Intensive home treatment in comparison with care as usual: Cost-utility analysis from a pre-randomized controlled trial in the netherlands

Introduction

The implementation of Intensive Home Treatment (IHT) aims to decrease the pressure on acute inpatient services that could lead to prevent hospitalization and reduce the number of hospitalization days and, ultimately, reduce cost in the mental health services. Although there are studies assessing the effectiveness of IHT, there is a shortage of research studying the cost-effectiveness.

Objectives

The aim of this study is to present an cost-utility analysis of IHT compared to care as usual (CAU)

Methods

Patients between 18 and 65 years of age whose mental health professionals considered hospitalization were included. These patients were pre-randomized in either IHT or CAU and followed up for 12-months. For this study, the base case analysis was performed from the societal and healthcare perspective. For the cost-utility analyses the Euroqol 5D was used to calculate quality adjusted life years (QALYs) as a generic measure of health gains.

Results

Data of 198 patients were used. From a sociatal perspective, the cost-utility analysis resulted in an incremental cost-effectiveness ratios (ICERs) of €58 730, and a 37% likelihood that IHT leads to higher QALYs at lower costs. The probability of IHT being cost-effective was >50% if there was no willingness to pay more for extra QALY than in the current situation under CAU.

Conclusions

Professionals working in crisis care are able to offer IHT with the same effect as other crisis care interventions at lower costs. IHT seem to be cost-effective compared with CAU over 52 weeks follow-up for patients who experience psychiatric crises.

Disclosure

No significant relationships.

Comparison of micro-CT imaging and histology for approximal caries detection

Histological sectioning is a generally accepted in vitro validation method for caries detection techniques. However, it requires cumbersome sample preparation and induces irreversible sample destruction. Micro-Computer Tomography (micro-CT) allows non-destructive imaging of tooth structure. The aim of this study was to compare the performance of histological sectioning and micro-CT imaging in detecting approximal carious lesions. Unlike previous studies, evaluation is objectified by comparing visual appearance of exactly corresponding anatomical regions. Sixty extracted human teeth were scanned with a desktop micro CT system. Axial histological slices were prepared and photographed. Sample preparation, combined with dedicated image processing, ensured selection of identical anatomical regions on radiographic and histological images. Evaluation of the presence and extent of carious lesions was performed by four dentists using custom-designed software. Each section was scored independently (histo or micro CT). Scores of approximal surfaces were retained for further analysis. Spearman’s correlation coefficients (0.738 to 0.829, p < 0.0001) showed a good agreement between signs of carious lesions in the identical region obtained with both methods. Bland-Altman plots showed that 90.76% of the data points were within the limits of agreement. Micro-CT imaging was shown to provide an interesting alternative to histological sectioning as detection method for carious lesions.

Determination of the precision and accuracy of morphological measurements using the Kinect™ sensor: comparison with standard stereophotogrammetry

The recent availability of the Kinect™ sensor, a low-cost Markerless Motion Capture (MMC) system, could give new and interesting insights into ergonomics (e.g. the creation of a morphological database). Extensive validation of this system is still missing. The aim of the study was to determine if the Kinect™ sensor can be used as an easy, cheap and fast tool to conduct morphology estimation. A total of 48 subjects were analysed using MMC. Results were compared with measurements obtained from a high-resolution stereophotogrammetric system, a marker-based system (MBS). Differences between MMC and MBS were found; however, these differences were systematically correlated and enabled regression equations to be obtained to correct MMC results. After correction, final results were in agreement with MBS data (p = 0.99). Results show that measurements were reproducible and precise after applying regression equations. Kinect™ sensors-based systems therefore seem to be suitable for use as fast and reliable tools to estimate morphology. Practitioner Summary: The Kinect™ sensor could eventually be used for fast morphology estimation as a body scanner. This paper presents an extensive validation of this device for anthropometric measurements in comparison to manual measurements and stereophotogrammetric devices. The accuracy is dependent on the segment studied but the reproducibility is excellent.

