Analyzing differences in the costs of treatment across centers within economic evaluations

Objectives: Assessments of health technologies increasingly include economic evaluations conducted alongside clinical trials. One particular concern with economic evaluations conducted alongside clinical trials is the generalizability of results from one setting to another. Much of the focus relating to this topic has been on the generalizability of results between countries, However, the characteristics of clinical trial design require further consideration of the generalizability of cost data between centers within a single country, which could be important in decisions about adoption of the new technology. Methods: We used data from a multicenter clinical trial conducted in the United Kingdom to assess the degree of variation in costs between patients and between treatment centers and the determinants of the degree of such variation. Results: The variation between patients was statistically significant for both the experimental and conventional treatments. However, the degree of variation between centers was only statistically significant for the experimental treatment. Such variation appeared to be a result of hospital practice, such as pay ment mechanisms for staff and provision of hostel accommodation, rather than variations in physical resource use or substantive differences in cost structure. Conclusions: Multicenter economic evaluations are necessary for determining the variations in hospital practice and characteristics that can in turn determine the generalizability of study results to other settings. Such analyses can identify issues that may be important in adopting a new health technology. Analysis is required of similar large multicenter trials to confirm these conclusions

Pupal and Adult Parameters as Potential Indicators of Cottonwood Leaf Beetle (Coleoptera: Chrysomelidae) Fecundity and Longevity

Cottonwood leaf beetle, Chrysomela scripta, pupae from a laboratory colony were weighed and monitored through adult emergence, oviposition, and mortality to determine if correlations existed between various pupal or adult parameters and fecundity or longevity. Forty-three female cottonwood leaf beetles were monitored. Pupal weight was not a good indicator of fecundity, total oviposition events, number of eggs/beetle/day, or adult longevity. In addition, adult weight showed very low correlation with fecundity, adult longevity, total oviposition events, or number of eggs/beetle/day. However, adult weight was a marginal indicator of the number of eggs/beetle/day, and correlated well with adult body length. Adult longevity could be used to predict fecundity

Design of a high-gain laser diode-array pumped Nd:YAG Alternating Precessive Slab Amplifier (APS-Amplifier)

In the design of space qualifiable laser systems for ranging and altimetry, such as NASA's Geodynamic Laser Ranging System (GLRS), the transmitter must be kept small, powerful yet efficient, and must consist of as few components as possible. A novel preamplifier design is examined which requires no external beam steering optics, yielding a compact component with simple alignment procedures. The gains achieved are comparable to multipass zigzag amplifiers using two or more sets of external optics for extra passes through the amplifying medium

Designing economic evaluations to facilitate optimal decisions: The need to avoid bias

Editorial Lette

Effect of folic acid supplementation in pregnancy on preeclampsia: The folic acid clinical trial study

Copyright © 2013 Shi Wu Wen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Preeclampsia (PE) is hypertension with proteinuria that develops during pregnancy and affects at least 5% of pregnancies. The Effect of Folic Acid Supplementation in Pregnancy on Preeclampsia: the Folic Acid Clinical Trial (FACT) aims to recruit 3,656 high risk women to evaluate a new prevention strategy for PE: supplementation of folic acid throughout pregnancy. Pregnant women with increased risk of developing PE presenting to a trial participating center between 80/7 and 166/7 weeks of gestation are randomized in a 1: 1 ratio to folic acid 4.0 mg or placebo after written consent is obtained. Intent-to-treat population will be analyzed. The FACT study was funded by the Canadian Institutes of Health Research in 2009, and regulatory approval from Health Canada was obtained in 2010. A web-based randomization system and electronic data collection system provide the platform for participating centers to randomize their eligible participants and enter data in real time. To date we have twenty participating Canadian centers, of which eighteen are actively recruiting, and seven participating Australian centers, of which two are actively recruiting. Recruitment in Argentina, UK, Netherlands, Brazil, West Indies, and United States is expected to begin by the second or third quarter of 2013. This trial is registered with NCT01355159. © 2013 Shi Wu Wen et al.The Canadian Institutes of Healt

Injection seeded, diode pumped regenerative ring Nd:YAG amplifier for spaceborne laser ranging technology development

