No Strings Attached: When Giving it Away Versus Making Them Pay Leads to Negative Net Benefit Perceptions in Online Exchanges

2012 ◽  
Author(s):  
Tiffany Barnett White ◽  
Thomas P. Novak ◽  
Donna L. Hoffman
Keyword(s):  
Net Benefit ◽  
Online Exchanges

MODEL UNTUK UJI KUALITAS SISTEM INFORMASI UJIAN NASIONAL BERBASIS KOMPUTER TINGKAT SMA & MA

2018 ◽  
Vol 14 (2) ◽  
pp. 187
Author(s):  
Irwan Agus Sobari ◽  
Fajar Akbar ◽  
Robi Aziz Zauma ◽  
Amin Nur Rais
Keyword(s):  
Net Benefit

UNBK (Ujian Nasional Berbasis Komputer) adalah aplikasi ujian nasional yang berkembang yang telah mengklaim perhatian dan ketertarikan peneliti perkembangan ilmu komputer di dunia pendidikan. Salah satu perkembangan terbaru yang paling diterima di UNBK adalah kemanfaatan nya. Kami mengusulkan sebuah model model sukses DeLone & McLean IS untuk menganalisis kualitas UNBK pada kemanfaatan penggunanya. Pendekatan empiris didasarkan pada kuesioner survei online terhadap siswa SMA & MA, hasil feedback yang diterima sebanyak 74 individu. Hasilnya mengungkapkan bahwa Kualitas Informasi, Kualitias Sistem dan Kualitas pelayanan adalah preseden penting dari kepuasan pengguna, dan pentingnya kepuasan pengguna akan menghasilkan net benefit yang cukup signifikan. Memahami pentingnya konteks UNBK pada Net Benefit bagi pengguna berguna untuk memberikan wawasan baru kepada instansi terkait untuk menerapkan strategi untuk mempertahankan pengguna atau bahkan menarik pengadopsi potensial. penelitian ini memberikan implikasi teoritis dan praktis dari temuan penelitian.

Nitrogen Requirement of Potato for Eastern Indo-Gangatic Plain of India

2020 ◽  
Vol 7 (03) ◽  
Author(s):  
S. K. YADAV ◽  
R. K. SINGH ◽  
V. K. DUA ◽  
S SINGH ◽  
SARALA YADAV ◽  
...  
Keyword(s):  
Tuber Yield ◽  
Potato Crop ◽  
Block Design ◽  
Nitrogen Level ◽  
Cost Ratio ◽  
Research Station ◽  
Net Benefit ◽  
Marketable Tuber ◽  
Benefit Cost Ratio ◽  
Significant Difference

A field experiment was carried out during 2015-16 and 2016-17 at ICAR-Central Potato Research Station, Patna, Bihar, in randomized block design with four replications with objective to quantity the optimum requirement of nitrogen to potato crop. Significantly the highest plant height was recorded with nitrogen level of 300 kg/ha. Distributions of the smallest size of tuber yield of potato were decreasing with increasing the level of nitrogen. There was about 26.0% more yield of the smallest size tuber of potato was recorded with zero nitrogen as compare to the highest level of nitrogen i.e. 300 kg/ha. Increasing the nitrogen over the level of 150 to 225 kg per hectare, increasing the yield of tuber gradually slower rate than nitrogen level from 0 to 150 kg/ha. Total and marketable tuber yield of potato were increasing significantly with increasing level of nitrogen up to 150 kg/ha. There was no significant difference in marketable tuber yield was found for nitrogen level between 150 and 225 kg/ha. Highest (1.66) net benefit cost ratio was also recorded with level of nitrogen @ 150 kg/ha in potato. Hence, application of nitrogen @ 150 kg/ha was found statistically and economically more beneficial for potato cultivation in Eastern Indo-Gangatic plain of India.

scholarly journals Reproductive Performance and Partial Budget Analysis of a Prostaglandin or a Modified Ovsyn3ch Protocol in Autumn Calving Dairy Herds

Animals ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 1031
Author(s):  
George Lindley ◽  
Jim Willshire ◽  
Steven Van Winden
Keyword(s):  
Relative Effectiveness ◽  
Dairy Herds ◽  
Net Benefit ◽  
Start Date ◽  
Budget Analysis ◽  
Partial Budget ◽  
Holstein Friesian ◽  
Input Variables ◽  
Input Uncertainties ◽  
Relative Profitability

