Absolute Effectiveness Research Articles

Pectoralis-II Myofascial Block and Analgesia in Breast Cancer Surgery: A Systematic Review and Meta-analysis.

Thoracic paravertebral block is the preferred regional anesthetic technique for breast cancer surgery, but concerns over its invasiveness and risks have prompted search for alternatives. Pectoralis-II block is a promising analgesic technique and potential alternative to paravertebral block, but evidence of its absolute and relative effectiveness versus systemic analgesia (Control) and paravertebral block, respectively, is conflicting. This meta-analysis evaluates the analgesic effectiveness of Pectoralis-II versus Control and paravertebral block for breast cancer surgery. Databases were searched for breast cancer surgery trials comparing Pectoralis-II with Control or paravertebral block. Postoperative oral morphine consumption and difference in area under curve for pooled rest pain scores more than 24 h were designated as coprimary outcomes. Opioid-related side effects, effects on long-term outcomes, such as chronic pain and opioid dependence, were also examined. Results were pooled using random-effects modeling. Fourteen randomized trials (887 patients) were analyzed. Compared with Control, Pectoralis-II provided clinically important reductions in 24-h morphine consumption (at least 30.0 mg), by a weighted mean difference [95% CI] of -30.5 mg [-42.2, -18.8] (P < 0.00001), and in rest pain area under the curve more than 24 h, by -4.7cm · h [-5.1, -4.2] or -1.2cm [-1.3, -1.1] per measurement. Compared with paravertebral block, Pectoralis-II was not statistically worse (not different) for 24-h morphine consumption, and not clinically worse for rest pain area under curve more than 24 h. No differences were observed in opioid-related side effects or any other outcomes. We found that Pectoralis-II reduces pain intensity and morphine consumption during the first 24 h postoperatively when compared with systemic analgesia alone; and it also offers analgesic benefits noninferior to those of paravertebral block after breast cancer surgery. Evidence supports incorporating Pectoralis-II into multimodal analgesia and also using it as a paravertebral block alternative in this population.

The effectiveness of demand creation interventions for voluntary male medical circumcision for HIV prevention in sub-Saharan Africa: a mixed methods systematic review.

Introduction UNAIDS has recommended that in 14 countries across sub‐Saharan Africa (SSA), 90% of men aged 10 to 29 years should be circumcised by 2021 to help reduce transmission of HIV. To achieve this target demand creation programmes have been widely implemented to increase demand for Voluntary Medical Male Circumcision (VMMC). This review explores the effectiveness of demand creation interventions and factors affecting programme implementation.MethodsWe completed a mixed methods systematic review searching Medline, Embase, Global health, psycINFO and CINAHL databases in August 2018 with no time restrictions. Demand creation interventions conducted in SSA were categorized and quantitative data about VMMC uptake was used to compare relative and absolute effectiveness of interventions. Qualitative data were summarized into themes relevant to the delivery and impact of programmes.Results and discussionEighteen of the 904 titles were included in the review. Effective interventions were identified in each demand creation category: financial incentives, counselling or education, involvement of influencers and novel information delivery. Of the 11 randomized controlled trials (RCTs), the greatest absolute impact on VMMC prevalence was seen with a complex intervention including VMMC promotion training for religious leaders (compared to control: 23% (95% CI 22.8 to 23.8) absolute increase; odds ratio (OR) 3.2 (1.4 to 7.3)). Financial incentives generally produced the largest relative effects with men up to seven‐times more likely to undergo VMMC in the intervention arm compared to control (adjusted OR 7.1 (95% CI 2.4 to 20.8), 7.1% (3.7 to 10.5) absolute increase). Qualitative findings suggest that interventions are more impactful when they are judged appropriate and acceptable by the target population; delivered by people with relevant personal experience; and addressing broader social and cultural influences through partnership with and education of community leaders.ConclusionsA range of demand creation interventions can increase VMMC uptake. The most acceptable and effective interventions are financial incentives framed as fair compensation (relative effect) and programmes of education or counselling delivered by people who are influential in the community (absolute effect). Future research should include larger studies with longer follow‐up and a consistent definition of VMMC uptake.

Polarized Polychromatic Noncoherent Light (Bioptron Light) as Adjunctive Treatment in Chronic Oral Mucosal Pain: A Pilot Study.

