71 research outputs found
PCV101 Cost-effectiveness modelling of telemonitoring after discharge from hospital with heart failure
Frequency energy characteristics of a CuBr laser under breakdown conditions
The active medium of pulsed periodic copper vapor lasers (CVL) is characterized by a high pre pulse electron concentration ne0 1013 cm–3. Therefore, it was assumed that the development of the discharge under these conditions occurs without a breakdown stage, and a simple oscillatory circuit is used as the equivalent circuit of the laser discharge circuit, which determined the approach to choosing the optimal pumping conditions. However, as studies have shown, the development of a discharge in gas discharge tubes (GDT) with electrodes located in cold buffer zones (CBZ) is carried out with a breakdown stage
Metastable states relaxation in the active medium of metal vapor lasers
One of the main reasons for limiting the frequency-energy characteristics (FEC) of radiation from lasers based on self limited transitions of metal atoms (LSTM) is the high values of the prepulse electron concentration and metastable states population of metal atoms in the active medium. Which of these parameters determines the limitation of the frequency energy characteristics of laser radiation has been the subject of a long discussion, although it is well known that metastable states are very effectively quenched in collisions with electrons
Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modelling of alternative service designs.
Objectives To estimate the cost-effectiveness of remote monitoring strategies versus usual care for adults recently discharged after a heart failure (HF) exacerbation.
Design Decision analysis modelling of cost-effectiveness using secondary data sources.
Setting Acute hospitals in the UK.
Patients Patients recently discharged (within 28 days) after a HF exacerbation.
Interventions Structured telephone support (STS) via human to machine (STS HM) interface, (2) STS via human to human (STS HH) contact and (3) home telemonitoring (TM), compared with (4) usual care.
Main outcome measures The incremental cost per quality-adjusted life year (QALY) gained by each strategy compared to the next most effective alternative and the probability of each strategy being cost-effective at varying willingness to pay per QALY gained.
Results TM was the most cost-effective strategy in the scenario using these base case costs. Compared with usual care, TM had an estimated incremental cost effectiveness ratio (ICER) of £11 873/QALY, whereas STS HH had an ICER of £228 035/QALY against TM. STS HM was dominated by usual care. Threshold analysis suggested that the monthly cost of TM has to be higher than £390 to have an ICER greater than £20 000/QALY against STS HH. Scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs of TM do not substantially change the conclusions.
Conclusions Cost-effectiveness analyses suggest that TM was an optimal strategy in most scenarios, but there is considerable uncertainty in relation to clear descriptions of the interventions and robust estimation of costs
Discharge formation in a copper vapor laser: optimal pumping conditions
The electrophysical process in the discharge circuit of a copper vapor laser (CVL) is investigated. It is shown that the pumping of the active medium of a CVL in gas-discharge tubes (GDT) with electrodes located in cold buffer zones is carried out in two stages. At the first (preparatory) stage, the capacitive components of the laser discharge circuit are charged from the storage capacitor, and at the second stage, the active medium is directly pumped. The transition from the preparatory stage to the pumping stage is carried out as a result of a breakdown. It is shown that breakdown is a transient process of discharge development from a glowing to a non-thermal arc discharge and is characterized by a sharp change in the cathode potential drop across the GDT. The inductance of the discharge circuit is a factor that determines the efficiency of pumping the active medium since the release of the energy stored in the inductance at the preparatory stage provides heating of the cathode spot and determines the conditions for the occurrence of thermal emission of electrons from the GDT cathode
Optimal pumping parameters of a copper vapor laser under breakdown conditions
The active medium of pulsed-periodic copper vapor lasers (CVL) is characterized by a high prepulse electron concentration ne0 1013 cm–3. Therefore, it was assumed that the development of the discharge under these conditions is carried out without the breakdown stage. However, as studies have shown, the development of a discharge in gas discharge tubes (GDT) with electrodes located in cold buffer zones (CBZ) is carried out with a breakdown stage
Developing Markov models from real-world data: A case study of heart failure modeling using administrative data
Objectives
Markov models characterize disease progression as specific health states based on clinical or biological measures. However, these measures are not always collected outside clinical trials. In this article, an alternative approach is presented that uses real-world data to define the health states and to model transitions between them, specific to a local setting, to estimate the cost-effectiveness of telemonitoring (TM) versus no TM for heart failure.
