Cost-effectiveness of natriuretic peptide-based screening and collaborative care: a report from the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) study

AIMS: Prevention of cardiovascular disease and heart failure (HF) in a cost-effective manner is a public health goal. This work aims to assess the cost-effectiveness of the St Vincent's Screening TO Prevent Heart Failure (STOP-HF) intervention.

METHODS AND RESULTS: This is a substudy of 1054 participants with cardiovascular risk factors [median age 65.8 years, interquartile range (IQR) 57.8:72.4, with 4.3 years, IQR 3.4:5.2, follow-up]. Annual natriuretic peptide-based screening was performed, with collaborative cardiovascular care between specialist physicians and general practitioners provided to patients with BNP levels >50 pg/mL. Analysis of cost per case prevented and cost-effectiveness per quality-adjusted life year (QALY) gained was performed. The primary clinical endpoint of LV dysfunction (LVD) with or without HF was reduced in intervention patients [odds ratio (OR) 0.60; 95% confidence interval (CI) 0.38-0.94; P = 0.026]. There were 157 deaths and/or emergency hospitalizations for major adverse cardiac events (MACE) in the control group vs. 102 in the intervention group (OR 0.68; 95% CI 0.49-0.93; P = 0.01). The cost per case of LVD/HF prevented was €9683 (sensitivity range -€843 to €20 210), whereas the cost per MACE prevented was €3471 (sensitivity range -€302 to €7245). Cardiovascular hospitalization savings offset increased outpatient and primary care costs. The cost per QALY gain was €1104 and the intervention has an 88% probability of being cost-effective at a willingness to pay threshold of €30 000.

CONCLUSION: Among patients with cardiovascular risk factors, natriuretic peptide-based screening and collaborative care reduced LVD, HF, and MACE, and has a high probability of being cost-effective.

TRIAL REGISTRATION: NCT00921960.

Natriuretic peptide-based screening and collaborative care for heart failure:the STOP-HF randomized trial

IMPORTANCE: Prevention strategies for heart failure are needed.

OBJECTIVE: To determine the efficacy of a screening program using brain-type natriuretic peptide (BNP) and collaborative care in an at-risk population in reducing newly diagnosed heart failure and prevalence of significant left ventricular (LV) systolic and/or diastolic dysfunction.

DESIGN, SETTING, AND PARTICIPANTS: The St Vincent's Screening to Prevent Heart Failure Study, a parallel-group randomized trial involving 1374 participants with cardiovascular risk factors (mean age, 64.8 [SD, 10.2] years) recruited from 39 primary care practices in Ireland between January 2005 and December 2009 and followed up until December 2011 (mean follow-up, 4.2 [SD, 1.2] years).

INTERVENTION: Patients were randomly assigned to receive usual primary care (control condition; n=677) or screening with BNP testing (n=697). Intervention-group participants with BNP levels of 50 pg/mL or higher underwent echocardiography and collaborative care between their primary care physician and specialist cardiovascular service.

MAIN OUTCOMES AND MEASURES: The primary end point was prevalence of asymptomatic LV dysfunction with or without newly diagnosed heart failure. Secondary end points included emergency hospitalization for arrhythmia, transient ischemic attack, stroke, myocardial infarction, peripheral or pulmonary thrombosis/embolus, or heart failure.

RESULTS: A total of 263 patients (41.6%) in the intervention group had at least 1 BNP reading of 50 pg/mL or higher. The intervention group underwent more cardiovascular investigations (control, 496 per 1000 patient-years vs intervention, 850 per 1000 patient-years; incidence rate ratio, 1.71; 95% CI, 1.61-1.83; P<.001) and received more renin-angiotensin-aldosterone system-based therapy at follow-up (control, 49.6%; intervention, 56.5%; P=.01). The primary end point of LV dysfunction with or without heart failure was met in 59 (8.7%) of 677 in the control group and 37 (5.3%) of 697 in the intervention group (odds ratio [OR], 0.55; 95% CI, 0.37-0.82; P = .003). Asymptomatic LV dysfunction was found in 45 (6.6%) of 677 control-group patients and 30 (4.3%) of 697 intervention-group patients (OR, 0.57; 95% CI, 0.37-0.88; P = .01). Heart failure occurred in 14 (2.1%) of 677 control-group patients and 7 (1.0%) of 697 intervention-group patients (OR, 0.48; 95% CI, 0.20-1.20; P = .12). The incidence rates of emergency hospitalization for major cardiovascular events were 40.4 per 1000 patient-years in the control group vs 22.3 per 1000 patient-years in the intervention group (incidence rate ratio, 0.60; 95% CI, 0.45-0.81; P = .002).

