Tomographic Reconstruction of Neopterous Carboniferous Insect Nymphs

Two new polyneopteran insect nymphs from the Montceau-les-Mines Lagerstätte of France are presented. Both are preserved in three dimensions, and are imaged with the aid of X-ray micro-tomography, allowing their morphology to be recovered in unprecedented detail. One–Anebos phrixos gen. et sp. nov.–is of uncertain affinities, and preserves portions of the antennae and eyes, coupled with a heavily spined habitus. The other is a roachoid with long antennae and chewing mouthparts very similar in form to the most generalized mandibulate mouthparts of extant orthopteroid insects. Computer reconstructions reveal limbs in both specimens, allowing identification of the segments and annulation in the tarsus, while poorly developed thoracic wing pads suggest both are young instars. This work describes the morphologically best-known Palaeozoic insect nymphs, allowing a better understanding of the juveniles’ palaeobiology and palaeoecology. We also consider the validity of evidence from Palaeozoic juvenile insects in wing origin theories. The study of juvenile Palaeozoic insects is currently a neglected field, yet these fossils provide direct evidence on the evolution of insect development. It is hoped this study will stimulate a renewed interest in such work.     

Tomographic Reconstruction and Analysis of a Silver CO2 Reduction Cathode

Tomographic reconstruction has been well established as a valuable tool in the analysis of polymer electrolyte fuel cell (PEMFC) electrodes. While forays have been made into applying it to polymer electrolyte water electrolyzer (PEMWE) electrodes, CO₂ electrolyzer electrodes are still new ground. Here a tomographic analysis of an electrochemical CO₂ reduction gas diffusion electrode by means of focused ion beam scanning electron microscope tomography is presented. The reconstruction shows a porosity of 68%. While most of the porosity is on the nanoscale, a broad tail of micropores is observed in the distribution. The spatial distribution of the pores is nonuniform. The large pores are concentrated in the center of the layer in the through‐plane direction. From the reconstruction, an effective diffusivity factor of 0.5 for the catalyst layer is calculated. The Knudsen number of 0.19 obtained from the later shows that the diffusion is mostly in the bulk regime. Flooding of the catalyst layer is likely to decrease the effective diffusivity factor substantially.     

A Strategy for Electron Tomographic Data Collection and Crystallographic Reconstruction of Biological Bundles

Structures of highly ordered biological bundles have unique features which call for special experimental and computational methods in electron cryomicroscopy. They can be considered as three-dimensional quasi-crystals and reconstructed using a crystallographic approach. However, they are neither “infinitely” large with respect to the borders of the bundle, nor are they a single unit cell in thickness along the viewing direction. Also, because of their shape, bundles do not generally have a preferred azimuthal orientation, which poses challenges for orientation estimation and refinement. We developed a strategy for recording and processing electron cryomicroscopic images that differs from classical two-dimensional crystalline reconstruction techniques. These developments allowed us to merge data from tomographic tilt series of ice-embedded acrosomal bundles. The goal is to determine accurately amplitudes and phases at the diffraction maxima in terms ofhklindices, and compute a three-dimensional map from the diffraction data.     

Comparison of Multi-Slice Computed Tomographic Angiography and Dual-Source Computed Tomographic Angiography in Resectability Evaluation of Pancreatic Carcinoma

The assessment of pancreatic cancer resectability is based mainly on the extent of the peripancreatic vasculature involvement with tumor mass. The 16-slice computed tomography (MSCT) and dual-source computed tomography (DSCT) were used in non-invasive imaging of the pancreas and the regional vessels in 48 pancreatic carcinoma patients. Both of these techniques were combined with contrast-enhanced angiography and post-scanning reconstruction of 2D and 3D images. Based on the degree of involvement revealed by these images, the pre-operative tumor resectability was determined. The CTA-based resectability was then correlated with the surgical and pathological findings for the evaluation of their sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy. The study suggests that resectability based on dual-source CTA showed higher sensitivity, specificity, and diagnostic accuracy than that obtained from MSCTA scanning.     

