Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation.

OBJECTIVE: To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis. DESIGN: Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis. SETTING: London, United Kingdom. Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London's enhanced tuberculosis surveillance system. MAIN OUTCOME MEASURES: Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service. RESULTS: The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10,000/QALY gained (about €7300-€11,000 or $10,000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18,000-£26,000/QALY gained; case management support team, £4100-£6800/QALY gained). CONCLUSIONS: Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance

New consistency index based on inertial operating speed

The occurrence of road crashes depends on several factors, with design consistency (i.e., conformance of highway geometry to drivers' expectations) being one of the most important. A new consistency model for evaluating the performance of tangent-to-curve transitions on two-lane rural roads was developed. This model was based on the inertial consistency index (ICI) defined for each transition. The ICI was calculated at the beginning point of the curve as the difference between the average operating speed on the previous 1-km road segment (inertial operating speed) and the actual operating speed at this point. For the calibration of the ICI and its thresholds, 88 road segments, which included 1,686 tangent-to-curve transitions, were studied. The relationship between those results and the crash rate associated with each transition was analyzed. The results showed that the higher the ICI was, the higher the crash rate; thus, the probability of accidents increased. Similar results were obtained from the study of the relationship between the ICI and the weighted average crash rate of the corresponding group of transitions. A graphical and statistical analysis established that road consistency might be considered good when the ICI was lower than 10 km/h, poor when the ICI was higher than 20 km/h, and fair otherwise. A validation process that considered 20 road segments was performed. The ICI values obtained were highly correlated to the number of crashes that had occurred at the analyzed transitions. Thus, the ICI and its consistency thresholds resulted in a new approach for evaluation of consistency.The authors thank the Center for Studies and Experimentation of Public Works of the Spanish Ministry of Public Works, which partially subsidized the data collection, for obtaining the empirical operating speed profiles used in the validation process. The authors also thank the General Directorate of Public Works of the Infrastructure and Transportation Department of the Valencian government, the Valencian Province Council, and the General Directorate of Traffic of the Ministry of the Interior of the Government of Spain for their cooperation in data gathering.García García, A.; Llopis Castelló, D.; Camacho Torregrosa, FJ.; Pérez Zuriaga, AM. (2013). New consistency index based on inertial operating speed. Transportation Research Record. (2391):105-112. doi:10.3141/2391-10S1051122391Ng, J. C. ., & Sayed, T. (2004). Effect of geometric design consistency on road safety. Canadian Journal of Civil Engineering, 31(2), 218-227. doi:10.1139/l03-090Gibreel, G. M., Easa, S. M., Hassan, Y., & El-Dimeery, I. A. (1999). State of the Art of Highway Geometric Design Consistency. Journal of Transportation Engineering, 125(4), 305-313. doi:10.1061/(asce)0733-947x(1999)125:4(305)Hassan, Y. (2004). Highway Design Consistency: Refining the State of Knowledge and Practice. Transportation Research Record: Journal of the Transportation Research Board, 1881(1), 63-71. doi:10.3141/1881-08Polus, A., & Mattar-Habib, C. (2004). New Consistency Model for Rural Highways and Its Relationship to Safety. Journal of Transportation Engineering, 130(3), 286-293. doi:10.1061/(asce)0733-947x(2004)130:3(286)Cafiso, S., Di Graziano, A., Di Silvestro, G., La Cava, G., & Persaud, B. (2010). Development of comprehensive accident models for two-lane rural highways using exposure, geometry, consistency and context variables. Accident Analysis & Prevention, 42(4), 1072-1079. doi:10.1016/j.aap.2009.12.015Zuriaga, A. M. P., García, A. G., Torregrosa, F. J. C., & D’Attoma, P. (2010). Modeling Operating Speed and Deceleration on Two-Lane Rural Roads with Global Positioning System Data. Transportation Research Record: Journal of the Transportation Research Board, 2171(1), 11-20. doi:10.3141/2171-0

An exploratory genome-wide analysis of genetic risk for alcoholic hepatitis

To elucidate the genetic variability between heavy drinkers with and without alcoholic hepatitis

1951: Abilene Christian College Bible Lectures - Full Text

Delivered in the Auditorium of Abilene Christian College Abilene, Texas February 18-22, 1951 Price, $3.00 FIRM FOUNDATION PUBLISHING HOUSE Austin, Texa

1959: Abilene Christian College Bible Lectures - Full Text

UNTO ALL THE WORLD” Being the Abilene Christian College Annual Bible Lectures 1959 Price: $3.00 Published by FIRM FOUNDATION PUBLISHING HOUSE Box 77 Austin, Texa

WETMETH 1.0: A New Wetland Methane Model for Implementation in Earth System Models

Wetlands are the single largest natural source of methane (CH4), a powerful greenhouse gas affecting the global climate. In turn, wetland CH4 emissions are sensitive to changes in climate conditions such as temperature and precipitation shifts. However, biogeochemical processes regulating wetland CH4 emissions (namely microbial production and oxidation of CH4) are not routinely included in fully coupled Earth system models that simulate feedbacks between the physical climate, the carbon cycle, and other biogeochemical cycles. This paper introduces a process-based wetland CH4 model (WETMETH) developed for implementation in Earth system models and currently embedded in an Earth system model of intermediate complexity. Here, we (i) describe the wetland CH4 model, (ii) evaluate the model performance against available datasets and estimates from the literature, and (iii) analyze the model sensitivity to perturbations of poorly constrained parameters. Historical simulations show that WETMETH is capable of reproducing mean annual emissions consistent with present-day estimates across spatial scales. For the 2008–2017 decade, the model simulates global mean wetland emissions of 158.6 Tg CH4 yr−1, of which 33.1 Tg CH4 yr−1 is from wetlands north of 45∘ N. WETMETH is highly sensitive to parameters for the microbial oxidation of CH4, which is the least constrained process in the literature

1957: Abilene Christian College Bible Lectures - Full Text

Featuring the Theme CHRIST IN YOU -THE HOPE OF GLORY PRICE: $3.00 FIRM FOUNDATION PUBLISHING HOUSE BOX 77 AUSTIN, TEXA

1955: Abilene Christian College Bible Lectures - Full Text

Delivered in the Auditorium of Abilene Christian College, February, 1955 ABILENE, TEXAS PRICE, $3.00 FIRM FOUNDATION PUBLISHING HOUSE Box 77 Austin 61, Texa