CONCLUSION AND RELEVANCE: Among patients at risk of heart failure, BNP-based screening and collaborative care reduced the combined rates of LV systolic dysfunction, diastolic dysfunction, and heart failure.

TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00921960.

A Collaborative Multiagent Framework based on Online Risk-Aware Planning and Decision-Making

Planning is an essential process in teams of multiple agents pursuing a common goal. When the effects of actions undertaken by agents are uncertain, evaluating the potential risk of such actions alongside their utility might lead to more rational decisions upon planning. This challenge has been recently tackled for single agent settings, yet domains with multiple agents that present diverse viewpoints towards risk still necessitate comprehensive decision making mechanisms that balance the utility and risk of actions. In this work, we propose a novel collaborative multi-agent planning framework that integrates (i) a team-level online planner under uncertainty that extends the classical UCT approximate algorithm, and (ii) a preference modeling and multicriteria group decision making approach that allows agents to find accepted and rational solutions for planning problems, predicated on the attitude each agent adopts towards risk. When utilised in risk-pervaded scenarios, the proposed framework can reduce the cost of reaching the common goal sought and increase effectiveness, before making collective decisions by appropriately balancing risk and utility of actions. 

User-centered, research-based design of futuristic intensive care units

Context-aware framework for collaborative applications

Future pervasive environments will take into consideration not only individual user’s interest, but also social relationships. In this way, pervasive communities can lead the user to participate beyond traditional pervasive spaces, enabling the cooperation among groups and taking into account not only individual interests, but also the collective and social context. Social applications in CSCW (Computer Supported Cooperative Work) field represent new challenges and possibilities in terms of use of social context information for adaptability in pervasive environments. In particular, the research describes the approach in the design and development of a context.aware framework for collaborative applications (CAFCA), utilizing user’s context social information for proactive adaptations in pervasive environments. In order to validate the proposed framework an evaluation was conducted with a group of users based on enterprise scenario. The analysis enabled to verify the impact of the framework in terms of functionality and efficiency in real-world conditions. The main contribution of this thesis was to provide a context-aware framework to support collaborative applications in pervasive environments. The research focused on providing an innovative socio-technical approach to exploit collaboration in pervasive communities. Finally, the main results reside in social matching capabilities for session formation, communication and coordinations of groupware for collaborative activities.

Handling Heterogeneity in Collaborative Networked Surgical Simulators

Stand-alone and networked surgical virtual reality based simulators have been proposed as means to train surgical skills with or without a supervisor nearby the student or trainee -- However, surgical skills teaching in medicine schools and hospitals is changing, requiring the development of new tools to focus on: (i) importance of mentors role, (ii) teamwork skills and (iii) remote training support -- For these reasons, a surgical simulator should not only allow the training involving a student and an instructor that are located remotely, but also the collaborative training of users adopting different medical roles during the training sesión -- Collaborative Networked Virtual Surgical Simulators (CNVSS) allow collaborative training of surgical procedures where remotely located users with different surgical roles can take part in the training session -- To provide successful training involving good collaborative performance, CNVSS should handle heterogeneity factors such as users’ machine capabilities and network conditions, among others -- Several systems for collaborative training of surgical procedures have been developed as research projects -- To the best of our knowledge none has focused on handling heterogeneity in CNVSS -- Handling heterogeneity in this type of collaborative sessions is important because not all remotely located users have homogeneous internet connections, nor the same interaction devices and displays, nor the same computational resources, among other factors -- Additionally, if heterogeneity is not handled properly, it will have an adverse impact on the performance of each user during the collaborative sesión -- In this document, the development of a context-aware architecture for collaborative networked virtual surgical simulators, in order to handle the heterogeneity involved in the collaboration session, is proposed -- To achieve this, the following main contributions are accomplished in this thesis: (i) Which and how infrastructure heterogeneity factors affect the collaboration of two users performing a virtual surgical procedure were determined and analyzed through a set of experiments involving users collaborating, (ii) a context-aware software architecture for a CNVSS was proposed and implemented -- The architecture handles heterogeneity factors affecting collaboration, applying various adaptation mechanisms and finally, (iii) A mechanism for handling heterogeneity factors involved in a CNVSS is described, implemented and validated in a set of testing scenarios

