A Cost-Benefit Analysis of Early Childhood Intervention: Evidence from an Experimental Evaluation of the Incredible Years Parenting Program.

A number of researchers and policy makers have recently argued that the most effective way of dealing with long-run disadvantage and the intergenerational transmission of poverty is through early childhood intervention and in particular policies aimed at supporting the family. This study was part of a randomised evaluation of the Incredible Years Program, which is aimed at improving the skills and parenting strategies of parents who have children with conduct problems. The results show that the treatment significantly reduced behavioural problems in young children. Furthermore our detailed cost analysis, when combined with a consideration of the potential long-run benefits associated with the programme, suggest that the long-run rate of return to society from this program is likely to be relatively high.

The impact of three evidence-based programmes delivered in public systems in Birmingham, UK

The Birmingham Brighter Futures strategy was informed by epidemiological data on child well-being and evidence on “what works,” and included the implementation and evaluation of three evidence-based programmes in regular children’s services systems, as well as an integrated prospective cost-effectiveness analysis (reported elsewhere). A randomised controlled trial (RCT) of the Incredible Years BASIC parenting programme involved 161 children aged three and four at risk of a social-emotional or behavioural disorder. An RCT of the universal PATHS social-emotional learning curriculum involved children aged four–six years in 56 primary schools. An RCT of the Level 4 Group Triple-P parenting programme involved parents of 146 children aged four–nine years with potential social-emotional or behavioural disorders. All three studies used validated standardised measures. Both parenting programme trials used parentcompleted measures of child and parenting behaviour. The school-based trial used teacher reports of children’s behaviour, emotions, and social competence. Incredible Years yielded reductions in negative parenting behaviours among parents, reductions in child behaviour problems, and improvements in children’s relationships. In the PATHS trial, modest improvements in emotional health and behavioural development after one year disappeared by the end of year two. There were no effects for Triple-P. Much can be learned from the strengths and limitations of the Birmingham experience

A Cost-Benefit Analysis of Early Childhood Intervention: Evidence from an Experimental Evaluation of the Incredible Years Parenting Program.

A number of researchers and policy makers have recently argued that the most effective way of dealing with long-run disadvantage and the intergenerational transmission of poverty is through early childhood intervention and in particular policies aimed at supporting the family. This study was part of a randomised evaluation of the Incredible Years Program, which is aimed at improving the skills and parenting strategies of parents who have children with conduct problems. The results show that the treatment significantly reduced behavioural problems in young children. Furthermore our detailed cost analysis, when combined with a consideration of the potential long-run benefits associated with the programme, suggest that the long-run rate of return to society from this program is likely to be relatively high

The mTORC1 inhibitor everolimus prevents and treats Eμ-Myc lymphoma by restoring oncogene-induced senescence

MYC deregulation is common in human cancer. IG-MYC translocations that are modeled in EμMyc mice occur in almost all cases of Burkitt lymphoma as well as in other B-cell lymphoproliferative disorders. Deregulated expression of MYC results in increased mTOR complex 1 (mTORC1) signaling. As tumors with mTORC1 activation are sensitive to mTORC1 inhibition, we used everolimus, a potent and specific mTORC1 inhibitor, to test the requirement for mTORC1 in the initiation and maintenance of EμMyc lymphoma. Everolimus selectively cleared premalignant B cells from the bone marrow and spleen, restored a normal pattern of B-cell differentiation, and strongly protected against lymphoma development. Established EμMyc lymphoma also regressed after everolimus therapy. Therapeutic response correlated with a cellular senescence phenotype and induction of p53 activity. Therefore, mTORC1-dependent evasion of senescence is critical for cellular transformation and tumor maintenance by MYC in B lymphocytes

