Clinical biomarker innovation: when is it worthwhile?

Contains fulltext : 208980.pdf (publisher's version ) (Open Access

Mindfulness-based cognitive therapy versus treatment as usual in adults with ADHD: A trial-based economic evaluation

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Effective Prolonged Therapy with Voriconazole in a Lung Transplant Recipient with Spondylodiscitis Induced by Scedosporium apiospermum

Scedosporium/Pseudallescheria species are frequently seen in cystic fibrosis patients. However, disseminated forms after lung transplantation in these patients are rarely seen, but often with poor outcome. In this case report we describe a lung transplant recipient with cystic fibrosis who developed a spondylodiscitis that was caused by Scedosporium apiospermum. The patient was treated with anti-fungal treatment by voriconazole for over three years with a clinical good response and without the need for surgical intervention. To our opinion this is the first anti-fungal treated case of invasive disease caused by Scedosporium/Pseudallescheria in a cystic fibrosis (CF) patient who underwent lung transplantation that survived

Chlamydia psittaci: a relevant cause of community-acquired pneumonia in two Dutch hospitals.

Of all hospitalised community-acquired pneumonias (CAPs) only a few are known to be caused by Chlamydia psittaci. Most likely the reported incidence, ranging from of 0% to 2.1%, is an underestimation of the real incidence, since detection of psittacosis is frequently not incorporated in the routine microbiological diagnostics in CAP or serological methods are used

An assessment of validity and responsiveness of generic measures of health-related quality of life in hearing impairment

This article is made available through the Brunel Open Access Publishing Fund. This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.Purpose: This review examines psychometric performance of three widely used generic preference-based measures, that is, EuroQol 5 dimensions (EQ-5D), Health Utility Index 3 (HUI3) and Short-form 6 dimensions (SF-6D) in patients with hearing impairments. Methods: A systematic search was undertaken to identify studies of patients with hearing impairments where health state utility values were measured and reported. Data were extracted and analysed to assess the reliability, validity (known group differences and convergent validity) and responsiveness of the measures across hearing impairments. Results: Fourteen studies (18 papers) were included in the review. HUI3 was the most commonly used utility measures in hearing impairment. In all six studies, the HUI3 detected difference between groups defined by the severity of impairment, and four out of five studies detected statistically significant changes as a result of intervention. The only study available suggested that EQ-5D only had weak ability to discriminate difference between severity groups, and in four out of five studies, EQ-5D failed to detected changes. Only one study involved the SF-6D; thus, the information is too limited to conclude on its performance. Also evidence for the reliability of these measures was not found. Conclusion: Overall, the validity and responsiveness of the HUI3 in hearing impairment was good. The responsiveness of EQ-5D was relatively poor and weak validity was suggested by limited evidence. The evidence on SF-6D was too limited to make any judgment. More head-to-head comparisons of these and other preference measures of health are required.Medical Research Counci

Ecological impact and cost-effectiveness of wildlife crossings in a highly fragmented landscape:A multi-method approach

Context: Road infrastructure construction is integral to economic development, but negatively affects biodiversity. To mitigate the negative impacts of infrastructure, various types of wildlife crossings are realized worldwide, but little is known about their effectiveness, and cost-effectiveness. Objective: The paper contributes to the methodological and empirical discussion on the effectiveness of wildlife crossings for enhancing the quality of surrounding nature and its cost-effectiveness by analyzing a large-scale wildlife-crossings program in the Netherlands. Method: A multi-criteria cost–benefit analysis is applied, comprised of monetary and non-monetary measures, and a mixed-method approach is used to determine ecological effects. Ecological effects are expressed in the standardized weighted hectare measurement of threat-weighted ecological quality area (1 T-EQA = 1 ha of 100% ecological quality, averagely threatened). Cost-effectiveness is calculated comparing the monetary costs of intervention with ecological benefits (Euro costs/T-EQA), for different types of wildlife crossings and for two other nature policies. Results: The Dutch habitat defragmentation program has induced an increase in nature value of 1734 T-EQA at a cost of Euro 283 million. Ecological gains per hierarchically ordered groups of measures differ strongly: The most effective are ecoducts (wildlife crossing bridges) followed by shared-use viaducts and large fauna tunnels. Ecoducts generated the largest gain in nature value, but were also the most costly measures. In terms of cost-effectiveness, both large fauna tunnels and shared-use viaducts for traffic and animals outperformed ecoducts. Conclusions: Ecoducts deliver ecologically, but their cost-effectiveness appears modest. Purchasing agricultural land for restoration of nature appears more cost-effective than building wildlife crossings. Yet, reducing environmental pressures or their effects on existing nature areas is likely to be most cost-effective.</p

What to choose as radical local treatment for lung metastases from cob-rectal cancer: Surgery or radiofrequency ablation?

Background: Long-term survival can be obtained with local treatment of lung metastases from colorectal cancer. However, it is unclear as to what the optimal local therapy is: surgery, radiofrequency ablation (RFA) or stereotactic radiotherapy (SBRT). Methods: A systematic review included 27 studies matching with the a priori selection criteria, the most important being &gt;= 50 patients and a follow-up period of &gt;= 24 months. No SBRT studies were eligible. The review was therefore conducted on 4 RFA and 23 surgical series. Results: Four of the surgical studies were prospective, all others were retrospective. No randomized trial was found. The reporting of data differed between the studies, which led to difficulties in the analyses. Treatment-related mortality rates for RFA and surgery were 0% and 1.4-2.4%, respectively, whereas morbidity rates were reported inconsistently but seemed the lowest for surgery. Conclusion: Due to the lack of phase III trials, no firm conclusions can be drawn, although most evidence supports surgery as the most effective treatment option. High-quality trials comparing currently used treatment modalities such as SBRT, RFA and surgery are needed to inform treatment decisions

Optimization Strategies for Interactive Classification of Interstitial Lung Disease Textures

For computerized analysis of textures in interstitial lung disease, manual annotations of lung tissue are necessary. Since making these annotations is labor intensive, we previously proposed an interactive annotation framework. In this framework, observers iteratively trained a classifier to distinguish the different texture types by correcting its classification errors. In this work, we investigated three ways to extend this approach, in order to decrease the amount of user interaction required to annotate all lung tissue in a computed tomography scan. First, we conducted automatic classification experiments to test how data from previously annotated scans can be used for classification of the scan under consideration. We compared the performance of a classifier trained on data from one observer, a classifier trained on data from multiple observers, a classifier trained on consensus training data, and an ensemble of classifiers, each trained on data from different sources. Experiments were conducted without and with texture selection (ts). In the former case, training data from all eight textures was used. In the latter, only training data from the texture types present in the scan were used, and the observer would have to indicate textures contained in the scan to be analyzed. Second, we simulated interactive annotation to test the effects of (1) asking observers to perform ts before the start of annotation, (2) the use of a classifier trained on data from previously annotated scans at the start of annotation, when the interactive classifier is untrained, and (3) allowing observers to choose which interactive or automatic classification results they wanted to correct. Finally, various strategies for selecting the classification results that were presented to the observer were considered. Classification accuracies for all possible interactive annotation scenarios were compared. Using the best-performing protocol, in which observers select the textures that should be distinguished in the scan and in which they can choose which classification results to use for correction, a median accuracy of 88% was reached. The results obtained using this protocol were significantly better than results obtained with other interactive or automatic classification protocols