An educational tool to illustrate cost-effectiveness in diagnostic pathways for coronary artery disease

Rapid increases in healthcare costs have led to increased interest in the cost-effectiveness of medical interventions. Coronary artery disease is responsible for a significant share of total healthcare spending, and therefore economic evaluations of medical procedures to treat the condition are potentially very important. We have developed a spreadsheet model as an educational tool that can be used to illustrate cost-effectiveness in the selection of diagnostic pathways (a "work-up" strategy of tests designed to reach a final diagnosis) for coronary artery disease. The model, in Microsoft Excel, is easy to use, requiring no specialist computer knowledge. It is menu-driven and the user navigates the model via a number of on-screen buttons. A data entry screen allows the user to customize the data for the key model parameters, making it possible to take into account location-specific features. The data entry screen also allows the user to undertake sensitivity analysis and rate "what if" scenarios. The model demonstrates how sensitive the cost-effectiveness of different diagnostic pathways is to the pretest probability of disease. This package could also be used as a decision support tool, although it is important to recognize some of its limitations for this purpose.     

Doping Mechanism and Permittivity Correlations in Nd-Doped BaTiO3

BaTiO₃ forms an extensive range of solid solutions with Nd₂O₃ by means of the double substitution mechanism: Ba + Ti 2Nd, as shown by both a phase diagram study and Rietveld refinement using powder neutron diffraction data. The solid solutions have the general formula Ba_1-xTi_1-xNd_2xO₃Odxd0.12 at 1300°C and 1300°C and O dxd at 1400°C. With increasing x, the symmetry changes from tetragonal to cubic at x 0.09. The sharp permittivity maximum at 127°C in stoichiometric BaTiO₃ broadens very rapidly with increasing x and gradually moves to lower temperatures: this appears to be because, with substitution of Nd onto Ti sites, formation of the ferroelectric domains is increasingly difficult because of the presence of dipole-inactive Nd³⁺ ions on the Ti sites.     

Orange fruit is more effective than are dark-green, leafy vegetables in increasing serum concentrations of retinol and beta-carotene in schoolchildren in Indonesia

The objectives of this study were to quantify the effectiveness of dietary retinol sources, orange fruit, and dark-green, leafy vegetables in improving vitamin A status, and to test whether orange fruit is a better source of vitamin A and carotenoids than are leafy vegetables. Anemic schoolchildren aged 7-11 y (n = 238) in West Java, Indonesia, were randomly allocated to 1 of 4 groups to consume 2 complete meals/d, 6 d/wk, for 9 wk: 1) 556 retinol equivalents (RE)/d from retinol-rich food (n = 48); 2) 509 RE/d from fruit (n = 49); 3) 684 RE/d from dark-green, leafy vegetables and carrots (n = 45); and 4) 44 RE/d from low-retinol, low-carotene food (n = 46). Mean changes in serum retinol concentrations of the retinol-rich, fruit, vegetable, and low-retinol, low-carotene groups were 0.23 (95% CI: 0.18, 0.28), 0.12 (0.06, 0.18), 0.07 (0.03,0.11), and 0.00 (-0.06, 0.05) micromol/L, respectively. Mean changes in serum beta-carotene concentrations in the vegetable and fruit groups were 0.14 (0.12, 0.17) and 0.52 (0.43, 0.60) micromol/L, respectively. Until now, it has been assumed that 6 microg dietary beta-carotene is equivalent to 1 RE. On the basis of this study, however, the equivalent of 1 RE would be 12 microg beta-carotene (95% CI: 6 microg, 29 microg) for fruit and 26 microg beta-carotene (95% CI: 13 microg, 76 microg) for leafy vegetables and carrots. Thus, the apparent mean vitamin A activity of carotenoids in fruit and in leafy vegetables and carrots was 50% (95% CI: 21%, 100%) and 23% (95% CI: 8%, 46%) of that assumed, respectively. This has important implications for choosing strategies for controlling vitamin A deficiency. Research should be directed toward ways of improving bioavailability and bioconversion of dietary carotenoids, focusing on factors such as intestinal parasites, absorption inhibitors, and food matrixes.     

The female athlete. The triad of disordered eating, amenorrhoea and osteoporosis

The value of routine follow-up programs for patients with early stage breast cancer remains an area of controversy. In recent years, the cost-effectiveness of routine investigations has been questioned, and 2 prospective randomized clinical trials have shown no survival advantage to more intensive diagnostic follow-up approaches. Under the auspices of the Ottawa Regional Cancer Centre, a national survey of the practice patterns of Canadian surgical, radiation and medical oncologists was undertaken to measure current Canadian standards of care and to determine average costs of 5-year follow-up for patients completing primary treatment for stage I and II breast cancer. Standardized questionnaires were sent out to 130 surgeons, 59 radiation oncologists and 89 medical oncologists. The overall response rate was 44%. Based on the frequency of follow-up visits and investigations recommended by respondents, an average cost per patient for a 5-year follow-up plan was derived for each subspecialist group: $791, $911 and $904 for surgeons, radiation oncologists and medical oncologists respectively. Use of a less interventionist follow-up program was estimated to result in a cost saving of $300 per patient over 5 years. The results indicate that, for the most part, Canadian oncologists have been influenced by the available literature concerning follow-up practices and are ordering fewer routine tests. Further cost savings to the Canadian health care system could be achieved with the adoption of even less interventionist follow-up programs.     

