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The structure and physicochemical characteristics of weathered surfaces of marble in industrial environments can be attributed to the interconnected evolution of the processes taking place at the atmospheric environment--marble interface. The present work is an attempt to correlate the aerosols of a heavily polluted atmosphere with the different weathering patterns observed on marble surfaces. Energy Dispersive X-Ray Fluorescence, X-Ray Diffraction, Porosimetry, Atomic Absorption, Atomic Emission Spectrometry, Ion Chromatography, Optical Microscopy and Scanning Electron Microscopy results were used together in principal component and discriminant analysis. These analyses were performed on forty six samples of aerosols and eighteen samples of crusts. Other parameters like orientation of the weathered surface, exposure to rainfall, presence of recrystalised calcite and gypsum were also used. The samples were collected from the archaeological site of the Sanctuary of Demeter, located near Eleusis (west of Athens, Greece), where a great number of industries (mainly metallurgical and chemical) cause several environmental problems. The results provide invaluable information on the nature of marble surface decay. The elements determining the chemical composition of the coarse airborne particles are Ca, Si, S, Br and Cl. The presence of gypsum is strongly related to black crusts or loose deposits. Y, Mn and rain exposure, are correlated with each other and related to black-gray crusts. Ca and Sr are correlated with washed-out surfaces. Finally discriminant analysis is proved to be a powerful tool in prediction of the type of decay that will be occur on a marble surface, given the composition and type of the polluted atmosphere.

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The Disability Assessment for Dementia (DAD) scale was developed and validated as a measure of functional ability in dementia. DAD results have been reported in Alzheimer disease (AD) randomized, controlled treatment trials of up to 6 months, but results beyond 6 months have yet to be described. SAB INT 12 was a randomized, double-blind, placebo-controlled, parallel-group study in mild to moderate AD that included DAD assessments at baseline, month 6, and month 12. One hundred forty-four patients with AD in the placebo arm of SAB INT 12 were followed up for 12 months. DAD scores were obtained at baseline (mean DAD = 70.1, SD = 22.2), 6 months (mean DAD = 63.7, SD = 25.2), and 12 months (mean DAD = 59.3, SD = 28.9). The rate of decline was consistent across the domains of basic activities of daily living (ADLs) and instrumental ADLs, as well as the scoring of initiation, planning, and organization. The decline in DAD total scores in mild to moderate AD averages about one point per month, which equates to the loss of one item on the DAD scale every 2 months.

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This paper considers standard effective treatments for non-Hodgkin's lymphoma and early breast cancer in premenopausal women. The literature assesses the treatments' effectiveness, and expected charges for different treatments in the context of the Belgian Health Insurance System are compared. Ovariectomy in breast cancer (770 ECU) and conventional chemotherapy in non-Hodgkin (2,745 lymphoma ECU) prove equally effective and are less costly in comparison with chemotherapy (1,904 ECU) in breast cancer or chemotherapy and autologous bone marrow transplantation (19,262 ECU) in non-Hodgkin's lymphoma. Further unbiased insights in competitive treatments' costs and outcome could save money and enhance developments in cancer care.

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In recent years, quality of life (QoL) and economic evaluations have become increasingly important as additional outcome measures in cancer clinical trials. However, both fields of research are relatively new and in need of finding solutions to a substantial number of specific methodological problems. This paper reports on the proceedings of a symposium aimed at summarising and discussing some of the most contentious methodological and statistical issues in QoL and economic evaluations. In addition, possible solutions are indicated and the most pertinent areas of research are identified. Issues specific to QoL evaluations that are addressed include clinically meaningful changes in QoL scores; how to analyse QoL data and to handle missing and censored data and integration of length of life and QoL outcomes. Issues specific to economic evaluations are the advantages and disadvantages of various outcome measures; statistical methods to analyse economic data and choice of decision criteria and analytical perspective. How to perform QoL and economic evaluations in large and simple trials and whether the gap between QoL and utility measures can be bridged are also discussed.