Objective: Aim of this study was to assess the efficacy of polarized polychromatic noncoherent light (Bioptron light) in the treatment of chronic oral mucosal pain (COMP). Patients and methods: Twenty-two patients affected by COMP were treated with standardized pharmacological protocols in association with Bioptron light (90 W; light wavelength = 480-3400 nm; degree of polarization = 95%; specific power density = 40 mW/cm2; energy density = 2.4 J/cm). The outcome measures were intensity of pain [measured by visual analog scale (VAS) score] and signs reduction (measured by Eisen score) recorded at baseline (t0), after 4 weeks (t1), and after 8 weeks (t2). Signs and symptoms scores were compared with those of a cohort of comparable patients selected from institutional medical record files. Results: Patients in pharmacological treatment associated with Bioptron showed a significant VAS score decrease at t1 and t2 (t0 = 6.9, t1 = 3.9, t2 = 1.8, p < 0.05), whereas the patients in exclusive pharmacological treatment showed a significant VAS score improvement only at t2. Comparing the VAS score at t1 and t2 in the two groups, a significant improvement was recorded in patients undergoing Bioptron adjunctive treatment (t1 = 3.9 vs. 5.9; p < 0.05 and t2 = 1.8 vs. 3.6; p < 0.05). In both groups Eisen score improved at t1 and t2, but in the Bioptron-treated patients the improvement was statistically better at t1 (1.9 vs. 0.8; p < 0.05) and at t2 (2.7 vs. 1.4; p < 0.05). Conclusions: In COMP patients, Bioptron use associated with pharmacological treatment allows a better and faster signs and symptoms reduction when compared with the exclusive pharmacological treatment. Further controlled studies are needed to establish the relative and absolute effectiveness of Bioptron in COMP management.

Fiber-welded ciliated-like nonwoven fabric nano-composite multiscale architectures for superior mechanical and electromagnetic shielding behaviors

To manufacture desired shielding materials, nonwoven fabrics with welding-network, ciliated-like and random orientation structure were utilized as the reinforcement and conducting framework. The welding-network provided a more effective highway for electron transport and the ciliated-like structures enhanced the multiple reflection and the interface polarization. Consequently, an exceptional EMI shielding effectiveness (up to 2575.7 dB cm3 g−1) and absolute shielding effectiveness (38181.8 dB cm2 g−1) values in ranges of 30–3000 MHz were achieved for the epoxy nanocomposite, which were far better than those of nonwoven fabric, graphene and carbon nanotube-based epoxy nanocomposites. More importantly, the fiber-welded ciliated-like nonwoven fabric showed a great potential for preparing high-strength polymer-based composites, which significantly increased the tensile and bending strength by 152% and 75% to epoxy. These results exhibited an alternative approach to exploit the potentials of carbon fiber-based nonwoven fabrics for developing advanced multifunctional materials.

Compressed Influenza Vaccination in U.S. Older Adults: A Decision Analysis

Tradeoffs exist between efforts to increase influenza vaccine uptake, including early season vaccination, and potential decreased vaccine effectiveness if protection wanes during influenza season. U.S. older adults increasingly receive vaccination before October. Influenza illness peaks vary from December to April. A Markov model compared influenza likelihood in older adults with (1) status quo vaccination (August-May) to maximize vaccine uptake or (2) vaccination compressed to October-May (to decrease waning vaccine effectiveness impact). The Centers for Disease Control and Prevention data were used for influenza incidence and vaccination parameters. Prior analyses showed that absolute vaccine effectiveness decreased by 6%-11% per month, favoring later season vaccination. However, compressed vaccination could decrease overall vaccine uptake. Influenza incidence was based on average monthly incidence with earlier and later peaks also examined. Influenza strain distributions from two seasons were modeled in separate scenarios. Sensitivity analyses were performed to test result robustness. Data were collected and analyzed in 2018. Compressed vaccination would avert ≥11,400 influenza cases in older adults during a typical season if it does not decrease vaccine uptake. However, if compressed vaccination decreases vaccine uptake or there is an early season influenza peak, more influenza can result. In probabilistic sensitivity analyses, compressed vaccination was never favored if it decreased absolute vaccine uptake by >5.5% in any scenario; when influenza peaked early, status quo vaccination was favored. Compressed vaccination could decrease waning vaccine effectiveness and decrease influenza cases in older adults. However, this positive effect is negated when early season influenza peaks occur and diminished by decreased vaccine uptake that could occur with shortening the vaccination season.

