Applying economic evaluation to public health interventions: The case of interventions to promote physical activity

Copyright @ 2012 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: This paper explores the application of alternative approaches to economic evaluation of public health interventions, using a worked example of exercise referral schemes (ERSs). METHODS: Cost-utility (CUA) and cost-consequence analyses (CCA) were used to assess the cost-effectiveness of ERSs. For the CUA, evidence was synthesized using a decision analytic model that adopts a lifetime horizon and NHS/Personal Social Services perspective. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). CCA was conducted from a partial-societal perspective, including health and non-healthcare costs and benefits. Outcomes were reported in natural units, such as cases of strokes or CHD avoided. RESULTS: Compared with usual care, the incremental cost per QALY of ERS is £20 876. Based on a cohort of 100 000 individuals, CCA estimates cost of ERS at £22 million to the healthcare provider and £12 million to participants. The benefits of ERS include additional 3900 people becoming physically active, 51 cases of CHD avoided, 16 cases of stroke avoided, 86 cases of diabetes avoided and a gain of ∼800 QALYs. CONCLUSIONS: CCA might provide greater transparency than CUA in reporting the outcomes of public health interventions and have greater resonance with stakeholders involved in commissioning these interventions.This work was supported by the NIHR Health Technology Assessment programme (project number 08/72/01). This article is made available through the Brunel Open Access Publishing Fund

Preterm infants have deficient monocyte and lymphocyte cytokine responses to Group B Streptococcus

Group B streptococcus GBS) is an important cause of early-and late-onset sepsis in the newborn. Preterm infants have markedly increased susceptibility and worse outcomes, but their immunological responses to GBS are poorly defined. We compared mononuclear cell and whole-blood cytokine responses to heat-killed GBS HKGBS) of preterm infants gestational age [GA], 26 to 33 weeks), term infants, and healthy adults. We investigated the kinetics and cell source of induced cytokines and quantified HKGBS phagocytosis. HKGBS-induced tumor necrosis factor TNF) and interleukin 6 (IL-6) secretion was significantly impaired in preterm infants compared to that in term infants and adults. These cytokines were predominantly monocytic in origin, and production was intrinsically linked to HKGBS phagocytosis. Very preterm infants GA, < 30 weeks) had fewer cytokine-producing monocytes, but nonopsonic phagocytosis ability was comparable to that for term infants and adults. Exogenous complement supplementation increased phagocytosis in all groups, as well as the proportion of preterm monocytes producing IL-6, but for very preterm infants, responses were still deficient. Similar defective preterm monocyte responses were observed in fresh whole cord blood stimulated with live GBS. Lymphocyte-associated cytokines were significantly deficient for both preterm and term infants compared to levels for adults. These findings indicate that a subset of preterm monocytes do not respond to GBS, a defect compounded by generalized weaker lymphocyte responses in newborns. Together these deficient responses may increase the susceptibility of preterm infants to GBS infection

THYMOCYTES FROM MICE IMMUNIZED AGAINST AN ALLOGRAFT RENDER BONE-MARROW CELLS SPECIFICALLY CYTOTOXIC

Thymocytes from C57BL mice immunized with the DBA/2 lymphoma L5178Y exert in vitro an immunologically specific cytotoxic action against the target cells in the presence of bone-marrow cells. Neither the nonimmune bone marrow nor the immune thymocytes are by themselves cytotoxic. The cells in the bone marrow which take part in the cytotoxic action adhere to glass and are sensitive to anti-macrophage serum. These bone-marrow cells can also be rendered specifically cytotoxic by exposure to the supernatant obtained from a culture of immune thymocytes with the specific target cells. The thymocytes before they are confronted with the specific target cells are very radiosensitive; however, on coming into contact with the target cells, an immunologically specific increase in RNA synthesis occurs and thereafter the thymocytes' capacity to render bone-marrow cells cytotoxic is relatively radioresistant. Two classes of immune lymphocytes occur in mice immunized with allogeneic cells, those that are capable of killing target cells directly and those that produce a factor capable of rendering macrophages (or monocytes) specifically cytotoxic. In the thymus of immune animals only the latter are found while both categories are present in the spleen and lymph nodes of immune animals

