Change in viral bronchiolitis management in hospitals in the UK after the publication of NICE guideline.

BACKGROUND: Viral bronchiolitis is one of the most common causes of hospitalisation in young infants. It has previously been shown that many United Kingdom (UK) hospital Trusts were not compliant with many aspects of the National Institute for Health and Care Excellence (NICE) bronchiolitis guideline prior to its publication. OBJECTIVES: This study aimed to investigate changes in the management of bronchiolitis by hospital Trusts between 2015 (before NICE guideline publication) and 2017, after publication. STUDY DESIGN: We prospectively surveyed paediatricians at UK hospital Trusts on the management of bronchiolitis before (March to May 2015) and after (January to May 2017) the NICE bronchiolitis guideline publication in June 2015, using an electronic, structured questionnaire. RESULTS: In 2015 111 Trusts were represented and in 2017 100 Trusts. Significant improvements were seen in the use of nebulised bronchodilators and hypertonic saline and provision of parental written guidance. However, full compliance with the guideline did not change with 18% of Trusts compliant before publication of the guideline in 2015 and 19% fully compliant with the guideline in 2017. CONCLUSIONS: Overall there were modest but important improvements in the reported management of bronchiolitis after the publication of the NICE guideline

A Compton telescope for remote location and identification of radioactive material

The spare detectors from NASA Compton Gamma-Ray Observatory COMPTEL instrument have been reconfigured to demonstrate the capability at ground level to remotely locate and identify sources of g radiation or the movement of material that might shield γ-ray sources. The Gamma-Ray Experimental Telescope Assembly (GRETA) employs two 28 cm diameter scintillation detectors separated by 81 cm: one 8.5 cm thick liquid scintillator detector and one 7.5 cm thick NaI(Tl) detector. The assembly electronics and real-time data acquisition system measures the energy deposits and time-of- flight for each coincident detection and compiles histograms of total energy and incident angle as computed using the kinematics of Compton scattering. The GRETA field of view is a cone with full angle approximately 120°. The sensitive energy range is 0.3 to 2.6 MeV. Energy resolution is ~10% FWHM. The angular resolution, ~19° in the simplified configuration tested, will improve to better than 5° with well-defined enhancements to the data acquisition hardware and data analysis routines. When operated in the mode that was used in space, the instrument is capable of measuring and imaging up to 30 MeV with an angular resolution of 1.5°. The response of the instrument was mapped in the laboratory with 14 Ci 22Na source 3 m from the instrument. Later, we conducted demonstrations under two measurement scenarios. In one, the remotely located instrument observed an increase of background radiation counts at 1.4 MeV when a large amount of lead was removed from a building and a corresponding decrease when the lead was replaced. In the other scenario, the location and isotope-identifying energy spectrum of a 500 μCi137Cs source 3-5 m from the instrument with two intervening walls was determined in less than one minute. We report details of the instrument design and these measurements

Fusion of radar data to extract 3-dimensional objects LDRD final report

Interferometric Synthetic Aperture Radar (IFSAR) is a very promising technology for remote mapping of 3-Dimensional objects. In particular, 3-D maps of urban areas are extremely important to a wide variety of users, both civilian and military. However, 3-D maps produced by traditional optical stereo (stereogrammetry) techniques can be quite expensive to obtain, and accurate urban maps can only be obtained with a large amount of human-intensive interpretation work. IFSAR has evolved over the last decade as a mapping technology that promises to eliminate much of the human-intensive work in producing elevation maps. However, IFSAR systems have only been robustly demonstrated in non-urban areas, and have not traditionally been able to produce data with enough detail to be of general use in urban areas. Sandia Laboratories Twin Otter IFSAR was the first mapping radar system with the proper parameter set to provide sufficiently detailed information in a large number of urban areas. The goal of this LDRD was to fuse previously unused information derived from IFSAR data in urban areas that can be used to extract accurate digital elevation models (DEMs) over wide areas without intensive human interaction

