Cost-Effectiveness Analysis of Neonatal Screening of Critical Congenital Heart Defects in China.

Background: Pulse oximetry screening is a highly accurate tool for the early detection of critical congenital heart disease (CCHD) in newborn infants. As the technique is simple, noninvasive, and inexpensive, it has potentially significant benefits for developing countries. The aim of this study is to provide information for future clinical and health policy decisions by assessing the costeffectiveness of CCHD screening in China. Methods and Findings: We developed a cohort model to evaluate the cost-effectiveness of screening all Chinese newborns annually using 3 possible screening options compared to no intervention: pulse oximetry alone, clinical assessment alone, and pulse oximetry as an adjunct to clinical assessment. We calculated the incremental cost per averted disability-adjusted life years (DALYs) in 2015 international dollars to measure cost-effectiveness. One-way sensitivity analysis and multivariate probabilistic sensitivity analysis were performed to test the robustness of the model. Of the three screening options, we found that clinical assessment is the most cost-effective strategy compared to no intervention with an incremental cost-effectiveness ratio (ICER) of Int$5,728/DALY, while pulse oximetry plus clinical assessment with the highest ICER yielded the best health outcomes. Sensitivity analysis showed that when the treatment rate increased up to 57.5%, pulse oximetry plus clinical assessment showed the best expected values among the three screening options. Conclusion: In China, for neonatal screening for CCHD at the national level, clinical assessment was a very cost-effective preliminary choice and pulse oximetry plus clinical assessment was worth considering for the long term. Improvement in accessibility to treatment is crucial to expand the potential health benefits of screening. Abbreviations: ACER = average cost-effectiveness ratio, CCHD = critical congenital heart disease, CHD = congenital heart disease, DALYs = disability adjusted life years, GDP = gross domestic product, ICER = incremental cost-effectiveness analysis, WHO = World Health Organization, WTP = willingness-to-pay

Conflict of norms in European Union law and the legal reasoning of the European Court of Justice

This thesis examines the topic of conflict of norms in European Union (EU) law and the legal reasoning of the European Court of Justice (ECJ), arguing that the framework of conflict of norms provides conceptual insight into justification and the role of value choices in legal reasoning. After examining the theory of conflict of norms, which seems to have been relatively under-studied generally and especially in EU law, it examines three particular aspects of norm conflict resolution in the legal reasoning of the ECJ and EU law: conflict of interpretative norms, especially the opposition between conserving and innovative interpretation; conflicts of human rights norms, looking in particular at the idea of a hierarchy of rights and of specificationism in the articulation of rights; and conflicts of competence norms. It concludes that the scope exists for a fuller justification of the choice of norms in the legal reasoning of the ECJ and generally in EU law and offers a perspective on how the values articulated by the EU suggest particular approaches to norm conflict resolution by the ECJ in its decision-making in these fields, in particular, a greater resort to lex specialis and originalist or historical interpretation, in contrast to its current method.EThOS - Electronic Theses Online ServiceDepartment of Education and Learning of Northern IrelandScholarship from the Modern Law ReviewGBUnited Kingdo

Design of a control architecture for an underwater remotely operated vehicle (ROV) used for search and rescue operations

summary:A control system architecture design for an underwater ROV, primarily Class I - Pure Observation underwater ROV is presented in this paper. A non-linear plant model was designed using SolidWorks 3D modeling tool and is imported to MATLAB as a 3D model. The non-linear modeled plant is linearized using the MATLAB linear analysis toolbox to have a linear approximate model of the system. The authors designed controllers for the linear plant model of underwater ROV. PID controllers are utilized as a controller of the modeled plant. The PID tuning tools by MATLAB are utilized to tune the controller of the plant model of underwater ROV. The researchers test the control design of underwater ROV using MATLAB Simulink by analyzing the response of the system and troubleshoot the control design to achieve the objective parameters for the control design of underwater ROV

Feasibility of implementing pulse oximetry screening for congenital heart disease in a community hospital.