Tomographic Three-dimensional Reconstruction of Insect Flight Muscle Partially Relaxed by AMPPNP and Ethylene Glycol

Rigor insect flight muscle (IFM) can be relaxed without ATP by increasing ethylene glycol concentration in the presence of adenosine 5′-[β′γ- imido]triphosphate (AMPPNP). Fibers poised at a critical glycol concentration retain rigor stiffness but support no sustained tension (“glycol-stiff state”). This suggests that many crossbridges are weakly attached to actin, possibly at the beginning of the power stroke. Unaveraged three-dimensional tomograms of “glycol-stiff” sarcomeres show crossbridges large enough to contain only a single myosin head, originating from dense collars every 14.5 nm. Crossbridges with an average 90° axial angle contact actin midway between troponin subunits, which identifies the actin azimuth in each 38.7-nm period, in the same region as the actin target zone of the 45° angled rigor lead bridges. These 90° “target zone” bridges originate from the thick filament and approach actin at azimuthal angles similar to rigor lead bridges. Another class of glycol-PNP crossbridge binds outside the rigor actin target zone. These “nontarget zone” bridges display irregular forms and vary widely in axial and azimuthal attachment angles. Fitting the acto-myosin subfragment 1 atomic structure into the tomogram reveals that 90° target zone bridges share with rigor a similar contact interface with actin, while nontarget crossbridges have variable contact interfaces. This suggests that target zone bridges interact specifically with actin, while nontarget zone bridges may not. Target zone bridges constitute only ∼25% of the myosin heads, implying that both specific and nonspecific attachments contribute to the high stiffness. The 90° target zone bridges may represent a preforce attachment that produces force by rotation of the motor domain over actin, possibly independent of the regulatory domain movements. Force production by myosin heads during muscle contraction has long been modeled as a transition of attached crossbridges from a 90° to a 45° axial angle. Efforts to image crossbridge forms and angles intermediate between 90° heads in ATP-relaxed insect flight muscle (IFM)¹ and the 45° angled bridges in rigor have used nucleotide analogs such as adenosine 5′-[β′γ-imido] triphosphate (AMPPNP) in stable equilibrium states to drive the crossbridges backwards from the 45° angle in rigor to an attached 90° preforce form, otherwise similar to myosin heads in ATP-relaxed fibers (Reedy et al., 1988; Tregear et al., 1990). However, AMPPNP alone will not fully relax IFM, and crossbridges binding AMPPNP retain many rigor-like features (Schmitz et al., 1996; Winkler et al., 1996). On the other hand, AMPPNP in combination with ethylene glycol will relax IFM. When poised at a critical glycol concentration, muscle stiffness is as high as rigor, suggesting crossbridge attachment, but fibers will not bear sustained tension (Clarke et al., 1984; Tregear et al., 1984). Two-dimensional (2-D) analysis of electron micrographs showed that this stiff glycol-PNP state resembled ATP-relaxed fibers in having dense collars every 14.5 nm along the thick filament and thin crossbridges originating from these collars at various axial angles around 90°. However, unlike relaxed muscle, stiff glycol-PNP fibers showed both 90° angled bridges that were regularly spaced every 38.7 nm and more intensity on the 19.3-nm layer line in optical and x-ray diffraction patterns (Reedy et al., 1988; Tregear et al., 1990). Crossbridges in this partially relaxed, glycol-PNP state are important because they may represent the form of the initial attachment of myosin with bound nucleotide preceding force generation (Marston and Tregear, 1984; Tregear et al., 1984; Reedy et al., 1988). This putative preforce 90° crossbridge could not be characterized in 3-D because its variable form and lattice arrangement precluded imaging by averaging methods of 3-D reconstruction. Recently, nonaveraging tomographic methods have been developed and successfully applied to rigor and aqueous-PNP, facilitating characterization of variable crossbridge forms that occur in situ (Taylor and Winkler, 1995, 1996; Schmitz et al., 1996; Winkler and Taylor, 1996). IFM is superb for structural study because the symmetry and spatial arrangement of filaments results in paired crossbridges on opposite sides of the actin filament. This in turn has given rise to a unique shorthand terminology. The individual crossbridge forms are not unique to IFM, only their symmetrical placement about the thin filament. The filament arrangement also facilitates the microtomy of a type of thin section with coplanar filaments that provide views of the entire crossbridge. The best of these, the myac layer, is a 25-nm-thick longitudinal section containing alternating myosin and actin filaments. In rigor, the maximum number of myosin heads attach to actin, forming doublet pairs every 38.7 nm, the “double chevrons” (Reedy, 1968). “Lead bridges,” which form the pair proximal to the M-band, consist of both heads of a myosin molecule and show an overall axial angle of 45° (Taylor et al., 1984). “Rear bridges,” which form the pair proximal to the Z-disk, consist of a single myosin head angled closer to 90°. Crossbridges originate from the thick filament along helical tracks so the azimuths of their origins follow a regular pattern. Relative to the thin filament in the myac layer, the lead bridges originate from the