The utility and cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis

BACKGROUND AND OBJECTIVE: The potential utility of D-dimer measurements for the diagnosis of deep vein thrombosis became evident soon after the development of reliable commercial assays. The purpose of this review is to outline some critical aspects affecting cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis (DVT). METHODS: The authors have been working in this field contributing original papers whose data have been used for this study. In addition, the material analyzed in this article includes papers published in the journals covered by the Science Citation Index and Medline. RESULTS: D-dimer levels are very sensitive to the process of fibrin formation/dissolution occurring with ongoing thrombosis. However, they may not be highly specific for venous thromboembolism as they are influenced by the presence of comorbid conditions potentially elevating plasma D-dimer (cancer, surgery, infectious diseases). In addition, commercially available ELISA assays, although quantitative and reproducible, cannot be used under emergency conditions because they are time-consuming and suited for batch-processing of plasma samples. Recently, new assays have been introduced which permit fast and quantitative D-dimer estimations in individual patients. We have evaluated the utility of two new rapid assays (LPIA D-dimer. Mitsubishi, and VIDAS D-DIMER, bio-Merieux) in combination with compression real-time-B-mode ultrasonography for the detection of deep vein thrombosis in asymptomatic patients following elective hip replacement and in patients with clinically suspected deep vein thrombosis. In both settings, we identified cut-off values with optimal sensitivity which allow exclusion of deep vein thrombosis in a considerable percentage of patients, with substantial sparing of economic resources. In fact, based on a cost-effectiveness analysis, a diagnostic algorithm combining D-dimers measurement and compression ultrasonography would result in cost-savings ranging from 5% to 55% in patients with high or low clinical pretest probability respectively. However, the specificity of D-dimer measurements for deep vein thrombosis was much higher in symptomatic than in asymptomatic patients. Choice of the cut-off value proved to be dependent on the method as well as on the patient populations studied. CONCLUSIONS: The cost-effectiveness of D-dimers measurement in the diagnosis of asymptomatic DVT remains questionable. Conversely, our data strongly support the utility of D-dimers determinations in the diagnosis of symptomatic DVT. In terms of sparing economic resources, the introduction in the clinical laboratory of the rapid quantitative assays would be highly convenient, because they avoid a source of bias in the interpretation of D-dimers results, are easy to perform and do not require dedicated personnel or instrumentation. Prospective management studies validating the utility of D-dimer measurement in the diagnosis of deep vein thrombosis are urgently needed.     

Distributed real-time control of a spatial robot juggler

The Yale spatial juggler and an emerging set of working principles for the design and implementation of embedded real-time distributed controllers are described. The robot uses a distributed network of transputers to process stereo camera data and control the torque of a three-degree-of-freedom arm to juggle a ball. The juggling algorithm is a direct extension of a novel class of nonlinear feedback controllers, called mirror laws. The algorithm takes the form of a mathematical expression that specifies robot position as a function of the ball's position and velocity. The programming approach, called geometric programming, substitutes event-driven dynamical processes and geometrical transformations for a more syntactically oriented if-then-else approach     

Direct Methods Optimised for Solving Crystal Structure by Powder Diffraction Data: Limits,Strategies, and Prospects

The ab-initio crystal structure solution by powder diffraction data requires great efforts because of the collapse of the experimental information onto the one dimensional 2θ axis of the pattern. Different strategies will be described aiming at improving the process of extraction of the integrated intensities from the experimental pattern in order to make more straightforward the structure solution process by direct methods. Particular attention will be devoted to the EXPO program. Some of its performance will be analysed and results will be shown.     

Structural optimization strategies to design green products

This paper addresses the need for a structured approach to environmental assessment and improvement. We propose a computer-aided methodology, named Eco-OptiCAD, based on the integration of Structural Optimization and Life Cycle Assessment (LCA) tools. Eco-OptiCAD supports the designer during product development, highlighting when and where the core of the environmental impact lies. Furthermore, it provides effective tools to address such impacts, improving the original product, while ensuring structural and functional requirements. It foresees the synergic use of (1) virtual prototyping tools, such as 3D CAD, Finite Element Analysis (FEA) and Structural optimization, (2) function modeling methodology and (3) Life Cycle Assessment (LCA) tools. The kernel of the methodology is constituted by a set of optimization strategies and a module, named Life Cycle Mapping (LCM). In particular, we have conceived ten optimization strategies converting environmental objectives and constraints into structural and geometrical parameters. They enable the designer to generate alternative green scenarios according to the triad shape–material–production. The LCM tool has been specifically developed to easily trace the growth of environmental impacts throughout the product's life cycle and allow the user to focus his effort on the most relevant aspects. Thanks to the integration of the structural optimizer with an LCA map, the designer becomes aware of the consequences that each change in the geometry, the material or the manufacturing process will produce on the environmental impact of the product throughout its life cycle. With a complete view of the product life cycle, the designer can improve a single phase, while retaining a global perspective; thus avoiding the possibility of gaining a local green improvement at the cost of a global increase in environmental impacts.     

Mangrove forests as a nature-based solution for coastal flood protection: Biophysical and ecological considerations

Nature-based coastal protection is increasingly recognised as a potentially sustainable and cost-effective solution to reduce coastal flood risk. It uses coastal ecosystems such as mangrove forests to create resilient designs for coastal flood protection. However, to use mangroves effectively as a nature-based measure for flood risk reduction, we must understand the biophysical processes that govern risk reduction capacity through mangrove ecosystem size and structure. In this perspective, we evaluate the current state of knowledge on local physical drivers and ecological processes that determine mangrove functioning as part of a nature-based flood defence. We show that the forest properties that comprise coastal flood protection are well-known, but models cannot yet pinpoint how spatial heterogeneity of the forest structure affects the capacity for wave or surge attenuation. Overall, there is relatively good understanding of the ecological processes that drive forest structure and size, but there is a lack of knowledge on how daily bed-level dynamics link to long-term biogeomorphic forest dynamics, and on the role of combined stressors influencing forest retreat. Integrating simulation models of forest structure under changing physical (e.g. due to sea-level change) and ecological drivers with hydrodynamic attenuation models will allow for better projections of long-term natural coastal protection.     

Complexity issues in color-preserving graph embeddings

In the context of comparative analysis of protein–protein interaction graphs, we use a graph-based formalism to detect the preservation of a given protein complex (pattern graph) in the protein–protein interaction graph (target graph) of another species with respect to (w.r.t.) orthologous proteins. We give an efficient exponential-time randomized algorithm in case the occurrence of the pattern graph in the target graph is required to be exact. For approximate occurrences, we prove a tight inapproximability result and give four approximation algorithms that deal with bounded degree graphs, small ortholog numbers, linear forests and very simple yet hard instances, respectively.