144 research outputs found
Calibrating models in economic evaluation: A comparison of alternative measures of goodness of fit, parameter search strategies and convergence criteria
No full textBackgroundThe importance of assessing the accuracy of health economic decision models is widely recognized. Many applied decision models (implicitly) assume that the process of identifying relevant values for a model's input parameters is sufficient to prove the model's accuracy. The selection of infeasible combinations of input parameter values is most likely in the context of probabilistic sensitivity analysis (PSA), where parameter values are drawn from independently specified probability distributions for each model parameter. Model calibration involves the identification of input parameter values that produce model output parameters that best predict observed data.MethodsAn empirical comparison of three key calibration issues is presented: the applied measure of goodness of fit (GOF); the search strategy for selecting sets of input parameter values; and the convergence criteria for determining acceptable GOF. The comparisons are presented in the context of probabilistic calibration, a widely applicable approach to calibration that can be easily integrated with PSA. The appendix provides a user's guide to probabilistic calibration, with the reader invited to download the Microsoft® Excel-based model reported in this article.ResultsThe calibrated models consistently provided higher mean estimates of the models' output parameter, illustrating the potential gain in accuracy derived from calibrating decision models. Model uncertainty was also reduced. The chi-squared GOF measure differentiated between the accuracy of different parameter sets to a far greater degree than the likelihood GOF measure. The guided search strategy produced higher mean estimates of the models' output parameter, as well as a narrower range of predicted output values, which may reflect greater precision in the identification of candidate parameter sets or more limited coverage of the parameter space. The broader convergence threshold resulted in lower mean estimates of the models' output, and slightly wider ranges, which were closer to the outputs associated with the non-calibrated approach.ConclusionsProbabilistic calibration provides a broadly applicable method that will improve the relevance of health economic decision models, and simultaneously reduce model uncertainty. The analyses reported in this paper inform the more efficient and accurate application of calibration methods for health economic decision models.Jonathan Karnon, Tazio Vann
Economic modelling assessment of cervical cancer screening and HPV vaccination in Brazil
No full textMore than 85% of the global burden of cervical cancer occurs in developing countries, where it
is the second most common cancer among women. In Brazil alone, a total of 17,500 new cases
and 3,300 deaths of cervical cancer are expected in 2012. Despite the investments in cytologybased
screening in the country, the reduction of cervical cancer incidence has been less than
expected. The aim of this thesis was to investigate the cost-effectiveness of alternative cervical
cancer screening and HPV vaccination strategies in Brazil. This was achieved by focusing on
three specific objectives: 1) To evaluate the cost-effectiveness of cervical cancer screening
strategies for women presenting equivocal cytological results, 2) To evaluate the costeffectiveness
of cervical cancer screening strategies for HIV-infected women, 3) To evaluate
the cost-effectiveness of HPVvaccination for pre-adolescent women. An additional objective
was to review and provide guidance on the use of model calibration methods in economic
modelling assessments,as they are particularly important in screening and vaccination studies.
The first empirical analysis found that HPV triage for women above 30 years-old presenting
equivocal cytology results was likely to be very cost-effective. The second empirical analysis
found that to screen HIV-infected women with HPVtesting followed by cytology annually was
also likely to be very cost-effective. The third empirical analysis demonstrated that adding the
quadrivalent vaccination of pre-adolescent girls to the current efforts to control cervical cancer
in Brazil was very cost-effective for most of the scenarios analyzed. The vaccine was even cost
saving when considering low coverage and cost of vaccination. This thesis presents findings
that will inform cervical cancer screening and HPV vaccination policies in middle-income
countries like Brazil and also provides guidance to help improve the standards of model
calibration approaches used in cost-effectiveness analysis
International scientific collaboration in HIV and HPV: a network analysis
