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Surgical revascularization for Moyamoya disease in the United States: A cost-effectiveness analysis
Wali Arvin R.,Santiago-Dieppa David. R.,Srinivas Shanmukha,Brandel Michael G.,Steinberg Jeffrey A.,Rennert Robert C,Mandeville Ross,Murphy James D.,Olson Scott,Pannell J. Scott,Khalessi Alexander A. 대한뇌혈관외과학회 2021 Journal of Cerebrovascular and Endovascular Neuros Vol.23 No.1
Objective Moyamoya disease (MMD) is a vasculopathy of the internal carotid arteries with ischemic and hemorrhagic sequelae. Surgical revascularization confers upfront peri-procedural risk and costs in exchange for long-term protective benefit against hemorrhagic disease. The authors present a cost-effectiveness analysis (CEA) of surgical versus non-surgical management of MMD. Methods A Markov Model was used to simulate a 41-year-old suffering a transient ischemic attack (TIA) secondary to MMD and now faced with operative versus nonoperative treatment options. Health utilities, costs, and outcome probabilities were obtained from the CEA registry and the published literature. The primary outcome was incremental cost-effectiveness ratio which compared the quality adjusted life years (QALYs) and costs of surgical and nonsurgical treatments. Base-case, one-way sensitivity, two-way sensitivity, and probabilistic sensitivity analyses were performed with a willingness to pay threshold of $50,000. Results The base case model yielded 3.81 QALYs with a cost of $99,500 for surgery, and 3.76 QALYs with a cost of $106,500 for nonsurgical management. One-way sensitivity analysis demonstrated the greatest sensitivity in assumptions to cost of surgery and cost of admission for hemorrhagic stroke, and probabilities of stroke with no surgery, stroke after surgery, poor surgical outcome, and death after surgery. Probabilistic sensitivity analyses demonstrated that surgical revascularization was the cost-effective strategy in over 87.4% of simulations. Conclusions Considering both direct and indirect costs and the postoperative QALY, surgery is considerably more cost-effective than non-surgical management for adults with MMD.
THE SAMI GALAXY SURVEY: REVISITING GALAXY CLASSIFICATION THROUGH HIGH-ORDER STELLAR KINEMATICS
Sande, Jesse van de,Bland-Hawthorn, Joss,Fogarty, Lisa M. R.,Cortese, Luca,d’Eugenio, Francesco,Croom, Scott M.,Scott, Nicholas,Allen, James T.,Brough, Sarah,Bryant, Julia J.,Cecil, Gerald,Colless, Ma American Astronomical Society 2017 The Astrophysical journal Vol.835 No.1
<P>Recent cosmological hydrodynamical simulations suggest that integral field spectroscopy can connect the high-order stellar kinematic moments h(3) (similar to skewness) and h(4) (similar to kurtosis) in galaxies to their cosmological assembly history. Here, we assess these results by measuring the stellar kinematics on a sample of 315 galaxies, without a morphological selection, using two-dimensional integral field data from the SAMI Galaxy Survey. Proxies for the spin parameter (lambda(Re)) and ellipticity (epsilon(e)) are used to separate fast and slow rotators; there exists a good correspondence to regular and non-regular rotators, respectively, as also seen in earlier studies. We confirm that regular rotators show a strong h(3) versus V/sigma s anti-correlation, whereas quasi-regular and non-regular rotators show a more vertical relation in h(3) and V/sigma. Motivated by recent cosmological simulations, we develop an alternative approach to kinematically classify galaxies from their individual h(3) versus V/sigma signatures. Within the SAMI Galaxy Survey, we identify five classes of high-order stellar kinematic signatures using Gaussian mixture models. Class 1 corresponds to slow rotators, whereas Classes 2-5 correspond to fast rotators. We find that galaxies with similar lambda(Re)-epsilon(e) -values can show distinctly different h(3)-V/sigma signatures. Class 5 objects are previously unidentified fast rotators that show a weak h(3) versus V/sigma anti-correlation. From simulations, these objects are predicted to be disk-less galaxies formed by gas-poor mergers. From morphological examination, however, there is evidence for large stellar disks. Instead, Class 5 objects are more likely disturbed galaxies, have counter-rotating bulges, or bars in edge-on galaxies. Finally, we interpret the strong anti-correlation in h(3) versus V/sigma as evidence for disks in most fast rotators, suggesting a dearth of gas-poor mergers among fast rotators.</P>