[A new, more comprehensive role model for the psychiatrist; the need to adapt and personalise psychiatric concepts and actions]

BACKGROUND

More and more criticism is being levelled at the traditional cornerstones of psychiatric treatment such as medication, diagnostics and the specific effectiveness of treatment models. On the other hand, however, increasing attention is being given to other 'non-specific' factors such as the quality of the working alliance, the value of feedback and the personality and character of the therapist. In addition, there is an ever-increasing demand on the part of the public who want a more prominent role in the treatment process for relatives and family members.

AIM

To respond to these societal developments by delineating a new and more comprehensive role for the psychiatrist.

METHOD

The authors analyse how the need for new roles is connected with the fact that psychiatrists and the general public have different conceptual frameworks and tend to use different conversational styles and vocabulary.

RESULTS

According to the authors, the psychiatrist should be able to fulfill several roles in the treatment process. The traditional psychiatric 'jargon' is inadequate for expressing the specific value of the differing roles and conceptual frameworks of psychiatrists and members of the public.

CONCLUSION

When opting for a specific role and type of language, the psychiatrist should be guided by what is most likely to lead to fruitful cooperation with the patient and his or her relatives. In discussing treatment plans with the patient the psychiatrist must learn to use more comprehensive and flexible language.

Validity and reliability of the Kinect within functional assessment activities: comparison with standard stereophotogrammetry

The recent availability of the Kinect™ sensor, a cost-effective markerless motion capture system (MLS), offers interesting possibilities in clinical functional analysis and rehabilitation. However, neither validity nor reproducibility of this device is known yet. These two parameters were evaluated in this study. Forty-eight volunteers performed shoulder abduction, elbow flexion, hip abduction and knee flexion motions; the same protocol was repeated one week later to evaluate reproducibility. Movements were simultaneously recorded by the Kinect (with Microsoft Kinect SDK v.1.5) MLS and a traditional marker-based stereophotogrammetry system (MBS). Considering the MBS as reference, discrepancies between MLS and MBS were evaluated by comparing the range of motion (ROM) between both systems. MLS reproducibility was found to be statistically similar to MBS results for the four exercises. Measured ROMs however were found different between the systems.

Preclinical evaluation of [(18)F]JNJ42259152 as a PET tracer for PDE10A

Phosphodiesterase-10A (PDE10A) is implicated in several neuropsychiatric disorders involving basal ganglia neurotransmission, such as schizophrenia, obsessive-compulsive disorder and Huntington's disease. To confirm target engagement and exposure-occupancy relationships of clinical candidates for treatment, and to further explore the in vivo biology of PDE10A, non-invasive imaging using a specific PET ligand is warranted. Recently we have reported the in vivo evaluation of [(18)F]JNJ41510417 which showed specific binding to PDE10A in rat striatum, but with relatively slow kinetics. A chemically related derivative JNJ42259152 was found to have a similar in vivo occupancy, but lower lipophilicity and lower PDE10A in vitro inhibitory activity compared to JNJ41510417. (18)F-labeled JNJ42259152 was therefore evaluated as a potential PDE10A PET radiotracer. Baseline PET in rats and monkey showed specific retention in the PDE10A-rich striatum, and fast wash-out, with a good contrast to non-specific binding, in other brain regions. Pretreatment and chase experiments in rats with the selective PDE10A inhibitor MP-10 showed that tracer binding was specific and reversible. Absence of specific binding in PDE10A knock-out (KO) mice further confirmed PDE10A specificity. In vivo radiometabolite analysis using high performance liquid chromatography (HPLC) showed presence of polar radiometabolites in rat plasma and brain. In vivo imaging in rat and monkey further showed faster brain kinetics, and higher striatum-to-cerebellum ratios for [(18)F]JNJ42259152 compared to [(18)F]JNJ41510417. The arterial input function corrected for radiometabolites was determined in rats and basic kinetic modeling was established. For a 60-min acquisition time interval, striatal binding potential of the intact tracer referenced to the cerebellum showed good correlation with corresponding binding potential values of a Simplified Reference Tissue Model and referenced Logan Plot, the latter using a population averaged reference tissue-to-plasma clearance rate and offering the possibility to generate representative parametric binding potential images. In conclusion we can state that in vivo imaging in PDE10A KO mice, rats and monkey demonstrates that [(18)F]JNJ42259152 provides a PDE10A-specific signal in the striatum with good pharmacokinetic properties. Although presence of a polar radiometabolite in rat brain yielded a systematic but reproducible underestimation of the striatal BPND, a Logan reference tissue model approach using 60 min acquisition data is appropriate for quantification.

