Designing and Undertaking a Health Economics Study of Digital Health Interventions.

This paper introduces and discusses key issues in the economic evaluation of digital health interventions. The purpose is to stimulate debate so that existing economic techniques may be refined or new methods developed. The paper does not seek to provide definitive guidance on appropriate methods of economic analysis for digital health interventions. This paper describes existing guides and analytic frameworks that have been suggested for the economic evaluation of healthcare interventions. Using selected examples of digital health interventions, it assesses how well existing guides and frameworks align to digital health interventions. It shows that digital health interventions may be best characterized as complex interventions in complex systems. Key features of complexity relate to intervention complexity, outcome complexity, and causal pathway complexity, with much of this driven by iterative intervention development over time and uncertainty regarding likely reach of the interventions among the relevant population. These characteristics imply that more-complex methods of economic evaluation are likely to be better able to capture fully the impact of the intervention on costs and benefits over the appropriate time horizon. This complexity includes wider measurement of costs and benefits, and a modeling framework that is able to capture dynamic interactions among the intervention, the population of interest, and the environment. The authors recommend that future research should develop and apply more-flexible modeling techniques to allow better prediction of the interdependency between interventions and important environmental influences.This paper is one of the outputs of two workshops, one supported by the Medical Research Council (MRC)/National Institute for Health Research (NIHR) Methodology Research Programme (PI Susan Michie) and the Robert Wood Johnson Foundation (PI Kevin Patrick), and the other by the National Science Foundation (PI Donna Spruitj-Metz, proposal # 1539846). The Health Economics Research Unit is funded in part by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates.This is the author accepted manuscript. It is currently under an indefinite embargo pending publication by Elsevier

Screening for type 2 diabetes : literature review and economic modelling

Objectives: To reconsider the aims of screening for undiagnosed diabetes, and whether screening should be for other abnormalities of glucose metabolism such as impaired glucose tolerance (IGT), or the ‘metabolic syndrome’. Also to update the previous review for the National Screening Committee (NSC) on screening for diabetes, including reviewing choice of screening test; to consider what measures would be taken if IGT and impaired fasting glucose (IFG) were identified by screening, and in particular to examine evidence on treatment to prevent progression to diabetes in these groups; to examine the cost-effectiveness of screening; and to consider groups at higher risk at which screening might be targeted. Data sources: Electronic databases were searched up to the end of June 2005. Review methods: Literature searches and review concentrated on evidence published since the last review of screening, both reviews and primary studies. The review of economic studies included only those models that covered screening. The new modelling extended an existing diabetes treatment model by developing a screening module. The NSC has a set of criteria, which it applies to new screening proposals. These criteria cover the condition, the screening test or tests, treatment and the screening programme. Screening for diabetes was considered using these criteria. Results: Detection of lesser degrees of glucose intolerance such as IGT is worthwhile, partly because the risk of cardiovascular disease (CVD) can be reduced by treatment aimed at reducing cholesterol level and blood pressure, and partly because some diabetes can be prevented. Several trials have shown that both lifestyle measures and pharmacological treatment can reduce the proportion of people with IGT who would otherwise develop diabetes. Screening could be two-stage, starting with the selection of people at higher risk. The second-stage choice of test for blood glucose remains a problem, as in the last review for NSC. The best test is the oral glucose tolerance test (OGTT), but it is the most expensive, is inconvenient and has weak reproducibility. Fasting plasma glucose would miss people with IGT. Glycatedhaemoglobin does not require fasting, and may be the best compromise. It may be that more people would be tested and diagnosed if the more convenient test was used, rather than the OGTT. Five economic studies assessed the costs and short-term outcomes of using different screening tests. None examined the long-term impact of different proportions of false negatives. All considered the costs that would be incurred and the numbers identified by different tests, or different cut-offs. Results differed depending on different assumptions. They did not give a clear guide as to which test would be the best in any UK screening programme, but all recognised that the choice of cut-off would be a compromise between sensitivity and specificity; there is no perfect test. The modelling exercise concluded that screening for diabetes appears to be cost-effective for the 40–70-year age band, more so for the older age bands, but even in the 40–49-year age group, the incremental cost-effectiveness ratio for screening versus no screening is only £10,216 per quality-adjusted life-year. Screening is more cost-effective for people in the hypertensive and obese subgroups and the costs of screening are offset in many groups by lower future treatment costs. The cost-effectiveness of screening is determined as much by, if not more than, assumptions about the degree of control of blood glucose and future treatment protocols than by assumptions relating to the screening programme. The very low cost now of statins is also an important factor. Although the prevalence of diabetes increases with age, the relative risk of CVD falls, reducing the benefits of screening. Screening for diabetes meets most of the NSC criteria, but probably fails on three: criterion 12, on optimisation of existing management of the condition; criterion 13, which requires that there should be evidence from high-quality randomised controlled trials (RCTs) showing that a screening programme would reduce mortality or morbidity; and criterion 18, that there should be adequate staffing and facilities for all aspects of the programme. It is uncertain whether criterion 19, that all other options, including prevention, should have been considered, is met. The issue here is whether all methods of improving lifestyles in order to reduce obesity and increase exercise have been sufficiently tried. The rise in overweight and obesity suggests that health promotion interventions have not so far been effective. Conclusions: The case for screening for undiagnosed diabetes is probably somewhat stronger than it was at the last review, because of the greater options for reduction of CVD, principally through the use of statins, and because of the rising prevalence of obesity and hence type 2 diabetes. However, there is also a good case for screening for IGT, with the aim of preventing some future diabetes and reducing CVD. Further research is needed into the duration of undiagnosed diabetes, and whether the rise in blood glucose levels is linear throughout or whether there may be a slower initial phase followed by an acceleration around the time of clinical diagnosis. This has implications for the interval after which screening would be repeated. Further research is also needed into the natural history of IGT, and in particular what determines progression to diabetes. An RCT of the type required by NSC criterion 13 is under way but will not report for about 7 years

