Endogenizing the Planning Horizon in Urban fringe agriculture

To evaluate the nature of farm operation longevity in urban fringe agriculture, this paper develops a model that endogenizes planning horizon and estimates an empirical model whereby anticipated longevity in farming is regressed against farm, farmer, regulatory and land market related variables. The results suggest that the length of the planning horizon is directly related to farm profitability and confirm the impermanence syndrome hypothesis that land values are inversely related to the planning horizon. Contrary to farmers’ claims that periodic land disposal provides an internal source of credit to support long-term viability, the disposition of portions of the farmland is found to shorten the planning horizon. Innovative farmers are found to have longer planning horizons while experiences with Right-to-Farm conflicts are found to result in decreased planning horizon. Given the expected continual increase in land values and the growing physical closeness of farmers to their non-farm neighbors, significant concerns remain about the long-term survivability of urban fringe farmers. This study suggests the importance of considering farmers’ planning horizon as a key component in farmland retention programs.     

Cost of care for new versus recurrent acute coronary syndrome patients

Abstract

Introduction: The economic burden of acute coronary syndrome (ACS) continues long after the acute event has resolved. This study compared ACS-related costs between new and recurrent ACS patients using retrospective claims data from a large US health plan.

Methods: Patients with ACS were identified using ICD-9 codes between the 1st January 2001 and the 30th June 2003. The first diagnosis was defined as the index event. Patient claims were examined 1 year before, and up to 1 year after, the index event. Hospitalisations, revascularisations and costs for new and recurrent cohorts were compared. Multivariate regression was used to examine cost predictors.

Results: In total, 15,508 patients were identified, 82% had new ACS. The new ACS cohort was more likely to have myocardial infarction and be hospitalised for the index event, leading to higher index event costs. However, the recurrent ACS cohort had more re-hospitalisations, longer lengths of inpatient stay and a higher probability of revascularisation during follow-up. The index event cost per patient and per patient-month was higher for new ACS patients. After adjusting for confounding factors, multivariate cost models revealed annualised follow-up medical costs were 9.9% higher (p=0.017) and annualised follow-up pharmacy costs were 8.3% higher (p≤0.0001) for the new ACS cohort.

Conclusion: Newly diagnosed ACS patients had significantly higher adjusted costs in the year following the index event, but recurrent ACS patients still experienced high medical costs. More emphasis by providers and patients on adherence to treatment guidelines may be one step to improving patient outcomes.

*This paper was presented in part at the Academy of Managed Care Pharmacy Annual Meeting, 7th April 2006.     

Literature-related discovery: Potential treatments and preventatives for SARS

Literature-related discovery (LRD) is the linking of two or more previously disjoint concepts in order to produce novel, interesting, plausible, and intelligible connections (i.e., potential discovery). LRD has been used to identify potential treatments or preventative actions for challenging medical problems, among myriad other applications.Severe acute respiratory syndrome (SARS) was the first pandemic of the 21st century. SARS was eventually controlled through increased hygienic measures (e.g., face mask protection, frequent hand washing, living quarter disinfection), travel restrictions, and quarantine. According to recent reviews of SARS, none of the drugs that were used during the pandemic worked.For the present paper, SARS was selected as the first application of LRD to an infectious disease. The main goal of this research was to identify non-drug non-surgical treatments that would 1) prevent the occurrence, or 2) reduce the progression rate, or 3) stop/reverse the progression of SARS. The MeSH taxonomy of Medline was used to restrict potential discoveries to selected semantic classes, and to identify potential discoveries efficiently. To enhance the volume of potential discovery, databases were used in addition to Medline. These included the Science Citation Index (SCI) and, in contrast to previous work, a full text database. Because of the richness of the full text, ‘surgical’ queries were developed that targeted the exact types of potential discovery of interest while eliminating clutter more efficiently.     

