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Summary Objective To identify research gaps and inform implementation we systematically reviewed the literature evaluating cost-effectiveness of recommended treatments (education, exercise and diet) for the management of hip and/or knee OA. Methods We searched Medline, Embase, Cochrane Central Register of Controlled Trials, National Health Services Economic Evaluation Database, and EconLit from inception to November 2019 for trial-based economic evaluations investigating hip and/or knee OA core treatments. Two investigators screened relevant publications, extracted data and synthesized results. Risk of bias was assessed using the Consensus on Health Economic Criteria list. Results Two cost-minimization, five cost-effectiveness and 16 cost-utility analyses evaluated core treatments in six health systems. Exercise therapy with and without education or diet was cost-effective or cost-saving compared to education or physician-delivered usual care at conventional willingness to pay (WTP) thresholds in 15 out of 16 publications. Exercise interventions were cost-effective compared to physiotherapist-delivered usual care in three studies at conventional WTP thresholds. Education interventions were not cost-effective compared to usual care or placebo at conventional WTP thresholds in three out of four publications. Conclusions Structured core treatment programs were clinically effective and cost-effective, compared to physician-delivered usual care, in five health care systems. Providing education about core treatments was not consistently cost-effective. Implementing structured core treatment programs into funded clinical pathways would likely be an efficient use of health system resources and enhance physician-delivered usual primary care.

Background International guidelines recommend education, exercise, and dietary weight management as core treatments to manage osteoarthritis (OA) regardless of disease severity or co-morbidity. Evidence supports the clinical effectiveness of OA management programs, but the cost-effectiveness of core treatments remains unclear. We will systematically review, synthesize, and assess the literature in economic evaluations of core treatments (education, exercise, and dietary weight management) for the management of hip and/or knee OA. Methods We will search the following elecftronic databases (from inception onwards): MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), National Health Services Economic Evaluation Database, and EconLit. Economic evaluations alongside randomized or nonrandomized clinical trials investigating OA education, exercise, and dietary weight management interventions will be included. Title, abstract, and full text of relevant publications will be screened independently by two reviewers. A content matter expert will resolve any conflicts between two reviewers. Key information from relevant papers will be extracted and tabulated to provide an overview of the published literature. Methodological quality will be evaluated using the Consensus on Health Economic Criteria list. A narrative synthesis without meta-analysis will be conducted. Subgroup analysis will attempt to find trends between research methods, intervention characteristics, and results. Discussion The findings of this review will evaluate the breadth and quality of economic evaluations conducted alongside clinical trials for core treatments in OA management. Systematic review registration PROSPERO CRD42020155964

Background: Clinicians and decision-makers are mostly interested in how the overall effect in a randomized controlled trial impact patient differently due to differential treatment effects. Subgroup analyses of randomized trials examine if the overall treatment effect is consistent among the subgroup or to identify groups that modify the intervention effects. Well defined and performed subgroup analyses led to critical policy decisions; however, inappropriately performed subgroup analyses had resulted in incorrect decisions with negative consequences. This systematic review examines the reporting quality and the subgroup analyses’ credibility in stroke clinical trials. Methods and analysis: We will extract relevant studies from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science using three concepts in the Medical Subject Headings (MESH) heading. Two reviewers will independently screen the title, abstract, and full text of relevant studies. We will examine the risk of bias and the credibility of reported subgroup analyses using two validated instruments, i.e., Cochrane Risk-of-Bias tool for randomized trials version 2 (RoB 2) and the Instrument for assessing the Credibility of Effect Modification Analyses (ICEMAN), respectively. Random effects regression will be used to evaluate study characteristics associated with the credibility of subgroup analyses in the included studies.Expected outcomes: This research aims to review the quality of subgroup analyses’ results and reporting. The research’s results will also provide critical methodological contributions to the statistical literature of clinical trials. Ethics and dissemination: This systematic review does not require primary patient data and does not require ethical approval. The review’s results will be published in a peer-review and scientific conferences.Trial registration number: CRD42020223133

We describe a case of endovascular treatment in a 64-year-old woman affected by a penetrating atherosclerotic ulcer (PAU) of the abdominal aorta with a 26-mm pseudoaneurysm involving the celiac trunk (CT) origin and with superior mesenteric artery (SMA) occlusion in the first 30 mm. The patient underwent stenting to treat the SMA occlusion and subsequent deployment of a custom-designed fenestrated endovascular stent-graft to treat the PAU involving the CT origin. Follow-up at 6 months after device placement demonstrated no complications, and there was complete thrombosis of the PAU and patency of the two branch vessels.

