153 research outputs found

    Exploring the Cost Effectiveness of Shared Decision Making for Choosing between Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis in the Netherlands:A State Transition Model

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    Background Up to 31% of patients with relapsing-remitting multiple sclerosis (RRMS) discontinue treatment with disease-modifying drug (DMD) within the first year, and of the patients who do continue, about 40% are nonadherent. Shared decision making may decrease nonadherence and discontinuation rates, but evidence in the context of RRMS is limited. Shared decision making may, however, come at additional costs. This study aimed to explore the potential cost-effectiveness of shared decision making for RRMS in comparison with usual care, from a (limited) societal perspective over a lifetime. Methods An exploratory economic evaluation was conducted by adapting a previously developed state transition model that evaluates the cost-effectiveness of a range of DMDs for RRMS in comparison with the best supportive care. Three potential effects of shared decision making were explored: 1) a change in the initial DMD chosen, 2) a decrease in the patient's discontinuation in using the DMD, and 3) an increase in adherence to the DMD. One-way and probabilistic sensitivity analyses of a scenario that combined the 3 effects were conducted. Results Each effect separately and the 3 effects combined resulted in higher quality-adjusted life years (QALYs) and costs due to the increased utilization of DMD. A decrease in discontinuation of DMDs influenced the incremental cost-effectiveness ratio (ICER) most. The combined scenario resulted in an ICER of euro17,875 per QALY gained. The ICER was sensitive to changes in several parameters. Conclusion This study suggests that shared decision making for DMDs could potentially be cost-effective, especially if shared decision making would help to decrease treatment discontinuation. Our results, however, may depend on the assumed effects on treatment choice, persistence, and adherence, which are actually largely unknown

    Open Transfer: Ergebnisse des BMBF-geförderten Verbundprojektes zu Wissenschaft-Wirtschaft-Kooperationen in den Branchen Mikroelektronik, Optik sowie Mobilität und Verkehr

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    Digitalisierung und neue Innovationszyklen stellen wissensintensive Branchen vor große Herausforderungen. Neue Innovationsstrategien und neue Geschäftsmodelle ersetzen konventionelle Wertschöpfungsmuster. Der daraus resultierende Veränderungsdruck betrifft sowohl die interne Wissensproduktion von Unternehmen als auch ihre Forschungs- und Innovationskooperationen mit externen Forschungseinrichtungen: Die Aufgabenprofile und Anforderungen an die Forschungs- und Entwicklungsabteilungen verändern sich, der Stellenwert externen Wissens nimmt zu und alternative Formen der Kooperation gewinnen an Bedeutung. Das Projekt „Open Transfer“ hat sich in zwei Fallstudien mit der Frage beschäftigt, wie sich die Wertschöpfungsketten und die FuE-Kooperationen zwischen Unternehmen und Forschungseinrichtungen verändern. Die vorliegenden Ergebnisse beschreiben etablierte und innovative Kooperationspraktiken und zeigen aktuelle Herausforderungen. Die Analyse verdeutlicht den gegenwärtigen und zunehmenden Stellenwert der engen Zusammenarbeit unterschiedlicher Akteure in Innovationsökosystemen

    Open Transfer: Ergebnisse des BMBF-geförderten Verbundprojektes zu Wissenschaft-Wirtschaft-Kooperationen in den Branchen Mikroelektronik, Optik sowie Mobilität und Verkehr

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    Digitalisierung und neue Innovationszyklen stellen wissensintensive Branchen vor große Herausforderungen. Neue Innovationsstrategien und neue Geschäftsmodelle ersetzen konventionelle Wertschöpfungsmuster. Der daraus resultierende Veränderungsdruck betrifft sowohl die interne Wissensproduktion von Unternehmen als auch ihre Forschungs- und Innovationskooperationen mit externen Forschungseinrichtungen: Die Aufgabenprofile und Anforderungen an die Forschungs- und Entwicklungsabteilungen verändern sich, der Stellenwert externen Wissens nimmt zu und alternative Formen der Kooperation gewinnen an Bedeutung. Das Projekt „Open Transfer“ hat sich in zwei Fallstudien mit der Frage beschäftigt, wie sich die Wertschöpfungsketten und die FuE-Kooperationen zwischen Unternehmen und Forschungseinrichtungen verändern. Die vorliegenden Ergebnisse beschreiben etablierte und innovative Kooperationspraktiken und zeigen aktuelle Herausforderungen. Die Analyse verdeutlicht den gegenwärtigen und zunehmenden Stellenwert der engen Zusammenarbeit unterschiedlicher Akteure in Innovationsökosystemen

