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Standard treatment for early breast cancer includes whole breast irradiation (WBI) after breast-conserving surgery. Recently, accelerated partial breast irradiation (APBI) has been proposed for well-selected patients. A cost and cost-effectiveness analysis was carried out comparing WBI with two APBI techniques. An activity-based costing method was used to determine the treatment cost from a societal perspective of WBI, high dose rate brachytherapy (HDR) and permanent breast seed implants (PBSI). A Markov model comparing the three techniques was developed with downstream costs, utilities and probabilities adapted from the literature. Sensitivity analyses were carried out for a wide range of variables, including treatment costs, patient costs, utilities and probability of developing recurrences. Overall, HDR was the most expensive ($14 400), followed by PBSI ($8700), with WBI proving the least expensive ($6200). The least costly method to the health care system was WBI, whereas PBSI and HDR were less costly for the patient. Under cost-effectiveness analyses, downstream costs added about $10 000 to the total societal cost of the treatment. As the outcomes are very similar between techniques, WBI dominated under cost-effectiveness analyses. WBI was found to be the most cost-effective radiotherapy technique for early breast cancer. However, both APBI techniques were less costly to the patient. Although innovation may increase costs for the health care system it can provide cost savings for the patient in addition to convenience. Copyright 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
The objective of the present study was to determine if there is a sex-based difference in lifting technique across increasing-load conditions. Eleven male and 14 female participants (n = 25) with no previous history of low back disorder participated in the study. Participants completed freestyle, symmetric lifts of a box with handles from the floor to a table positioned at 50% of their height for five trials under three load conditions (10%, 20%, and 30% of their individual maximum isometric back strength). Joint kinematic data for the ankle, knee, hip, and lumbar and thoracic spine were collected using a two-camera Optotrak motion capture system. Joint angles were calculated using a three-dimensional Euler rotation sequence. Principal component analysis (PCA) and single component reconstruction were applied to assess differences in lifting technique across the entire waveforms. Thirty-two PCs were retained from the five joints and three axes in accordance with the 90% trace criterion. Repeated-measures ANOVA with a mixed design revealed no significant effect of sex for any of the PCs. This is contrary to previous research that used discrete points on the lifting curve to analyze sex-based differences, but agrees with more recent research using more complex analysis techniques. There was a significant effect of load on lifting technique for five PCs of the lower limb (PC1 of ankle flexion, knee flexion, and knee adduction, as well as PC2 and PC3 of hip flexion) (p < 0.005). However, there was no significant effect of load on the thoracic and lumbar spine. It was concluded that when load is standardized to individual back strength characteristics, males and females adopted a similar lifting technique. In addition, as load increased male and female participants changed their lifting technique in a similar manner. Copyright 2016. Published by Elsevier Ltd.
The aim of this study was to specify the causes of occupational accidents, determine social responsibility and the role of groups involved in work-related accidents. This study develops occupational accidents causes tree, occupational accidents responsibility tree, and occupational accidents component-responsibility analysis worksheet; based on these methods, it develops cause-responsibility analysis (CRA) techniques, and for testing them, analyzes 100 fatal/disabling occupational accidents in the construction setting that were randomly selected from all the work-related accidents in Tehran, Iran, over a 5-year period (2010-2014). The main result of this study involves two techniques for CRA: occupational accidents tree analysis (OATA) and occupational accidents components analysis (OACA), used in parallel for determination of responsible groups and responsibilities rate. From the results, we find that the management group of construction projects has 74.65% responsibility of work-related accidents. The developed techniques are purposeful for occupational accidents investigation/analysis, especially for the determination of detailed list of tasks, responsibilities, and their rates. Therefore, it is useful for preventing work-related accidents by focusing on the responsible group's duties. Copyright 2016 Elsevier Ltd. All rights reserved.
The article presents a hybrid monitoring technique for the measurement of the deformation field. The goal is to obtain information about crack propagation in existing structures, for the purpose of monitoring their state of health. The measurement technique is based on the capture and analysis of a digital image set. Special markers were used on the surface of the structures that can be removed without damaging existing structures as the historical masonry. The digital image analysis was done using software specifically designed in Matlab to follow the tracking of the markers and determine the evolution of the deformation state. The method can be used in any type of structure but is particularly suitable when it is necessary not to damage the surface of structures. A series of experiments carried out on masonry walls of the Oliverian Museum (Pesaro, Italy) and Palazzo Silvi (Perugia, Italy) have allowed the validation of the procedure elaborated by comparing the results with those derived from traditional measuring techniques. PMID:28773129
The article presents a hybrid monitoring technique for the measurement of the deformation field. The goal is to obtain information about crack propagation in existing structures, for the purpose of monitoring their state of health. The measurement technique is based on the capture and analysis of a digital image set. Special markers were used on the surface of the structures that can be removed without damaging existing structures as the historical masonry. The digital image analysis was done using software specifically designed in Matlab to follow the tracking of the markers and determine the evolution of the deformation state. The method can be used in any type of structure but is particularly suitable when it is necessary not to damage the surface of structures. A series of experiments carried out on masonry walls of the Oliverian Museum (Pesaro, Italy) and Palazzo Silvi (Perugia, Italy) have allowed the validation of the procedure elaborated by comparing the results with those derived from traditional measuring techniques.
The efficacy of hypnotherapeutic techniques as treatment for symptoms of posttraumatic stress disorder (PTSD) was explored through meta-analytic methods. Studies were selected through a search of 29 databases. Altogether, 81 studies discussing hypnotherapy and PTSD were reviewed for inclusion criteria. The outcomes of 6 studies representing 391 participants were analyzed using meta-analysis. Evaluation of effect sizes related to avoidance and intrusion, in addition to overall PTSD symptoms after hypnotherapy treatment, revealed that all studies showed that hypnotherapy had a positive effect on PTSD symptoms. The overall Cohen's d was large (-1.18) and statistically significant (p < .001). Effect sizes varied based on study quality; however, they were large and statistically significant. Using the classic fail-safe N to assess for publication bias, it was determined it would take 290 nonsignificant studies to nullify these findings. Copyright 2016 International Society for Traumatic Stress Studies.
Objectives To demonstrate the effectiveness of in vivo replicas of fractured ceramic surfaces for descriptive fractography as applied to the analysis of clinical failures. Methods The fracture surface topography of partially failed veneering ceramic of a Procera Alumina molar and an In Ceram Zirconia premolar were examined utilizing gold-coated epoxy poured replicas viewed using scanning electron microscopy. The replicas were inspected for fractographic features such as hackle, wake hackle, twist hackle, compression curl and arrest lines for determination of the direction of crack propagation and location of the origin. Results For both veneering ceramics, replicas provided an excellent reproduction of the fractured surfaces. Fine details including all characteristic fracture features produced by the interaction of the advancing crack with the material's microstructure could be recognized. The observed features are indicators of the local direction of crack propagation and were used to trace the crack's progression back to its initial starting zone (the origin). Drawbacks of replicas such as artifacts (air bubbles) or imperfections resulting from inadequate epoxy pouring were noted but not critical for the overall analysis of the fractured surfaces. Significance The replica technique proved to be easy to use and allowed an excellent reproduction of failed ceramic surfaces. It should be applied before attempting to remove any failed part remaining in situ as the fracture surface may be damaged during this procedure. These two case studies are intended as an introduction for the clinical researcher in using qualitative (descriptive) fractography as a tool for understanding fracture processes in brittle restorative materials and, secondarily, to draw conclusions as to possible design inadequacies in failed restorations. PMID:17270267
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