University of East Anglia

About: University of East Anglia is a education organization based out in Norwich, Norfolk, United Kingdom. It is known for research contribution in the topics: Population & Climate change. The organization has 13250 authors who have published 37504 publications receiving 1669060 citations. The organization is also known as: UEA.

Effectiveness of continuous glucose monitoring in pregnant women with diabetes:randomised clinical trial

Abstract: Objective To evaluate the effectiveness of continuous glucose monitoring during pregnancy on maternal glycaemic control, infant birth weight, and risk of macrosomia in women with type 1 and type 2 diabetes. Design Prospective, open label randomised controlled trial. Setting Two secondary care multidisciplinary obstetric clinics for diabetes in the United Kingdom. Participants 71 women with type 1 diabetes (n=46) or type 2 diabetes (n=25) allocated to antenatal care plus continuous glucose monitoring (n=38) or to standard antenatal care (n=33). Intervention Continuous glucose monitoring was used as an educational tool to inform shared decision making and future therapeutic changes at intervals of 4-6 weeks during pregnancy. All other aspects of antenatal care were equal between the groups. Main outcome measures The primary outcome was maternal glycaemic control during the second and third trimesters from measurements of HbA 1c levels every four weeks. Secondary outcomes were birth weight and risk of macrosomia using birthweight standard deviation scores and customised birthweight centiles. Statistical analyses were done on an intention to treat basis. Results Women randomised to continuous glucose monitoring had lower mean HbA 1c levels from 32 to 36 weeks’ gestation compared with women randomised to standard antenatal care: 5.8% (SD 0.6) v 6.4% (SD 0.7). Compared with infants of mothers in the control arm those of mothers in the intervention arm had decreased mean birthweight standard deviation scores (0.9 v 1.6; effect size 0.7 SD, 95% confidence interval 0.0 to 1.3), decreased median customised birthweight centiles (69% v 93%), and a reduced risk of macrosomia (odds ratio 0.36, 95% confidence interval 0.13 to 0.98). Conclusion Continuous glucose monitoring during pregnancy is associated with improved glycaemic control in the third trimester, lower birth weight, and reduced risk of macrosomia. Trial registration Current Controlled Trials ISRCTN84461581.

A toolkit for analysing large-scale plant small RNA datasets

Abstract: Summary: Recent developments in high-throughput sequencing technologies have generated considerable demand for tools to analyse large datasets of small RNA sequences. Here, we describe a suite of web-based tools for processing plant small RNA datasets. Our tools can be used to identify micro RNAs and their targets, compare expression levels in sRNA loci, and find putative trans-acting siRNA loci. Availability: The tools are freely available for use at http://srna-tools.cmp.uea.ac.uk Contact: [email protected]

The Validity of Environmental Benefits Transfer: Further Empirical Testing

Abstract: This paper provides further empirical evidence of the validity of environmental benefits transfer based on CV studies by expanding the analysis to include control factors which have not been accounted for in previous studies. These factors refer to differences in respondent attitudes. Traditional population characteristics were taken into account, but these variables do not explain why respondents from the same socio-economic group may still hold different beliefs, norms or values and hence have different attitudes and consequently state different WTP amounts. The test results are mixed. The function transfer approach is valid in one case, but is rejected in the 3 other cases investigated in this paper. We provide further evidence that in the case of statistically valid benefits transfer, the function approach results in a more robust benefits transfer than the unit value approach. We also show that the equality of coefficient estimates is a necessary, but insufficient condition for valid benefit function transfer and discuss the implications for previous and future validity testing.

Cost effectiveness of telehealth for patients with long term conditions (Whole Systems Demonstrator telehealth questionnaire study): nested economic evaluation in a pragmatic, cluster randomised controlled trial

Abstract: Objective To examine the costs and cost effectiveness of telehealth in addition to standard support and treatment, compared with standard support and treatment. Design Economic evaluation nested in a pragmatic, cluster randomised controlled trial. Setting Community based telehealth intervention in three local authority areas in England. Participants 3230 people with a long term condition (heart failure, chronic obstructive pulmonary disease, or diabetes) were recruited into the Whole Systems Demonstrator telehealth trial between May 2008 and December 2009. Of participants taking part in the Whole Systems Demonstrator telehealth questionnaire study examining acceptability, effectiveness, and cost effectiveness, 845 were randomised to telehealth and 728 to usual care. Interventions Intervention participants received a package of telehealth equipment and monitoring services for 12 months, in addition to the standard health and social care services available in their area. Controls received usual health and social care. Main outcome measure Primary outcome for the cost effectiveness analysis was incremental cost per quality adjusted life year (QALY) gained. Results We undertook net benefit analyses of costs and outcomes for 965 patients (534 receiving telehealth; 431 usual care). The adjusted mean difference in QALY gain between groups at 12 months was 0.012. Total health and social care costs (including direct costs of the intervention) for the three months before 12 month interview were £1390 (€1610; $2150) and £1596 for the usual care and telehealth groups, respectively. Cost effectiveness acceptability curves were generated to examine decision uncertainty in the analysis surrounding the value of the cost effectiveness threshold. The incremental cost per QALY of telehealth when added to usual care was £92 000. With this amount, the probability of cost effectiveness was low (11% at willingness to pay threshold of £30 000; >50% only if the threshold exceeded about £90 000). In sensitivity analyses, telehealth costs remained slightly (non-significantly) higher than usual care costs, even after assuming that equipment prices fell by 80% or telehealth services operated at maximum capacity. However, the most optimistic scenario (combining reduced equipment prices with maximum operating capacity) eliminated this group difference (cost effectiveness ratio £12 000 per QALY). Conclusions The QALY gain by patients using telehealth in addition to usual care was similar to that by patients receiving usual care only, and total costs associated with the telehealth intervention were higher. Telehealth does not seem to be a cost effective addition to standard support and treatment. Trial registration ISRCTN43002091.