Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis C

The cost-effectiveness of noninvasive tests (NITs) as alternatives to liver biopsy is unknown. We compared the cost-effectiveness of using NITs to inform treatment decisions in adult patients with chronic hepatitis C (CHC). We conducted a systematic review and meta-analysis to calculate the diagnostic accuracy of various NITs using a bivariate random-effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes (quality-adjusted life-years; QALYs) using data from the meta-analysis, literature, and national UK data. We compared the cost-effectiveness of four treatment strategies: testing with NITs and treating patients with fibrosis stage ≥F2; testing with liver biopsy and treating patients with ≥F2; treat none; and treat all irrespective of fibrosis. We compared all NITs and tested the cost-effectiveness using current triple therapy with boceprevir or telaprevir, but also modeled new, more-potent antivirals. Treating all patients without any previous NIT was the most effective strategy and had an incremental cost-effectiveness ratio (ICER) of £9,204 per additional QALY gained. The exploratory analysis of currently licensed sofosbuvir treatment regimens found that treat all was cost-effective, compared to using an NIT to decide on treatment, with an ICER of £16,028 per QALY gained. The exploratory analysis to assess the possible effect on results of new treatments, found that if SVR rates increased to >90% for genotypes 1-4, the incremental treatment cost threshold for the "treat all" strategy to remain the most cost-effective strategy would be £37,500. Above this threshold, the most cost-effective option would be noninvasive testing with magnetic resonance elastography (ICER=£9,189). Conclusions: Treating all adult patients with CHC, irrespective of fibrosis stage, is the most cost-effective strategy with currently available drugs in developed countries. © 2014 The Authors

Greek research reactor performance characteristics after addition of beryllium reflector and LEU fuel

The GRR-1 is a 5-MW pool-type, light-water-moderated and-cooled reactor fueled with MTR-type fuel elements. Recently received Be reflector blocks will soon be added to the core to add additional reactivity until fresh LEU fuel arrives. REBUS-3 xy fuel cycle analyses, using burnup dependent cross sections, were performed to assist in fuel management decisions for the water- and Be-reflected HEU nonequilibrium cores. Cross sections generated by EPRI-CELL have been benchmarked to identical VIM Monte Carlo models. The size of the Be-reflected LEU core has been reduced to 30 elements compared to 35 for the HEU water-reflected core, and an equilibrium cycle calculation has been performed

Analysis and tests of TF magnet insulation samples for the JET upgrade to 4 tesla

The JET Toroidal Field (TF) coils were originally designed for operation at 3.4 tesla. In order to upgrade the field to 4 tesla and thus improve the performance of the JET machine, new mechanical tests and analysis were carried out on the insulation of TF coil samples. They are aimed at investigating the mechanical properties and the status of the insulation in order to set allowable stresses and force limits. In particular since the shear stress in the insulation is strongly affected by the shear modulus of elasticity G, it is important to measure this parameter. A method for the measurement of G in glass-resin fibres, the V-notched beam method (Iosipescu method) , was applied. The particular shape of the rectangular Iosipescu V- notched sample and the particular modality of force application produce pure shear stress for a reliable measurement of the G value and of the shear strength of the insulation. The effect of temperature on these mechanical properties was also investigated. Results show higher average shear strength with lower scatter compared with previous tests on conventional rectangular samples, thus confirming the reliability of the method. Micrographic analysis of the insulation and comparison between the straight and curved regions of the magnet, where the highest stress occurs, confirm the good quality of the impregnation of the coil. Glass-resin content, void content, micros and TG measurements have been performed on different samples and correlation between the different properties of the insulation investigated. Moreover fatigue tests at different temperatures were performed and data analyzed with the cumulative damage technique, which allows for an extrapolation of the fatigue curve with less samples than the standard method. (6 refs)

Are confidence levels of hospital pharmacists different from other pharmacists in the management of anticoagulation therapy? Preliminary results from a multinational pharmacists needs assessment survey

Poster presented at the 22nd Congress of the EAHP (European Association of Hospital Pharmacists): Hospital pharmacists – catalysts for change, 22-24 March 2017, Cannes, FranceN/

Cost-effectiveness of noninvasive liver fibrosis tests for treatment decisions in patients with chronic hepatitis B in the UK: systematic review and economic evaluation

The copyright line for this article was changed on 18 November 2016 after original online publication. Abbreviations: CEAF cost-effectiveness frontier. CHB chronic hepatitis B. CI confidence intervals. FN false negative. FP false positive. HBV hepatitis B virus. HCC hepatocellular carcinoma. ICER incremental cost-effectiveness ratio. NITs noninvasive tests. QUADAS Quality Assessment of Diagnostic Accuracy Studies. QUALYs quality-adjusted-life-years. TN true negative. TP true positive.Copyright © 2015 The Authors. We compared the cost-effectiveness of various noninvasive tests (NITs) in patients with chronic hepatitis B and elevated transaminases and/or viral load who would normally undergo liver biopsy to inform treatment decisions. We searched various databases until April 2012. We conducted a systematic review and meta-analysis to calculate the diagnostic accuracy of various NITs using a bivariate random-effects model. We constructed a probabilistic decision analytical model to estimate health care costs and outcomes quality-adjusted-life-years (QALYs) using data from the meta-analysis, literature, and national UK data. We compared the cost-effectiveness of four decision-making strategies: testing with NITs and treating patients with fibrosis stage ≥F2, testing with liver biopsy and treating patients with ≥F2, treat none (watchful waiting) and treat all irrespective of fibrosis. Treating all patients without prior fibrosis assessment had an incremental cost-effectiveness ratio (ICER) of £28 137 per additional QALY gained for HBeAg-negative patients. For HBeAg-positive patients, using Fibroscan was the most cost-effective option with an ICER of £23 345. The base case results remained robust in the majority of sensitivity analyses, but were sensitive to changes in the ≥F2 prevalence and the benefit of treatment in patients with F0–F1. For HBeAg-negative patients, strategies excluding NITs were the most cost-effective: treating all patients regardless of fibrosis level if the high cost-effectiveness threshold of £30 000 is accepted; watchful waiting if not. For HBeAg-positive patients, using Fibroscan to identify and treat those with ≥F2 was the most cost-effective option.The analysis for Hepatitis B was part of a larger project funded by The National Institute for Health Research Health Technology Assessment (HTA project 09/114/02) and will be published in full in the Health Technology Assessment journal series. Visit the HTA programme website for more details www.hta.ac.uk/link to project page