Comparative effectiveness of abatacept, rituximab, tocilizumab and TNFi biologics in RA: results from the nationwide Swedish register.

Current guidelines rank abatacept, rituximab, tocilizumab and TNF-inhibitors (TNFi) as having equal effectiveness for the treatment of RA, at least as second line therapies. These recommendations are mainly based on meta-analysis of randomized controlled trials, with few direct drug-drug comparisons. Our objective was to compare the real-world absolute and relative effectiveness among RA patients starting any of the available biologic DMARDs (bDMARDs). We used the Swedish Rheumatology Register to identify patients with RA initiating TNFi, rituximab, abatacept or tocilizumab in 2010-2016 as first bDMARD (n = 9333), or after switch from TNFi as first bDMARD (n = 3941). National Swedish registers provided additional covariates and censoring events. Effectiveness was assessed 3 and 12 months after treatment start, as the proportion remaining on therapy and with EULAR Good Response, HAQ improvement >0.2, zero swollen/tender joints and CDAI remission. Adjusted differences were estimated with multivariable linear regression. Patients starting non-TNFi (vs TNFi) as first bDMARD had a higher proportion remaining on drug and reaching most response outcomes as first bDMARD (1-year EULAR Good Response/HAQ improvement: TNFi 24.9/25.4%, rituximab 28.6/37.2%, abatacept 31.9/33.7%, tocilizumab 50.9/43.1%). After switch from a first TNFi, rituximab and tocilizumab, but not abatacept, were associated with significantly better response measures than TNFi (1-year EULAR Good Response/HAQ improvement: TNFi 11.6/16.1%, rituximab 24.8/33.2%, abatacept 13.1/17.5%, tocilizumab 34.1/29.4%). Differences remained significant after adjusting for potential confounders. Treatment outcomes among RA patients treated in Swedish clinical practice are in line with a superior effectiveness of non-TNFi bDMARDs, in particular tocilizumab and rituximab, compared with TNFi.

Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500000 patients with Type 2 diabetes mellitus.

Although group-level effectiveness of lipid, blood pressure, glucose, and aspirin treatment for prevention of cardiovascular disease (CVD) has been proven by trials, important differences in absolute effectiveness exist between individuals. We aim to develop and validate a prediction tool for individualizing lifelong CVD prevention in people with Type 2 diabetes mellitus (T2DM) predicting life-years gained without myocardial infarction or stroke. We developed and validated the Diabetes Lifetime-perspective prediction (DIAL) model, consisting of two complementary competing risk adjusted Cox proportional hazards functions using data from people with T2DM registered in the Swedish National Diabetes Registry (n = 389366). Competing outcomes were (i) CVD events (vascular mortality, myocardial infarction, or stroke) and (ii) non-vascular mortality. Predictors were age, sex, smoking, systolic blood pressure, body mass index, haemoglobin A1c, estimated glomerular filtration rate, non- high-density lipoprotein cholesterol, albuminuria, T2DM duration, insulin treatment, and history of CVD. External validation was performed using data from the ADVANCE, ACCORD, ASCOT and ALLHAT-LLT-trials, the SMART and EPIC-NL cohorts, and the Scottish diabetes register (total n = 197785). Predicted and observed CVD-free survival showed good agreement in all validation sets. C-statistics for prediction of CVD were 0.83 (95% confidence interval: 0.83-0.84) and 0.64-0.65 for internal and external validation, respectively. We provide an interactive calculator at www.U-Prevent.com that combines model predictions with relative treatment effects from trials to predict individual benefit from preventive treatment. Cardiovascular disease-free life expectancy and effects of lifelong prevention in terms of CVD-free life-years gained can be estimated for people with T2DM using readily available clinical characteristics. Predictions of individual-level treatment effects facilitate translation of trial results to individual patients.