left-front and back-right of the adjacent thick filaments, while rear bridges originate from the left-back and right-front. At their actin ends, the crossbridge attachments follow the changing rotation of the actin protomers along the actin helix. The combination of the azimuth of the origin and the azimuth of the crossbridge contact to actin define the azimuthal angle of the crossbridge.Target zone is the name given to the region of the thin filament where crossbridges bind (Reedy, 1968); by implication this is the region of the thin filament where actin monomers are most favorably placed for actomyosin interaction. In our previous 3-D reconstructions of rigor and aqueous-PNP (Schmitz et al., 1996; Winkler et al., 1996), it was recognized that troponin maintained a constant position with respect to the most regularly positioned crossbridges, the lead bridges, and could thus be used as a landmark to determine the actin dyad orientation in the lead bridge target zone. The most sterically favorable actin position for crossbridge binding in the IFM lattice is midway between troponin densities, where lead bridges bind. The strained structure of the rigor rear bridges suggests that they bind at the very edge of the target zone (Schmitz et al., 1996; Winkler et al., 1996). The target zone defined by lead bridges alone is narrower than target zones previously considered for rigor muscle (Reedy, 1968) because it does not include rear bridge targets. When aqueous AMPPNP was added to rigor IFM, the tension dropped by two thirds, but the stiffness remained as high as rigor. This initially suggested a reversal of the power stroke, but 3-D reconstructions revealed that the lead bridges remained attached, midway between troponin densities, at axial and azimuthal angles close to rigor. The drop in tension without a large change in axial angle seemed to contradict the lever arm hypothesis for motion producing force. However, a cause for the loss of tension was found in tomograms, which showed that rear bridges detached and were replaced by nonrigor bridges bound to actins outside of the rigor target zone, to sites not selected by crossbridges even under the high-affinity conditions of rigor. These nontarget bridges in aqueous-PNP had variable axial and azimuthal angles and appeared to bind actin with variable contact interfaces. This suggested that they were nonspecifically bound to actin. Moreover, their variable structure did not suggest how a simple axial angle change could convert them to a familiar form, such as an angled rigor bridge. However, an intriguing doublet crossbridge group with a consistent structure was recognized in aqueous-PNP. Immediately M-ward of the “lead” rigor-like bridge was a “nonrigor” bridge bound at a 90° or antirigor angle. In this doublet, called a mask motif, both lead and M-ward nonrigor bridge pairs had similar azimuths and contact interfaces with actin and bound within the lead bridge target zone. A simple angle change could convert the M-ward, nonrigor bridge in a mask motif to a single headed lead bridge. Thus, in the mask motif, the lead bridge could be at the end of the power stroke, with the M-ward, nonrigor bridge near the beginning. The pairing of rigor and antirigor angled crossbridges bound to the same target zone suggests that crossbridges might act as a relay during muscle contraction (Schmitz et al., 1996). The affinity of myosin for actin in aqueous-PNP is high compared with weak binding intermediates thought to represent the beginning of the power stroke (Green and Eisenberg, 1980; Biosca et al., 1990). Therefore, the M-ward crossbridge in the mask motif may not represent the best candidate for a preforce crossbridge. Thus, it is important to characterize crossbridge structure in a state with lower actomyosin affinity, such as the stiff glycol-PNP state, where earlier 2-D analysis indicated that weakly attached 90° bridges are prevalent (Reedy et al., 1988). In this work, we have used two spatially invariant features, troponin position and lead crossbridge origins, to identify distinct classes of crossbridges. The invariant position of troponin recognized in 3-D reconstructions allows us to identify the lead bridge target zone and the actin dyad orientation relative to the bound crossbridges. In addition, the “front-back” rule for the azimuth of the origins of the lead target zone bridges distinguishes crossbridges that bind actin with the correct azimuth for specific binding from those that bind nonspecifically. By fitting the myosin subfragment 1 (S1) atomic structure to the in situ bridges, we can compare the positions of the motor and regulatory domains. Previous results and models have introduced the idea that during a power stroke, the crossbridge rotates over the actin binding site while acting as a long, relatively rigid lever arm (Huxley and Simmons, 1971), while others propose that the motor domain position remains constant and light chain domain movements provide a shorter lever arm (Rayment et al., 1993b ; Whittaker et al., 1995). Our previous results (Reedy et al., 1987, 1988; Schmitz et al., 1996; Winkler et al., 1996) and the present work show (a) that regulatory domain position can vary significantly while motor domain position remains constant and (b) that the motor domain can bind actin with varying orientations. This work supports the possibility that both rotation of the motor domain on actin and movements of the regulatory domain could contribute to the power stroke.     