Hamiltonian Formulation of Two Body Problem in Wheeler-Feynman electrodynamics

A Hamiltonian formulation for the classical problem of electromagnetic interaction of two charged relativistic particles is found.Comment: 22 pages, 8 Uuencoded Postscript figure

A new version of the HBSC Family Affluence Scale - FAS III: Scottish qualitative findings from the International FAS Development Study

A critical review of the Family Affluence Scale (FAS) concluded that FAS II was no longer discriminatory within very rich or very poor countries, where a very high or a very low proportion of children were categorised as high FAS or low FAS respectively (Currie et al. 2008). The review concluded that a new version of FAS - FAS III - should be developed to take into account current trends in family consumption patterns across the European region, the US and Canada. In 2012, the FAS Development and Validation Study was conducted in eight countries - Denmark, Greenland, Italy, Norway, Poland, Romania, Slovakia and Scotland. This paper describes the Scottish qualitative findings from this study. The Scottish qualitative fieldwork comprising cognitive interviews and focus groups sampled from 11, 13 and 15 year-old participants from 18 of the most- and least- economically deprived schools. These qualitative results were used to inform the final FAS III recommendations.Publisher PDFPeer reviewe

Gauge Invariant Hamiltonian Formalism for Spherically Symmetric Gravitating Shells

The dynamics of a spherically symmetric thin shell with arbitrary rest mass and surface tension interacting with a central black hole is studied. A careful investigation of all classical solutions reveals that the value of the radius of the shell and of the radial velocity as an initial datum does not determine the motion of the shell; another configuration space must, therefore, be found. A different problem is that the shell Hamiltonians used in literature are complicated functions of momenta (non-local) and they are gauge dependent. To solve these problems, the existence is proved of a gauge invariant super-Hamiltonian that is quadratic in momenta and that generates the shell equations of motion. The true Hamiltonians are shown to follow from the super-Hamiltonian by a reduction procedure including a choice of gauge and solution of constraint; one important step in the proof is a lemma stating that the true Hamiltonians are uniquely determined (up to a canonical transformation) by the equations of motion of the shell, the value of the total energy of the system, and the choice of time coordinate along the shell. As an example, the Kraus-Wilczek Hamiltonian is rederived from the super-Hamiltonian. The super-Hamiltonian coincides with that of a fictitious particle moving in a fixed two-dimensional Kruskal spacetime under the influence of two effective potentials. The pair consisting of a point of this spacetime and a unit timelike vector at the point, considered as an initial datum, determines a unique motion of the shell.Comment: Some remarks on the singularity of the vector potantial are added and some minor corrections done. Definitive version accepted in Phys. Re

JHK Observations of Faint Standard Stars in the Mauna Kea Near-Infrared Photometric System

JHK photometry in the Mauna Kea Observatory (MKO) near-IR system is presented for 115 stars. Of these, 79 are UKIRT standards and 42 are LCO standards. The average brightness is 11.5 mag, with a range of 10 to 15. The average number of nights each star was observed is 4, and the average of the internal error of the final results is 0.011 mag. These JHK data agree with those reported by other groups to 0.02 mag. The measurements are used to derive transformations between the MKO JHK photometric system and the UKIRT, LCO and 2MASS systems. The 2MASS-MKO data scatter by 0.05 mag for redder stars: 2MASS-J includes H2O features in dwarfs and MKO-K includes CO features in giants. Transformations derived for stars whose spectra contain only weak features cannot give accurate transformations for objects with strong absorption features within a filter bandpasses. We find evidence of systematic effects at the 0.02 mag level in the photometry of stars with J<11 and H,K<10.5. This is due to an underestimate of the linearity correction for stars observed with the shortest exposure times; very accurate photometry of stars approaching the saturation limits of infrared detectors which are operated in double-read mode is difficult to obtain. Four stars in the sample, GSPC S705-D, FS 116 (B216-b7), FS 144 (Ser-EC84) and FS 32 (Feige 108), may be variable. 84 stars in the sample have 11< J< 15 and 10.5<H,K<15, are not suspected to be variable, and have magnitudes with an estimated error <0.027 mag; 79 of these have an error of <0.020 mag. These represent the first published high-accuracy JHK stellar photometry in the MKO photometric system; we recommend these objects be employed as primary standards for that system [abridged].Comment: Accepted for publication in MNRAS, 14 pages, 5 Figure