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The guiding principles of the predominant methods of economic evaluation, cost-effectiveness analysis and cost-utility analysis, are briefly outlined, stressing the usefulness of the methods as a systematic approach to a structured and consistent analysis of decision problems, e.g. involving choices between treatment alternatives. The paper continues with an assessment of state of the art of economic evaluations of urinary tract cancers, based on a comprehensive survey of the available publications, which are limited to bladder cancer and advanced prostate cancer. Following a description of the methods employed in the relatively few existing studies and their results, it is concluded that they are of very dubious value in providing reliable guidance on the relative costs and benefits of treatment alternatives, as they are very rudimentary and usually based on data of low quality. Considering the high and growing incidence of both prostate and bladder cancer, there is an urgent need for economic assessment of a high methodological standard and based on data of a good quality.

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Although health care expenditure has increased steadily over the past decennium, the general feeling is that resources are more limited than ever. One reason for this may be that the range of treatment options has grown so wide that the need to make rational choices has become apparent. Since treatments vary with respect to both effectiveness and cost, economic evaluations are becoming an important tool for assessing new and existing treatment strategies. The basic concepts of economic evaluation will be introduced here and the key economic questions with respect to treatment of fungal infections in cancer patients identified. Some of these concepts are explained using findings from a pilot survey carried out among participants in the symposium "Trends in Invasive Fungal Infections-3" 7-9 held September, 1995, in Brussels, Belgium. The conclusion will offer recommendations for assessing economic evaluations.

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A total of 134 episodes of staphylococcal bacteremia (SBE) appearing among 9987 admissions, and 979 episodes of bacteremia in cancer patients within 5 years, were analyzed for risk factors, clinical course and outcome; 64 were monomicrobial and 70 polymicrobial. The most frequent risk factors were acute leukemia, catheter insertion, long-lasting neutropenia, and prior prophylaxis with quinolones. There was no significant difference between polymicrobial and monomicrobial SBE in risk factors. The two groups differed only in the source of bacteremia (gastrointestinal and respiratory-tract infections were more common in monomicrobial SBE) and etiology-Staphylococcus aureus appeared more frequently in monomicrobial than in polymicrobial bacteremia (20.3% compared to 4.3%, P < 0.05). More complications (14.3%) such as abscesses, endocarditis, etc. appeared in the group of polymicrobial SBE (P < 0.05). No difference was observed in clinical course and outcome between monomicrobial and polymicrobial SBE. The incidence of SBE has increased since 1991, when quinolones were first used in prophylaxis in afebrile neutropenia at our center; however, the infection-associated mortality in monomicrobial SBE was low (4.3%).

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An estimation of resource utilisation in the treatment of advanced colorectal cancer has been carried out by the European Organization for Research and Treatment of Cancer. Data on resource utilisation were collected retrospectively from 10 European centres, examining 20 consecutive patient files in each centre. Data from eight centres are reported in this paper. 160 patients were included in the sample, followed up for a median of 530 days. All patients were hospitalised and almost all underwent surgery. Fifty-four per cent received chemotherapy, and most visited the hospital as an outpatient. Including hospital stay and outpatient visits, patients spent almost 10% of their time in hospital or associated travelling. The most common diagnostic tests were chest X-ray, electrocardiogram and abdomen ultrasound. There was considerable variation between hospitals in resource utilisation, both within and between countries. Surgical procedures, chemotherapy, hospitalisation, diagnostic tests and outpatient visits are major cost determinants in the treatment of colorectal cancer. The variation in resource utilisation suggests that efficiency could be improved.

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With the growing international literature in economic evaluation and the rapid spread of new health technologies, there is a need to undertake, or at least interpret, economic evaluations on the international level. However, the ways in which cross-national differences affect the cost-effectiveness of health technologies or their evaluations have never been studied. This paper explores these issues by taking advantage of a unique situation in which the same economic evaluation of a new indication for a health technology was conducted simultaneously in four countries using an identical methodology. The study showed that if prior agreement on methods can be reached and local data applied, economic evaluations can be undertaken in a way that facilitates the extrapolation of results from country to country.

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It is demonstrated in clinical studies that Misoprostol is effective in preventing gastric ulcers in osteoarthritic patients treated with non-steroidal anti-inflammatory drugs (NSAIDs). The primary purpose of this article is to analyze the cost-effectiveness of Misoprostol. The methodology used is decision analysis. Clinical probability data for two patient groups (the Misoprostol and placebo group) were combined with data related to the costs of medical treatment and to the preventive use of Misoprostol. The basic conclusion is that the preventive treatment with Misoprostol entails net savings for society as a whole. However, the size of net savings is rather sensitive to changes in important parameters such as the presence of asymptomatic ulcers and the price of Misoprostol.

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