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Economic evaluation of the hepatitis C elimination strategy in Greece in the era of affordable direct-acting antivirals

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World Journal of Gastroenterology 2019年第11期25卷 1327-1340页

作者： Ilias Gountas Vana Sypsa George Papatheodoridis Kyriakos Souliotis kostas athanasakis Homie Razavi Angelos Hatzakis Department of Hygiene Epidemiology and Medical StatisticsMedical SchoolNational and Kapodistrian University of Athens Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases Department of Gastroenterology Medical SchoolNational and Kapodistrian University of AthensLaiko General Hospital Faculty of Social and Political Sciences University of Peloponnese Department of Health Economics National School of Public Health Center for Disease Analysis

BACKGROUND Hepatitis C virus(HCV) is a leading cause of worldwide liver-related morbidity and mortality. The World Health Organization released an integrated strategy targeting HCV-elimination by 2030. This study aims to estimate the required interventions to achieve elimination using updated information for direct-acting antiviral(DAA) treatment coverage, to compute the total costs(including indirect/societal costs) of the strategy and to identify whether the elimination strategy is cost-effective/cost-saving in *** To estimate the required interventions and subsequent costs to achieve HCV elimination in *** A previously validated mathematical model was adapted to the Greek HCVinfected population to compare the outcomes of DAA treatment without the additional implementation of awareness or screening campaigns versus an HCV elimination strategy, which includes a sufficient number of treated patients. We estimated the total costs(direct and indirect costs), the disability-adjusted life years and the incremental cost-effectiveness ratio using two different price *** Without the implementation of awareness or screening campaigns,approximately 20000 patients would be diagnosed and treated with DAAs by2030. This strategy would result in a 19.6% increase in HCV-related mortality in2030 compared to 2015. To achieve the elimination goal, 90000 patients need to be treated by 2030. Under the elimination scenario, viremic cases would decrease by78.8% in 2030 compared to 2015. The cumulative direct costs to eliminate the disease would range from 2.1-2.3 billion euros(€) by 2030, while the indirect costs would be €1.1 billion. The total elimination cost in Greece would range from €3.2-3.4 billion by 2030. The cost per averted disability-adjusted life year is estimated between €10100 and €13380, indicating that the elimination strategy is very costeffective. Furthermore, HCV elimination strategy would save €560-895 million *** Without

关键词： Hepatitis C elimination Cost effectiveness Cost of elimination Indirect costs Projections Mathematical modelling Awareness and screening programs World Health Organization targets

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Cost-Minimization and Budget Impact Analysis of Rituximab SC VS Rituximab IV for Non-Hodgkin’s Lymphoma (NHLs) in Greece

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Journal of Cancer Therapy 2017年第8期8卷 726-734页

作者： Dionysis Kyriopoulos Vasiliki Tsiantou Labrini Papageorgiou Fani Theodoropoulou kostas athanasakis Department of Health Economics National School of Public Health Athens Greece Roche (Hellas) Athens Greece

Background: Non-Hodgkin’s lymphoma (NHLs) is a prevalent type of cancer for which Intravenous (IV) Rituximab is a widely used treatment option. Nevertheless, IV infusions can lead to intense resource use and, subsequently, costs. Given that a subcutaneous (SC) therapeutically equivalent formulation of the drug is currently available, this study aimed to examine the potential clinical and economic value of the introduction of the SC formulation for the Greek healthcare setting. Methods: A cost-minimization and budget-impact analysis contributed to comparing staff, patient time and resource utilization and estimating the clinical effects and associated costs in the IV and SC administration. A questionnaire-based survey was used to provide data regarding the local treatment patterns and the resource use associated with each treatment in the Greek NHS. The analysis followed the third-party payer perspective, and cost data relevant to personnel salaries, pharmaceuticals and resource utilization were obtained from official government sources. Results: SC administration was associated with time savings in activities such as pre-medication administration (3 minutes saved with the SC use), monitoring during infusion (12 minutes for physicians and 3 minutes for nurses) as well as time-savings in the preparation of the drugs, the actual dispensing process and the post-injecting monitoring processes. A significant decrease was observed in the nursing and chair time (57% and 90% per case, respectively) and a higher level of services could be secured in terms of hospital capacity with the SC use. SC administration was found to generate budget savings of 618,708€ per 1000 patients/3 years over the full course of treatment. Conclusions: Switching IV to SC administration, as demonstrated in the case of Rituximab for NHLs in Greece, can reduce staff time and administration costs, improve the capacity of the system and, possibly, improve resource allocation in the healthcare system.

