Differences across health care systems in outcome and cost-utility of surgical and conservative treatment of chronic low back pain: a study protocol

BACKGROUND: There is little evidence on differences across health care systems in choice and outcome of the treatment of chronic low back pain (CLBP) with spinal surgery and conservative treatment as the main options. At least six randomised controlled trials comparing these two options have been performed; they show conflicting results without clear-cut evidence for superior effectiveness of any of the evaluated interventions and could not address whether treatment effect varied across patient subgroups. Cost-utility analyses display inconsistent results when comparing surgical and conservative treatment of CLBP. Due to its higher feasibility, we chose to conduct a prospective observational cohort study. METHODS: This study aims to examine if1. Differences across health care systems result in different treatment outcomes of surgical and conservative treatment of CLBP2. Patient characteristics (work-related, psychological factors, etc.) and co-interventions (physiotherapy, cognitive behavioural therapy, return-to-work programs, etc.) modify the outcome of treatment for CLBP3. Cost-utility in terms of quality-adjusted life years differs between surgical and conservative treatment of CLBP.This study will recruit 1000 patients from orthopaedic spine units, rehabilitation centres, and pain clinics in Switzerland and New Zealand. Effectiveness will be measured by the Oswestry Disability Index (ODI) at baseline and after six months. The change in ODI will be the primary endpoint of this study.Multiple linear regression models will be used, with the change in ODI from baseline to six months as the dependent variable and the type of health care system, type of treatment, patient characteristics, and co-interventions as independent variables. Interactions will be incorporated between type of treatment and different co-interventions and patient characteristics. Cost-utility will be measured with an index based on EQol-5D in combination with cost data. CONCLUSION: This study will provide evidence if differences across health care systems in the outcome of treatment of CLBP exist. It will classify patients with CLBP into different clinical subgroups and help to identify specific target groups who might benefit from specific surgical or conservative interventions. Furthermore, cost-utility differences will be identified for different groups of patients with CLBP. Main results of this study should be replicated in future studies on CLBP.

Energy Storage Systems for Electric Vehicles: Performance Comparison based on a Simple Equivalent Circuit and Experimental Tests

The decision to select the most suitable type of energy storage system for an electric vehicle is always difficult, since many conditionings must be taken into account. Sometimes, this study can be made by means of complex mathematical models which represent the behavior of a battery, ultracapacitor or some other devices. However, these models are usually too dependent on parameters that are not easily available, which usually results in nonrealistic results. Besides, the more accurate the model, the more specific it needs to be, which becomes an issue when comparing systems of different nature. This paper proposes a practical methodology to compare different energy storage technologies. This is done by means of a linear approach of an equivalent circuit based on laboratory tests. Via these tests, the internal resistance and the self-discharge rate are evaluated, making it possible to compare different energy storage systems regardless their technology. Rather simple testing equipment is sufficient to give a comparative idea of the differences between each system, concerning issues such as efficiency, heating and self-discharge, when operating under a certain scenario. The proposed methodology is applied to four energy storage systems of different nature for the sake of illustration.

Interaction between interconnected and isolated grounding systems: a case study of transferred potentials

The effect caused by ground fault current in a complex system of interacting electrodes is theoretically studied. The calculation applies to a specific case in which a set of interconnected electrodes, which are part of a grounding facility network, are activated by a ground fault current. Transferred potentials to adjacent passive electrodes are calculated and the most relevant parameters of the electrode system are evaluated. Finally, the convenience of connecting the grounding electrodes is discussed.

Unit Commitment and Electricity Prices Forecasting for Market Strategy Preparation in Interconnected Systems

In this paper we present a solution for building a better strategy to take part in external electricity markets. For an optimal strategy development, both the internal system costs as well as the future values of the series of electricity prices in external markets need to be known. But in practice, the real problems that must be faced are that both future electricity prices and costs are unknown. Thus, the first ones must be modeled and forecasted and the costs must be calculated. Our methodology for building an optimal strategy consists of three steps: The first step is modeling and forecasting market prices in external systems. The second step is the cost calculation on internal system taking into account the expected prices in the first step. The third step is based on the results of the previous steps, and consists of preparing the bids for external markets. The main goal is to reduce consumers' costs unlike many others that are oriented to increase GenCo's profits.

Hearings on the Navy proposal to modify SSN-688 contracts with the General Dynamics Corp. (Electric Boat Division) and LHA and DD-963 contracts with Litton Industries, Inc./Litton Systems, Inc. (Ingalls Shipbuilding Division /

Mode of access: Internet.

An electric discharge as a trap for diffusion pump vacuum systems /

An electrical discharge is used as a trap for a diffusion pump using DC-704 silicone pump fluid. The discharge cracks the pump fluid vapor thus taking it out of the system. In the process much hydrogen and some other lighter gases are evolved.

Procedure for making a sectionalizing study on rural electric systems.

Mode of access: Internet.

Utility corporations. Letters from the chairman of the Federal trade commission transmitting, in response to Senate resolution no. 83, 70th Congress, a monthly report on the electric power and gas utilities inquiry.

Nos. 71B, 81A, and 84D constitute a general index to all numbers.

Design of electric systems for naval aircraft and missiles; technical manual.

"NAVWEPS 01-1A-514."

Understanding air conditioning systems for better energy efficiency : operations and maintenance procedures for utility cost control /

"ILENR/BE-87/01."

Operators, organizational, direct support, and general support maintenance manual : water purification unit, 420 gallons per hour, electric driven, 115V, single phase, 60 hertz 1/20 to 1 1/4 hp (Litton Systems, Inc. model LPU 420-1), FSN 4610-012-5490.

"1 October 1969"--P. i.

Operator's manual : test set, generator, and voltage regulator, automotive, 6, 12, and 24 volt systems (Sun Electric Corp., model no. VAT-25) (4910-270-3780).

"August 1966."

Operator, organizational, direct support, and general support maintenance manual (including repair parts and special tools list and depot maintenance repair parts and special tools) : test set, generator and voltage regulator, automotive, 12-and 24-volt systems (Allen Electric and Equipment Company model no. 30-92) (4910-092-9136).

"15 October 1971."

Final environmental statement : crude oil transportation systems (proposed under Public Law 95-617, the Public utility regulatory policies act of 1978), Northern Tier Pipeline Company, Northwest Energy Company, Kitimat Pipe Line Ltd., Trans Mountain Oil Pipe Line Corporation /

Bibliography: p. R-1 - R-19, v.3.