Objective: Pulse oximetry has been recognized as a promising screening tool for critical congenital heart disease (CCHD). The aim of this research was to study the feasibility of implementation in a community hospital setting. Study Design: Meetings were conducted to determine an implementation plan. Pulse oximetry was performed on the right hand and foot after 24h of age. Newborns with a saturation 95% or a 3% difference were considered to have a positive screen. Screening barriers, screening time and ability to effectively screen all eligible newborns were noted. Result: From January 2009 through May 2010, of 6841 eligible newborns, 6745 newborns (98.6%) were screened. Of the nine infants with positive pulse oximetry screens, one had CCHD, four had CHD and four others were determined to have false positive screens. Average screening time was 3.5min (0 to 35min). Conclusion: Pulse oximetry can be implemented successfully in community hospitals without an excessive number of false positives or additional nursing staff

Chemical Abundances in AGN Environment: X-Ray/UV Campaign on the MRK 279 Outflow

We present the first reliable determination of chemical abundances in an AGN outflow. The abundances are extracted from the deep and simultaneous FUSE and HST/STIS observations of Mrk 279. This data set is exceptional for its high signal-to-noise, unblended doublet troughs and little Galactic absorption contamination. These attributes allow us to solve for the velocity-dependent covering fraction, and therefore obtain reliable column densities for many ionic species. For the first time we have enough such column densities to simultaneously determine the ionization equilibrium and abundances in the flow. Our analysis uses the full spectral information embedded in these high-resolution data. Slicing a given trough into many independent outflow elements yields the extra constraints needed for a physically meaningful abundances determination. We find that relative to solar the abundances in the Mrk 279 outflow are (linear scaling): carbon 2.2+/-0.7, nitrogen 3.5+/-1.1 and oxygen 1.6+/-0.8. Our UV-based photoionization and abundances results are in good agreement with the independent analysis of the simultaneous Mrk 279 X-ray spectra. This is the best agreement between the UV and X-ray analyses of the same outflow to date.Comment: 28 pages, 7 figures, accepted on 29 Nov 2006 for publication in the ApJ (submission date: 27 Jul 2006

An evolvable space telescope for future astronomical missions 2015 update

In 2014 we presented a concept for an Evolvable Space Telescope (EST) that was assembled on orbit in 3 stages, growing from a 4x12 meter telescope in Stage 1, to a 12-meter filled aperture in Stage 2, and then to a 20-meter filled aperture in Stage 3. Stage 1 is launched as a fully functional telescope and begins gathering science data immediately after checkout on orbit. This observatory is then periodically augmented in space with additional mirror segments, structures, and newer instruments to evolve the telescope over the years to a 20-meter space telescope. In this 2015 update of EST we focus upon three items: 1) a restructured Stage 1 EST with three mirror segments forming an off-axis telescope (half a 12-meter filled aperture); 2) more details on the value and architecture of the prime focus instrument accommodation; and 3) a more in depth discussion of the essential in-space infrastructure, early ground testing and a concept for an International Space Station testbed called MoDEST. In addition to the EST discussions we introduce a different alternative telescope architecture: a Rotating Synthetic Aperture (RSA). This is a rectangular primary mirror that can be rotated to fill the UV-plane. The original concept was developed by Raytheon Space and Airborne Systems for non-astronomical applications. In collaboration with Raytheon we have begun to explore the RSA approach as an astronomical space telescope and have initiated studies of science and cost performance

Global change and conservation triage on National Wildlife Refuges

National Wildlife Refuges (NWRs) in the United States play an important role in the adaptation of social-ecological systems to climate change, land-use change, and other global-change processes. Coastal refuges are already experiencing threats from sea-level rise and other change processes that are largely beyond their ability to influence, while at the same time facing tighter budgets and reduced staff. We engaged in workshops with NWR managers along the U.S. Atlantic coast to understand the problems they face from global-change processes and began a multidisciplinary collaboration to use decision science to help address them. We are applying a values-focused approach to base management decisions on the resource objectives of land managers, as well as those of stakeholders who may benefit from the goods and services produced by a refuge. Two insights that emerged from our workshops were a conspicuous mismatch between the scale at which management can influence outcomes and the scale of environmental processes, and the need to consider objectives related to ecosystem goods and services that traditionally have not been explicitly considered by refuges (e.g., protection from storm surge). The broadening of objectives complicates the decision-making process, but also provides opportunities for collaboration with stakeholders who may have agendas different from those of the refuge, as well as an opportunity for addressing problems across scales. From a practical perspective, we recognized the need to (1) efficiently allocate limited staff time and budgets for short-term management of existing programs and resources under the current refuge design and (2) develop long-term priorities for acquiring or protecting new land/habitat to supplement or replace the existing refuge footprint and thus sustain refuge values as the system evolves over time. Structuring the decision-making problem in this manner facilitated a better understanding of the issues of scale and suggested that a long-term solution will require a significant reassessment of objectives to better reflect the comprehensive values of refuges to society. We discuss some future considerations to integrate these two problems into a single framework by developing novel optimization approaches for dynamic problems that account for uncertainty in future conditions