Notre but etait de prouver la faisabilite et la securite d'un protocole de sortie precoce et protegee un jour apres une endarteriectomie carotidienne (EC) utilisant un systeme de monitorage par telemedecine. Sur 147 malades operes de 163 EC, nous avons selectionne un groupe A de 36 malades remplissant les criteres de sortie un jour apres l'intervention chirurgicale. Un manometre pour prise de pression electronique, un videophone, un anti-hypertenseur (amlodipine) et un questionnaire de satisfaction ont ete donnes a tous les malades du groupe A. Avec un programme de video-communication lie au Web, nous avons monitore toutes les quatre heures (de 8 heures du matin a 8 heures du soir) pendant deux jours la plaie chirurgicale, la pression arterielle et la frequence cardiaque des malades. Les autres malades ont ete inclus dans le groupe B. Nous n'avons note aucune difference entre les groupes A et B concernant les caracteristiques demographiques, les facteurs de risque, les lesions carotidiennes, la duree de l'intervention, les complications post-operatoires ou les pertes sanguines. Vingt et un malades du groupe A sont effectivement sortis un jour apres l'intervention chirurgicale. Aucun hematome cervical ne s'est developpe. Trois poussees d'hypertension arterielle ont ete traitees avec succes dans le groupe A. D'apres le questionnaire, un sentiment d'insecurite lors de la sortie etait evident mais il s'est rapidement dissipe. Le cout global de la connexion video etait de 25,39 ± 0,25 euros par malade. L'EC peut etre realisee en toute securite avec une sortie le lendemain en utilisant un systeme de monitorage par telemedecine dans des cas selectionnes. Notre protocole a permis en toute securite une sortie precoce, entrainant une diminution des couts hospitaliers.

We compared the intra-operative diagnostic value of CDS vs IA-DSA in identifying major and minor technical defects after CEA. Between August 1997 and December 1998, 138 consecutive patients undergoing 141 carotid endarterectomies were intra-operatively investigated with colour duplex scan and intra-arterial digital subtraction angiography. Thirty-six (25.5%) technical defects were identified. Four (11.1%) major defects were detected by both methods and they were immediately corrected. Fifteen (41.6%) minor defects were detected by both methods, thirteen (36.1%) minor defects were detected by colour duplex but ignored by angiography. Angiography detected four (11.1%) kinkings missed with the colour duplex. The overall sensitivity of both methods for major defect was 100%. The sensitivity of colour duplex for minor defects was 87% vs 59% for angiography. On the basis of our study, colour duplex could be considered the choice method for quality control after carotid endarterectomy.

In the present work, an easy automatic method based on foil laser scattering measurements is applied to evaluate the induction time (ti) in CR-39 solid state nuclear track detectors for different etching temperatures. A quantity q, proportional to the amount of suface layer removed is plotted against etching temperature. The experimental results are compared with those obtained from microspectrophotometer measurements for Macrofol-E detectors.

We report three theoretical methods which yield, by means of a computer program, the theoretical Submicroscopic and microscopic track profiles corresponding to normal incidence ions for velocities of chemical attack which vary with the position on the incidence axis (x) of the ion and the perpendicular distance measured on the y axis. The program can simulate tracks for cases in which there are weak or sharp fluctuations in the physical damage. These fluctuations may come statistical changes in the damage or changes in the charge state of the incident ion. We report here an alternative solution for problems identified in earlier studies (e.g. G. Somogyi and S.A. Slazay, Nucl. Instr. and Meth. 109 (1973) 211 and R. Mazzei et al., Nucl. Instr. and Meth. B9 (1985) 163) for the microscopic and Submicroscopic tracks, respectively.

The currently available sudden cardiac death (SCD) risk prediction tools fail to identify most at-risk patients and cannot delineate a specific patient's SCD risk. We sought to develop a tool to improve the risk stratification of patients with coronary artery disease. Clinical, demographic, and angiographic characteristics were evaluated among 37,258 patients who had undergone coronary angiography from January 1, 1985 to May 31, 2005, and who were found to have at least one native coronary artery stenosis ofor =75%. After a median follow-up of 6.2 years, SCD had occurred in 1,568 patients, 14,078 patients had died from other causes, and 21,612 patients remained alive. A Cox proportional hazards model identified 10 independent patient characteristic variables significantly associated with SCD. A simplified model accounting for 97% of the predictive capacity of the full model included the following 7 variables: depressed left ventricular ejection fraction, number of diseased coronary arteries, diabetes mellitus, hypertension, heart failure, cerebrovascular disease, and tobacco use. The Duke SCD risk score was created from the simplified model to predict the likelihood of SCD among patients with coronary artery disease. It was internally validated with bootstrapping (c-index = 0.75, chi-square = 1,220.8) and externally validated in patients with ischemic cardiomyopathy from the Sudden Cardiac Death Heart Failure Trial (SCD-HeFT) database (c-index = 0.64, chi-square = 14.1). In conclusion, the Duke SCD risk score represents a simple, validated method for predicting the risk of SCD among patients with coronary artery disease and might be useful for directing treatment strategies designed to mitigate the risk of SCD.

