Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>There is a considerable public health burden due to physical inactivity, because it is a major independent risk factor for several diseases (e.g., type 2 diabetes, cardiovascular disease, moderate mood disorders neurotic diseases such as depression, etc.). This study assesses the cost utility of the adding a supervised walking programme to the standard "best primary care" for overweight, moderately obese, or moderately depressed elderly women.</p> <p>Methods</p> <p>One-hundred six participants were randomly assigned to an interventional group (n = 55) or a control group (n = 51). The intervention consisted of an invitation, from a general practitioner, to participate in a 6-month walking-based, supervised exercise program with three 50-minute sessions per week. The main outcome measures were the healthcare costs from the Health System perspective and quality adjusted life years (QALYs) using EuroQol (EQ-5D.)</p> <p>Results</p> <p>Of the patients invited to participate in the program, 79% were successfully recruited, and 86% of the participants in the exercise group completed the programme. Over 6 months, the mean treatment cost per patient in the exercise group was €41 more than "best care". The mean incremental QALY of intervention was 0.132 (95% CI: 0.104–0.286). Each extra QALY gained by the exercise programme relative to best care cost €311 (95% CI, €143–€394). The cost effectiveness acceptability curves showed a 90% probability that the addition of the walking programme is the best strategy if the ceiling of inversion is €350/QALY.</p> <p>Conclusion</p> <p>The invitation strategy and exercise programme resulted in a high rate of participation and is a feasible and cost-effective addition to best care. The programme is a cost-effective resource for helping patients to increase their physical activity, according to the recommendations of general practitioners. Moreover, the present study could help decision makers enhance the preventive role of primary care and optimize health care resources.</p> <p>Trial Registration</p> <p>[ISRCTN98931797]</p

Colorless devices and reception techniques for polarization multiplexed communications

Future optical networks call for flexible, high performance and low cost coherent optical receivers. We present here several advances towards such receivers, including integrated optical couplers with ultra-broad bandwidth, as well as novel reception techniques and architectures that will enable high performance coherent reception without filtering and polarization splitting elements.Universidad de Málaga - Campus de Excelencia Internacional Andalucía Tech. Spanish Ministry of Science under project TEC2013-46917-C2-1-

Greater loss and fragmentation of savannas than forests over the last three decades in Yunnan Province, China

Yunnan Province, southwest China, has a monsoonal climate suitable for a mix of fire-driven savannas and fire-averse forests as alternate stable states, and has vast areas with savanna physiognomy. Presently, savannas are only formally recognised in the dry valleys of the region, and a no-fire policy has been enforced nationwide since the 1980s. Misidentification of savannas as forests may have contributed to their low protection level and fire-suppression may be contributing to vegetation change towards forest states through woody encroachment. Here, we present an analysis of vegetation and land-use change in Yunnan for years 1986, 1996, 2006, and 2016 by classifying Landsat imagery using a hybrid of unsupervised and supervised classification. We assessed how much savanna area had changed over the 3 decades (area loss, fragmentation), and of this how much was due to direct human intervention versus vegetation transition. We also assessed how climate (mean annual temperature, aridity), landscape accessibility (slope, distance to roads), and fire had altered transition rates. Our classification yielded accuracy values of 77.89%, 82.16%, 94.93%, and 86.84% for our four maps, respectively. In 1986, savannas had the greatest area of any vegetation type in Yunnan at 40.30%, whereas forest cover was 30.78%. Savanna coverage declined across the decades mainly due to a drop in open parkland savannas, while forest cover remained stable. Savannas experienced greater fragmentation than forests. Savannas suffered direct loss of coverage to human uses and to woody encroachment. Savannas in more humid environments switched to denser vegetation at a higher rate. Fire slowed the rate of conversion away from savanna states and promoted conversion towards them. We identified remaining savannas in Yunnan that can be considered when drafting future protected areas. Our results can inform more inclusive policy-making that considers Yunnan\u27s forests and savannas as distinct vegetation types with different management needs

FPGA Implementation of a Telecommunications Trainer System

Field programmable gate arrays (FPGAs) have been used in a wide range of applications including the field of telecommunications. This paper presents the use of FPGAs in the implementation of both analog and digital modulation that includes amplitude modulation, frequency modulation, phase modulation, pulse code modulation, pulse width modulation, pulse position modulation, pulse amplitude modulation, delta modulation, amplitude shift keying, frequency shift keying, phase shift keying, time division multiplexing and different encoding techniques like non-return-to-zero line code, non-return-to-zero mark line code, non-return to zero inversion line code, Unipolar return-to-zero line code, bipolar return-to-zero line code, alternate mark inversion line code, and Manchester line code. Moreover, an FPGA can be designed to emulate a particular device like an oscilloscope, a function generator, or the like. This paper describes the capability of an FPGA to internally generate a low frequency input signal and through the use of a VGA port, it is able to display the signals in an output device. However, the use of FPGAs is not limited to the aforementioned applications because of its reconfigurability and reprogrammability

Analyzing the Socio-economic Impacts of Mining with Propensity Score Matching (PSM): Insights for Responsible Mining in Caraga Region, Philippines

