Estimating the cost-effectiveness of fluticasone propionate for treating chronic obstructive pulmonary disease in the presence of missing data

Objectives: To explore the cost-effectiveness of fluticasone propionate (FP) for the treatment of chronic obstructive pulmonary disease (COPD), we estimated costs and qualityadjusted life-years (QALYs) over 3 years, based on an economic appraisal of a previously reported clinical trial (Inhaled Steroids in Obstructive Lung Disease in Europe [ISOLDE]). Methods: Seven hundred forty-two patients enrolled in the ISOLDE trial who received either FP or placebo had data available on health-care costs and quality of life over the period of the study. The SF-36-based utility scores for quality of life were used to calculate QALYs. A combined imputation and bootstrapping procedure was employed to handle missing data and to estimate statistical uncertainty in the estimated cumulative costs and QALYs over the study period. The imputation approach was based on propensity scoring and nesting this approach within the bootstrap ensured that multiple imputations were performed such that statistical estimates included imputation uncertainty. Results: Complete data were available on mortality within the follow-up period of the study and a nonsignificant trend toward improved survival of 0.06 (95% confidence interval [CI] –0.01 to 0.15) life-years was observed. In an analysis based on a propensity scoring approach to missing data we estimated the incremental costs of FP versus placebo to be £1021 (95% CI £619–1338) with an additional effect of 0.11 QALYs (CI 0.04–0.20). Cost-effectiveness estimates for the within-trial period of £17,700 per life-year gained (£6900 to ∞) and £9500 per QALY gained (CI £4300–26,500) were generated that include uncertainty due to the imputation process. An alternative imputation approach did not materially affect these estimates. Conclusions: Previous analyses of the ISOLDE study showed significant improvement on disease-specific health status measures and a trend toward a survival advantage for treatment with FP. This analysis shows that joint considerations of quality of life and survival result in a substantial increase in QALYs favoring treatment with FP. Based on these data, the inhaled corticosteroid FP appears costeffective for the treatment of COPD. Confirmation or refutation of this result may be achieved once the Towards a Revolution in COPD Health (TORCH) study reports, a large randomized controlled trial powered to detect mortality changes associated with the use of FP alone, or in combination with salmeterol, which is also collecting resource use and utility data suitable for estimating cost-effectiveness

Tunable entanglement distillation of spatially correlated down-converted photons

We report on a new technique for entanglement distillation of the bipartite continuous variable state of spatially correlated photons generated in the spontaneous parametric down-conversion process (SPDC), where tunable non-Gaussian operations are implemented and the post-processed entanglement is certified in real-time using a single-photon sensitive electron multiplying CCD (EMCCD) camera. The local operations are performed using non-Gaussian filters modulated into a programmable spatial light modulator and, by using the EMCCD camera for actively recording the probability distributions of the twin-photons, one has fine control of the Schmidt number of the distilled state. We show that even simple non-Gaussian filters can be finely tuned to a ~67% net gain of the initial entanglement generated in the SPDC process.Comment: 12 pages, 6 figure

A homogenization theorem for Langevin systems with an application to Hamiltonian dynamics

This paper studies homogenization of stochastic differential systems. The standard example of this phenomenon is the small mass limit of Hamiltonian systems. We consider this case first from the heuristic point of view, stressing the role of detailed balance and presenting the heuristics based on a multiscale expansion. This is used to propose a physical interpretation of recent results by the authors, as well as to motivate a new theorem proven here. Its main content is a sufficient condition, expressed in terms of solvability of an associated partial differential equation ("the cell problem"), under which the homogenization limit of an SDE is calculated explicitly. The general theorem is applied to a class of systems, satisfying a generalized detailed balance condition with a position-dependent temperature.Comment: 32 page

Design Principles for Sparse Matrix Multiplication on the GPU

We implement two novel algorithms for sparse-matrix dense-matrix multiplication (SpMM) on the GPU. Our algorithms expect the sparse input in the popular compressed-sparse-row (CSR) format and thus do not require expensive format conversion. While previous SpMM work concentrates on thread-level parallelism, we additionally focus on latency hiding with instruction-level parallelism and load-balancing. We show, both theoretically and experimentally, that the proposed SpMM is a better fit for the GPU than previous approaches. We identify a key memory access pattern that allows efficient access into both input and output matrices that is crucial to getting excellent performance on SpMM. By combining these two ingredients---(i) merge-based load-balancing and (ii) row-major coalesced memory access---we demonstrate a 4.1x peak speedup and a 31.7% geomean speedup over state-of-the-art SpMM implementations on real-world datasets.Comment: 16 pages, 7 figures, International European Conference on Parallel and Distributed Computing (Euro-Par) 201

Disproportionation Phenomena on Free and Strained Sn/Ge(111) and Sn/Si(111) Surfaces

Distortions of the $\sqrt3\times\sqrt3$ Sn/Ge(111) and Sn/Si(111) surfaces are shown to reflect a disproportionation of an integer pseudocharge, $Q$, related to the surface band occupancy. A novel understanding of the $(3\times3)$-1U (``1 up, 2 down'') and 2U (``2 up, 1 down'') distortions of Sn/Ge(111) is obtained by a theoretical study of the phase diagram under strain. Positive strain keeps the unstrained value Q=3 but removes distorsions. Negative strain attracts pseudocharge from the valence band causing first a $(3\times3)$-2U distortion (Q=4) on both Sn/Ge and Sn/Si, and eventually a $(\sqrt3\times\sqrt3)$-3U (``all up'') state with Q=6. The possibility of a fluctuating phase in unstrained Sn/Si(111) is discussed.Comment: Revtex, 5 pages, 3 figure

Boost invariant marginally trapped surfaces in Minkowski 4-space

The extremal and partly marginally trapped surfaces in Minkowski 4-space, which are invariant under the group of boost isometries, are classified. Moreover, it is shown that there do not exist extremal surfaces of this kind with constant Gaussian curvature. A procedure is given in order to construct a partly marginally trapped surface by gluing two marginally trapped surfaces which are invariant under the group of boost isometries. As an application, a proper star-surface is constructed.Comment: 13 pages, comment added in section

Evaluation of radiography as a screening method for detection and characterisation of congenital vertebral malformations in dogs

Congenital vertebral malformations (CVM) are common in brachycephalic ‘screw-tailed’ dogs; they can be associated with neurological deficits and a genetic predisposition has been suggested. The purpose of this study was to evaluate radiography as a screening method for congenital thoracic vertebral malformations in brachycephalic ‘screw-tailed’ dogs by comparing it with CT. Forty-nine dogs that had both radiographic and CT evaluations of the thoracic vertebral column were included. Three observers retrospectively reviewed the images independently to detect CVMs. When identified, they were classified according to a previously published radiographic classification scheme. A CT consensus was then reached. All observers identified significantly more affected vertebrae when evaluating orthogonal radiographic views compared with lateral views alone; and more affected vertebrae with the CT consensus compared with orthogonal radiographic views. Given the high number of CVMs per dog, the number of dogs classified as being CVM free was not significantly different between CT and radiography. Significantly more midline closure defects were also identified with CT compared with radiography. Malformations classified as symmetrical or ventral hypoplasias on radiography were frequently classified as ventral and medial aplasias on CT images. Our results support that CT is better than radiography for the classification of CVMs and this will be important when further evidence of which are the most clinically relevant CVMs is identified. These findings are of particular importance for designing screening schemes of CVMs that could help selective breeding programmes based on phenotype and future studies