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The formation of dental caries is the most common chronic disease in children, and is preventable. The oral health-related quality of life has an immense impact on an individual's daily functioning, well-being or overall quality of life.This study aims to investigate the cost effectiveness of the Dental RECUR Brief Negotiated Interview for Oral Health (DR-BNI). This 30-minute therapeutic "talk" by a dental nurse with a parent/guardian was compared with a placebo-controlled intervention in preventing reoccurrence of dental caries in children who have had a primary tooth extracted.An economic model was developed to simulate the clinical progression of dental caries among children who have previously had a primary tooth extracted. The analysis was conducted using the UK NHS perspective. The main outcome was the incremental cost-effectiveness ratio (ICER) based on the quality-adjusted life years (QALYs). Estimates of costs and probabilities were obtained from the DR-BNI multicentre randomised controlled trial (RCT), while QALY values were obtained from published literature. Univariate and probabilistic sensitivity analyses were conducted to assess the uncertainty of the result and robustness of the model. Affordability and risk-aversion of the intervention were investigated to help decision makers make the best possible choices.With an intervention cost of £6.47, the results from the RCT showed the healthcare cost for the DR-BNI intervention was £115.90 per child while the control had a healthcare cost of £119.46 per child. The QALYs gained for the prevention of reoccurrence of dental caries was higher in the DR-BNI intervention arm by 0.023 QALYs; thus, the DR-BNI was the dominant intervention. At willingness to pay threshold of £3500/QALY gained, a maximum probability of being cost effectiveness is achieved at 86%. The secondary analysis showed a cost-savings of £20.94 per participant for the prevention of at least one filling or extraction. Affordability results showed that the DR-BNI programme is affordable to the UK health system at a moderately low budget.This study shows the proactive talking intervention to have a very moderate cost and to be effective in providing better health related quality-of-life gains. The intervention is cost savings with a dominant ICER even with a 200% increase in the cost of intervention. The NHS will be providing better oral health for children at a better net monetary benefit-to-risk ratio by adopting the DR-BNI intervention in preventing the reoccurrence of dental fillings and extractions for each participant.This trial was registered prospectively on 27th September 2013 with the trial registration number ISRCTN 24958829.

Contains fulltext : 98426.pdf (Publisher’s version ) (Open Access) ABSTRACT: OBJECTIVE: This study was designed to investigate the effect of hypertonic fluid administration on inflammatory mediator gene expression in patients with septic shock. DESIGN AND SETTING: Prospective, randomized, controlled, double-blind clinical study in a 15-bed mixed intensive care unit in a tertiary referral teaching hospital. INTERVENTIONS: Twenty-four patients, who met standard criteria for septic shock, were randomized to receive a bolus of hypertonic fluid (HT, 250 ml 6% HES/7.2% NaCl) or isotonic fluid (IT, 500 ml 6% HES/0.9% NaCl) administered over 15 minutes. Randomization and study fluid administration was within 24 hours of ICU admission for all patients. This trial is registered with ANZCTR.org.au as ACTRN12607000259448. RESULTS: Blood samples were taken immediately before and 4, 8, 12, and 24 hours after fluid administration. Real-time reverse transcriptase polymerase chain reaction (RT rtPCR) was used to quantify mRNA expression of different inflammatory mediators in peripheral leukocytes. In the HT group, compared with the IT group, levels of gene expression of MMP9 and L-selectin were significantly suppressed (p = 0.0002 and p = 0.007, respectively), and CD11b gene expression tended to be elevated (p = NS). No differences were found in the other mediators examined. CONCLUSIONS: In septic shock patients, hypertonic fluid administration compared with isotonic fluid may modulate expression of genes that are implicated in leukocyte-endothelial interaction and capillary leakage.The study was performed at the Intensive Care Department, Waikato Hospital, and at the Molecular Genetics Laboratory, University of Waikato, Hamilton, New Zealand. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12607000259448.