马凡综合征Bentall术后半年再发DebakeyⅢ一例

马凡氏综合征属遗传性常染色体显性遗传性结缔组织疾病,属少见的心血管疾病。该病可通过心脏外科Bentall手术缓解临床症状,延缓生命,提高生活质量。马凡氏综合征术后半年并发DeBakeyIII再次手术成功治愈的病例临床上少见,本文是根据我科成功救治的病例,进行的整理分析,内容如文所述。     

Towards a phenomenology of civil war: Hobbes meets Benjamin in Beirut

Based on interviews with Beirut intellectuals and architects, this essay endeavours to trace the contours for a phenomenology or anthropology of civil war. Thomas Hobbes serves as a guide, with his idea of civil war representing a relapse into the ‘state of nature’; as absence of sovereignty resulting in a ‘war of everybody against everybody’. The effects of ever-latent civil war in Beirut are far-reaching: the fragmentation of urban space and the disappearance of public space, the loss of memory and the fragmentation of time, even the reification of language. In the collective imagination and in the arts, Beirut appears as a ghost town, a spectral city with a spectral civility. What we discover is a city, its inhabitants, its social behaviour, but also its art and literature, in the grip of post-traumatic stress syndrome. From all this, we take home two things: first, any city can (at least in principle) relapse into a similar state of nature — Beirut can become a paradigm of latent civil war; and second, the traumatic modernity of Beirut mirrors the traumatic artistic expressions of modernism — the shock of modernity is also always a modernity of shock.     

基于置信度判定的循环冗余校验纠错技术

以S模式下行数据链的检纠错为例,给出了基于置信度判定的循环冗余校验多位纠错技术,实现了突发和随机分布的多位差错的纠正,在不增加冗余码的情况下大大增强了循环冗余校验码的纠错能力.     

Cost-effectiveness analysis of rasburicase over standard of care for the prevention and treatment of tumor lysis syndrome in children with hematologic malignancies in China

Aims: To conduct a lifetime cost-effectiveness analysis (CEA) of rasburicase compared with standard of care (SOC) for tumor lysis syndrome (TLS) in children with hematologic malignancies from the Chinese healthcare system perspective.

Materials and methods: The CEA was performed using a decision tree model with a lifetime horizon. The model explores the cost-effectiveness of rasburicase vs SOC for both preventing TLS and treating established TLS among pediatric patients with acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), and non-Hodgkin’s lymphoma (NHL). Both the prophylaxis-use model and treatment-use model incorporate long-term health states of the diseases: survival without TLS and death. The efficacy data of rasburicase and SOC were obtained from published literature. Drug costs, healthcare resource utilization (HRU), and adverse event (AE) management costs were obtained via a published study with clinical experts. Costs in US dollar and quality-adjusted life year (QALY) are reported, and incremental cost-effectiveness ratios (ICERs) were also calculated. Uncertainties due to parameter fluctuations in the model were assessed through one-way sensitivity analysis and probabilistic sensitivity analysis (PSA).

Results: During TLS prevention, compared with SOC, the ICER of rasburicase treatment in China are $17,580.04/QALY, $5,783.45/QALY, and $5,391.00/QALY for pediatric patients with AML, ALL, and NHL, respectively. For the established TLS treatment, compared with SOC, the ICERs of rasburicase treatment are $2,031.18/QALY, $1,142.93/QALY, and $990.37/QALY for pediatric patients with AML, ALL, and NHL, respectively.

Limitations: The clinical data for SOC are based on the published study in China, and the rasburicase prevention or treatment failure rate was either calculated based on the risk ratio or directly from the clinical study among non-Chinese pediatric patients. Another study limitation was the lack of utility data for pediatric patients with TLS and without TLS. Thus, the utility scores of pediatric cancer survivors were used as an alternative.

Conclusion: Rasburicase is estimated to be a cost-effective alternative to SOC in the prevention and treatment of TLS among Chinese pediatric patients with AML, ALL, and NHL.     

Prospective utility study of patients with multiple cardiovascular events

Objectives: The effects of acute coronary syndrome (ACS) events on health-related quality-of-life (HRQoL) and the time dependency of these effects are unknown. This study aimed to characterize health utilities in ACS patients to aid development of future economic models estimating the cost per quality-adjusted life-year impact of ACS events and potential treatments.

Methods: Multi-center, non-interventional, longitudinal evaluation of health utility in patients experiencing ACS or stroke events. EuroQol-5 dimension 3 level (EQ-5D-3L) surveys were sent to patients (≥18 years) from three UK centers, 1 month after hospital discharge for myocardial infarction (MI), unstable angina (UA), or stroke. Patient demographics, lifestyle, and baseline utility score were collected in the first survey. Follow-up surveys were sent at 6, 12, 18, and 24 months to prospectively capture utility and subsequent health events. Two methods of patient identification were adopted—prospective, where the patient’s qualifying events occurred after the study index date, and retrospective, where the patient’s qualifying event occurred prior to the study index date. General healthy population utility values were assumed for pre-event HRQoL.

