Assessing the cost-effectiveness of tumor necrosis factor inhibitors and prescribing practices of rheumatologists in patients with rheumatoid arthritis

Three new tumor necrosis factor (TNF) inhibitors, adalimumab, etanercept, and infliximab, have been approved for use in patients with active RA. The goals of the study were two fold: (1) to perform a cost-effectiveness analysis of the three TNF inhibitors in patients with RA that inadequately respond to MTX alone and (2) to assess the current prescribing patterns, laboratory monitoring practices, and perceived barriers of rheumatologists in prescribing these agents in patients with RA. Phase I involved the development of a Markov simulation model to estimate the health effects and costs associated with five treatment strategies in patients with RA that inadequately respond to MTX alone: (1) adalimumab plus MTX, (2) etanercept plus MTX, (3) infliximab plus MTX, (4) leflunomide plus MTX, and (5) standard therapy of MTX. A hypothetical cohort of 10,000 55-year old women was evaluated using Monte Carlo simulation. The study was conducted from a societal perspective. The main outcome measures were net gains in quality-adjusted life expectancy and incremental cost-effectiveness ratios, (ICERs) in dollars per quality adjusted life year (QALY) gained. Costs and effects were discounted at 3%. Etanercept plus MTX was the most cost-effective treatment with an ICER of {dollar}49,724/QALY. Leflunomide plus MTX was the second most cost-effective option with an ICER of {dollar}52,833/QALY. One-way and probabilistic sensitivity analyses indicated that the conclusions were relatively stable to variations in model assumptions. In phase II, a survey was mailed to a randomly selected national sample of rheumatologists, of which 22.3% responded. The survey findings indicated that TNF inhibitor use was not restricted to moderate and severe patients with RA. Also, TNF inhibitor plus one disease modifying anti-rheumatic drug was the treatment of choice in patients with severe RA that inadequately respond to MTX alone. Costs to the patient and insurance coverage were perceived as major barriers in prescribing TNF inhibitors. One-fourth of the rheumatologists reported not using any monitoring guidelines for the TNF inhibitors indicating a need to revise monitoring guidelines or perhaps implement new guidelines for TNF inhibitors

Poverty, Growth and Income Distribution in Lebanon

This Country Study is based on a full national report that is the first to draw a profile of poverty in Lebanon based on money-metric poverty measurements of household expenditures. The report provides a comprehensive overview of the characteristics of the poor and estimates the extent of poverty and the degree of inequality in the country. It finds that nearly 28 per cent of the Lebanese population can be considered poor and eight per cent can be considered extremely poor. However, the most important finding of the report is that regional disparities are striking. For example, whereas poverty rates are insignificant in the capitol, Beirut, they are very high in the Northern city of Akkar. In general, the North governorate has been lagging behind the rest of the country and thus its poverty rate has become high. Levels of poverty are above-average in the South but are not as severe as expected. There are three other major results that have notable implications for a poverty-reduction programme in Lebanon. First, with few exceptions, measures of human deprivation, such as that provided by an Unsatisfied Basic Needs methodology, are generally commensurate with those for money-metric measures based on household expenditures. Second, the projected cost of halving extreme poverty is very modest, namely, a mere fraction of the cost of the country?s large external debt obligations. However, such a cost would rise dramatically if inequality were to worsen (i.e., if future growth were anti-poor). Also, the cost of reducing overall poverty would be substantially higher. Third, the poor are heavily concentrated among the unemployed and among unskilled workers, with the latter concentrated in sectors such as agriculture and construction. This places a priority on a broad-based, inclusive pattern of economic growth that could stimulate employment in such sectors. Based on such findings, the report concentrates on providing general policy recommendations on issues of directing public expenditures to poor households. One of its major recommendations is to concentrate on channelling resources to poor regions below the governorate level, such as to four ?strata? where two-thirds of the poor in Lebanon are concentrated. However, the report notes that macroeconomic policies, particularly fiscal policies, will have to be redesigned to mobilize the reources necessary to finance the increases in public expenditures on the social safety nets and public investment in social services that should be part of a major poverty-reduction programme.Poverty, Growth and Income Distribution in Lebanon

A systematic review of quality of life instruments in long-term breast cancer survivors

Abstract Background Breast cancer is the most common cancer in women, representing 16% of all female cancers. According to the American Cancer Society, long-term cancer survival is defined as more than five years of survivorship since diagnosis, with approximately 2.5 million breast cancer survivors (BCS) in 2006. The long-term effects from breast cancer and its treatment have been shown to have positive and negative effects on both recovery and survivors' quality of life (QoL). The purpose of the study was to identify QoL instruments that have been validated in long-term BCS and to review the studies that have used the QoL instruments in this population. Methods A systematic literature search was conducted from January 1990 to October 2010 using electronic databases. Instruments validated and used in BCS were included in the review. In addition, QoL studies in long-term BCS using the validated instruments were reviewed. The search was limited to studies in English language. Studies of BCS of less than five years after initial diagnosis, any clinical or review studies were excluded. Results The review identified a total of 12 instruments (10 disease-specific, 2 condition-specific) validated in long-term BCS. According to the QoL framework proposed by Ferrell and colleagues, three instruments (Quality of Life-Cancer Survivors, Quality of Life in Adult Cancer Survivors Scale, and Quality of Life Index-Cancer Version) evaluated all four domains (physical, psychological, social, and spiritual) of QoL. A review of the psychometric evaluation showed that Quality of Life in Adult Cancer Survivors Scale has acceptable reliability, validity, and responsiveness in long-term BCS compared to other disease-specific instruments. The review also yielded 19 studies that used these QoL instruments. The study results indicated that age-group, ethnicity, and type of treatment influenced different aspects of QoL. Conclusions There is a significant impact of breast cancer on QoL in long-term BCS. The review can help researchers and clinicians select the most appropriate instruments to assess the changes in QoL in BCS.</p

