Approaches to modelling the cost-effectiveness of interventions for heart failure: a systematic review

Poster presentationOBJECTIVES: To review modelling methods used to assess the cost-effectiveness of interventions for heart failure (HF). METHODS: A systematic search of the literature up to September 2016 across Medline, Embase, Cochrane Library, EconLit and CINAHL databases. We included studies that reported a model-based evaluation, including both costs and health impacts, of a HF intervention. Studies reporting only cost-effectiveness analyses alongside a clinical trial were excluded. RESULTS: We identified 54 publications describing 52 economic models associated with HF interventions. The model-based evaluations comprised surgical (n=20), medical (n=16), service-level (e.g. telehealth, specialist clinics) (n=9) or screening-/monitoring-type interventions (n=4), or assessed disease management (n=2). One study compared multiple interventions. The most common modelling framework was a Markov cohort method (n=41); with models predominantly modelling disease progression via New York Heart Association grade or using a simple two-state (alive/dead) model. Several studies additionally included transition states for hospitalisation events. Two studies adapted the Markov cohort approach for sub-group analyses using risk equations. Eight studies reported a patient-level discrete event simulation approach, and four studies were decision trees. Key structural inputs to model development were data used to model mortality and to predict hospital admissions. CONCLUSIONS: A range of modelling approaches have been used successfully to assess the cost-effectiveness of HF interventions. Whilst the simple Markov cohort approach appears appropriate for the decision problem stated in most cases (i.e. estimating cost effectiveness), other methods have been used to good effect. To date modelling has not addressed the specific nature of the impact of HF on quality of life/ wellbeing, other than via use of NYHA and/or impact of hospital admissions. Future modelling may further consider this through use of natural history states using health states informed by health outcome measures commonly used in HF.This work was carried out as part of the REACH-HF trial, an independent research programme funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research scheme (Reference Number RP-PG-1210-12004

A Sensor Failure Simulator for Control System Reliability Studies

A real-time Sensor Failure Simulator (SFS) was designed and assembled for the Advanced Detection, Isolation, and Accommodation (ADIA) program. Various designs were considered. The design chosen features an IBM-PC/XT. The PC is used to drive analog circuitry for simulating sensor failures in real-time. A user defined scenario describes the failure simulation for each of the five incoming sensor signals. Capabilities exist for editing, saving, and retrieving the failure scenarios. The SFS has been tested closed-loop with the Controls Interface and Monitoring (CIM) unit, the ADIA control, and a real-time F100 hybrid simulation. From a productivity viewpoint, the menu driven user interface has proven to be efficient and easy to use. From a real-time viewpoint, the software controlling the simulation loop executes at greater than 100 cycles/sec

From gas to galaxies

The unsurpassed sensitivity and resolution of the Square Kilometer Array (SKA) will make it possible for the first time to probe the continuum emission of normal star forming galaxies out to the edges of the universe. This opens the possibility for routinely using the radio continuum emission from galaxies for cosmological research as it offers an independent probe of the evolution of the star formation density in the universe. In addition it offers the possibility to detect the first star forming objects and massive black holes. In deep surveys SKA will be able to detect HI in emission out to redshifts of $z \approx 2.5$ and hence be able to trace the conversion of gas into stars over an era where considerable evolution is taking place. Such surveys will be able to uniquely determine the respective importance of merging and accreting gas flows for galaxy formation over this redshift range (i.e. out to when the universe was only one third its present age). It is obvious that only SKA will able to see literally where and how gas is turned into stars. These and other aspects of SKA imaging of galaxies will be discussed.Comment: To be published in New Astronomy Reviews, Elsevier, Amsterdam as part of "Science with the Square Kilometre Array", eds. C. Carilli and S. Rawlings. 18 pages + 13 figures; high resolution version and other chapters of "Science with the Square Kilometre Array" available at http://www.skatelescope.org/pages/science_gen.ht

HI in four star-forming low-luminosity E/S0 and S0 galaxies

We present HI data cubes of four low-luminosity early-type galaxies which are currently forming stars. These galaxies have absolute magnitudes in the range M_B=-17.9 to -19.9 (H_o=50 km/s/Mpc). Their HI masses range between a few times 10^8 and a few times 10^9 M_sun and the corresponding values for M_HI/L_B are between 0.07 and 0.42, so these systems are HI rich for their morphological type. In all four galaxies, the HI is strongly centrally concentrated with high central HI surface densities, in contrast to what is typically observed in more luminous early-type galaxies. In two galaxies (NGC 802 and ESO 118-G34), the kinematics of the HI suggests that the gas is in a strongly warped disk, which we take as evidence for recent accretion of HI. In the other two galaxies (NGC 2328 and ESO 027-G21) the HI must have been part of the systems for a considerable time. The HI properties of low-luminosity early-type galaxies appear to be systematically different from those of many more luminous early-type galaxies, and we suggest that these differences are due to a different evolution of the two classes. The star formation history of these galaxies remains unclear. Their UBV colours and Halpha emission-line strengths are consistent with having formed stars at a slowly-declining rate for most of the past 10^10 years. However, the current data do not rule out a small burst of recent star formation overlaid on an older stellar population.Comment: To appear in AJ, LateX, figures in gif format, paper also available at http://www.nfra.nl/~morganti/LowLu

