Levonorgestrel-releasing intrauterine system vs. usual medical treatment for menorrhagia: An economic evaluation alongside a randomised controlled trial

Objective: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device ('LNG-IUS') and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life. Methods: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov) model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY) estimated using both EQ-5D and SF-6D. Results: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100) and generated 0.002 more QALYs. Conclusion: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most costeffective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial. Copyright: © 2014 Sanghera et al

Predicting Remaining Useful Life with Similarity-Based Priors

Prognostics is the area of research that is concerned with predicting the remaining useful life of machines and machine parts. The remaining useful life is the time during which a machine or part can be used, before it must be replaced or repaired. To create accurate predictions, predictive techniques must take external data into account on the operating conditions of the part and events that occurred during its lifetime. However, such data is often not available. Similarity-based techniques can help in such cases. They are based on the hypothesis that if a curve developed similarly to other curves up to a point, it will probably continue to do so. This paper presents a novel technique for similarity-based remaining useful life prediction. In particular, it combines Bayesian updating with priors that are based on similarity estimation. The paper shows that this technique outperforms other techniques on long-term predictions by a large margin, although other techniques still perform better on short-term predictions.</p

A kinematic analysis of a haptic handheld stylus in a virtual environment: a study in healthy subjects

<p>Abstract</p> <p>Background</p> <p>Virtual Reality provides new options for conducting motor assessment and training within computer-generated 3 dimensional environments. To date very little has been reported about normal performance in virtual environments. The objective of this study was to evaluate the test-retest reliability of a clinical procedure measuring trajectories with a haptic handheld stylus in a virtual environment and to establish normative data in healthy subjects using this haptic device.</p> <p>Methods</p> <p>Fifty-eight normal subjects; aged from 20 to 69, performed 3 dimensional hand movements in a virtual environment using a haptic device on three occasions within one week. Test-retest stability and standardized normative data were obtained for all subjects.</p> <p>Results</p> <p>No difference was found between test and retest. The limits of agreement revealed that changes in an individual's performance could not be detected. There was a training effect between the first test occasion and the third test occasion. Normative data are presented.</p> <p>Conclusion</p> <p>A new test was developed for recording the kinematics of the handheld haptic stylus in a virtual environment. The normative data will be used for purposes of comparison in future assessments, such as before and after training of persons with neurological deficits.</p

Clinically Relevant Characterization of Lung Adenocarcinoma Subtypes Based on Cellular Pathways: An International Validation Study

Lung adenocarcinoma (AD) represents a predominant type of lung cancer demonstrating significant morphologic and molecular heterogeneity. We sought to understand this heterogeneity by utilizing gene expression analyses of 432 AD samples and examining associations between 27 known cancer-related pathways and the AD subtype, clinical characteristics and patient survival. Unsupervised clustering of AD and gene expression enrichment analysis reveals that cell proliferation is the most important pathway separating tumors into subgroups. Further, AD with increased cell proliferation demonstrate significantly poorer outcome and an increased solid AD subtype component. Additionally, we find that tumors with any solid component have decreased survival as compared to tumors without a solid component. These results lead to the potential to use a relatively simple pathological examination of a tumor in order to determine its aggressiveness and the patient's prognosis. Additional results suggest the ability to use a similar approach to determine a patient's sensitivity to targeted treatment. We then demonstrated the consistency of these findings using two independent AD cohorts from Asia (N = 87) and Europe (N = 89) using the identical analytic procedures

Predictors for neonatal death in the rural areas of Shaanxi Province of Northwestern China: a cross-sectional study

