Economic evaluation of different screening alternatives for patients with clinically suspected acute deep vein thrombosis

Introduction:

We examined the cost-effectiveness of the three different D-dimer measurements in the screening of DVT in models with and without calculation of pre-test probability (PTP) score. Moreover, we calculated the minimal cost in DVT detection.

Material and methods:

In the group of 192 patients with clinically suspected acute DVT, we examined the three different D-dimer measurements (Innovance D-dimer, Hemosil D-dimer HS and Vidas D-dimer Exclusion II) in combination with and without PTP assessment.

Results:

The diagnostic alternative employing Vidas D-dimer Exclusion II assay without and with PTP calculation gave lower incremental cost-effectiveness ratio (ICER) than the alternative employing Hemosil D-dimer HS assay (0.187 Euros vs. 0.998 Euros per one additional DVT positive patient selected for CUS in model without PTP assessment and 0.450 vs. 0.753 Euros per one DVT positive patient selected for CUS in model with PTP assessment). According to sensitivity analysis, the Hemosil D-dimer HS assay was the most cost effective alternative when one patient was admitted to the vascular ambulance per day. Vidas D-dimer Exclusion II assay was the most cost effective alternative when more than one patient were admitted to the vascular ambulance per day. Cost minimisation analysis indicated that selection of patients according to PTP score followed by D-dimer analysis decreases the cost of DVT diagnosis.

Conclusions:

ICER analysis enables laboratories to choose optimal laboratory tests according to number of patients admitted to laboratory. Results support the feasibility of using PTP scoring and D-dimer measurement before CUS examination in DVT screening.     

The Act of Looking: Wofgang Iser's Literary Theory and Meaning Making in the Visual Arts

In his account about reading novels, Wolfgang Iser argued that the work of art is not the text itself but the experience that emerges as a reader interacts with the text. Yet, he clarified that the aesthetic object is not based only on the subjective input of the reader but also determined by specific signs that a text presents. This article draws from Iser's theories to examine the process through which five teenagers discover meaning in an abstract sculpture by artist Isamu Noguchi. The author shows how the young viewers arrived at a series of readings that were elicited by the qualities of the work and that built upon each other in a sort of snowballing process. The article also illustrates how the sort of meaning that an artwork can yield stretches throughout the whole experience and can therefore not be translated into a discursive statement.     

Preverbal infants anticipate that food will be brought to the mouth: an eye tracking study of manual feeding and flying spoons

This study relies on eye tracking technology to investigate how humans perceive others' feeding actions. Results demonstrate that 6-month-olds (n = 54) anticipate that food is brought to the mouth when observing an adult feeding herself with a spoon. Still, they fail to anticipate self-propelled (SP) spoons that move toward the mouth and manual combing actions directed toward the head. Ten-month-olds (n = 54) and adults (n = 32) anticipate SP spoons; however, only adults anticipate combing actions. These results suggest that goal anticipation during observation of feeding actions develops earlier and is less dependent on directly perceived actions than goal anticipation during observation of other manual actions. These results are discussed in relation to experience and a possible phylogenetic influence on perception and understanding of feeding.     

The Council of Europe’s citizenship conception in ‘Education for Democratic Citizenship’: a critical discourse analysis of two textbooks

This paper presents a neocommunitarian conception of citizenship identified in two textbooks of the programme ‘Education for Democratic Citizenship’, organised by the Council of Europe. Critical discourse analysis is applied to the key themes of the textbooks T-Kit 7: Under construction: Citizenship Youth and Europe and Compass Manual enclosing citizenship and human rights discourses, respectively. An intra-disciplinary discussion follows drawing on critical political economy. The findings of the analysis are that the textbooks exhibit an abstract representation of social reality as well as moral relativism stemming from neoliberal communitarianism. The identification of the neocommunitarian conception of citizenship reveals the power of citizenship education today.     

