Early psychosocial intervention in Alzheimer’s disease:Cost utility evaluation alongside the Danish Alzheimer’s Intervention Study (DAISY)

OBJECTIVE: To assess the cost utility of early psychosocial intervention for patients with Alzheimer's disease and their primary caregivers. DESIGN: Cost utility evaluation alongside a multicentre, randomised controlled trial with 3 years of follow-up. SETTING: Primary care and memory clinics in five Danish districts. PARTICIPANTS: 330 community-dwelling patients and their primary caregivers. INTERVENTION: Psychosocial counselling and support lasting 8–12 months after diagnosis and follow-up at 3, 6, 12 and 36 months in the intervention group or follow-up only in the control group. MAIN OUTCOME MEASURES: The primary outcome measure was the cost of additional quality-adjusted life years (QALYs). Costs were measured from a societal perspective, including the costs of healthcare, social care, informal care and production loss. QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis. RESULTS: None of the observed cost and QALY measures were significantly different between the intervention and control groups, although a tendency was noted for psychosocial care leading to cost increases with informal care that was not outweighed by the tendency for cost savings with formal care. The probability of psychosocial intervention being cost-effective did not exceed 36% for any threshold value. The alternative scenario analysis showed that the probability of cost-effectiveness increased over the range of threshold values used if the cost perspective was restricted to formal healthcare. CONCLUSIONS: A multifaceted, psychosocial intervention programme was found unlikely to be cost-effective from a societal perspective. The recommendation for practice in settings that are similar to the Danish setting is to provide follow-up with referral to available local support programmes when needed, and to restrict large multifaceted intervention programmes to patients and caregivers with special needs until further evidence for cost-effectiveness emerges. TRIAL REGISTRATION: The study was registered in the Clinical Trial Database as ISRCTN74848736

Classification of cow’s behaviors based on 3-DoF accelerations from cow’s movements

Cow’s behavior classification helps people to monitor cow activities, thus the health and physiological periods of cows can be well tracked. To classify the behavior of cows, the data from the 3-axis acceleration sensor mounted on their neck is often used. Data acquisition and preprocessing of sensor data is required in this device. We acquire data from the 3-axis acceleration sensor mounted on the cows’neck and send to the microcontrollter. At the microcontroller, a proposed decision tree is applied in real-time manner to classify four important activities of the cows (standing, lying, feeding, and walking). Finally, the results can be sent to the server through the wireless transmission module. The test results confirm the reliability of the proposed device

Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries

Background: The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year. Although most dengue infections are asymptomatic, patients can present with a wide spectrum of clinical symptoms ranging from mild febrile illness through to severe manifestations of bleeding, organ impairment, and hypovolaemic shock due to a systemic vascular leak syndrome. Clinical diagnosis of dengue and identification of which patients are likely to develop severe disease remain challenging. This study aims to improve diagnosis and clinical management through approaches designed a) to differentiate between dengue and other common febrile illness within 72 h of fever onset, and b) among patients with dengue to identify markers that are predictive of the likelihood of evolving to a more severe disease course. Method/Design: This is a prospective multi-centre observational study aiming to enrol 7–8000 participants aged ≥ 5 years presenting with a febrile illness consistent with dengue to outpatient health facilities in 8 countries across Asia and Latin America. Patients presenting within 72 h of fever onset who do not exhibit signs of severe disease are eligible for the study. A broad range of clinical and laboratory parameters are assessed daily for up to 6 days during the acute illness, and also at a follow up visit 1 week later. Discussion: Data from this large cohort of patients, enrolled early with undifferentiated fever, will be used to develop a practical diagnostic algorithm and a robust clinical case definition for dengue. Additionally, among patients with confirmed dengue we aim to identify simple clinical and laboratory parameters associated with progression to a more severe disease course. We will also investigate early virological and serological correlates of severe disease, and examine genetic associations in this large heterogeneous cohort. In addition the results will be used to assess the new World Health Organization classification scheme for dengue in practice, and to update the guidelines for “Integrated Management of Childhood Illness” used in dengue-endemic countries. Trial registration: NCT01550016. Registration Date: March 7, 201

