PIH22 Cost-Effectiveness Of Cyp2d6 Genotyping In Older Depressed Patients, Starting With Nortriptyline Therapy

Objectives: Genotyping for the cytochrome P450-2D6 has the potency to predict differences in metabolism of nortriptyline. This information could optimize treatment. We explored if possible benefits could outweigh genotyping costs for Dutch depressed patients in clinical psychiatry. Methods: First, a decision-tree was created to model the first weeks of nortriptyline therapy. In the model, costs of hospitalization, therapeutic drug monitoring, and drug costs were captured. Based on the patients genetics, patients were distributed among three health states: correctly, sub-, or supra-therapeutically dosed. Utilities for each of these health states and at different points in time were obtained from an expert opinion (nine clinicians). Second, an improvement in sub or supra-therapeutically dosed patients to correctly dosed patients, was simulated, assuming genotyping would prevent under or overdosing. In the base case the improvement was 36%. In addition, we assumed genotyping could reduce hospitalization days with a maximum of 3.7 days (average: 28.6 days). Results from the model without genotyping were compared with the genotyping model. In a scenario analyses we varied the effects of genotyping to reach cost-effectiveness at € 20 000/quality adjusted life year (QALY) or € 50 000/ QALY. In a univariate sensitivity analysis, effects of lowering genotyping costs were examined. A probabilistic sensitivity analysis (PSA) was performed to investigate influence of parameter uncertainty. Results: In the base case, the incremental cost-effectiveness ratio (ICER) was € 32 697/QALY. For an ICER of € 20 000/QALY, a genotyping facilitated improvement of 45% was needed and for € 50 000/QALY this was 27%. Lowering the genotype price to € 162 made genotyping cost-saving. Results of the PSA indicated a probability of 0.95 for a willingness-to-pay threshold of € 46000/ QALY. Conclusions: Genotyping could be cost-effective and even be cost-saving when genotyping costs drops. However, there is a need for more clinical evidence to support assumptions made in this model

Entanglement swapping between independent and asynchronous integrated photon-pair sources

Integrated photonics represents a technology that could greatly improve quantum communication networks in terms of cost, size, scaling, and robustness. A key benchmark for this is to demonstrate their performance in complex quantum networking protocols, such as entanglement swapping between independent photon-pair sources. Here, using time-resolved detection, and two independent and integrated Si$_3$N$_4$ microring resonator photon-pair sources, operating in the CW regime at telecom wavelengths, we obtained spectral purities up to $0.97 \pm 0.02$ and a HOM interference visibility between the two sources of $V_{\rm HOM}=93.2 \pm 1.6\,\%$. This results in entanglement swapping visibility as high as $91.2 \pm 3.4\,\%

Photonic quantum state transfer between a cold atomic gas and a crystal

Interfacing fundamentally different quantum systems is key to build future hybrid quantum networks. Such heterogeneous networks offer superior capabilities compared to their homogeneous counterparts as they merge individual advantages of disparate quantum nodes in a single network architecture. However, only very few investigations on optical hybrid-interconnections have been carried out due to the high fundamental and technological challenges, which involve e.g. wavelength and bandwidth matching of the interfacing photons. Here we report the first optical quantum interconnection between two disparate matter quantum systems with photon storage capabilities. We show that a quantum state can be faithfully transferred between a cold atomic ensemble and a rare-earth doped crystal via a single photon at telecommunication wavelength, using cascaded quantum frequency conversion. We first demonstrate that quantum correlations between a photon and a single collective spin excitation in the cold atomic ensemble can be transferred onto the solid-state system. We also show that single-photon time-bin qubits generated in the cold atomic ensemble can be converted, stored and retrieved from the crystal with a conditional qubit fidelity of more than $85\%$. Our results open prospects to optically connect quantum nodes with different capabilities and represent an important step towards the realization of large-scale hybrid quantum networks

Planning, implementation and scientific goals of the Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC4RS) field mission

The Studies of Emissions and Atmospheric Composition, Clouds and Climate Coupling by Regional Surveys (SEAC4RS) field mission based at Ellington Field, Texas, during August and September 2013 employed the most comprehensive airborne payload to date to investigate atmospheric composition over North America. The NASA ER-2, DC-8, and SPEC Inc. Learjet flew 57 science flights from the surface to 20 km. The ER-2 employed seven remote sensing instruments as a satellite surrogate and eight in situ instruments. The DC-8 employed 23 in situ and five remote sensing instruments for radiation, chemistry, and microphysics. The Learjet used 11 instruments to explore cloud microphysics. SEAC4RS launched numerous balloons, augmented AErosol RObotic NETwork, and collaborated with many existing ground measurement sites. Flights investigating convection included close coordination of all three aircraft. Coordinated DC-8 and ER-2 flights investigated the optical properties of aerosols, the influence of aerosols on clouds, and the performance of new instruments for satellite measurements of clouds and aerosols. ER-2 sorties sampled stratospheric injections of water vapor and other chemicals by local and distant convection. DC-8 flights studied seasonally evolving chemistry in the Southeastern U.S., atmospheric chemistry with lower emissions of NOx and SO2 than in previous decades, isoprene chemistry under high and low NOx conditions at different locations, organic aerosols, air pollution near Houston and in petroleum fields, smoke from wildfires in western forests and from agricultural fires in the Mississippi Valley, and the ways in which the chemistry in the boundary layer and the upper troposphere were influenced by vertical transport in convective clouds

