A systematic review of scabies transmission models and data to evaluate the cost-effectiveness of scabies interventions

© 2019 van der Linden et al. Background: Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. Objective: To review published scabies models and data to inform the design of a comprehensive scabies transmission modelling framework to evaluate the cost-effectiveness of scabies interventions. Methods: Systematic literature search in PubMed, Medline, Embase, CINAHL, and the Cochrane Library identified scabies studies published since the year 2000. Selected papers included modelling studies and studies on the life cycle of scabies mites, patient quality of life and resource use. Reference lists of reviews were used to identify any papers missed through the search strategy. Strengths and limitations of identified scabies models were evaluated and used to design a modelling framework. Potential model inputs were identified and discussed. Findings: Four scabies models were published: a Markov decision tree, two compartmental models, and an agent-based, network-dependent Monte Carlo model. None of the models specifically addressed crusted scabies, which is associated with high morbidity, mortality, and increased transmission. There is a lack of reliable, comprehensive information about scabies biology and the impact this disease has on patients and society. Discussion: Clinicians and health economists working in the field of scabies are encouraged to use the current review to inform disease transmission modelling and economic evaluations on interventions against scabies

Health care cost of crusted scabies in Aboriginal communities in the Northern Territory, Australia.

BACKGROUND: Crusted scabies is a debilitating dermatological condition. Although still relatively rare in the urban areas of Australia, rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are reported to be among the highest in the world. OBJECTIVE: To estimate the health system costs associated with diagnosing, treating and managing crusted scabies. METHODS: A disease pathway model was developed to identify the major phases of managing crusted scabies. In recognition of the higher resource use required to treat more severe cases, the pathway differentiates between crusted scabies severity grades. The disease pathway model was populated with data from a clinical audit of 42 crusted scabies patients diagnosed in the Top-End of Australia's Northern Territory between July 1, 2016 and May 1, 2018. These data were combined with standard Australian unit costs to calculate the expected costs per patient over a 12-month period, as well as the overall population cost for treating crusted scabies. FINDINGS: The expected health care cost per patient diagnosed with crusted scabies is $35,418 Australian dollars (AUD) (95$27,000 to $43,800), resulting in an overall cost of$1,558,392AUD (95% CI: $1,188,000 to$1,927,200) for managing all patients diagnosed in the Northern Territory in a given year (2018). By far, the biggest component of the health care costs falls on the hospital system. DISCUSSION: This is the first cost-of-illness analysis for treating crusted scabies. Such analysis will be of value to policy makers and researchers by informing future evaluations of crusted scabies prevention programs and resource allocation decisions. Further research is needed on the wider costs of crusted scabies including non-financial impacts such as the loss in quality of life as well as the burden of care and loss of well-being for patients, families and communities

Lessons from Love-Locks: The archaeology of a contemporary assemblage

This document is the Accepted Manuscript version. The final, definitive version of this paper has been published in Journal of Material Culture, November 2017, published by SAGE Publishing, All rights reserved.Loss of context is a challenge, if not the bane, of the ritual archaeologist’s craft. Those who research ritual frequently encounter difficulties in the interpretation of its often tantalisingly incomplete material record. Careful analysis of material remains may afford us glimpses into past ritual activity, but our often vast chronological separation from the ritual practitioners themselves prevent us from seeing the whole picture. The archaeologist engaging with structured deposits, for instance, is often forced to study ritual assemblages post-accumulation. Many nuances of its formation, therefore, may be lost in interpretation. This paper considers what insights an archaeologist could gain into the place, people, pace, and purpose of deposition by recording an accumulation of structured deposits during its formation, rather than after. To answer this, the paper will focus on a contemporary depositional practice: the love-lock. This custom involves the inscribing of names/initials onto a padlock, its attachment to a bridge or other public structure, and the deposition of the corresponding key into the water below; a ritual often enacted by a couple as a statement of their romantic commitment. Drawing on empirical data from a three-year diachronic site-specific investigation into a love-lock bridge in Manchester, UK, the author demonstrates the value of contemporary archaeology in engaging with the often enigmatic material culture of ritual accumulations.Peer reviewe

Reanalysis of Data Taken by the CANGAROO 3.8 Meter Imaging Atmospheric Cherenkov Telescope: PSR B1706-44, SN 1006, and Vela