Our aim was to prove the feasibility and safety of a protocol for early and protected discharge 1 day after carotid endarterectomy (CEA) using a system of telemedicine (TMD) monitoring. Among 147 patients operated upon for 163 CEAs, we selected a group (A) of 36 patients fulfilling criteria for discharge 1 day after surgery. An electronic blood pressure manometer, a videophone, an antihypertensive drug (amlodipine), and a customer satisfaction questionnaire were given to every group A patient. With a video-communication program linked to the Web, we monitored every 4 hours (from 8:00 a.m. to 8:00 p.m.) for 2 days the surgical wound, blood pressure, and heart frequency of the patients. Other patients were included in group B. No differences regarding demographic characteristics, risk factors, carotid lesions, operative time, postoperative complications, or blood loss were noted between group A and group B. Twenty-one patients in group A were actually discharged 1 day after surgery. No cervical hematoma developed. Three hypertensive crises were treated successfully in group A. From the questionnaire a feeling of insecurity at discharge emerged, but it rapidly resolved. The overall cost of video connections was 25.39 +/- 0.25 Euros per patient. CEA can be safely done as 1-day surgery using a TMD monitoring system in selected cases. Our protocol allowed early discharge safely, leading to reduced hospital costs.

Long-term success of endovascular treatment of infrarenal abdominal aortic aneurysms (AAA) depends on secure "attachment" of the stent to the proximal and distal necks of the aneurysm. The purpose of this retrospective study was to detect changes in the proximal neck early after endovascular treatment of infrarenal AAA. Between November 1997 and December 1998, we performed endovascular treatment of infrarenal AAA in 43 patients. A bifurcated modular stent (AneuRx by Medtronic) was used in all patients. An oversized stent with a diameter 10% greater than the preoperative diameter of the proximal neck of the AAA was used in all cases. Follow-up examinations were carried out at 1, 6, and 12 months using plain roentgenography, color Doppler ultrasound, and CT scan with contrast injection. Statistical analysis was performed using the Student's t-test. Deterioration of the aortic neck is the result of a variety of mechanisms. The natural history of the infrarenal neck of AAA following endovascular repair (as well as conventional open repair) is progressive enlargement. Stenting could be an added risk factor for expansion. Strict follow-up is essential for early detection of this complication.

The paper introduces a model of massively parallel computation based on broadcast synchronous agents. It consists of a collection of uniform automata which evolve synchronously. Each agent may observe the state of any other agent via broadcast communication, but it is not aware of the identity of the other agents. A broadcast automata based system (BAS) is presented as a new approach to the development of embedded system prototypes, specifically in the field of space applications, where the resource constraints, as well as fault detection and recovery, are critical. An example of application in signal processing is illustrated.

Different organizations are showing more preoccupation for acheiving a greater performance in the protection of the environment. This growing worry has as an envolving frame a series of environmental pressures that are added to the already existing worries in the companies. It's worth noting that national and international legislation is getting stricter, the public opinion is exercising a much more severe role, consumer requirements are growing considerably in order to improve the quality of their lives, and the development must be completed within a circle of restrictive economic measures. As a consequence of this, many companies have started to take actions, such as: environment audits, environment impact studies, etc. But these studies do not insure, within themselves, a good organization performance, they simply show us a situation regarding the follow-up of current policies, besides showing us the positioning of the company in order to meet all of the future reglementary measures. Our country has also started its part in conserving the environment on an energetic level, creating organizations at the highest government levels in order to control said policies and taking advantage of the privatization wave, establishing environmental obligations for the companies, through the regulation of their activities. In the case of Edenor, which grants services of distribution and commercialization of electric energy, according to its Concession Agreement, it must: adequate its actions with the objective of preserving and/or improving the ecosystems involved in the development of its activity, fulfilling the policies currently in force, as well as those established in the future, destined to the protection of the environment, approved by Resolution N° 170/92 of the National Energy Department. With regards to this, we will proceed to show a brief analysis of the environmental policies in force on a national, provincial and municipal level, which directly or indirectly regulates the protection of the environment in general and, particularly, natural resources.

The classic method for the evaluation of the induction time in SSNTD with electron and light microscopy is based on the analysis of the evolution of track diameters as a function of etching time and the extrapolation to zero diameter. The present study outlines a simple method to evaluate the induction time, which is based on the evaluation of changes in light transmission in the irradiated area of the foil. This change is the result of the collective effect of tracks (diameters of less than 500 A) in saturated foils which can be visualized as individual tracks only by electron microscopy.

The examination and evaluation of very small-size etched tracks (⋍ 200 A) generated in Makrofol E detectors after irradiation with alpha-particles have been performed with an improved method using Pt and C replicas analyzed by electron microscopy. Careful handling of the replica allowed to visualize directly ‘finger like’ structures protruding from the replica that correspond to the internal configuration of the tracks.

Chemical etching track profiles in the bulk region, as well as in the physical damage region, were described in a track kinetic theory by Mazzei et al. applying submicroscopic evaluations. In the present work this theory proves useful also to analyze the profiles of “new born” tracks. The equation describing height variations along each track profile is similar to that describing track velocity variation along the axis perpendicular to the ion incidence direction. The theory proves that for “new born” tracks, the chemical etching wave fronts generated in any point of the track are not exceeded by that wave front generated along the heavy ion incidence axis.