BackgroundThe aim of this study was to create a new meta-analysis method for cost-effectiveness studies using comparative efficiency research (COMER).MethodsWe built a new score named total incremental net benefit (TINB), with inverse variance weighting of incremental net benefits (INB). This permits determination of whether an alternative is cost-effective, given a specific threshold (TINB > 0 test). Before validation of the model, the structure of dependence between costs and quality-adjusted life years (QoL) was analysed using copula distributions. The goodness-of-fit of a Spanish prospective observational study (n = 498) was analysed using the Independent, Gaussian, T, Gumbel, Clayton, Frank and Placket copulas. Validation was carried out by simulating a copula distribution with log-normal distribution for costs and gamma distribution for disutilities. Hypothetical cohorts were created by varying the sample size (n: 15–500) and assuming three scenarios (1-cost-effective; 2-non-cost-effective; 3-dominant). The COMER result was compared to the theoretical result according to the incremental cost-effectiveness ratio (ICER) and the INB, assuming a margin of error of 2,000 and 500 monetary units, respectively.ResultsThe Frank copula with positive dependence (−0.4279) showed a goodness-of-fit sufficient to represent costs and QoL (p-values 0.524 and 0.808). The theoretical INB was within the 95% confidence interval of the TINB, based on 15 individuals with a probability > 80% for scenarios 1 and 2, and > 90% for scenario 3. The TINB > 0 test with 15 individuals showed p-values of 0.0105 (SD: 0.0411) for scenario 1, 0.613 (SD: 0.265) for scenario 2 and < 0.0001 for scenario 3.ConclusionsCOMER is a valid tool for combining cost-effectiveness studies and may be of use to health decision makers.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2288-14-139) contains supplementary material, which is available to authorized users.

The occurrence of a number of large-scale disasters or catastrophes in recent years, including the Indian Ocean tsunami (2004), the Kashmir earthquake (2005), Hurricane Katrina (2005) and Hurricane Ike (2008), have raised our awareness regarding the devastating effects of disasters on human populations and the importance of developing mitigation and preparedness strategies to limit the consequences of such events. However, there is still a dearth of social science research focusing on the socio-economic impact of disasters on businesses in the United States. This paper contributes to this research literature by focusing on the impact of disasters on business closure and relocation through the use of multivariate logistic regression models, specifically focusing on the Loma Prieta earthquake (1989) and Hurricane Andrew (1992). Using a multivariate model, we examine how physical damage to the infrastructure, lifeline disruption and business characteristics, among others, impact business closure and relocation following major disasters.

It is well accepted that the presence of cytokines belonging to the Th1/Th17/Th22 axis of immuno-inflammatory response in the joint environment, such as IL-1β, IL-17 and IL-22, respectively, are associated with pathogenesis of several synovial joint degenerative disorders. During temporomandibular joint osteoarthritis (TMJ-OA), IL-1β and IL-17 have been implicated in the inflammation and resorption of sub-chondral bone; however, the role of Th22 response in the TMJ-OA pathophysiology has not been established. This study aimed to compare the expression of Th1/Th17/Th22-type cytokines, chemokines and chemokine receptors in synovial fluid samples obtained from TMJ-OA or disk displacement with reduction (DDWR) patients. In addition, it aimed to associate these levels with joint pain, imagenological signs of bone degeneration, RANKL production, osteoclastogenesis and osteoclast-induced bone resorption. Higher levels of IL-1β, IL-17 and IL-22 were expressed in TMJ-OA compared with DDWR subjects, and these increased levels significantly correlated with RANKL expression, joint pain and articular bone degeneration. Higher levels of CCR5, CCR6 and CCR7, as well as their respective ligands CCL5 and CCL20, responsible for recruitment of IL-1β, IL-17 and IL-22-producing cells, were over-expressed in TMJ-OA compared with DDWR subjects. Osteoclastogenesis and osteoclast-induced bone resorption were significantly greater in presence of synovial fluid from TMJ-OA compared with DDWR subjects. These data demonstrate that cytokines, CCLs and CCRs associated with the Th1/Th17/Th22 axis of immuno-inflammatory response are involved in TMJ-OA pathogenesis. These findings suggest that IL-22 is involved in the RANKL expression in TMJ-OA, which in turn induces differentiation of osteoclasts and subsequent resorption of sub-chondral bone.

Recent research in three Southern states supplied data describing the role community structure and culture played in shaping public response to tornado risks. The following study identifies and describes how residents received, made sense of, and ultimately used information to make decisions about responding to warnings. In addition to a range of theoretical concerns, research was also intended to develop a set of safety policies derived from what the data reveals about the social psychology of risk perception, economic constraints to shelter, and the cultural aspects of response. Data analysis reveals a diverse set of social factors governing community response to tornado warnings, including social networks, language, issues in comprehension, siren ambiguities, false alarms, tornado tracking, local business behaviors, warning specificity, and cultural myths.

Emergency managers (EMs) play a critical role in communicating severe weather and tornado warnings to the public, yet communicating the uncertainty of when, where or if a tornado may hit remains a great challenge for EMs. Focus group and survey data concerning weather product usage, weather observing spotter interaction, and decisions to warn the public were collected from Oklahoma EMs in order to characterize the communication processes EMs employ during severe weather outbreaks. These processes include: (1) acquiring weather information, (2) interpreting the information in order to make weather hazard threat assessments, (3) verifying the information, and (4) making time-sensitive warning decisions. The results indicate that while EMs use a variety of weather and radar products to acquire information, weather observing spotters are key sources of verification data. With respect to warning the public about tornado threats, sirens are the primary method. These findings are related to the development of a new radar system being developed by the Center for Collaborative Adaptive Sensing of the Atmosphere (CASA), so that this new technology can be designed to reduce uncertainty in the EM decision-making and warning communication processes.