Research-based spin-offs as agents of knowledge dissemination: evidence from the analysis of innovation networks

The paper addresses the role played by research-based spin-offs (RBSOs) as knowledge dissemination mechanisms, through their position in knowledge networks. For this purpose the paper analyses the formal networks established by the Portuguese RBSOs in the context of publicly funded research, technology and pre-commercial product development projects, and investigates their configuration along two levels. At organisational level, in order to understand whether RBSOs extend their reach beyond the academic sphere; and if they do, whether they relate with similar firms or connect to organisations located downstream in the knowledge value chain, and which is their position in networks involving both research organisations and other firms. At spatial level, in order to understand whether RBSOs extend their reach beyond the region where they are created, thus potentially acting as connectors between diverse regions. The analysis starts from the population of RBSOs created in Portugal until 2007 (387) and identifies those that have established formal technological relationships as part of projects funded by all the programmes launched in the period 1993-2012. As a result, the analysis encompasses 192 collaborative projects and involves 82 spin-offs and 281 partners, of which only 20% are research organisations, the remaining being other firms and a variety of other user organisations. The results, although still preliminary, provide some insights into the knowledge networking behaviour of the RBSOs. As expected, research organisations are a central actor in spin-offs’ networks, being the sole partner for some of them. But half of the RBSOs have moved beyond the academic sphere, being frequently a central element in tripartite technological relationships between research and other organisations and occupying an intermediation position in the network, thus potentially acting as facilitators in knowledge circulation and transformation. Also as expected, RBSOs are predominantly located in the main metropolitan areas and tend to relate with organisations similarly located. But while geographical proximity emerges as important in the choice of partners, in about half of the cases, RBSOs knowledge networks have extended beyond regional boundaries. Given their central position in the network this suggests a role as connectors across regions that will be explored in subsequent research.

A User Interaction Bug Analyzer Based on Image

Context: Mobile applications support a set of user-interaction features that are independent of the application logic. Rotating the device, scrolling, or zooming are examples of such features. Some bugs in mobile applications can be attributed to user-interaction features. Objective: This paper proposes and evaluates a bug analyzer based on user-interaction features that uses digital image processing to find bugs. Method: Our bug analyzer detects bugs by comparing the similarity between images taken before and after a user-interaction. SURF, an interest point detector and descriptor, is used to compare the images. To evaluate the bug analyzer, we conducted a case study with 15 randomly selected mobile applications. First, we identified user-interaction bugs by manually testing the applications. Images were captured before and after applying each user-interaction feature. Then, image pairs were processed with SURF to obtain interest points, from which a similarity percentage was computed, to finally decide whether there was a bug. Results: We performed a total of 49 user-interaction feature tests. When manually testing the applications, 17 bugs were found, whereas when using image processing, 15 bugs were detected. Conclusions: 8 out of 15 mobile applications tested had bugs associated to user-interaction features. Our bug analyzer based on image processing was able to detect 88% (15 out of 17) of the user-interaction bugs found with manual testing.

User Interface Abstraction for enabling TV set based Inclusive Access to the Information Society

199 p.

Collaborative Web-Based Simulation Platform for Construction Project Planning

Part 13: Virtual Reality and Simulation

Collaborative Networked Organizations as System of Systems: A Model-Based Engineering Approach

Part 6: Engineering and Implementation of Collaborative Networks

An Innovation Model for Collaborative Networks of SOA-Based Software Providers

Part 5: Service Orientation in Collaborative Networks