In autumn calving dairy herds, treatment of cattle not observed in estrus prior to the breeding season is common. Routinely, a single prostaglandin or a modified Ovsynch (MOFT) protocol are used—without evidence of their relative effectiveness. This study compares the effects on conception, associated timing, and profitability of administering cows with prostaglandin or MOFT treatment. A hundred and ninety-two Holstein-Friesian cows from three herds without an observed estrus within 28-days before mating start date were randomly treated with d-cloprostenol (PGOD) or an 8-day MOFT protocol. The association of treatment and calving-breeding start-date interval (CBSI) on the risk of conception were investigated. Partial budget, sensitivity analysis, and Monte Carlo simulation was used to assess economic performance, identify critical input variables, and explore the effects of input uncertainties on model output. There was a significant association between MOFT treatment and conception during 21 and 84 days after mating start date, compared to PGOD. MOFT treatment was associated with a mean net benefit of £58.21 (sd £19.42) and £27.29 (sd £17.75) per cow for herds with a fixed or variable dry-off date, respectively. The relative profitability of an MOFT protocol is dependent on its effects on barren rate and herd dry-off strategy.

scholarly journals Clinical use of the SelectMDx urinary-biomarker test with or without mpMRI in prostate cancer diagnosis: a prospective, multicenter study in biopsy-naïve men

2021 ◽  
Author(s):  
Rianne J. Hendriks ◽  
Marloes M. G. van der Leest ◽  
Bas Israël ◽  
Gerjon Hannink ◽  
Anglita YantiSetiasti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Risk Stratification ◽  
Specific Antigen ◽  
Low Grade ◽  
Diagnostic Study ◽  
High Grade ◽  
Net Benefit ◽  
Conditional Strategy ◽  
Detection Rates ◽  
Guided Biopsy

Abstract Background Risk stratification in men with suspicion of prostate cancer (PCa) requires reliable diagnostic tests, not only to identify high-grade PCa, also to minimize the overdetection of low-grade PCa, and reduction of “unnecessary” prostate MRIs and biopsies. This study aimed to evaluate the SelectMDx test to detect high-grade PCa in biopsy-naïve men. Subsequently, to assess combinations of SelectMDx test and multi-parametric (mp) MRI and its potential impact on patient selection for prostate biopsy. Methods This prospective multicenter diagnostic study included 599 biopsy-naïve patients with prostate-specific antigen level ≥3 ng/ml. All patients underwent a SelectMDx test and mpMRI before systematic transrectal ultrasound-guided biopsy (TRUSGB). Patients with a suspicious mpMRI also had an in-bore MR-guided biopsy (MRGB). Histopathologic outcome of TRUSGB and MRGB was used as reference standard. High-grade PCa was defined as ISUP Grade Group (GG) ≥ 2. The primary outcome was the detection rates of low- and high-grade PCa and number of biopsies avoided in four strategies, i.e., (1) SelectMDx test-only, (2) mpMRI-only, (3) SelectMDx test followed by mpMRI when SelectMDx test was positive (conditional strategy), and (4) SelectMDx test and mpMRI in all (joint strategy). A positive SelectMDx test outcome was a risk score of ≥−2.8. Decision curve analysis (DCA) was performed to assess clinical utility. Results Prevalence of high-grade PCa was 31% (183/599). Thirty-eight percent (227/599) of patients had negative SelectMDx test in whom biopsy could be avoided. Low-grade PCa was not detected in 35% (48/138) with missing 10% (18/183) high-grade PCa. Yet, mpMRI-only could avoid 49% of biopsies, not detecting 4.9% (9/183) of high-grade PCa. The conditional strategy reduces the number of mpMRIs by 38% (227/599), avoiding biopsy in 60% (357/599) and missing 13% (24/183) high-grade PCa. Low-grade PCa was not detected in 58% (80/138). DCA showed the highest net benefit for the mpMRI-only strategy, followed by the conditional strategy at-risk thresholds >10%. Conclusions SelectMDx test as a risk stratification tool for biopsy-naïve men avoids unnecessary biopsies in 38%, minimizes low-grade PCa detection, and misses only 10% high-grade PCa. Yet, using mpMRI in all patients had the highest net benefit, avoiding biopsy in 49% and missing 4.9% of high-risk PCa. However, if mpMRI availability is limited or expensive, using mpMRI-only in SelectMDx test positive patients is a good alternative strategy.

