Evaluating the cost-effectiveness of existing needle and syringe programmes in preventing hepatitis C transmission in people who inject drugs

AIM: To evaluate the cost-effectiveness of needle and syringe programmes (NSPs) compared with no NSPs on hepatitis C virus (HCV) transmission in the United Kingdom. DESIGN: Cost-effectiveness analysis from a National Health Service (NHS)/health-provider perspective, utilizing a dynamic transmission model of HCV infection and disease progression, calibrated using city-specific surveillance and survey data, and primary data collection on NSP costs. The effectiveness of NSPs preventing HCV acquisition was based on empirical evidence. SETTING AND PARTICIPANTS: UK settings with different chronic HCV prevalence among people who inject drugs (PWID): Dundee (26%), Walsall (18%) and Bristol (45%) INTERVENTIONS: Current NSP provision is compared with a counterfactual scenario where NSPs are removed for 10 years and then returned to existing levels with effects collected for 40 years. MEASUREMENTS: HCV infections and cost per quality-adjusted life year (QALY) gained through NSPs over 50 years. FINDINGS: Compared with a willingness-to-pay threshold of £20 000 per QALY gained, NSPs were highly cost-effective over a time-horizon of 50 years and decreased the number of HCV incident infections. The mean incremental cost-effectiveness ratio was cost-saving in Dundee and Bristol, and £596 per QALY gained in Walsall, with 78, 46 and 40% of simulations being cost-saving in each city, respectively, with differences driven by coverage of NSP and HCV prevalence (lowest in Walsall). More than 90% of simulations were cost-effective at the willingness-to-pay threshold. Results were robust to sensitivity analyses, including varying the time-horizon, HCV treatment cost and numbers of HCV treatments per year. CONCLUSIONS: Needle and syringe programmes are a highly effective low-cost intervention to reduce hepatitis C virus transmission, and in some settings they are cost-saving. Needle and syringe programmes are likely to remain cost-effective irrespective of changes in hepatitis C virus treatment cost and scale-up

Intussusceptive pillar formation in developing porcine glomeruli

Background/Aims: Intussusceptive angiogenesis (IA) is a dynamic process which contributes to vascular expansion and remodeling. Intraluminal pillars have long been the distinctive structural indicator of intussusceptive angiogenesis. However, the mechanism of their formation has not been fully elucidated yet. Methods: Using light and electron microscopy, we studied intussusceptive vascular growth in the developing porcine metanephric kidney. Results: We observed intraluminal pillars formed by endothelial cells in the vasculature of developing glomeruli. Their diameter was < 2.5 µm, consistent with the diameter of nascent pillars. TEM revealed that the majority of these pillars consisted only of endothelium. However, a central core of extracellular matrix (ECM) covered by endothelium, reminiscent of a more mature intussusceptive pillar, was also found in the lumen of a glomerular capillary. Perivascular cells or pericytes were not involved in the pillar structure during these stages of formation. Conclusion: This study shows ECM presence in a mature intussusceptive pillar without any perivascular cell involvement in the structure. This leads to the hypothesis that ECM deposition preceeds the participation of these cells in the formation of intraluminal pillars during IA in porcine metanephric glomerular capillaries

'Overjoyed that I can go outside': Using walking interviews to learn about the lived experience and meaning of neighbourhood for people living with dementia

This study explores the relationships between people living with dementia and their neighbourhood as they venture out from home on a regular and often routine basis. Here, we report findings from the Swedish field site of an international 5-year project: Neighbourhoods: our people, our places. The aims of this study were to investigate the lived experience of the neighbourhood for people with dementia and through this to better understand the meaning that neighbourhood held for the participants. In this study, we focus on the walking interviews which were conducted with 14 community-dwelling people with dementia (11 men and 3 women) and were analysed using an interpretative phenomenological method. Four themes were revealed from these interviews: life narratives embedded within neighbourhood; the support of selfhood and wellbeing through movement; the neighbourhood as an immediate social context; and restorative connections to nature. These themes were distilled into the ‘essence’ of what neighbourhood meant for the people we interviewed: A walkable area of subjective significance and social opportunity in which to move freely and feel rejuvenated. We have found that the neighbourhood for community-dwelling people with dementia holds a sense of attachment and offers the potential for freedom of movement. Our research indicates that a dementia diagnosis doesn’t necessarily reduce this freedom of movement. The implications for practice and policy are considered: future research should explore and pay closer attention to the diverse living conditions of people living with dementia, and not least the particular challenges faced by people living alone with dementia

Cave dig shows the earliest Australians enjoyed a coastal lifestyle

[Extract] Archaeological excavations in a remote island cave off northwest Australia reveal incredible details of the early use by people of the continent’s now-submerged coast. Our latest study reveals that at lower sea levels, this island was used as a hunting shelter between about 50,000 and 30,000 years ago, and then as a residential base for family groups by 8,000 years ago