Lightweight and flexible Ni-Co alloy nanoparticle-coated electrospun polymer nanofiber hybrid membranes for high-performance electromagnetic interference shielding

Low-density, flexible and high-performance electromagnetic interference (EMI) shielding materials are urgently required to address the increasingly serious problem of radiation pollution. Ni-Co alloys with intrinsic conductivity and magnetism are good candidates for providing excellent EMI shielding performance. However, their high density and poor flexibility severely restrict their further applications in some specific fields. Herein, lightweight and flexible Ni-Co alloy nanoparticle-coated PAN-PU (P@Ni-Co) nanofiber membrane is fabricated through the combination of the electrospinning technique and the electroless deposition process, and it is employed as an effective EMI shielding material. Due to its remarkable conductivity of 1139.6 S/cm and the satisfactory saturation magnetization value of 49.6 emu/g, P@Ni-Co hybrid membrane with a thickness of 0.180 mm and a density of 0.59 g cm−3 exhibits excellent electromagnetic interference shielding effectiveness (EMI SE) of >68 dB over a wide frequency band (8–26.5 GHz); moreover, the average EMI SE reached as high as 77.8 dB with an absolute EMI shielding effectiveness (SSET) of 7325.8 dB cm2·g−1, which are higher than those for most of the reported EMI shielding materials. Compared to reflection, absorption makes a much larger contribution to the total EMI shielding effectiveness. These results suggest that Ni-Co alloy nanoparticle-coated PAN-PU nanofiber membrane would be very promising for applications as a thinner and lighter EMI shielding material.

Scale for efficacy and safety evidence based on design and methodological quality of treatments and preventive technologies trials

The quality of the evidence on the efficacy and safety of therapeutic and preventive interventions is analyzed in health technology assessment procedure (including the development of reimbursement lists such as the List of Vital and Essential Drugs in Russian Federation) and during development of clinical guidelines. The traditional approach to assess the evidence quality is based on the well-known pyramid of research designs (from meta-analyses to case descriptions), and now it is obsolete. The modern approach is to take into account also the methodological quality of studies. The methodological quality depends on risks of biases and the risk of incorrect data analysis. The article proposes a scale based on combinations of designs and three levels of methodological quality (high, medium, poor) for each of them. The scale differentiates meta-analyses based on randomized controlled trials and comparative studies of other designs. In the scale, the new design of indirect comparisons is envisaged, its’ evidence is lower than for RCT that are used for indirect comparisons. The scale can be used for assessing the absolute and relative effectiveness and safety of medical and preventive medical technologies. At present, the scale is included in the guidelines for the complex assessment of pharmaceuticals.

Proposal for determining absolute biological effectiveness of boron neutron capture therapy-the effect of 10B(n,α)7Li dose can be predicted from the nucleocytoplasmic ratio or the cell size.

The relationship between the radiation dose delivered to a tumor and its effect is not completely predictable. Uncertainty in the estimation of the boron concentration in a tumor, variation in the radiation sensitivity of the tumor cells, and the complexity of the interactions between the four types of radiation comprising the boron neutron capture therapy (BNCT) dose contribute to this uncertainty. We reanalyzed the data of our previous papers to investigate the variation in radiosensitivity of tumor cells to the 10B(n,α)7Li dose: the dose generated by the reaction of thermal neutrons and 10B, hereafter the ‘boron-neutron dose’. The radiosensitivities of five tumors (EL4, SAS/neo, SAS/mp53, SCCVII and B16-BL6 melanoma) were examined. For the combination of p-boron-L-phenylalanine (BPA: C9H12BNO4) with neutron irradiation, D0, the cell survival curve for the boron-neutron dose was the smallest for the SAS/neo, followed by the EL4, SAS/mp53, SCCVII and B16-BL6 melanoma, in that order. For the combination of mercaptoundecahydrododecaborate (BSH: Na2B12H11SH) with neutron irradiation, D0 was the smallest for the EL4, followed by the SAS/neo, B16–BL6melanoma, SAS/mp53 and SCCVII, in that order. The relationships between these D0 values and the nucleocytoplasmic ratios (Xncs) or cell size indices (Xcs) obtained by histopathological microslide image were as follows: (D0 = 0.1341Xnc–1.586, R2 = 0.9721) for all tumor types with BPA-BNCT, and D0 = 0.0122Xcs–0.1319 (R2 = 0.9795) for four tumor types (all except the B16-BL6 melanoma) with BSH-BNCT. Based on these results, we proposed a new biologically equivalent effectiveness factor: the absolute biological effectiveness (ABE) factor. The ABE factor is Gy/D0. Thus, the ABE dose is the physical dose multiplied by the ABE factor, and refers to the dose needed to decrease the cell survival rate to e–ABE dose/Gy.