Occupational safety and health practice: a study at Infrastructure construction work

Safety is the state of being “safe”, the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types of consequences of failure, damage, error, accidents, harm or any other event which could be considered non-desirable. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. In that case, Occupational Safety and Health Act (OSHA) is an act that ensure the well-being of workers in a broad scope of many specialized fields. This study is focused on the construction of a police headquarters located in Seriab, Perlis. A big number of construction companies in Malaysia might not perform safety practice for their workers, lack of safety appliances, and did not perform a regular safety check-up on their workers as the reason was they want to earn more profits and they took the safety measures of their foreign workers for granted. Note that most of construction workers in Malaysia are immigrants. The data collection was carried out through site investigation using Preliminary Hazard analysis (PHA), HIRARC form and interview session with a worker in the construction site. The objective of this study is to spread the awareness of the importance of safety among workers in the construction site based on the existing potential hazards. This report was initially to identify the hazard on the construction site and to analyse the occupational safety and health factor in the workplace. The results are to analyse and suggest recommendations for improving occupational safety and health act in the construction site. Practicing a good safety measures in the workplace will ensure the well-being of workers

A review of digital forensics methods for JPEG file carving

Digital forensics is an important field of cybersecurity and digital crimes investigation. It entails applying file recovery methods to analyze data from storage media and extract hidden, deleted or overwritten files. The recovery process might have accompanied with cases of unallocated partitions of blocks or clusters and the absence of file system metadata. These cases entail advance recovery methods that have carving abilities. The file carving methods include different types of techniques to identify, validate and reassemble the file. This paper presents a comprehensive study of data recovery, file carving, and file reassembling. It focuses on identifying and recovering JPEG Images as it is a wildly covered in the literature. It classifies the carving techniques into three types: signature-, structure-, and content-based carvers. Subsequently, the paper reviews seven advanced carving methods in the literature. Finally, the paper presents a number of research gaps and conclude a number of possible improvements. Generally, both the gaps and possible improvements are associated with the fragmentation problem of data files

Robust Adaptive Control of Switched Systems

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Dynamic Optimization of Network Routing Problem through Ant Colony Optimization (ACO)

Search Based Software Engineering (SBSE) is a new paradigm of Software engineering, which considers software engineering problems as search problems and emphasizes to find out optimal solution for the given set of available solutions using metaheuristic techniques like hill climbing simulated annealing, evolutionary programming and tabu search. On the other hand AI techniques like Swarm particle optimization and Ant colony optimization (ACO) are used to find out solutions for dynamic problems. SBSE is yet not used for dynamic problems. In this study ACO techniques are applied on SBSE problem by considering Network routing problem as case study, in which the nature of problem is dynamic. Keywords: SBSE, ACO, Metaheuristic search techniques, dynamic optimizatio

Performance analysis of Gb/s WDM FDDI network

In this paper, we propose a time-token multi-Gb/s Wavelength Division Multiplexing Fibre Distributed Data Interface (WDM/FDDI) architecture and examine its throughput efficiency and delay under heavy load for different network configuration using discrete event simulator

Temporal dynamics of willingness to pay for alternatives that increase the reliability of water and wastewater service

Public perceptions are dynamic and, continually being in flux, they can profoundly impact infrastructure projects and policies. Providers of water and wastewater services need to understand the dynamic nature of public perceptions so as to be able to identify times of greater public support. They may thus be able to take timely actions to implement capital projects or increase operational revenues. In this study, the dynamic nature of public perceptions is demonstrated through survey analyses of data collected, between 2013 and 2016, in 21 shrinking U.S. cities. A random-parameters Tobit regression model identified influential geographic and sociodemographic factors that changed over time on user stated willingness to pay (WTP). A likelihood ratio test confirmed a statistically significant shift, between 2013 and 2016, in participants’ WTP values. Model results reveal that, between the timeframes of the deployed surveys, the influences of geographic (e.g., Michigan and Ohio) and sociodemographic (e.g., age, income) factors on stated WTP did in fact change. The influential parameters that indicate greater public support can be leveraged by infrastructure managers to develop strategies that may result in the successful delivery of infrastructure projects and that increase operational revenues. Moreover, public perceptions should be periodically investigated to continually identify times of greater public support for infrastructure projects.Civil, Architectural, and Environmental Engineerin

Estudio de las etapas de automatización de una aplicación industrial basada en la gestión y transporte de paquetes

En este proyecto sea ha realizado la simulación de un proceso industrial de paquetes en el laboratorio de la Universidad Politécnica de Cataluña, Terrassa. El proceso industrial está formado por cinco estaciones de trabajo donde se ubicaría un robot, seis sensores de reconocimiento y una estación de entrada para los paquetes vacíos. Todos estos elementos mencionados serán simulados. El proceso consiste en llenar los paquetes con el producto correspondiente y dirigirlos a las estaciones de trabajo que les corresponden. En esta línea hay tres tipos de producto que se introducirán en los paquetes vacíos. Las cajas vacías ya tendrán determinado que tipo de producto debe ir en ellas gracias a los identificadores. Además, la línea gestiona en todo momento donde está situado cada paquete y también determina la dirección a la que debe ir para su acabado. Este proyecto consta de la programación del PLC para llevar a cabo las acciones simulada