    Endotoxin Induced Chorioamnionitis Prevents Intestinal Development during Gestation in Fetal Sheep

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    Chorioamnionitis is the most significant source of prenatal inflammation and preterm delivery. Prematurity and prenatal inflammation are associated with compromised postnatal developmental outcomes, of the intestinal immune defence, gut barrier function and the vascular system. We developed a sheep model to study how the antenatal development of the gut was affected by gestation and/or by endotoxin induced chorioamnionitis

    Audio-based narratives for the trenches of World War I : intertwining stories, places and interaction for an evocative experience

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    We report in detail the co-design, setup and evaluation of a technological intervention for a complex outdoor heritage site: a World War I fortified camp and trenches located in the natural setting of the Italian Alps. Sound was used as the only means of content delivery as it was considered particularly effective in engaging visitors at an emotional level and had the potential to enhance the physical experience of being at an historical place. The implemented prototype is visitor-aware personalised multi-point auditory narrative system that automatically plays sounds and stories depending on a combination of features such as physical location, visitor proximity and visitor preferences. The curators created for the trail multiple narratives to capture the different voices of the War. The stories are all personal accounts (as opposed to objective and detached reporting of the facts); they were designed to trigger empathy and understanding while leaving the visitors free to interpret the content and the place on the bases of their own understanding and sensitivity. The result is an evocative embodied experience that does not describe the place in a traditional sense, but leaves its interpretation open. It takes visitors beyond the traditional view of heritage as a source of information toward a sensorial experience of feeling the past. A prototype was set up and tested with a group of volunteers showing that a design that carefully combines content design, sound design, tangible and embodied interaction can bring archaeological remains, with very little to see, back to file

    COVID-19 in children: analysis of the first pandemic peak in England.

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    OBJECTIVES: To assess disease trends, testing practices, community surveillance, case-fatality and excess deaths in children as compared with adults during the first pandemic peak in England. SETTING: England. PARTICIPANTS: Children with COVID-19 between January and May 2020. MAIN OUTCOME MEASURES: Trends in confirmed COVID-19 cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity rates in children compared with adults; community prevalence of SARS-CoV-2 in children with acute respiratory infection (ARI) compared with adults, case-fatality rate in children with confirmed COVID-19 and excess childhood deaths compared with the previous 5 years. RESULTS: Children represented 1.1% (1,408/129,704) of SARS-CoV-2 positive cases between 16 January 2020 and 3 May 2020. In total, 540 305 people were tested for SARS-COV-2 and 129,704 (24.0%) were positive. In children aged <16 years, 35,200 tests were performed and 1408 (4.0%) were positive for SARS-CoV-2, compared to 19.1%-34.9% adults. Childhood cases increased from mid-March and peaked on 11 April before declining. Among 2,961 individuals presenting with ARI in primary care, 351 were children and 10 (2.8%) were positive compared with 9.3%-45.5% in adults. Eight children died and four (case-fatality rate, 0.3%; 95% CI 0.07% to 0.7%) were due to COVID-19. We found no evidence of excess mortality in children. CONCLUSIONS: Children accounted for a very small proportion of confirmed cases despite the large numbers of children tested. SARS-CoV-2 positivity was low even in children with ARI. Our findings provide further evidence against the role of children in infection and transmission of SARS-CoV-2

    Planet Hunters: The First Two Planet Candidates Identified by the Public using the Kepler Public Archive Data