We have reanalyzed data from observations of PSR B1706-44, SN 1006, and the Vela pulsar region made with the CANGAROO 3.8 m imaging atmospheric Cherenkov telescope between 1993 and 1998 in response to the results reported for these sources by the H.E.S.S. collaboration. In our reanalysis, in which gamma-ray selection criteria have been determined exclusively using gamma-ray simulations and OFF-source data as background samples, no significant TeV gamma-ray signals have been detected from compact regions around PSR B1706-44 or within the northeast rim of SN 1006. We discuss reasons why the original analyses gave the source detections. The reanalysis did result in a TeV gamma-ray signal from the Vela pulsar region at the 4.5 sigma level using 1993, 1994, and 1995 data. The excess was located at the same position, 0.13 deg. to the southeast of the Vela pulsar, as that reported in the original analysis. We have investigated the effect of the acceptance distribution in the field of view of the 3.8 m telescope, which rapidly decreases toward the edge of the field of the camera, on the detected gamma-ray morphology. The expected excess distribution for the 3.8 m telescope has been obtained by reweighting the distribution of HESS J0835-455 measured by H.E.S.S. with the acceptance of the 3.8 m telescope. The result is morphologically comparable to the CANGAROO excess distribution, although the profile of the acceptance-reweighted H.E.S.S. distribution is more diffuse than that of CANGAROO. The integral gamma-ray flux from HESS J0835-455 has been estimated for the same region as defined by H.E.S.S. from the 1993-1995 data of CANGAROO to be F(> 4.0 +/- 1.6 TeV) = (3.28 +/- 0.92) x 10^{-12} photons cm^{-2} s^{-1}, which is statistically consistent with the integral flux obtained by H.E.S.S.Comment: Published in ApJ, minor improvement

High-temperature change of the creep rate in YBa 2Cu 3O 7-δ films with different pinning landscapes

Magnetic relaxation measurements in YBa 2Cu 3O 7-δ (YBCO) films at intermediate and high temperatures show that the collective vortex creep based on the elastic motion of the vortex lattice has a crossover to fast creep that significantly reduces the superconducting critical current density (J c). This crossover occurs at temperatures much lower than the irreversibility field line. We study the influence of different kinds of crystalline defects, such as nanorods, twin boundaries, and nanoparticles, on the high-temperature vortex phase diagram of YBCO films. We found that the magnetization relaxation data is a fundamental tool to understand the pinning at high temperatures. The results indicate that high J c values are directly associated with small creep rates. Based on the analysis of the depinning temperature in films with columnar defects, our results indicate that the size of the defects is the relevant parameter that determines thermal depinning at high temperatures. Also, the extension of the collective creep regime depends on the density of the pinning centers.Fil: Haberkorn, Nestor Fabian. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Patagonia Norte; ArgentinaFil: Miura, M.. No especifíca;Fil: Baca, J.. No especifíca;Fil: Maiorov, B.. No especifíca;Fil: Usov, I.. No especifíca;Fil: Dowden, P.. No especifíca;Fil: Foltyn, S. R.. No especifíca;Fil: Holesinger, T. G.. No especifíca;Fil: Willis, J. O.. No especifíca;Fil: Marken, K. R.. No especifíca;Fil: Izumi, T.. No especifíca;Fil: Shiohara, Y.. No especifíca;Fil: Civale, L.. No especifíca

Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals

Background: Australian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional's perceptions of models of care and related quality improvement activities since the implementation of the Partnership. Methods: Changes to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A 'systems assessment tool' was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology. Results: Key improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes. Conclusions: The Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes.R. Kirkham, J.A. Boyle, C. Whitbread, M. Dowden, C. Connors, S. Corpus, L. McCarthy, J. Oats, H.D. McIntyre, E. Moore, K. O’Dea, A. Brown, L. Maple-Brown (On behalf of the NT Diabetes in Pregnancy Partnership