Relational Analysis is concerned with the analysis of binary relations and their applicationsin different mathematical fields. The approach presented here and which has been developpedinitially by J.F. Marcotorchino and P. Michaud is particular as it represents the binary relationsas pairwise comparisons matrices, and as it is basically related to different tools from graphtheory, statistics and linear programming. The most usual application domains of RelationalAnalysis are clustering and multicriteria decision making which are respectively based uponthe analysis of equivalence and order relations.We have been interested in extending Relational Analysis to binary relations algebra, multi-valued logics, combinatorics and combinatorial optimization. These researches have given newresults in the usual application domains which have been mentionned beforehand and also tosome new extensions namely, the axiomatic of social choice theory and braids and knots theo-ries. Finally, this work presents the following contributions :• A new clustering algorithm for which the number of clusters is not required• A unified framework for some similarity indices between numerical vectors (which arevalid for binary or qualitative or quantitative variables), some categorical variables asso-ciation criteria and ordered variables association criteria• An aggregation process called the “consensus principle”, which is based on a generalizedmajority rule and which is derived from the combinatoric formulas of H. Poincaré andCh. Jordan• A generalization of the D. Black, K. Inada and A.K. Sen restriction conditions in socialchoice theory, which aims at defining sufficient and necessary conditions for the transiti-vity of the social choice obtained from several individual preferences• A new modelling approach for braids that enables to take into account generic isotopicmovements of strings and to present algorithmic problems in braids and knots theory ascombinatorial optimization problems; L’Analyse Relationnelle est un ensemble de méthodes qui s’intéresse à l’étude des relationsbinaires et aux applications faisant intervenir ces dernières. La particularité de la théorie pré-sentée ici et proposée initialement par J.F. Marcotorchino et P. Michaud, est de représenter cesrelations binaires sous la forme de matrices de comparaisons par paires d’objets sur lesquelsportent ces relations. Par ailleurs, elle fait appel à diverses branches mathématiques que sontla théorie des graphes, la statistique et la programmation linéaire. Deux des applications clas-siques de l’Analyse Relationnelle sont la classification automatique et l’agrégation multicritèrequi correspondent respectivement à l’étude des relations d’équivalence et des relations d’ordre.Nous avons cherché à enrichir l’Analyse Relationnelle de différents outils provenant de l’al-gèbre relationnelle, de la logique multivalente, de l’analyse combinatoire et de l’optimisationcombinatoire. Cette approche nous a permis d’étendre la théorie et les champs d’applicationde l’Analyse Relationnelle. Outre les applications classiques citées précédemment, nous noussommes intéressés à l’axiomatique issue de la théorie du choix social et à la théorie des tresses.Les contributions que nous avons pu obtenir finalement dans le cadre de ce mémoire de thèsesont les suivantes :• Définition d’un nouvel algorithme de classification automatique ne nécessitant pas lafixation d’un nombre de classes• Présentation unifiée de certains indices de similarité entre vecteurs numériques (issus devariables binaires, qualitatives ou quantitatives), de certains critères d’association entrevariables qualitatives et de certains critères d’association entre variables ordonnées• Définition d’une méthode d’agrégation appelée calcul consensuel, fondée sur une règlemajoritaire et qui se base sur les formules combinatoires de H. Poincaré et de Ch. Jordan• Généralisation des résultats de D. Black, de K. Inada et de A.K. Sen en théorie du choixsocial aboutissant à des conditions nécessaires et suffisantes pour que la préférence col-lective issue de plusieurs préférences individuelles soit transitive• Modélisation originale des tresses permettant de définir de manière générique des mou-vements isotopiques de brins et d’aborder les problèmes algorithmiques autour du groupedes tresses et celui des noeuds sous l’angle de l’optimisation combinatoire

Relational Analysis is concerned with the analysis of binary relations and their applicationsin different mathematical fields. The approach presented here and which has been developpedinitially by J.F. Marcotorchino and P. Michaud is particular as it represents the binary relationsas pairwise comparisons matrices, and as it is basically related to different tools from graphtheory, statistics and linear programming. The most usual application domains of RelationalAnalysis are clustering and multicriteria decision making which are respectively based uponthe analysis of equivalence and order relations.We have been interested in extending Relational Analysis to binary relations algebra, multi-valued logics, combinatorics and combinatorial optimization. These researches have given newresults in the usual application domains which have been mentionned beforehand and also tosome new extensions namely, the axiomatic of social choice theory and braids and knots theo-ries. Finally, this work presents the following contributions :• A new clustering algorithm for which the number of clusters is not required• A unified framework for some similarity indices