Cost-effectiveness acceptability curves in the dock: case not proven?

No abstract available

Pre-operative optimisation employing dopexamine or adrenaline for patients undergoing major elective surgery: a cost-effectiveness analysis

<b>Objective</b>: To compare the cost and cost-effectiveness of a policy of pre-operative optimisation of oxygen delivery (using either adrenaline or dopexamine) to reduce the risk associated with major elective surgery, in high-risk patients. <b>Methods</b>: A cost-effectiveness analysis using data from a randomised controlled trial (RCT). In the RCT 138 patients undergoing major elective surgery were allocated to receive pre-operative optimisation employing either adrenaline or dopexamine (assigned randomly), or to receive routine peri-operative care. Differential health service costs were based on trial data on the number and cause of hospital in-patient days and the utilisation of health care resources. These were costed using unit costs from a UK hospital. The cost-effectiveness analysis related differential costs to differential life-years during a 2 year trial follow-up. <b>Results</b>: The mean number of in-patient days was 16 in the pre-optimised groups (19 adrenaline; 13 dopexamine) and 22 in the standard care group. The number (%) of deaths, over a 2 year follow-up, was 24 (26%) in the pre-optimised groups and 15 (33%) in the standard care group. The mean total costs were EUR 11,310 in the pre-optimised groups and EUR 16,965 in the standard care group. Life-years were 1.68 in the pre-optimised groups and 1.46 in the standard care group. The probability that pre-operative optimisation is less costly than standard care is 98%. The probability that it dominates standard care is 93%. Conclusions: Based on resource use and effectiveness data collected in the trial, pre-operative optimisation of high-risk surgical patients undergoing major elective surgery is cost-effective compared with standard treatment

Space Shuttle Main Engine (SSME) Pogo testing and results

To effectively assess the Pogo stability of the space shuttle vehicle, it was necessary to characterize the structural, propellant, and propulsion dynamics subsystems. Extensive analyses and comprehensive testing programs were established early in the project as an implementation of management philosophy of Pogo prevention for space shuttle. The role of the space shuttle main engine (SSMF) in the Pogo prevention plans, the results obtained from engine ground testing with analysis, and measured data from STS-1 flight are discussed

Non-conventional charge transport in organic semiconductors: magnetoresistance and thermoelectricity

Magnetoresistance and thermoelectricity require additional properties of materials beyond their ability to transport charge, namely a large resistive response to a magnetic field, or in the case of thermoelectrics a large Seebeck coefficient combined with low thermal conductivity.</p

Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions

Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the textbook illustration of the CEAC. This textbook CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (). But this familiar ogive shape which makes the textbook CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may straddle quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y-axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a gallery of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals

POGO Instabilities Suppression Evaluation

A dynamic (frequency response) analysis was made of a liquid oxygen feed system consisting of a low-speed inducer, a high-speed main pump and a positive displacement pulser utilized for simulating pogo induced pressure oscillations. Based on the results of the analysis, an active control system for suppression of pulser generated pressure oscillations was designed, fabricated and tested. The test results verified that the suppressor was effective in attenuating the generated pressure oscillations over the frequency range from 10 to 30 Hz

Transverse waves in a post-flare supra-arcade

Observations of propagating transverse waves in an open magnetic field structure with the Transition Region And Coronal Explorer (TRACE) are presented. Waves associated with dark tadpole-like sunward moving structures in the post-flare supra-arcade of NOAA active region 9906 on the 21st of April 2002 are analysed. They are seen as quasi-periodic transverse displacements of the dark tadpole tails, with periods in the range of 90–220 s. Their phase speeds and displacement amplitudes decrease as they propagate sunwards. At heights of 90 and 60 Mm above the post-flare loop footpoints the phase speeds are in the ranges 200–700 km s −1 and 90–200 km s −1 respectively. Furthermore, for consecutive tadpoles the phase speeds decrease and periods increase as a function of time. The waves are interpreted as propagating fast magnetoacoustic kink waves guided by a vertical, evolving, open structure

Association between body mass index and mental health among Scottish adult population: a cross-sectional study of 37,272 participants