Curricular Landscapes: Preservice Teachers’ Perceptions of Place and Identity

The longitudinal study explored preservice teachers’ understandings of Canadian identity and representations of identity in Canadian multicultural picture books. The design involved descriptive case studies in six Faculties of Education across six provinces. Some participants viewed place as related to landscape and geography; some perceived place as a site for promoting sociocultural understanding; others articulated critical discourse of place. Perspectives ranged from sophisticated understandings of Canadian identity and representations in the picture books to resistance to representations or issues that disrupt a dominant (white) perspective of a benevolent multicultural Canada

The University of Iowa Biomass Energy Sustainability Index: A decision-making tool for the University of Iowa Biomass Partnership Project

Work continued on a plan to increase the renewable, sustainable fuel sources available to power operations at the University of Iowa in Iowa City. A team of researchers from multiple institutions collaborated to create a tool that would allow the UI to evaluate its alternative energy options more effectively

Measuring dysfunctional parenting: Psychometrics of three versions of the Parenting Scale

Abstract Objective: This study assessed the psychometric properties of three versions of the Parenting Scale (PS; original PS, 13-item version, and 10-item version) in three European middle-income countries. Background: The PS is one of the most frequently used questionnaires for measuring dysfunctional discipline strategies. Although its validity has been extensively investigated in American samples, there are mixed results regarding the recommended number of items and subscales, raising the question of replicability across European middle-income countries. Method: Multigroup confirmatory factor analysis (MCFA) and item response theory (IRT) were applied to N = 835 parents from North Macedonia, Moldova, and Romania. Results: All three versions were significantly correlated with parental- and child-related variables. Confirmatory factor analysis indicated the best model fit for the 10-item version, and configural and partial metric invariance across countries could be established for this version. Item response theory analyses also supported this measure. Conclusions: Our findings show that the 10-item version performed better than the 13-item version and the original PS both overall and on the country level. Reliability values were somewhat lower than reported in studies from the United States. Implications: The 10-item version constitutes a promising short measure for assessing dysfunctional parenting in European middle-income countries for researchers and practitioners

A strategy for assessing continuity in terrestrial and maritime landscapes from Murujuga (Dampier Archipelago), North West Shelf, Australia

Over the last 20,000 years one-third of the continental land mass of Australia, or 2.12 million km2, has been drowned by postglacial sea-level rise. Much of this drowned territory is thought to have been occupied by humans and where archaeological remains have survived inundation, they can be investigated by underwater and airborne remote sensing, survey and ground-truthing. This study of the Dampier Archipelago of NW Australia is contextualised by a review of the current state of the art of underwater prehistory. In the absence of known sites, we propose terrestrial analogy as a predictive tool for targeting submerged archaeological sites. Geological and topographic contexts are important for assessing preservation potential as is identifying landforms and features around which people may have focused their occupation. Analysis of over 2,500 known archaeological sites from the extraordinarily rich Dampier Archipelago reveals that the vast majority are rock art sites but these are interspersed by a significant number of artefact scatters, myriad stone structures, shell middens and quarry and reduction areas. The majority of these sites are focused on coastal and interior valleys, associated uplands and coastal embayments. While over two-thirds of sites occur on granophyre and basalt substrates, the others are located on quaternary sediments. Regional research on nearby continental islands shows that use of these environments can be expected to pre-date sea level rise. The most likely submerged sites include (i) compacted middens associated with rock pools and estuarine features; (ii) stone structures with associated midden on limestone pavements or with granophyre and basalt boulder fields; (iii) buried midden and other occupation deposits on protected sand sheets; (iv) quarry outcrops, extraction pits and associated reduction debris in areas of fine-grained granophyre and basalt; and (v) midden in consolidated calcarenite shoreline contexts to the north and west of the volcanic suites of the Dampier Archipelago

Underwater Shell Middens : Excavation and Remote Sensing of a Submerged Mesolithic site at Hjarnø, Denmark

Shell middens, or shell-matrix deposits, occur in large numbers across the coastlines of the world from the mid-Holocene (c. 6000-5000 cal. BC) onwards, often forming substantial mounds. However, they become smaller, rarer or absent as one goes back into earlier periods, suggesting a world-wide process of economic intensification. Since sea level was generally much lower during these earlier periods, a critical question is the extent to which mounded shell middens could have accumulated on now-submerged palaeoshorelines, and if so, how they were affected by the potentially destructive impact of sea-level rise. Further, and important to modern practice, it is essential that archaeologists consider how such sites can be discovered through underwater investigation. Here we offer a proof of concept that shell middens can survive submergence and can be detected, using systematic investigation of a rare example of a confirmed underwater shell midden at the Mesolithic site of Hjarnø (c. 5300-4300 cal. BC) in Denmark. We compare the excavation results with the results of geophysical survey, explore the problems of distinguishing underwater cultural shell middens from natural shell beds and conclude that shell middens can survive inundation by sea-level rise and can be detected by remote sensing, but require at least minimally invasive sampling to establish their cultural status. We suggest the methods developed may be applicable to coastal and marine sites impacted by postglacial sea-level rise worldwide