Contributions from the systematic review of economic evaluations: the case of childhood hepatitis A vaccination in Brazil

The aim of this study was to present the contributions of the systematic review of economic evaluations to the development of a national study on childhood hepatitis A vaccination. A literature review was performed in EMBASE, MEDLINE, WOPEC, HealthSTAR, SciELO and LILACS from 1995 to 2010. Most of the studies (8 of 10) showed favorable cost-effectiveness results. Sensitivity analysis indicated that the most important parameters for the results were cost of the vaccine, hepatitis A incidence, and medical costs of the disease. Variability was observed in methodological characteristics and estimates of key variables among the 10 studies reviewed. It is not possible to generalize results or transfer epidemiological estimates of resource utilization and costs associated with hepatitis A to the local context. Systematic review of economic evaluation studies of hepatitis A vaccine demonstrated the need for a national analysis and provided input for the development of a new decision-making model for Brazil.

Effect of the Canary Islands in the blockage and mixing of the North Atlantic eastern water masses

[EN] We apply an inverse model to a hydrographic cruise that completely closes the Canary Islands to investigate their effect on the water masses transports. Most central waters are transported south between the eastern islands and the African coast, with 2.5 Sv out of a total of 3.5 Sv. Intermediate waters are effectively blocked by the islands passages, with Mediterranean/Antarctic waters predominantly found north/south of the islands, and most deep waters loop around the archipelago plateau. A process model upholds the existence of intense two-way exchange between central and intermediate waters along the eastern passage, with vertical velocities of order 10 m s.

Creazione e sviluppo di un sistema di controllo in tempo reale per un sistema fuel cell

The control of a proton exchange membrane fuel cell system (PEM FC) for domestic heat and power supply requires extensive control measures to handle the complicated process. Highly dynamic and non linear behavior, increase drastically the difficulties to find the optimal design and control strategies. The objective is to design, implement and commission a controller for the entire fuel cell system. The fuel cell process and the control system are engineered simultaneously; therefore there is no access to the process hardware during the control system development. Therefore the method of choice was a model based design approach, following the rapid control prototyping (RCP) methodology. The fuel cell system is simulated using a fuel cell library which allowed thermodynamic calculations. In the course of the development the process model is continuously adapted to the real system. The controller application is designed and developed in parallel and thereby tested and verified against the process model. Furthermore, after the commissioning of the real system, the process model can be also better identified and parameterized utilizing measurement data to perform optimization procedures. The process model and the controller application are implemented in Simulink using Mathworks` Real Time Workshop (RTW) and the xPC development suite for MiL (model-in-theloop) and HiL (hardware-in-the-loop) testing. It is possible to completely develop, verify and validate the controller application without depending on the real fuel cell system, which is not available for testing during the development process. The fuel cell system can be immediately taken into operation after connecting the controller to the process.

Identificazione dei fenotipi clinici dell’insufficienza renale cronica che predicono la progressione della malattia. Un’applicazione della tecnica degli alberi decisionali

The primary aim of this dissertation to identify subgroups of patients with chronic kidney disease (CKD) who have a differential risk of progression of illness and the secondary aim is compare 2 equations to estimate the glomerular filtration rate (GFR). To this purpose, the PIRP (Prevention of Progressive Kidney Disease) registry was linked with the dialysis and mortality registries. The outcome of interest is the mean annual variation of GFR, estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. A decision tree model was used to subtype CKD patients, based on the non-parametric procedure CHAID (Chi-squared Automatic Interaction Detector). The independent variables of the model include gender, age, diabetes, hypertension, cardiac diseases, body mass index, baseline serum creatinine, haemoglobin, proteinuria, LDL cholesterol, tryglycerides, serum phoshates, glycemia, parathyroid hormone and uricemia. The decision tree model classified patients into 10 terminal nodes using 6 variables (gender, age, proteinuria, diabetes, serum phosphates and ischemic cardiac disease) that predict a differential progression of kidney disease. Specifically, age <=53 year, male gender, proteinuria, diabetes and serum phosphates >3.70 mg/dl predict a faster decrease of GFR, while ischemic cardiac disease predicts a slower decrease. The comparison between GFR estimates obtained using MDRD4 and CKD-EPI equations shows a high percentage agreement (>90%), with modest discrepancies for high and low age and serum creatinine levels. The study results underscore the need for a tight follow-up schedule in patients with age <53, and of patients aged 54 to 67 with diabetes, to try to slow down the progression of the disease. The result also emphasize the effective management of patients aged>67, in whom the estimated decrease in glomerular filtration rate corresponds with the physiological decrease observed in the absence of kidney disease, except for the subgroup of patients with proteinuria, in whom the GFR decline is more pronounced.