Age of high-grade gneisses south of Grand Lake, Newfoundland

Crystalline rocks of the Steel Mountain Subzone of the Humber Zone in southwest Newfoundland give an age for granulite-grade metamorphism of 1498+9/-8 Ma, similar to ages from the Long Range inlier and northwestern Cape Breton Island. Peralkaline leucogranite was emplaced at 608 ± 4 Ma. The emplacement of anorthosite-gabbro complexes and amphibolite-grade metamorphism took place between these dates. The southern part of the Dunnage Zone (Central Gneiss Subzone), in contact with the Steel Mountain Subzone at the Long Range Fault, lacks Precambrian crystalline rocks, but was intruded by charnockitic plutons and metamorphosed to granulite facies at 460 ±10 Ma. This subzone was exhumed before 435 Ma. In the Meelpaeg Subzone of the Gander Zone, which is in contact with the Central Gneiss Subzone along the Victoria River Fault, the oldest intrusive component of a granoblastic migmatitic gneiss was emplaced at 418 ± 4 Ma. These data demonstrate that both the Long Range and Victoria River faults form major tectonic boundaries. Subzones appear to have been thrust westward in Silurian or later time. R&#xC9;SUM&#xC9; Les roches cristallines de la sous-zone du mont Steel, dans la zone de Humber du sud-ouest de Terre-Neuve, ont donn&#xE9; des &#xE2;ges de 1498+9/-8 Ma pour le m&#xE9;tamorphisme de haul grade, similaires &#xE0; ceux de la boutonni&#xE8;re de Long Range et du nord de l'ile-du-Cap-Breton. Un leucogranite peralcalin s'est mis en place &#xE0; 608 ± 4 Ma. L'intrusion des complexes &#xE0; anorthosite-gabbro et le m&#xE9;tamorphisme au faci&#xE8;s amphibolite se sont produits entre ces deux &#xE9;v&#xE8;nements. La partie sud de la zone de Dunnage (sous-zone de gneiss centrale), en contact avec la sous-zone du mont Steel a la faille de Long Range, ne contient pas de roches cristallines pr&#xE9;cambriennes mais &#xE0; 616 recouped par des plutons charnockitiques et &#xE0; 616 m&#xE9;tamorphis&#xE9;e au faci&#xE8;s granulite &#xE0; 460 ± 10 Ma. Cette sous-zone a &#xE9;t&#xE9; exhumge avant 435 Ma. Dans la sous-zone Mulpaeg de la zone de Gander, qui est mise en contact avec la sous-zone de gneiss centrale par la faille de la rivi&#xE8;re Victoria, la phase intrusive la plus ancienne d'un gneiss migmatitique et granoblastique s'est mise en place &#xE0; 418 ± 4 Ma. Ces donn&#xE9;es d&#xE9;montrent que les failles de Long Range et de la rivi&#xE8;re Victoria sont des fronti&#xE8;res tectoniques majeures. Les sous-zones semblent avoir subi un chevauchement vers l'ouest au plus tard au Silurien. [Traduit par le journal

Paper versus electronic feedback in high stakes assessment

Peer reviewedPublisher PD

Developmental changes in spinal neuronal properties, motor network configuration, and neuromodulation at free-swimming stages of Xenopus tadpoles

We describe a novel preparation of the isolated brainstem and spinal cord from pro-metamorphic tadpole stages of the South African clawed frog (Xenopus laevis) that permits whole cell patch-clamp recordings from neurons in the ventral spinal cord. Previous research on earlier stages of the same species has provided one of the most detailed understandings of the design and operation of a CPG circuit. Here we have addressed how development sculpts complexity from this more basic circuit. The preparation generates bouts of fictive31 swimming activity either spontaneously or in response to electrical stimulation of the optic tectum, allowing an investigation into how the neuronal properties, activity patterns and neuromodulation of locomotor rhythm generation change during development. We describe an increased repertoire of cellular responses compared to younger larval stages and investigate the cellular level effects of nitrergic neuromodulation as well as the development of a sodium pump-mediated ultra-slow afterhyperpolarisation (usAHP) in these free-swimming larval animals.PostprintPeer reviewe