&lt;b&gt;Background:&lt;/b&gt; The evidence is conflicting as to whether body mass index (BMI) is associated with mental health and, if so, to what extent it varies by sex and age. We studied mental health across the full spectrum of BMI among the general population, and conducted subgroup analyses by sex and age.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Method:&lt;/b&gt; We undertook a cross-sectional study of a representative sample of the Scottish adult population. The Scottish Health Survey provided data on mental health, measured by the General Health Questionnaire-12 (GHQ), BMI, demographic and life-style information. Good mental health was defined as a GHQ score &#60;4, and poor mental health as a GHQ score ≥4. Logistic regression models were applied. Results Of the 37 272 participants, 5739 (15.4%) had poor mental health. Overall, overweight participants had better mental health than the normal-weight group [adjusted odds ratio (OR) 0.93, 95% confidence interval (CI) 0.87–0.99, p = 0.049], and individuals who were underweight, class II or class III obese had poorer mental health (class III obese group: adjusted OR 1.26, 95% CI 1.05–1.51, p = 0.013). There were significant interactions of BMI with sex (p = 0.013) and with age (p &#60; 0.001). Being overweight was associated with significantly better mental health in middle-aged men only. In contrast, being underweight at all ages or obese at a young age was associated with significantly poorer mental health in women only.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusions:&lt;/b&gt; The adverse associations between adiposity and mental health are specific to women. Underweight women and young women who are obese have poorer mental health. In contrast, middle-aged overweight men have better mental health.&lt;p&gt;&lt;/p&gt

Reducing the Impact of Organisational Silos on Resilience: A Report on the impact of silos on resilience and how the impacts might be reduced

Organisations need to perform effectively if they are to meet societal goals and expectations. This is especially important when adverse events arise, whatever the cause. Silos are organisational units where there is a breakdown in communication, co-operation and co-ordination with external parties. Silos can arise within organisations, a result of silo mentality. Or organisations themselves can become siloed if they unduly limit their connections with other organisations. Silos are often detrimental to the resilience of organisations and communities. Two definitions of resilience are suggested; one based on New Zealand research undertaken within the Resilient Organisations Research Programme (www.resorgs.org.nz) and another from the UK that addresses resilience at both organisational and national levels. There is a need to improve the way that we manage silos in the interests of organisational and community resilience. How silos arise and what can be done about them to promote resilience is the topic of this report. Good internal management practices, together with bridge-building between organisations to improve collaboration, appear to be particular needs. Specific steps need to be taken where private incentives fall short of delivering all of the community’s resilience requirements. This report concludes by suggesting some points that need to be recognised to reduce the impact of silos on resilience

The Impact of Diabetic Retinopathy and Diabetic Macular Edema on Health-Related Quality of Life in Type 1 and Type 2 Diabetes

This article is made available with the permission of the publisher, Association for Research in Vision and OphthalmologyPurpose.: To assess the impact of diabetic retinopathy (DR) and diabetic macular edema (DME) on health-related quality of life (HRQoL) in type 1 and type 2 diabetes using the EuroQoL EQ-5D generic multi-attribute utility instrument (MAUI). Methods.: In this cross-sectional study, 577 patients with diabetes were recruited from specialized eye clinics in Melbourne, Australia. Each patient underwent clinical, biochemical, and anthropometric assessments. The severity of combined DR and DME (no DR/DME; mild NPDR [nonproliferative DR (NPDR)] and/or mild DME; moderate NPDR and/or moderate DME; and vision-threatening DR (VTDR) (severe NPDR or PDR and/or severe DME) in the worse eye was calculated. EQ-5D utility measures were the main outcome. Because the distribution of the utility measures was skewed, independent associations were explored using multivariate quantile regression models (five quintiles, namely 15th, 30th, 45th, 60th, 75th) ranging from poorest to highest HRQoL. Results.: Median age of the participants was 66 years (range, 26–90 years). Of the 577 participants, 223 (38.7%) had no DR/DME, 35 (6.1%) had mild NPDR/DME, 127 (22.0%) had moderate NPDR/DME, and 192 (33.3%) had VTDR. In adjusted models, neither presence nor severity of DR/DME was significantly associated with any quantile of the EQ-5D. In contrast, the presence of diabetic complications (other than DR) (β = −0.153; SE = 0.052; P < 0.001), other nonocular comorbidities (β = −0.115; SE = 0.038; P < 0.01), and higher body mass index (β = −0.007; SE = 0.002; P < 0.001) were all associated with worse HRQoL. Conclusions.: Using a generic MAUI, the EQ-5D, the authors found that the presence or severity of DR/DME and concomitant vision loss were not associated with any quantile of HRQoL. These findings suggest that the EQ-5D lacks sensitivity in assessing the impact of the severity of DR/DME on HRQoL parameters and that condition-specific instruments may better capture the full impact of the association