Development and investigation on the dehumidification and corrosion resistance performance of a new mixed liquid desiccant

The liquid desiccant cooling system (LDCS) is regarded as a promising alternative for the traditional vapor compression cooling system due to its energy saving potential and accurate control ability of both temperature and humidity. However, metal corrosion of mass exchanger plate caused by the liquid desiccant greatly restricts the application of LDCS. The present study developed a new kind of mixed liquid desiccant to reduce the corrodibility, and the corrodibility of new mixed solution was examined as well as the dehumidification performance. The vapor pressure of the mixed solution was measured by static method firstly, and the corrosion characteristics were tested by electrochemical method and compared with the ones of normal lithium chloride (LiCl) solution. Comparative investigations were also conducted to study the dehumidification performance under various operating conditions. The experimental results indicate that the corrodibility of new mixed solution is far smaller than that of normal LiCl solution, and the dehumidification performance in terms of absolute moisture change and effectiveness has a significant improvement of 8.7–14.3% and 5.8–15.2% for the newly mixed solution compared with LiCl solution because of the excellent wettability of mixed solution on dehumidifier. The wetting area increases from 0.172 m2 for LiCl solution to 0.184 m2 for mixed solution. In addition, a correlation to predict the dehumidification effectiveness of the mixed solution was also proposed with the average mean absolute relative deviation of 4.51%. The newly developed mixed liquid desiccant is a promising alternative for the commercial application of LDCS with small corrodibility and better dehumidification performance.

Electromagnetic Shielding by MXene-Graphene-PVDF Composite with Hydrophobic, Lightweight and Flexible Graphene Coated Fabric.

MXene and graphene based thin, flexible and low-density composite were prepared by cost effective spray coating and solvent casting method. The fabricated composite was characterized using Raman spectroscopy, X-ray diffraction (XRD), scanning electron microscope (SEM), X-ray photoelectron spectroscopy (XPS) and energy dispersive X-ray (EDX). The prepared composites showed hydrophobic nature with higher contact angle of 126°, −43 mN·m−1 wetting energy, −116 mN·m−1 spreading Coefficient and 30 mN·m−1 lowest work of adhesion. The composites displayed excellent conductivity of 13.68 S·cm−1 with 3.1 Ω·sq−1 lowest sheet resistance. All the composites showed an outstanding thermal stability and constrain highest weight lost until 400 °C. The MXene-graphene foam exhibited excellent EMI shielding of 53.8 dB (99.999%) with reflection of 13.10 dB and absorption of 43.38 dB in 8–12.4 GHz. The single coated carbon fabric displayed outstanding absolute shielding effectiveness of 35,369.82 dB·cm2·g−1. The above results lead perspective applications such as aeronautics, radars, air travels, mobile phones, handy electronics and military applications.

Potential Cost-Effectiveness of a Universal Influenza Vaccine in Older Adults.

Background and Objectives“Universal” vaccines that could have multistrain and multiyear effectiveness are being developed. Their potential cost-effectiveness in geriatric populations is unknown.Research Design and MethodsA Markov model estimated effects of a theoretical universal influenza vaccine compared with available seasonal vaccines in hypothetical cohorts of U.S. 65+-year olds followed over a 5-year time horizon to capture potential multiyear protection. Outcomes included costs per quality-adjusted life-year gained and influenza cases avoided.ResultsUsing hypothetical universal vaccine parameter values (cost $100, vaccine effectiveness 39%, uptake 64%, effectiveness duration 5 years), universal vaccine was less costly than seasonal influenza vaccination strategies. High-dose trivalent influenza vaccine, compared with universal vaccine, gained 0.0028 quality-adjusted life-years and cost $82 more, or $28,700 per quality-adjusted life-year gained. Other seasonal vaccines were not favorable economically. Five-year influenza risk with universal vaccination was 32.3% under base case assumptions, compared with <30% with adjuvanted or high-dose vaccine use. In sensitivity analyses, universal vaccine was favored when uptake or vaccine effectiveness was greater than standard-dose influenza vaccine. If absolute universal vaccine effectiveness was 10% less than standard-dose vaccine, universal vaccine could be cost-saving but not more effective than other strategies. Universal vaccine was not favored if its effectiveness duration was <3 years.Discussion and ImplicationsUniversal vaccine use in older persons could be either cost effective or cost saving when universal vaccine parameters are within plausible ranges. However, if its effectiveness is substantially less than current vaccines, its use would probably not be favored in geriatric populations.

