Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting

Introduction:
Low dose spiral computed tomography (CT) is a sensitive screening tool for lung cancer that is currently being evaluated in both non-randomised studies and randomised controlled trials.
Methods:
We conducted a quantitative decision analysis using a Markov model to determine whether, in the Australian setting, offering spiral CT screening for lung cancer to high risk individuals would be cost-effective compared with current practice. This exploratory analysis was undertaken predominantly from the perspective of the government as third-party funder. In the base-case analysis, the costs and health outcomes (life-years saved and quality-adjusted life years) were calculated in a hypothetical cohort of 10,000 male current smokers for two alternatives: (1) screen for lung cancer with annual CT for 5 years starting at age 60 year and treat those diagnosed with cancer or (2) no screening and treat only those who present with symptomatic cancer.
Results:
For male smokers aged 60–64 years, with an annual incidence of lung cancer of 552 per 100,000, the incremental cost-effectiveness ratio was $57,325 per life-year saved and $105,090 per QALY saved. For females aged 60–64 years with the same annual incidence of lung cancer, the cost-effectiveness ratio was $51,001 per life-year saved and $88,583 per QALY saved. The model was used to examine the relationship between efficacy in terms of the expected reduction in lung cancer mortality at 7 years and cost-effectiveness. In the base-case analysis lung cancer mortality was reduced by 27% and all cause mortality by 2.1%. Changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. The results were also sensitive to assumptions about the test performance characteristics of CT scanning, the proportion of lung cancer cases overdiagnosed by screening, intervention rates for benign disease, the discount rate, the cost of CT, the quality of life in individuals with early stage screen-detected cancer and disutility associated with false positive diagnoses. Given current knowledge and practice, even under favourable assumptions, reductions in lung cancer mortality of less than 20% are unlikely to be cost-effective, using a value of $50,000 per life-year saved as the threshold to define a “cost-effective” intervention.
Conclusion:
The most feasible scenario under which CT screening for lung cancer could be cost-effective would be if very high-risk individuals are targeted and screening is either highly effective or CT screening costs fall substantially.

Language processing and acquisition in languages of Semitic, root-based, morphology / Joseph Shimron

This book addresses a fundamental question in the morphological analysis and representation of Semitic languages—namely, whether Semitic word morphology is root based or word based. As Shimron suggests, “there are reasons to view the templates, not the roots, as the more influential factor in determining Semitic morphology” (p. 5). Yet, as others would argue, there are reasons not to disregard the root-based hypothesis altogether. In the case of Arabic morphology, for example, verbal forms inherently contain three nonlinear levels: the consonantal root, the vowel pattern, and the templatic prosody. This nonlinear feature provided a perfect illustration of what has become termed in the literature as root-and-patterns morphology (McCarthy & Prince, 1986, 1990).

Investigation of compounds causing water repellency in the rhizosphere of sandy soils from a wide range of locations.

Although soils are generally considered to wet readily, some are actually water repellent at the surface and in the rhizosphere. This phenomenon occurs at low to moderate moisture contents and has been reported from soils under a range of vegetation types and from many regions around the globe. Water repellency in soils can have serious environmental implications including reduced seed germination and plant growth as well as irrigation efficiency, accelerated soil erosion, and enhanced leaching of agrochemicals through preferential flow. it has been proposed that water repellency is caused by the accumulation of hydrophobic organic compounds released as root exudates, microbial byproducts or from decomposing organic matter, which are deposited on mineral or aggregate surfaces, or are present as interstitial matter, Few studies to date have attempted to isolate and characterize these compounds and their structure is therefore only poorly understood, These studies have generally focussed on only a single soil or a small range of samples, have not included non-repellent soils as a control and have not always been able to demonstrate that the substances isolated are indeed responsible for repellency formation.

This study reports on the first part (extraction procedures) of a research programme addressing these gaps in current knowledge by investigating a wide range of severely repellent and wettable ‘control’ samples from different countries, and by including assessments of extraction efficiency and ability of extracts to cause repellency. Analytical methods include DRIFT (Diffuse Reflectance Infrared Fourier Transform Spectroscopy) of soils and IR (Infrared) analysis of extracts.

