Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community

Background The purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression. Method Modelling methods were used to develop a conceptual and health economic model of the current configuration of services in Sheffield, England for people with longer-term depression. Data and assumptions were synthesised to estimate cost per Quality Adjusted Life Years (QALYs). Results Three service changes were developed and resulted in increased QALYs at increased cost. Versus current care, the incremental cost-effectiveness ratio (ICER) for a self-referral service was £11,378 per QALY. The ICER was £2,227 per QALY for the dropout reduction service and £223 per QALY for an increase in non-therapy services. These results were robust when compared to current cost-effectiveness thresholds and accounting for uncertainty. Conclusions Cost-effective service improvements for longer-term depression have been identified. Also identified were limitations of the current evidence for the long term impact of services

Design, Construction and Installation of the ATLAS Hadronic Barrel Scintillator-Tile Calorimeter

The scintillator tile hadronic calorimeter is a sampling calorimeter using steel as the absorber structure and scintillator as the active medium. The scintillator is located in "pockets" in the steel structure and the wavelength-shifting fibers are contained in channels running radially within the absorber to photomultiplier tubes which are located in the outer support girders of the calorimeter structure. In addition, to its role as a detector for high energy particles, the tile calorimeter provides the direct support of the liquid argon electromagnetic calorimeter in the barrel region, and the liquid argon electromagnetic and hadronic calorimeters in the endcap region. Through these, it indirectly supports the inner tracking system and beam pipe. The steel absorber, and in particular the support girders, provide the flux return for the solenoidal field from the central solenoid. Finally, the end surfaces of the barrel calorimeter are used to mount services, power supplies and readout crates for the inner tracking systems and the liquid argon barrel electromagnetic calorimeter

The Optical Instrumentation of the ATLAS Tile Calorimeter

The purpose of this Note is to describe the optical assembly procedure called here Optical Instrumentation and the quality tests conducted on the assembled units. Altogether, 65 Barrel (or LB) modules were constructed - including one spare - together with 129 Extended Barrel (EB) modules (including one spare). The LB modules were mechanically assembled at JINR (Dubna, Russia) and transported to CERN, where the optical instrumentation was performed with personnel contributed by several Institutes. The modules composing one of the two Extended Barrels (known as EBA) were mechanically assembled in the USA, and instrumented in two US locations (ANL, U. of Michigan), while the modules of the other Extended barrel (EBC) were assembled in Spain and instrumented at IFAE (Barcelona). Each of the EB modules includes a subassembly known as ITC that contributes to the hermeticity of the calorimeter; all ITCs were assembled at UTA (Texas), and mounted onto the module mechanical structures at the EB mechanical assembly locations.The Tile Calorimeter, covering the central region of the ATLAS experiment up to pseudorapidities of ±1.7, is a sampling device built with scintillating tiles that alternate with iron plates. The light is collected in wave-length shifting (WLS) fibers and is read out with photomultipliers. In the characteristic geometry of this calorimeter the tiles lie in planes perpendicular to the beams, resulting in a very simple and modular mechanical and optical layout. This paper focuses on the procedures applied in the optical instrumentation of the calorimeter, which involved the assembly of about 460,000 scintillator tiles and 550,000 WLS fibers. The outcome is a hadronic calorimeter that meets the ATLAS performance requirements, as shown in this paper

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

The Production and Qualification of Scintillator Tiles for the ATLAS Hadronic Calorimeter

The production of the scintillator tiles for the ATLAS Tile Calorimeter is presented. In addition to the manufacture and production, the properties of the tiles will be presented including light yield, uniformity and stability

Chemotherapy effectiveness in trial-underrepresented groups with early breast cancer:A retrospective cohort study

BACKGROUND: Adjuvant chemotherapy in early stage breast cancer has been shown to reduce mortality in a large meta-analysis of over 100 randomised trials. However, these trials largely excluded patients aged 70 years and over or with higher levels of comorbidity. There is therefore uncertainty about whether the effectiveness of adjuvant chemotherapy generalises to these groups, hindering patient and clinician decision-making. This study utilises administrative healthcare data-real world data (RWD)-and econometric methods for causal analysis to estimate treatment effectiveness in these trial-underrepresented groups. METHODS AND FINDINGS: Women with early breast cancer aged 70 years and over and those under 70 years with a high level of comorbidity were identified and their records extracted from Scottish Cancer Registry (2001-2015) data linked to other routine health records. A high level of comorbidity was defined as scoring 1 or more on the Charlson comorbidity index, being in the top decile of inpatient stays, and/or having 5 or more visits to specific outpatient clinics, all within the 5 years preceding breast cancer diagnosis. Propensity score matching (PSM) and instrumental variable (IV) analysis, previously identified as feasible and valid in this setting, were used in conjunction with Cox regression to estimate hazard ratios for death from breast cancer and death from all causes. The analysis adjusts for age, clinical prognostic factors, and socioeconomic deprivation; the IV method may also adjust for unmeasured confounding factors. Cohorts of 9,653 and 7,965 were identified for women aged 70 years and over and those with high comorbidity, respectively. In the ≥70/high comorbidity cohorts, median follow-up was 5.17/6.53 years and there were 1,935/740 deaths from breast cancer. For women aged 70 years and over, the PSM-estimated HR was 0.73 (95% CI 0.64-0.95), while for women with high comorbidity it was 0.67 (95% CI 0.51-0.86). This translates to a mean predicted benefit in terms of overall survival at 10 years of approximately3% (percentage points) and 4%, respectively. A limitation of this analysis is that use of observational data means uncertainty remains both from sampling uncertainty and from potential bias from residual confounding. CONCLUSIONS: The results of this study, as RWD, should be interpreted with caution and in the context of existing and emerging randomised data. The relative effectiveness of adjuvant chemotherapy in reducing mortality in patients with early stage breast cancer appears to be generalisable to the selected trial-underrepresented groups.</p