The Penny’s Dropped: Renegotiating the contemporary coin deposit

This is the Accepted Manuscript of the following article: Ceri Houlbrook, “The penny’s dropped: Renegotiating the contemporary coin deposit”, Journal of Material Culture, Vol. 20(2): 173-189, March 2015. The final published version is available at: http://journals.sagepub.com/doi/pdf/10.1177/1359183515577120#articleCitationDownloadContainer © 2015, © SAGE Publications.This article examines the status of coins as contemporary deposits in the British Isles. With a focus on both historical and contemporary sites, from the Neolithic long barrow of Wayland’s Smithy, Oxfordshire, to the plethora of wishing-wells and coin-trees distributed across the British Isles, it demonstrates the popularity of coins as ritual deposits. The author considers how they are perceived and treated by site custodians, and concludes with a case study of an archaeological excavation, the 2013 Ardmaddy Wishing-Tree Project, which recovered a large amount of contemporary coin deposits. This article does not aim to locate itself within the debates of site custodianship and accessibility, nor does it propose to address the broader dilemmas of a site’s ritual continuity or resurgence. Instead, its aim is to encourage archaeologists to consider the contemporary deposit as an integral part of the ritual narrative of a site, rather than as disposable ‘ritual litter’.Peer reviewedFinal Accepted Versio

Understanding uptake of continuous quality improvement in Indigenous primary health care: lessons from a multi-site case study of the Audit and Best Practice for Chronic Disease project

<p>Abstract</p> <p>Background</p> <p>Experimentation with continuous quality improvement (CQI) processes is well underway in Indigenous Australian primary health care. To date, little research into how health organizations take up, support, and embed these complex innovations is available on which services can draw to inform implementation. In this paper, we examine the practices and processes in the policy and organisational contexts, and aim to explore the ways in which they interact to support and/or hinder services' participation in a large scale Indigenous primary health care CQI program.</p> <p>Methods</p> <p>We took a theory-driven approach, drawing on literature on the theory and effectiveness of CQI systems and the Greenhalgh diffusion of innovation framework. Data included routinely collected regional and service profile data; uptake of tools and progress through the first CQI cycle, and data collected quarterly from hub coordinators on their perceptions of barriers and enablers. A total of 48 interviews were also conducted with key people involved in the development, dissemination, and implementation of the Audit and Best Practice for Chronic Disease (ABCD) project. We compiled the various data, conducted thematic analyses, and developed an in-depth narrative account of the processes of uptake and diffusion into services.</p> <p>Results</p> <p>Uptake of CQI was a complex and messy process that happened in fits and starts, was often characterised by conflicts and tensions, and was iterative, reactive, and transformational. Despite initial enthusiasm, the mixed successes during the first cycle were associated with the interaction of features of the environment, the service, the quality improvement process, and the stakeholders, which operated to produce a set of circumstances that either inhibited or enabled the process of change. Organisations had different levels of capacity to mobilize resources that could shift the balance toward supporting implementation. Different forms of leadership and organisational linkages were critical to success. The Greenhalgh framework provided a useful starting point for investigation, but we believe it is more a descriptive than explanatory model. As such, it has limitations in the extent to which it could assist us in understanding the interactions of the practices and processes that we observed at different levels of the system.</p> <p>Summary</p> <p>Taking up CQI involved engaging multiple stakeholders in new relationships that could support services to construct shared meaning and purpose, operationalise key concepts and tools, and develop and embed new practices into services systems and routines. Promoting quality improvement requires a system approach and organization-wide commitment. At the organization level, a formal high-level mandate, leadership at all levels, and resources to support implementation are needed. At the broader system level, governance arrangements that can fulfil a number of policy objectives related to articulating the linkages between CQI and other aspects of the regulatory, financing, and performance frameworks within the health system would help define a role and vision for quality improvement.</p

Small Change: Economics and the British coin-tree

This is the accepted manuscript for the following article: Ceri Houlbrook, “Small Change: Economics and the British coin-tree”, Post Medieval Archaeology, Vol. 49(1), June 2015. The final published version can be found at: http://www.tandfonline.com/doi/full/10.1179/0079423615Z.00000000074 © Society for Post-Medieval Archaeology 2015Throughout the c.2000 year period coins have been circulated in Britain, they have also been ritually employed, most notably as votive deposits. Focusing specifically on the understudied custom of the British coin-tree, whereby coins are ritually embedded into the barks of trees, this paper considers the coin’s role and applicability as a deposit. It aims to demonstrate that our understanding of the coin’s past, present, and future ritual employment is not only aided by a consideration of economics and the coin’s secular function; it would be utterly incomplete without it.Peer reviewedFinal Accepted Versio