5,918 research outputs found

    The cost-effectiveness of an early interventional strategy in non-ST-elevation acute coronary syndrome based on the RITA 3 trial

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    The published version of the aritcle can be found at the link below.Background: Evidence suggests that an early interventional strategy for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) can improve health outcomes but also increase costs when compared with a conservative strategy.Objective: The aim of this study was to assess the cost-effectiveness of an early interventional strategy in different risk groups from a UK health-service perspective.Design: Decision-analytic model based on randomised clinical trial data.Main outcome measures: Costs in UK Sterling at 2003/2004 prices and quality-adjusted life years (QALYs) combined into an incremental cost-effectiveness ratio.Methods: Data from the third Randomised Intervention Trial of unstable Angina (RITA 3) was employed to estimate rates of cardiovascular death and myocardial infarction, costs and health-related quality of life. Cost-effectiveness was estimated over patients' lifetimes within the decision-analytic model.Results: The mean incremental cost per QALY gained for an early interventional strategy was approximately £55000, £22000 and £12000 for patients at low, intermediate and high risk, respectively. The early interventional strategy is approximately 1%, 35% and 95% likely to be cost-effective for patients at low, intermediate and high risk, respectively, at a threshold of £20000 per QALY. The cost-effectiveness of early intervention in low-risk patients is sensitive to assumptions about the duration of the treatment effect.Conclusion: An early interventional strategy in patients presenting with NSTE-ACS is likely to be considered cost-effective for patients at high and intermediate risk, but this is less likely to be the case for patients at low risk

    A multiproxy analysis of extreme wave deposits in a tropical coastal lagoon in Jamaica, West Indies

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    The Small Island Developing States (SIDS) of the Caribbean Region are vulnerable to natural hazards including earthquakes, tsunamis and tropical cyclones that can cause widespread devastation. Sedimentary archives of these hazards are often well-preserved in coastal lagoons; however, few studies in the Caribbean have adopted a multiproxy approach to their reconstruction. Here, we present a 1200-year multiproxy record of extreme washover events deposited within a coastal mangrove lagoon on the south coast of Jamaica. Manatee Bay lagoon is a permanent fresh-brackish-water mangrove lagoon separated from the Caribbean Sea by a low-elevation carbonate beach. Fifteen sediment cores recovered along five shore-normal transects contain ostracod-rich authigenic carbonate lake muds interspersed with beds of organic lake mud and mangrove peat. The cores contain evidence of multiple palaeo-washover deposits that are readily distinguished by their sedimentology, geochemistry and microfossil assemblages. Hypersaline conditions dominated the early part of the record (~ 800 to 900 CE), and we infer a freshening of lagoonal waters and the subsequent expansion of the mangrove community following an extreme wave event that occurred some time before ~ 1290 to 1400 CE. We constrain the primary historical-washover deposit to 1810–1924 CE (2σ; 71% probability), a period characterised by extreme tectonic and meteorological events, which include the Great Kingston Earthquake of 1907 and a local episode of enhanced hurricane activity. Whilst the balance of circumstantial evidence indicates that the deposit was probably emplaced during the tsunami generated by the 1907 earthquake, we are currently unable to differentiate between tectonically and meteorologically driven washover events based on their sedimentological characteristics

    Simple individual-based models effectively represent Afrotropical forest bird movement in complex landscapes

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    Reliable estimates of dispersal rates between habitat patches (i.e. functional connectivity) are critical for predicting long-term effects of habitat fragmentation on population persistence. Connectivity measures are frequently derived from least cost path or graph-based approaches, despite the fact that these methods make biologically unrealistic assumptions. Individual-based models (IBMs) have been proposed as an alternative as they allow modelling movement behaviour in response to landscape resistance. However, IBMs typically require excessive data to be useful for management. Here, we test the extent to which an IBM requiring only an uncomplicated set of movement rules [the 'stochastic movement simulator' (SMS)] can predict animal movement behaviour in real-world landscapes. Movement behaviour of two forest birds, the Cabanis's greenbul Phyllastrephus cabanisi (a forest specialist) and the white-starred robin Pogonocichla stellata (a habitat generalist), across an Afrotropical matrix was simulated using SMS. Predictions from SMS were evaluated against a set of detailed movement paths collected by radiotracking homing individuals. SMS was capable of generating credible predictions of bird movement, although simulations were sensitive to the cost values and the movement rules specified. Model performance was generally highest when movement was simulated across low-contrasting cost surfaces and when virtual individuals were assigned low directional persistence and limited perceptual range. SMS better predicted movements of the habitat specialist than the habitat generalist, which highlights its potential to model functional connectivity when species movements are affected by the matrix. Synthesis and applications. Modelling the dispersal process with greater biological realism is likely to be critical for improving our predictive capability regarding functional connectivity and population persistence. For more realistic models to be widely applied, it is vital that their application is not overly complicated or data demanding. Here, we show that given relatively basic understanding of a species' dispersal ecology, the stochastic movement simulator represents a promising tool for estimating connectivity, which can help improve the design of functional ecological networks aimed at successful species conservation

