Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial

OBJECTIVE: To evaluate the cost effectiveness of standard treatment with and without the addition of ward based non-invasive ventilation in patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease. DESIGN: Incremental cost effectiveness analysis of a randomised controlled trial. SETTING: Medical wards in 14 hospitals in the United Kingdom. PARTICIPANTS: The trial comprised 236 patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease and mild to moderate acidosis (pH 7.25-7.35) secondary to respiratory failure. The economic analysis compared the costs of treatment that these patients received after randomisation. MAIN OUTCOME MEASURE: Incremental cost per in-hospital death. RESULTS: 24/118 died in the group receiving standard treatment and 12/118 in the group receiving non-invasive ventilation (P=0.05). Allocation to the group receiving non-invasive ventilation was associated with a reduction in costs of £49 362 ($78 741; 73 109), mainly through reduced use of intensive care units. The incremental cost effectiveness ratio was £645 per death avoided (95% confidence interval £2310 to £386), indicating a dominant (more effective and less costly) strategy. Modelling of these data indicates that a typical UK hospital providing a non-invasive ventilation service will avoid six deaths and three to nine admissions to intensive care units per year, with an associated cost reduction of £12 000-53 000 per year. CONCLUSIONS: Non-invasive ventilation is a highly cost effective treatment that both reduced total costs and improved mortality in hospital

Chiral restoration effects on the shear viscosity of a pion gas

We investigate the shear viscosity of a pion gas in relativistic kinetic theory, using the Nambu-Jona-Lasinio model to construct the pion mass and the pi-pi interaction at finite temperature. Whereas at low temperatures the scattering properties and, hence, the viscosity are in agreement with lowest-order chiral perturbation theory, we find strong medium modifications in the crossover region. Here the system is strongly coupled and the scattering lengths diverge, similarly as for ultra-cold Fermi gases at a Feshbach resonance. As a consequence, the ratio eta/s is found to be strongly reduced as compared to calculations without medium-modified masses and scattering amplitudes. However, the quantitative results are very sensitive to the details of the applied approximations.Comment: 15 pages, 12 figures; v2: extended discussions of the dressed sigma propagator and the low-temperature limit, typos corrected, accepted versio

The relative lung and systemic bioavailability of terbutaline following nebulisation in non-invasively ventilated patients

Nebulising a bronchodilator during non-invasive ventilation (NIV) is effective but there is a lack of consensus on the system to use because comparator in vivo studies in these patients are difficult. Urinary pharmacokinetic methodology post inhalation could provide this information. Chronic obstructive pulmonary disease patients requiring NIV received randomised study doses of either 2 mg terbutaline nebulised from an Aeroneb Pro (AERO) or 5 mg from a Sidestream (SIDE) on days 1 and 3 of admission. Urine samples were provided at 30 min then pooled up to 24 h post inhalation and amounts of urinary terbutaline (UTER0.5 and UTER24; indices of relative lung and systemic bioavailability, respectively) were determined. Twelve consenting patients receiving NIV mean (SD) age and weight of 74.8 (8.2) years and 61.0 (10.7) kg completed the study. The mean (SD) UTER0.5 following AERO and SIDE was 9.4 (3.7) and 10.4 (4.1) μg with a mean ratio (90% confidence interval) of 89.7 (87.8, 92.3)%. UTER24 was 192.3 (52.4) and 205.3 (58.0) mcg with a mean ratio (90% CI) of 93.7 (113.5, 77.3)%. This urinary pharmacokinetic method to identity relative lung and systemic bioavailability between two nebuliser systems was easy to perform and is a useful and simple in vivo method to compare different nebulisers in patients receiving non-invasive ventilation

AgMIP Wheat Pilot Data 4 release

This dataset contains the underlaying data for the study: Benchmark data set for wheat growth models: field experiments and AgMIP multi-model simulations. Open Data Journal for Agricultural Research : ODjAR The data set includes a current representative management treatment from detailed, quality-tested sentinel field experiments with wheat from four contrasting environments including Australia, The Netherlands, India and Argentina. Measurements include local daily climate data (solar radiation, maximum and minimum temperature, precipitation, surface wind, dew point temperature, relative humidity, and vapor pressure), soil characteristics, frequent growth, nitrogen in crop and soil, crop and soil water and yield components. Simulations include results from 27 wheat models and a sensitivity analysis with 26 models and 30 years (1981-2010) for each location, for elevated atmospheric CO2 and temperature changes, a heat stress sensitivity analysis at anthesis, and a sensitivity analysis with soil and crop management variations and a Global Climate Model end-century scenario