Results: Between January 2011 and March 2014, 2,103 prospectively (n?=?1,350)/retrospectively (n?=?753) identified patients (mean age?=?68.3 years; 67.9% male) responded: MI?=?55.9% (n?=?1,176), UA?=?42.7% (n?=?898), stroke?=?1.4% (n?=?29); 24% had type 2 diabetes. Post-event utility values were lower than general healthy population values, although significant differences in utility between subsequent 6 (n?=?1,031, change?=?–0.002), 12 (n?=?1,096, change?=?–0.008), 18 (n?=?1,246, change?=?–0.007), and 24 (n?=?1,277, change?=?–0.004) month timepoints were not detected. Through multivariate regression analyses, wheelchair use, current smoking, and secondary mental and joint health events were associated with the greatest statistically significant utility decrements.

Conclusions: This study indicates that health utility decreases following a cardiovascular event and, although some improvement occurs over the subsequent 24 months, general healthy population utility is not necessarily attained.     

Cost reduction from resolution/improvement of carcinoid syndrome symptoms following treatment with above-standard dose of octreotide LAR

Aims: To calculate the cost reduction associated with diarrhea/flushing symptom resolution/improvement following treatment with above-standard dose octreotide-LAR from the commercial payor’s perspective.

Materials and methods: Diarrhea and flushing are two major carcinoid syndrome symptoms of neuroendocrine tumor (NET). Previously, a study of NET patients from three US tertiary oncology centers (NET 3-Center Study) demonstrated that dose escalation of octreotide LAR to above-standard dose resolved/improved diarrhea/flushing in 79% of the patients within 1 year. Time course of diarrhea/flushing symptom data were collected from the NET 3-Center Study. Daily healthcare costs were calculated from a commercial claims database analysis. For the patient cohort experiencing any diarrhea/flushing symptom resolution/improvement, their observation period was divided into days of symptom resolution/improvement or no improvement, which were then multiplied by the respective daily healthcare cost and summed over 1 year to yield the blended mean annual cost per patient. For patients who experienced no diarrhea/flushing symptom improvement, mean annual daily healthcare cost of diarrhea/flushing over a 1-year period was calculated.

Results: The economic model found that 108 NET patients who experienced diarrhea/flushing symptom resolution/improvement within 1 year had statistically significantly lower mean annual healthcare cost/patient than patients with no symptom improvement, by $14,766 (p?=?.03). For the sub-set of 85 patients experiencing resolution/improvement of diarrhea, their cost reduction was more pronounced, at $18,740 (p?=?.01), statistically significantly lower than those with no improvement; outpatient costs accounted for 56% of the cost reduction (p?=?.02); inpatient costs, emergency department costs, and pharmacy costs accounted for the remaining 44%.

Limitations: The economic model relied on two different sources of data, with some heterogeneity in the prior treatment and disease status of patients.

Conclusions: Symptom resolution/improvement of diarrhea/flushing after treatment with an above-standard dose of octreotide-LAR in NET was associated with a statistically significant healthcare cost decrease compared to a scenario of no symptom improvement.     

大剂量盐酸氨溴索配合护理干预治疗成人急性呼吸窘迫综合征患者的临床疗效

目的：探讨大剂量盐酸氨溴索配合护理干预治疗成人急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法选取2012年7月至2014年7月内江市东兴区人民医院收治的57例ARDS患者资料,按随机数字表法将其分为对照组（27例）和观察组（30例）。对照组患者积极治疗原发病,并行机械通气呼吸支持,试验组患者在对照组基础上给予大剂量盐酸氨溴索治疗,且两组患者均给予积极护理干预。比较两组患者的肺通气指标、氧化应激指标及临床疗效。结果治疗后,试验组患者的内源性呼气末正压（PEEPi）、气道阻力（RAW）均明显低于对照组,氧合指数（PaO2/FiO2）、肺顺应性（CL）均明显高于对照组,丙二醛（MDA）明显低于对照组,谷胱甘肽（GSH）、超氧化物歧化酶（SOD）、总氧化能力（TAO）均明显高于对照组,差异均有统计学意义（均P＜0.05）;观察组患者总有效率为73.3%,明显高于对照组的55.6%,差异有统计学意义（P＜0.05）。结论积极正确的治疗和护理措施是严重ARDS患者抢救成功的重要条件。