Background Almost all (99%) neonatal deaths arise in low-income and middle-income countries. Approximately 450 new-born children die every hour, which is mainly from preventable causes. There has been increased recognition of the need for these countries to implement public health interventions that specifically target neonatal deaths. The purpose of this paper is to identify the predictors of neonatal death in Type 4 rural (poorest) counties in Shaanxi Province of northwestern China. Methods A cross-sectional study was conducted in Shaanxi Province, China. A single-stage survey design was identified to estimate standard errors. Because of concern about the complex sample design, the data were analysed using multivariate logistic regression analysis. Socioeconomic and maternal health service utilization factors were added into the model. Results During the study period, a total of 4750 women who delivered in the past three years were randomly selected for interview in the five counties. There were 4880 live births and 54 neonatal deaths identified. In the multiple logistic regression, the odds of neonatal death was significantly higher for multiparous women (OR = 2.77; 95% CI: 1.34, 5.70) and women who did not receive antennal health care in the first trimester of pregnancy (OR = 2.49; 95% CI: 1.41, 4.40). Women who gave birth in a county-level hospital (OR = 0.18; 95% CI: 0.04, 0.86) and had junior high school or higher education level (OR = 0.20; 95% CI: 0.05, 0.84) were significantly protected from neonatal death. Conclusions Public health interventions directed at reducing neonatal death should address the socioeconomic factors and maternal health service utilization, which significantly influence neonatal mortality in rural China. Multipara, low educational level of the women, availability of prenatal visits in the first trimester of pregnancy and hospital delivery should be considered when planning the interventions to reduce the neonatal mortality in rural areas

Abundance, movements and biodiversity of flying predatory insects in crop and non-crop agroecosystems