Facet-based opinion retrieval from blogs

The paper presents methods of retrieving blog posts containing opinions about an entity expressed in the query. The methods use a lexicon of subjective words and phrases compiled from manually and automatically developed resources. One of the methods uses the Kullback–Leibler divergence to weight subjective words occurring near query terms in documents, another uses proximity between the occurrences of query terms and subjective words in documents, and the third combines both factors. Methods of structuring queries into facets, facet expansion using Wikipedia, and a facet-based retrieval are also investigated in this work. The methods were evaluated using the TREC 2007 and 2008 Blog track topics, and proved to be highly effective.     

Microfluidics platform for measurement of volume changes in immobilized intestinal enteroids

Intestinal enteroids are ex vivo primary cultured single-layer epithelial cell spheroids of average diameter ∼150 μm with luminal surface facing inward. Measurement of enteroid swelling in response to secretagogues has been applied to genetic testing in cystic fibrosis and evaluation of drug candidates for cystic fibrosis and secretory diarrheas. The current measurement method involves manual addition of drugs and solutions to enteroids embedded in a Matrigel matrix and estimation of volume changes from confocal images of fluorescently stained enteroids. We developed a microfluidics platform for efficient trapping and immobilization of enteroids for quantitative measurement of volume changes. Multiple enteroids are trapped in a “pinball machine-like” array of polydimethylsiloxane posts for measurement of volume changes in unlabeled enteroids by imaging of an extracellular, high-molecular weight fluorescent dye. Measurement accuracy was validated using slowly expanding air bubbles. The method was applied to measure swelling of mouse jejunal enteroids in response to an osmotic challenge and cholera toxin-induced chloride secretion. The microfluidics platform allows for parallel measurement of volume changes on multiple enteroids during continuous superfusion, without an immobilizing matrix, and for quantitative volume determination without chemical labeling or assumptions about enteroid shape changes during swelling.     

Special educational needs and disability

Issues relating to the categorisation and labelling of pupils, and, the use of the terms 'special educational needs' and 'disability' in particular, have been the topic of debate in BJSE before. In this article, Sue Keil, a research officer at the Royal National Institute for the Blind (RNIB), Olga Miller, of the Institute of Education, University of London, and Rory Cobb, a development officer at the RNIB, summarise some of the key findings from a review carried out on behalf of the Disability Rights Commission (DRC). The authors highlight confusion over the use of terms that represent differing ideological perspectives. Despite the social focus that characterises much of the discourse about disability, disability is frequently regarded as an aspect of special educational needs, an area in which a medical model is often dominant. These confusions benefit neither children with disabilities nor those with less clearly-defined difficulties. Sue Keil, Olga Miller and Rory Cobb note with interest recent developments in Scotland where a new framework based on the concept of 'additional support needs' separates disability from educational need and is intended to represent a more inclusive approach to children's learning.     

Early Behavioral Inhibition and Emotion Regulation: Pathways Toward Social Competence in Middle Childhood

This study examined emotion regulation (ER) as a mediator in the relation between early behavioral inhibition (BI) and later social competence (N = 257), and whether this mediation varied depending on BI levels. Maternal report and observational measures were used to assess BI (ages 2 and 3). Children's ER strategies (age 5) and social competence with an unfamiliar peer (age 7) were measured using observational measures. Results showed that BI predicted less engaged ER strategies during a disappointment task, and engaged ER predicted higher social competence. Engaged ER mediated the effect of BI on social competence, but only for highly inhibited children. Findings elucidate developmental trajectories of risk and resilience, and suggest targeting regulatory strategies in early prevention efforts with highly inhibited children.     

Discursive practices of private online tutoring websites in Russia

A recent development in English teaching in Russia is the emergence of private online language-tutoring schools, which offer one-on-one lessons by means of audio/videoconferencing. It remains unclear: (1) how these new providers of educational services are presenting themselves to the potential learners; (2) what ideology they tend to drawn on and (3) whether there is sufficient similarity to conceptualise these websites as exemplars of the same genre. This paper employs the tools of critical discourse analysis (CDA), Genre Theory and Appraisal within the Systemic Functional Linguistics to study the language of 17 websites of private online language schools. The study aims to investigate whether the websites exhibit similar discourse and ideology and whether they might belong to the same ‘genre prototype’. The analysis reveals a considerable thematic, structural and rhetorical similarity between the websites and a high presence of neoliberal ideology.