Cost-effectiveness of a physical exercise programme for residents of care homes: a pilot study

BACKGROUND: Oomph! Wellness organises interactive exercise and activity classes (Oomph! classes) for older people in care homes. We investigated the cost-effectiveness of Oomph! classes. METHODS: Health-related quality of life was measured using the EQ-5D-5 L questionnaire at three time points; 3 months and 1 week prior to the start of the classes and after 3 months of Oomph! classes. Costs included the costs of organising the classes, training instructors and health service use (General Practitioner (GP) and hospital outpatient visits). To determine the cost-effectiveness of Oomph! classes, total costs and quality-adjusted life-years (QALYs) during the 3 months after initiation of the classes were compared to the total costs and QALYs of the 3 months prior to the classes and extrapolated to a 1-year time horizon. Uncertainty was taken into account using one-way and probabilistic sensitivity analysis. RESULTS: Sixteen residents completed all three EQ-5D-5 L questionnaires. There was a decrease in mean health related quality of life per participant in the 3 months before Oomph! classes (0.56 to 0.52, p = 0.26) and an increase in the 3 months after the start of Oomph! classes (0.52 to 0.60, p = 0.06), but the changes were not statistically significant. There were more GP visits after the start of Oomph! classes and fewer hospital outpatient visits, leading to a slight decrease in NHS costs (mean £132 vs £141 per participant), but the differences were not statistically significant (p = 0.79). In the base case scenario, total costs for Oomph! classes were £113 higher per participant than without Oomph! classes (£677 vs £564) and total QALYs were 0.074 higher (0.594 vs 0.520). The incremental costs per QALY gained were therefore £1531. The 95 % confidence intervals around the cost/QALY gained varied from dominant to dominated, meaning there was large uncertainty around the cost-effectiveness results. Given a willingness to pay threshold of £20,000 per QALY gained, Oomph! classes had a 62 %-86 % probability of being cost-effective depending on the scenario used. CONCLUSIONS: Preliminary evidence suggests that Oomph! classes may be cost-effective, but further evidence is needed about its impact on health-related quality of life and health service use

Lessons from snake venom: new insights into the structural and functional aspects of factor V and factor X

The venom of the Australian snake Pseudonaja textilis contains coagulation factors V (five) and X (ten) which have been adapted to derail the blood clotting system of its prey. Snake venom factor V is unique in that is constitutively active, unlike its human counterpart. The snake liver transcriptome was found to contain alternatively spliced factor V mRNA that encoded for either the activated protein or its quiescent form. A potential pre-mRNA splicing mechanism was uncovered that may yield the active protein. Snake venom factor V is also particularly stable due to several modifications to its molecular structure. These modifications have been investigated in detail by engineering chimeras of human and snake venom factor V. The snake venom factor X molecule was also investigated in more detail. It was discovered that this enzyme is insensitive to the action of certain anticoagulant drugs (Factor Xa inhibitors) due to a unique molecular modification. A Human factor X can be modified in similar fashion, so that it is no longer sensitive to the action of Factor Xa inhibitors. This finding could make an important contribution to acute care for patients who experience life-threatening bleeding after the use of FXa inhibitors.The research described in this thesis was funded by the European Union FP7 People Program, the National Blood Foundation, the Trombosestichting Nederland and the Bayer Hemophilia Awards Program. The research was performed at the Einthoven Laboratory for Vascular and Regenerative Medicine of the Leiden University Medical Center, Leiden, The Netherlands. Financial support by VarmX. B.V. for the publication of this thesis is gratefully acknowledged

Experimental study of abattoir wastewater treatment from an economic perspective

The most cost effective treatment scheme for effluent from Midfield Meats, an abattoir in Warrnambool, Australia, was evaluated via a series of laboratory and commercial scale experiments. Effectiveness was measured in terms of suspended solids (SS) and biological oxygen demand (BOD) reduction. Economic assessment was based on predicted reduction in trade waste charges versus infrastructure and running costs. From the range of potential treatment technologies, those deemed most appropriate for trialling included pre-screening, sedimentation, coagulation and flocculation treatment and dissolved air floatation (DAF). Prior to evaluation of treatment types, flow, loads and contaminant characterisation of the waste streams was conducted to aid in selection of treatment type and capacity. Prescreening was found to be the most cost effective, followed by sedimentation, coagulation and flocculation treatment and finally DAF. The most economical treatment scheme that satisfied the requirements of Midfield Meats included a combination of prescreening and sedimentation. DAF and coagulation and flocculation treatment satisfactorily treated the wastewater, however were not cost effective under the current trade waste agreement

