Economic consequences of near-patient test results - the case of tests for the Helicobacter Pylori bacterium in dyspepsia

Abstract Diagnostic tests and in particular laboratory tests are often important in diagnostic work-up and monitoring of patients. Therefore the economic consequences of medical actions based on test results may amount to a substantial proportion of health service costs. Thus, it is of public interest to study the consequences and costs of using laboratory tests. We develop a model for economic evaluation related to the diagnostic accuracy (sensitivity and specificity) of near patient tests. Blood sample based tests to detect the bacterium Helicobacter Pylori (HP) are useful in diagnosing peptic ulcer and suitable to illustrate the model. First, general practitioners’ initial management plans for a dyspeptic patient are elucidated using a paper vignette survey. Based on survey results, and medical literature, a decision tree is constructed to visualize expected costs and outcomes resulting from using three different HP tests in the clinical situation described in the vignette. Tests included are two rapid tests for use in general practice, and one hospital laboratory test for comparison. The tests had different sensitivities and specificities. Then a costeffectiveness analysis is undertaken from a societal perspective. Finally we use sensitivity analyses to model the decision uncertainty. Estimating for a follow-up period of 120 days, the rapid test with lower sensitivity and specificity than the hospital HP test is cost-effective because the laboratory result is available immediately. Further, in general practice, the rapid test with the highest sensitivity is significantly cost effective compared to the test with the highest specificity when the willingness to pay for each dyspepsia-free day exceeds €42.6. When deciding whether a laboratory analysis should be analysed in the office laboratory or not, it is important to consider both the diagnostic accuracy of the tests and the waiting time for the alternative, i.e. a hospital laboratory result.cost-effectiveness; laboratory tests; general practice; probabilistic sensitivity; analysis

Decision-making in General Practice: The importance of laboratory analyses when choosing medical actions

The focus of this study is the effect of a laboratory analysis and socioeconomic variables on choosing medical actions in a specific situation (a clinical vignette - a young woman, Mrs Hansen, with dyspepsia - presented to GPs). We assume that the GP’s decision depends on what he or she thinks is best for the patients, based on the best clinical evidence available. Significant variables associated with the choice of medical actions are: the result of the Helicobacter pylori (HP) test, the GP’s stated importance of HPRT, the location of the general practice, the GP recommending sick leave, the GP’s stated probability that Mrs Hansen’s symptoms are due to a H.pylori infection after the HP-result is known, and how the GP follows up the patient. Our results show that the HP-analysis has a significant and major influence on the GPs choice of medical actions. Therefore the quality of the analysis is likely to affect the patients’ health and social costs. Hence institutions for quality monitoring and improvement are important elements of health care reforms. Such institutions should balance cost and benefits of quality improving measures, and will be the focus of closer studies in our future research.Discrete choice models; Decision-making; Primary Health Care

Water Protectors & Land Defenders: Recentering Indigenous Reciprocity with the Living World

Mni Wiconi. Water is life. These are the words that fueled protests of the Dakota Access Pipeline at the Standing Rock Sioux Reservation beginning in 2016. The construction of the Dakota Access Pipeline (DAPL) underneath Mni Sose, or the Missouri River, poses a direct threat to Standing Rock’s primary drinking source (Weston, para. 2). Recognizing that the federal and Tribal court systems would likely ignore their pleas, the people of Standing Rock joined together with members of their sister Tribes among the Oceti Sakowin (Seven Council Fires), or Great Sioux Nation, to protect the drinking water from potential destruction. The movement encouraged indigenous people from around the world to join the Water Protectors—as they called themselves—in their efforts. Months of protest by the Oceti Sakowin people and indigenous and environmental activists brought world-wide attention to the movement and sparked a stream of social media posts with hashtags #NODAPL, #mniwiconi, #waterislife, and #rezpectourwater (Weston, para. 9). Thousands of people joined this Indigenous-led movement, participating in marches, encampments, relay runs, letter campaigns, elaborate banner drops, blockades, and more

The ehrenfeucht conjecture: An algebra-framework for its proof

AbstractWe describe an algebraic framework including, in particular, the affine monoid of a given ring. Within this framework it is a simple matter to deduce Ehrenfeucht's Conjecture from Hilbert's Basis Theorem

State Capacity, Internal Conflict and Democratic Breakdown - A Comparative Study of Mali and Ghana.

The two underdeveloped, West-African states, Mali and Ghana, have been praised for their well-established democratic institutions, and have been said to be good role models when it comes to democracy in an African context. However, Mail experienced a sudden democratic breakdown in 2012, after violent rebellion and a military coup. This puzzle" is what this thesis is about, and to unravel the underlying structures and causes, a qualitative case study is conducted to investigate how variations in state capacity and internal conflict can help explain the difference in outcome in Mali and Ghana. There is a clear pattern showing in Mali, where incapacity on a range of indicators of state capacity, and an unresolved conflict in the northern region can be said to have caused the democratic breakdown. A more muted conflict level and a higher degree of state capacity is the trend in Ghana, and stands as the reason for why the breakdown happened in Mali, and not in Ghana.Master i Sammenliknende politikkSAMPOL350MASV-SAP

The Entropy of Square-Free Words

Finite alphabets of at least three letters permit the construction of square-free words of infinite length. We show that the entropy density is strictly positive and derive reasonable lower and upper bounds. Finally, we present an approximate formula which is asymptotically exact with rapid convergence in the number of letters.Comment: 18 page

Vertex coloring of plane graphs with nonrepetitive boundary paths

A sequence $s_1,s_2,...,s_k,s_1,s_2,...,s_k$ is a repetition. A sequence $S$ is nonrepetitive, if no subsequence of consecutive terms of $S$ form a repetition. Let $G$ be a vertex colored graph. A path of $G$ is nonrepetitive, if the sequence of colors on its vertices is nonrepetitive. If $G$ is a plane graph, then a facial nonrepetitive vertex coloring of $G$ is a vertex coloring such that any facial path is nonrepetitive. Let $\pi_f(G)$ denote the minimum number of colors of a facial nonrepetitive vertex coloring of $G$. Jendro\vl and Harant posed a conjecture that $\pi_f(G)$ can be bounded from above by a constant. We prove that $\pi_f(G)\le 24$ for any plane graph $G$

A fast hidden line algorithm with contour option

The JonesD algorithm was modified to allow the processing of N-sided elements and implemented in conjunction with a 3-D contour generation algorithm. The total hidden line and contour subsystem is implemented in the MOVIE.BYU Display package, and is compared to the subsystems already existing in the MOVIE.BYU package. The comparison reveals that the modified JonesD hidden line and contour subsystem yields substantial processing time savings, when processing moderate sized models comprised of 1000 elements or less. There are, however, some limitations to the modified JonesD subsystem