From treebank resources to LFG F-structures

We present two methods for automatically annotating treebank resources with functional structures. Both methods define systematic patterns of correspondence between partial PS configurations and functional structures. These are applied to PS rules extracted from treebanks, or directly to constraint set encodings of treebank PS trees

What Powers the Compact Radio Emission in Nearby Elliptical and S0 Galaxies?

Many nearby early-type (elliptical and S0) galaxies contain weak (milli-Jansky level) nuclear radio sources on scales a few hundred parsecs or less. The origin of the radio emission, however, has remained unclear, especially in volume-limited samples that select intrinsically less luminous galaxies. Both active galactic nuclei and nuclear star formation have been suggested as possible mechanisms for producing the radio emission. This paper utilizes optical spectroscopic information to address this issue. A substantial fraction of the early-type galaxies surveyed with the Very Large Array by Wrobel & Heeschen (1991) exhibits detectable optical emission lines in their nuclei down to very sensitive limits. Comparison of the observed radio continuum power with that expected from the thermal gas traced by the optical emission lines implies that the bulk of the radio emission is nonthermal. Both the incidence and the strength of optical line emission correlate with the radio power. At a fixed line luminosity, ellipticals have stronger radio cores than S0s. The relation between radio power and line emission observed in this sample is consistent with the low-luminosity extension of similar relations seen in classical radio galaxies and luminous Seyfert nuclei. A plausible interpretation of this result is that the weak nuclear sources in nearby early-type galaxies are the low-luminosity counterparts of more powerful AGNs. The spectroscopic evidence supports this picture. Most of the emission-line objects are optically classified as Seyfert nuclei or low-ionization nuclear emission-line regions (LINERs), the majority of which are likely to be accretion-powered sources.Comment: LaTex, 16 pages including embedded figures. Accepted for publication in the Astrophysical Journa

Psychiatric Diagnoses in Patients with Williams Syndrome and Their Families

Williams Syndrome (WS) is a genetic disorder associated with mental retardation (MR) and a distinct behavioral phenotype including a friendly and outgoing personality. This population, like others with MR, has been reported to have an increased rate of symptoms of mental illness; however, few studies have used DSM-IV criteria to quantify specific psychiatric diagnoses in WS and the prevalence of psychiatric illness in relatives of individuals with WS and the possible relationship between family and patient diagnoses is currently unknown. Methods: Twenty-one families participated; the patients’ average age was 16 years. DSM-IV diagnoses were applied by using the Anxiety Disorders Interview Schedule (ADIS, Parent and Child Versions) and the Family History Screen. Results: A diagnosis from the ADIS was applicable to 13 patients (62%), and in 16 patients (76%) a diagnosis was applicable in their first-degree family members. Ten patients (48%) had some form of anxiety, specific phobia being the most common. Three patients (14%) had major depressive disorder and 9 patients (43%) had attention-deficit/hyperactivity disorder (ADHD). The presence of anxiety or mood disorders in patients with WS and the presence of these disorders in their family members were unrelated. Conclusions: Patients with WS have a high prevalence of anxiety disorders and of ADHD. The presence of psychiatric disorders in WS did not appear to have a significant relationship to family history of psychiatric disorders, consistent with the hypothesis that the specific genetic alteration in WS causes, or contributes to causing, the anxiety disorders and the ADHD that are so common in the disorder

A full free spectral range tuning of p-i-n doped Gallium Nitride microdisk cavity

Effective, permanent tuning of the whispering gallery modes (WGMs) of p-i-n doped GaN microdisk cavity with embedded InGaN quantum dots over one free spectral range is successfully demonstrated by irradiating the microdisks with a ultraviolet laser (380nm) in DI water. For incident laser powers between 150 and 960 nW, the tuning rate varies linearly. Etching of the top surface of the cavity is proposed as the driving force for the observed shift in WGMs, and is supported by experiments. The tuning for GaN/InGaN microdisk cavities is an important step for deterministically realizing novel nanophotonic devices for studying cavity quantum electrodynamics