[EN] Predatory insects are key natural enemies that can highly reduce crops pest damage. However, there is a lack of knowledge about the movements of flying predatory insects in agroecosystems throughout the year. In particular, it is still unclear how these predators move from crop to non-crop habitats, which are the preferred habitats to overwinter and to spread during the spring and if these predators leave or stay after chemical treatments. Here, the Neuroptera, a generalist, highly mobile, flying predator order of insects, was selected as model. We studied the effects of farming management and the efficiency of edge shelterbelts, ground cover vegetation, and fruit trees canopy on holding flying predatory insects in Mediterranean traditional agroecosystems. Seasonal movements and winter effects were also assessed. We evaluated monthly nine fruit agroecosystems, six organic, and three pesticides sprayed, of 0.5-1 ha in eastern Spain during 3 years using two complementary methods, yellow sticky traps and aspirator. Results show surprisingly that the insect abundance was highest in pesticide sprayed systems, with 3.40 insects/sample versus 2.32 insects/sample in organic systems. The biodiversity indices were highest in agroecosystems conducted under organic management, with S of 4.68 and D of 2.34. Shelterbelts showed highest biodiversity indices, S of 3.27 and D of 1.93, among insect habitats. Insect species whose adults were active during the winter preferred fruit trees to spend all year round. However, numerous species moved from fruit trees to shelterbelts to overwinter and dispersed into the orchard during the following spring. The ground cover vegetation showed statistically much lower attractiveness for flying predatory insects than other habitats. Shelterbelts should therefore be the first option in terms of investment in ecological infrastructures enhancing flying predators.Sorribas Mellado, JJ.; González Cavero, S.; Domínguez Gento, A.; Vercher Aznar, R. (2016). Abundance, movements and biodiversity of flying predatory insects in crop and non-crop agroecosystems. Agronomy for Sustainable Development. 36(2). doi:10.1007/s13593-016-0360-3S362Altieri MA, Letourneau DK (1982) Vegetation management and biological control in agroecosystems. Crop Prot 1:405–430. doi: 10.1016/0261-2194(82)90023-0Altieri MA, Schmidt LL (1986) The dynamics of colonizing arthropod communities at the interface of abandoned, organic and commercial apple orchards and adjacent woodland habitats. Agric Ecosyst Environ 16:29–43. doi: 10.1016/0167-8809(86)90073-3Bengtsson J, Ahnström J, Weibull A (2005) The effects of organic agriculture on biodiversity and abundance: a meta-analysis. J App Ecol 42:261–269. doi: 10.1111/j.1365-2664.2005.01005.xBianchi F, Booij CJH, Tscharntke T (2006) Sustainable pest regulation in agricultural landscapes: a review on landscape composition, biodiversity and natural pest control. Proc R Soc B 273:1715–1727. doi: 10.1098/rspb.2006.3530Chaplin-Kramer RM, Rourke E, Blitzer EJ, Kremen C (2011) A meta-analysis of crop pest and natural enemy response to landscape complexity. Ecol Lett 14:922–932. doi: 10.1111/j.1461-0248.2011.01642.xCrowder DW, Northfield TD, Strand MR, Snyder WE (2010) Organic agriculture promotes evenness and natural pest control. Nature 466:109–112. doi: 10.1038/nature09183Dogramaci M, DeBano SJ, Kimoto C, Wooster DE (2011) A backpack-mounted suction apparatus for collecting arthropods from various habitats and vegetation. Entomol Exp et Appl 139:86–90. doi: 10.1111/j.1570-7458.2011.01099.xDuelli P, Studer M, Marchland I, Jakob S (1990) Population movements of arthropods between natural and cultivated areas. Biol Conserv 54:193–207. doi: 10.1016/0006-3207(90)90051-PEilenberg J, Hajek A, Lomer C (2001) Suggestions for unifying the terminology in biological control. BioControl 46:387–400. doi: 10.1023/A:1014193329979Forman RTT, Baudry J (1984) Hedgerows and hedgerow networks in landscape ecology. Environ Manage 8:495–510. doi: 10.1007/BF01871575Gurr GM, Wratten SD, Luna JM (2003) Multi-function agricultural biodiversity: pest management and other benefits. Basic Appl Ecol 4:107–116. doi: 10.1078/1439-1791-00122Hole DG, Perkins AJ et al (2005) Does organic farming benefit biodiversity? Biol Conserv 122:113–130. doi: 10.1016/j.biocon.2004.07.018Landis DA, Wratten SD, Gurr GM (2000) Habitat management to conserve natural enemies of arthropod pests in agriculture. Annu Rev Entomol 45:175–201. doi: 10.1146/annurev.ento.45.1.175Long RF, Corbett A, Lamb C, Reberg-Horton C, Chandler J, Stimmann M (1998) Beneficial insects move from flowering plants to nearby crops. Calif Agr 52:23–26. doi: 10.3733/ca.v052n05p23Östman Ö, Ekbom B, Bengtsson J (2001) Landscape heterogeneity and farming practice influence biological control. Basic App Ecol 2:365–371. doi: 10.1078/1439-1791-00072Pantaleoni RA, Ticchiati V (1988) I Neurotteri delle colture agrarie: osservazioni sulle fluttuazioni stagionali di populazione in frutteti. Boll dell’Ist di Entomol 43:43–57Panzer R, Schwartz MW (1998) Effectiveness of a vegetation-based approach to insect conservation. Conserv Biol 12:693–702. doi: 10.1111/j.1523-1739.1998.97051.xParedes D, Cayuela L, Gurr G, Campos M (2013) Effect of non-crop vegetation types on conservation biological control of pests in olive groves. PeerJ 1:1–16. doi: 10.7717/peerj.116Pekar S, Michalko R, Loverre P, Líznarová E, Cernecká L (2015) Biological control in winter: novel evidence for the importance of generalist predators. J Appl Ecol 52:270–279. doi: 10.1111/1365-2664.12363Pollard KA, Holland JM (2006) Arthropods within the woody element of hedgerows and their distribution pattern. Agric Forest Entomol 8:203–211. doi: 10.1111/j.1461-9563.2006.00297.xRand TA, Tylianakis JM, Tscharntke T (2006) Spillover edge effects: the dispersal of agriculturally subsidized insect natural enemies into adjacent natural habitats. Ecol Lett 9:603–614. doi: 10.1111/j.1461-0248.2006.00911.xSilva EB, Franco JC, Vasconcelos T, Branco M (2010) Effect of ground cover vegetation on the abundance and diversity of beneficial arthropods in citrus orchards. Bull Entomol Res 100:489–499. doi: 10.1017/S0007485309990526Smukler SM, Sánchez-Moreno S et al (2010) Biodiversity and multiple ecosystem functions in an organic farmscape. Agric Ecosyst Environ 139:80–97. doi: 10.1016/j.agee.2010.07.004Stelzl M, Devetak D (1999) Neuroptera in agricultural ecosystems. Agric Ecosyst Environ 74:305–321. doi: 10.1016/S0167-8809(99)00040-7Straub CS, Finke DL, Snyder WE (2008) Are the conservation of natural enemy biodiversity and biological control compatible goals? Biol Control 45:225–237. doi: 10.1016/j.biocontrol.2007.05.013Thierry D, Deutsch B, Paulian M, Villenave J, Canard M (2005) Typifying ecosystems by using green lacewing assemblages. Agron Sustain Dev 25:473–479. doi: 10.1051/agro:2005047Thomas CFG, Parkinson L, Griffiths GJK, García AF, Marshall EJP (2001) Aggregation and temporal stability of carabid beetle distributions in field and hedgerow habitats. J App Ecol 38:100–116. doi: 10.1046/j.1365-2664.2001.00574.xVillenave J, Thierry D, Mamun A, Lode T, Rat-Morris E (2005) The pollens consumed by common green lacewings Chrysoperla spp. in cabbage crop environment in western France. Eur J Entomol 02:547–552, 10.14411/eje.2005.078You M, Hou Y, Liu Y, Yang G, Li Z, Cai H (2004) Non-crop habitat manipulation and integrated pest management in agroecosystems. Acta Entomol Sinica 47:260–268 (http://www.insect.org.cn/EN/Y2004/V47/I2/260