关键词： Non-Hodgkin’s Lymphoma Intravenous Subcutaneous Nursing Time Chair Time Greece

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Micromechanical experiments using a new inter-granule loading apparatus on gravel to ballast-sized materials

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Friction 2020年第1期8卷 70-82页

作者： Chitta Sai SANDEEP kostas SENETAKIS City University of Hong Kong Hong Kong SARChina

Micromechanical and tribological studies of geological materials with a particular focus on their contact-mechanics behavior at the grain scale are currently a major interest in the engineering and geoscience disciplines. In this study, a new robust micromechanical apparatus developed at the City University of Hong Kong is described;it is capable of conducting inter-granule(or inter-particle) loading tests on fine gravel to ballast-sized materials of sizes as small as 5-10 mm to granules(or ballast) as big as 50 mm. The focus of our study is the description of the major technical features of the new apparatus and its performance and repeatability in conducting experiments on reference grains of chrome steel balls and glass balls;in addition, we conducted a preliminary set of experiments on crushed granitic rock, which is a material widely used in geotechnical and transportation infrastructure. The representative results of these experiments are presented in terms of the normal force-displacement relationship, friction, and tangential stiffness. The newly developed large-size apparatus is further compared with a well-established apparatus that can conduct micromechanical tests on sand-sized materials.

关键词： experimental micromechanics contact mechanics linear bearings inter‐particle friction granite debris flow ballast

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Function of the hemochromatosis protein HFE:Lessons from animal models

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World Journal of Gastroenterology 2008年第45期14卷 6893-6901页

作者： kostas Pantopoulos Lady Davis Institute for Medical Research Sir Mortimer B Davis Jewish General Hospital Department of Medicine McGill University

Hereditary hemochromatosis （HH） is caused by chronic hyperabsorption of dietary iron. Progressive accumulation of excess iron within tissue parenchymal cells may lead to severe organ damage. The most prevalent type of HH is linked to mutations in the HFE gene, encoding an atypical major histocompatibility complex class I molecule. Shortly after its discovery in 1996, the hemochromatosis protein HFE was shown to physically interact with transferrin receptor 1 （TfR1） and impair the uptake of transferrin-bound iron in cells. However, these findings provided no clue why HFE mutations associate with systemic iron overload. It was later established that all forms of HH result from misregulation of hepcidin expression. This liverderived circulating peptide hormone controls iron efflux from duodenal enterocytes and reticuloendothelial macrophages by promoting the degradation of the iron exporter ferroportin. Recent studies with animal models of HH uncover a crucial role of HFE as a hepatocyte iron sensor and upstream regulator of hepcidin. Thus, hepatocyte HFE is indispensable for signaling to hepcidin, presumably as a constituent of a larger ironsensing complex. A working model postulates that the signaling activity of HFE is silenced when the protein is bound to TfR1. An increase in the iron saturation of plasma transferrin leads to displacement of TfR1 from HFE and assembly of the putative iron-sensing complex. In this way, iron uptake by the hepatocyte is translated into upregulation of hepcidin, reinforcing the concept that the liver is the major regulatory site for systemic iron homeostasis, and not merely an iron storage depot.