scholarly journals Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies

2021 ◽  
Vol 9 (1) ◽  
pp. e002150
Author(s):  
Francesca M Chappell ◽  
Fay Crawford ◽  
Margaret Horne ◽  
Graham P Leese ◽  
Angela Martin ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Secondary Care ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Initial Assessment ◽  
Validation Dataset ◽  
Benefit Analysis ◽  
Clinical Prediction ◽  
Net Benefit ◽  
Foot Ulceration

IntroductionThe aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes.Research design and methodsDevelopment of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2 years of initial assessment and validated it in a fifth study (n=3324). The CPR’s performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis.ResultsCPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2 years of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was −0.374 (95% CI −0.561 to −0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment.ConclusionThe clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings.

scholarly journals Head-to-Head Comparison of Two Nomograms Predicting Probability of Lymph Node Invasion in Prostate Cancer and the Therapeutic Impact of Higher Nomogram Threshold

2021 ◽  
Vol 10 (5) ◽  
pp. 999
Author(s):  
Zilvinas Venclovas ◽  
Tim Muilwijk ◽  
Aivaras J. Matjosaitis ◽  
Mindaugas Jievaltas ◽  
Steven Joniau ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Area Under The Curve ◽  
Pelvic Lymph Node ◽  
Cancer Center ◽  
Study Cohort ◽  
Net Benefit ◽  
Characteristic Analysis ◽  
Therapeutic Impact ◽  
Mskcc Nomogram

Introduction: The aim of the study was to compare the performance of the 2012 Briganti and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with pelvic lymph node dissection (PLND), to examine their performance and to analyse the therapeutic impact of using 7% nomogram cut-off. Materials and Methods: The study cohort consisted of 807 men with clinically localised prostate cancer (PCa) who underwent open RP with PLND between 2001 and 2019. The area under the curve (AUC) of the receiver operator characteristic analysis was used to quantify the accuracy of the 2012 Briganti and MSKCC nomograms to predict LNI. Calibration plots were used to visualise over or underestimation by the models and a decision curve analysis (DCA) was performed to evaluate the net benefit associated with the used nomograms. Results: A total of 97 of 807 patients had LNI (12%). The AUC of 2012 Briganti and MSKCC nomogram was 80.6 and 79.2, respectively. For the Briganti nomogram using the cut-off value of 7% would lead to reduce PLND in 47% (379/807), while missing 3.96% (15/379) cases with LNI. For the MSKCC nomogram using the cut-off value of 7% a PLND would be omitted in 44.5% (359/807), while missing 3.62% (13/359) of cases with LNI. Conclusions: Both analysed nomograms demonstrated high accuracy for prediction of LNI. Using a 7% nomogram cut-off would allow the avoidance up to 47% of PLNDs, while missing less than 4% of patients with LNI.

scholarly journals PHI density prospectively improves prostate cancer detection

2021 ◽  
Author(s):  
Carsten Stephan ◽  
Klaus Jung ◽  
Michael Lein ◽  
Hannah Rochow ◽  
Frank Friedersdorff ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Specific Antigen ◽  
Roc Curves ◽  
Grey Zone ◽  
Net Benefit ◽  
Threshold Probability ◽  
Free Psa ◽  
Prostate Health Index ◽  
Magnetic Resonance Imaging Mri ◽  
Prostate Health

Abstract Purpose To evaluate the Prostate Health Index (PHI) density (PHID) in direct comparison with PHI in a prospective large cohort. Methods PHID values were calculated from prostate-specific antigen (PSA), free PSA and [− 2]proPSA and prostate volume. The 1057 patients included 552 men with prostate cancer (PCa) and 505 with no evidence of malignancy (NEM). In detail, 562 patients were biopsied at the Charité Hospital Berlin and 495 patients at the Sana Hospital Offenbach. All patients received systematic or magnetic resonance imaging (MRI)/ultrasound fusion-guided biopsies. The diagnostic accuracy was evaluated by receiver operating characteristic (ROC) curves comparing areas under the ROC-curves (AUC). The decision curve analysis (DCA) was performed with the MATLAB Neural Network Toolbox. Results PHID provided a significant larger AUC than PHI (0.835 vs. 0.801; p = 0.0013) in our prospective cohort of 1057 men from 2 centers. The DCA had a maximum net benefit of ~ 5% for PHID vs. PHI between 35 and 65% threshold probability. In those 698 men within the WHO-calibrated PSA grey-zone up to 8 ng/ml, PHID was also significantly better than PHI (AUC 0.819 vs. 0.789; p = 0.0219). But PHID was not different from PHI in the detection of significant PCa. Conclusions Based on ROC analysis and DCA, PHID had an advantage in comparison with PHI alone to detect any PCa but PHI and PHID performed equal in detecting significant PCa.