Multimodal Nanoscale Tomographic Imaging for Battery Electrodes

Accurate representations of the 3D structure within a lithium‐ion battery are key to understanding performance limitations. However, obtaining exact reconstructions of electrodes, where the active particles, the carbon black and polymeric binder domain, and the pore space are visualized is challenging. Here, it is shown that multimodal imaging can be used to overcome this challenge. High‐resolution ptychographic X‐ray computed tomography are combined with lower resolution but higher contrast transmission X‐ray tomographic microscopy to obtain 3D reconstructions of pristine and cycled graphite‐silicon composite electrodes. This cross‐correlation enables quantitative analysis of the surface of active particles, including the heterogeneity of carbon‐black and binder domain and solid‐electrolyte interphase coverage. Capturing the active particles as well as the carbon black‐binder domain allows using these segmented structures for electrochemical simulations to highlight the influence of the particle embedding on local state of charge heterogeneities.     

In Vitro Evaluation of Spider Silk Meshes as a Potential Biomaterial for Bladder Reconstruction

Reconstruction of the bladder by means of both natural and synthetic materials remains a challenge due to severe adverse effects such as mechanical failure. Here we investigate the application of spider major ampullate gland-derived dragline silk from the Nephila edulis spider, a natural biomaterial with outstanding mechanical properties and a slow degradation rate, as a potential scaffold for bladder reconstruction by studying the cellular response of primary bladder cells to this biomaterial. We demonstrate that spider silk without any additional biological coating supports adhesion and growth of primary human urothelial cells (HUCs), which are multipotent bladder cells able to differentiate into the various epithelial layers of the bladder. HUCs cultured on spider silk did not show significant changes in the expression of various epithelial-to-mesenchymal transition and fibrosis associated genes, and demonstrated only slight reduction in the expression of adhesion and cellular differentiation genes. Furthermore, flow cytometric analysis showed that most of the silk-exposed HUCs maintain an undifferentiated immunophenotype. These results demonstrate that spider silk from the Nephila edulis spider supports adhesion, survival and growth of HUCs without significantly altering their cellular properties making this type of material a suitable candidate for being tested in pre-clinical models for bladder reconstruction.     