    Ten-Year Trends in Children’s Caloric-Beverage Consumption and Behavioral Intent

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    Soft drinks, fruit juice and milk are the most common caloric-beverages consumed by adolescents and teens. We report the ten-year trends in the percentage of daily calories consumed in the form of caloric-beverages from a broad sample of fifth-grade students in the United States. This is a major area of concern related to dietary quality and body weight amongst children. The study was conducted from 2001-2011 through the Healthy Hearts for Kids (HH4K) online instructional program. A total of 17,559 students from 1,048 schools in 49 US states participated. Results reveal there were no changes across the ten-year period in reported fruit juice and milk consumption in the past week. There was a significant downward trend in soft drink consumption in the ten-year period. Juice consumption was positively correlated with soft drink and milk consumption in the past week. Soft drink consumption was positively correlated with milk consumption. The intent to drink two or more soft drinks tomorrow was significantly related to soft drink consumption in the last week and to expected soft drink consumption a year from now. The intent to drink two or more soft drinks in a day one year from now was not related to reported soft drink consumption in the last week. The intent to drink two or more soft drinks tomorrow was not correlated with juice consumption in the past week or with milk consumption in the past week. In conclusion, soft drink consumption declined, but there were no changes in consumption of milk and fruit juice. Soft drinks did not appear to displace either milk or fruit juice. These participants appear to be aware that soft drinks are a less healthy choice

    Socioeconomic disadvantage and childhood growth: A review of the literature focusing on the mediatory roles of birth weight, maternal age and parity

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    In this paper we review the literature on the relationship between maternal social disadvantage and childhood growth. We focus particularly on the potential mediatory roles played by birth weight, maternal age, and parity, and on studies of UK populations. We find convincing evidence of social inequalities of growth, both in terms of stature (height) and adiposity/overweight. Maternal age, parity and, particularly, birth weight are plausible mediators of the association between socioeconomic disadvantage and growth due to the acknowledged relationships between each of these factors. However, few studies have considered such mediation explicitly. Further work is required in this area

    Exploring small extra dimensions at the Large Hadron Collider

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    Many models that include small extra space dimensions predict graviton states which are well separated in mass, and which can be detected as resonances in collider experiments. It has been shown that the ATLAS detector at the Large Hadron Collider can identify such narrow states up to a mass of 2080 GeV in the decay mode G->ee, using a conservative model. This work extends the study of the ee channel over the full accessible parameter space, and shows that the reach could extend as high as 3.5 TeV. It then discusses ways in which the expected universal coupling of the resonance can be confirmed using other decay modes. In particular, the mode G-> di-photons is shown to be measurable with good precision, which would provide powerful confirmation of the graviton hypothesis. The decays G-> mu mu, WW, ZZ and jet--jet are measurable over a more limited range of couplings and masses. Using information from mass and cross-section measurements, the underlying parameters can be extracted. In one test model, the size of the extra dimension can be determined to a precision in length of 7x10^-33 m

    Sexual health interventions delivered to participants by mobile technology: a systematic review and meta-analysis of randomised controlled trials

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    Background: The use of mobile technologies to prevent STIs is recognised as a promising approach worldwide; however, evidence has been inconclusive, and the field has developed rapidly. With about 1 million new STIs a day globally, up-to-date evidence is urgently needed. // Objective: To assess the effectiveness of mobile health interventions delivered to participants for preventing STIs and promoting preventive behaviour. // Methods: We searched seven databases and reference lists of 49 related reviews (January 1990–February 2020) and contacted experts in the field. We included randomised controlled trials of mobile interventions delivered to adolescents and adults to prevent sexual transmission of STIs. We conducted meta-analyses and assessed risk of bias and certainty of evidence following Cochrane guidance. // Results: After double screening 6683 records, we included 22 trials into the systematic review and 20 into meta-analyses; 18 trials used text messages, 3 used smartphone applications and 1 used Facebook messages as delivery modes. The certainty of evidence regarding intervention effects on STI/HIV occurrence and adverse events was low or very low. There was moderate certainty of evidence that in the short/medium-term text messaging interventions had little or no effect on condom use (standardised mean differences (SMD) 0.02, 95% CI −0.09 to 0.14, nine trials), but increased STI/HIV testing (OR 1.83, 95% CI 1.41 to 2.36, seven trials), although not if the standard-of-care control already contained an active text messaging component (OR 1.00, 95% CI 0.68 to 1.47, two trials). Smartphone application messages also increased STI/HIV testing (risk ratio 1.40, 95% CI 1.22 to 1.60, subgroup analysis, two trials). The effects on other outcomes or of social media or blended interventions is uncertain due to low or very low certainty evidence

    Opportunities for Process Control and Quality Assurance Using Online NIR Analysis to a Continuous Wet Granulation Tableting Line

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    This paper investigates the application of online near-infrared measurements as a means to measure blend uniformity in a continuous tableting line. Underlying all the monitoring and control methods is the ability to measure key tablet properties online at a rate suitable for control purposes. The use of NIR to determine any deviations in blend uniformity is demonstrated by interpreting the relevant spectral signature allowing quantitative information to be acquired for process monitoring and quality assurance. In addition to demonstrating the functionality of the NIR probe, the practical issues arising in the application are discussed. The composition of the blend was measured using an NIR probe over a range of concentrations and the results were calculated comparing sub unit dose scale of scrutiny of small populations. This was compared with predicted product quality for whole tablets over the whole production period. This technique has demonstrated how data collected online can be used to successfully predict the quality of the whole production run for the purposes of real-time product quality assurance
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