Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service

Introduction: In the UK, there is significant variation in respiratory care and outcomes. An integrated approach to the management of high-risk respiratory patients, incorporating specialist and primary care teams' expertise, is the basis for new integrated respiratory services designed to reduce this variation; however, this model needs evaluating.Methods: To evaluate an integrated service managing high-risk respiratory patients, electronic searches for patients with asthma and chronic obstructive pulmonary disease at risk of poor outcomes were performed in two general practitioner (GP) practices in a local service-development initiative. Patients were reviewed at joint clinics by primary and secondary care professionals. GPs also nominated patients for inclusion. Reviews were delivered to best standards of care including assessments of diagnosis, control, spirometry, self-management, education, medication, inhaler technique and smoking cessation support. Follow-up of routine clinical data collected at 9-months postclinic were compared with seasonally matched 9-months prior to integrated review.Results: 82 patients were identified, 55 attended. 13 (23.6%) had their primary diagnosis changed. In comparison with the seasonally adjusted baseline period, in the 9-month follow-up there was an increase in inhaled corticosteroid prescriptions of 23.3%, a reduction in short-acting β2-agonist prescription of 33.3%, a reduction in acute respiratory exacerbations of 67.6%, in unscheduled GP surgery visits of 53.3% and acute respiratory hospital admissions reduced from 3 to 0. Only 4 patients (7.3%) required referral to secondary care. Health economic evaluation showed respiratory-related costs per patient reduced by £231.86.Conclusions: Patients with respiratory disease in this region at risk of suboptimal outcomes identified proactively and managed by an integrated team improved outcomes without the need for hospital referral

Information transmission in energy futures markets

Since the mid 1980s the world oil price discovery process has been dominated by two crude oil futures markets: the New York Mercantile Exchange (NYMEX) and London's International Petroleum Exchange (IPE). To date considerable work has been done to scrutinize the degree to which these two markets price efficiently, but little with regard to the way the two markets interact. It is the first attempt, to our knowledge, to investigate the interaction of the two markets. Given that participants in these markets move with relative ease from one market to the other and usually take positions in both of them, prices of these two leading crudes are kept closely related to each other. It is of interest, therefore, to investigate the speed of information. transmission between IPE and NYMEX and, perhaps, identify which market is the true price leader. To carry out this empirical investigation, simultaneous and non-simultaneous trading sessions of IPE and NYMEX are examined separately. Interesting findingsare disclosed. Firstly, non-simultaneous trading sessions of IPE (IPE morning session) and NYMEX are analyzed with univariate and multivariate time series analysis respectively. In univariate analysis, spillover effects in mean returns are found in the IPE morning session from previous day NYMEX trading information, while no information transmission is found from IPE morning session to NYMEX same-day trading. In multivariate time series analysis with a larger data set, estimation using all data available suggests different results from that used in univariate analysis. However, closer analysis on sub-period estimation reveals consistent findings: the results from the first sub-period, which has the same observation data as in the univariate analysis, mirror those from univariate analysis; results from the second sub-period with extended data have a largely different behaviour from the first sub-period. It thus can be implied that the estimated results using all available information are averages of the behaviour of the two sub-periods. This changing behaviour from one sub-period to the next points to a possible structural break between the two sub-periods. Given that there are no significant political forces, such as "oil shocks", taking place during the period under investigation, the changing forces must be coming from the markets themselves. Secondly, the simultaneous trading session of IPE and NYMEX is examined to detect the temporal lead-lag relationship between the two futures markets using 5minute intervals. Results indicate a bi-directional relationship between the two, however the lead ofNYMEX futures is dominant within 5-minute intervals. Further analyses under major news effects both on the supply side and demand side reveal: (1) the two markets move closer when there are major US news events taking place, and IPE is more efficient in information incorporation when there are major news events both on the supply and the demand sides; (2) the lead ofNYMEX is stronger when there are major US events and that of IPE is stronger when there are major supply side events. Finally, intra-day trading activities of IPE are examined using the tick-by-tick transaction data. Empirical evidence from diurnal factor (intra-day seasonality), and from ACD model suggests that the patterns of IPE morning and afternoon durations are distinctively different from each other. These findings suggest that NYMEX has a large impact on IPE trading. Empirical findings in this thesis imply that NYMEX is a leader in the information incorporation process, but the extent of this leadership changes dynamically; under different news effects as well as different time periods. These results would impose significant challenges to regulators, in today's global market, to keep their market competitive as well as prudent. They should also benefit hedgers, who after taking into account their hedging implementation criteria such as liquidity, may be able to benefit from the faster information transmission ability of the leading market by directly taking hedging positions using the leading market contracts. The users most likely to benefit from the above findings are traders, who may be able to take arbitrage profits after taking into account trading costs, borrowing costs, etc

Recent Progress of the Application of Electropolymerization in Batteries and Supercapacitors Specific Design of Functions in Electrodes