关键词： Hepcidin Iron metabolism Transferrin Hemojuvelin Bone morphogenetic proteins

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Fluxes,stocks and availability of nitrogen in evergreen broadleaf and fir forests:similarities and differences

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Journal of Forestry Research 2021年第5期32卷 2059-2066页

作者： Panagiotis Michopoulos Athanassios Bourletsikas kostas Kaoukis o.demeter-institute of mediterranean forest ecosystems terma alkmanos11528 athensgreece

In this study,nitrogen fluxes or flows in litterfall,nitrogen stocks and available nitrogen in soils of two plots representing evergreen broadleaf and Bulgarian fir forests were *** plots are in good quality sites and for this reason,the litterfall quantities and nitrogen fluxes were relatively *** woody litterfall flux of nitrogen was significantly higher in the fir forest than in the evergreen broadleaf *** total nitrogen stock was higher in the soil under the fir ***,the percentage of the available nitrogen(ammonium+nitrates)was significantly higher in the upper 20 cm soil layer of the evergreen broadleaf forest in spite of the higher average C/N ratios in the foliar litterfall of the broadleaf forest and insignificant difference of the C/N ratios in all soil layers of the two *** microclimatic conditions(higher soil temperatures in the evergreen broadleaf forest)is probable possible cause for this *** available nitrogen in the soils and its retranslocation from senescing leaves cover the nitrogen requirements of *** is hypothesized that trees may also take up nitrogen from deeper soil layers.

关键词： Maquis Fir Nitrogen Litterfall fluxes Soil

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Computational and conceptual blends: Material considerations and agency in a multi-material design workflow

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Frontiers of Architectural Research 2022年第4期11卷 618-629页

作者： kostas Grigoriadis Bartlett School of Architecture University College LondonLondon WC1H 0QBUK

The assimilation of functionally graded (or multi-) materials into architecture is deemed to enable the rethinking of current architectural design practice and bring back material considerations at the heart of the early design process. In response, the paper outlines a functionally graded material (FGM) design workflow that departs from standard early-stage CAD, which is typically performed via computer elements devoid of materiality. It then analyses this workflow from a theoretical perspective, namely through Edwin Hutchins’ materially anchored conceptual blending, Lambros Malafouris’ Material Engagement Theory (MET) and John Searle’s concepts of intentionality. The aim is to demonstrate that due to the superimposition of material considerations that precede and succeed the CAD operation, working with material-less entities during early-stage FGM design is not logically sustainable. Additionally, multi-materiality allows for the questioning of authorship in the design process and leads to a repositioning of agency from the subject to the locus of engagement with digital materials and their affordances.

关键词： Digital design Multi-materials Computer simulation Material agency Materially anchored conceptual blends

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Diverging rationalities between forest fire management services and the general public after the 21st-century mega-fires in Greece

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Journal of Forestry Research 2022年第2期33卷 553-564页

作者： Andreas Y.Troumbis kostas Kalabokidis Palaiologos Palaiologou Department of Environment University of the Aegean81100 MytileneLesvos IslandGreece Department of Geography University of the Aegean81100 MytileneLesvos IslandGreece

Wildfire risk related to hazards on people and assets is expected to increase in the face of climate change,especially in fire-prone environments such as the Mediterranean *** rationalities,i.e.,the complex profile of multi-thematic,wildfire-related perceptions that collectively characterize and quantify all of a society’s responses,its interrelations,and influence on its insights,are of primary importance to understand the degree of preparedness and the direction that wildfire management policies are *** is a country that suffered mega-wildfire events during the first years of the twenty-first *** paper presents a scheme of advanced multivariate statistical procedures applied on standard social survey questionnaires to uncover different or similar rationalities between fire management services and the general ***-centered versus message-oriented rationalities is *** differ mainly on the priorities attributed to strengthening personnel and equipment capacities versus the need for public education and *** are evaluated against the needs of long-term risk assessment and forest management policies in *** main conclusion is that Greek society,although traumatized by recent fire disasters,is not yet prepared for long-term strategic forestry adaptation and planning.