No full textResearch endeavours require the collaborative effort of an increasing number of individuals. International scientific collaborations are particularly important for HIV and HPV co-infection studies, since the burden of disease is rising in developing countries, but most experts and research funds are found in developed countries, where the prevalence of HIV is low. The objective of our study was to investigate patterns of international scientific collaboration in HIV and HPV research using social network analysis. Through a systematic review of the literature, we obtained epidemiological data, as well as data on countries and authors involved in co-infection studies. The collaboration network was analysed in respect to the following: centrality, density, modularity, connected components, distance, clustering and spectral clustering. We observed that for many low- and middle-income countries there were no epidemiological estimates of HPV infection of the cervix among HIV-infected individuals. Most studies found only involved researchers from the same country (64%). Studies derived from international collaborations including high-income countries and either low- or middle-income countries had on average three times larger sample sizes than those including only high-income countries or low-income countries. The high global clustering coefficient (0.9) coupled with a short average distance between researchers (4.34) suggests a “small-world phenomenon.” Researchers from high-income countries seem to have higher degree centrality and tend to cluster together in densely connected communities. We found a large well-connected community, which encompasses 70% of researchers, and 49 other small isolated communities. Our findings suggest that in the field of HIV and HPV, there seems to be both room and incentives for researchers to engage in collaborations between countries of different income-level. Through international collaboration resources available to researchers in high-income countries can be efficiently used to enroll more participants in low- and middle-income countries.<br/
A Study on the Symptomatology and Diagnostic Methodology of Vanni Pitham
No full textVanni Pitham a clinical entity was described by Sage Yugi in his wisdom. The study conducted has come out with excellent results validating the clinical features of Vanni Pitham elucidated in an ultra short poetic segment by Yugi. The study was aimed at evolving a set of exclusive Siddha diagnostic findings for Vanni Pitham with the observation and inference of various parameters like Naadi, Neikkuri and disease acquired season, it can be concluded that all of them point to the development or vitiation of humour leading to the disease Vanni Pitham. The patient reported with the symptoms of Vanni Pitham were subjected to the standard set of investigations, the results and findings of the investigations were suggestive of Vanni Pitham according to modern classification of disease. Manikkadai Nool and Nei kuri findings may help in the identifying of preponderance in a person to develop Vanni Pitham, hence it can be used as a screening measure to advise the preventive measures well in advance. Almost the patients who diagnosed as Vanni Pitham had significant study of colonoscopy evidence conforming to the correlation of disease with inflammatory bowel disease. From the analysis done between Vanni Pitham cases and control group, notable variations were observed in both Siddha and Modern parameters. Interestingly, it was found that the symptoms presented by the patients in the study were those of a constant subset of symptoms of inflammatory bowel disease explained in the present day classification. It correlated with all of the symptoms mentioned by Yugi muni under Vanni Pitham. Thus the author concludes by throwing lights on validation of symptomatology and exclusive Siddha diagnostic methodology for Vanni Pitham so that a physician can arrive at proper treatment procedures by rightly diagnosing the disease
Prima dei numeri. Mart. Cap. VII 731-732 fra Aristotele e platonismo
No full textNella trattazione della monade di De nuptiis VII 731-732 convergono dottrine differenti, armonizzate in una visione unitaria che è l’essenza della summa marzianea; dai dialoghi di Platone alla Metafisica di Aristotele, da Filone di Alessandria al Corpus Hermeticum, Marziano dimostra una conoscenza diretta delle fonti e una precisa consapevolezza della tradizione filosofica antica.In the treatment of the monad in De nuptiis VII 731-732 different doctrines converge, harmonized in a unitary vision that is the essence of Martianus’ summa; the author proves to have directly read sources like Platonic dialogues, Aristotle’s Metaphysics, Philo of Alexandria and Corpus Hermeticum, and he demonstrates a precise knowledge of the ancient philosophical tradition
Maestro Irripetibile : Vanni Pasca e il suo impatto nella storia del design
No full textVanni Pasca, a critic and university professor of design, was a pioneer in giving dignity and theoretical depth to design. He educated young scholars and promoted the history of design as a key discipline in the training of designers. Founder of the Italian Association of Design Historians in 2009, Pasca also organized the First International Conference on Historical Studies of Design in Milan in 1991. An author of influential texts, including an essay on Christopher Dresser, he developed the concept of “expanded design”, suggesting an evolution of design beyond its traditional boundaries. Despite his significant impact, his legacy in Palermo has been overlooked. This article emphasizes the importance of recognizing and celebrating his contribution, highlighting his international influence in design and beyond
Per una rilettura del prologo di Marziano Capella
