Assessment of the learning curve in health technologies: a systematic review

Objective: We reviewed and appraised the methods by which the issue of the learning curve has been addressed during health technology assessment in the past. Method: We performed a systematic review of papers in clinical databases (BIOSIS, CINAHL, Cochrane Library, EMBASE, HealthSTAR, MEDLINE, Science Citation Index, and Social Science Citation Index) using the search term "learning curve:" Results: The clinical search retrieved 4,571 abstracts for assessment, of which 559 (12%) published articles were eligible for review. Of these, 272 were judged to have formally assessed a learning curve. The procedures assessed were minimal access (51%), other surgical (41%), and diagnostic (8%). The majority of the studies were case series (95%). Some 47% of studies addressed only individual operator performance and 52% addressed institutional performance. The data were collected prospectively in 40%, retrospectively in 26%, and the method was unclear for 31%. The statistical methods used were simple graphs (44%), splitting the data chronologically and performing a t test or chi-squared test (60%), curve fitting (12%), and other model fitting (5%). Conclusions: Learning curves are rarely considered formally in health technology assessment. Where they are, the reporting of the studies and the statistical methods used are weak. As a minimum, reporting of learning should include the number and experience of the operators and a detailed description of data collection. Improved statistical methods would enhance the assessment of health technologies that require learning

Assessing the learning curve effect in health technologies: Lessons from the non-clinical literature

Introduction: Many health technologies exhibit some form of learning effect, and this represents a barrier to rigorous assessment. It has been shown that the statistical methods used are relatively crude. Methods to describe learning curves in fields outside medicine, for example, psychology and engineering, may be better. Methods: To systematically search non–health technology assessment literature (for example, PsycLit and Econlit databases) to identify novel statistical techniques applied to learning curves. Results: The search retrieved 9,431 abstracts for assessment, of which 18 used a statistical technique for analyzing learning effects that had not previously been identified in the clinical literature. The newly identified methods were combined with those previously used in health technology assessment, and categorized into four groups of increasing complexity: a) exploratory data analysis; b) simple data analysis; c) complex data analysis; and d) generic methods. All the complex structured data techniques for analyzing learning effects were identified in the nonclinical literature, and these emphasized the importance of estimating intra- and interindividual learning effects. Conclusion: A good dividend of more sophisticated methods was obtained by searching in nonclinical fields. These methods now require formal testing on health technology data sets

Decision tools for sustainable development

Sustainable food production and improved food security are major aim of donors and developing country governments alike. Sustaining food production whilst avoiding environmental degradation require a supportive policy framework and the delivery of appropriate information to facilitate the decision making procedure. Better decision-making provides better early warning, improved judgement of risk and better timing of intervention. Decision Tools for Sustainable Development bring together up-to-date techniques for the collection and management of environmental and socio-economic information. It describes practical decision-making tools for use at all levels from local to international, for rural communities, research services, the food industry and for institutional decision-makers. The book will be essential reading for research managers, development specialists, government policy-makers, NGO staff and all those who need to make sound and effective decisions for the sustainable development of natural resources

Direct measurements of ice-shelf flexure caused by surface meltwater ponding and drainage.

Global sea-level rise is caused, in part, by more rapid ice discharge from Antarctica, following the removal of the restraining forces of floating ice-shelves after their break-up. A trigger of ice-shelf break-up is thought to be stress variations associated with surface meltwater ponding and drainage, causing flexure and fracture. But until now, there have been no direct measurements of these processes. Here, we present field data from the McMurdo Ice Shelf, Antarctica, showing that the filling, to ~2 m depth, and subsequent draining, by overflow and channel incision, of four surface lakes causes pronounced and immediate ice-shelf flexure over multiple-week timescales. The magnitude of the vertical ice-shelf deflection reaches maxima of ~1 m at the lake centres, declining to zero at distances of <500 m. Our results should be used to guide development of continent-wide ice-sheet models, which currently do not simulate ice-shelf break-up due to meltwater loading and unloading.This work was supported by the U.S. National Science Foundation under award PLR-1443126 to the University of Chicago, a Leverhulme Early Career Fellowship (ECF-2014-412) and a CIRES Postdoctoral Visiting Fellowship, both awarded to A.F.B., and a NASA Earth and Space Science Fellowship (NNX15AN44H) awarded to G.J.M

Balancing Pastoral and Plantation Forestry Options in New Zealand and the Role of Agroforestry

Pastoral agriculture and forestry enterprises are key features of New Zealand’s landscape and are very important economically. They are competing landuses, particularly on moderate to steep hill country. Agroforestry involving spaced trees of Pinus radiata on pasture was developed in the 1970s to provide dual incomes from livestock enterprises and the later tree crop. In contrast, wide-spaced trees of predominantly Populus and Salix spp. are planted mainly for erosion control. Characteristics of pastoralism and plantation forestry are reviewed, including trends in conversions between these landuses. Roles, challenges and opportunities with wide-spaced trees are presented, together with current and future research initiatives. Pastoralism and forestry will continue to compete strongly for hill country sites and at present there is an increasing trend of converting previously forested areas to pasture, particularly in the central North Island. Agroforestry involving Pinus radiata has virtually ceased because of adverse effects on wood quality, pasture production and animal performance. There are millions of wide-spaced trees of Populus and Salix spp. on hill country and their planting is expected to continue unabated because they are the most practical and efficient means of enabling pastoralism on erodible slopes and they provide multiple ecosystem services. The species have significant advantages compared to other woody species but many older trees have grown very large because they have received negligible or no silviculture. This is an increasing problem, requiring development and implementation of appropriate management strategies. There is growing interest by landowners in the environmental outcomes of spaced-tree plantings