Gene-Expression Signature Predicts Postoperative Recurrence in Stage I Non-Small Cell Lung Cancer Patients

About 30% stage I non-small cell lung cancer (NSCLC) patients undergoing resection will recur. Robust prognostic markers are required to better manage therapy options. The purpose of this study is to develop and validate a novel gene-expression signature that can predict tumor recurrence of stage I NSCLC patients. Cox proportional hazards regression analysis was performed to identify recurrence-related genes and a partial Cox regression model was used to generate a gene signature of recurrence in the training dataset −142 stage I lung adenocarcinomas without adjunctive therapy from the Director's Challenge Consortium. Four independent validation datasets, including GSE5843, GSE8894, and two other datasets provided by Mayo Clinic and Washington University, were used to assess the prediction accuracy by calculating the correlation between risk score estimated from gene expression and real recurrence-free survival time and AUC of time-dependent ROC analysis. Pathway-based survival analyses were also performed. 104 probesets correlated with recurrence in the training dataset. They are enriched in cell adhesion, apoptosis and regulation of cell proliferation. A 51-gene expression signature was identified to distinguish patients likely to develop tumor recurrence (Dxy = −0.83, P<1e-16) and this signature was validated in four independent datasets with AUC >85%. Multiple pathways including leukocyte transendothelial migration and cell adhesion were highly correlated with recurrence-free survival. The gene signature is highly predictive of recurrence in stage I NSCLC patients, which has important prognostic and therapeutic implications for the future management of these patients

Meta-analysis of prophylactic corticosteroid use in post-ERCP pancreatitis

<p>Abstract</p> <p>Background</p> <p>Acute pancreatitis is a common complication of endoscopic retrograde cholangiopancreatography and benefit of pharmacological treatment is unclear. Although prophylactic use of corticosteroid for reduction of pancreatic injury after ERCP has been evaluated, discrepancy about beneficial effect of corticosteroid on pancreatic injury still exists. The aim of current study is to evaluate effectiveness and safety of corticosteroid in prophylaxis of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP).</p> <p>Methods</p> <p>We employed the method recommended by the Cochrane Collaboration to perform a meta-analysis of seven randomized controlled trials (RCTs) of corticosteroid in prevention of post-ERCP pancreatitis (PEP) around the world.</p> <p>Results</p> <p>Most of the seven RCTs were of high quality. When the RCTs were analyzed, odds ratios (OR) for corticosteroid were 1.13 [95% CI (0.89~1.44), p = 0.32] for PEP, 1.61 [95% CI (0.74~3.52), p = 0.23] for severe PEP, 0.92 [95% CI (0.57~1.48), p = 0.73] for post-ERCP hyperamylasemia respectively. The results indicated that there were no beneficial effects of corticosteroid on acute pancreatitis and hyperamylasemia. No evidence of publication bias was found.</p> <p>Conclusion</p> <p>Corticosteroids cannot prevent pancreatic injury after ERCP. Therefore, their use in the prophylaxis of PEP is not recommended.</p