关键词： Wildfire Qualitative research Rationality Fire governance Public Perception Risk assessment

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An integrated multi-criteria analysis for assessing sustainability of agricultural production at regional level

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Information Processing in Agriculture 2020年第2期7卷 223-232页

作者： Georgios Bartzas kostas Komnitsas School of Mining and Metallurgical Engineering National Technical University of AthensZografos CampusAthens 15780Greece School of Mineral Resources Engineering Technical University of CreteChaniaCrete 73100Greece

Assessment of agricultural production sustainability is a multi-dimensional task that involves the quantification of various economic,social and environmental indicators at different scales and uncertainty *** this context,a particularly challenging approach is proposed involving the appropriate selection of the most representative criteria that ensure economic viability,eco-friendliness and social development,in order to overcome the limitations of other methodological approaches that are often vague and *** this study,a holistic methodology that integrates life cycle analysis(LCA),environmental risk assessment(ERA)along with on-site farm and regional surveys using the multi-criteria environment of the Analytical Hierarchy Process(AHP)is designed for the identification of the most sustainable agricultural management practices at regional *** on a set of 13 representative sub-criteria,the proposed approach was applied to Pistacia vera *** in Aegina island,Greece,where narrow range of resources is available,groundwater supply is scarce and of poor ***,three alternative scenarios,*** scenario representing the current production(BL)as well as Composting(CO)and Biochar Use(BU)scenarios aiming at sustainability improvement were *** of multi-criteria and sensitivity analyses suggest that the optimal sustainable management scenario is CΟ,which involves on-site composting of organic solid waste,mainly produced at farm site,and subsequent application in the *** proposed methodology shows significant potential as a valuable multi-criteria tool that can be easily adapted at regional level to assist decision makers such as farmers and their associations,policy makers,local and regional authorities to efficiently explore a range of alternative farm management practices and thus identify pathways toward sustainability.

关键词： Sustainability Multi-criteria analysis LCA AHP Pistacia vera L. Sensitivity analysis

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A note on influence of stress anisotropy on the Poisson's ratio of dry sand

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Journal of Rock Mechanics and Geotechnical Engineering 2017年第6期9卷 1159-1164页

作者： Huan He Mingnan Li kostas Senetakis University of New South Wales(UNSW) SydneyAustralia City University of Hong Kong Hong Kong Special Administrative Region

In this study, extender and bender element tests were conducted investigating the small-strain Poisson’s ratio of variable sands, with a focus on the effect of stress anisotropy in order to quantify the sensitivity of Poisson’s ratio to the applied deviatoric stress. Four different uniform sands were tested, including a biogenic sand, a crushed rock and two natural sands, covering a wide range of particle shapes. From these sands, eleven samples were prepared in the laboratory and were tested under variable stress paths,maintaining a constant mean effective pressure while increasing the deviatoric compressive load. Under the application of these given stress paths, the data analysis indicated that the sensitivity of Poisson’s ratio to the stress ratio was more pronounced for sands with irregularly shaped particles in comparison to sands with fairly rounded and spherical grains. For sands with very irregularly shaped particles, the increase of Poisson’s ratio from the isotropic to the anisotropic stress state reached 50%, while this increase for natural sands with fairly rounded particles was in the order of 20%.

关键词： Bender elements Sand Poisson’s ratio

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Genetic alterations in pancreatic cancer

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World Journal of Gastroenterology 2007年第33期13卷 4423-4430页

作者： Muhammad Wasif Saif Lena Karapanagiotou kostas Syrigos Yale University School of Medicine Section of Medical Oncology 333 Cedar Street NewHaven CT 06520-8032 United States Oncology Unit Third Department of MedicineAthens Medical SchoolSotiria General HospitalMesogion 152 11526 AthensGreece

The diagnosis of pancreatic patients and their relatives cancer is devastating for as the incidence rate is approximately the same as mortality rate. Only a small percentage, which ranges from 0.4% to 4% of patients who have been given this diagnosis, will be alive at five years. At the time of diagnosis, 80% of pancreatic cancer patients have unresectable or metastatic disease. Moreover, the therapeutic alternatives offered by chemotherapy or radiotherapy are few, if not zero. For all these reasons, there is an imperative need of analyzing and understanding the primitive lesions that lead to invasive pancreatic adenocarcinoma. Molecular pathology of these lesions is the key of our understanding of the mechanisms underlying the development of this cancer and will probably help us in earlier diagnosis and better therapeutic results. This review focuses on medical research on pancreatic cancer models and the underlying genetic alterations.

关键词： Carcinogenesis Telomerase p21 p16 Oncogenes Epidermal growth factor

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