Targeted genetic testing is a tool to identify women at increased risk of gynaecological cancer.
This systematic review evaluates the results and quality of cost-effectiveness modeling studies that ...assessed targeted genetic-based screen-and-treat strategies to prevent breast and ovarian cancer.
Using MEDLINE and databases of the Centre for Reviews and Dissemination, we searched for health economic modeling evaluations of targeted genetic-based screen-and-treat strategies to prevent inheritable breast and ovarian cancer (until August 2020). The incremental cost-effectiveness ratios (ICERs) were compared. Methodological variations were addressed by evaluating the model conceptualizations, the modeling techniques, parameter estimation and uncertainty, and transparency and validation of the models. Additionally, the reporting quality of each study was assessed.
Eighteen studies met our inclusion criteria. From a payer perspective, the ICERs of (1) BRCA screening for high-risk women without cancer ranged from dominating the no test strategy to an ICER of $21 700/quality-adjusted life years (QALY). In studies that evaluated (2) BRCA cascade screening (ie, screening of women with cancer plus their unaffected relatives) compared with no test, the ICERs were between $6500/QALY and $50 200/QALY. Compared with BRCA alone, (3) multigene testing in women without cancer had an ICER of $51 800/QALY (one study), while for (4) multigene-cascade screening the ICERs were $15 600/QALY, $56.500/QALY, and $69 600/QALY for women in the United Kingdom, Norway, and the United States, respectively (2 studies). More recently published studies showed a higher methodological and reporting quality.
Targeted BRCA or multiple gene screening is likely to be cost-effective. Methodological variations could be decreased by the development of a reference model, which may serve as a tool for validation of present and future cost-effectiveness models.
•Targeted screening approaches based on BRCA1 and on BRCA2 or multiple genes are likely to be cost-effective for women without cancer and for women with cancer and their unaffected relatives.•Uptake rates of surgery and mutation penetrance are based on heterogeneous data sources and often are considered to be sensitive parameters for the cost-effectiveness ratio.•In most models, data on utility rarely reflects a woman’s emotional and psychological distress or relief associated with the carrier status and physical or psychological long-term effects of surgical prevention.•Decision makers should be aware of the methodological variations and the reporting quality of the studies.
The novel coronavirus SARS-CoV-2 and the associated infectious disease COVID-19 pose a significant challenge to healthcare systems worldwide. Patients with cancer have been identified as a high-risk ...population for severe infections, rendering prophylaxis and treatment strategies for these patients particularly important. Rapidly evolving clinical research, resulting in the recent advent of various vaccines and therapeutic agents against COVID-19, offers new options to improve care and protection of cancer patients. However, ongoing epidemiological changes and rise of new virus variants require repeated revisions and adaptations of prophylaxis and treatment strategies to meet these new challenges. Therefore, this guideline provides an update on evidence-based recommendations with regard to vaccination, pharmacological prophylaxis and treatment of COVID-19 in cancer patients in light of the currently dominant omicron variants. It was developed by an expert panel of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO) based on a critical review of the most recent available data.
•Changes in epidemiology of SARS-CoV-2 variants require review of strategies.•Vaccination against COVID-19 is of particular importance in cancer patients.•Early treatment of COVID-19 in cancer patients reduces risk of severe disease.•Long-COVID is common in cancer patients and poses a particular challenge.•Evidence-based recommendations can help clinicians make informed decisions.
Observation to examine the clinical usefulness of a cluster of sacroiliac joint tests.
To find the sensitivity, specificity, and positive and negative predictive values (4 commonly used epidemiologic ...measures) for a cluster of sacroiliac joint tests in a group of subjects with and without low back pain.
Sacroiliac joint testing is commonly used by orthopaedic physical therapists in the evaluation of patients with low back pain.
Two hundred nineteen patients who either were being treated for low back pain or were being treated for some other condition not related to the low back participated in the study. The diagnosis of low back pain was obtained from the physician's prescription, which included low back strain, low back pain, or sacroiliac joint dysfunction, and the patient's pain drawing.
The results were a finding of 0.82 for sensitivity, 0.88 for specificity, 0.86 for positive predictive value of a test, and 0.84 for negative predictive value of the cluster of tests.
The results of this study show that using a cluster of sacroiliac joint tests can be useful in identifying sacroiliac joint dysfunction in patients with low back pain.
Many applications require circuits to be operated close to the performance limits of current silicon (production) processes to meet the required circuit specifications for, e.g., high speed, low ...noise, and low power consumption. Therefore, the circuits must be carefully optimized by selecting the individual transistor configurations. As a consequence, model parameters for a large variety of configurations (100 or more) are often requested. Unfortunately, most present design tools and modeling methods do not support an efficient generation of the respective parameter sets for bipolar compact models. This paper describes an approach that is physics and process based; facilitates an extremely fast generation of consistent model parameter sets, even during the initial phase of process development; and reduces parameter extraction efforts significantly. This allows one to quickly explore various process options in advance and to align process development with circuit product requirements. The approach is supported by a computer-aided-design tool named TRADICA, which can be combined with circuit simulators allowing the emitter size and number of emitter, base, and collector contacts to be the only model parameters visible to designers. Related modeling and parameter extraction issues are also discussed because these areas are often unknown and tend to be underestimated by circuit designers and process developers but have a significant impact on the flexibility, capability, and accuracy of circuit design.
The archaeological record of the Patrick phase (cal. A.D. 650–900) is often interpreted as representing the origins of sedentary village life in the American Bottom region. Our analysis of new ...excavation data and revaluation of previous collections indicates that instead, the Patrick phase marks the expansion of semisedentary pioneering groups engaged in a forest-fallow system of swidden agriculture. Patrick phase groups were pre-maize farmers and foragers who took full advantage of the regions natural resources by spreading themselves across the region, frequently relocating villages, regularly dispatching task groups, and routinely using fire to clear fields and encourage economically important plants and habitats. This new interpretation calls into question longstanding assumptions about the sedentary nature of the largest excavated Patrick phase sites in the region, in particular the Range site. These large sites do not appear to be the remnants of large, permanent (multiyear) communities, as previously argued, but rather, represent frequently reused "focal points" within a cyclical land-use pattern.
Archaic Societies Emerson, Thomas E; McElrath, Dale L; Fortier, Andrew C
2012, 2009
eBook
Sweeping and detailed, this long-awaited volume is an indispensable guide to the Archaic period across the midcontinent. Archaeologists throughout the region share the latest excavation results and ...analytical perspectives to reveal and reinterpret the worlds of those Native peoples who lived there for some 9, 000 years (up to about 3, 000 years ago). Of particular concern is the establishment of relative and absolute chronologies for the Archaic period, the relationships between the artifacts left behind and the peoples who made and used them, and the changing interactions between cultures, climate, and landscape. Archaeologists offer useful, up-to-date overviews of Archaic societies, assessment of stratigraphic sequences, and detailed discussions of finds and interpretations from the Mississippi and Ohio river regions and the Great Lakes. Comprehensive and accessible, this landmark book is a must for anyone wanting to understand a crucial but little-understood period in North America's prehistory.
This demo paper is on an introspection tool for an agile workflow engine that executes long-term workflows. Agile workflows are workflows whose control flow structure can be adapted at run-time. We ...will present the architecture of the overall agile workflow management system, briefly introduce the agile workflow modelling language, and describe the tool for the introspection into the representation and execution of the workflows.
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