Testing the role of circadian genes in conferring risk for psychiatric disorders

Disturbed sleep and disrupted circadian rhythms are a common feature of psychiatric disorders, and many groups have postulated an association between genetic variants in circadian clock genes and psychiatric disorders. Using summary data from the association analyses of the Psychiatric Genomics Consortia (PGC) for schizophrenia, bipolar disorder and major depressive disorder, we evaluated the evidence that common SNPs in genes encoding components of the molecular clock influence risk to psychiatric disorders. Initially, gene-based and SNP P-values were analyzed for 21 core circadian genes. Subsequently, an expanded list of genes linked to control of circadian rhythms was analyzed. After correcting for multiple comparisons, none of the circadian genes were significantly associated with any of the three disorders. Several genes previously implicated in the etiology of psychiatric disorders harbored no SNPs significant at the nominal level of

The Cascade GIS Diffusion Model for Measuring Housing Absorption by Small Area with a Case Study of St. Lucie County, Florida

The geographer's spatial diffusion theory is combined with Geographic Information Systems (GIS) technology to provide a new framework for predicting residential single-family development patterns. We refer to the model as a multiple-state 'Cascade' GIS diffusion model. Parameter calibration is done using two-stage least squares. The model predicts new housing built and purchased by small submarket. Our example submarket is at the census tract level; a smaller submarket could have been chosen. The contribution to housing forecasting literature is a structural model that captures the spatial diffusion process at various geographical scales. Model estimation and forecasts are facilitated using GIS technology via a high resolution and high precision database using county property tax bills.

Eukaryotic Cell Toxicity and HSA Binding of [Ru(Me4phen)(bb7)]2+ and the Effect of Encapsulation in Cucurbit[10]uril

The toxicity (IC50) of a series of mononuclear ruthenium complexes containing bis[4(4′-methyl-2,2′-bipyridyl)]-1,n-alkane (bbn) as a tetradentate ligand against three eukaryotic cell lines—BHK (baby hamster kidney), Caco-2 (heterogeneous human epithelial colorectal adenocarcinoma) and Hep-G2 (liver carcinoma)—have been determined. The results demonstrate that cis-α-[Ru(Me4phen)(bb7)]2+ (designated as α-Me4phen-bb7, where Me4phen = 3,4,7,8-tetramethyl-1,10-phenanthroline) showed little toxicity toward the three cell lines, and was considerably less toxic than cis-α-[Ru(phen)(bb12)]2+ (α-phen-bb12) and the dinuclear complex [{Ru(phen)2}2{μ-bb12}]4+. Fluorescence spectroscopy was used to study the binding of the ruthenium complexes with human serum albumin (HSA). The binding of α-Me4phen-bb7 to the macrocyclic host molecule cucurbit[10]uril (Q[10]) was examined by NMR spectroscopy. Large upfield 1H NMR chemical shift changes observed for the methylene protons in the bb7 ligand upon addition of Q[10], coupled with the observation of several intermolecular ROEs in ROESY spectra, indicated that α-Me4phen-bb7 bound Q[10] with the bb7 methylene carbons within the cavity and the metal center positioned outside one of the portals. Simple molecular modeling confirmed the feasibility of the binding model. An α-Me4phen-bb7-Q[10] binding constant of 9.9 ± 0.2 × 106 M−1 was determined by luminescence spectroscopy. Q[10]-encapsulation decreased the toxicity of α-Me4phen-bb7 against the three eukaryotic cell lines and increased the binding affinity of the ruthenium complex for HSA. Confocal microscopy experiments indicated that the level of accumulation of α-Me4phen-7 in BHK cells is not significantly affected by Q[10]-encapsulation. Taken together, the combined results suggest that α-Me4phen-7 could be a good candidate as a new antimicrobial agent, and Q[10]-encapsulation could be a method to improve the pharmacokinetics of the ruthenium complex

ASIME 2018 White Paper. In-Space Utilisation of Asteroids: Asteroid Composition -- Answers to Questions from the Asteroid Miners

In keeping with the Luxembourg government's initiative to support the future use of space resources, ASIME 2018 was held in Belval, Luxembourg on April 16-17, 2018. The goal of ASIME 2018: Asteroid Intersections with Mine Engineering, was to focus on asteroid composition for advancing the asteroid in-space resource utilisation domain. What do we know about asteroid composition from remote-sensing observations? What are the potential caveats in the interpretation of Earth-based spectral observations? What are the next steps to improve our knowledge on asteroid composition by means of ground-based and space-based observations and asteroid rendez-vous and sample return missions? How can asteroid mining companies use this knowledge? ASIME 2018 was a two-day workshop of almost 70 scientists and engineers in the context of the engineering needs of space missions with in-space asteroid utilisation. The 21 Questions from the asteroid mining companies were sorted into the four asteroid science themes: 1) Potential Targets, 2) Asteroid-Meteorite Links, 3) In-Situ Measurements and 4) Laboratory Measurements. The Answers to those Questions were provided by the scientists with their conference presentations and collected by A. Graps or edited directly into an open-access collaborative Google document or inserted by A. Graps using additional reference materials. During the ASIME 2018, first day and second day Wrap-Ups, the answers to the questions were discussed further. New readers to the asteroid mining topic may find the Conversation boxes and the Mission Design discussions especially interesting.Comment: Outcome from the ASIME 2018: Asteroid Intersections with Mine Engineering, Luxembourg. April 16-17, 2018. 65 Pages. arXiv admin note: substantial text overlap with arXiv:1612.0070

Xpert MTB/RIF as a Measure of Sputum Bacillary Burden. Variation by HIV Status and Immunosuppression

Rationale: Xpert MTB/RIF cycle threshold values are a measure of sputum mycobacterial burden. Data on the impact of HIV infection and immunosuppression on this measure are limited