Water table depth modulates productivity and biomass across Amazonian forests

Funding: This work was part of the PhD thesis of the first author, developed at the Graduate Program in Ecology of the National Institute of Amazonian Research (INPA), with a fellowship funded by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES), Finance Code 001, (88887.141433/2017-00). The authors are also grateful for the financial and research support of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Amazonas State Research Foundation (FAPEAM), the Newton Fund via the Natural Environment Research Council (NE/M022021/1 to O.L.P. and F.R.C.C.), PPBio Manaus, Centro de Estudos Integrados da Biodiversidade Amazônica and RAINFOR. We also thank Karina Melgaço, Aurora Levesley and Gabriela Lopez-Gonzalez for curating and managing ForestPlots.net. This was ForestPlots.net Project 26 led by Thaiane Sousa. This is publication number 832 of the Technical Series of the Biological Dynamics of Forest Fragments Project (BDFFP, INPA/STRI).Aim : Water availability is the major driver of tropical forest structure and dynamics. Most research has focused on the impacts of climatic water availability, whereas remarkably little is known about the influence of water table depth and excess soil water on forest processes. Nevertheless, given that plants take up water from the soil, the impacts of climatic water supply on plants are likely to be modulated by soil water conditions. Location : Lowland Amazonian forests. Time period : 1971–2019. Methods : We used 344 long-term inventory plots distributed across Amazonia to analyse the effects of long-term climatic and edaphic water supply on forest functioning. We modelled forest structure and dynamics as a function of climatic, soil-water and edaphic properties. Results : Water supplied by both precipitation and groundwater affects forest structure and dynamics, but in different ways. Forests with a shallow water table (depth <5 m) had 18% less above-ground woody productivity and 23% less biomass stock than forests with a deep water table. Forests in drier climates (maximum cumulative water deficit < −160 mm) had 21% less productivity and 24% less biomass than those in wetter climates. Productivity was affected by the interaction between climatic water deficit and water table depth. On average, in drier climates the forests with a shallow water table had lower productivity than those with a deep water table, with this difference decreasing within wet climates, where lower productivity was confined to a very shallow water table. Main conclusions : We show that the two extremes of water availability (excess and deficit) both reduce productivity in Amazon upland (terra-firme) forests. Biomass and productivity across Amazonia respond not simply to regional climate, but rather to its interaction with water table conditions, exhibiting high local differentiation. Our study disentangles the relative contribution of those factors, helping to improve understanding of the functioning of tropical ecosystems and how they are likely to respond to climate change.Peer reviewe

Mechanical construction and installation of the ATLAS tile calorimeter

This paper summarises the mechanical construction and installation of the Tile Calorimeter for the ATLAS experiment at the Large Hadron Collider in CERN, Switzerland. The Tile Calorimeter is a sampling calorimeter using scintillator as the sensitive detector and steel as the absorber and covers the central region of the ATLAS experiment up to pseudorapidities +/- 1.7. The mechanical construction of the Tile Calorimeter occurred over a period of about 10 years beginning in 1995 with the completion of the Technical Design Report and ending in 2006 with the installation of the final module in the ATLAS cavern. During this period approximately 2600 metric tons of steel were transformed into a laminated structure to form the absorber of the sampling calorimeter. Following instrumentation and testing, which is described elsewhere, the modules were installed in the ATLAS cavern with a remarkable accuracy for a structure of this size and weight

Study of DsJ(*) + mesons decaying to D∗ +KS0 and D*0K+ final states

A search is performed for D sJ (*) + mesons in the reactions pp → D ∗ + K S 0 X and pp → D *0 K + X using data collected at centre-of-mass energies of 7 and 8 TeV with the LHCb detector. For the D ∗ + K S 0 final state, the decays D *+ → D 0 π + with D 0 → K − π + and D 0 → K − π + π + π − are used. For D *0 K +, the decay D *0 → D 0 π 0 with D 0 → K − π + is used. A prominent D s1(2536)+ signal is observed in both D ∗ + K S 0 and D *0 K + final states. The resonances D s1 * (2700)+ and D s3 * (2860)+ are also observed, yielding information on their properties, including spin-parity assignments. The decay D s2 * (2573)+ → D ∗ + K S 0 is observed for the first time, at a significance of 6.9 σ, and its branching fraction relative to the D s2 * (2573)+ → D + K S 0 decay mode is measured

A search for new physics in central exclusive production using the missing mass technique with the CMS detector and the CMS-TOTEM precision proton spectrometer

A generic search is presented for the associated production of a Z boson or a photon with an additional unspecified massive particle X, pp → pp + Z/γ + X, in proton-tagged events from proton–proton collisions at √s = 13 TeV, recorded in 2017 with the CMS detector and the CMS-TOTEM precision proton spectrometer. The missing mass spectrum is analysed in the 600–1600 GeV range and a fit is performed to search for possible deviations from the background expectation. No significant excess in data with respect to the background predictions has been observed. odelindependent upper limits on the visible production cross section of pp → pp + Z/γ + X are set