1,720,992 research outputs found
Cost-effectiveness of Proprotein Convertase Subtilisin/Kexin Type 9 Inhibitors: An Economic Evaluation
No full textFamilial hypercholesterolemia is an autosomal inherited genetic disorder characterized by high levels of low-density lipoprotein cholesterol circulating in the bloodstream. If left untreated, this condition can substantially increase cardiovascular risk, lead to the rapid development of premature coronary artery disease, or cause sudden cardiac death. Despite the high risks associated with familial hypercholesterolemia, a considerable number of these individuals are unable to achieve adequate reductions in low-density lipoprotein cholesterol levels with conventional lipid lowering therapy. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are emerging pharmacological treatments for managing patients with these conditions. Therefore, the goal of this thesis is to assess the cost-effectiveness of PCSK9 inhibitors for the treatment of elevated low-density lipoprotein cholesterol in individuals with familial hypercholesterolemia
Psoriatic Arthritis Screening: A Systematic Review, Meta-Analysis, and Economic Evaluation
No full textPsoriatic arthritis (PsA) is an autoimmune disease that affects the skin and the musculoskeletal system. It causes joint damage and psoriasis of the skin. Untreated disease is usually related to a delayed diagnosis and has been associated with physical disability and high treatment costs later on. Although expensive biologic therapy has proven to slow disease progression and improve health outcomes, rheumatologists have suggested initiating treatment with less expensive Disease Modifying Anti-Rheumatic Drugs (DMARDs). Identifying early PsA is expected to improve health outcomes through early treatment with DMARDs. It is also expected to reduce the proportion of severe disease and biologic treatment. Given that the prevalence of PsA among psoriasis patients is relatively high, dermatologists are well-positioned to screen for arthritis symptoms with already validated self-administered screening questionnaires for patients with psoriasis. The goal of this thesis is to systematically review the characteristics and accuracy estimates of the validated PsA screening tools (chapter 2). It also seeks to evaluate the cost-effectiveness of implementing a PsA screening program in Canada relative to the current practice where psoriasis patients are not systematically screened (chapter 3). The National Institute of Health Research is currently developing a randomized controlled trial for PsA screening in the United Kingdom that will inform the cost-effectiveness model presented in this thesis
On the Optimization of Clostridioides difficile Diagnostics Through RT-PCR Cycle Threshold Defined Zones of Disease Probability
No full textClostridioides difficile is an opportunistic pathogen with a large burden of disease and no gold standard test. Quantitative polymerase chain reaction (qPCR) offers excellent sensitivity but overcalls clinical C. difficile infections (CDI) due to the prevalence of colonization. The hypothesis of this thesis is that the CDI qPCR results can be titrated to determine clinical CDI more accurately and aid in predicting disease severity. A cross-sectional study was conducted on suspected CDI patients evaluating if qPCR cycle threshold (Ct) can be correlated to probability of CDI. Latent class analysis (LCA) was employed with observed variables including four commercial qPCR tests, toxin detection by enzyme immunoassay, toxigenic culture, fecal calprotectin, and clinical diagnosis. Three defined zones as a function of qPCR cycle threshold (Ct) were identified: CDI likely (>90% probability), CDI equivocal (<90% and >10%), CDI unlikely (<10%). A model comprising toxigenic culture, clinical diagnosis, and toxin EIA demonstrated the best fitness. The following Ct cut-offs for 4 commercial test platforms delineated CDI probability zones: GeneXpert®: 24.00, 33.61; Simplexa®: 28.97, 36.85; Elite MGB®: 30.18, 37.43; and BD Max™: 27.60, 34.26. A prospective cohort study was conducted to investigate if these zones can be further correlated to indicators of severe CDI. Primary diagnosis, demographic data and indicators of disease severity were captured: white blood cell, creatinine, albumin, C-reactive protein, and hospital length of stay. A sub analysis was conducted evaluating a subset of the patient population attempting to isolate patients whose clinical variables were most influenced by CDI. No significant correlations were found between the clinical variables investigated and Ct values or Ct zones. This work establishes a method of using deployed diagnostics to allow clinicians to reduce overdiagnosis of CDI. Decreasing false positives could have broad impacts, increase targeted treatments, and decrease antibiotics. The average cost attributed to CDI for one patient is estimated at 929,000 annually with no additional investment in laboratory infrastructure
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Enhancing the Reproducibility of Health Technology Assessments
No full textHealth systems around the world depend on Health Technology Assessment (HTA) programs to provide policy guidance on many factors, including value-for-money. To ensure decisions are made with current information, methods of evidence synthesis and economic evaluation are used to inform a continuous process of evidence gathering and decision making. While computers are used in almost every part of this process, the act of updating an existing HTA often involves a duplication of the original effort. The experience of other scientific fields suggests this is attributable to a lack of reproducibility. This refers to the ability to obtain consistent computational results, using the same set of files and processes. The objective of this thesis was to explore how an emphasis on reproducibility can support the effective development and maintenance of HTAs.
Satisfaction of this objective required the identification and implementation of computing strategies to enhance the reproducibility of HTAs. A literature review was used to identify techniques for reproducibility which had proven successful in other fields. The identified strategies encouraged the creation of an accurate and complete record of the research process in human and machine-readable formats. These findings were subsequently applied to a case study which redeveloped an existing appraisal of biologic treatment for psoriatic arthritis. The first part of the case study summarized the development and execution of an automated workflow. The second part explored how the computing strategies affected the programming of the economic model. Outcomes from the case study included improved quality control, more efficient updating, and the elimination of barriers to the characterization of uncertainty. With enough investment, enhancing the reproducibility of HTAs will enable improved transparency, better decision making, and ultimately population health gains
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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