Economic analysis of a transesophageal echocardiography-guided approach to cardioversion of patients with atrial fibrillation The ACUTE economic data at eight weeks

AbstractObjectivesThe aim of this study was to compare the relative cost of a transesophageal echocardiography (TEE)-guided strategy versus conventional strategy for patients with atrial fibrillation (AF) >2 days duration undergoing electrical cardioversion over an eight-week period.BackgroundThe Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) trial found no difference in embolic rates between the two approaches. However, the TEE-guided strategy had a shorter time to cardioversion and a lower rate of composite bleeding. While similar clinical efficacy was concluded, the relative cost of these two strategies has not been explored.MethodsTwo economic approaches were employed in the ACUTE trial. The first approach was based on hospital charge data from complete hospital Universal Billing Code of 1992 forms, a detailed hospital charge questionnaire, or imputation. Regression analysis was used to investigate the added cost of adverse events. The second economic approach involved the development of an independent analytic model simulating treatment and actual ACUTE outcome costs as a validation of clinically derived data. Sensitivity analysis was performed on the analytic model to investigate the potential range in cost differences between the strategies.ResultsA total of 833 of the 1,222 patients were enrolled from 53 U.S. sites; TEE-guided (n = 420) and conventional (n = 413). At eight-week follow-up, total mean costs did not significantly differ between the two groups, respectively ($6,508 vs.$6,239; difference of $269; p = 0.50). Cumulative costs were 24% higher in the conventional group, primarily due to increased incidence of bleeding and hospital costs associated with bleeding. A separate analytic model showed that treatment costs were higher for the TEE-guided strategy, but outcome costs were higher for the conventional strategy. Sensitivity analysis of the analytic model illustrated that varying the incidence and cost of major bleeding and the cost of TEE had the greatest impact on cost differences between the two groups.ConclusionsIn patients with AF >2 days duration undergoing electrical cardioversion, the TEE-guided group showed little difference in patient costs compared with the conventional group. The TEE strategy had higher initial treatment costs but lower outcome-associated costs. Cumulative costs were 24% higher in the conventional group, primarily due to bleeding. The TEE-guided strategy is an economically feasible approach compared with the conventional strategy

Using Wireless Power Meters to Measure Energy Use of Miscellaneous and Electronic Devices in Buildings

Miscellaneous and electronic devices consume about one-third of the primary energy used in U.S. buildings, and their energy use is increasing faster than other end-uses. Despite the success of policies, such as Energy Star, that promote more efficient miscellaneous and electronic products, much remains to be done to address the energy use of these devices if we are to achieve our energy and carbon reduction goals. Developing efficiency strategies for these products depends on better data about their actual usage, but very few studies have collected field data on the long-term energy used by a large sample of devices due to the difficulty and expense of collecting device-level energy data. This paper describes the development of an improved method for collecting device-level energy and power data using small, relatively inexpensive wireless power meters. These meters form a mesh network based on Internet standard protocols and can form networks of hundreds of metering points in a single building. Because the meters are relatively inexpensive and do not require manual data downloading, they can be left in the field for months or years to collect long time-series energy use data. In addition to the metering technology, we also describe a field protocol used to collect comprehensive, robust data on the miscellaneous and electronic devices in a building. The paper presents sample results from several case study buildings, in which all the plug-in devices for several homes were metered, and a representative sample of several hundred plug-in devices in a commercial office building were metered for several months

Translation Studies versus Comparative Literature?

Comparative literature is one of the main disciplines out of which translation studies emerged, so it is hardly surprising if at times the relationship between the two subjects has been marked by antagonism. Comparative literary scholars, in particular – perennially anxious about the status of comparative literature itself – have argued that their discipline has been subsumed and superseded by translation studies. Yet in recent decades the two subject areas have also been growing further apart, to the extent that Susan Bassnett, one of the key exponents of the antagonistic view, has modified her stance and argued instead for a rapprochement between the two under the heading of intercultural studies

A group randomized trial of a complexity-based organizational intervention to improve risk factors for diabetes complications in primary care settings: study protocol