The \u201cRCT augmentation\u201d: a novel simulation method to add patient heterogeneity into phase III trials

BackgroundPhase III randomized controlled trials (RCT) typically exclude certain patient subgroups, thereby potentially jeopardizing estimation of a drug’s effects when prescribed to wider populations and under routine care (“effectiveness”). Conversely, enrolling heterogeneous populations in RCTs can increase endpoint variability and compromise detection of a drug’s effect. We developed the “RCT augmentation” method to quantitatively support RCT design in the identification of exclusion criteria to relax to address both of these considerations. In the present manuscript, we describe the method and a case study in schizophrenia.MethodsWe applied typical RCT exclusion criteria in a real-world dataset (cohort) of schizophrenia patients to define the “RCT population” subgroup, and assessed the impact of re-including each of the following patient subgroups: (1) illness duration 1–3 years; (2) suicide attempt; (3) alcohol abuse; (4) substance abuse; and (5) private practice management. Predictive models were built using data from different “augmented RCT populations” (i.e., subgroups where patients with one or two of such characteristics were re-included) to estimate the absolute effectiveness of the two most prevalent antipsychotics against real-world results from the entire cohort. Concurrently, the impact on RCT results of relaxing exclusion criteria was evaluated by calculating the comparative efficacy of those two antipsychotics in virtual RCTs drawing on different “augmented RCT populations”.ResultsData from the “RCT population”, which was defined with typical exclusion criteria, allowed for a prediction of effectiveness with a bias < 2% and mean squared error (MSE) = 5.8–6.8%. Compared to this typical RCT, RCTs using augmented populations provided improved effectiveness predictions (bias < 2%, MSE = 5.3–6.7%), while returning more variable comparative effects. The impact of augmentation depended on the exclusion criterion relaxed. Furthermore, half of the benefit of relaxing each criterion was gained from re-including the first 10–20% of patients with the corresponding real-world characteristic.ConclusionsSimulating the inclusion of real-world subpopulations into an RCT before running it allows for quantification of the impact of each re-inclusion upon effect detection (statistical power) and generalizability of trial results, thereby explicating this trade-off and enabling a controlled increase in population heterogeneity in the RCT design.

Clinical and MRI changes of puborectalis and iliococcygeus after a short period of intensive pelvic floor muscles training with or without instrumentation : A prospective randomized controlled trial.

This study evaluates the impact of a 3-week period of intensive pelvic floor muscles training (PFMT), with or without instrumentation, on clinical and static magnetic resonance imaging (MRI) changes of puborectalis (PR) and iliococcygeus (IL) muscles. 24 healthy young women were enrolled in the study and 17 achieved the 9 sessions of 30 min training exercises and conducted all assessments. Participants were randomly assigned in two training groups: voluntary contractions combined with hypopressive exercises (HYPO) or biofeedback exercises combined with transvaginal electrical stimulations (ELEC). Clinical and T2-weighted MRI assessments were realized before and after training. Modified Oxford Grading System (MOGS) scores for left PR and perineal body significantly increased in the two groups (p = 0.039, p = 0.008), but MOGS score for right PR significantly increased only in HYPO (p = 0.020). Muscle volumes of right and left IL significantly decreased (p = 0.040, p = 0.045) after training as well as signal intensities of right and left PR (p = 0.040, p = 0.021) and thickness of right and left IL at mid-vagina location (p = 0.012, p = 0.011). A short period of intensive PFMT induces clinical and morphological changes in PFMs at rest suggesting a decrease in IL volume and adipose content of PR. Although the results suggested that an intensive non-instrumented PFMT is as effective as an instrumented training, future controlled studies with greater sample sizes are needed to establish the relative and absolute effectiveness of each of the two interventions.

Sacrifice and extracranial reconstruction of the common or internal carotid artery in advanced head and neck carcinoma: Review and meta-analysis.

