Public health economics: a systematic review of guidance for the economic evaluation of public health interventions and discussion of key methodological issues

BACKGROUND: If Public Health is the science and art of how society collectively aims to improve health, and reduce inequalities in health, then Public Health Economics is the science and art of supporting decision making as to how society can use its available resources to best meet these objectives and minimise opportunity cost. A systematic review of published guidance for the economic evaluation of public health interventions within this broad public policy paradigm was conducted. METHODS: Electronic databases and organisation websites were searched using a 22 year time horizon (1990–2012). References of papers were hand searched for additional papers for inclusion. Government reports or peer-reviewed published papers were included if they; referred to the methods of economic evaluation of public health interventions, identified key challenges of conducting economic evaluations of public health interventions or made recommendations for conducting economic evaluations of public health interventions. Guidance was divided into three categories UK guidance, international guidance and observations or guidance provided by individual commentators in the field of public health economics. An assessment of the theoretical frameworks underpinning the guidance was made and served as a rationale for categorising the papers. RESULTS: We identified 5 international guidance documents, 7 UK guidance documents and 4 documents by individual commentators. The papers reviewed identify the main methodological challenges that face analysts when conducting such evaluations. There is a consensus within the guidance that wider social and environmental costs and benefits should be looked at due to the complex nature of public health. This was reflected in the theoretical underpinning as the majority of guidance was categorised as extra-welfarist. CONCLUSIONS: In this novel review we argue that health economics may have come full circle from its roots in broad public policy economics. We may find it useful to think in this broader paradigm with respect to public health economics. We offer a 12 point checklist to support government, NHS commissioners and individual health economists in their consideration of economic evaluation methodology with respect to the additional challenges of applying health economics to public health

Towards a novel carbon device for the treatment of sepsis

Sepsis is a systemic inflammatory response to infection in which the balance of pro- andanti-inflammatory mediators, which normally isolate and eliminate infection, is disrupted[1]. Gram negative sepsis is initiated by bacterial endotoxin release which activatesmacrophages and circulating monocytes to release TNF and IL-1β followed by IL-6 andother inflammatory cytokines [2]. As the disease progresses, an unregulatedinflammatory response results in, tissue injury, haematological dysfunction and organdysfunction. Severe sepsis, involving organ hypoperfusion may be further complicatedby hypotension that is unresponsive to adequate fluid replacement, resulting in septicshock and finally death [3].Despite improvements in anti-microbial and supportive therapies, sepsis remains asignificant cause of morbidity and mortality in ICUs worldwide [4]. The complexity ofprocesses mediating the progression of sepsis suggests that an extracorporeal devicecombining blood filtration with adsorption of a wide range of toxins, and inflammatorymediators offers the most comprehensive treatment strategy. However, no such deviceexists at present. A novel, uncoated, polymer pyrolysed synthetic carbon device isproposed which combines the superior adsorption properties of uncoated activatedcarbons with the capacity to manipulate porous structure for controlled adsorption oftarget plasma proteins and polypeptides [5]. Preliminary haemocompatibility andadsorptive capacity was assessed using a carbon matrix prototype

Late Glacial to Holocene relative sea level change in Assynt, northwest Scotland, UK

Relative sea-level change (RSL), from the Late Glacial through to the late Holocene, is reconstructed for the Assynt region, northwest Scotland, based on bio- and lithostratigraphical analysis. Four new radiocarbon-dated sea-level index points help constrain RSL change for the Late Glacial to late Holocene. These new data, in addition to published material, capture the RSL fall during the Late Glacial and the rise and fall associated with the mid-Holocene highstand. Two of these index points constrain the Late Glacial RSL history in Assynt for the first time, reconstructing RSL falling from 2.47 ± 0.59 m OD to 0.15 ± 0.59 m OD at c. 14000 - 15000 cal yr BP. These new data test model predictions of glacial isostatic adjustment (GIA), particularly during the early deglacial period which is currently poorly constrained throughout the British Isles. While the empirical data from the mid- to late-Holocene to present matches quite well with recent GIA model output, there is a relatively poor fit between the timing of the Late Glacial RSL fall and early Holocene RSL rise. This mismatch, also evident elsewhere in northwest Scotland, may result from uncertainties associated with both the global and local ice components of GIA models