Propensity-score matching (PSM) is an estimation procedure used in this study to address selection bias and endogeneity to obtain robust results in determining the impacts of mining on the socio-economic condition of the people in the mining areas of Caraga Region, Philippines. This study has used it with three matching methods (nearest neighbor, kernel and radius matching) to come up with implications on the socio-economic underpinnings of responsible mining for the region. The impacts of mining in this study are signified by the significance of average treatment effects on the treated (ATT) for each of the socio-economic parameters of the households under study. Consistently, the results demonstrate increased borrowing in the mining areas of the region.  Results of radius matching have indicated increase in investment for human capital buildup, as implied by the increase in food and education expenditures. There are also manifestations of in-migration and efforts on the part of mining to participate in the improvement of accessibility condition through the provision of paved roads. Yet, the results signify that there is yet a need to work for the improvement of the quality of life as perceived by the households in the mining areas.  This study has recommended intensified efforts towards human development, entrepreneurship and pollution control, especially that responsible mining is to build the resilience of people to natural hazards for sustainable development in Caraga Region, Philippines. Keywords: propensity-score matching, nearest neighbor, kernel and radius matching, AT

Lower urinary tract symptoms secondary to a vaginal leiomioma the female prostate: case report

This is a case report of lower urinary tract symptoms secondary to a vaginal leiomioma “the female prostate”. A 45-year-old female patient with no significant personal history, sensation of a vaginal foreign body accompanied by lower urinary tract symptoms, on vaginal physical examination with a 7×7 cm deep tumor, increased consistency, not painful, without hemorrhage. Magnetic resonance imaging with hypointense T1 and T2 images, few linear hyperintense areas in T2, homogeneous postgadolinium enhancement 69×66×53 mm, solid tumor dependent on the vaginal vault. Tumor markers CA 19-9: 5.98 U/ml, CEA: 1.09 ng/ml and CA 125: 11.73 U/ml. Open surgery was performed in which a 8×6 cm tumor was found in the vaginal vault dependent on the posterior wall of the vagina. Histopathological report: conventional leiomyoma measuring 9×7.5 cm in long axes, without nuclear atypia. With resolution of symptoms in the lower urinary tract, with normal urinary frequency, without presence of urgency, without urinary incontinence or voiding symptoms. It is important to identify and diagnose lower urinary tract symptoms always, since they could be an initial manifestation of pelvic tumors in which the treatment approach should not be delayed.

ExoMars Raman Laser Spectrometer RLS, a tool for the potential recognition of wet target craters on Mars

In the present work, NIR, LIBS, Raman and XRD techniques have been complementarily used to carry out a comprehensive characterization of a terrestrial analogue selected from the Chesapeake Bay Impact Structure (CBIS). The obtained data clearly highlight the key role of Raman spectroscopy in the detection of minor and trace compounds, through which inferences about geological processes occurred in the CBIS can be extrapolated. Beside the use of commercial systems, further Raman analyses were performed by the Raman Laser Spectrometer (RLS) ExoMars Simulator. This instrument represents the most reliable tool to effectively predict the scientific capabilities of the ExoMars/Raman system that will be deployed on Mars in 2021. By emulating the analytical procedures and operational restrictions established by the ExoMars mission rover design, it was proved that the RLS ExoMars Simulator is able to detect the amorphization of quartz, which constitutes an analytical clue of the impact origin of craters. On the other hand, the detection of barite and siderite, compounds crystallizing under hydrothermal conditions, helps to indirectly confirm the presence of water in impact targets. Furthermore, the RLS ExoMars Simulator capability of performing smart molecular mappings was also evaluated. According to the obtained results, the algorithms developed for its operation provide a great analytical advantage over most of the automatic analysis systems employed by commercial Raman instruments, encouraging its application for many additional scientific and commercial purposes

Throughput and Power Consumption Comparisons of Zigbee-based and ISM-based Implementations of WSAN

Wireless sensor and actuator networks have expanding applications which requires better throughput, power efficiency and cost effectiveness. This study intends to contribute to the growing pool of knowledge on WSAN especially in the design for novel applications such as image or video over WSANs, and solar energy and RF energy harvesting for the WSAN nodes. Two basic scalable wireless sensor and actuator networks were implemented and characterized in terms of throughput and power consumption. The two WSANs are the Zigbee-based WSAN which is based on the IEEE 802.15.4 protocol, and the ISM-based Zigbee which makes use of the industrial, scientific and medical (ISM) radio bands. The star topology was used for both WSAN implementations. The throughput is quantified with varied factors including distance from node to node, obstructions in between nodes and cochannel interference. As distance and obstructions between nodes are increased, the throughput for both networks decreases with varying degrees. Co-channel interference is also considered. The ISM-based WSAN network is weak in dealing with co-channel interference and error rate as compared to the Zigbee-based WSAN, thus requiring it to have a better data encryption. Power consumption is generally larger for the ISM-based WSAN as compared to its Zigbee-based counterpart. However, the ISM-based nodes consume the same power even up to a few hundreds of meters distance and are thus practical for covering large distances. Therefore, the Zigbee-based WSAN system is more appropriate for closed environment, such as in room automation and home automation applications where distance from node to node is relatively shorter. The ISMbased WSAN prototype, on the other hand, can be developed further for applications in larger areas such as deployment in fields and cities, since transmission is not generally limited by distance and obstructions