3,116 research outputs found
Illustrating potential efficiency gains from using cost-effectiveness evidence to reallocate Medicare expenditures
No full textThis article is available open access through the publisher’s website at the linke below. Copyright @ 2013, International Society for Pharmacoeconomics and
Outcomes Research (ISPOR).This article has been made available through the Brunel Open Access Publishing Fund.Objectives - The Centers for Medicare & Medicaid Services does not explicitly use cost-effectiveness information in national coverage determinations. The objective of this study was to illustrate potential efficiency gains from reallocating Medicare expenditures by using cost-effectiveness information, and the consequences for health gains among Medicare beneficiaries.
Methods - We included national coverage determinations from 1999 through 2007. Estimates of cost-effectiveness were identified through a literature review. For coverage decisions with an associated cost-effectiveness estimate, we estimated utilization and size of the “unserved” eligible population by using a Medicare claims database (2007) and diagnostic and reimbursement codes. Technology costs originated from the cost-effectiveness literature or were estimated by using reimbursement codes. We illustrated potential aggregate health gains from increasing utilization of dominant interventions (i.e., cost saving and health increasing) and from reallocating expenditures by decreasing investment in cost-ineffective interventions and increasing investment in relatively cost-effective interventions.
Results - Complete information was available for 36 interventions. Increasing investment in dominant interventions alone led to an increase of 270,000 quality-adjusted life-years (QALYs) and savings of $12.9 billion. Reallocation of a broader array of interventions yielded an additional 1.8 million QALYs, approximately 0.17 QALYs per affected Medicare beneficiary. Compared with the distribution of resources prior to reallocation, following reallocation a greater proportion was directed to oncology, diagnostic imaging/tests, and the most prevalent diseases. A smaller proportion of resources went to cardiology, treatments (including drugs, surgeries, and medical devices, as opposed to nontreatments such as preventive services), and the least prevalent diseases.
Conclusions - Using cost-effectiveness information has the potential to increase the aggregate health of Medicare beneficiaries while maintaining existing spending levels.The Commonwealth Fun
Qaisra Shahraz in Interview with Claire Chambers
No full textQaisra Shahraz is a popular and acclaimed Pakistan-born and Manchester-resident screenwriter, educationalist, novelist and short story author. She was recently recognised as number 1 out of the 50 most influential women in Manchester. Last year she won the National Diversity “Lifetime Achiever” Award for services to literature, education, women’s rights and interfaith relationships. She is a Fellow of the Royal Society of Arts, and advisor to Asia Pacific Writers & Translators partnerships. Her novels have been translated into many languages including Mandarin. In this interview, Claire Chambers discusses her new short story collection The Concubine and the Slave-Catcher in detail with Shahraz, as well as asking her to give readers a preview of her current work
Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma
No full textBackground
In acute asthma inhaled beta₂-agonists are often administered by nebuliser to relieve bronchospasm, but some have argued that metered-dose inhalers with a holding chamber (spacer) can be equally effective. Nebulisers require a power source and need regular maintenance, and are more expensive in the community setting.
Objectives
To assess the effects of holding chambers (spacers) compared to nebulisers for the delivery of beta₂-agonists for acute asthma.
Search methods
We searched the Cochrane Airways Group Trial Register and reference lists of articles. We contacted the authors of studies to identify additional trials. Date of last search: February 2013.
Selection criteria
Randomised trials in adults and children (from two years of age) with asthma, where spacer beta₂-agonist delivery was compared with wet nebulisation.
Data collection and analysis
Two review authors independently applied study inclusion criteria (one review author for the first version of the review), extracted the data and assessed risks of bias. Missing data were obtained from the authors or estimated. Results are reported with 95% confidence intervals (CIs).
Main results
This review includes a total of 1897 children and 729 adults in 39 trials. Thirty-three trials were conducted in the emergency room and equivalent community settings, and six trials were on inpatients with acute asthma (207 children and 28 adults). The method of delivery of beta₂-agonist did not show a significant difference in hospital admission rates. In adults, the risk ratio (RR) of admission for spacer versus nebuliser was 0.94 (95% CI 0.61 to 1.43). The risk ratio for children was 0.71 (95% CI 0.47 to 1.08, moderate quality evidence). In children, length of stay in the emergency department was significantly shorter when the spacer was used. The mean duration in the emergency department for children given nebulised treatment was 103 minutes, and for children given treatment via spacers 33 minutes less (95% CI -43 to -24 minutes, moderate quality evidence). Length of stay in the emergency department for adults was similar for the two delivery methods. Peak flow and forced expiratory volume were also similar for the two delivery methods. Pulse rate was lower for spacer in children, mean difference -5% baseline (95% CI -8% to -2%, moderate quality evidence), as was the risk of developing tremor (RR 0.64; 95% CI 0.44 to 0.95, moderate quality evidence).