Key findings are that (i) soil sample heating after extraction is valuable in assessing the effectiveness of the extraction procedure, (ii) Soxhlet extraction using isopropanol/ ammonia (70/30 v/v) was the most effective method in extracting hydrophobic compounds, while leaving the ability of extracted compounds to induce water repellency virtually unaffected, (iii) wettable control soils also contain hydrophobic substances capable of inducing water repellency, (iv) the amount of organic compounds extracted was poorly related to sample repellency, indicating that compounds responsible for repellency may only represent a small fraction of the extract, (v) differences in extraction efficiency between different samples indicate that the compounds responsible may differ generically and/or in terms of their bonding to minerals, and (vi) the combination of repellency assessments with DRIFT on soils and JR on extracts used with internal standards has considerable potential to allow quantification of CH bearing organic matter in the soil, the efficiency of extraction processes for its removal, and its significance in causing water repellency in soils.

Ambulance call triage outcomes for patients reporting pain : a retrospective cross-sectional analysis of pain score versus traige level

Objective: To identify any association between the response priority code generated during calls to the ambulance communication centre and patient reports of pain severity.

Methods: A retrospective analysis of patient care records was undertaken for all patients transported by paramedics over a 7-day period. The primary research interest was the association between the response code allocated at the time of telephone triage and the initial pain severity score recorded using a numeric rating scale (NRS). Univariate and multivariate logistic regression methods were used to analyse the association between the response priority variable and explanatory variables.

Results: There were 1246 cases in which both an initial pain score using the NRS and a response code were recorded. Of these cases, 716/1246 (57.5%) were associated with a code 1 ("time-critical") response. After adjusting for gender, age, cause of pain and duration of pain, a multivariate logistic regression analysis found no significant change in the odds of a patient in pain receiving a time-critical response compared with patients who had no pain, regardless of their initial pain score (NRS 1–3, odds ratio (OR) 1.11, 95% CI 0.7 to 1.8; NRS 4–7, OR 1.12, 95% CI 0.7 to 1.8; NRS 8–10, OR 0.84, 95% CI 0.5 to 1.4).

Conclusion: The severity of pain experienced by the patient appeared to have no influence on the priority (urgency) of the dispatch response. Triage systems used to prioritise ambulance calls and decide the urgency of response or type of referral options should consider pain severity to facilitate timely and humane care.

A soil-free plant growth system to facilitate analysis of plant pathogen interactions in roots

Analysis of the interaction of pathogens with plant roots is often complicated by the growth of plants in a soil substrate. A soil-free plant growth system (SPS) was developed that removes the need for a substrate while supporting the growth of seedlings in a nutrient rich, oxygenated environment. The model legume Lupinus angustifolius was used to compare the growth of seedlings within soil and the SPS. Seedlings grown under both conditions were similar in morphology, anatomy and health (measured by leaf chlorophyll abundance) and importantly there was little difference in root growth and development although straighter and fuller root systems were achieved in the SPS. The ease of access to the root system proved efficient for the analysis of root and pathogen interactions with no interference from soil or adhering particulate matter. Following inoculation of L. angustifolius roots with Phytophthora cinnamomi the host/pathogen interaction was easily observed and tissues sampled undamaged.

Statphylococcus aureus bacteraemia : a major cause of mortaility in Australia and New Zealand

Objective : To document the types of, and mortality from, Staphylococcus aureus bacteraemia in Australia and New Zealand, and determine factors associated with mortality.

Design and setting : Prospective observational study in 27 independent or hospital pathology laboratories in Australia (24) and New Zealand (3), employing a web-based database to prospectively record demographic features, selected risk factors, principal antibiotic treatment and mortality data on all patients with positive blood cultures for S. aureus from June 2007 to May 2008.

Main outcome measure : 30-day all-cause mortality.