Methods
The incidence of hospitalization for usual care was estimated from hospital episode statistics (HES) data in the United Kingdom and converted into a monthly transition matrix with 5 health states (4 states are defined based on the number of hospitalizations in the previous year and death) to estimate the cost-effectiveness of TM in a local UK primary care trust (PCT) using probabilistic sensitivity analysis from a healthcare perspective.
Results
Geographical variation in hospitalization rates were present, which led to different health state transition matrices in different localities. In the PCT that was evaluated, TM accrued mean additional costs of £3610 and 0.075 additional quality-adjusted life-years (QALYs) compared with usual care per patient, resulting in a mean incremental cost effectiveness ratio of £48 172/QALY.
Conclusions
The use of administrative data to define health states and transition matrices based on health service events is feasible, and TM was not cost-effective in our analysis. Given the increasing emphasis on using real-world evidence, it is likely that these approaches will be used more in the future
Activation of sub-3 nm organic particles in the particle size magnifier using humid and dry conditions
The accurate measurement of aerosol particles and clusters smaller than 3 nm in diameter is crucial for the understanding of new particle formation processes. The particle counters used for measuring these particles are typically calibrated with metal or salt particles under dry conditions, which does not always represent the field conditions where these instruments are later used. In this study, we calibrated the All nano Condensation Nucleus Counter (nCNC), consisting of the PSM (Particle Size Magnifier) and a laminar flow butanol based CPC (Condensational Particle Counter), with well-defined biogenic oxidation products from beta-caryophyllene oxidation and compared it to a calibration with tungsten oxide under the same conditions. The organic particles were detected less efficiently than the inorganic ones. This resulted in a higher cut-off size for beta-caryophyllene oxidation products than for tungsten oxide. At the same PSM settings, the cut-off size for tungsten oxide was 1.2 nm and for beta-caryophyllene oxidation products 1.9 nm. However, repeating the calibration of the biogenic particles at 13% relative humidity at 31 degrees C, increased their detection efficiency in the PSM, increasing the cut-off diameter to 1.6 nm. Additionally, we present a comparison of the ion concentrations measured with the PSM and the NAIS (Neutral Cluster and Air Ion Spectrometer) during new particle formation experiments in the CLOUD (Cosmics Leaving Outdoors Droplets) chamber. In these experiments, we produced particles from different organic precursors, such as alpha-pinene, beta-caryophyllene and isoprene, as well as iodine. This way, we could determine the shift in cut-off diameter of the PSM for several different atmospherically relevant chemical compounds and compare it to the laboratory calibrations. We saw a diameter shift for the organic precursors of +0.3 nm in the PSM compared to the NAIS. These two approaches agreed well with each other and show that it is important to know the chemical composition of the measured particles to determine the exact size distribution using a supersaturation scanning method.Peer reviewe
Home telemonitoring or structured telephone support programmes after recent discharge in patients with heart failure: systematic review and economic evaluation
BACKGROUND: Remote monitoring (RM) strategies have the potential to deliver specialised care and management to patients with heart failure (HF). OBJECTIVE: To determine the clinical effectiveness and cost-effectiveness of home telemonitoring (TM) or structured telephone support (STS) strategies compared with usual care for adult patients who have been recently discharged (within 28 days) from acute care after a recent exacerbation of HF. DATA SOURCES: Fourteen electronic databases (including MEDLINE, EMBASE, PsycINFO and The Cochrane Library) and research registers were searched to January 2012, supplemented by hand-searching relevant articles and contact with experts. The review included randomised controlled trials (RCTs) or observational cohort studies with a contemporaneous control group that included the following RM interventions: (1) TM (including cardiovascular implanted monitoring devices) with medical support provided during office hours or 24/7; (2) STS programmes delivered by human-to-human contact (HH) or human-to-machine interface (HM). REVIEW METHODS: A systematic review and network meta-analysis (where appropriate) of the clinical evidence was carried out using standard methods. A Markov model was developed to evaluate the cost-effectiveness of different RM