Glacial isostatic adjustment associated with the Barents Sea ice sheet: a modelling inter-comparison

The 3D geometrical evolution of the Barents Sea Ice Sheet (BSIS), particularly during its late-glacial retreat phase, remains largely ambiguous due to the paucity of direct marine- and terrestrial-based evidence constraining its horizontal and vertical extent and chronology. One way of validating the numerous BSIS reconstructions previously proposed is to collate and apply them under a wide range of Earth models and to compare prognostic (isostatic) output through time with known relative sea-level (RSL) data. Here we compare six contrasting BSIS load scenarios via a spherical Earth system model and derive a best-fit, χ2 parameter using RSL data from the four main terrestrial regions within the domain: Svalbard, Franz Josef Land, Novaya Zemlya and northern Norway. Poor χ2 values allow two load scenarios to be dismissed, leaving four that agree well with RSL observations. The remaining four scenarios optimally fit the RSL data when combined with Earth models that have an upper mantle viscosity of 0.2–2 × 1021 Pa s, while there is less sensitivity to the lithosphere thickness (ranging from 71 to 120 km) and lower mantle viscosity (spanning 1–50 × 1021 Pa s). GPS observations are also compared with predictions of present-day uplift across the Barents Sea. Key locations where relative sea-level and GPS data would prove critical in constraining future ice-sheet modelling efforts are also identified

Exploring the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination

Introduction Autism is a neuro-developmental condition which affects the social-emotional skills, behaviour, language, communication skills and flexibility of thoughts of an individual and their sensory processing. This can result in Autistic service users finding it difficult to navigate current healthcare provision and cope with the unpredictable environment. This paper explores the experiences of parents of Autistic children when attending the diagnostic imaging department for an X-ray examination. Methods A cross sectional, mixed methods approach was adopted and the initial phase consisting of an online survey for parents to complete is the subject of this paper. The quantitative data was analysed using descriptive statistics and cross comparison between questions was also completed. Thematic analysis was taken to analyse the data from the two open questions at the end of the survey. Results The online survey results are presented in this paper under four key themes; waiting times and environment, forms of communication, lack of understanding of staff regarding Autism and preparation for the X-ray examination. Conclusion The overall rating of the parents' experience whilst in the X-ray/diagnostic imaging department was positive, however there are several areas which received low scores which need further attention. These were waiting areas, waiting times, staff development and patient preparation. Implications for practice The development of more inclusive waiting areas is needed, more effective lines of communication between staff to expedite the patient journey where possible, staff development of both radiographers and also support staff and the review of design of more accessible and inclusive patient information

Blue-enriched Lighting for Older People Living in Care Homes: Effect on Activity, Actigraphic Sleep, Mood and Alertness

Objective: Environmental (little outdoor light; low indoor lighting) and age-related physiological factors (reduced light transmission through the ocular lens, reduced mobility) contribute to a light-deprived environment for older people living in care homes. Methods: This study investigates the effect of increasing indoor light levels with blue-enriched white lighting on objective (rest-activity rhythms, performance) and self-reported (mood, sleep, alertness) measures in older people. Eighty residents (69 female), aged 86 ± 8 yrs (mean ± SD), participated (MMSE 19 ± 6). Overhead fluorescent lighting was installed in communal rooms (n=20) of seven care homes. Four weeks of blue-enriched white lighting (17000 K ≅ 900 lux) were compared with four weeks of control white lighting (4000 K ≅ 200 lux), separated by three weeks wash-out. Participants completed validated mood and sleep questionnaires, psychomotor vigilance task (PVT) and wore activity and light monitors (AWL). Rest-activity rhythms were assessed by cosinor, non-parametric circadian rhythm (NPCRA) and actigraphic sleep analysis. Blue-enriched (17000 K) light increased wake time and activity during sleep decreasing actual sleep time, sleep percentage and sleep efficiency (p < 0.05) (actigraphic sleep). Compared to 4000 K lighting, blue-enriched 17000 K lighting significantly (p < 0.05) advanced the timing of participants’ rest-activity rhythm (cosinor), increased daytime and night-time activity (NPCRA), reduced subjective anxiety (HADA) and sleep quality (PSQI). There was no difference between the two light conditions in daytime alertness and performance (PVT). Conclusion: Blue-enriched lighting produced some positive (increased daytime activity, reduced anxiety) and negative (increased night-time activity, reduced sleep efficiency and quality) effects in older people

