Impact of an integrated disease management program in reducing exacerbations in patients with severe asthma and COPD

SummaryBackgroundConflicting data exists on the effectiveness of integrated programs in reducing recurrent exacerbations and hospitalizations in patients with Asthma and chronic obstructive lung disease (COPD). We developed a Pulmonologist-led Chronic Lung Disease Program (CLDP) for patients with severe asthma and COPD and analyzed its impact on healthcare utilization and predictors of its effectiveness.MethodsCLDP elements included clinical evaluation, onsite pulmonary function testing, health education, and self-management action plan along with close scheduled and on-demand follow-up. Patients with ≥2 asthma or COPD exacerbations requiring emergency room visit or hospitalization within the prior year were enrolled, and followed for respiratory related ER visits (RER) and hospitalizations (RHA) over the year (357 ± 43 days) after CLDP interventions.ResultsA total of 106 patients were enrolled, and 104 patients were subject to analyses. During the year of follow-up after CLDP enrollment, there was a significant decrease in mean RER (0.56 ± 1.48 versus 2.62 ± 2.81, p < 0.0001), mean RHA (0.39 ± 0.08 versus 1.1 ± 1.62, p < 0.0001), and 30 day rehospitalizations (0.05 ± 0.02 versus 0.28 ± 0.07, p < 0.0001). Reduction of healthcare utilization was strongly associated with GERD and sinusitis therapy, and was independent of pulmonary rehabilitation. Direct variable cost analyses estimated annual savings at $1.17 million. Multivariate logistic regression analysis revealed lack of spirometry utilization as an independent risk factor for severe exacerbations.ConclusionsA Pulmonologist-led disease management program integrating key elements of care is cost effective and significantly decreases severe exacerbations. Integrated programs should be encouraged for care of frequent exacerbators of asthma and COPD

Priorities and interactions of Sustainable Development Goals (SDGs) with focus on wetlands

Wetlands are often vital physical and social components of a country's natural capital, as well as providers of ecosystem services to local and national communities. We performed a network analysis to prioritize Sustainable Development Goal (SDG) targets for sustainable development in iconic wetlands and wetlandscapes around the world. The analysis was based on the information and perceptions on 45 wetlandscapes worldwide by 49 wetland researchers of the GlobalWetland Ecohydrological Network (GWEN). We identified three 2030 Agenda targets of high priority across the wetlandscapes needed to achieve sustainable development: Target 6.3-'Improve water quality'; 2.4-'Sustainable food production'; and 12.2-'Sustainable management of resources'. Moreover, we found specific feedback mechanisms and synergies between SDG targets in the context of wetlands. The most consistent reinforcing interactions were the influence of Target 12.2 on 8.4-'Efficient resource consumption'; and that of Target 6.3 on 12.2. The wetlandscapes could be differentiated in four bundles of distinctive priority SDG-targets: 'Basic human needs', 'Sustainable tourism', 'Environmental impact in urban wetlands', and 'Improving and conserving environment'. In general, we find that the SDG groups, targets, and interactions stress that maintaining good water quality and a 'wise use' of wetlandscapes are vital to attaining sustainable development within these sensitive ecosystems. © 2019 by the authors

Sequencing of the Sea Lamprey (Petromyzon marinus) Genome Provides Insights into Vertebrate Evolution

Lampreys are representatives of an ancient vertebrate lineage that diverged from our own ∼500 million years ago. By virtue of this deeply shared ancestry, the sea lamprey (P. marinus) genome is uniquely poised to provide insight into the ancestry of vertebrate genomes and the underlying principles of vertebrate biology. Here, we present the first lamprey whole-genome sequence and assembly. We note challenges faced owing to its high content of repetitive elements and GC bases, as well as the absence of broad-scale sequence information from closely related species. Analyses of the assembly indicate that two whole-genome duplications likely occurred before the divergence of ancestral lamprey and gnathostome lineages. Moreover, the results help define key evolutionary events within vertebrate lineages, including the origin of myelin-associated proteins and the development of appendages. The lamprey genome provides an important resource for reconstructing vertebrate origins and the evolutionary events that have shaped the genomes of extant organisms

Honesty above all else? Expectations and perceptions of political conduct in three established democracies

The authors gratefully acknowledge financial support from the ESRC (grant number RES-000-22-3459) and British Academy (grant numbers SG-101785 and SG-52322). They would also like to thank two anonymous reviewers for their helpful comments and suggestions

Correction: Priorities and interactions of sustainable development goals (SDGs) with focus on wetlands. Water 2019, 11, 619 doi: 10.3390/w11030619

10.3390/w12010088Water (Switzerland)1218

Wireless Emergency Alerts: Trust Model Technical Report

<p>Trust is a key factor in the effectiveness of the Wireless Emergency Alerts (WEA) service. Alert originators (AOs) must trust WEA to deliver alerts to the public in an accurate and timely manner. Members of the public must also trust the WEA service before they will act on the alerts that they receive. This research aimed to develop a trust model to enable the Federal Emergency Management Agency (FEMA) to maximize the effectiveness of WEA and provide guidance for AOs that would support them in using WEA in a manner that maximizes public safety. The research method included Bayesian belief networks to model trust in WEA because they enable reasoning about and modeling of uncertainty. The research approach was to build models that could predict the levels of AO trust and public trust in specific scenarios, validate these models using data collected from AOs and the public, and execute simulations on these models for numerous scenarios to identify recommendations to AOs and FEMA for actions to take that increase trust and actions to avoid that decrease trust. This report describes the process used to develop and validate the trust models and the resulting structure and functionality of the models.</p

Quantifying Uncertainty in Early Lifecycle Cost Estimation (QUELCE)

Difficulties with estimating the costs of developing new systems have been well documented, and are compounded by the fact that estimates are now prepared much earlier in the acquisition lifecycle, before there is concrete technical information available on the particular program to be developed. This report describes an innovative synthesis of analytical techniques into a cost estimation method that models and quantifies the uncertainties associated with early lifecycle cost estimation. The method described in this report synthesizes scenario building, Bayesian Belief Network (BBN) modeling and Monte Carlo simulation into an estimation method that quantifies uncertainties, allows subjective inputs, visually depicts influential relationships among program change drivers and outputs, and assists with the explicit description and documentation underlying an estimate. It uses scenario analysis and design structure matrix (DSM) techniques to limit the combinatorial effects of multiple interacting program change drivers to make modeling and analysis more tractable. Representing scenarios as BBNs enables sensitivity analysis, exploration of scenarios, and quantification of uncertainty. The methods link to existing cost estimation methods and tools to leverage their cost estimation relationships and calibration. As a result, cost estimates are embedded within clearly defined confidence intervals and explicitly associated with specific program scenarios or alternate futures.</p