Satisfaction with follow-up consultations among younger adults treated for cancer: the role of quality of life and psychological variables

Given increased survival rates and treatment-related late effects, follow-up for cancer survivors is increasingly recommended. However, information about adverse events (e.g. possibility of late effects) may be distressing for the cancer survivor and lead to poor clinic attendance. Survivor satisfaction with appointments and the information provided are important. The Monitoring Process Model provides a theoretical framework to understand how survivors cope with threatening information, and consequences for follow-up care. Our aims were to describe satisfaction with routine follow-up and association between monitoring/blunting and satisfaction with care.

Evaluating the usefulness of soil moisture (forecasts) in streamflow prediction for central Texas

The past decade has brought significant advancements in seasonal climate forecasting. However, water resources decision support and management continues to be based almost entirely on historical observations and does not take advantage of climate forecasts. This study builds on previous work that conditioned streamflow ensemble forecasts on observable climate indicators, such as the El Niño-Southern Oscillation (ENSO) and the Pacific Decadal Oscillation (PDO) for use in a decision support model for the Highland Lakes multi-reservoir system in central Texas operated by the Lower Colorado River Authority (LCRA). In the current study, seasonal soil moisture is explored as a climate indicator and predictor of annual streamflow for the LCRA region. The main purpose of this study is to evaluate the correlation of fractional soil moisture with streamflow using the 1950-2000 Variable Infiltration Capacity (VIC) Retrospective Land Surface Data Set over the LCRA region. Correlations were determined by examining different annual and seasonal combinations of VIC modeled fractional soil moisture and observed streamflow. The applicability of the VIC Retrospective Land Surface Data Set as a data source for this study is tested along with establishing and analyzing patterns of climatology for the watershed study area using the selected data source (VIC model) and historical data. Correlation results showed potential for the use of soil moisture as a predictor of streamflow over the LCRA region. This was evident by the good correlations found between seasonal soil moisture and seasonal streamflow during coincident seasons as well as between seasonal and annual soil moisture with annual streamflow during coincident years. With the findings of good correlation between seasonal soil moisture from the VIC Retrospective Land Surface Data Set with observed annual streamflow presented in this study, future research would evaluate the application of NOAA Climate Prediction Center (CPC) forecasts of soil moisture in predicting annual streamflow for use in the decision support model for the LCRA.

The Influence of Enterprise Systems on Business and Information Technology

Business strategy is important to all organizations. Nearly all Fortune 500 firms are implementing Enterprise Resource Planning (ERP) systems to improve the execution of their business strategy and to improve integration with its information technology (IT) strategy. Successful implementation of these multi-million dollar software systems are requiring new emphasis on change management and on Business and IT strategic alignment. This paper examines business and IT strategic alignment and seeks to explore whether an ERP implementation can drive business process reengineering and business and IT strategic alignment. An overview of business strategy and strategic alignment are followed by an analysis of ERP. The “As-Is/To-Be” process model is then presented and explained as a simple, but vital tool for improving business strategy, strategic alignment, and ERP implementation success.

Beitrag zur Prozessstandardisierung in der Intralogistik

Ein dynamisches Umfeld erforderte die permanente Anpassung (intra-)logistischer Prozesse zur Aufrechterhaltung der Leistungs- und Wettbewerbsfähigkeit von Unternehmen. In der Standardisierung von Prozessen und in unternehmensübergreifenden Prozessmodellen wurden Schlüsselfaktoren für ein effizientes Geschäftsprozessmanagement gesehen, insbesondere in Netzwerken. In der Praxis fehlten wissenschaftlich fundierte und detaillierte Referenzprozessmodelle für die (Intra-)Logistik. Mit der Erforschung und Entwicklung eines Referenzprozessmodells und der prototypischen Realisierung einer Prozess-Workbench zur generischen Erstellung wandelbarer Prozessketten wurde ein Beitrag zur Prozessstandardisierung in der Logistik geleistet. Im Folgenden wird der beschrittene Lösungsweg dargestellt, der erstens aus der Entwicklung eines Metamodells für die Referenzmodellierung, zweitens aus dem empirischen Nachweis der Generierung eines Referenzprozessmodells aus „atomaren“ Elementen und drittens aus der Modellevaluation bestand.