Sacrifice and reconstruction of the carotid artery in cases of head and neck carcinoma with invasion of the common or internal carotid artery is debated. We conducted a systematic search of electronic databases and provide a review and meta-analysis. Of the 72 articles identified, 24 met the inclusion criteria resulting in the inclusion of 357 patients. The overall perioperative 30-day mortality was 3.6% (13/357). Permanent cerebrovascular complications occurred in 3.6% (13/357). Carotid blowout episodes were encountered in 1.4% (5/357). The meta-regression analysis showed a significant difference in 1-year overall survival between reports published from 1981-1999 (37.0%) and 2001-2016 (65.4%; P = .02). This review provides evidence that sacrifice with extracranial reconstruction of common or internal carotid artery in selected patients with head and neck carcinoma may improve survival with acceptable complication rates. However, all of the published literature is retrospective involving selected series and, therefore, precludes determining the absolute effectiveness of the surgery.

Radiofrequency versus Cryoballoon Ablation of Atrial Fibrillation: An Evaluation Using ECG, Holter Monitoring, and Implantable Loop Recorders to Monitor Absolute and Clinical Effectiveness.

Introduction While several studies have compared the radiofrequency current (RFC) and cryoablation for the treatment of patients with atrial fibrillation (AF), no study has monitored the long-term outcomes with the usage of implantable loop recorders (ILRs). Methods We enrolled 89 consecutive patients with nonvalvular paroxysmal AF (N = 44 for RFC and N = 45 for cryoballoon). The primary efficacy end point was the assessment of effectiveness for each group (RFC versus cryoballoon) when examining freedom from arrhythmia by monitoring with ECG, Holter, and implantable loop recoder (ILR). The primary safety end point compared rates of adverse events between both groups. The secondary efficacy end point examined the duration of the postablation blanking period from ILR retrieved data. Results The mean age of the study population was 56.6 ± 10.2 years, and the follow-up duration was 12 months. There were no differences in baseline patient characteristics between groups. At 12 months, the absolute effectiveness (measured by ILR) was 65.9% in the RFC group and 51.1% in the cryoballoon group (OR = 1.85; 95% CI: 0.79–4.35; p = 0.157), and the clinical effectiveness (measured by ECG and Holter) was 81.8% in the RFC group and 55.6% in the cryoballoon group (OR = 3.6; 95% CI: 1.37–9.46; p = 0.008). There was no difference in safety between both groups. Asymptomatic episodes were significantly more present in the RFC group as measured by ILRs (p < 0.010). In cryoballoon group, arrhythmia episodes were recorded equally irrespective of the follow-up method (i.e., ECG and Holter versus ILR (p > 0.010)). The blanking period does not seem to be as important in cryoballoon as compared to RFC. Conclusion RFC and cryoballoon ablation had similar absolute effectiveness at 12 months. ECG and Holter were effective when assessing the efficacy of the cryoballoon ablation; however, in the RFC group, ILR was necessary to accurately assess long-term efficacy.

An integral approach to evaluating the effectiveness of tax incentives

The article analyzes the prospects and opportunities for using integral indicators to evaluate the effectiveness of tax incentives. The following key indicators are selected: the integral index of 13 tax incentive indicators’ growth rate; the multidimensional mean calculated on the basis of trade turnover of the Eurasian Economic Union; a complex rating evaluation of the effectiveness of regional tax incentives. Tax incentive indicators are understood as those indices that best reflect the economic performance of companies in a certain business sector. The goal of the article is to determine the priority areas of using tax incentives based on the comparative theoretical analysis of integral indicators for evaluating their effectiveness. Research methodology includes the analysis of tax incentives’ indicators calculated on the basis of official statistics and characterizing budgetary, social and economic effectiveness. Besides, the authors use the instruments of the regression and correlation analysis. It is determined that the coefficient approach is best used to evaluate time oriented tax incentives, while the absolute approach –socially or spatially oriented tax incentives. The authors use their own methodology to prove that in 2011–2016 tax incentives for agriculture (from the industry-based perspective) and for research and development (from the target-based perspective) were effective. The use of the complex rating of tax incentives’ effectiveness at the regional level showed that high effectiveness was achieved only in two subjects of the Russian Federation, while absolute effectiveness was not achieved in any of them. At the same time, most regions stayed in the range of sufficient and low effectiveness. Research results can be used by the Ministry of Finance and the Government of the Russian Federation when developing ways of improving the taxation policy. Highlights 1. The coefficient approach is most commonly used to evaluate tax incentives, although it is advisable to use the absolute approach through the calculation of the multidimensional mean for some social and territorial tax incentives 2. To analyze the effectiveness of tax incentives, the authors selected thirteen tax incentive indicators that reflect the social and economic development of an industry. They include budgetary revenues by tax type, the number of workplaces in the full-time equivalent, GVA, growth rate of investments in fixed assets, etc. 3. It is advisable to evaluate the effectiveness of the instruments of industry-based and target (specific) tax incentives by using the integral index of the tax incentive indicators’ growth rate 4. It is suggested that the multidimensional mean should be used to evaluate the impact of reduced tax rates on VAT and excise duties on the volume of trans-border trade of the Eurasian Economic Union countries 5. The regional tax policy of stimulating production should be evaluated through the complex rating of the effectiveness of regional tax incentives by using the instruments of the regression and correlation analysis For citation Steshenko J. A., Tikhonova A. V. An integral approach to evaluating the effectiveness of tax incentives. Journal of Tax Reform, 2018, vol. 4, no. 2, pp. 157–173. DOI: 10.15826/jtr.2018.4.2.050 Article info Received July 1, 2018; accepted August 6, 2018