Enabling transparent technologies for the development of highly granular flexible optical cross-connects

Flexible optical networking is identified today as the solution that offers smooth system upgradability towards Tb/s capacities and optimized use of network resources. However, in order to fully exploit the potentials of flexible spectrum allocation and networking, the development of a flexible switching node is required capable to adaptively add, drop and switch tributaries with variable bandwidth characteristics from/to ultra-high capacity wavelength channels at the lowest switching granularity. This paper presents the main concept and technology solutions envisioned by the EU funded project FOX-C, which targets the design, development and evaluation of the first functional system prototype of flexible add-drop and switching cross-connects. The key developments enable ultra-fine switching granularity at the optical subcarrier level, providing end-to-end routing of any tributary channel with flexible bandwidth down to 10Gb/s (or even lower) carried over wavelength superchannels, each with an aggregated capacity beyond 1Tb/s. © 2014 IEEE

Designing Playful Games and Applications to Support Science Centers Learning Activities

In recent years there has been a renewed interest on science, technology, engineering, and mathematics (STEM) education. Following this interest, science centers\u27 staff started providing technology enhanced informal STEM education experiences. The use of well-designed mobile and ubiquitous forms of technology to enrich informal STEM education activities is an essential success factor. The goal of our research is to investigate how technology applications can be better used and developed for taking full advantage of the opportunities and challenges they provide for students learning about STEM concepts. In our approach, we have conducted a series of interviews with experts from science center curating and outdoor learning activities development, with the final goal of exploring and improving current learning environments and practices. This paper presents the development of set of design considerations for the development of STEM games and applications of young students. An initial set of best practices was first developed through semi-structures interviews with experts; and afterwards, by employing content analysis, a revised set of considerations was obtained. These results are useful for STEM education teachers, curriculum designers, curators and developers for K-12 education environments

Inflammation-based scores do not predict post-transplant recurrence of hepatocellular carcinoma (HCC) in patients within Milan criteria.

Background: Increased preoperative inflammation scores, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and inflammation-based index (IBI) have been related to post-transplant HCC recurrence. We evaluated the association between inflammation-based scores (NLR, PLR, IBI) and post-LT HCC recurrence as well as tumour necrosis after transarterial embolisation. Methods: 150 consecutive patients that were transplanted for HCC within the Milan criteria between 1996-2010 were included; data regarding inflammatory markers, patient and tumour characteristics were analyzed. Results: NLR, PLR and IBI were not significantly associated with post-LT HCC recurrence or worse overall survival. Increased NLR and PLR were associated with complete tumour necrosis in the subset of patients that received preoperative transarterial embolization (P<0.05). Cox regression analysis revealed that absence of neo-adjuvant transarterial therapy (OR=4.33, 95%CI 1.28-14.64; P=0.02) and no fulfilment of the Milan criteria in the explanted liver (OR=3.34, 95%CI 1.08-10.35; P=0.04) were independently associated with post-LT HCC recurrence. Conclusion: Inflammation-based scores did not predict HCC recurrence post-LT in our group of patients. NLR and PLR were associated with better response to TAE, as this was recorded histologically in the explanted liver. Histological fulfilment of the Milan criteria and absence of neo-adjuvant transarterial treatment were significantly associated with post-LT HCC recurrence. Liver Transpl , 2014. © 2014 AASLD

Promoting dental care to children using traditional and interactive media following threat appeals

In recent years, computer games have become an important part of children’s lives. Gaming is not only one of their favorite pastime activities, but games are also increasingly used by marketers in an attempt to influence children’s purchase behavior. Today, almost every food and beverage brand targeting children has an advergame on its website. Advergames are “computer games specifically created to function as advertisements to promote brands”, containing brand identifiers such as logos and brand characters (Kretchmer, 2005: 7). Games can also be powerful learning tools. Several authors (e.g., Gee, 2003; Prensky, 2001) argue that computer games can be more enjoyable, more interesting and thus more effective than traditional learning modes to increase children’s knowledge. Empirical studies that evaluated the impact of the use of games within disciplines such as mathematics, science, language, geography and computer science show positive outcomes in terms of learning effectiveness in relation to curricular objectives (e.g., Papastergiou, 2009; Rosas et al., 2003). However, these authors mainly focus on the learning ability of games rather than their persuasive impact for social marketing purposes. In the area of health education, playing computer games has often been seen with skepticism (e.g., Bale, 1994; Funk and Buchman, 1995)