Results : 1994 episodes of S. aureus bacteraemia were identified, and complete 30-day follow-up data were available for 1865. Most episodes had their onset in the community (60.8%; 95% CI, 58.7%–63.0%). Methicillin-resistant S. aureus (MRSA) caused 450 episodes (24.1%; 95% CI, 22.2%–25.9%), and 123 of these (27.3%) had a susceptibility profile consistent with community-associated MRSA. All-cause mortality at 30 days was 20.6% (95% CI, 18.8%–22.5%). On univariate analysis, increased mortality was significantly associated with older age, European ethnicity, MRSA infection, infections not originating from a medical device, sepsis syndrome, pneumonia/empyema, and treatment with a glycopeptide or other non-β-lactam antibiotic. On multivariable analysis, independent predictors of mortality were age, sepsis syndrome, pneumonia/empyema, device-associated infection with a secondary focus, left-sided endocarditis, and treatment with a glycopeptide such as vancomycin, but not MRSA infection.

Conclusions : S. aureus bacteraemia is a common infection in both the community and hospitals in Australia and New Zealand, and is associated with appreciable mortality. Invasive MRSA infection may be more life-threatening, partly because of the inferior efficacy of the standard treatment, vancomycin. National web-based surveillance of S. aureus bacteraemia and its outcomes is not only important but also easily achievable.

Architects and their clients : relationships analysis using habitus theory

The nature and quality of hte architect relationship is critical fror project success yet its managment remains problematic.  This interdisciplinary study draws theory from sociology to further our understanding of this built environment industry problem.  The concept of habitus, developed by french sociologist Bourdieu, helps to demystify the architect-client relationship and explain the underlaying cause of conflicts between architects and clients.  Habitus theory explains that the nature of architecture as a specialised activity places architects within an architectural habitus, distinguishing architects from clients who are not trained as professional architects.

Spatial ecology of a root parasite : from pattern to process

Occurrence patterns of parasitic plants are constrained by the distribution of suitable hosts and movement patterns of seed vectors and, accordingly, represent a simplified system to study many aspects of spatial ecology and determinants of distribution. Previous work has focused on the aerially hemiparasitic mistletoes, and it is unclear whether root parasites are affected by similar factors. Here, we evaluate spatial patterns in the root parasitic Santalum lanceolatum in an arid shrubland in north-western New South Wales, central Australia. In this region, the principal host is a long-lived nitrogen fixing shrub Acacia tetragonophylla closely associated with ephemeral creek-lines. The location of 765 individuals of both species was mapped along a 250-m section of creek-line using a total survey station, and occurrence patterns of the root parasite related to host distribution and landscape context. We used Ripley's K-function and the O-ring statistic to determine whether the distribution of S. lanceolatum was random, aggregated or regular; the spatial scales at which these patterns occurred; and to quantify any spatial associations between the parasite and its host, A. tetragonophylla. While acacias were closely associated with the creek-line, S. lanceolatum plants were more tightly clustered, displaying significant clustering at two spatial scales (1.2 m and 8.8 m). We suggest that host quality may act as an important constraint, with only those acacias growing in or near the creek-line being physiologically capable of supporting a parasite to maturity. Insights gained from spatial analysis are used to guide ongoing research in this system, and highlight the utility of the O-ring statistic for understanding patterns of distribution affected by multiple processes operating at critical scales.

A panel data analysis of the military expenditure-external debt nexus : evidence from six middle eastern countries

While a number of studies examine the nexus between military expenditure and economic growth, little consideration has been give to the effect of military expenditure on external debt. This article examines the impact of military expenditure and income on external debt for a panel of six Middle Eastern countries - Oman, Syria, Yemen, Bahrain, Iran, and Jordan - over the period 1988 to 2002. The Middle East represents an interesting study of the effect of military expenditure on external debt because it has one of the highest rates of arms imports in the world and it is one of the most indebted regions in the world. The study first establishes whether there is a long-run relationship between military expenditure, income, and external debt in the six countries using a panel unit root and panel cointegration framework and then proceeds to estimate the long-run and short-run effects of military expenditure and income on external debt. The study finds that external debt is elastic with respect to military expenditure in the long run and inelastic with respect to military expenditure in the short run. For the panel of six Middle Eastern countries, in the long run a 1% increase in military expenditure results in between a 1.1 % and 1.6% increase in external debt, while a 1% increase in income reduces external debt by between 0.6% and 0.8%, depending on the specific estimator employed. In the short run, a 1% increase in military expenditure increases external debt by 0.2%, while the effect of income on external debt is statistically insignificant.