No full textIl "De nuptiis Philologiae et Mercurii" di Marziano Capella si apre con un doppio prologo in versi e in prosa. Nella prosa l’autore è interrogato dal figlio sul significato dell’inno che ha appena recitato e che il giovane attribuisce a esercizio di un perdigiorno. Il verbo con cui questa attività viene bollata è, nella tradizione manoscritta, il neologismo greco γυμνολογίζεις che potrebbe essere interpretato sulla base di un altro neologismo, γυμνολογία, termine che compare nelle dispute teologiche sulla natura umana e/o divina del Cristo.Martianus Capella’s "De nuptiis Philologiae et Mercurii" opens with a double prologue, written in verse and in prose. In the prose section, the author is questioned by his son about the meaning of the hymn he has just recited and which the young man considers to be the creation of an idler. The verb with which this kind of activity is defined is, in the manuscript tradition, the Greek neologism γυμνολογίζεις, which could be interpreted on the basis of another neologism, γυμνολογία, a term which appears in the theological disputes on the human and/or divine nature of Jesus
Luigi Papo (de Montona): Combattente e attivista per l’Istria italiana - dalla guerra alla pseudo-storia
No full textLuigi Papo was the leader of the Motovun fascist group who participated in the War with other volunteers of fascist militias between 1943 and 1945 in Istria. At the end of the War, after a short imprisonment in Prestranek (Slovenia), he succeeded to escape to Italy to avoid the war crimes indictments launched against him by Yugoslavia. In the following years, now acting politically instead of militarily, Papo continued his activism in associations of Istrian exiles and in their journals. Papo was a prolific author: he wrote numerous publications about the early and modern history of Istria and about his experiences in the war. Through his constant activism, he participated in the development of the narrative discourse on the Istrian exodus and foibe and had a strong influence in the circles of exiles and later in the various sectors of the Italian public. This article presents some moments of Papo’s experience as a fighter, activist and writer, and in particular discusses his dichotomous view of linguistic and national relations in Istria.Luigi Papo bio je vođa motovunske fašističke skupine koja je sudjelovala u ratu s drugim dragovoljcima fašističkih milicija između 1943. i 1945. godine u Istri. Na kraju borbe uspio je, nakon kratka zatvora u Prestranku (Slovenija), pobjeći u Italiju kako bi izbjegao optužbe za ratne zločine koje je protiv njega pokrenula Jugoslavija. U sljedećim je godinama Papo nastavio svoj aktivizam, sada umjesto vojno djeluje politički, u udrugama istarskih ezula te u njihovim časopisima. Papo je bio plodan autor: napisao je brojne publikacije o staroj i novijoj povijesti Istre te o svojim iskustvima u ratu. Svojim stalnim aktivizmom sudjelovao je u izgradnji narativnoga diskursa o istarskom egzodusu i o fojbama te je imao snažan utjecaj u krugovima ezula i kasnije u različitim sektorima talijanske javnosti. Ovaj članak predstavlja neke trenutke Papova iskustva kao borca, aktivista i pisca, a posebice raspravlja o njegovu dihotomnom pogledu na jezične i nacionalne odnose u Istri.Luigi Papo fu a capo della squadra d’azione fascista di Montona che prese parte alla guerra insieme agli altri volontari delle milizie fasciste tra il 1943 e il 1945 in Istria. Alla fine del combattimento riuscì, dopo un breve periodo trascorso nel carcere di Prestranek (Slovenia), a fuggire in Italia per evitare le accuse per crimini di guerra intraprese da parte della Jugoslavia. Negli anni successivi Papo continuò con il suo attivismo, non opera più in modo militare ma politico, attraverso associazioni degli esuli istriani e le loro riviste. Fu autore prolifico: scrisse numerose pubblicazioni sulla storia remota e recente dell’Istria e sulle proprie esperienze in guerra. Con il suo costante attivismo partecipò alla costruzione del discorso narrativo sull’esodo istriano e sulle foibe ed ebbe un forte influsso tra gli esuli e, successivamente, nei vari settori pubblici italiani. Questo articolo rappresenta alcuni momenti delle esperienze di Papo come combattente, attivista e scrittore, e discute in particolare della sua visione dicotomica relativa ai rapporti linguistici e nazionali in Istria
Economic evaluation of linezolid versus vancomycin in mechanical ventilation-associated nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus
No full textCervical cancer screening: Barriers to access and potential solutions for Nigeria
No full textIn developed countries, giant strides have been made in reducing mortality due to cervical cancer. The success recorded has been largely attributed to effective screening programmes. In contrast, the burden and mortality due to this disease is rising in developing countries. Access to screening services remains a major challenge for the majority of the population at risk. This paper reviews the current demand-side barriers to cervical cancer screening inNigeriaand identifies potential solutions. Using academic databases and grey literature, a review was carried out to identify current screening modalities, barriers to access, and potential solutions. The current innovative method for control is early detection and treatment using “See and Treat” which involves visual inspection of the cervix with acetic acid (VIA) and cryotherapy. Lack of awareness, cost, and availability were identified as major barriers to access. Potential solutions feasible in the Nigerian context were categorized as financial and non-financial. The potential financial interventions include voucher schemes, conditional cash transfers, health equity, community loan funds, and prepayment mechanisms. Potential non-financial interventions that would be useful include raising awareness via health education and counseling, community participation, community based interventions, and pre-payment mechanisms
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