Targeting of autonomous parvoviruses to colon cancer by insertion of Tcf sites in the P4 promoter

The Wnt signaling pathway is activated by mutations in the adenomatous polyposis coli (APC) or beta-catenin genes in most colon cancers, leading to the transactivation of promoters containing binding sites for the Tcf/LEF family of transcription factors. We have previously shown that it is possible to confer colon cancer specificity on autonomous parvoviruses by inserting Tcf sites into the viral P4 promoter. The mutant Tcf promoters were responsive to activation of the Wnt pathway but the viruses replicated poorly. We show here that reduction of the number of Tcf sites from four to two leads to an increase in the efficiency of replication and toxicity of the viruses in Co115 colon cancer cells, with only a small reduction in selectivity for cells with an active Wnt signaling pathway. Despite this improvement, virus production by most colon cancer cells remained low. Analysis of parental phH1 virus infection of SW480 colon cancer cells showed that the nonstructural and capsid proteins were expressed, but single stranded DNA and progeny virus were not produced. This defect reflects the dependence of autonomous parvoviruses on host functions for many steps in their replication cycle and represents a major limitation to the use of selectively replicating parvoviruses for colon cancer therapy.

Model-based technique for the measurement of skin thickness in mammography

A model-based method is proposed for the measurement of breast skin thickness from digitised mammograms that takes into account both the geometric and radiographic properties of the skin region. The method initially identifies a salient feature that discriminates the skin from the other anatomical structures of the breast. Its identification is based on a multi-scale grey-level gradient estimation, using a wavelet decomposition of the image. The spatial distribution of this feature is organised as a graph, with each of its nodes associated with a binary set of interpretation labels. A Markov random field is defined on the set of labels, and the best graph labelling is finally determined with a maximum a posteriori (MAP) probability criterion. The method was applied on 11 mammograms with improved contrast characteristics at the breast periphery, obtained by an exposure equalisation technique during image acquisition. The validation of the approach was performed by calculating the root mean square (RMS) error between the detected skin thickness and manual measurements performed on each of the films. The resulting error values ranged from 0.1 mm to 0.2 mm for normal cases and reached a maximum of 0.5mm in pathological cases with advanced skin thickening.

Reconstruction of MR images from data acquired on a general nonregular grid by pseudoinverse calculation

A minimum-norm least-squares image-reconstruction method for the reconstruction of magnetic resonance images from non-Cartesian sampled data is proposed. The method is based on a general formalism for continuous-to-discrete mapping and pseudoinverse calculation. It does not involve any regridding or interpolation of the data and therefore the methodology differs fundamentally from existing regridding-based methods. Moreover, the method uses a continuous representation of objects in the image domain instead of a discretized representation. Simulations and experiments show the possibilities of the method in both radial and spiral imaging. Simulations revealed that minimum-norm least-squares image reconstruction can result in a drastic decrease of artifacts compared with regridding-based reconstruction. Besides, both in vivo and phantom experiments showed that minimum-norm least-squares image reconstruction leads to contrast improvement and increased signal-to-noise ratio compared with image reconstruction based on regridding. As an appendix, an analytical calculation of the raw data corresponding to the well-known Shepp and Logan software head phantom is presented.

Multipole approach to the inverse problem in electrocardiology: convergence of the multipole equivalent generator on the inhomogeneous body conductor

The multipole approach to the inverse electrocardiological problem consists of estimating the multipole components of the cardiac electric generator, starting from the measured body surface potential. This paper presents a critical investigation of the basic premise for the applicability of the multipole approach, namely the convergence of the multipole equivalent generator for the heart on the surface of an inhomogeneous body conductor. As an extension to multipole theory, a criterion for the convergence is derived. Based on realistic models for the body conductor and the cardiac electric generator, we observe that the criterion is not strictly satisfied in realistic conditions. Numerical simulations with the same models point out that the multipole equivalent generator is indeed not convergent in the strict mathematical sense. On the other hand, we show that the multipole equivalent generator yields a rather close approximation of the electrocardiological potential for intermediate values of the order of the multipole generator. A discussion is given on how to explain the apparently ambiguous results for the estimation of cardiac multipole components.