Aperçus mécanistiques de la décarboxylation et de l'insertion de CO₂ dans de nouveaux complexes de cuivre (I)

Decarboxylation of carboxylic acids to biaryl compounds catalyzed by copper complexes is of tremendous interest in cross-coupling. While many studies focused on the optimising reaction conditions and the substrates range , little is known about the active Cu species. Furthermore, the dehydrogenation of formic acid catalysed by copper complexes has been poorly studied and the reported activities are low. Studies offering a better understanding of the mechanisms and of the species involved in these catalytic transformations are vital. This requires to isolate copper complexes, studying their reactivity and identifying the reaction intermediates. Although bidentate nitrogen ligands such as phenanthroline are known to favor copper-catalysed decarboxylation reactions, they do not always offer the solubility and stability required for studies in solution. In this thesis, I synthesised novel carboxylate and aryl Cu(I) compounds, eg [(phen*)Cu(O₂CAr)] and [(phen*)Cu-Ar] (Ar=aryl), with a bulky nitrogen ancillary ligand. Their crystal structures are presented. This work reports on my experiments to decarboxylate the carboxylate complexes [(phen*)Cu(O₂CAr)] and to insert CO₂ into the aryl derivatives. Dehydrogenation of formic acid catalysed by copper formate [(phen*)Cu(O₂CH)] is also described. Different mechanisms are proposed for these transformations.La décarboxylation des acides carboxyliques en composés biarylés, catalysée par les complexes de cuivre, est depuis des décennies un sujet majeur dans le domaine du couplage croisé. Alors que de nombreuses études se concentrent sur l’optimisation des conditions de réaction et de l’étendue des substrats, les espèces actives de cuivre sont mal connues. Par ailleurs, la déshydrogénation de l'acide formique catalysée par des complexes de cuivre a été peu étudiée et les activités rapportées sont faibles. Ainsi, des études offrant une meilleure compréhension des mécanismes et des espèces impliquées dans ces transformations catalytiques sont capitales. Cela passe par l'isolement de complexes de cuivre, l’étude de leur réactivité et l'identification des intermédiaires réactionnels. Bien que les ligands azotés bidentes, telle que la phenthroline, soient connus pour favoriser les réactions de décarboxylation catalysées au cuivre, ceux-ci n’offrent pas toujours la solubilité et la stabilité requises pour des études en solution organiques. Dans cette thèse, j’ai synthétisé de nouveaux composés carboxylates et aryles de cuivre(I), eg [(phen*)Cu(O₂CAr)] et [(phen*)Cu-Ar] (Ar= aryle), avec un ligand ancillaire azoté volumineux (phen*). Les structures cristallines de ces espèces sont présentées. Ce travail rapporte également mes essais de décarboxylation des complexes [(phen*)Cu(O₂CAr)] ainsi que la réaction inverse d’insertion de CO₂ dans les dérivés aryles. La déshydrogénation de l'acide formique catalysée par le formiate de cuivre [(phen*)Cu(O₂CH)] est également décrite. Différents mécanismes sont proposés pour ces transformations

Development of Quantitative Structure Property relationships to Estimate Occupational Exposure Limit Values

Occupational Exposure Limits (OELs) are representing the amount of a workplace health hazard that most workers can be exposed to without harming their health. There are different OELs such as threshold limit value (TLV of ACGIH), permissible exposure limit (PEL of OSHA), recommended exposure limit (REL of NIOSH) and maximum concentration value in the workplace (MAK of DFG) can be found from different literatures and databases. Perhaps, the database provided by Yaws, (2003) can present various values for organic and inorganic chemicals. However, there are several compounds do not have these values. The traditional way to measure these values are using experimental methods. This is can be costly and time consuming. Therefore, this project intent to develop quantitative structure property relationships to estimate occupational exposure limits values. A new method for the estimation of properties of pure organic compounds is presented. Estimation is performed at three levels. The primary level uses contributions from simple groups that allow describing a wide variety of organic compounds while the higher levels involves poly functional and structural groups that provide more information about molecular fragments whose description through first-order groups is not possible