Cost-effectiveness of psychological and pharmacological interventions for generalized anxiety disorder and panic disorder

Objective: To assess from a health sector perspective the incremental cost-effectiveness of interventions for generalized anxiety disorder (cognitive behavioural therapy [CBT] and serotonin and noradrenaline reuptake inhibitors [SNRIs]) and panic disorder (CBT, selective serotonin reuptake inhibitors [SSRIs] and tricyclic antidepressants [TCAs]). Method: The health benefit is measured as a reduction in disability-adjusted life years (DALYs), based on effect size calculations from meta-analyses of randomised controlled trials. An assessment on second stage filters ('equity', 'strength of evidence', 'feasibility' and 'acceptability to stakeholders') is also undertaken to incorporate additional factors that impact on resource allocation decisions. Costs and benefits are calculated for a period of one year for the eligible population (prevalent cases of generalized anxiety disorder/panic disorder identified in the National Survey of Mental Health and Wellbeing, extrapolated to the Australian population in the year 2000 for those aged 18 years and older). Simulation modelling techniques are used to present 95% uncertainty intervals (UI) around the incremental cost-effectiveness ratios (ICERs). Results: Compared to current practice, CBT by a psychologist on a public salary is the most cost-effective intervention for both generalized anxiety disorder (A$6900/DALY saved; 95% UI A$4000 to A$12 000) and panic disorder (A$6800/DALY saved; 95% UI A$2900 to A$15 000). Cognitive behavioural therapy results in a greater total health benefit than the drug interventions for both anxiety disorders, although equity and feasibility concerns for CBT interventions are also greater. Conclusions: Cognitive behavioural therapy is the most effective and cost-effective intervention for generalized anxiety disorder and panic disorder. However, its implementation would require policy change to enable more widespread access to a sufficient number of trained therapists for the treatment of anxiety disorders.

Genetic algorithms with applications in wireless communications

Genetic algorithms (GAs) are known to locate the global optimal solution provided sufficient population and/or generation is used. Practically, a near-optimal satisfactory result can be found by Gas with a limited number of generations. In wireless communications, the exhaustive searching approach is widely applied to many techniques, such as maximum likelihood decoding (MLD) and distance spectrum (DS) techniques. The complexity of the exhaustive searching approach in the MLD or the DS technique is exponential in the number of transmit antennas and the size of the signal constellation for the multiple-input multiple-output (MIMO) communication systems. If a large number of antennas and a large size of signal constellations, e.g. PSK and QAM, are employed in the MIMO systems, the exhaustive searching approach becomes impractical and time consuming. In this paper, the GAs are applied to the MLD and DS techniques to provide a near-optimal performance with a reduced computational complexity for the MIMO systems. Two different GA-based efficient searching approaches are proposed for the MLD and DS techniques, respectively. The first proposed approach is based on a GA with sharing function method, which is employed to locate the multiple solutions of the distance spectrum for the Space-time Trellis Coded Orthogonal Frequency Division Multiplexing (STTC-OFDM) systems. The second approach is the GA-based MLD that attempts to find the closest point to the transmitted signal. The proposed approach can return a satisfactory result with a good initial signal vector provided to the GA. Through simulation results, it is shown that the proposed GA-based efficient searching approaches can achieve near-optimal performance, but with a lower searching complexity comparing with the original MLD and DS techniques for the MIMO systems.

Mid-late Holocene monsoon climate retrieved from seasonal Sr/Ca and delta O-18 records of Porites lutea corals at Leizhou Peninsula, northern coast of South China Sea

South China Sea (SCS) is a major moisture source region, providing summer monsoon rainfall throughout Mainland China, which accounts for more than 80% total precipitation in the region. We report seasonal to monthly resolution Sr/Ca and delta(18)O data for five Holocene and one modem Porites corals, each covering a growth history of 9-13 years. The results reveal a general decreasing trend in sea surface temperature (SST) in the SCS from similar to 6800 to 1500 years ago, despite shorter climatic cycles. Compared with the mean Sr/Ca-SST in the 1990s (24.8 degrees C), 10-year mean Sr/Ca-SSTs were 0.9-0.5 degrees C higher between 6.8 and 5.0 thousand years before present (ky BP), dropped to the present level by similar to 2.5 ky BP, and reached a low of 22.6 degrees C (2.2 degrees C lower) by similar to 1.5 ky BP. The summer Sr/Ca-SST maxima, which are more reliable due to faster summer-time growth rates and higher sampling resolution, follow the same trend, i.e. being 1-2 degrees C higher between 6.8 and 5.0 ky BP, dropping to the present level by -2.5 ky BP, and reaching a low of 28.7 degrees C (0.7 degrees C lower) by similar to 1.5 ky BP. Such a decline in SST is accompanied by a similar decrease in the amount of monsoon moisture transported out of South China Sea, resulting in a general decrease in the seawater delta(18)O values, reflected by offsets of mean 6 180 relative to that in the 1990s. This observation is consistent with general weakening of the East Asian summer monsoon since early Holocene, in response to a continuous decline in solar radiation, which was also found in pollen, lake-level and loess/paleosol records throughout Mainland China. The climatic conditions similar to 2.5 and similar to 1.5 ky ago were also recorded in Chinese history. In contrast with the general cooling trend of the monsoon climate in East Asia, SST increased dramatically in recent time, with that in the 1990s being 2.2 degrees C warmer than that similar to 1.5 ky ago. This clearly indicates that the increase in the concentration of anthropogenic greenhouse gases played a dominant role in recent global warming, which reversed the natural climatic trend in East Asian monsoon regime. (c) 2004 Elsevier B.V. All rights reserved.