Comprehensive embodied energy analysis framework

The assessment of the direct and indirect requirements for energy is known as embodied energy analysis. For buildings, the direct energy includes that used primarily on site, while the indirect energy includes primarily the energy required for the manufacture of building materials. This thesis is concerned with the completeness and reliability of embodied energy analysis methods. Previous methods tend to address either one of these issues, but not both at the same time. Industry-based methods are incomplete. National statistical methods, while comprehensive, are a ‘black box’ and are subject to errors. A new hybrid embodied energy analysis method is derived to optimise the benefits of previous methods while minimising their flaws. In industry-based studies, known as ‘process analyses’, the energy embodied in a product is traced laboriously upstream by examining the inputs to each preceding process towards raw materials. Process analyses can be significantly incomplete, due to increasing complexity. The other major embodied energy analysis method, ‘input-output analysis’, comprises the use of national statistics. While the input-output framework is comprehensive, many inherent assumptions make the results unreliable. Hybrid analysis methods involve the combination of the two major embodied energy analysis methods discussed above, either based on process analysis or input-output analysis. The intention in both hybrid analysis methods is to reduce errors associated with the two major methods on which they are based. However, the problems inherent to each of the original methods tend to remain, to some degree, in the associated hybrid versions. Process-based hybrid analyses tend to be incomplete, due to the exclusions associated with the process analysis framework. However, input-output-based hybrid analyses tend to be unreliable because the substitution of process analysis data into the input-output framework causes unwanted indirect effects. A key deficiency in previous input-output-based hybrid analysis methods is that the input-output model is a ‘black box’, since important flows of goods and services with respect to the embodied energy of a sector cannot be readily identified. A new input-output-based hybrid analysis method was therefore developed, requiring the decomposition of the input-output model into mutually exclusive components (ie, ‘direct energy paths’). A direct energy path represents a discrete energy requirement, possibly occurring one or more transactions upstream from the process under consideration. For example, the energy required directly to manufacture the steel used in the construction of a building would represent a direct energy path of one non-energy transaction in length. A direct energy path comprises a ‘product quantity’ (for example, the total tonnes of cement used) and a ‘direct energy intensity’ (for example, the energy required directly for cement manufacture, per tonne). The input-output model was decomposed into direct energy paths for the ‘residential building construction’ sector. It was shown that 592 direct energy paths were required to describe 90% of the overall total energy intensity for ‘residential building construction’. By extracting direct energy paths using yet smaller threshold values, they were shown to be mutually exclusive. Consequently, the modification of direct energy paths using process analysis data does not cause unwanted indirect effects. A non-standard individual residential building was then selected to demonstrate the benefits of the new input-output-based hybrid analysis method in cases where the products of a sector may not be similar. Particular direct energy paths were modified with case specific process analysis data. Product quantities and direct energy intensities were derived and used to modify some of the direct energy paths. The intention of this demonstration was to determine whether 90% of the total embodied energy calculated for the building could comprise the process analysis data normally collected for the building. However, it was found that only 51% of the total comprised normally collected process analysis. The integration of process analysis data with 90% of the direct energy paths by value was unsuccessful because: • typically only one of the direct energy path components was modified using process analysis data (ie, either the product quantity or the direct energy intensity); • of the complexity of the paths derived for ‘residential building construction’; and • of the lack of reliable and consistent process analysis data from industry, for both product quantities and direct energy intensities. While the input-output model used was the best available for Australia, many errors were likely to be carried through to the direct energy paths for ‘residential building construction’. Consequently, both the value and relative importance of the direct energy paths for ‘residential building construction’ were generally found to be a poor model for the demonstration building. This was expected. Nevertheless, in the absence of better data from industry, the input-output data is likely to remain the most appropriate for completing the framework of embodied energy analyses of many types of products—even in non-standard cases. ‘Residential building construction’ was one of the 22 most complex Australian economic sectors (ie, comprising those requiring between 592 and 3215 direct energy paths to describe 90% of their total energy intensities). Consequently, for the other 87 non-energy sectors of the Australian economy, the input-output-based hybrid analysis method is likely to produce more reliable results than those calculated for the demonstration building using the direct energy paths for ‘residential building construction’. For more complex sectors than ‘residential building construction’, the new input-output-based hybrid analysis method derived here allows available process analysis data to be integrated with the input-output data in a comprehensive framework. The proportion of the result comprising the more reliable process analysis data can be calculated and used as a measure of the reliability of the result for that product or part of the product being analysed (for example, a building material or component). To ensure that future applications of the new input-output-based hybrid analysis method produce reliable results, new sources of process analysis data are required, including for such processes as services (for example, ‘banking’) and processes involving the transformation of basic materials into complex products (for example, steel and copper into an electric motor). However, even considering the limitations of the demonstration described above, the new input-output-based hybrid analysis method developed achieved the aim of the thesis: to develop a new embodied energy analysis method that allows reliable process analysis data to be integrated into the comprehensive, yet unreliable, input-output framework. Plain language summary Embodied energy analysis comprises the assessment of the direct and indirect energy requirements associated with a process. For example, the construction of a building requires the manufacture of steel structural members, and thus indirectly requires the energy used directly and indirectly in their manufacture. Embodied energy is an important measure of ecological sustainability because energy is used in virtually every human activity and many of these activities are interrelated. This thesis is concerned with the relationship between the completeness of embodied energy analysis methods and their reliability. However, previous industry-based methods, while reliable, are incomplete. Previous national statistical methods, while comprehensive, are a ‘black box’ subject to errors. A new method is derived, involving the decomposition of the comprehensive national statistical model into components that can be modified discretely using the more reliable industry data, and is demonstrated for an individual building. The demonstration failed to integrate enough industry data into the national statistical model, due to the unexpected complexity of the national statistical data and the lack of available industry data regarding energy and non-energy product requirements. These unique findings highlight the flaws in previous methods. Reliable process analysis and input-output data are required, particularly for those processes that were unable to be examined in the demonstration of the new embodied energy analysis method. This includes the energy requirements of services sectors, such as banking, and processes involving the transformation of basic materials into complex products, such as refrigerators. The application of the new method to less complex products, such as individual building materials or components, is likely to be more successful than to the residential building demonstration.