Planning, implementation, and first results of the Tropical Composition, Cloud and Climate Coupling Experiment (TC4)

The Tropical Composition, Cloud and Climate Coupling Experiment (TC4), was based in Costa Rica and Panama during July and August 2007. The NASA ER-2, DC-8, and WB-57F aircraft flew 26 science flights during TC4. The ER-2 employed 11 instruments as a remote sampling platform and satellite surrogate. The WB-57F used 25 instruments for in situ chemical and microphysical sampling in the tropical tropopause layer (TTL). The DC-8 used 25 instruments to sample boundary layer properties, as well as the radiation, chemistry, and microphysics of the TTL. TC4 also had numerous sonde launches, two ground-based radars, and a ground-based chemical and microphysical sampling site. The major goal of TC4 was to better understand the role that the TTL plays in the Earth's climate and atmospheric chemistry by combining in situ and remotely sensed data from the ground, balloons, and aircraft with data from NASA satellites. Significant progress was made in understanding the microphysical and radiative properties of anvils and thin cirrus. Numerous measurements were made of the humidity and chemistry of the tropical atmosphere from the boundary layer to the lower stratosphere. Insight was also gained into convective transport between the ground and the TTL, and into transport mechanisms across the TTL. New methods were refined and extended to all the NASA aircraft for real-time location relative to meteorological features. The ability to change flight patterns in response to aircraft observations relayed to the ground allowed the three aircraft to target phenomena of interest in an efficient, well-coordinated manner

NASA's Earth Venture-1 (EV-1) Airborne Science Investigations

In 2010, NASA announced the first Earth Venture (EV-1) selections in response to a recommendation made by the National Research Council for low-cost investigations fostering innovation in Earth science. The five EV-1 investigations span the Earth science focus areas of atmosphere, weather, climate, water and energy and, carbon and represent earth science researchers from NASA as well as other government agencies, academia and industry from around the world. The EV-1 missions are: 1) Airborne Microwave Observatory of Subcanopy and Subsurface (AirMOSS), 2) Airborne Tropical Tropopause Experiment (ATTREX), 3) Carbon in Arctic Reservoirs Vulnerability Experiment (CARVE), 4) Deriving Information on Surface Conditions from Column and Vertically Resolved Observations Relevant to Air Quality (DISCOVER-AQ), and 5) Hurricane And Severe Storm Sentinel (HS3). The Earth Venture missions are managed out of the Earth System Science Pathfinder (ESSP) Program Office (Allen, et. al. 2010b

Near-Real-Time Measurement Of Sea-Salt Aerosol During the Seas Campaign: Comparison Of Emission-Based Sodium Detection With an Aerosol Volatility Technique

The first deployment of an emission-based aerosol sodium detector (ASD), designed to chemically characterize marine aerosols on a near-real-time basis, is reported. Deployment occurred as part of the Shoreline Environment Aerosol Study ( SEAS) from 16 April to 1 May 2000 at Bellows Air Force Base on the east side of Oahu, where the University of Hawaii\u27s Department of Oceanography maintains a tower for aerosol measurements. The instrument was operated in size-unsegregated mode and measurements were made that included two extended continuous sampling periods, each of which lasted for 24 h. During this time, the ASD was compared with measurements that used aerosol volatility coupled with optical particle counting to infer sea-salt size distributions. A reasonable agreement was obtained between the instruments when sampling in clean air, suggesting that under these conditions both approaches can provide reliable sea-salt distributions. The combination of these measurements suggested that sea salt was the dominant constituent of aerosol particles with diameters larger than 500 nm and that sulfate was the dominant constituent at smaller diameters during clean air sampling

PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study:protocol for a hybrid type I, mixed method, randomised controlled trial

INTRODUCTION: Kidney transplant candidates (KTCs) need to be in optimal physical and psychological condition prior to surgery. However, KTCs often experience compromised functional capacity which can be characterised as frailty. Prehabilitation, the enhancement of a person's functional capacity, may be an effective intervention to improve the health status of KTCs. The PREhabilitation of CAndidates for REnal Transplantation (PreCareTx) study aims to examine the effectiveness of a multimodal prehabilitation programme on the health status of KTCs, and to explore the potential of implementation of prehabilitation in daily clinical practice.METHODS AND ANALYSIS: This study uses a single centre, effectiveness-implementation hybrid type I study design, comprised of a randomised controlled trial and a mixed-methods study. Adult patients who are currently on the transplant waiting list or are waitlisted during the study period, at a university medical centre in The Netherlands, will be randomly assigned to either prehabilitation (n=64) or care as usual (n=64) groups. The prehabilitation group will undergo a 12-week home-based, tailored prehabilitation programme consisting of physical and/or nutritional and/or psychosocial interventions depending on the participant's deficits. This programme will be followed by a 12-week maintenance programme in order to enhance the incorporation of the interventions into daily life. The primary endpoint of this study is a change in frailty status as a proxy for health status. Secondary endpoints include changes in physical fitness, nutritional status, psychological well-being, quality of life and clinical outcomes. Tertiary endpoints include the safety, feasibility and acceptability of the prehabilitation programme, and the barriers and facilitators for further implementation.ETHICS AND DISSEMINATION: Medical ethical approval was granted by the Medical Ethics Committee Groningen, Netherlands (M22.421). Written informed consent will be obtained from all participants. The results will be disseminated at international conferences and in peer-reviewed journals.TRIAL REGISTRATION NUMBER: ClinicalTrials.gov, NCT05489432.</p