Interferometric synthetic aperture radar imagery of the Gulf Stream

The advent of interferometric synthetic aperture radar (INSAR) imagery brought to the ocean remote sensing field techniques used in radio astronomy. Whilst details of the interferometry differ between the two fields, the basic idea is the same: Use the phase information arising from positional differences of the radar receivers and/or transmitters to probe remote structures. The interferometric image is formed from two complex synthetic aperture radar (SAR) images. These two images are of the same area but separated in time. Typically the time between these images is very short -- approximately 50 msec for the L-band AIRSAR (Airborne SAR). During this short period the radar scatterers on the ocean surface do not have time to significantly decorrelate. Hence the two SAR images will have the same amplitude, since both obtain the radar backscatter from essentially the same object. Although the ocean surface structure does not significantly decorrelate in 50 msec, surface features do have time to move. It is precisely the translation of scattering features across the ocean surface which gives rise to phase differences between the two SAR images. This phase difference is directly proportional to the range velocity of surface scatterers. The constant of proportionality is dependent upon the interferometric mode of operation

Financing of U.S. Biomedical Research and New Drug Approvals across Therapeutic Areas

We estimated U.S. biomedical research funding across therapeutic areas, determined the association with disease burden, and evaluated new drug approvals that resulted from this investment.We calculated funding from 1995 to 2005 and totaled Food and Drug Administration approvals in eight therapeutic areas (cardiovascular, endocrine, gastrointestinal, genitourinary, HIV/AIDS, infectious disease excluding HIV, oncology, and respiratory) primarily using public data. We then calculated correlations between funding, published estimates of disease burden, and drug approvals. Financial support for biomedical research from 1995 to 2005 increased across all therapeutic areas between 43% and 369%. Industry was the principal funder of all areas except HIV/AIDS, infectious disease, and oncology, which were chiefly sponsored by the National Institutes of Health (NIH). Total (rho = 0.70; P = .03) and industry funding (rho = 0.69; P = .04) were correlated with projected disease burden in high income countries while NIH support (rho = 0.80; P = .01) was correlated with projected disease burden globally. From 1995 to 2005 the number of new approvals was flat or declined across therapeutic areas, and over an 8-year lag period, neither total nor industry funding was correlated with future approvals.Across therapeutic areas, biomedical research funding increased substantially, appears aligned with disease burden in high income countries, but is not linked to new drug approvals. The translational gap between funding and new therapies is affecting all of medicine, and remedies must include changes beyond additional financial investment

Are vaccination programmes delivered by lay health workers cost-effective? A systematic review

<p>Abstract</p> <p>Background</p> <p>A recently updated Cochrane systematic review on the effects of lay or community health workers (LHWs) in primary and community health care concluded that LHW interventions could lead to promising benefits in the promotion of childhood vaccination uptake. However, understanding of the costs and cost-effectiveness of involving LHWs in vaccination programmes remains poor. This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving LHWs.</p> <p>Methods</p> <p>Articles were retrieved if the title, keywords or abstract included terms related to 'lay health workers', 'vaccination' and 'economics'. Reference lists of studies assessed for inclusion were also searched and attempts were made to contact authors of all studies included in the Cochrane review. Studies were included after assessing eligibility of the full-text article. The included studies were then reviewed against a set of background and technical characteristics.</p> <p>Results</p> <p>Of the 2616 records identified, only three studies fully met the inclusion criteria, while an additional 11 were retained as they included some cost data. Methodologically, the studies were strong but did not adequately address affordability and sustainability and were also highly heterogeneous in terms of settings and LHW outcomes, limiting their comparability. There were insufficient data to allow any conclusions to be drawn regarding the cost-effectiveness of LHW interventions to promote vaccination uptake. Studies focused largely on health outcomes and did illustrate to some extent how the institutional characteristics of communities, such as governance and sources of financial support, influence sustainability.</p> <p>Conclusion</p> <p>The included studies suggest that conventional economic evaluations, particularly cost-effectiveness analyses, generally focus too narrowly on health outcomes, especially in the context of vaccination promotion and delivery at the primary health care level by LHWs. Further studies on the costs and cost-effectiveness of vaccination programmes involving LHWs should be conducted, and these studies should adopt a broader and more holistic approach.</p

The economics of debt clearing mechanisms

We examine the evolution of decentralized clearinghouse mechanisms from the 13th to the 18th century; in particular, we explore the clearing of non- or limitedtradable debts like bills of exchange. We construct a theoretical model of these clearinghouse mechanisms, similar to the models in the theoretical matching literature, and show that specific decentralized multilateral clearing algorithms known as rescontre, skontrieren or virement des parties used by merchants were efficient in specific historical contexts. We can explain both the evolutionary self-organizing emergence of late medieval and early modern fairs, and its robustness during the 17th and 18th century