Electricity consumption in G7 countries : a panel cointegration analysis of residential demand elasticities

This article applies recently developed panel unit root and panel cointegration techniques to estimate the long-run and short-run income and price elasticities for residential demand for electricity in G7 countries. The panel results indicate that in the long-run residential demand for electricity is price elastic and income inelastic. The study concludes that from an environmental perspective there is potential to use pricing policies in the G7 countries to curtail residential electricity demand, and thus curb carbon emissions, in the long run.

Peak to average power ratio analysis for LTE systems

The 3rd generation partnership project (3GPP) long term evolution (LTE) standard uses single carrier frequency division multiple access (SCFDMA) scheme for the uplink transmissions and orthogonal frequency division multiplexing access (OFDMA) in downlink. SCFDMA uses DFT spreading prior to OFDMA modulation to map the signal from each user to a subset of the available subcarriers i.e., single carrier modulation. The efficiency of a power amplifier is determined by the peak to average power ratio (PAPR) of the modulated signal. In this paper, we analyze the PAPR in 3GPP LTE systems using root raised cosine based filter. Simulation results show that the SCFDMA subcarrier mapping has a significantly lower PAPR compared to OFDMA. Also comparing the three forms of SCFDMA subcarrier mapping, results show that interleave FDMA (IFDMA) subcarrier mapping with proposed root raised cosine filter reduced PAPR significantly than localized FDMA (LFDMA) and distributed (DFDMA) mapping. This improves its radio frequency (RF) power amplifier efficiency and also the mean power output from a battery driven mobile terminal.

