Cost-Effectiveness Findings from the Agewell Pilot Study of Behaviour Change to Promote Health and Wellbeing in Later Life.

Background: Participation in cognitive and physical activities may help to maintain health and wellbeing in older people. The Agewell study explored the feasibility of increasing cognitive and physical activity in older people through a goal-setting approach. This paper describes the findings of the cost-effectiveness analysis. Method: Individuals over the age of 50 and attending an Agewell centre in North Wales were randomised to one of three conditions: control (IC), goal-setting (GS), or goal-setting with mentoring (GM). We undertook a cost-effectiveness analysis comparing GS vs. IC, GM vs. IC and GM vs. GS. The primary outcome measure for this analysis was the QALY, calculated using the EQ-5D. Participants’ health and social care contacts were recorded and costed using national unit costs. Results: Seventy participants were followed-up at 12 months. Intervention set up and delivery costs were £252 per participant in the GS arm and £269 per participant in the GM arm. Mean health and social care costs over 12 months were £1,240 (s.d. £3,496) per participant in the IC arm, £1,259 (s.d. £3,826) per participant in the GS arm and £1,164 (s.d. £2,312) per participant in the GM arm. At a willingness to pay threshold of £20,000 per QALY there was a 65% probability that GS was cost-effective compared to IC (ICER of £1,070). However, there was only a 41% probability that GM was cost-effective compared to IC (ICER of £2,830) at a threshold of £20,000 per QALY. Conclusion: Setting up and running the community based intervention was feasible. Due to the small sample size it is not possible to draw a firm conclusion about cost-effectiveness; however, our preliminary results suggest that goal- setting is likely to be cost-effective compared to the control condition of no goal-setting, the addition of mentoring was effective but not cost-effective.Lifelong Health and Well-being Programme through the Medical Research Counci

Functional cardiac MRI in preterm and term newborns.

Published versio

The Agewell trial: a pilot randomised controlled trial of a behaviour change intervention to promote healthy ageing and reduce risk of dementia in later life.

This is the final version of the article. Available from BioMed Central via the DOI in this record.BACKGROUND: Lifestyle factors represent prime targets for behaviour change interventions to promote healthy ageing and reduce dementia risk. We evaluated a goal-setting intervention aimed at promoting increased cognitive and physical activity and improving mental and physical fitness, diet and health. METHODS: This was a pilot randomised controlled trial designed to guide planning for a larger-scale investigation, provide preliminary evidence regarding efficacy, and explore feasibility and acceptability. Primary outcomes were engagement in physical and cognitive activity. Participants aged over 50 living independently in the community were recruited through a community Agewell Centre. Following baseline assessment participants were randomly allocated to one of three conditions: control (IC) had an interview in which information about activities and health was discussed; goal-setting (GS n = 24) had an interview in which they set behaviour change goals relating to physical, cognitive and social activity, health and nutrition; and goal-setting with mentoring (GM, n = 24) had the goal-setting interview followed by bi-monthly telephone mentoring. Participants and researchers were blinded to group assignment. Participants were reassessed after 12 months. RESULTS: Seventy-five participants were randomised (IC n = 27, GS n = 24, GM n = 24). At 12-month follow-up, the two goal-setting groups, taken together (GS n = 21, GM n = 22), increased their level of physical (effect size 0.37) and cognitive (effect size 0.15) activity relative to controls (IC n = 27). In secondary outcomes, the two goal-setting groups taken together achieved additional benefits compared to control (effect sizes ≥ 0.2) in memory, executive function, cholesterol level, aerobic capacity, flexibility, balance, grip strength, and agility. Adding follow-up mentoring produced further benefits compared to goal-setting alone (effect sizes ≥ 0.2) in physical activity, body composition, global cognition and memory, but not in other domains. Implementation of the recruitment procedure, assessment and intervention was found to be feasible and the approach taken was acceptable to participants, with no adverse effects. CONCLUSIONS: A brief, low-cost goal-setting intervention is feasible and acceptable, and has the potential to achieve increased activity engagement. TRIAL REGISTRATION: Current Controlled Trials ISRCTN30080637.This trial was funded by Medical Research Council grant G1001888/1 to LC, JVH, IRJ, JT and CJW. The funding body played no role in the design of the study, in collection, analysis and interpretation of data, in the writing of the manuscript, or in the decision to submit the manuscript for publication. We acknowledge the support of Age Cymru Gwynedd a Môn including John Clifford Jones, Maldwyn Roberts, Stephen Williams and Mici Plwm. We would like to thank Sharman Harris and Catrin Searell, Department of Clinical Chemistry, Ysbyty Gwynedd, Bangor, the volunteers at the Nefyn Agewell Centre, and all the members of the Nefyn Agewell Centre, and especially all those who took part in the research project. We are grateful to Professor Carol Brayne, Cambridge University, Professor Martin Knapp, London School of Economics, Professor Mike Martin, Zürich University, and Professor Robin Morris, King’s College London Institute of Psychiatry, who acted as external advisors to the project. Special thanks go to Andrew Brand for statistical advice

A tract-specific approach to assessing white matter in preterm infants.

