Cost-effectiveness of external cephalic version for term breech presentation

<p>Abstract</p> <p>Background</p> <p>External cephalic version (ECV) is recommended by the American College of Obstetricians and Gynecologists to convert a breech fetus to vertex position and reduce the need for cesarean delivery. The goal of this study was to determine the incremental cost-effectiveness ratio, from society's perspective, of ECV compared to scheduled cesarean for term breech presentation.</p> <p>Methods</p> <p>A computer-based decision model (TreeAge Pro 2008, Tree Age Software, Inc.) was developed for a hypothetical base case parturient presenting with a term singleton breech fetus with no contraindications for vaginal delivery. The model incorporated actual hospital costs (e.g., $8,023 for cesarean and$5,581 for vaginal delivery), utilities to quantify health-related quality of life, and probabilities based on analysis of published literature of successful ECV trial, spontaneous reversion, mode of delivery, and need for unanticipated emergency cesarean delivery. The primary endpoint was the incremental cost-effectiveness ratio in dollars per quality-adjusted year of life gained. A threshold of $50,000 per quality-adjusted life-years (QALY) was used to determine cost-effectiveness.</p> <p>Results</p> <p>The incremental cost-effectiveness of ECV, assuming a baseline 58$7,900/QALY. If the estimated probability of successful ECV is less than 32%, then ECV costs more to society and has poorer QALYs for the patient. However, as the probability of successful ECV was between 32% and 63%, ECV cost more than cesarean delivery but with greater associated QALY such that the cost-effectiveness ratio was less than $50,000/QALY. If the probability of successful ECV was greater than 63%, the computer modeling indicated that a trial of ECV is less costly and with better QALYs than a scheduled cesarean. The cost-effectiveness of a trial of ECV is most sensitive to its probability of success, and not to the probabilities of a cesarean after ECV, spontaneous reversion to breech, successful second ECV trial, or adverse outcome from emergency cesarean.</p> <p>Conclusions</p> <p>From society's perspective, ECV trial is cost-effective when compared to a scheduled cesarean for breech presentation provided the probability of successful ECV is > 32%. Improved algorithms are needed to more precisely estimate the likelihood that a patient will have a successful ECV.</p

Methodological developments in violence research

Über Jahrzehnte wurde Gewalt durch Interviews mit Betroffenen oder Tätern, durch teilnehmende Beobachtung oder Gewaltstatistiken untersucht, meist unter Verwendung entweder qualitativer oder quantitativer Analysemethoden. Seit der Jahrhundertwende stehen Forschenden eine Reihe neuer Ansätze zur Verfügung: Es gibt immer mehr Videoaufnahmen von gewaltsamen Ereignissen, Mixed Methods-Ansätze werden stetig weiterentwickelt und durch Computational Social Sciences finden Big Data-Ansätze Einzug in immer mehr Forschungsfelder. Diese drei Entwicklungen bieten großes Potenzial für die quantitative und qualitative Gewaltforschung. Der vorliegende Beitrag diskutiert Videodatenanalyse, Triangulation und Mixed Methods-Ansätze sowie Big Data und bespricht den gegenwärtigen und zukünftigen Einfluss der genannten Entwicklungen auf das Forschungsfeld. Das Augenmerk liegt besonders darauf, (1) wie neuere Videodaten genutzt werden können, um Gewalt zu untersuchen und wo ihre Vor- und Nachteile liegen, (2) wie Triangulation und Mixed Methods-Ansätze umfassendere Analysen und theoretische Verknüpfungen in der Gewaltforschung ermöglichen und (3) wo Anwendungen von Big Data und Computational Social Science in der Gewaltforschung liegen können.For decades violence research has relied on interviews with victims and perpetrators, on participant observation, and on survey methods, and most studies focused on either qualitative or quantitative analytic strategies. Since the turn of the millennium, researchers can draw on a range of new approaches: there are increasing amounts of video data of violent incidents, triangulation and mixed methods approaches become ever more sophisticated, and computational social sciences introduce big data analysis to more and more research fields. These three developments hold great potential for quantitative and qualitative violence research. This paper discusses video data analysis, mixed methods, and big data in the context of current and future violence research. Specific focus lies on (1) potentials and challenges of new video data for studying violence; (2) the role of triangulation and mixed methods in enabling more comprehensive violence research from multiple theoretical perspectives, and (3) what potential uses of big data and computational social science in violence research may look like

Lipid interactions of LAH4, a peptide with antimicrobial and nucleic acid transfection activities

The cationic amphipathic designer peptide LAH4 exhibits potent antimicrobial, nucleic acid transfection and cell penetration activities. Closely related derivatives have been developed to enhance viral transduction for gene therapeutic assays. LAH4 contains four histidines and, consequently, its overall charge and membrane topology in lipid bilayers are strongly pH dependent. In order to better understand the differential interactions of this amphipathic peptide with negatively-charged membranes its interactions, topologies, and penetration depth were investigated in the presence of lipid bilayers as a function of pH, buffer, phospholipid head group, and fatty acyl chain composition using a combination of oriented synchrotron radiation circular dichroism spectroscopy as well as oriented and non-oriented solid-state NMR spectroscopy. This combination of methods indicates that in the presence of lipids with phosphatidylglycerol head groups, the topological equilibria of LAH4 is shifted towards more in-plane configurations even at neutral pH. In contrast, a transmembrane alignment is promoted when LAH4 interacts with membranes made of dimyristoyl phospholipids rather than palmitoyl-oleoyl-phospholipids. Finally, the addition of citrate buffer favours LAH4 transmembrane alignments, even at low pH, probably by complex formation with the cationic charges of the peptide. In summary, this study has revealed that the membrane topology of this peptide is readily modulated by the environmental conditions