scholarly journals POS0261 DIAGNOSTIC PERFORMANCE AND CLINICAL UTILITY OF TWO REFERRAL RULES FOR INFLAMMATORY ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 353.1-353
Author(s):  
E. Van Delft ◽  
D. Lopes Barreto ◽  
A. Van der Helm - van Mil ◽  
C. Alves ◽  
J. Hazes ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Inflammatory Arthritis ◽  
Clinical Utility ◽  
Diagnostic Performance ◽  
Youden Index ◽  
Care Model ◽  
Net Benefit ◽  
Independent Population ◽  
The Right

Background:The Rotterdam Early Arthritis Cohort (REACH) rule [1] and Clinical Arthritis RulE (CARE) [2] are both evidence-based and easy-to-use methods developed to identify the presence of inflammatory arthritis (IA) in patients suspected by their general practitioner (GP). However, the clinical utility of both models in daily clinical practice in an independent primary care setting has not yet been established. While developed for recognizing IA, we believe that it is also important that the broader spectrum of inflammatory rheumatic diseases (IRDs) is correctly classified from primary care, to facilitate appropriate referral towards outpatient rheumatology clinics.Objectives:The primary objective was to determine the diagnostic performance and clinical utility of the REACH and CARE referral rules in identifying IA in an independent population of unselected suspected patients from primary care. Secondly we will assess the diagnostic performance and clinical utility of both models in identifying IRDs.Methods:This prospective observational diagnostic study consisted of adults newly suspected by their GP for the need of referral to the rheumatology outpatient clinic of the Maasstad Hospital in Rotterdam. Primary outcome was IA, consisting of rheumatoid arthritis, axial spondylitis and psoriatic arthritis. Secondary outcome was IRD, defined as IA plus arthritis in systemic disorders such as systemic lupus erythematosus, systemic sclerosis and morbus sjögren. Rheumatologist diagnosis was used as gold standard. To evaluate the clinical performance of the REACH and CARE referral rules in this population, diagnostic accuracy measures were investigated using the Youden index (J) [3]. Moreover, a net benefit approach [4] was used to determine clinical utility of both rules when compared to usual care.Results:This study consisted of 250 patients (22.8% male) with a mean age of 50.8 years (SD 13.9 years). In total 42 (17%) patients were diagnosed with IA and 55 (22%) with an IRD. Figure 1 presents the diagnostic performance in IA (Figure 1A) and in IRD (Figure 1B). For the primary outcome, the REACH model shows an AUC of 0.72 (95% CI 0.64-0.80) and the optimal cut-off point is indicated (J). The CARE model shows an AUC of 0.82 (95% CI 0.75-0.88) and at J there is a somewhat higher sensitivity and specificity. When taking the broader spectrum of IRDs as outcome, the AUC was 0.66 (95% CI 0.58-0.74) for the REACH and 0.76 (95% CI 0.69-0.83) for the CARE model. The net benefit analysis with either IA or IRD as outcome showed that the CARE was of the highest clinical value when compared to usual care.Conclusion:Both the REACH and CARE model showed a good diagnostic performance for detecting IA in an independent population of unselected suspected patients from primary care. Although not specifically developed to recognize the entire spectrum of IRDs, the CARE shows a good performance in doing so. When evaluating clinical utility, we see that both rules have a net benefit in recognizing IA as well as IRDs compared to usual care, however the CARE shows superiority over the REACH. By using the CARE, over half of all suspected patients can be withheld from expensive outpatient rheumatology care, implied by the high specificity of 70%. These results support the idea that incorporating these easy-to-use methods into primary care could lead to providing patients the right care at the right place and improving value based health care.References:[1]ten Brinck RM, van Dijk BT, van Steenbergen HW, le Cessie S, Numans ME. Development and validation of a clinical rule for recognition of early inflammatory arthritis. BMJ Open; 2018: 8[2]Alves, C. Improving early referral of inflammatory arthritis. In Early detection of patients at risk for rheumatoid arthritis – a challenge for primary and secondary care; 2015: 27-38 Ridderkerk, the Netherlands.[3]Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J; 2005: 47(4): 458-472[4]Vickers AJ, Elkin EB. Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making; 2006: 26(6): 565-574Disclosure of Interests:None declared

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