Cost-Effectiveness of Internet-Based Self-Management Compared with Usual Care in Asthma

BACKGROUND: Effectiveness of Internet-based self-management in patients with asthma has been shown, but its cost-effectiveness is unknown. We conducted a cost-effectiveness analysis of Internet-based asthma self-management compared with usual care. METHODOLOGY AND PRINCIPAL FINDINGS: Cost-effectiveness analysis alongside a randomized controlled trial, with 12 months follow-up. Patients were aged 18 to 50 year and had physician diagnosed asthma. The Internet-based self-management program involved weekly on-line monitoring of asthma control with self-treatment advice, remote Web communications, and Internet-based information. We determined quality adjusted life years (QALYs) as measured by the EuroQol-5D and costs for health care use and absenteeism. We performed a detailed cost price analysis for the primary intervention. QALYs did not statistically significantly differ between the Internet group and usual care: difference 0.024 (95% CI, -0.016 to 0.065). Costs of the Internet-based intervention were $254 (95$243 to $265) during the period of 1 year. From a societal perspective, the cost difference was$641 (95% CI, $-1957 to$3240). From a health care perspective, the cost difference was $37 (95$-874 to $950). At a willingness-to-pay of$50,000 per QALY, the probability that Internet-based self-management was cost-effective compared to usual care was 62% and 82% from a societal and health care perspective, respectively. CONCLUSIONS: Internet-based self-management of asthma can be as effective as current asthma care and costs are similar. TRIAL REGISTRATION: Current Controlled Trials ISRCTN79864465

Weekly self-monitoring and treatment adjustment benefit patients with partly controlled and uncontrolled asthma: an analysis of the SMASHING study

Background: Internet-based self-management has shown to improve asthma control and asthma related quality of life, but the improvements were only marginally clinically relevant for the group as a whole. We hypothesized that self-management guided by weekly monitoring of asthma control tailors pharmacological therapy to individual needs and improves asthma control for patients with partly controlled or uncontrolled asthma. Methods: In a 1-year randomised controlled trial involving 200 adults (18-50 years) with mild to moderate persistent asthma we evaluated the adherence with weekly monitoring and effect on asthma control and pharmacological treatment of a self-management algorithm based on the Asthma Control Questionnaire (ACQ). Participants were assigned either to the Internet group (n = 101) that monitored asthma control weekly with the ACQ on the Internet and adjusted treatment using a self-management algorithm supervised by an asthma nurse specialist or to the usual care group (UC) (n = 99). We analysed 3 subgroups: patients with well controlled (ACQ ACQ 1.5) asthma at baseline. Results: Overall monitoring adherence was 67% (95% CI, 60% to 74%). Improvements in ACQ score after 12 months were -0.14 (p = 0.23), -0.52 (p < 0.001) and -0.82 (p < 0.001) in the Internet group compared to usual care for patients with well, partly and uncontrolled asthma at baseline, respectively. Daily inhaled corticosteroid dose significantly increased in the Internet group compared to usual care in the first 3 months in patients with uncontrolled asthma (+278 mu g, p = 0.001), but not in patients with well or partly controlled asthma. After one year there were no differences in daily inhaled corticosteroid use or long-acting beta(2)-agonists between the Internet group and usual care. Conclusions: Weekly self-monitoring and subsequent treatment adjustment leads to improved asthma control in patients with partly and uncontrolled asthma at baseline and tailors asthma medication to individual patients' needs.Pathogenesis and treatment of chronic pulmonary disease

Nonquasiparticle states in half-metallic ferromagnets

Anomalous magnetic and electronic properties of the half-metallic ferromagnets (HMF) have been discussed. The general conception of the HMF electronic structure which take into account the most important correlation effects from electron-magnon interactions, in particular, the spin-polaron effects, is presented. Special attention is paid to the so called non-quasiparticle (NQP) or incoherent states which are present in the gap near the Fermi level and can give considerable contributions to thermodynamic and transport properties. Prospects of experimental observation of the NQP states in core-level spectroscopy is discussed. Special features of transport properties of the HMF which are connected with the absence of one-magnon spin-flip scattering processes are investigated. The temperature and magnetic field dependences of resistivity in various regimes are calculated. It is shown that the NQP states can give a dominate contribution to the temperature dependence of the impurity-induced resistivity and in the tunnel junction conductivity. First principle calculations of the NQP-states for the prototype half-metallic material NiMnSb within the local-density approximation plus dynamical mean field theory (LDA+DMFT) are presented.Comment: 27 pages, 9 figures, Proceedings of Berlin/Wandlitz workshop 2004; Local-Moment Ferromagnets. Unique Properties for Moder Applications, ed. M. Donath, W.Nolting, Springer, Berlin, 200

High-dimensional maximum marginal likelihood item factor analysis by adaptive quadrature

Although the Bock–Aitkin likelihood-based estimation method for factor analysis of dichotomous item response data has important advantages over classical analysis of item tetrachoric correlations, a serious limitation of the method is its reliance on fixed-point Gauss-Hermite (G-H) quadrature in the solution of the likelihood equations and likelihood-ratio tests. When the number of latent dimensions is large, computational considerations require that the number of quadrature points per dimension be few. But with large numbers of items, the dispersion of the likelihood, given the response pattern, becomes so small that the likelihood cannot be accurately evaluated with the sparse fixed points in the latent space. In this paper, we demonstrate that substantial improvement in accuracy can be obtained by adapting the quadrature points to the location and dispersion of the likelihood surfaces corresponding to each distinct pattern in the data. In particular, we show that adaptive G-H quadrature, combined with mean and covariance adjustments at each iteration of an EM algorithm, produces an accurate fast-converging solution with as few as two points per dimension. Evaluations of this method with simulated data are shown to yield accurate recovery of the generating factor loadings for models of upto eight dimensions. Unlike an earlier application of adaptive Gibbs sampling to this problem by Meng and Schilling, the simulations also confirm the validity of the present method in calculating likelihood-ratio chi-square statistics for determining the number of factors required in the model. Finally, we apply the method to a sample of real data from a test of teacher qualifications.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43596/1/11336_2003_Article_1141.pd

Population change of Common Buzzards Buteo buteo in central southern England between 2011 and 2016

Capsule: Distance sampling identified an increase in estimated population size of Common Buzzards Buteo buteo in central southern England between 2011 and 2016 of more than 50%. The rate of population growth slowed in later years. Aims: To assess the utility of a targeted distance sampling protocol to derive seasonal and annual population estimates for Common Buzzards across an area of southern England. Methods: We used a line transect survey methodology and multiple covariate distance sampling to assess population density and abundance of Common Buzzards in spring and autumn between 2011 and 2016 across a 2600 km2 area of central southern England. Results: Estimated population size increased by more than 50%, from approximately 2900 to 4500 individuals, across the period in a trend similar to that shown by Breeding Bird Survey data. Discussion: A slowing of the growth in population size of Common Buzzards in central southern England suggests that the species may be approaching carrying capacity in this area. These results also suggest that currently employed broad scale survey methodologies adequately reflect the general population trends for this species. Our data provide the first published estimates of the Common Buzzard population in central southern England derived from direct empirical assessment