numbers of above ground stems and there was no interaction with tuber size. The density of the seed crop had no effect on any character measured and irrigation well after tuber initiation did not affect tuber shape, numbers of sprouts or numbers of stems. Seed production treatments, which resulted in earlier dormancy break, were associated with tubers that produced more sprouts and above ground stems, in contrast to the conventional understanding of apical dominance. Storage at 3 °C gave fewer sprouts, a lower proportion of eyes with sprouts and fewer stems than storage at 10 °C. The major effects on stem production appear to result from environmental conditions at the time of tuber initiation of the seed crop and sprouting temperature

    Searching for a threshold, not setting one: The role of the National Institute for Health and Clinical Excellence

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    There has been much speculation about whether the National Institute for Health and Clinical Excellence (NICE) has, or ought to have, a'threshold' figure for the cost of an additional quality-adjusted life-year above which a technology will not be recommended for use. We argue that it is not constitutionally appropriate for NICE to set such a threshold, which is properly the business of parliament. Instead, the task for NICE is as a 'threshold-searcher' - to seek to identify an optimal threshold incremental cost-effectiveness ratio, at the ruling rate of expenditure, that is consistent with the aim of the health service to maximize population health. This will involve the identification of technologies currently made available by the National Health Service that have incremental cost-effectiveness ratios above the threshold, and alternative uses for those resources in the shape of technologies not currently provided that fall below the threshol

    Effectiveness and cost-effectiveness of prognostic markers in prostate cancer

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    This paper demonstrates how economic modelling can be used to derive estimates of the cost-effectiveness of prognostic markers in the management of clinically localised and moderately graded prostate cancer. The model uses a Markov process and is populated using published evidence and local data. The robustness of the results has been tested using sensitivity analysis. Three treatment policies of 'monitoring' (observation), radical prostatectomy, or a selection-based management policy using DNA-ploidy as an experimental marker, have been evaluated. Modelling indicates that a policy of managing these tumours utilising experimental markers has an estimated cost per quality-adjusted life year (QALY) of pound 12 068. Sensitivity analysis shows the results to be relatively sensitive to quality-of-life variables. If novel and experimental markers can achieve specificity in excess of 80%, then a policy of radical surgery for those identified as being at high risk and conservative treatment for the remainder would be both better for patients and cost-effective. The analysis suggests that a radical prostatectomy treatment policy for the moderately graded tumours (Gleason grades -7) modelled in this paper may be inferior to a conservative approach in the absence of reliable prognostic markers, being both more costly and yielding fewer QALYs

    Pattern-based model-to-model transformation: Handling attribute conditions

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    The final publication is available at Springer via http://dx.doi.org/10.1007/978-3-642-02408-5_7Proceedings of Second International Conference, ICMT 2009, Zurich, Switzerland, June 29-30, 2009Pattern-based model-to-model transformation is a new approach for specifying transformations in a declarative, relational and formal style. The language relies on patterns describing allowed or forbidden relations between two models, which are compiled into operational mechanisms to perform forward and backward transformations. In this paper, we extend the approach for handling attribute conditions expressed in some suitable logic, adapt the operational mechanisms based on graph transformation to relax attribute handling by constraint solving, and discuss heuristics for the compilation of patterns into rules.Work supported by the Spanish Ministry of Science and Innovation, projects METEORIC (TIN2008-02081),MODUWEB (TIN2006-09678) and FORMALISM (TIN2007-66523).Moreover, part of this work was done during a sabbatical leave of the third author at TU Berlin, with financial support from the Ministerio de Ciencia e Innovaci´on (grant ref. PR2008-0185). We thank the referees for their useful comment
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