Cost-effectiveness of a preventive counseling and support package for postnatal depression

Objectives: This study reports the cost-effectiveness of a preventive intervention, consisting of counseling and specific support for the mother-infant relationship, targeted at women at high risk of developing postnatal depression. Methods: A prospective economic evaluation was conducted alongside a pragmatic randomized controlled trial in which women considered at high risk of developing postnatal depression were allocated randomly to the preventive intervention (n = 74) or to routine primary care (n = 77). The primary outcome measure was the duration of postnatal depression experienced during the first 18 months postpartum. Data on health and social care use by women and their infants up to 18 months postpartum were collected, using a combination of prospective diaries and face-to-face interviews, and then were combined with unit costs ( pound, year 2000 prices) to obtain a net cost per mother-infant dyad. The nonparametric bootstrap method was used to present cost-effectiveness acceptability curves and net benefit statistics at alternative willingness to pay thresholds held by decision makers for preventing 1 month of postnatal depression. Results: Women in the preventive intervention group were depressed for an average of 2.21 months (9.57 weeks) during the study period, whereas women in the routine primary care group were depressed for an average of 2.70 months (11.71 weeks). The mean health and social care costs were estimated at 2,396.9 pound per mother-infant dyad in the preventive intervention group and 2,277.5 pound per mother-infant dyad in the routine primary care group, providing a mean cost difference of 119.5 pound (bootstrap 95 percent confidence interval [Cl], -535.4, 784.9). At a willingness to pay threshold of 1,000 pound per month of postnatal depression avoided, the probability that the preventive intervention is cost-effective is .71 and the mean net benefit is 383.4 pound (bootstrap 95 percent Cl, -863.3- pound 1,581.5) pound. Conclusions: The preventive intervention is likely to be cost-effective even at relatively low willingness to pay thresholds for preventing 1 month of postnatal depression during the first 18 months postpartum. Given the negative impact of postnatal depression on later child development, further research is required that investigates the longer-term cost-effectiveness of the preventive intervention in high risk women.

The relationship between absolute and proportion scores of serial order memory: simulation predictions and empirical data

The capability of a feature model of immediate memory (Nairne, 1990; Neath, 2000) to predict and account for a relationship between absolute and proportion scoring of immediate serial recall when memory load is varied (the list-length effect, LLE) is examined. The model correctly predicts the novel finding of an LLE in immediate serial order memory similar to that observed with free recall and previously assumed to be attributable to the long-term memory component of that procedure (Glanzer, 1972). The usefulness of formal models as predictive tools and the continuity between short-term serial order and longer term item memory are considered.

A simulation model of self-organising evolvability in software systems

The evolvability of a software artifact is its capacity for producing heritable or reusable variants; the inverse quality is the artifact's inertia or resistance to evolutionary change. Evolvability in software systems may arise from engineering and/or self-organising processes. We describe our 'Conditional Growth' simulation model of software evolution and show how, it can be used to investigate evolvability from a self-organisation perspective. The model is derived from the Bak-Sneppen family of 'self-organised criticality' simulations. It shows good qualitative agreement with Lehman's 'laws of software evolution' and reproduces phenomena that have been observed empirically. The model suggests interesting predictions about the dynamics of evolvability and implies that much of the observed variability in software evolution can be accounted for by comparatively simple self-organising processes.

Immersive open surgery simulation

Realistic medical simulation has great potential for augmenting or complimenting traditional medical training or surgery planning, and Virtual Reality (VR) is a key enabling technology for delivering this goal. Although, medical simulators are now widely used in medical institutions, the majority of them are still reliant on desktop monitor displays, and many are restricted in their modelling capability to minimally invasive or endoscopic surgery scenarios. Whilst useful, such models lack the realism and interaction of the operating theatre. In this paper, we describe how we are advancing the technology by simulating open surgery procedures in an Immersive Projection Display CAVE environment thereby enabling medical practitioners to interact with their virtual patients in a more realistic manner.

Solving optimal control problems with state constraints using nonlinear programming and simulation tools

This paper illustrates how nonlinear programming and simulation tools, which are available in packages such as MATLAB and SIMULINK, can easily be used to solve optimal control problems with state- and/or input-dependent inequality constraints. The method presented is illustrated with a model of a single-link manipulator. The method is suitable to be taught to advanced undergraduate and Master's level students in control engineering.

Norms-based simulation for personalised service provision

User interfaces have the primary role of enabling access to information meeting individual users' needs. However, the user-systems interaction is still rigid, especially in support of complex environments where various types of users are involved. Among the approaches for improving user interface agility, we present a normative approach to the design interfaces of web applications, which allow delivering users personalized services according to parameters extracted from the simulation of norms in the social context. A case study in an e-Government context is used to illustrate the implications of the approach.

e-learning in project management using simulation models: a case study based on the replication of an experiment

Current e-learning systems are increasing their importance in higher education. However, the state of the art of e-learning applications, besides the state of the practice, does not achieve the level of interactivity that current learning theories advocate. In this paper, the possibility of enhancing e-learning systems to achieve deep learning has been studied by replicating an experiment in which students had to learn basic software engineering principles. One group learned these principles using a static approach, while the other group learned the same principles using a system-dynamics-based approach, which provided interactivity and feedback. The results show that, quantitatively, the latter group achieved a better understanding of the principles; furthermore, qualitatively, they enjoyed the learning experience

Influence of the solvent on the self-assembly of a modified amyloid beta peptide fragment. II. NMR and computer simulation investigation

The conformation of a model peptide AAKLVFF based on a fragment of the amyloid beta peptide A beta 16-20, KLVFF, is investigated in methanol and water via solution NMR experiments and Molecular dynamics computer simulations. In previous work, we have shown that AAKLVFF forms peptide nanotubes in methanol and twisted fibrils in water. Chemical shift measurements were used to investigate the solubility of the peptide as a function of concentration in methanol and water. This enabled the determination of critical aggregation concentrations, The Solubility was lower in water. In dilute solution, diffusion coefficients revealed the presence of intermediate aggregates in concentrated solution, coexisting with NMR-silent larger aggregates, presumed to be beta-sheets. In water, diffusion coefficients did not change appreciably with concentration, indicating the presence mainly of monomers, coexisting with larger aggregates in more concentrated solution. Concentration-dependent chemical shift measurements indicated a folded conformation for the monomers/intermediate aggregates in dilute methanol, with unfolding at higher concentration. In water, an antiparallel arrangement of strands was indicated by certain ROESY peak correlations. The temperature-dependent solubility of AAKLVFF in methanol was well described by a van't Hoff analysis, providing a solubilization enthalpy and entropy. This pointed to the importance of solvophobic interactions in the self-assembly process. Molecular dynamics Simulations constrained by NOE values from NMR suggested disordered reverse turn structures for the monomer, with an antiparallel twisted conformation for dimers. To model the beta-sheet structures formed at higher concentration, possible model arrangements of strands into beta-sheets with parallel and antiparallel configurations and different stacking sequences were used as the basis for MD simulations; two particular arrangements of antiparallel beta-sheets were found to be stable, one being linear and twisted and the other twisted in two directions. These structures Were used to simulate Circular dichroism spectra. The roles of aromatic stacking interactions and charge transfer effects were also examined. Simulated spectra were found to be similar to those observed experimentally.(in water or methanol) which show a maximum at 215 or 218 nm due to pi-pi* interactions, when allowance is made for a 15-18 nm red-shift that may be due to light scattering effects.