Transcatheter aortic valve implantation: patient selection

Transcatheter aortic valve implantation (TAVI) is a disruptive technology as it satisfies a previously unmet need which is associated with a profound therapeutic benefit. In randomized clinical trials, TAVI has been shown to improve survival compared with medical treatment among patients considered not suitable candidates for surgical aortic valve replacement (SAVR), and to provide similar outcomes as SAVR in selected high-risk patients. Currently, TAVI is limited to selected elderly patients with symptomatic severe aortic stenosis. As this patient population frequently suffers from comorbid conditions, which may influence outcomes, the selection of patients to undergo TAVI underlies a complex decision process. Several clinical risk score algorithms are routinely used, although they fall short to fully appreciate the true risk among patients currently referred for TAVI. Beyond traditional risk scores, the clinical assessment by an interdisciplinary Heart Team as well as detailed imaging of the aortic valve, aortic root, descending and abdominal aorta as well as peripheral vasculature are important prerequisites to plan a successful procedure. This review will familiarize the reader with the concepts of the interdisciplinary Heart team, risk scores as well as the most important imaging algorithms suited to select appropriate TAVI patients.

Transient simulations of the carbon and nitrogen dynamics in northern peatlands: from the Last Glacial Maximum to the 21st century

The development of northern high-latitude peatlands played an important role in the carbon (C) balance of the land biosphere since the Last Glacial Maximum (LGM). At present, carbon storage in northern peatlands is substantial and estimated to be 500 ± 100 Pg C (1 Pg C = 1015 g C). Here, we develop and apply a peatland module embedded in a dynamic global vegetation and land surface process model (LPX-Bern 1.0). The peatland module features a dynamic nitrogen cycle, a dynamic C transfer between peatland acrotelm (upper oxic layer) and catotelm (deep anoxic layer), hydrology- and temperature-dependent respiration rates, and peatland specific plant functional types. Nitrogen limitation down-regulates average modern net primary productivity over peatlands by about half. Decadal acrotelm-to-catotelm C fluxes vary between −20 and +50 g C m−2 yr−1 over the Holocene. Key model parameters are calibrated with reconstructed peat accumulation rates from peat-core data. The model reproduces the major features of the peat core data and of the observation-based modern circumpolar soil carbon distribution. Results from a set of simulations for possible evolutions of northern peat development and areal extent show that soil C stocks in modern peatlands increased by 365–550 Pg C since the LGM, of which 175–272 Pg C accumulated between 11 and 5 kyr BP. Furthermore, our simulations suggest a persistent C sequestration rate of 35–50 Pg C per 1000 yr in present-day peatlands under current climate conditions, and that this C sink could either sustain or turn towards a source by 2100 AD depending on climate trajectories as projected for different representative greenhouse gas concentration pathways.

Cost-effectiveness of universal prophylaxis in pregnancy with prior group B streptococci colonization.

OBJECTIVE: To estimate the costs and outcomes of rescreening for group B streptococci (GBS) compared to universal treatment of term women with history of GBS colonization in a previous pregnancy. STUDY DESIGN: A decision analysis model was used to compare costs and outcomes. Total cost included the costs of screening, intrapartum antibiotic prophylaxis (IAP), treatment for maternal anaphylaxis and death, evaluation of well infants whose mothers received IAP, and total costs for treatment of term neonatal early onset GBS sepsis. RESULTS: When compared to screening and treating, universal treatment results in more women treated per GBS case prevented (155 versus 67) and prevents more cases of early onset GBS (1732 versus 1700) and neonatal deaths (52 versus 51) at a lower cost per case prevented ($8,805 versus $12,710). CONCLUSION: Universal treatment of term pregnancies with a history of previous GBS colonization is more cost-effective than the strategy of screening and treating based on positive culture results.

Cost-effectiveness analysis of paclitaxel-coated balloons for endovascular therapy of femoropopliteal arterial obstructions.