Authors' conclusions
Nebuliser delivery produced outcomes that were not significantly better than metered-dose inhalers delivered by spacer in adults or children, in trials where treatments were repeated and titrated to the response of the participant. Spacers may have some advantages compared to nebulisers for children with acute asthma
Letter From William Bell Scott to Mr Chambers
No full textabstract: Concerning Scott's thanks, his writings about his own works, and a manuscript of "The Nightingale Unheard."Seller's Description: Reads "A.L.S. from Author to Mr. Chambers explaining how busy he is... The sonnet is printed in the book. Fredeman: 56.7 £87.50"Handwritten Note: Unknown handwriting at top right reads "June 1st 1877."Publication Details: "The Nightingale Unheard" published in "Poems" by William Bell Scott.Creation Date Details: Undated range is the author's lifespan.Provenance: Removed from:
Poems / by William Bell Scott. Ballads, studies from nature, sonnets, etc. / illustrated by seventeen etchings by the author and L. Alma Tadema. Publisher London : Longmans, Green, 1875. CALL #
HAYDEN SPECIAL COLL SPEC PRB-13
Letter from M.L.A. Tom Chambers
No full textLetter from Tom Chambers (M.L.A. for Edmonton Calder Constituency) to Mr. John Birzgalis describing a monitary award of $1,000.00 from Horst A. Schmidt, Miniter of Culture toward's the Edmonton Latvian Society's Imanta.1.0 Imanta, 1.1.1 Histor of Imanta in Albert
A treatise on civil architecture : in which the principles of that art are laid down, and illustrated by a great number of plates, accurately designed, and elegantly engraved by the best hands
No full textby William Chambers ..
Critical parameters and procedures for anaerobic cultivation of yeasts in bioreactors and anaerobic chambers
No full textAll known facultatively fermentative yeasts require molecular oxygen for growth. Only in a small number of yeast species, these requirements can be circumvented by supplementation of known anaerobic growth factors such as nicotinate, sterols and unsaturated fatty acids. Biosynthetic oxygen requirements of yeasts are typically small and, unless extensive precautions are taken to minimize inadvertent entry of trace amounts of oxygen, easily go unnoticed in small-scale laboratory cultivation systems. This paper discusses critical points in the design of anaerobic yeast cultivation experiments in anaerobic chambers and laboratory bioreactors. Serial transfer or continuous cultivation to dilute growth factors present in anaerobically pre-grown inocula, systematic inclusion of control strains and minimizing the impact of oxygen diffusion through tubing are identified as key elements in experimental design. Basic protocols are presented for anaerobic-chamber and bioreactor experiments. </p
Modelling Truncated and Clustered Count Data
No full textCount response data often exhibit departures from the assumptions of standard Poisson generalized linear models (McCullagh & Nelder 1989). In particular, cluster level correlation of the data and truncation at zero are two common characteristics of such data. In this paper we describe a random components truncated Poisson model that can be applied to clustered and zero-truncated count data. Residual maximum likelihood method estimators for the parameters of this model are developed and their use illustrated using a data set of non-zero counts of sheets with edge strain defects in iron sheets produced by the Mobarekeh Steel Complex, Iran. We also report on a small scale simulation study that supports the estimation procedure
Another Map, another History, another Modernity
No full textIn this article, the author criticizes the consensual cultural configuration of present-day Italy by displacing concerns of historical and intellectual identity onto a wider Mediterranean map. Elaborating an interdisciplinary and intercultural position that looks to languages and histories that Italian academic life and institutional culture tends to ignore, or repress, the disparaged sides of modernity – the South, the Mediterranean, the Muslim world – become the sites of a diverse critical understanding. Drawing upon the metaphorical powers of the sea itself, this “Mediterranean” view of modern Italy, of the formation of its cultural and critical languages, proposes a more unsettled and fluid cartography that renders inherited questions and “solutions” vulnerable to an inquiry that a national culture is unable to authorize. In particular, the desire for cultural and critical continuity, sustained in a diffuse historicist syntax and policed by moribund disciplinary protocols, is challenged via a “postcolonial” elaboration of Italy as both a Mediterranean and modern formation. This leads to a proposed rupture with the mold of a fundamentally patrician and provincial understanding of native culture. In particular, the contemporary figure of the so-called illegal migrant announces the hidden colonial histories that planetary process return to disturb the surfaces of everyday life. It is the unwelcome turbulence of migration, as one of the central chapters of modernity itself, which now cuts into the historical, political, and cultural body of Italy, exposing it in a global frame that can only be registered in “worldly thinking” (Antonio Gramsci). Precisely at this point, it becomes imperative to draw up another map, narrate another history, and seek another modernity
Britain Through Muslim Eyes:An Interview with Claire Chambers
No full textClaire Chambers is a senior lecturer in global literature at the University of York. She is the author of Britain Through Muslim Eyes: Literary Representations, 1780–1989 (2015) and British Muslim Fictions: Interviews with Contemporary Writers (2011). She edited (with Caroline Herbert) Imagining Muslims in South Asia and the Diaspora (2014). In this 2017 interview with Anastasia Valassopoulos, she discusses her exploration of literary representations of Muslims in Britain and South Asia, and her engagement with audiences and scholars in that field. She also discusses her current writing and reflects on sources such as the Making Britain archive that have helped to shape her current work. Finally, Claire explores crucial questions around liberalism and contemporary multicultural politics
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