Wavelet image compression--the quadtree coding approach

Perfect reconstruction, quality scalability, and region-of-interest coding are basic features needed for the image compression schemes used in telemedicine applications. This paper proposes a new wavelet-based embedded compression technique that efficiently exploits the intraband dependencies and uses a quadtree-based approach to encode the significance maps. The algorithm produces a losslessly compressed embedded data stream, supports quality scalability, and permits region-of-interest coding. Moreover, experimental results obtained on various images show that the proposed algorithm provides competitive lossless/lossy compression results. The proposed technique is well suited for telemedicine applications that require fast interactive handling of large image sets, over networks with limited and/or variable bandwidth.

Oncogenic transformation-dependent expression of a transcription factor NF-Y subunit

As a result of differential splicing, one subunit of the nuclear factor Y (NF-Y) consists of two major isoforms designated short (NF-YaS) and long (NF-YaL). In proliferating normal human fibroblasts, NF-YaL is by far the more expressed isoform. Surprisingly, NF-YaS was found by immunoblotting to be as prominent as NF-YaL in simian virus 40 (SV40)-transformed cell derivatives. As a consequence, two NF-Y/DNA complexes, one containing the long and the other the short isoform, were formed with extracts from transformed cells and a target promoter element in electrophoretic mobility-shift assays. Only the complex containing NF-YaL was detected with extracts from normal fibroblasts. Furthermore, the NF-Y recognition motif contributed to promoter activation in SV40-transformed cells but not in normal, cells. Our finding links transcription stimulation in transformed cells to quantitative changes in the expression of an NF-Ya subunit.

Oncogenic transformation-dependent expression of a transcription factor NF-Y subunit

As a result of differential splicing, one subunit of the nuclear factor Y (NF-Y) consists of two major isoforms designated short (NF-YaS) and long (NF-YaL). In proliferating normal human fibroblasts, NF-YaL is by far the more expressed isoform. Surprisingly, NF-YaS was found by immunoblotting to be as prominent as NF-YaL in simian virus 40 (SV40)-transformed cell derivatives. As a consequence, two NF-Y/DNA complexes, one containing the long and the other the short isoform, were formed with extracts from transformed cells and a target promoter element in electrophoretic mobility-shift assays. Only the complex containing NF-YaL was detected with extracts from normal fibroblasts. Furthermore, the NF-Y recognition motif contributed to promoter activation in SV40-transformed cells but not in normal, cells. Our finding links transcription stimulation in transformed cells to quantitative changes in the expression of an NF-Ya subunit.

Wavelet-based lossless compression of coronary angiographic images

The final diagnosis in coronary angiography has to be performed on a large set of original images. Therefore, lossless compression schemes play a key role in medical database management and telediagnosis applications. This paper proposes a wavelet-based compression scheme that is able to operate in the lossless mode. The quantization module implements a new way of coding of the wavelet coefficients that is more effective than the classical zerotree coding. The experimental results obtained on a set of 20 angiograms show that the algorithm outperforms the embedded zerotree coder, combined with the integer wavelet transform, by 0.38 bpp, the set partitioning coder by 0.21 bpp, and the lossless JPEG coder by 0.71 bpp. The scheme is a good candidate for radiological applications such as teleradiology and picture archiving and communications systems (PACS's).

Object recognition in brain CT-scans: knowledge-based fusion of data from multiple feature extractors

Describes a knowledge-based image interpretation system for the segmentation and labeling of a series of 2-D brain X-ray CT-scans, parallel to the orbito-meatal plane. The system combines the image primitive information produced by different low level vision techniques in order to improve the reliability of the segmentation and the image interpretation. It is implemented in a blackboard environment that is holding various types of prior information and which controls the interpretation process. The scoring model is applied for the fusion of information derived from three types of image primitives (points, edges, and regions). A model, containing both analogical and propositional knowledge on the brain objects, is used to direct the interpretation process. The linguistic variables, introduced to describe the propositional features of the brain model, are defined by fuzzy membership functions. Constraint functions are applied to evaluate the plausibility of the mapping between image primitives and brain model data objects. Procedural knowledge has been integrated into different knowledge sources. Experimental results illustrate the reliability and robustness of the system against small variations in slice orientation and interpatient variability in the images.