Cost-effectiveness analysis of a two-stage screening intervention for hepatocellular carcinoma in Taiwan

Background/Purpose

Hepatocellular carcinoma (HCC) has been the leading cause of cancer death in Taiwan since the 1980s. A two-stage screening intervention was introduced in 1996 and has been implemented in a limited number of hospitals. The present study assessed the costs and health outcomes associated with the introduction of screening intervention, from the perspective of the Taiwanese government. The cost-effectiveness analysis aimed to assist informed decision making by the health authority in Taiwan.
Methods

A two-phase economic model, 1-year decision analysis and a 60-year Markov simulation, was developed to conceptualize the screening intervention within current practice, and was compared with opportunistic screening alone. Incremental analyses were conducted to compare the incremental costs and outcomes associated with the introduction of the intervention. Sensitivity analyses were performed to investigate the uncertainties that surrounded the model.
Results

The Markov model simulation demonstrated an incremental cost-effectiveness ratio (ICER) of NT$498,000 (US$15,600) per life-year saved, with a 5% discount rate. An ICER of NT$402,000 (US$12,600) per quality-adjusted life-year was achieved by applying utility weights. Sensitivity analysis showed that excess mortality reduction of HCC by screening and HCC incidence rates were the most influential factors on the ICERs. Scenario analysis also indicated that expansion of the HCC screening intervention by focusing on regular monitoring of the high-risk individuals could achieve a more favorable result.
Conclusion

Screening the population of high-risk individuals for HCC with the two-stage screening intervention in Taiwan is considered potentially cost-effective compared with opportunistic screening in the target population of an HCC endemic area.

Differential expression of ATP7A, ATP7B and CTR1 in adult rat dorsal root ganglion tissue

Background: ATP7A, ATP7B and CTR1 are metal transporting proteins that control the cellular disposition of copper and platinum drugs, but their expression in dorsal root ganglion (DRG) tissue and their role in platinum-induced neurotoxicity are unknown. To investigate the DRG expression of ATP7A, ATP7B and CTR1, lumbar DRG and reference tissues were collected for real time quantitative PCR, RT-PCR, immunohistochemistry and Western blot analysis from healthy control adult rats or from animals treated with intraperitoneal oxaliplatin (1.85 mg/kg) or drug vehicle twice weekly for 8 weeks.
Results: In DRG tissue from healthy control animals, ATP7A mRNA was clearly detectable at levels similar to those found in the brain and spinal cord, and intense ATP7A immunoreactivity was localised to the cytoplasm of cell bodies of smaller DRG neurons without staining of satellite cells, nerve fibres or co-localisation with phosphorylated heavy neurofilament subunit (pNF-H). High levels of CTR1 mRNA were detected in all tissues from healthy control animals, and strong CTR1 immunoreactivity was associated with plasma membranes and vesicular cytoplasmic structures of the cell bodies of larger-sized DRG neurons without co-localization with ATP7A. DRG neurons with strong expression of ATP7A or CTR1 had distinct cell body size profiles with minimal overlap between them. Oxaliplatin treatment did not alter the size profile of strongly ATP7A-immunoreactive neurons but significantly reduced the size profile of strongly CTR1-immunoreactive neurons. ATP7B mRNA was barely detectable, and no specific immunoreactivity for ATP7B was found, in DRG tissue from healthy control animals.
Conclusions: In conclusion, adult rat DRG tissue exhibits a specific pattern of expression of copper transporters with distinct subsets of peripheral sensory neurons intensely expressing either ATP7A or CTR1, but not both or ATP7B. The neuron subtype-specific and largely non-overlapping distribution of ATP7A and CTR1 within rat DRG tissue may be required to support the potentially differing cuproenzyme requirements of distinct subsets of sensory neurons, and could influence the transport and neurotoxicity of oxaliplatin.

The productivity-wage and productivity-employment nexus : a panel data analysis of Indian manufacturing

This article investigates the long-run relationship between labour productivity and employment, and between labour productivity and real wages in the case of the Indian manufacturing sector. The panel data set consists of 17 two-digit manufacturing industries for the period 1973–1974 to 1999–2001. We find that productivity-wages and productivity-employment are panel cointegrated for all industries. We find that both employment and real wages exert a positive effect on labour productivity. We argue that flexible labour market has a significant influence on manufacturing productivity, employment and real wages in the case of Indian manufacturing.