The British Society for Rheumatology Biologics Registers in Ankylosing Spondylitis (BSRBR-AS) study : Protocol for a prospective cohort study of the long-term safety and quality of life outcomes of biologic treatment

Acknowledgements Oversight of the study is provided by the BSR Registers Committee of which GJM and GTJ are members, together with investigators from BSRBR-RA, representatives from the BSR clinical affairs section and BSR independent members, currently, Alex MacGregor (University of East Anglia), Elaine Dennison (University of Southampton), Jon Packham (Keele University) and patient representatives Ailsa Bosworth and Debbie Cook. We acknowledge the contribution of the International Advisory Group members Desireé van der Heijde (Netherlands), Matthew Brown (Australia) and Walter Maksymowych (Canada). We thank Neil Basu (University of Aberdeen) for his role with regards to pharmacovigilance and the Robertson Centre for Biostatistics (University of Glasgow) for data management services. Author KTM is currently at the Tayside Clinical Trials Unit, University of Dundee. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Peer reviewedPublisher PD

Cost-effectiveness of cognitive behavioural and personalised exercise interventions for reducing fatigue in inflammatory rheumatic diseases

Acknowledgements The authors would like to thank all the participants who supported this trial. We acknowledge the contribution of the Trial Steering Committee and Data Monitoring Committee, and Brian Taylor and Mark Forrest (Centre for Healthcare Randomised Trials [CHaRT], University of Aberdeen, Aberdeen, UK) for their technical assistance. Funding: This work was supported by Versus Arthritis (formerly Arthritis Research UK) grant number 21175.Peer reviewe

Findings of the IWSLT 2022 Evaluation Campaign.

The evaluation campaign of the 19th International Conference on Spoken Language Translation featured eight shared tasks: (i) Simultaneous speech translation, (ii) Offline speech translation, (iii) Speech to speech translation, (iv) Low-resource speech translation, (v) Multilingual speech translation, (vi) Dialect speech translation, (vii) Formality control for speech translation, (viii) Isometric speech translation. A total of 27 teams participated in at least one of the shared tasks. This paper details, for each shared task, the purpose of the task, the data that were released, the evaluation metrics that were applied, the submissions that were received and the results that were achieved

Arizona\u27s Vulnerable Populations

Arizona’s vulnerable populations are struggling on a daily basis but usually do so in silence, undetected by traditional radar and rankings, often unaware themselves of their high risk for being pushed or pulled into a full crisis. Ineligible for financial assistance under strict eligibility guidelines, they don’t qualify as poor because vulnerable populations are not yet in full crisis. To be clear, this report is not about the “poor,” at least not in the limited sense of the word. It is about our underemployed wage earners, our single-parent households, our deployed or returning military members, our under-educated and unskilled workforce, our debt-ridden neighbors, our uninsured friends, our family members with no savings for an emergency, much less retirement

Propelling the Commercialization of ‘Novel Cements’: An investigation of demand-side factors to accelerate decarbonizing technologies within the cement industry

Accounting for approximately 8% of global CO2 emissions, the cement industry is one of the greatest contributors to climate change, despite the lack of focus on this sector in popular discourse. Deep cuts in this sector are challenging to achieve due to necessitated alteration of material components and formulation of the traditional product in addressing non-energy related ‘process emissions’. Technologies able to deeply decarbonize this sector are currently not fully developed or commercialized. This research explores one innovative technology with deep decarbonization potential: novel cements, classified as non-limestone clinker-based cements or those with low-limestone content produced through alternative manufacturing methods. It focuses on the demand-side landscape of these products as increasing demand and adoption may promote wider commercialization and corresponding emissions reductions. More specifically, demand-side stakeholder landscape, drivers and barriers for novel cement commercialization, strategic niche management, and strategies to advance these technologies are investigated. These themes are examined from a geographically broad lens through the utilization of a literature review and expert interviews. Results support the potential for and benefits of novel cements being incubated and commercialized within certain niche applications and market segments. Following successes of these products in certain niches, novel cements may then be suited to expand to other, larger markets. Several demand-side barriers to the wider implementation of these products were identified, particularly risk aversion and lack of inclusion in standards and specifications, along with some interrelated supply-side factors. Several strategies that various actors can pursue in attempts to propel these technologies forward were also recognized including business-oriented strategies for manufacturers, various policy options, and collaboration opportunities amongst various actor groups to optimize knowledge and resource sharing. While novel cements offer decarbonizing attributes that can help to significantly decrease emissions in the cement sector, other green cement and concrete technologies compete with sustainability-driven demand for these products. However, there is likely no ‘silver bullet’ technology to decarbonize this sector; deep emissions reductions will require the simultaneous utilization of several technologies. Accordingly, the pursuit, development, and commercialization of novel cements as one of these technologies needs to be pursued

ミズ オヨビ エタノールチュウ デ ノ シリカ ヒョウメン ニ カンスル ゲンシカンリョク ケンビキョウホウテキ カイメン ドウデンイホウテキ ケンキュウ : コウブンシ デンカイシツ ト カイメン カッセイザイ ノ キュウチャク ノ コウカ

京都大学0048新制・課程博士博士(理学)甲第9193号理博第2406号新制||理||1248(附属図書館)UT51-2001-R742京都大学大学院理学研究科化学専攻(主査)教授 磯田 正二, 教授 中原 勝, 教授 時任 宣博学位規則第4条第1項該当Doctor of ScienceKyoto UniversityDA