Cost-effectiveness of osimertinib versus standard EGFR-TKI as first-line treatment for locally advanced or metastatic EGFR mutation-positive non-small cell lung cancer in Australia.

Objectives: To assess the cost-effectiveness of osimertinib versus standard epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), gefitinib or erlotinib, as first-line treatment for patients with locally advanced or metastatic EGFR mutation-positive non-small cell lung cancer in Australia from a healthcare system perspective. Methods: A partitioned survival model comprising three mutually exclusive health states with a five-year time horizon was developed. Model inputs were sourced from the pivotal trial (FLAURA) and published literature. Incremental cost-effectiveness ratios (ICERs), in terms of cost per quality-adjusted life-year (QALY) gained and cost per life-year (LY) gained, were calculated. Uncertainty of the results was assessed using deterministic and probabilistic sensitivity analyses. Results: Compared with standard EGFR-TKIs, osimertinib was associated with a higher incremental cost of A$118,502, and an incremental benefit of 0.274 QALYs and 0.313 LYs. The ICER was estimated to be A$432,197/QALY gained and A$378,157/LY gained. The base-case ICER was most sensitive to changes in cost of first-line osimertinib, time horizon, and choice of overall survival data (interim versus final analysis). Conclusions: At a willingness-to-pay threshold of A$50,000/QALY, first-line osimertinib is not cost-effective compared with standard EGFR-TKIs in Australia based on the current published price. To achieve acceptable cost-effectiveness, the cost of first-line osimertinib needs to be reduced by at least 68.4%

Probing the gateway to superheavy nuclei in cranked relativistic Hartree-Bogoliubov theory

The cranked relativistic Hartree+Bogoliubov theory has been applied for a systematic study of the nuclei around 254No, the heaviest nuclei for which detailed spectroscopic data are available. The deformation, rotational response, pairing correlations, quasi-particle and other properties of these nuclei have been studied with different relativistic mean field (RMF) parametrizations. For the first time, the quasi-particle spectra of odd deformed nuclei have been calculated in a fully self-consistent way within the framework of the RMF theory. The energies of the spherical subshells, from which active deformed states of these nuclei emerge, are described with an accuracy better than 0.5 MeV for most of the subshells with the NL1 and NL3 parametrizations. However, for a few subshells the discrepancy reach 0.7-1.0 MeV. The implications of these results for the study of superheavy nuclei are discussed.Comment: 7 pages, 3 figures, Proceedings of the Conference on Frontiers of Nuclear Structure, Berkeley, California, July 29th - August 2nd, 2002, UC Berkeley, Clark Kerr Campus, in pres

Lost in translation: how can education about dementia be effectively integrated into medical school contexts? A realist synthesis

\ua9 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. OBJECTIVES: The prevalence of dementia in both community and hospital settings requires a clinical workforce that is skilled in diagnosis and management of the condition to competently care for patients. Though evidence of successful educational interventions about dementia exists, effective translation into medical school curricula is the exception rather than the norm. DESIGN: We adopted a realist synthesis approach following Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) guidelines to answer the following questions: (1) what are the barriers to integrating effective interventions about dementia into medical school curricula and (2) where they are successfully delivered, what are the contextual factors that allow for this enactment? DATA SOURCES: We searched PubMed, Embase, CINAHL and PsycINFO using the MesH terms Schools, Medical; Students, Medical; Education, Medical AND Neurocognitive disorders or the closest possible set of terms within each database. ELIGIBILITY CRITERIA: Undergraduate or graduate entry medical school programme, teaching and learning focussing on dementia, evaluating student outcomes (satisfaction, knowledge, skills, attitudes or behaviours), interventions described clearly enough to classify teaching method, any research design (quantitative and qualitative), English language. DATA EXTRACTION AND SYNTHESIS: We used a shared spreadsheet to enter key information about eligible studies and the reasons for excluding studies that did not fit eligibility criteria. We extracted descriptive data about the nature of educational interventions and narrative information as to barriers and facilitators to implementing those interventions. RESULTS: Our initial literature search identified 16 relevant papers for review. Systematic extraction of data informed the development of an initial programme theory (IPT) structured around four contextual barriers: \u27culture\u27, \u27concern for patient welfare\u27, \u27student attitudes\u27 and \u27logistics\u27 with associated facilitatory mechanisms embed medical education about dementia. CONCLUSIONS: We outline the process of generating our IPT, including overlap with Cultural Historical Activity Theory. We outline our intention to refine our programme theory through ongoing review of the evidence base and collaboration with stakeholders, with the aim of finalising a model for successful integration of dementia education

Heated Motorized Stage for Nanoscale Thin Film Deposition

ME450 Capstone Design and Manufacturing Experience: Fall 2015Thin film deposition is a technology of applying a very thin film of material onto a substrate surface to be coated, or onto a previously deposited coating to form layers. As a modified Atomic Layer Deposition (ALD) method, Spatial ALD greatly improves the efficiency of the process by separating the half-reactions spatially instead of through the use of purge steps in convectional ALD. This paper proposes the use of heated motorized stage as a research prototype to further study the effect of deposition conditions such as gap size, gap alignment and substrate temperature on the SALD coating results. This strategy utilized three stepper motors and high precision non-contact gap sensors to control gap alignment and gap size between the substrate and the depositor. The details of the involved methodology, engineering analysis, validation of the final design and the design critiques are discussed in this paper.http://deepblue.lib.umich.edu/bitstream/2027.42/117338/1/ME450-F15-Project19-FinalReport.pd

Simple model for decay of superdeformed nuclei

Recent theoretical investigations of the decay mechanism out of a superdeformed nuclear band have yielded qualitatively different results, depending on the relative values of the relevant decay widths. We present a simple two-level model for the dynamics of the tunneling between the superdeformed and normal-deformed bands, which treats decay and tunneling processes on an equal footing. The previous theoretical results are shown to correspond to coherent and incoherent limits of the full tunneling dynamics. Our model accounts for experimental data in both the A~150 mass region, where the tunneling dynamics is coherent, and in the A~190 mass region, where the tunneling dynamics is incoherent.Comment: 4 page