PURPOSE To explore the cost-effectiveness of using drug-eluting balloon (DEB) angioplasty for the treatment of femoropopliteal arterial lesions, which has been shown to significantly lower the rates of target lesion revascularization (TLR) compared with standard balloon angioplasty (BA). METHODS A simplified decision-analytic model based on TLR rates reported in the literature was applied to baseline and follow-up costs associated with in-hospital patient treatment during 1 year of follow-up. Costs were expressed in Swiss Francs (sFr) and calculated per 100 patients treated. Budgets were analyzed in the context of current SwissDRG reimbursement figures and calculated from two different perspectives: a general budget on total treatment costs (third-party healthcare payer) as well as a budget focusing on the physician/facility provider perspective. RESULTS After 1 year, use of DEB was associated with substantially lower total inpatient treatment costs when compared with BA (sFr 861,916 vs. sFr 951,877) despite the need for a greater investment at baseline related to higher prices for DEBs. In the absence of dedicated reimbursement incentives, however, use of DEB was shown to be the financially less favorable treatment approach from the physician/facility provider perspective (12-month total earnings: sFr 179,238 vs. sFr 333,678). CONCLUSION Use of DEBs may be cost-effective through prevention of TLR at 1 year of follow-up. The introduction of dedicated financial incentives aimed at improving DEB reimbursements may help lower total healthcare costs.

Isotopic constraints on marine and terrestrial N2O emissions during the last deglaciation

Nitrous oxide (N2O) is an important greenhouse gas and ozone-depleting substance that has anthropogenic as well as natural marine and terrestrial sources. The tropospheric N2O concentrations have varied substantially in the past in concert with changing climate on glacial–interglacial and millennial timescales. It is not well understood, however, how N2O emissions from marine and terrestrial sources change in response to varying environmental conditions. The distinct isotopic compositions of marine and terrestrial N2O sources can help disentangle the relative changes in marine and terrestrial N2O emissions during past climate variations. Here we present N2O concentration and isotopic data for the last deglaciation, from 16,000 to 10,000 years before present, retrieved from air bubbles trapped in polar ice at Taylor Glacier, Antarctica. With the help of our data and a box model of the N2O cycle, we find a 30 per cent increase in total N2O emissions from the late glacial to the interglacial, with terrestrial and marine emissions contributing equally to the overall increase and generally evolving in parallel over the last deglaciation, even though there is no a priori connection between the drivers of the two sources. However, we find that terrestrial emissions dominated on centennial timescales, consistent with a state-of-the-art dynamic global vegetation and land surface process model that suggests that during the last deglaciation emission changes were strongly influenced by temperature and precipitation patterns over land surfaces. The results improve our understanding of the drivers of natural N2O emissions and are consistent with the idea that natural N2O emissions will probably increase in response to anthropogenic warming.

Appraisal-driven somatovisceral response patterning: effects of intrinsic pleasantness and goal conduciveness.

Several componential emotion theories suggest that appraisal outcomes trigger characteristic somatovisceral changes that facilitate information processing and prepare the organism for adaptive behavior. The current study tested predictions derived from Scherer's Component Process Model. Participants viewed unpleasant and pleasant pictures (intrinsic pleasantness appraisal) and were asked to concurrently perform either an arm extension or an arm flexion, leading to an increase or a decrease in picture size. Increasing pleasant stimuli and decreasing unpleasant stimuli were considered goal conducive; decreasing pleasant stimuli and increasing unpleasant stimuli were considered goal obstructive (goal conduciveness appraisal). Both appraisals were marked by several somatovisceral changes (facial electromyogram, heart rate (HR)). As predicted, the changes induced by the two appraisals showed similar patterns. Furthermore, HR results, compared with data of earlier studies, suggest that the adaptive consequences of both appraisals may be mediated by stimulus proximity.

First evidence for differential and sequential efferent effects of stimulus relevance and goal conduciveness appraisal.

In the context of a memory task, participants were presented with pictures displaying biological and cultural threat stimuli or neutral stimuli (stimulus relevance manipulation) with superimposed symbols signaling monetary gains or losses (goal conduciveness manipulation). Results for heart rate and facial electromyogram show differential efferent effects of the respective appraisal outcomes and provide first evidence for sequential processing, as postulated by Scherer's component process model of emotion. Specifically, as predicted, muscle activity over the brow and cheek regions marking the process of relevance appraisal occurred significantly earlier than facial muscle activity markers of goal conduciveness appraisal. Heart rate, in contrast, was influenced by the stimulus relevance manipulation only.