Diffusion-weighted imaging (DWI) is becoming an increasingly important tool for studying brain development. DWI analyses relying on manually-drawn regions of interest and tractography using manually-placed waypoints are considered to provide the most accurate characterisation of the underlying brain structure. However, these methods are labour-intensive and become impractical for studies with large cohorts and numerous white matter (WM) tracts. Tract-specific analysis (TSA) is an alternative WM analysis method applicable to large-scale studies that offers potential benefits. TSA produces a skeleton representation of WM tracts and projects the group's diffusion data onto the skeleton for statistical analysis. In this work we evaluate the performance of TSA in analysing preterm infant data against results obtained from native space tractography and tract-based spatial statistics. We evaluate TSA's registration accuracy of WM tracts and assess the agreement between native space data and template space data projected onto WM skeletons, in 12 tracts across 48 preterm neonates. We show that TSA registration provides better WM tract alignment than a previous protocol optimised for neonatal spatial normalisation, and that TSA projects FA values that match well with values derived from native space tractography. We apply TSA for the first time to a preterm neonatal population to study the effects of age at scan on WM tracts around term equivalent age. We demonstrate the effects of age at scan on DTI metrics in commissural, projection and association fibres. We demonstrate the potential of TSA for WM analysis and its suitability for infant studies involving multiple tracts

Extreme enriched and heterogeneous ⁸⁷Sr/⁸⁶Sr ratios recorded in magmatic plagioclase from the Samoan hotspot

We report the major-element, trace-element, and 87Sr/86Sr compositions of six plagioclase crystals from two Samoan lavas with extreme EM2 isotopic compositions (ALIA-115-18 with whole-rock 87Sr/86Sr of 0.718592, and ALIA-115-21 with whole-rock 87Sr/86Sr of 0.720469). We employed laser-ablation split-stream mass spectrometry (LASS) to simultaneously measure 87Sr/86Sr ratios, major-element concentrations, and trace-element concentrations in the same plagioclase crystal volume. We find that two plagioclase crystals have extreme 87Sr/86Sr heterogeneity in excess of 5000 ppm (where ppm of 87Sr/Sr variability86=106⋅[Sr/8687Srmax−87Sr/86Srmin]/87Sr/86Sravg). In two of the plagioclase crystals, we identify the highest 87Sr/86Sr ratios (0.7224) ever measured in any fresh, mantle-derived ocean island basalt (OIB) or OIB-hosted mineral phase.We find that in 87Sr/86Sr-versus-Sr concentration space, the six plagioclase crystals overlap in a “common component” region with higher 87Sr/86Sr than has been previously identified in whole-rock Samoan lavas or mineral separates. We use the occurrence of olivine mineral inclusions (Fo=74.5±0.8, 2 SD) in the high-87Sr/86Sr zone of one plagioclase crystal to infer the bulk composition (Mg#=46.8±0.8, 2 SD) of the extreme EM2 magma from which the olivine and high-87Sr/86Sr plagioclase crystallized. We argue that a relatively evolved EM2 endmember magma mixed with at least one lower-87Sr/86Sr melt to generate the observed intra-crystal plagioclase isotopic heterogeneity.By inferring that subducted terrigenous sediment gives rise to EM2 signatures in Samoan lavas, we estimate that the quantity of sediment necessary to generate the most-elevated 87Sr/86Sr ratios observed in the Samoan plagioclase is ∼7% of the mantle source. We also estimate that sediment subduction into the mantle over geologic time has generated a sediment domain that constitutes 0.02% of the mass of the mantle, a much lower proportion than required in the EM2 mantle source. Even if subducted sediment is concentrated in large low-shear-velocity provinces (LLSVPs) at the base of the mantle (which constitute up to 7.7% of the mantle's mass), then only 0.25% of the LLSVPs are composed of sediment. This requires that the distribution of subducted sediment in the mantle is heterogeneous, and the high relative abundance of sediment in the Samoan EM2 mantle is an anomalous relic of ancient subduction that has survived convective attenuation

General insurance marketing: a review and future research agenda

The financial services sector is a huge and diverse industry comprising many different forms of organisations and product offerings. Yet, a review of past papers in the Journal of Financial Services Marketing (JFSM) reveals a heavy bias towards articles on banking, to the neglect of other equally important financial services categories. The purpose of this paper is to address this imbalance and to call for more research to be conducted in a wider range of financial services categories. In particular, general insurance is singled out as a category worthy of further research. Looking to the past, this paper reviews research published to-date on general insurance in the JFSM to establish a benchmark and explore theoretical contributions. Attention is then turned to the future to identify a research agenda for the general insurance sector going forward. 5 important themes are identified: trust, transparency and simplification, technology, HNW and Takaful

Parental age effects on neonatal white matter development.