Chromatic adaptation and color constancy: A possible dichotomy

Differences between chromatic adaptation and color constancy are discussed, in order to call into question the commonly held view that chromatic adaptation is the mechanism of color constancy. Whereas chromatic adaptation requires many seconds of time and occurs for simple visual scenes, color constancy asserts itself immediately and is most powerful in complex visual scenes. Furthermore, models of chromatic adaptation are not so illuminant invariant as other models of color vision. Therefore, a new operational foundation for color constancy is proposed, and existing non-adaptation models of color constancy are enumerated for future tests.     

An application of prefrontal cortex function theory to cognitive aging.

The purpose of this review is to extend the existing application of the frontal lobe hypothesis of cognitive aging beyond the limited work on inhibitory control (F. N. Dempster, see record 1992-22951-001) to include memory processes supported by the prefrontal cortex. To establish a background for this analysis, I review existing models of prefrontal cortex function and present a synthesized model that includes a general function of temporal integration, supported by 4 specific processes: prospective memory, retrospective memory, interference control, and inhibition of prepotent responses. I found the frontal lobe hypothesis to perform well, with the exception of an inability to account for age-related declines in item recall and recognition memory, possibly a result of age-related declines in medial temporal function. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Towards Analyzing and Synthesizing Protocols

The production of error-free protocols or complex process interactions is essential to reliable communications. This paper presents techniques for both the detection of errors in protocols and for prevention of errors in their design. The methods have been used successfully to detect and correct errors in existing protocols. A technique based on a reachability analysis is described which detects errors m a design. This "perturbation technique" has been implemented and has successfully detected inconsistencies or errors in existing protocol designs including both X.21 and X.25. The types of errors handled are state deadlocks, unspecified receptions, nonexecutable interactions, and state smbiguities. These errors are discussed and their effects considered. An interactive design technique is then described that prevents design errors. The technique is based on a set of production rules which guarantee that complete reception capability is provided in the interacting processes. These rules have been implemented in the form of a tracking algorithm that prevents a designer from creating unspecified receptions and nonexecutable interactions and monitors for the presence of state deadlocks and ambiguities.     

Effect of cholesterol and cholestyramine feeding and of fasting on sterol synthesis in the liver, lleum, and lung of the guinea pig

The effects of feeding diest containing either cholesterol (0.24% w/w) or cholestyramine (2.5% w/w) and of fasting on sterol synthesis in the liver, ileum, and lung of both male and female guinea pigs have been studied by measuring the incorporation by tissue slices of 14C-labeled acetate into total digitoninpredipitable sterols. Cholesterol feeding significantly decreased (P less than 0.05) sterol synthesis in the liver, ileum, and lung of the males and in the ileum of females. Cholestyramine feeding stimulated the rate of hepatic sterol synthesis 13-fold but did not significantly affect sterologenesis in the ileum. Sterol synthesis in the lung was significantly increased (P less than 0.05) but to a much lesser extent than in the liver. Fatty acid synthesis in the liver, ileum, and lung was not significantly affected by either cholesterol or cholestyramine feeding. In guinea pigs fasted for 24 hr, sterol synthesis was inhibited in all three tissues, the most pronounced effect occurring in the liver. Only in the lung was fatty acid synthesis significantly decreased (P less than 0.001) by fasting. Cholesterol feeding resulted in increased concentrations of cholesterol in the plasma and liver. Cholestyramine feeding reduced plasma cholesterol concentration by 81% in females and by 64% in males. However, it did not significantly change the tissue cholesterol concentrations. Fasting resulted in a significant increase (P less than 0.05) in plasma cholesterol concentration but did not effect the concentration of cholesterol in the tissues. It was concluded that in the normal guinea pig, the feedback inhibition produced by both cholesterol and also possibly by bile acids suppresses sterol synthesis in the liver to very low rates compared to those in the small intestine, where sterologenesis is not only less sensitive to the cholesterol negative feedback system than that in the liver, but also is not subject to regulation by the bile acid negative feedback system.     

Measurement of charge distribution in polymer electrets by a new pressure-pulse method

Summary The charge distribution in the thickness direction of 10 to 100 m thick polymer electrets can be determined with a new method utilizing a <1 ns laser pulse to launch a pressure pulse in the sample. Propagation of the pressure pulse through the film causes electrode currents which yield the charge distribution. The method has been applied to electron-beam charged PETP and FEP samples.