A small, all solid state, regenerative ring amplifier designed as a prototype for space application is discussed. Novel features include dual side pumping of the Nd:YAG crystal and a triangular ring cavity design which minimizes the number of optical components and losses. The amplifier is relatively small (3 ns round trip time) even though standard optical elements are employed. The ring regeneratively amplifies a 100 ps single pulse by approximately 10(exp 5) at a repetition rate of 10 to 100 Hz. The amplifier is designed to be injection seeded with a pulsed, 100 ps laser diode at 1.06 microns, but another Nd:YAG laser system supplying higher pulse energies was employed for laboratory experiment. This system is a prototype laser oscillator for the Geoscience Laser Ranging System (GLRS) platform. Results on measurements of beam quality, astigmatism, and gain are given

4-Pass Pumping of Nd+3:YAG Slabs

A solid-state, side pumping scheme, designed to enhance pump energy absorption, has been adapted for use in small, side-pumped, Nd+3:YAG zigzag lasers. This technique allows for pump radiation to make four complete passes through the gain medium, effectively doubling the absorption length of the usual 2-pass geometry. This produces higher inversion densities, higher gains, broader operating temperature bands and overall higher efficiencies. The improved performance has been demonstrated with a small Nd+3:YAG, mJ-class oscillator, and will aid in the development for space-based remote sensing laser transmitters for altimetry and mapping instruments

PRM93 Assesing parameter importance in health economics models. Can we make it faster?

Pla general del monument en commemoració de la visita del rei Alfons XIII i la reina Victòria Eugènia. Marbre blanc. Parc del Laberint d'Horta. 1908. Inaugurat 197

Real-world Gyroscope-based Gait Event Detection and Gait Feature Extraction

Falls in older adults are a major clinical problem often resulting in serious injury. The costly nature of clinic-based testing for the propensity of falling and a move towards homebased care and monitoring of older adults has led to research in wearable sensing technologies for identifying fall-related parameters from activities of daily living. This paper discusses the development of two algorithms for identifying periods of walking (gait events) and extracting characteristic patterns for each gait event (gait features) with a view to identifying the propensity to fall in older adults. In this paper, we present an evaluation of the algorithms involving a small real-world dataset collected from healthy adults in an uncontrolled environment. 92.5% of gait events were extracted from lower leg gyroscope data from 5 healthy adults (total duration of 33 hours) and over 95% of the gait characteristic points were identified in this data. A user interface to aid clinicians review gait features from walking events captured over multiple days is also proposed. The work presents initial steps in the development of a platform for monitoring patients within their daily routine in uncontrolled environments to inform clinical decision-making related to falls

Operation of EMEP ‘supersites’ in the United Kingdom. Annual report for 2008.

As part of its commitment to the UN-ECE Convention on Long-range Transboundary Air Pollution the United Kingdom operates two ‘supersites’ reporting data to the Co-operative Programme for Monitoring and Evaluation of the Long-range Transmission of Air Pollutants in Europe (EMEP). This report provides the annual summary for 2008, the second full calendar year of operation of the first EMEP ‘supersite’ to be established in the United Kingdom. Detailed operational reports have been submitted to Defra every 3 months, with unratified data. This annual report contains a summary of the ratified data for 2008. The EMEP ‘supersite’ is located in central southern Scotland at Auchencorth (3.2oW, 55.8oN), a remote rural moorland site ~20 km south-west of Edinburgh. Monitoring operations started formally on 1 June 2006. In addition to measurements made specifically under this contract, the Centre for Ecology & Hydrology also acts as local site operator for measurements made under other UK monitoring networks: the Automated Urban and Rural Network (AURN), the UK Eutrophication and Acidification Network (UKEAP), the UK Hydrocarbons Network, and the UK Heavy Metals Rural Network. Some measurements were also made under the auspices of the ‘Air Pollution Deposition Processes’ contract. All these associated networks are funded by Defra. This report summarises the measurements made between January and December 2008, and presents summary statistics on average concentrations. The site is dominated by winds from the south-west, but wind direction data highlight potential sources of airborne pollutants (power stations, conurbations). The average diurnal patterns of gases and particles are consistent with those expected for a remote rural site. The frequency distributions are presented for data where there was good data capture throughout the whole period. Some components (e.g. black carbon) show log-normal frequency distributions, while other components (e.g. ozone) have more nearly normal frequency distributions. A case study is presented for a period in June 2008, showing the influence of regional air pollutants at this remote rural site. All the data reported under the contract are shown graphically in the Appendix