Pouillon’s Practical Theory. A Design Method for Contemporary Architectural Practice

The aim of this paper is to underline the currency and modernity of Fernand Pouillon’s method for contemporary architectural practices. In particular, this dissertation analyzes the theory hidden behind Pouillon’s practice, and the motivation influencing the final quality of his works in order to make this method implementable to the current conditions of architectural design related to the management of complexity, buildability and quality of buildings. This paper explains Pouillon’s design process through the case study of Résidence Les 200 Logements, or dwellings, built in Aix-en-Provence between 1951 and 1955. This work represents the turning point experience in the development of a design methodology that Pouillon will use for the following twenty years of his career. The 200 Logements project demonstrates the absolute effectiveness of this design method to achieve a certain quality in all the production phases. By merging technological and humanistic culture, the buildings designed by Pouillon exemplify the possibility of making theory through practice. Intended as “practical theories,” the models and the approaches proposed by Pouillon represent a design method that can still be used today.

Perceptions of Financial Incentives for Smoking Cessation: A Survey of Smokers in a Country With an Endgame Goal.

Financial incentives can support smoking cessation, yet low acceptability may limit the wider implementation of such schemes. Few studies have examined how smokers view financial-incentive interventions aimed at reducing smoking prevalence. We recruited a sample of 623 smokers from an internet panel to a survey assessing support for, and perceived effectiveness of, financial incentives for smoking cessation. We used descriptive statistics, plus logistic regression, to test associations between demographics and smoking, and support. We used qualitative content analysis to analyze open-ended responses to a question that invited respondents to comment on financial incentives. Financial incentives were supported by 38.4% of smokers; 42.2% did not support and 19.4% had no opinion. Support was higher among heavy (OR = 3.96, 95% CI = 2.39 to 6.58) and moderate smokers (OR = 1.68, 95% CI = 1.13 to 2.49), and those with a recent quit attempt (OR = 1.47, 95% CI = 1.04 to 2.07). Support was strongly associated with perceived effectiveness. A Government-funded reward-only scheme was seen as the most acceptable option (preferred by 26.6% of participants), followed by a Government-funded deposit-based scheme (20.6%); few respondents supported employer-funded schemes. Open-ended responses (n = 301) indicated three overarching themes expressing opposition to financial incentives: smokers' individual responsibility for quitting, concerns about abuse of an incentive scheme, and concerns about unfairness. Even amongst those who would benefit from schemes designed to reward smokers for quitting, support for such schemes is muted, despite the evidence of their effectiveness. Media advocacy and health education could be used to increase the understanding of, and support for, financial incentives for smoking cessation. Given the absolute effectiveness and cost effectiveness of financial-incentive schemes for smoking cessation amongst pregnant smokers and in workplaces, implementing such schemes at a national-level could help reduce overall smoking prevalence and contribute to endgame goals. Our study found that similar proportions of smokers supported and opposed financial-incentive schemes and suggests that much of the opposition was underpinned by information gaps, which could be addressed using education and media advocacy.