When is Better Best? A multiobjective perspective

Purpose: To identify the most informative methods for reporting results of treatment planning comparisons. Methods: Seven papers from the past year of International Journal of Radiation Oncology Biology Physics reported on comparisons of treatment plans for IMRT and IMAT. The papers were reviewed to identify methods of comparisons. Decision theoretical concepts were used to evaluate the study methods and highlight those that provide the most information. Results: None of the studies examined the correlation between objectives. Statistical comparisons provided some information but not enough to make provide support for a robust decision analysis. Conclusion: The increased use of treatment planning studies to evaluate different methods in radiation therapy requires improved standards for designing the studies and reporting the results

Cost and patency rate targets for the development of endovascular devices to treat femoropopliteal arterial disease

PURPOSE: To determine the criteria that would make use of an endovascular device cost-effective compared with bypass surgery and percutaneous transluminal angioplasty in the treatment of femoropopliteal arterial disease. MATERIALS AND METHODS: A decision model was developed to compare treatment with the use of a hypothetical endovascular device with established therapies. Cost-effectiveness from the perspective of the health care system was considered. Outcome measures were lifetime costs and quality-adjusted life-years. With the use of net health benefit calculations and threshold analysis, combinations of costs and patency rates were determined that would make the device cost-effective compared with established therapies. In subgroup and sensitivity analyses, the effect on decision-making of sex, age, indication, lesion type, procedural risk, and society's willingness to pay for incremental gain in health were explored. RESULTS: Use of a device that costs $3,000 would be cost-effective compared with bypass surgery for critical ischemia if the 5-year patency rate is 29%-46%. Use of the same device would be cost-effective compared with angioplasty for disabling claudication and stenosis if the 5-year patency rate is 69%-86%. CONCLUSION: The target combinations of costs and patency rates found in this study are probably attainable, and further development of such endovascular devices seems warranted

Study design for concurrent development, assessment, and implementation of new diagnostic imaging technology

With current constraints on health care resources and emphasis on value for money, new diagnostic imaging technologies must be assessed and their value demonstrated. The state of the art in the field of diagnostic imaging technology assessment advocates a hierarchical step-by-step approach. Although rigorous, such a hierarchical assessment is time-consuming, and, given the current rapid advances in technology, results are often too late to influence management and policy decisions. The purpose of this article is to discuss a study design in which development, assessment, and implementation of new diagnostic imaging technology take place concurrently in one integrated process. An empirically based pragmatic study design is proposed for imaging technology assessment. To minimize bias and enable comparison with current technology, a randomized controlled design is used whenever feasible and ethical. Outcome measures should reflect the clinical decision-making process based on imaging information and acceptance of the new test. Outcome measures can include additional imaging studies requested, costs of diagnostic work-up and treatment, physicians' confidence in therapeutic decision making, recruitment rate, and patient outcome measures related to the clinical problem. The key feature of the proposed study design is analysis of trends in outcome measures over time

Peripheral arterial disease: gadolinium-enhanced MR angiography versus color-guided duplex US--a meta-analysis

PURPOSE: To summarize and compare the published data on gadolinium-enhanced magnetic resonance (MR) angiography and color-guided duplex ultrasonography (US) for the work-up for peripheral arterial disease. MATERIALS AND METHODS: Studies published between January 1984 and November 1998 were included if (a) gadolinium-enhanced MR angiography and/or color-guided duplex US were performed for evaluation of arterial stenoses and occlusions in the work-up for peripheral arterial disease of the lower extremities, (b) conventional angiography was the reference standard, and (c) absolute numbers of true-positive, false-negative, true-negative, and false-positive results were available or derivable. RESULTS: With a random effects model, pooled sensitivity for MR angiography (97.5% [95% CI: 95.7%, 99.3%]) was higher than that for duplex US (87.6% [95% CI: 84.4%, 90.8%]). Pooled specificities were similar: 96.2% (95% CI: 94.4%, 97.9%) for MR angiography and 94.7% (95% CI: 93.2%, 96.2%) for duplex US. Summary receiver operating characteristic analysis demonstrated better discriminatory power for MR angiography than for duplex US. Regression coefficients for MR angiography versus US were 1.67 (95% CI: -0.23, 3.56) with adjustment for covariates, 2.11 (95% CI: 0.12, 4.09) without such adjustment, and 1.73 (95% CI: 0.44, 3.02) with a random effects model. CONCLUSION: Gadolinium-enhanced MR angiography has better discriminatory power than does color-guided duplex US and is a highly sensitive and specific method, as compared with conventional angiography, for the work-up for peripheral arterial disease

