942 research outputs found
Development of a cost-effectiveness model for optimisation of the screening interval in diabetic retinopathy screening
No full textBACKGROUND:
The English NHS Diabetic Eye Screening Programme was established in 2003. Eligible people are invited annually for digital retinal photography screening. Those found to have potentially sight-threatening diabetic retinopathy (STDR) are referred to surveillance clinics or to Hospital Eye Services.
OBJECTIVES:
To determine whether personalised screening intervals are cost-effective.
DESIGN:
Risk factors were identified in Gloucestershire, UK using survival modelling. A probabilistic decision hidden (unobserved) Markov model with a misgrading matrix was developed. This informed estimation of lifetime costs and quality-adjusted life-years (QALYs) in patients without STDR. Two personalised risk stratification models were employed: two screening episodes (SEs) (low, medium or high risk) or one SE with clinical information (low, medium-low, medium-high or high risk). The risk factor models were validated in other populations.
SETTING:
Gloucestershire, Nottinghamshire, South London and East Anglia (all UK).
PARTICIPANTS:
People with diabetes in Gloucestershire with risk stratification model validation using data from Nottinghamshire, South London and East Anglia.
MAIN OUTCOME MEASURES:
Personalised risk-based algorithm for screening interval; cost-effectiveness of different screening intervals.
RESULTS:
Data were obtained in Gloucestershire from 12,790 people with diabetes with known risk factors to derive the risk estimation models, from 15,877 people to inform the uptake of screening and from 17,043 people to inform the health-care resource-usage costs. Two stratification models were developed: one using only results from previous screening events and one using previous screening and some commonly available GP data. Both models were capable of differentiating groups at low and high risk of development of STDR. The rate of progression to STDR was 5 per 1000 person-years (PYs) in the lowest decile of risk and 75 per 1000 PYs in the highest decile. In the absence of personalised risk stratification, the most cost-effective screening interval was to screen all patients every 3 years, with a 46% probability of this being cost-effective at a £30,000 per QALY threshold. Using either risk stratification models, screening patients at low risk every 5 years was the most cost-effective option, with a probability of 99-100% at a £30,000 per QALY threshold. For the medium-risk groups screening every 3 years had a probability of 43-48% while screening high-risk groups every 2 years was cost-effective with a probability of 55-59%.
CONCLUSIONS:
The study found that annual screening of all patients for STDR was not cost-effective. Screening this entire cohort every 3 years was most likely to be cost-effective. When personalised intervals are applied, screening those in our low-risk groups every 5 years was found to be cost-effective. Screening high-risk groups every 2 years further improved the cost-effectiveness of the programme. There was considerable uncertainty in the estimated incremental costs and in the incremental QALYs, particularly with regard to implications of an increasing proportion of maculopathy cases receiving intravitreal injection rather than laser treatment. Future work should focus on improving the understanding of risk, validating in further populations and investigating quality issues in imaging and assessment including the potential for automated image grading
Relation between ultrasonic properties, rheology and baking quality for bread doughs of widely differing formulation
No full textBACKGROUND
The objective was to evaluate whether an ultrasonic reflectance technique has predictive capacity for breadmaking performance of doughs made from a wide range of formulation conditions. Two flours of contrasting dough strength augmented with different levels of ingredients (inulin, oil, emulsifier or salt) were used to produce different bread doughs with a wide range of properties. Breadmaking performance was evaluated by conventional large-strain rheological tests on the dough and by assessment of loaf quality. The ultrasound tests were performed with a broadband reflectance technique in the frequency range of 0.3-6 MHz.
RESULTS
Principal component analysis (PCA) showed that ultrasonic attenuation and phase velocity at frequencies between 0.3 and 3 MHz are good predictors for rheological and bread scoring characteristics.
CONCLUSIONS
Ultrasonic parameters had predictive capacity for breadmaking performance for a wide range of dough formulations. Lower frequency attenuation coefficients correlated well with conventional quality indices of both the dough and the bread
Author Correction: Global water resources and the role of groundwater in a resilient water future
No full textIn the version of this article originally published, reference 9 was incorrectly cited in the last sentence of the second paragraph under ‘Introduction’ and in the first sentence of the second paragraph under the ‘Water scarcity’ subsection. Scanlon et al. (Environ. Res. Lett. https://doi.org/ 10.1088/1748-9326/ac3bfc, 2022) was incorrectly cited in the last sentence under ‘Drivers of water-resource variability’ but is now replaced with reference 38, and Figure 3 was wrongly stated to be adapted from reference 19 instead of reference 36. Reference 40 was mistakenly cited in the last sentence of the second paragraph under the ‘Increasing water access and supplies’ subsection, and reference 37 was inadvertently duplicated in the reference list. References 28 (now reading ‘Winter, T. C., Harvey, J. W., Franke, O. L. and Alley, W. M. Ground Water and Surface Water: A Single Resource. Circular 1139 (United States Geological Survey, 1998)’) and 94 (now reading ‘Scanlon, B. R., Reedy, R. C., Faunt, C. C., Pool, D. and Uhlman, K. Enhancing drought resilience with conjunctive use and managed aquifer recharge in California and Arizona. Environ. Res. Lett. 11, 035013 (2016)’) initially referred to incorrect sources. Lastly, the name of author Hannes Müller Schmied was incorrectly spelled Hannes Mueller Schmied, and an affiliation for him was missing: Senckenberg Leibniz Biodiversity and Climate Research Centre (SBiK-F), Frankfurt am Main, Germany. The errors have been corrected in the HTML and PDF versions of the article
Author Correction: Global water resources and the role of groundwater in a resilient water future
No full textIn the version of this article originally published, reference 9 was incorrectly cited in the last sentence of the second paragraph under ‘Introduction’ and in the first sentence of the second paragraph under the ‘Water scarcity’ subsection. Scanlon et al. (Environ. Res. Lett. https://doi.org/ 10.1088/1748-9326/ac3bfc, 2022) was incorrectly cited in the last sentence under ‘Drivers of water-resource variability’ but is now replaced with reference 38, and Figure 3 was wrongly stated to be adapted from reference 19 instead of reference 36. Reference 40 was mistakenly cited in the last sentence of the second paragraph under the ‘Increasing water access and supplies’ subsection, and reference 37 was inadvertently duplicated in the reference list. References 28 (now reading ‘Winter, T. C., Harvey, J. W., Franke, O. L. and Alley, W. M. Ground Water and Surface Water: A Single Resource. Circular 1139 (United States Geological Survey, 1998)’) and 94 (now reading ‘Scanlon, B. R., Reedy, R. C., Faunt, C. C., Pool, D. and Uhlman, K. Enhancing drought resilience with conjunctive use and managed aquifer recharge in California and Arizona. Environ. Res. Lett. 11, 035013 (2016)’) initially referred to incorrect sources. Lastly, the name of author Hannes Müller Schmied was incorrectly spelled Hannes Mueller Schmied, and an affiliation for him was missing: Senckenberg Leibniz Biodiversity and Climate Research Centre (SBiK-F), Frankfurt am Main, Germany. The errors have been corrected in the HTML and PDF versions of the article
Understanding and Modeling the Processing‐Mechanical Property Relationship of Bread Crumb Assessed by Indentation
No full text- …