Palaeoenvironmental reconstruction of the alluvial landscape of Neolithic Çatalhöyük, central southern Turkey: The implications for early agriculture and responses to environmental change

Archaeological discussions of early agriculture have often used the Neolithic village of Çatalhöyük in central southern Turkey as a key example of the restricting effect of environment on agricultural production and organization. Central to these discussions is the palaeoenvironmental reconstruction of the landscape surrounding the site. This paper presents an important new dataset from an intensive coring programme undertaken between 2007 and 2013 in the immediate environs of the site, designed to improve significantly the spatial resolution of palaeoenvironmental data. Using sediment analyses including organic content, magnetic susceptibility, particle size, total carbon and nitrogen contents and carbon isotope analysis, coupled with 3D modelling, we are able to present a new reconstruction of the palaeotopography and sedimentary environments of the site. Our findings have major implications for our understanding of Neolithic agricultural production and social practice. We present four phases of environmental development. Phase 1 consists of the final phases of regression of Palaeolake Konya in the later parts of the Pleistocene, dominated by erosion due to wind and water that created an undulating surface of the marl deposited in the palaeolake. Phase 2 occurs in the latest Pleistocene and early Holocene, and indicates increased wetness, probably characteristic of a humid anabranching channel system, in which there are localized pockets of wetter conditions. In Phase 3a, this infilling continues, producing a flatter surface, and there are fewer pockets being occupied by wetter conditions. The fluvial régime shifts from humid to dryland anabranching conditions. The earliest period of occupation of the Neolithic East Mound coincides with this phase. Phase 3b coincides with the shift of occupation to the West Mound in the Chalcolithic, when there is evidence for a very localized wetter area to the southeast of the West Mound, but otherwise a continuation of the dryland anabranching system. Finally, Phase 4 shows a shift to the pre-modern style of fluvial environment, modified by channelization. This reanalysis demonstrates the importance of extensive spatial sampling as part of geoarchaeological investigations. With this new evidence we demonstrate that the landscape was highly variable in time and space with increasingly dry conditions developing from the early Holocene onwards. In contrast to earlier landscape reconstructions that have presented marshy conditions during the early Holocene that impacted agriculture, we argue that localized areas of the floodplain would have afforded significant opportunities for agriculture closer to the site. In this way, the results have important implications for how we understand agricultural practices in the early Neolithic

Renormalization group and isochronous oscillations

We show how the condition of isochronicity can be studied for two dimensional systems in the renormalization group (RG) context. We find a necessary condition for the isochronicity of the Cherkas and another class of cubic systems. Our conditions are satisfied by all the cases studied recently by Bardet et al \cite{bard} and Ghose Choudhury and Guh

The crime drop and the security hypothesis

Major crime drops were experienced in the United States and most other industrialised countries for a decade from the early to mid-1990s. Yet there is little agreement over explanation or lessons for policy. Here it is proposed that change in the quantity and quality of security was a key driver of the crime drop. From evidence relating to vehicle theft in two countries it is concluded that electronic immobilisers and central locking were particularly effective. It is suggested that reduced car theft may have induced drops in other crime including violence. From this platform a broader security hypothesis, linked to routine activity and opportunity theory, is outlined