OBJECTIVE: Advanced paternal age is associated with poor offspring developmental outcome. Though an increase in paternal age-related germline mutations may affect offspring white matter development, outcome differences could also be due to psychosocial factors. Here we investigate possible cerebral changes prior to strong environmental influences using brain MRI in a cohort of healthy term-born neonates. METHODS: We used structural and diffusion MRI images acquired soon after birth from a cohort (n = 275) of healthy term-born neonates. Images were analysed using a customised tract based spatial statistics (TBSS) processing pipeline. Neurodevelopmental assessment using the Bayley-III scales was offered to all participants at age 18 months. For statistical analysis neonates were compared in two groups, representing the upper quartile (paternal age ≥38 years) and lower three quartiles. The same method was used to assess associations with maternal age. RESULTS: In infants with older fathers (≥38 years), fractional anisotropy, a marker of white matter organisation, was significantly reduced in three early maturing anatomical locations (the corticospinal tract, the corpus callosum, and the optic radiation). Fractional anisotropy in these locations correlated positively with Bayley-III cognitive composite score at 18 months in the advanced paternal age group. A small but significant reduction in total brain volume was also observed in in the infants of older fathers. No significant associations were found between advanced maternal age and neonatal imaging. CONCLUSIONS: The epidemiological association between advanced paternal age and offspring outcome is extremely robust. We have for the first time demonstrated a neuroimaging phenotype of advanced paternal age before sustained parental interaction that correlates with later outcome

Impaired development of the cerebral cortex in infants with congenital heart disease is correlated to reduced cerebral oxygen delivery

Neurodevelopmental impairment is the most common comorbidity associated with complex congenital heart disease (CHD), while the underlying biological mechanism remains unclear. We hypothesised that impaired cerebral oxygen delivery in infants with CHD is a cause of impaired cortical development, and predicted that cardiac lesions most associated with reduced cerebral oxygen delivery would demonstrate the greatest impairment of cortical development. We compared 30 newborns with complex CHD prior to surgery and 30 age-matched healthy controls using brain MRI. The cortex was assessed using high resolution, motion-corrected T2-weighted images in natural sleep, analysed using an automated pipeline. Cerebral oxygen delivery was calculated using phase contrast angiography and pre-ductal pulse oximetry, while regional cerebral oxygen saturation was estimated using near-infrared spectroscopy. We found that impaired cortical grey matter volume and gyrification index in newborns with complex CHD was linearly related to reduced cerebral oxygen delivery, and that cardiac lesions associated with the lowest cerebral oxygen delivery were associated with the greatest impairment of cortical development. These findings suggest that strategies to improve cerebral oxygen delivery may help reduce brain dysmaturation in newborns with CHD, and may be most relevant for children with CHD whose cardiac defects remain unrepaired for prolonged periods after birth

Structure/Function Analysis of Nonwoven Cotton Topsheet Fabrics: Multi-Fiber Blending Effects on Fluid Handling and Fabric Handle Mechanics

Greige cotton (GC) has attracted interest in recent years as an eco-friendly, functional fiber for use in nonwoven topsheet materials. GC imparts favorable fluid management and sensorial properties associated with urinary liquid transport and indices related to comfort in wearable incontinence nonwovens. Nonwoven GC has material surface polarity, an ambient moisture content, and a lipid/polysaccharide matrix that imparts positive fluid mechanic properties applicable to incontinence management topsheet materials. However, a better understanding of the connection between functionality and compositional aspects of molecular, mechanical, and material property relations is still required to employ structure/function relations beyond a priori design. Thus, this study focuses on the relation of key indices of material fluid and sensorial functions to nonwoven topsheet composition. Greige cotton, polypropylene, bleached cotton, and polyester fiber blends were hydroentangled at 60, 80, and 100 bar. Greige cotton polypropylene and bleached cotton were blended at ratios to balance surface polarity, whereas low percentages of polyester were added to confer whiteness properties. Electrokinetic and contact angle measurements were obtained for the hydroentangled nonwovens to assess surface polarity in light of material composition. Notably, materials demonstrated a relation of hydrophobicity to swelling as determined electrokinetically by Δζ, ζplateau, and contact angles greater than 90°. Subsequently, three blended nonwoven fabrics were selected to assess effects on fluid management properties including topsheet performance indices of rewet, strikethrough, and fluid handling (rate and efficiency of transport to the absorbent core). These materials aligned well with commercial topsheet fluid mechanics. Using the Leeds University Fabric Handle Evaluation System (LUFHES), the nonwovens were tested for total fabric hand. The results of the LUFHES measurements are discussed in light of fiber contributions. Fiber ratios were found to correlate well with improvement in softness, flexibility, and formability. This study provides insights that improves the understanding of the multifunctional properties accessible with greige cotton toward decisions valuable to selecting greige cotton as an environmentally friendly fiber for nonwoven topsheets