Mind the Gap! - Geographic transferability of economic evaluation in health

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.Background: Transferring cost-effectiveness information between geographic domains offers the potential for more efficient use of analytical resources. However, it is difficult for decision-makers to know when they can rely on costeffectiveness evidence produced for another context. Objectives: This thesis explores the transferability of economic evaluation results produced for one geographic area to another location of interest, and develops an approach to identify factors to predict when this is appropriate. Methods: Multilevel statistical models were developed for the integration of published international costeffectiveness data to assess the impact of contextual effects on country-level; whilst controlling for baseline characteristics within, and across, a set of economic evaluation studies. Explanatory variables were derived from a list of factors suggested in the literature as possible constraints on the transferability of costeffectiveness evidence. The approach was illustrated using published estimates of the cost-effectiveness of statins for the primary and secondary prevention of cardiovascular disease from 67 studies and related to 23 geographic domains, together with covariates on data, study and country-level. Results: The proportion of variation at the country-level observed depends on the appropriate multilevel model structure and never exceeds 15% for incremental effects and 21% for incremental cost. Key sources of variability are patient and disease characteristics, intervention cost and a number of methodological characteristics defined on the data-level. There were fewer significant covariates on the study and country-levels. Conclusions: Analysis suggests that variability in cost-effectiveness data is primarily due to differences between studies, not countries. Further, comparing different models suggests that data from multinational studies severely underestimates country-level variability. Additional research is needed to test the robustness of these conclusions on other sets of cost-effectiveness data, to further explore the appropriate set of covariates, and to foster the development of multilevel statistical modelling for economic evaluation data in health.This study is funded by MATCH, the Engineering and Physical Science Research Council (EPSRC), and the German Academic Merit Foundation

A Scalable VLSI Architecture for Soft-Input Soft-Output Depth-First Sphere Decoding

Multiple-input multiple-output (MIMO) wireless transmission imposes huge challenges on the design of efficient hardware architectures for iterative receivers. A major challenge is soft-input soft-output (SISO) MIMO demapping, often approached by sphere decoding (SD). In this paper, we introduce the - to our best knowledge - first VLSI architecture for SISO SD applying a single tree-search approach. Compared with a soft-output-only base architecture similar to the one proposed by Studer et al. in IEEE J-SAC 2008, the architectural modifications for soft input still allow a one-node-per-cycle execution. For a 4x4 16-QAM system, the area increases by 57% and the operating frequency degrades by 34% only.Comment: Accepted for IEEE Transactions on Circuits and Systems II Express Briefs, May 2010. This draft from April 2010 will not be updated any more. Please refer to IEEE Xplore for the final version. *) The final publication will appear with the modified title "A Scalable VLSI Architecture for Soft-Input Soft-Output Single Tree-Search Sphere Decoding

Relationship of pulmonary toxicity and carcinogenicity of fine and ultrafine granular dusts in a rat bioassay

The current carcinogenicity study with female rats focused on the toxicity and carcinogenicity of intratracheally instilled fine and ultrafine granular dusts. The positive control, crystalline silica, elicited the greatest magnitude and progression of pulmonary inflammatory reactions, fibrosis and the highest incidence of primary lung tumors (39.6%). Addition of poly-2-vinylpyridine-N-oxide decreased inflammatory responses, fibrosis, and the incidence of pulmonary tumors induced by crystalline quartz to 21.4%. After repeated instillation of soluble, ultrafine amorphous silica (15 mg) a statistically significant tumor response (9.4%) was observed, although, the inflammatory response in the lung was not as persistently severe as in rats treated with carbon black. Instillation of ultrafine carbon black (5 mg) caused a lung tumor incidence of 15%. In contrast to a preceding study using a dose of 66 mg coal dust, lung tumors were not detected after exposure to the same coal dust at a dose of 10 mg in this study. Pulmonary inflammatory responses to coal dust were very low indicating a mechanistic threshold for the development of lung tumors connected with particle related chronic inflammation. The animals treated with ultrafine carbon black and ultrafine amorphous silica showed significantly more severe lesions in non-cancerous endpoints when compared to animals treated with fine coal dust. Furthermore, carbon black treated rats showed more severe non-cancerous lung lesions than amorphous silica treated rats. Our data show a relationship between tumor frequencies and increasing scores when using a qualitative scoring system for specific non-cancerous endpoints such as inflammation, fibrosis, epithelial hyperplasia, and squamous metaplasia

Virum magnificum et summe venerabilem Fr. Volkm. Reinhardum quum regio iussu Academiam Vitebergensem viseret, rite salutatum esse voluit Seminarium academicum : insunt observationes criticae in Apollonii Rhodii Argonautica

https://repository.brynmawr.edu/digitizedbooks/1138/thumbnail.jp

Virum magnificum et summe venerabilem Fr. Volkm. Reinhardum quum regio iussu Academiam Vitebergensem viseret, rite salutatum esse voluit Seminarium academicum : insunt observationes criticae in Apollonii Rhodii Argonautica

https://repository.brynmawr.edu/digitizedbooks/1138/thumbnail.jp

Surfactant protein a in cystic fibrosis: supratrimeric structure and pulmonary outcome.

The state of oligomerization of surfactant associated protein-A (SP-A) monomers differs between individuals. This likely affects SP-A's functional properties and could thereby influence clinical status in patients with lung diseases. In this study we focus on SP-A structure in cystic fibrosis (CF) compared to both healthy subjects and disease controls. SP-A composition and function were assessed in both bronchoalveolar lavage (BAL) fluid and serum of 46 CF patients with mild disease, 25 patients with chronic bronchitis and 22 healthy subjects by gel chromatography and a functional agglutination assay. Relation of SP-A agglutination ability to disease severity of the subjects was explored. SP-A was present in seven major oligomeric forms with the majority of SP-A being structurally organized as complex oligomeric forms. More complex oligomeric forms were associated with better SP-A function with regard to its agglutination ability. These forms were more frequently observed in BAL than in serum, but there were no differences between disease groups. In CF patients, more complex forms of SP-A were associated with better lung function. Organizational structure of SP-A affects its functional activity and is linked to disease severity in CF

Analisia Pengaruh Campuran Bahan Bakar Solar-minyak Jarak Pagar Pada Kinerja Motor Diesel Dan Emisi Gas Buang

A test of a diesel motor using the fuel mixture of diesel-jatropha oil has been conducted in order to analyze the influence of fuel mixture composition to the motor performance and exhaust gas emission. The motor which had a single cylinder, 4 cycles, with maximum energy output of 4.4 kW at 2600 rpm, moved agenerator as electricity power load. The percentage of jatropha oil in fuel mixture was 0%, 10%, 30%, 50% and 100%. The testing method was, to each fuel mixture composition and at constant 2000 rpm motor rotation with electricity power load of 0 and 2 kW, the data concerning to the fuel consumption, lubricating oiltemperature and exhaust gas emission was measured. The test result indicated that the higher the percentage of jatropha oil in fuel mixture, the higher the fuel consumption and the CO2 and NOx emission in exhaust gas, but the lower the HC and O2 emission and opacity of exhaust gas