Is upper gastrointestinal radiography a cost-effective alternative to a Helicobacter pylori “Test and Treat” strategy for patients with suspected peptic ulcer disease?

Current clinical consensus supports an initial Helicobacter pylori (HP) “test and treat” approach when compared to immediate endoscopy for patients with suspected peptic ulcer disease. Alternative diagnostic approaches that incorporate upper GI radiography (UGI) have not been previously evaluated. We sought to determine the cost effectiveness of UGI compared to a HP test and treat strategy, incorporating recent data addressing the reduced prevalence of HP, lower cost of diagnostic interventions, and reduced attribution of PUD to HP. METHODS : Using decision analysis, three diagnostic and treatment strategies were evaluated: 1) Test and Treat —initial HP serology, treat patients who test positive with HP eradication and antiulcer therapy; 2) Initial UGI series —treat all patients with documented ulcer disease with HP eradication and antiulcer therapy; and 3) Initial UGI series, HP serology if ulcer present — treat ulcer and HP based on diagnostic test results. RESULTS : The estimated cost per ulcer cured for each strategy were as follows: test and treat, $3,025; initial UGI,$3,690; and UGI with serology, $3,790. The estimated cost per patient treatment were: test and treat,$498; initial UGI, $610; and UGI with serology,$620. When UGI reimbursement was decreased to less than $50, the UGI strategies yielded a lower cost per patient treated than the test and treat strategy. CONCLUSION : At the current level of reimbursement, UGI should not be considered a cost-effective alternative to the HP test and treat strategy for the initial evaluation of patients with suspected peptic ulcer disease.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73722/1/j.1572-0241.2000.01837.x.pd

StateWebCharts: A Formal Description Technique Dedicated to Navigation Modelling of Web Applications

International audienceThis paper presents StateWebCharts (SWC), a formal description technique based on statecharts for describing navigation on web applications. This notation extends the classical statecharts notation by adding more necessary concepts such as an appropriate semantics for states and transitions in a Web context, including notions like dialog initiative control and client and server activities. As well as statecharts do, this formal description technique features a graphical representation thus making it easier to use for web designers and formal enough to allow to rigorously reason about properties of navigation models. In order to show the applicability of the notation, we show, in the paper, its use on two real-size web applications

RRS James Clark Ross Cruise JR298: Marine geology and geophysics. Antarctic Peninsula Pacific Margin and southern Bellingshausen Sea. January - March 2015

The main purpose of cruise JR298 was to collect marine geological and geophysical samples and data to support International Ocean Discovery Program (IODP) proposal 732- Full2, “Sediment drifts off the Antarctic Peninsula and West Antarctica” (Channell, Larter, Hillenbrand et al.). The ship time was allocated for this purpose on the basis of a Site Survey Investigation grant from the NERC UK-IODP Programme (NE/J006548/1: Depositional patterns and records in sediment drifts off the Antarctic Peninsula and West Antarctica) to R.D. Larter, C.-D. Hillenbrand (both BAS), D.A. Hodell (University of Cambridge) and A.G.C. Graham (University of Exeter). The data and samples collected will also be used in two Collaborative Gearing Scheme projects, an Antarctic Science Bursary project, a University of Cambridge PhD studentship, and within the National Capability remit of the BAS Science Teams in “Geology and Geophysics” and “Palaeoenvironments and Climate Change”. These projects are: • Tracing and reconstructing the neodymium and carbon isotopic composition of circum-Antarctic waters (CGS-100, PI: A.M. Piotrowski, Department of Earth Sciences, University of Cambridge; cruise participants: A.M. Piotrowski and T.J. Williams). • Structural characterisation of Late Quaternary sediments from West Antarctic contourite drifts using three dimensional X-ray imaging (CT-scanning) (CGS-98, PI: C. Ó Cofaigh, Department of Geography, Durham University; cruise participant: J. Horrocks) • Tracing the Quaternary evolution of the Antarctic Peninsula and West Antarctic Ice Sheets using lead isotopes in ice-rafted feldspar mineral grains (Antarctic Science Bursary awarded to C. Cook). • Seismic imaging of oceanographic structures and processes in the Southern Ocean south of the Polar Front (component of University of Cambridge/BP Institute PhD studentship; primary supervisor: N.J. White, Department of Earth Sciences, University of Cambridge; PhD student and cruise participant: K.L. Gunn). • Modelling crustal structure across the Bellingshausen Gravity Anomaly and oceanic fracture zones formed at the Antarctic-Phoenix Ridge through integration of marine potential field and seismic data (Collaboration between two BAS Science Teams; cruise participant: T.A.R.M. Jordan). 2 The cruise also provided support for physical oceanography projects by deploying six Argo floats and rescuing a malfunctioning sea glider. Towards the end of the cruise, RRS James Clark Ross was diverted to Rothera to uplift 16 personnel who had been flown across from Halley in two ALCI Basler aircraft because the sea ice situation in the Weddell Sea was considered to pose a significant risk to the scheduled last call of the season at Halley by RRS Ernest Shackleton. This uplift resulted in a two-day delay to arrival at Punta Arenas at the end of the cruise, which was in addition to a two-day extension already agreed as a result of departure from Punta Arenas having been delayed by slow refuelling. Adverse weather conditions, particularly during the first half of the cruise, resulted in more downtime than the amount of contingency time that had been allowed in the proposal. As a result, one less piston core and about 20% fewer line-km of seismic data were collected than had been planned. Nevertheless, the key objectives were achieved and the cores and data that were collected are of very good quality. The data and cores collected on cruise JR298, combined with existing data and cores, should satisfy all of the requirements of the Site Characterisation Panel and the Environmental Protection and Safety Panel of IODP. They will also provide a good basis for addressing the science objectives set out in the UK-IODP Site Survey Investigation proposal and those of the ancillary projects listed above