Tomographic techniques for the study of exceptionally preserved fossils

Three-dimensional fossils, especially those preserving soft-part anatomy, are a rich source of palaeontological information; they can, however, be difficult to work with. Imaging of serial planes through an object (tomography) allows study of both the inside and outside of three-dimensional fossils. Tomography may be performed using physical grinding or sawing coupled with photography, through optical techniques of serial focusing, or using a variety of scanning technologies such as neutron tomography, magnetic resonance imaging and most usefully X-ray computed tomography. This latter technique is applicable at a variety of scales, and when combined with a synchrotron X-ray source can produce very high-quality data that may be augmented by phase-contrast information to enhance contrast. Tomographic data can be visualized in several ways, the most effective of which is the production of isosurface-based 'virtual fossils' that can be manipulated and dissected interactively.     

Evaluation of Accuracy and Precision of Downing Population Reconstruction

ABSTRACT Downing population reconstruction uses harvest-by-age data and backward addition of cohorts to estimate minimum population size over time. Although this technique is currently being used for management of black bear (Ursus americanus) and white-tailed deer (Odocoileus virginianus) populations, it had not undergone a rigorous evaluation of accuracy. We used computer simulations to evaluate the impacts of collapsing age classes and violating the assumptions of this technique on population reconstruction estimates and trends. Changes in harvest rate or survival over time affected accuracy of reconstructed population estimates and trends. The technique was quite robust to collapsing age classes as far as 3+ for bears and deer. This method would be suitable for estimating population growth rate (λ) for populations experiencing no trend in harvest rate or natural mortality rate over time. Our evaluation showed Downing population reconstruction to be a potentially valuable tool for managing harvested species with high harvest rates and low natural mortality, with possible application to black bear and white-tailed deer populations.     

Preparation,Characterization, and In Vitro Cytotoxicity Evaluation of a Novel Anti-Tuberculosis Reconstruction Implant

Background

Reconstruction materials currently used in clinical for osteoarticular tuberculosis (TB) are unsatisfactory due to a variety of reasons. Rifampicin (RFP) is a well-known and highly effective first-line anti-tuberculosis (anti-TB) drug. Poly-DL-lactide (PDLLA) and nano-hydroxyapatite (nHA) are two promising materials that have been used both for orthopedic reconstruction and as carriers for drug release. In this study we report the development of a novel anti-TB implant for osteoarticular TB reconstruction using a combination of RFP, PDLLA and nHA.

Methods

RFP, PDLLA and nHA were used as starting materials to produce a novel anti-TB activity implant by the solvent evaporation method. After manufacture, the implant was characterized and its biodegradation and drug release profile were tested. The in vitro cytotoxicity of the implant was also evaluated in pre-osteoblast MC3T3-E1 cells using multiple methodologies.

Results

A RFP/PDLLA/nHA composite was successfully synthesized using the solvent evaporation method. The composite has a loose and porous structure with evenly distributed pores. The production process was steady and no chemical reaction occurred as proved by Fourier Transform Infrared Spectroscopy (FTIR) and X-Ray Diffraction (XRD). Meanwhile, the composite blocks degraded and released drug for at least 12 weeks. Evaluation of in vitro cytotoxicity in MC3T3-E1 cells verified that the synthesized composite blocks did not affect cell growth and proliferation.

Conclusion

It is feasible to manufacture a novel bioactive anti-TB RFP/PDLLA/nHA composite by the solvent evaporation method. The composite blocks showed appropriate properties such as degradation, drug release and biosafety to MC3T3-E1 cells. In conclusion, the novel composite blocks may have great potential for clinical applications in repairing bone defects caused by osteoarticular TB.     

