Cost-Effectiveness of Point-of-Care C-Reactive Protein Tests for Respiratory Tract Infection in Primary Care in England

Introduction Despite recommendations that general practitioners (GPs) delay antibiotic prescribing for respiratory tract infections (RTIs), antibiotic prescriptions in primary care in England increased by 4.1% from 2010 to 2013. C-reactive protein (CRP) point-of-care tests (POCT), for example, the Afinion™ Analyzer (Alere Ltd, Stockport, UK) device, are widely used in several countries in the European Union. Studies suggest that CRP POCT use, either alone or in combination with communication training, reduces antibiotic prescribing and improves quality of life for patients presenting with RTI symptoms. The aim of this study is to evaluate the cost-effectiveness of CRP POCT for RTIs in primary care in England over 3 years for three different strategies of care compared to standard practice. Methods An economic evaluation was carried out to compare the costs and benefits of three different strategies of CRP testing (GP plus CRP; practice nurse plus CRP; and GP plus CRP and communication training) for patients with RTI symptoms as defined by National Institute for Health and Care Excellence guideline CG69, compared with current standard GP practice without CRP testing. Analysis consisted of a decision tree and Markov model to describe the quality-adjusted life years (QALYs) and cost per 100 patients, together with the number of antibiotic prescriptions and RTIs for each group. Results Compared with current standard practice, the GP plus CRP and practice nurse plus CRP test strategies result in increased QALYs and reduced costs, while the GP plus CRP testing and communication training strategy is associated with increased costs and reduced QALYs. Additionally, all three CRP arms led to fewer antibiotic prescriptions and infections over 3 years. Conclusion The additional cost per patient of the CRP test is outweighed by the associated cost savings and QALY increment associated with a reduction in infections in the long term

Method and apparatus for neutralizing potentials induced on spacecraft surfaces

A potential induced on the surface of an orbiting spacecraft is neutralized to the potential of a plasma through which the spacecraft is traveling by directing charged particles into the plasma from the spacecraft surface. The induced potential occurs in response to bombardment of the spacecraft surface by ambient charged particles which may be negative or positive. The charged particles directed into the plasma from the surface have the same polarity as the induced potential to provide the neutralization. The invention can be utilized to maintain different, electrically isolated segments of a spacecraft surface at the same potential to prevent electric discharges between the different parts and thereby protect electric circuits within the spacecraft

Distribution and movement of suspended sediment in the Gulf of Mexico off the Texas coast

ERTS-1 imagery has proven very useful in studies of the distribution of suspended sediment in the Gulf of Mexico off the Texas coast. Moreover, by using suspended matter concentrations as tags on water masses, much information on water movement can be obtained. The utility of suspended sediment as a tracer is dependent on the sediment remaining in suspension long enough to travel an appreciable distance or to be visible on successive images. Although the evidence is not conclusive, it seems likely that much of the suspended sediment in Gulf of Mexico nearshore waters during normal seastate conditions has remained in suspension since the time of its entry into the Gulf of Mexico through rivers and tidal inlets

Variable selection using MM algorithms

Variable selection is fundamental to high-dimensional statistical modeling. Many variable selection techniques may be implemented by maximum penalized likelihood using various penalty functions. Optimizing the penalized likelihood function is often challenging because it may be nondifferentiable and/or nonconcave. This article proposes a new class of algorithms for finding a maximizer of the penalized likelihood for a broad class of penalty functions. These algorithms operate by perturbing the penalty function slightly to render it differentiable, then optimizing this differentiable function using a minorize-maximize (MM) algorithm. MM algorithms are useful extensions of the well-known class of EM algorithms, a fact that allows us to analyze the local and global convergence of the proposed algorithm using some of the techniques employed for EM algorithms. In particular, we prove that when our MM algorithms converge, they must converge to a desirable point; we also discuss conditions under which this convergence may be guaranteed. We exploit the Newton-Raphson-like aspect of these algorithms to propose a sandwich estimator for the standard errors of the estimators. Our method performs well in numerical tests.Comment: Published at http://dx.doi.org/10.1214/009053605000000200 in the Annals of Statistics (http://www.imstat.org/aos/) by the Institute of Mathematical Statistics (http://www.imstat.org

Theoretical analysis of interhemispheric transfer costs in visual word recognition

It is becoming increasingly clear that interhemispheric transfer is an important factor in visual word recognition. One of the two computational models of visual word recognition that includes this aspect, the SERIOL model, is tested on the basis of recently obtained behavioural word naming data. Optimal viewing position (OVP) data were collected from participants with left hemisphere language dominance, right hemisphere language dominance, and bilateral language representation (as determined by fMRI). We employ a mathematical model, which is based on some of the underlying assumptions of SERIOL, to investigate the model's ability to predict our results. We show that this mathematical model, which makes use of the original parameters, is able to perfectly predict the differences in the OVP curves observed in the three groups of participants

Monitoring changing geologic features along the Texas Gulf Coast

There are no author-identified significant results in this report