The TURis System for Transurethral Resection of the Prostate: A NICE Medical Technology Guidance

The transurethral resection in saline (TURis) system was notified by the company Olympus Medical to the National Institute of Health and Care Excellence’s (NICE’s) Medical Technologies Evaluation Programme. Following selection for medical technologies guidance, the company developed a submission of clinical and economic evidence for evaluation. TURis is a bipolar surgical system for treating men with lower urinary tract symptoms due to benign prostatic enlargement. The comparator is any monopolar transurethral resection of the prostate (mTURP) system. Cedar, a collaboration between Cardiff and Vale University Health Board, Cardiff University and Swansea University in the UK, acted as an External Assessment Centre (EAC) for NICE to independently critique the company’s submission of evidence. Eight randomised trials provided evidence for TURis, demonstrating efficacy equivalent to that of mTURP for improvement of symptoms. The company presented meta-analyses of key outcome measures, and the EAC made methodological modifications in response to the heterogeneity of the trial data. The EAC analysis found that TURis substantially reduced the relative risks of transurethral resection syndrome (relative risk 0.18 [95 % confidence interval 0.05–0.62]) and blood transfusion (relative risk 0.35 [95 % confidence interval 0.19–0.65]). The company provided a de novo economic model comparing TURis with mTURP. The EAC critiqued the model methodology and made modifications. This found TURis to be cost saving at £70.55 per case for existing Olympus customers and cost incurring at £19.80 per case for non-Olympus customers. When an additional scenario based on the only available data on readmission (due to any cause) from a single trial was modelled, the estimated cost saving per case was £375.02 for existing users of Olympus electrosurgery equipment and £284.66 per case when new Olympus equipment would need to be purchased. Meta-analysis of eight randomised trials showed that TURis is associated with a statistically significantly reduced risk of transurethral resection syndrome and a reduced need for blood transfusion—two factors that may drive cost saving for the National Health Service. The clinical data are equivocal as to whether TURis shortens the hospital stay. Limited data from a single study suggest that TURis may reduce the rate of readmission after surgery. The NICE guidance supports adoption of the TURis technology for performing transurethral resection of the prostate in men with lower urinary tract symptoms due to benign prostatic enlargemen

A Reflection on Economic Uncertainty and Fertility in Europe: The Narrative Framework

none5openVignoli, Daniele; Guetto, Raffaele; Bazzani, Giacomo; Pirani, Elena; Minello, AlessandraVignoli, Daniele; Guetto, Raffaele; Bazzani, Giacomo; Pirani, Elena; Minello, Alessandr

Comparison of some performance characteristics in broiler chickens raised on deep litter and fed either pelleted or mash feed of similar nutritional value

No Abstract Available Ghana Jnl agric. Sci, Vol.36 2003: 135-14

Microstrip antenna on a high dielectric constant substrate: BaTiO3 (BTO)-CaCu3Ti4O12(CCTO) composite screen-printed thick films

The performance of microstrip antennas using composite thick films of (BTOBaTiO3) and CCTO (CaCu3Ti4O12) as a substrate were studied. The dielectric permittivity and loss of (BTO)(x)-(CCTO)(1-x) thick films with x = 0, 0.2, 0.5, 0.8, 0.9, and 1 were examined. These films were prepared in two-layer geometry using the screen-printing technique on Al2O3 substrates. Mechanical alloying followed by the solid-state procedure was successfully employed to produce powders of CCTO (CaCu3Ti4O12) used in the films. We also studied the films dielectric permittivity (K) and loss (D) in the medium-frequency (MF) range (100 Hz to 1 MHz). The performance of a planar microstrip antenna that uses the (BTO)(x):(CCTO)(1-x) thick films as a substrate of high K was also examined in the microwave range of frequencies. From the analysis of the antenna operation of the samples, one can conclude that the higher values of K in the range of 2.5-3.3 GHz antennas is presented by the BTO substrates. For the BTO film, the K value is similar to 66 (2.6 GHz) and decreases to 34 for the CCTO film (3 GHz). For the BTO and CCTO films, the antenna bandwidths (BW) are similar to 50% and similar to 38%, respectively. The higher bandwidth presented by the BTO compared to the CCTO is certainly associated with the higher loss presented by the BTO phase, which is a ferroelectric phase. Therefore, these measurements confirm the potential use of such materials for small microwave planar antennas, where the miniaturization of the devices is crucial.35101848185

Controlling pH in a Precipitation Plant

This paper deals with pH control in a precipitation and dissolution process. The process is a part of the electrolyte purification plant at Falconbridge Nikkelverk in Kristiansand, Norway. The process including the present strategy for pH control are presented, and experienced weaknesses with this strategy are described. A rigorous dynamic model of the process is briefly summarized. This model was developed in earlier work with the purpose of being a tool for control design. Because of the precipitation in form of hydroxides and the limited dissolution rate of nickel carbonate, the process is approximately linear in pH. Therefore, an alternative strategy for pH control based on adding derivative and feed forward action is suggested. The alternative control strategy is by simulations shown to give severe improvements in performance. The robustness of the proposed controller is briefly analysed