Tomographic evidence for continuous turnover of Golgi cisternae in Pichia pastoris

The budding yeast Pichia pastoris contains ordered Golgi stacks next to discrete transitional endoplasmic reticulum (tER) sites, making this organism ideal for structure-function studies of the secretory pathway. Here, we have used P. pastoris to test various models for Golgi trafficking. The experimental approach was to analyze P. pastoris tER-Golgi units by using cryofixed and freeze-substituted cells for electron microscope tomography, immunoelectron microscopy, and serial thin section analysis of entire cells. We find that tER sites and the adjacent Golgi stacks are enclosed in a ribosome-excluding "matrix." Each stack contains three to four cisternae, which can be classified as cis, medial, trans, or trans-Golgi network (TGN). No membrane continuities between compartments were detected. This work provides three major new insights. First, two types of transport vesicles accumulate at the tER-Golgi interface. Morphological analysis indicates that the center of the tER-Golgi interface contains COPII vesicles, whereas the periphery contains COPI vesicles. Second, fenestrae are absent from cis cisternae, but are present in medial through TGN cisternae. The number and distribution of the fenestrae suggest that they form at the edges of the medial cisternae and then migrate inward. Third, intact TGN cisternae apparently peel off from the Golgi stacks and persist for some time in the cytosol, and these "free-floating" TGN cisternae produce clathrin-coated vesicles. These observations are most readily explained by assuming that Golgi cisternae form at the cis face of the stack, progressively mature, and ultimately dissociate from the trans face of the stack.     

Implementation of a Reference Interferometer for Nanodetection

A thermally and mechanically stabilized fiber interferometer suited for examining ultra-high quality factor microcavities is fashioned. After assessing its free spectral range (FSR), the module is put in parallel with a fiber taper-microcavity system and then calibrated through isolating and eliminating random shifts in the laser frequency (i.e. laser jitter noise). To realize the taper-microcavity junction and to maximize the optical power that is transferred to the resonator, a single-mode optical fiber waveguide is pulled. Solutions containing polystyrene nanobeads are then prepared and flown to the microcavity in order to demonstrate the system’s ability to sense binding to the surface of the microcavity. Data is post-processed via adaptive curve fitting, which allows for high-resolution measurements of the quality factor as well as the plotting of time-dependent parameters, such as resonant wavelength and split frequency shifts. By carefully inspecting steps in the time-domain response and shifting in the frequency-domain response, this instrument can quantify discrete binding events.     

Implementation and Evaluation of an Integrated Program for Rodent Control in a Shantytown of Buenos Aires City, Argentina

The objective of this work was to evaluate the efficiency of an integrated program for the control of rodents in a shantytown of Buenos Aires City, Argentina. This program was developed in one year. During the preparation phase, an environmental survey of public spaces and dwellings was conducted in the test area to identify factors favoring the presence of rodents and to determine strategies and management measures to be implemented in the execution phase. Rodent abundance was monitored in the following four periods: (1) during the preparation phase, (2) during the execution phase, (3) immediately after the execution phase, and (4) 90 days after the end of the execution phase. According to the results of the preparation phase, we combined three different strategies to reduce rodent abundance in both dwellings and public spaces of the experimental area: rodenticide application, environmental sanitation in public spaces, and sanitary education. In this area the proportion of dwellings and public spaces with signs of rodent activity decreased significantly from the beginning of the trial to immediately after the end of the execution phase. There was a significant increase in rodent activity 90 days after the execution phase. This work reveals that although rodent infestation can be reduced in urban shantytowns, a long-term policy for sanitation improvement and sanitary education is required to keep rodent populations at safe levels for the community.     