packages compared with usual care for recently discharged HF patients. TM 24/7 or using cardiovascular monitoring devices was not considered in the economic model because of the lack of data and/or unsuitability for the UK setting. Given the heterogeneity in the components of usual care and RM interventions, the cost-effectiveness analysis was performed using a set of costing scenarios designed to reflect the different configurations of usual care and RM in the UK. RESULTS: The literature searches identified 3060 citations. Six RCTs met the inclusion criteria and were added to the 15 trials identified from the previous systematic reviews giving a total of 21 RCTs included in the systematic review. No trials of cardiovascular implanted monitoring devices or observational studies met the inclusion criteria. The methodological quality of the studies varied widely and reporting was generally poor. Compared with usual care, RM was beneficial in reducing all-cause mortality for STS HH [hazard ratio (HR) 0.77, 95% credible interval (CrI) 0.55 to 1.08], TM during office hours (HR 0.76, 95% CrI 0.49 to 1.18) and TM 24/7 (HR 0.49, 95% CrI 0.20 to 1.18); however, these results were statistically inconclusive. The results for TM 24/7 should be treated with caution because of the poor methodological quality of the only included study in this network. No favourable effect on mortality was observed with STS HM. Similar reductions were observed in all-cause hospitalisations for TM interventions, whereas STS interventions had no major effect. A sensitivity analysis, in which a study was excluded because it provided better-than-usual support to the control group, showed larger beneficial effects for most outcomes, particularly for TM during office hours. In the cost-effectiveness analyses, TM during office hours was the most cost-effective strategy with an estimated incremental cost-effectiveness ratio (ICER) of £11,873 per quality-adjusted life-year (QALY) compared with usual care, whereas STS HH had an ICER of £228,035 per QALY compared with TM during office hours. STS HM was dominated by usual care. Similar results were observed in scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs of TM during office hours. LIMITATIONS: The RM interventions included in the review were heterogeneous in terms of monitored parameters and HF selection criteria and lacked detail in the components of the RM care packages and usual care (e.g. communication protocols, routine staff visits and resources used). As a result, the economic model developed scenarios for different RM classifications and their costs were estimated using bottom-up costing methods. Although the users can decide which of these scenarios is most representative of their setting, uncertainties still remain about the assumptions made in the estimation of these costs. In addition, the model assumed that the effectiveness of the interventions was constant over time, irrespective of the duration of deployment, and that the intervention was equally effective in different age/severity groups. CONCLUSION: Despite wide variation in usual care and RM strategies, cost-effectiveness analyses suggest that TM during office hours was an optimal strategy (in most costing scenarios). However, clarity was lacking among descriptions of the components of RM packages and usual care and there was a lack of robust estimation of costs. Further research is needed in these areas. STUDY REGISTRATION: PROSPERO registration no. CRD42011001368. FUNDING: The National Institute for Health Research Health Technology Assessment programme
Polymorphism at High Molecular Weight Glutenin Subunits and Morphological Diversity of Aegilops geniculata Roth Collected in Algeria
A collection of 35 accessions of the tetraploid wild wheat Aegilops geniculata Roth (MM, UU) sampled in northern Algeria was evaluated for morphological and biochemical variability. Morphological and ecological analyses based on morphological traits and bioclimatic parameters, respectively, were assessed using principal component analysis (PCA). Accessions were differentiated by width characters, namely spike’s width, and a weak relationship between morphological traits and ecological parameters was found. Polymorphism of high molecular weight (HMW) glutenin subunits was carried on by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE). Among accessions analyzed, 27 alleles were identified at the two loci Glu-M1 and Glu-U1: resulting in twenty-nine patterns and a nomenclature was proposed. Two alleles at the Glu-U1 locus expressed a new subunit with a slightly slower mobility than subunit 8. These results provide new information regarding the genetic variability of HMW glutenin subunits, as well as their usefulness in cultivated wheat quality improvement
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