Synergistic and cannibalization effects in a partnership loyalty program

The implicit promise of a partnership in a loyalty program (LP) is that the partners will gain new customers and the LP will reinforce the loyalty to focal partners. Although customers may be encouraged to cross-purchase from partners (which may create positive synergies), they can also switch among partners without forfeiting rewards (which may lead to the cannibalization of sales among partners). To explore these cross-partner effects, we analyze the evolution of customer purchases in a partnership LP across 33 partners from 16 industry sectors. We find that cannibalizations arise more frequently than synergies among partners, contributing to a “rich-get-richer” effect for high-penetration partners; e.g., 10% increase in transactions at department stores reduce transactions at apparel partners (by.04% for new transactions and by 1.18% for recurring customers); but in turn, they attract positive synergies from apparel (.11% increase in transactions by new customers and.37% for recurring transactions)

Second best toll and capacity optimisation in network: solution algorithm and policy implications

This paper looks at the first and second-best jointly optimal toll and road capacity investment problems from both policy and technical oriented perspectives. On the technical side, the paper investigates the applicability of the constraint cutting algorithm for solving the second-best problem under elastic demand which is formulated as a bilevel programming problem. The approach is shown to perform well despite several problems encountered by our previous work in Shepherd and Sumalee (2004). The paper then applies the algorithm to a small sized network to investigate the policy implications of the first and second-best cases. This policy analysis demonstrates that the joint first best structure is to invest in the most direct routes while reducing capacities elsewhere. Whilst unrealistic this acts as a useful benchmark. The results also show that certain second best policies can achieve a high proportion of the first best benefits while in general generating a revenue surplus. We also show that unless costs of capacity are known to be low then second best tolls will be affected and so should be analysed in conjunction with investments in the network

Application of Sentinel-2A data for pasture biomass monitoring using a physically based radiative transfer model

A large proportion of the global land surface is covered by pasture. The advent of the Sentinel satellites program provides free datasets with good spatiotemporal resolution that can be a valuable source of information for monitoring pasture resources. We combined optical remote sensing data (proximal hyperspectral and Sentinel 2A) with a radiative transfer model (PROSAIL) to estimate leaf area index (LAI), and biomass, in a dairy farming context. Three sites in Southern England were used: two pasture farms that differed in pasture type and management, and a set of small agronomy trial plots with different mixtures of grasses, legumes and herbs, as well as pure perennial ryegrass. The proximal and satellite spectral data were used to retrieve LAI via PROSAIL model inversion, which were compared against field observations of LAI. The potential of bands of Sentinel 2A that corresponded with a 10 m resolution was studied by convolving narrow spectral bands (from a handheld hyperspectral sensor) into Sentinel 2A bands (10 m). Retrieved LAI, using these spectrally resampled S2A data, compared well with measured LAI, for all sites, even for those with mixed species cover (although retrieved LAI was somewhat overestimated for pasture mixtures with high LAI). This proved the suitability of 10 m Sentinel 2A spectral bands for capturing LAI dynamics for different types of pastures. We also found that inclusion of 20 m bands in the inversion scheme did not lead to any further improvement in retrieved LAI. Sentinel 2A image based retrieval yielded good agreement with LAI measurements obtained for a typical perennial ryegrass based pasture farm. LAI retrieved in this way was used to create biomass maps (that correspond to indirect biomass measurements by Rising Plate Meter (RPM)), for mixed-species paddocks for a farm for which limited field data were available. These maps compared moderately well with farmer-collected RPM measurements for this farm. We propose that estimates of paddock-averaged and within-paddock variability of biomass are more reliably obtained from a combined Sentinel 2A-PROSAIL approach, rather than by manual RPM measurements. The physically based radiative transfer model inversion approach outperformed the Normalised Difference Vegetation Index based retrieval method, and does not require site specific calibrations of the inversion scheme

How large is the gap between present and efficient transport prices in Europe?

In this paper we analyse the gap between present transport prices and efficient transport prices. Efficient transport prices are those prices that maximise economic welfare, including external costs (congestion, air pollution, accidents). The methodology is applied to six urban and interregional case studies using one common optimal pricing model. The case studies cover passenger as well as freight transport and cover all modes. We find that prices need to be raised most for peak urban passenger car transport and to a lesser extent for interregional road transport. Optimal pricing results for public transport are more mixed. We show that current external costs on congested roads are a bad guide for optimal taxes and tolls: the optimal toll that takes into account the reaction of demand is often less than one third of the present marginal external cost.transport pricing; external costs; social costs; congestion pricing