Modeling radon progeny absorbed in glass

The depth distribution of 214Pb and 210Pb in glass was calculated from 218Po and 214Po deposited on the surface. The activity is found in a very narrow zone near the surface (< 100 nm). A fraction of the absorbed 214Po is capable of reaching the surface by decay into 210Pb. This fraction amounts to 29.8%.

Do you also have problems with the file format syndrome?

In a biomedical data processing environment, an essential requirement is the ability to integrate a large class of standard modules for the acquisition, processing and display of the (image) data. Our approach to the management and manipulation of the different data formats is based on the specification of a common standard for the representation of data formats, called 'data nature descriptions' to emphasise that this representation not only specifies the structure but also the contents of data objects (files). The idea behind this concept is to associate each hardware and software component that produces or uses medical data with a description of the data objects manipulated by that component. In our approach a special software module (a format convertor generator) takes care of the appropriate data format conversions, required when two or more components of the system exchange data.

A monoclonal antibody to Ly-6 gene product inhibits generation of functionally active T cells and recognizes single antigenic specificity whose expression is up-regulated in virus-transformed rat fibroblast

In order to elucidate the relationship between the structure and function of proteins encoded for by the Ly-6 gene complex, a cDNA was constructed for a Ly-6.2 specificity and then monoclonal antibodies (mAb) generated to bacterially synthesized protein. The addition of one of these mAb, designated Pb-19, inhibited the proliferative response of T cells to concanavalin A (Con A) or major histocompatability complex (MHC) alloantigens. Reactivity of Pb-19 to the Ly-6 specificity was blocked by a known anti-Ly-6.A.2 mAb but not by an anti-Ly-6.E.1 mAb. This mAb detected a Ly-6.A.2 specificity (a 33,000 MW antigen) whose expression was increased in a transformed rat fibroblast containing the entire genome of bovine papillomavirus.

Transformation of established murine fibroblasts with an activated cellular Harvey-ras oncogene or the polyoma virus middle T gene increases cell permissiveness to parvovirus minute-virus-of-mice

Transformation of permanent rodent fibroblast cells by the polyoma virus middle T gene or the activated human Harvey-ras oncogene results in increased cellular permissiveness to the autonomous parvovirus minute-virus-of-mice. Parvoviral DNA amplification is restricted in the untransformed parental cell lines. Analysis of various parameters of the parvoviral life cycle shows that this block is partially overcome in the transformed lines.

Ultraviolet-irradiated simian virus 40 activates a mutator function in rat cells under conditions preventing viral DNA replication

The UV-irradiated temperature-sensitive early SV40 mutant tsA209 is able to activate at the nonpermissive temperature the expression of mutator and recovery functions in rat cells. Unirradiated SV40 activates these functions only to a low extent. The expression of these mutator and recovery functions in SV40-infected cells was detected using the single-stranded DNA parvovirus H-1 as a probe. Because early SV40 mutants are defective in the initiation of viral DNA synthesis at the nonpermissive temperature, these results suggest that replication of UV-damaged DNA is not a prerequisite for the activation of mutator and recovery functions in mammalian cells. The expression of the mutator function is dose-dependent, i.e., the absolute number of UV-irradiated SV40 virions introduced per cell determines its level. Implications for the interpretation of mutation induction curves in the progeny of UV-irradiated SV40 in permissive host cells are discussed.

Single line CCD camera to improve positioning

This article describes an opto-electronic device that allows on-line visualization of the optical intensity function along a strip. The use of a linear optical charge-coupled device (CCD) array eliminates all moving parts. This makes adaptation to a standard microscope possible without modifications. The setup described here is essential where precise positioning of a reference graticule on diffuse lines must be performed.

An active probe for electrocardiography

In order to improve the signal to noise ratio during the recording of electrocardiographic maps from moving patients, the effect of using active electrodes with built-in amplifiers was investigated. Two kinds of electrodes using different technologies were developed: a miniature printed circuit and a thin film circuit. The first method was found to be suitable for the fabrication of small quantities in a normally equipped electronics workshop while the second, requiring highly specialised equipment, is intended for industrial manufacture in large quantities.