Water balance estimation of the Campo de Cartagena watershed using hydrological modeling and remote sensing

This work uses hydrological modeling and remote sensing techniques to estimate the spatial and temporal patterns of the water balance of an intensively irrigated agricultural watershed in south-eastern Spain. Remote sensing-based vegetation indexes were used to estimate crop evapotranspiration rates and as an input in the model. Model outcomes give insight in the overall water account of the watershed. They highlight the critical role of the groundwater system in the water balance, and the differences between abstractions and recharge, depending on the hydrological conditions

Los documentos de la revolución: El Instituto Internacional de Historia Social de Ámsterdam (nacimiento y desarrollo 1935 - 1947)

In a country that seemed neutral in the face of the advance of Nazism, the Institute of Social History in Amsterdam was created in 1933 with the aim of safeguarding collections that were in danger, first in countries such as Germany and Austria, and soon after in almost all of Europe. Maria Hunink (1924-1988), who was the head of the library for many years, traces its development through the letters stored in the different collections that make up the Institute today. At the beginning, the article deals with the contacts between its two founders - Nicolaas W. Posthumus and Nehemia De Lieme - and its initial collaborators - the legendary librarian Annie Adama van Scheltema-Kleefstra, the historian expelled from post-revolutionary Russia Boris Nikolaevsky, the German historian Hans Stein, the libertarian historian and specialist on Russia Arthur Lehning, and Boris Souvarine, also founder of the French Communist Party and later a central member of Komitern. However, the focus remains on the acquisition of the initiatory funds that gave rise to its initial physiognomy, its prestige and, as a consequence, to the decision of many others to send their collections there.   The article gets a core of tension in what was the foundational donation that gave it international recognition: Max Nettlau's collection, whose producer became an icon of all the back-and-forth attacks before being able to decide to sell his collection scattered in different deposits in Vienna, Munich, London and Paris. Maria Huninck also traces the arrival of the other collections acquired during the early years, from James Guillaume, Robert Grimm, Valerian Smirnov, Wilhelrn Liebknecht, Karl Kautsky, Lev Trotsky, the library of the Russian Bund, the library of the Arbeiterbildungsverein, the documents of the Spanish anarchists Montseny and Santillán, and the Historical Archive of the German Social Democratic Party with the original manuscripts and letters of Marx and Engels.En un país que parecía neutral frente al avance del nazismo, el Instituto de Historia Social de Ámsterdam fue creado en 1933 con el fin de resguardar colecciones que se encontraban en peligro, primero en países como Alemania y Austria, poco después en casi toda Europa. Quien fue su responsable de biblioteca durante muchos años, Maria Hunink (1924-1988), recorre su conformación a través de las cartas resguardadas en las diferentes colecciones que hoy lo conforman. A su inicio, el artículo aborda los contactos entre sus dos fundadores —Nicolaas W. Posthumus y Nehemia De Lieme— y sus colaboradorxs iniciales —la legendaria bibliotecaria Annie Adama van Scheltema-Kleefstra, el historiador expulsado de la Rusia postrevolucionaria Boris Nikolaevsky, el historiador alemán Hans Stein, el historiador libertario especialista en Rusia Arthur Lehning, y  Boris Souvarine, también fundador del Partido Comunista Francés y luego miembro central de Komitern. No obstante, el foco queda puesto en la adquisición de los fondos iniciáticos que dieron lugar a su fisonomía inicial, su prestigio y, como consecuencia, a la decisión de muchxs otrxs de mandar allí sus colecciones. El artículo obtiene un núcleo de tensión en lo que fue la donación fundacional que le dio reconocimiento internacional: el fondo de Max Nettlau, cuyo productor se transformó en un ícono de todos los ataques de idas y venidas antes de poder decidirse a vender su colección dispersa en distintos depósitos, en Viena, Munich, Londres y Paris. Maria Huninck además recorre la llegada de las otras colecciones adquiridas durante los primeros años, de James Guillaume, Robert Grimm, Valerian Smirnov, Wilhelrn Liebknecht, Karl Kautsky, Lev Trotski, la biblioteca del Bund ruso, la biblioteca del Arbeiterbildungsverein, los documentos de los anarquistas españoles de lxs Montseny y Santillán, y el Archivo Histórico del partido socialdemocráta alemán con los manuscritos y cartas originales de Marx y Engels