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    Planet Hunters is a new citizen science project, designed to engage the public in an exoplanet search using NASA Kepler public release data. In the first month after launch, users identified two new planet candidates which survived our checks for false- positives. The follow-up effort included analysis of Keck HIRES spectra of the host stars, analysis of pixel centroid offsets in the Kepler data and adaptive optics imaging at Keck using NIRC2. Spectral synthesis modeling coupled with stellar evolutionary models yields a stellar density distribution, which is used to model the transit orbit. The orbital periods of the planet candidates are 9.8844 \pm0.0087 days (KIC 10905746) and 49.7696 \pm0.00039 (KIC 6185331) days and the modeled planet radii are 2.65 and 8.05 R\oplus. The involvement of citizen scientists as part of Planet Hunters is therefore shown to be a valuable and reliable tool in exoplanet detection.Comment: Submitted to MNRAS, added 1 line to table

    Three Pseudomonas putida FNR Family Proteins with Different Sensitivities to O-2

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    The Escherichia coli fumarate-nitrate reduction regulator (FNR) protein is the paradigm for bacterial O2-sensing transcription factors. However, unlike E. coli, some bacterial species possess multiple FNR proteins that presumably have evolved to fulfill distinct roles. Here, three FNR proteins (ANR, PP_3233, and PP_3287) from a single bacterial species, Pseudomonas putida KT2440, have been analyzed. Under anaerobic conditions, all three proteins had spectral properties resembling those of [4Fe-4S] proteins. The reactivity of the ANR [4Fe-4S] cluster with O2 was similar to that of E. coli FNR, and during conversion to the apo-protein, via a [2Fe-2S] intermediate, cluster sulfur was retained. Like ANR, reconstituted PP_3233 and PP_3287 were converted to [2Fe-2S] forms when exposed to O2, but their [4Fe-4S] clusters reacted more slowly. Transcription from an FNR-dependent promoter with a consensus FNR-binding site in P. putida and E. coli strains expressing only one FNR protein was consistent with the in vitro responses to O2. Taken together, the experimental results suggest that the local environments of the iron-sulfur clusters in the different P. putida FNR proteins influence their reactivity with O2, such that ANR resembles E. coli FNR and is highly responsive to low concentrations of O2, whereas PP_3233 and PP_3287 have evolved to be less sensitive to O2

    A multicentre non-blinded randomised controlled trial to assess the impact of regular early specialist symptom control treatment on quality of life in malignant mesothelioma (RESPECT-MESO): Study protocol for a randomised controlled trial

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    Background: Malignant pleural mesothelioma is an incurable cancer caused by exposure to asbestos. The United Kingdom has the highest death rate from mesothelioma in the world and this figure is increasing. Median survival is 8 to 12 months, and most patients have symptoms at diagnosis. The fittest patients may be offered chemotherapy with palliative intent. For patients not fit for systemic anticancer treatment, best supportive care remains the mainstay of management. A study from the United States examining advanced lung cancer showed that early specialist palliative care input improved patient health related quality of life and depression symptoms 12 weeks after diagnosis. While mesothelioma and advanced lung cancer share many symptoms and have a poor prognosis, oncology and palliative care services in the United Kingdom, and many other countries, vary considerably compared to the United States. The aim of this trial is to assess whether regular early symptom control treatment provided by palliative care specialists can improve health related quality of life in patients newly diagnosed with mesothelioma. Methods: This multicentre study is an non-blinded, randomised controlled, parallel group trial. A total of 174 patients with a new diagnosis of malignant pleural mesothelioma will be minimised with a random element in a 1:1 ratio to receive either 4weekly regular early specialist symptom control care, or standard care. The primary outcome is health related quality of life for patients at 12 weeks. Secondary outcomes include health related quality of life for patients at 24 weeks, carer health related quality of life at 12 and 24 weeks, patient and carer mood at 12 and 24 weeks, overall survival and analysis of healthcare utilisation and cost. Discussion: Current practice in the United Kingdom is to involve specialist palliative care towards the final weeks or months of a life-limiting illness. This study aims to investigate whether early, regular specialist care input can result in significant health related quality of life gains for patients with mesothelioma and if this change in treatment model is cost-effective. The results will be widely applicable to many institutions and patients both in the United Kingdom and internationally. Trial registration: Current controlled trials ISRCTN18955704.Date ISRCTN assigned: 31 January 2014
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