Modelling the cost effectiveness of interferon beta and glatiramer acetate in the management of multiple sclerosis

OBJECTIVE: To evaluate the cost effectiveness of four disease modifying treatments (interferon betas and glatiramer acetate) for relapsing remitting and secondary progressive multiple sclerosis in the United Kingdom. DESIGN: Modelling cost effectiveness. SETTING: UK NHS. PARTICIPANTS: Patients with relapsing remitting multiple sclerosis and secondary progressive multiple sclerosis. MAIN OUTCOME MEASURES: Cost per quality adjusted life year gained. RESULTS: The base case cost per quality adjusted life year gained by using any of the four treatments ranged from £42 000 ($66 469; 61 630) to £98 000 based on efficacy information in the public domain. Uncertainty analysis suggests that the probability of any of these treatments having a cost effectiveness better than £20 000 at 20 years is below 20%. The key determinants of cost effectiveness were the time horizon, the progression of patients after stopping treatment, differential discount rates, and the price of the treatments. CONCLUSIONS: Cost effectiveness varied markedly between the interventions. Uncertainty around point estimates was substantial. This uncertainty could be reduced by conducting research on the true magnitude of the effect of these drugs, the progression of patients after stopping treatment, the costs of care, and the quality of life of the patients. Price was the key modifiable determinant of the cost effectiveness of these treatments

Enhancing the Capacity of Community Health Centers to Achieve High Performance

Based on a survey of community health centers, assesses access to care, care coordination, quality improvement efforts, health information technology adoption, and ability to serve as patient-centered medical homes. Suggests policy to strengthen clinics

Radiometric calibration and processing procedure for reflective bands on LANDSAT-4 protoflight Thematic Mapper

The radiometric subsystem of NASA's LANDSAT-4 Thematic Mapper (TM) sensor is described. Special emphasis is placed on the internal calibrator (IC) pulse shapes and timing cycle. The procedures for the absolute radiometric calibration of the TM channels with a 122-centimeter integrating sphere and the transfer of radiometric calibration from the channels to the IC are reviewed. The use of the IC to calibrate TM data in the ground processing system consists of pulse integration, pulse averaging, IC state identification, linear regression analysis, and histogram equalization. An overview of the SCROUNGE-era (before August 1983) method is presented. Procedural differences between SCROUNGE and the TIPS-era (after July 1983) and the implications of these differences are discussed

Characterization of radiometric calibration of LANDSAT-4 TM reflective bands

Prelaunch and postlaunch internal calibrator, image, and background data is to characterize the radiometric performance of the LANDSAT-4 TM and to recommend improved procedures for radiometric calibration. All but two channels (band 2, channel 4; band 5, channel 3) behave normally. Gain changes relative to a postlaunch reference for channels within a band vary within 0.5 percent as a group. Instrument gain for channels in the cold focal plane oscillates. Noise in background and image data ranges from 0.5 to 1.7 counts. Average differences in forward and reverse image data indicate a need for separate calibration processing of forward and reverse scans. Precision is improved by increasing the pulse integration width from 31 to 41 minor frames, depending on the band

Commutator Leavitt path algebras

For any field K and directed graph E, we completely describe the elements of the Leavitt path algebra L_K(E) which lie in the commutator subspace [L_K(E),L_K(E)]. We then use this result to classify all Leavitt path algebras L_K(E) that satisfy L_K(E)=[L_K(E),L_K(E)]. We also show that these Leavitt path algebras have the additional (unusual) property that all their Lie ideals are (ring-theoretic) ideals, and construct examples of such rings with various ideal structures.Comment: 24 page

Polymers near Metal Surfaces: Selective Adsorption and Global Conformations

We study the properties of a polycarbonate melt near a nickel surface as a model system for the interaction of polymers with metal surfaces by employing a multiscale modeling approach. For bulk properties a suitably coarse grained bead spring model is simulated by molecular dynamics (MD) methods with model parameters directly derived from quantum chemical calculations. The surface interactions are parameterized and incorporated by extensive quantum mechanical density functional calculations using the Car-Parrinello method. We find strong chemisorption of chain ends, resulting in significant modifications of the melt composition when compared to an inert wall.Comment: 8 pages, 3 figures (2 color), 1 tabl

Health System Performance for the High-Need Patient: A Look at Access to Care and Patient Care Experiences

Achieving a high-performing health system will require improving outcomes and reducing costs for high-need, high-cost patients—those who use the most health care services and account for a disproportionately large share of health care spending. Goal: To compare the health care experiences of adults with high needs—those with three or more chronic diseases and a functional limitation in the ability to care for themselves or perform routine daily tasks—to all adults and to those with multiple chronic diseases but no functional limitations. Methods: Analysis of data from the 2009–2011 Medical Expenditure Panel Survey. Key findings: High-need adults were more likely to report having an unmet medical need and less likely to report having good patient–provider communication. High-need adults reported roughly similar ease of obtaining specialist referrals as other adults and greater likelihood of having a medical home. While adults with private health insurance reported the fewest unmet needs overall, privately insured highneed adults reported the greatest difficulties having their needs met. Conclusion: The health care system needs to work better for the highest-need, most-complex patients. This study's findings highlight the importance of tailoring interventions to address their need

The B→Xsl+l−B\to X_sl^+l^- and B→XsγB\to X_s \gamma decays with the fourth generation

If the fourth generation fermions exist, the new quarks could influence the branching ratios of the decays of $B\to X_s \gamma$ and $B\to X_sl^+l^-$. We obtain two solutions of the fourth generation CKM factor $V^{*}_{t^{'}s}V_{t^{'}b}$ from the decay of $B\to X_s \gamma$. We use these two solutions to calculate the new contributions of the fourth generation quark to Wilson coefficients of the decay of $B\to X_sl^+l^-$. The branching ratio and the forward-backward asymmetry of the decay of $B\to X_sl^+l^-$ in the two cases are calculated. Our results are quite different from that of SM in one case, almost same in another case. If Nature chooses the formmer, the $B$ meson decays could provide a possible test of the forth generation existence.Comment: 10 pages, 5 figure

The Electronic Controls Used in a Search For Fractional Charges in Mercury Drops

At San Francisco State University, we have developed an Automatic Millikan Device (AMI)) for measuring the charge on small drops of Mercury. The device uses a standard atomic physics laboratory Millikan chamber, a piezoelectric driven ink-jet glass dropper, and a laser-photomultiplier system for tracking the motion of the drop. This paper describes the electronic control and error detection system used with the AMO. Signals from this system are sent to a microprocessor which controls the experiment. To this date (Dec 7, 1981), we have measured 175 micrograms of Hg and found no fractional charges in 1.05 x 1020 nucleons

Collapse Dynamics of a Homopolymer: Theory and Simulation

We present a scaling theory describing the collapse of a homopolymer chain in poor solvent. At time t after the beginning of the collapse, the original Gaussian chain of length N is streamlined to form N/g segments of length R(t), each containing g ~ t monomers. These segments are statistical quantities representing cylinders of length R ~ t^{1/2} and diameter d ~ t^{1/4}, but structured out of stretched arrays of spherical globules. This prescription incorporates the capillary instability. We compare the time-dependent structure factor derived for our theory with that obtained from ultra-large-scale molecular dynamics simulation with explicit solvent. This is the first time such a detailed comparison of theoretical and simulation predictions of collapsing chain structure has been attempted. The favorable agreement between the theoretical and computed structure factors supports the picture of the coarse-graining process during polymer collapse.Comment: 4 pages, 3 figure