between numerical vectors (which arevalid for binary or qualitative or quantitative variables), some categorical variables asso-ciation criteria and ordered variables association criteria• An aggregation process called the “consensus principle”, which is based on a generalizedmajority rule and which is derived from the combinatoric formulas of H. Poincaré andCh. Jordan• A generalization of the D. Black, K. Inada and A.K. Sen restriction conditions in socialchoice theory, which aims at defining sufficient and necessary conditions for the transiti-vity of the social choice obtained from several individual preferences• A new modelling approach for braids that enables to take into account generic isotopicmovements of strings and to present algorithmic problems in braids and knots theory ascombinatorial optimization problems; L’Analyse Relationnelle est un ensemble de méthodes qui s’intéresse à l’étude des relationsbinaires et aux applications faisant intervenir ces dernières. La particularité de la théorie pré-sentée ici et proposée initialement par J.F. Marcotorchino et P. Michaud, est de représenter cesrelations binaires sous la forme de matrices de comparaisons par paires d’objets sur lesquelsportent ces relations. Par ailleurs, elle fait appel à diverses branches mathématiques que sontla théorie des graphes, la statistique et la programmation linéaire. Deux des applications clas-siques de l’Analyse Relationnelle sont la classification automatique et l’agrégation multicritèrequi correspondent respectivement à l’étude des relations d’équivalence et des relations d’ordre.Nous avons cherché à enrichir l’Analyse Relationnelle de différents outils provenant de l’al-gèbre relationnelle, de la logique multivalente, de l’analyse combinatoire et de l’optimisationcombinatoire. Cette approche nous a permis d’étendre la théorie et les champs d’applicationde l’Analyse Relationnelle. Outre les applications classiques citées précédemment, nous noussommes intéressés à l’axiomatique issue de la théorie du choix social et à la théorie des tresses.Les contributions que nous avons pu obtenir finalement dans le cadre de ce mémoire de thèsesont les suivantes :• Définition d’un nouvel algorithme de classification automatique ne nécessitant pas lafixation d’un nombre de classes• Présentation unifiée de certains indices de similarité entre vecteurs numériques (issus devariables binaires, qualitatives ou quantitatives), de certains critères d’association entrevariables qualitatives et de certains critères d’association entre variables ordonnées• Définition d’une méthode d’agrégation appelée calcul consensuel, fondée sur une règlemajoritaire et qui se base sur les formules combinatoires de H. Poincaré et de Ch. Jordan• Généralisation des résultats de D. Black, de K. Inada et de A.K. Sen en théorie du choixsocial aboutissant à des conditions nécessaires et suffisantes pour que la préférence col-lective issue de plusieurs préférences individuelles soit transitive• Modélisation originale des tresses permettant de définir de manière générique des mou-vements isotopiques de brins et d’aborder les problèmes algorithmiques autour du groupedes tresses et celui des noeuds sous l’angle de l’optimisation combinatoire

OBJECTIVE. Although the Health Care Financing Administration (HCFA) uses Medicare hospital mortality data as a measure of hospital quality of care, concerns have been raised regarding the validity of this concept. A problem that has not been fully evaluated in these data is the potential confounding effect of illness severity factors associated with referral selection and hospital mortality on comparisons of risk-adjusted hospital mortality. We address this issue. DATA SOURCES AND STUDY SETTING. We analyzed the 1988 Medicare hospitalization data file (MEDPAR). We selected data on patients treated at the two Mayo Clinic-associated hospitals in Rochester, Minnesota, and a group of seven other hospitals that treat many patients from large geographic areas. These hospitals have had observed mortality rates substantially lower than those predicted by the HCFA model for the period 1987-1990. STUDY DESIGN. Using the multiple logistic regression model applied by HCFA to the 1988 data, we evaluated the relationship between distance from patient residence to the admitting hospital and risk-adjusted hospital mortality. PRINCIPAL FINDINGS. Among patients admitted to Mayo Rochester-affiliated hospitals, residence outside Olmsted County, Minnesota was independently associated with a 33 percent lower 30-day mortality rate (p < .001) than that associated with residence in Olmsted County. When patients at Mayo hospitals were stratified by residence (Olmsted County versus non-Olmsted County), the observed mortality was similar to that predicted for community patients (9.6 percent versus 10.2 percent, p = .26), whereas hospital mortality for referral patients was substantially lower than predicted (5.0 percent versus 7.5 percent, p = < .001). After incorporation of the HCFA risk adjustment methods, distance from patient residence to the hospitals was also independently associated with mortality among the Mayo Rochester-affiliated hospitals and seven other referral center hospitals. CONCLUSIONS. The HCFA Medicare hospital mortality model should be used with extreme caution to evaluate hospital quality of care for national referral centers because of residual confounding due to severity of illness factors associated with geographic referral that are inadequately captured in the extant prediction model.