Electrochemical energy storage devices play a vital role in human life, and the requirements for their sustainability and environmental friendliness have been increasing in recent years. Electropolymerization, as a convenient method for polymer synthesis, has attracted increasing attentions in applications in the field of energy storage and conversion. It is not only commonly employed for the fabrication of various self supporting electrodes, but also is one of the most promising preparation strategies for organic electrode materials, internal interlayers within electrodes, functional protective layers, and current collector surface modifications. Previously published works have confirmed that the introduction of electropolymerization can effectively improve the electrochemical performance of various energy storage devices. However, there are still challenges in the universality of the synthesis route, in depth understanding of interface chemical behavior, and scaled up production. This mini review summarizes the main components in electropolymerization, material synthesis mechanisms, and their application principles in batteries and supercapacitors. Additionally, the current challenges and future development directions of electropolymerization have been discussed, offering some perspectives for further exploratio

Search for Heavy Neutral and Charged Leptons in e+ e- Annihilation at LEP

A search for exotic unstable neutral and charged heavy leptons as well as for stable charged heavy leptons is performed with the L3 detector at LEP. Sequential, vector and mirror natures of heavy leptons are considered. No evidence for their existence is found and lower limits on their masses are set

Search for an invisibly decaying Higgs boson in e^+e^- collisions at \sqrt{s} = 183 - 189 GeV

A search for a Higgs boson decaying into invisible particles is performed using the data collected at LEP by the L3 experiment at centre-of-mass energies of 183 GeV and 189 GeV. The integrated luminosities are respectively 55.3 pb^-1 and 176.4 pb^-1. The observed candidates are consistent with the expectations from Standard Model processes. In the hypothesis that the production cross section of this Higgs boson equals the Standard Model one and the branching ratio into invisible particles is 100%, a lower mass limit of 89.2 GeV is set at 95% confidence level

Search for Extra Dimensions in Boson and Fermion Pair Production in e+e- Interactions at LEP

Extra spatial dimensions are proposed by recent theories that postulate the scale of gravity to be of the same order as the electroweak scale. A sizeable interaction between gravitons and Standard Model particles is then predicted. Effects of these new interactions in boson and fermion pair production are searched for in the data sample collected at centre-of-mass energies above the Z pole by the L3 detector at LEP. In addition, the direct production of a graviton associated with a Z boson is investigated. No statistically significant hints for the existence of these effects are found and lower limits in excess of 1 TeV are derived on the scale of this new theory of gravity

Higgs Candidates in e+e- Interactions at root(s) = 206.6 GeV

In a search for the Standard Model Higgs boson, carried out on 212.5 pb-1 of data collected by the L3 detector at the highest LEP centre-of-mass energies, including 116.5 pb-1 above root(s) = 206GeV, an excess of candidates for the process e+e- -> Z* -> HZ is found for Higgs masses near 114.5GeV. We present an analysis of our data and the characteristics of our strongest candidates.Comment: Footnote added, matches the version to be published in Physics Letters

Measurement of Hadron and Lepton-Pair Production at 130GeV < \sqrt{s} < 189 GeV at LEP

We report on measurements of e+e- annihilation into hadrons and lepton pairs. The data have been collected with the L3 detector at LEP at centre-of-mass energies between 130 and 189 GeV. Using a total integrated luminosity of 243.7 pb^-1, 25864 hadronic and 8573 lepton-pair events are selected for the measurement of cross sections and leptonic forward-backward asymmetries. The results are in good agreement with Standard Model predictions

Measurement of the Tau Branching Fractions into Leptons

Using data collected with the L3 detector near the Z resonance, corresponding to an integrated luminosity of 150pb-1, the branching fractions of the tau lepton into electron and muon are measured to be B(tau->e nu nu) = (17.806 +- 0.104 (stat.) +- 0.076 (syst.)) %, B(tau->mu nu nu) = (17.342 +- 0.110 (stat.) +- 0.067 (syst.)) %. From these results the ratio of the charged current coupling constants of the muon and the electron is determined to be g_mu/g_e = 1.0007 +- 0.0051. Assuming electron-muon universality, the Fermi constant is measured in tau lepton decays as G_F = (1.1616 +- 0.0058) 10^{-5} GeV^{-2}. Furthermore, the coupling constant of the strong interaction at the tau mass scale is obtained as alpha_s(m_tau^2) = 0.322 +- 0.009 (exp.) +- 0.015 (theory)

Search for Manifestations of New Physics in Fermion-Pair Production at LEP

The measurements of hadron and lepton-pair production cross sections and leptonic forward-backward asymmetries performed with the L3 detector at centre-of-mass energies between 130 GeV and 189 GeV are used to search for new physics phenomena such as: contact interactions, exchange of virtual leptoquarks, scalar quarks and scalar neutrinos, effects of TeV strings in models of quantum gravity with large extra dimensions and non-zero sizes of the fermions. No evidence for these phenomena is found and new limits on their parameters are set