基于Renyi熵滤波的光声图像重建算法设计与实现

针对光声图像重建过程中存在的原始光声信号信噪比差、重建图像对比度低、分辨率不足等问题,提出了基于Renyi熵的光声图像重建滤波算法.该算法首先根据原始光声信号的Renyi熵分布情况,确定分割阈值,并滤除杂波信号;再利用滤波后的光声数据进行延时叠加光声图像重建.利用该滤波算法分别处理铅笔芯横截面(零维)、头发丝(一维)以及小鼠大脑皮层血管(二维)等不同维度样本的光声信号,实验结果表明:相比Renyi熵处理之前,重建图像对比度平均增强了32.45%,分辨率平均提高了30.78%,信噪比提高了47.66%,均方误差降低了35.01%;相比典型的滤波处理算法(模极大值法和阈值去噪法),本研究中图像的对比度、分辨率和信噪比分别提高了25.94%/10.60%、27.90%/19.48%、35.21%/10.60%,均方误差减小了28.57%/16.66%.因此,选择利用Renyi熵滤波算法处理光声信号,从而使光声图像重建质量得到大幅改善.     

Computerized Tomographic Scanning in Cases of Dementia

In assessing the clinical value of computerized tomographic (CT) scanning in elderly patients with dementia, only one of 100 patients with dementia of insidious onset and no other abnormal neurologic signs was found to have a potentially treatable disorder. In a second group of 100 patients with dementia of abrupt onset or with additional abnormal neurologic signs, 12 were found to have a lesion that potentially required medical or surgical intervention. We conclude that a subgroup of patients with dementia, representing about a third of demented patients in our hospital, are unlikely to benefit from CT scanning.     

Implementation of a Markov model for phylogenetic trees

A recently developed mathematical model for the analysis of phylogenetic trees is applied to comparative data for 48 species. The model represents a return to fundamentals and makes no hypothesis with respect to the reversibility of the process. The species have been analysed in all subsets of three, and a measure of reliability of the results is provided. The numerical results of the computations on 17,296 triples of species are made available on the Internet. These results are discussed and the development of reliable tree structures for several species is illustrated. It is shown that, indeed, the Markov model is capable of considerably more interesting predictions than has been recognized to date.     

Economic Evaluation of Active Implementation versus Guideline Dissemination for Evidence-Based Care of Acute Low-Back Pain in a General Practice Setting

Introduction

The development and publication of clinical practice guidelines for acute low-back pain has resulted in evidence-based recommendations that have the potential to improve the quality and safety of care for acute low-back pain. Development and dissemination of guidelines may not, however, be sufficient to produce improvements in clinical practice; further investment in active implementation of guideline recommendations may be required. Further research is required to quantify the trade-off between the additional upfront cost of active implementation of guideline recommendations for low-back pain and any resulting improvements in clinical practice.

Methods

Cost-effectiveness analysis alongside the IMPLEMENT trial from a health sector perspective to compare active implementation of guideline recommendations via the IMPLEMENT intervention (plus standard dissemination) against standard dissemination alone.

Results

The base-case analysis suggests that delivery of the IMPLEMENT intervention dominates standard dissemination (less costly and more effective), yielding savings of $135 per x-ray referral avoided (-$462.93/3.43). However, confidence intervals around point estimates for the primary outcome suggest that – irrespective of willingness to pay (WTP) – we cannot be at least 95% confident that the IMPLEMENT intervention differs in value from standard dissemination.

Conclusions

Our findings demonstrate that moving beyond development and dissemination to active implementation entails a significant additional upfront investment that may not be offset by health gains and/or reductions in health service utilization of sufficient magnitude to render active implementation cost-effective.     

医院综合绩效考核体系的构建与实施

医院综合绩效考核体系包括成本核算办法、平衡计分卡绩效考核、千分制质控考核、年度绩效考核、单项奖等方面,介绍和分析了各种绩效考核办法及其利弊。构建医院综合绩效考核体系,可以相互扬长避短,兼顾多个方面,促进医院又好又快发展。