The origin and maintenance of metabolic allometry in animals

Organisms vary widely in size, from microbes weighing 0.1 pg to trees weighing thousands of megagrams - a 10-fold range similar to the difference in mass between an elephant and the Earth. Mass has a pervasive influence on biological processes, but the effect is usually non-proportional; for example, a tenfold increase in mass is typically accompanied by just a four- to sevenfold increase in metabolic rate. Understanding the cause of allometric scaling has been a long-standing problem in biology. Here, we examine the evolution of metabolic allometry in animals by linking microevolutionary processes to macroevolutionary patterns. We show that the genetic correlation between mass and metabolic rate is strong and positive in insects, birds and mammals. We then use these data to simulate the macroevolution of mass and metabolic rate, and show that the interspecific relationship between these traits in animals is consistent with evolution under persistent multivariate selection on mass and metabolic rate over long periods of time

Understanding the implementation and effectiveness of a group-based early parenting intervention : a process evaluation protocol

BACKGROUND: Group-based early parenting interventions delivered through community-based services may be a potentially effective means of promoting infant and family health and wellbeing. Process evaluations of these complex interventions provide vital information on how they work, as well as the conditions which shape and influence outcomes. This information is critical to decision makers and service providers who wish to embed prevention and early interventions in usual care settings. In this paper, a process evaluation protocol for an early years parenting intervention, the Parent and Infant (PIN) program, is described. This program combines a range of developmentally-appropriate supports, delivered in a single intervention process, for parents and infants (0–2 years) and aimed at enhancing parental competence, strengthening parent-infant relationships and improving infant wellbeing and adjustment. METHODS: The process evaluation is embedded within a controlled trial and accompanying cost-effectiveness evaluation. Building from extant frameworks and evaluation methods, this paper presents a systematic approach to the process evaluation of the PIN program and its underlying change principles, the implementation of the program, the context of implementation and the change mechanisms which influence and shape parent and infant outcomes. We will use a multi-method strategy, including semi-structured interviews and group discussions with key stakeholders, documentary analysis and survey methodology. DISCUSSION: The integration of innovations into existing early years systems and services is a challenging multifaceted undertaking. This process evaluation will make an important contribution to knowledge about the implementation of such programs, while also providing an example of how theory-based research can be embedded within the evaluation of community-based interventions. We discuss the strengths of the research, such as the adoption of a collaborative approach to data collection, while we also identify potential challenges, including capturing and assessing complex aspects of the intervention. TRIAL REGISTRATION: ISRCTN17488830 (Date of registration: 27/11/15). This trial was retrospectively registered. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12913-016-1737-3) contains supplementary material, which is available to authorized users

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Perceptions of sustainability of dairy support land farmers

This project investigated how successful dairy support land (DSL) farmers perceive sustainability, how they use DSL to achieve their goals and the way that these perceptions vary across locations and types of DSL. Seventeen farmers were interviewed using Yin’s case study method (Yin, 2003). The list of interviewees was derived from focus group meetings with rural professionals undertaken to assist with developing a set of theoretical propositions regarding sustainability. Separation into economic, environmental and social sustainability does not reflect how farmers understand or perceive sustainability of DSL. Their perceptions are better described by separation into issues internal to the farm system and issues external to the farm system. Those who acquire DSL do so primarily in order to reduce the number of factors that fall outside the farm and outside their control. For those interviewed, feed grown is the best measure of the effectiveness of DSL management; more feed grown means more control over cost of bought in feed and cow condition. For DSL to be sustainable (i.e. to grow feed), it must be fully resourced. There must be time to plan and carry out essential tasks and environmentally important developments such as riparian fences and stockwater systems should be in place. If the DSL is not fully resourced, loss of control will result in unreliable supply of feed, cows calving in poor condition and overextended farm staff and management. Poor control over environmental effects is also highly likely. There is little difference in farmers’ perceptions of sustainability and practice across a variety of soil and climatic conditions in Canterbury and Southland.Funding for this project was through a grant from the Sustainable Farming Fund to the South Island Dairying Development Centre (SIDDC)