<p>Abstract</p> <p>Background</p> <p>Most patients with type 2 diabetes have suboptimal control of their glucose, blood pressure (BP), and lipids – three risk factors for diabetes complications. Although the chronic care model (CCM) provides a roadmap for improving these outcomes, developing theoretically sound implementation strategies that will work across diverse primary care settings has been challenging. One explanation for this difficulty may be that most strategies do not account for the complex adaptive system (CAS) characteristics of the primary care setting. A CAS is comprised of individuals who can learn, interconnect, self-organize, and interact with their environment in a way that demonstrates non-linear dynamic behavior. One implementation strategy that may be used to leverage these properties is practice facilitation (PF). PF creates time for learning and reflection by members of the team in each clinic, improves their communication, and promotes an individualized approach to implement a strategy to improve patient outcomes.</p> <p>Specific objectives</p> <p>The specific objectives of this protocol are to: evaluate the effectiveness and sustainability of PF to improve risk factor control in patients with type 2 diabetes across a variety of primary care settings; assess the implementation of the CCM in response to the intervention; examine the relationship between communication within the practice team and the implementation of the CCM; and determine the cost of the intervention both from the perspective of the organization conducting the PF intervention and from the perspective of the primary care practice.</p> <p>Intervention</p> <p>The study will be a group randomized trial conducted in 40 primary care clinics. Data will be collected on all clinics, with 60 patients in each clinic, using a multi-method assessment process at baseline, 12, and 24 months. The intervention, PF, will consist of a series of practice improvement team meetings led by trained facilitators over 12 months. Primary hypotheses will be tested with 12-month outcome data. Sustainability of the intervention will be tested using 24 month data. Insights gained will be included in a delayed intervention conducted in control practices and evaluated in a pre-post design.</p> <p>Primary and secondary outcomes</p> <p>To test hypotheses, the unit of randomization will be the clinic. The unit of analysis will be the repeated measure of each risk factor for each patient, nested within the clinic. The repeated measure of glycosylated hemoglobin A1c will be the primary outcome, with BP and Low Density Lipoprotein (LDL) cholesterol as secondary outcomes. To study change in risk factor level, a hierarchical or random effect model will be used to account for the nesting of repeated measurement of risk factor within patients and patients within clinics.</p> <p>This protocol follows the CONSORT guidelines and is registered per ICMJE guidelines:</p> <p>Clinical Trial Registration Number</p> <p>NCT00482768</p

On Estimating the Effect of Taxation On Labor Supply: A Methodological and Empirical Comparison of Four Estimation Procedures

233 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1981.In the past few years there has been a resurgence of interest in the effects of a progressive tax on an individual's work effort. This resurgence has been in part a response to political efforts to reduce marginal tax rates and in part a response to advances in econometric techniques of estimating non-linear budget constraints. As a result there is a need to reexamine cross-sectional estimates of the male labor supply model, since additional estimates of the parameters of the male labor supply curve will provide a better understanding of an individual's labor supply response under a progressive tax scheme.A detailed review of the labor supply literature indicates that most previous researchers have inadequately modeled the piecewise-linear budget constraint that results from the progressive United States Federal tax scheme. Only recently have several articles appeared in the literature which suggest alternative methodologies for obtaining consistent estimates of the labor supply curve. Thus the major objective of this study is to provide a detailed methodological and empirical comparison of the more sophisticated econometric techniques. A second objective of this thesis is to compare the predicted labor supply responses to changes in the parameters of the labor supply model in order to determine what difference, if any, the alternative estimation procedures imply for evaluating policy measures.In general the results of the four estimation procedures can be summarized as follows. First the coefficient for the next wage rate was negative and significantly different from zero for all the estimation procedures. Secondly, the coefficient on the income variable was only negative and significantly different from zero in the Pellechio approach. As for predicting the labor supply response to changes in policy measures, all four approaches provided very similar responses in terms of magnitude. This resulted from the fact that the total wage rate, income, and compensated wage elasticities for the male labor supply curve were found to be nearly zero in all the estimation procedures.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD