A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence

Background: Opioid dependence is a chronic condition with substantial health, economic and social costs. The study objective was to conduct a systematic review of published health-economic models of opioid agonist therapy for non-prescription opioid dependence, to review the different modelling approaches identified, and to inform future modelling studies. Methods: Literature searches were conducted in March 2015 in eight electronic databases, supplemented by hand-searching reference lists and searches on six National Health Technology Assessment Agency websites. Studies were included if they: investigated populations that were dependent on non-prescription opioids and were receiving opioid agonist or maintenance therapy; compared any pharmacological maintenance intervention with any other maintenance regimen (including placebo or no treatment); and were health-economic models of any type. Results: A total of 18 unique models were included. These used a range of modelling approaches, including Markov models (n = 4), decision tree with Monte Carlo simulations (n = 3), decision analysis (n = 3), dynamic transmission models (n = 3), decision tree (n = 1), cohort simulation (n = 1), Bayesian (n = 1), and Monte Carlo simulations (n = 2). Time horizons ranged from 6 months to lifetime. The most common evaluation was cost-utility analysis reporting cost per quality-adjusted life-year (n = 11), followed by cost-effectiveness analysis (n = 4), budget-impact analysis/cost comparison (n = 2) and cost-benefit analysis (n = 1). Most studies took the healthcare provider’s perspective. Only a few models included some wider societal costs, such as productivity loss or costs of drug-related crime, disorder and antisocial behaviour. Costs to individuals and impacts on family and social networks were not included in any model. Conclusion: A relatively small number of studies of varying quality were found. Strengths and weaknesses relating to model structure, inputs and approach were identified across all the studies. There was no indication of a single standard emerging as a preferred approach. Most studies omitted societal costs, an important issue since the implications of drug abuse extend widely beyond healthcare services. Nevertheless, elements from previous models could together form a framework for future economic evaluations in opioid agonist therapy including all relevant costs and outcomes. This could more adequately support decision-making and policy development for treatment of non-prescription opioid dependence

Framework for land value capture from investments in transit in car-dependent cities

Many car-dependent cities have major transit projects stuck in financial and economic assessment due to inadequate links between land use, transport, and funding. This has left most urban transport networks underfunded and requiring significant government support. During this widening transit funding gap, there has been an international increase in demand on transit systems, which is in part a response to the global peak in car use per capita. This paper demonstrates to transit proponents and practitioners how to facilitate infrastructure projects by optimizing induced and activated land-use change. A five-step framework for assessment is proposed that includes assessing the regional and local legislation and regulations to determine what alternative funding opportunities are available, undertaking accessibility beneficiary analysis, analyzing the project-induced land value uplift, developing an alternative funding strategy to implement integrated land-use and transport planning mechanisms, and preparing a procurement and delivery strategy. The proposed assessment framework enables transit business cases to extend project funding for integrated transit and land-use projects, especially in car-dependent cities. This is demonstrated through a case study of Perth, Western Australia

Archaeological Excavations at Nethermills Farm, Deeside, 1978-81

This publication is grant aided by Historic Environment Scotland.Peer reviewedPublisher PD

Donor data vacuuming

In this essay, we seek to understand how the stunning rise of data vacuuming, necessitated by the pretense of ‘partnership’ within global health, has fundamentally altered how routine health data in poor countries is collected, analyzed, prioritized, and used to inform management and policy. Writing as a team of authors with experiences on multiple sides of global health partnerships in the United States, Mozambique, Nepal, Lesotho, Kenya, and Cote d’Ivoire, we argue that solidarity-based partnership between donor and recipient countries is impossible when evidence production and management is effectively outsourced to external organizations to meet the criteria of donor partners. Specifically, to meet the 2030 Sustainable Development Goals, equity-oriented strategies are critically needed to create data collection, analysis, and use activities that are mutually beneficial and sustainable

Interests in high-functioning autism are more intense, interfering, and idiosyncratic than those in neurotypical development

Although circumscribed interests are pathognomonic with autism, much about these interests remains unknown. Using the Interests Scale (IS), this study compares interests between 76 neurotypical (NT) individuals and 109 individuals with high-functioning autism spectrum disorder (HF-ASD) matched groupwise on age, IQ, and gender ratio. Participants and their parents/caregivers completed diagnostic measures (the Autism Diagnostic Interview—Revised and the Autism Diagnostic Observation Schedule; HF-ASD only), cognitive tests (Wechsler IQ Scales), and questionnaires (the Repetitive Behavior Scale—Revised, the Behavior Rating Inventory of Executive Function, and the Social Responsiveness Scale), in addition to the IS. Consistent with previous research, HF-ASD and NT individuals did not differ in number of interest areas, but the types of interests and intensity of those interests differed considerably. Using only the IS intensity score, 81% of individuals were correctly classified (NT or HF-ASD) in a logistic regression analysis. Among individuals with HF-ASD, Interests Scale scores were significantly related to Autism Diagnostic Observation Schedule, Behavior Rating Inventory of Executive Function, Repetitive Behavior Scale—Revised, and Social Responsiveness Scale scores, but they were not related to Autism Diagnostic Interview—Revised scores, IQ, gender, age, or psychotropic medication use. The type and intensity, but not the number, of interests distinguish high-functioning individuals with ASD from NT individuals

Seagrasses in the Age of Sea Turtle Conservation and Shark Overfishing

Efforts to conserve globally declining herbivorous green sea turtles have resulted in promising growth of some populations. These trends could significantly impact critical ecosystem services provided by seagrass meadows on which turtles feed. Expanding turtle populations could improve seagrass ecosystem health by removing seagrass biomass and preventing of the formation of sediment anoxia. However, overfishing of large sharks, the primary green turtle predators, could facilitate turtle populations growing beyond historical sizes and trigger detrimental ecosystem impacts mirroring those on land when top predators were extirpated. Experimental data from multiple ocean basins suggest that increasing turtle populations can negatively impact seagrasses, including triggering virtual ecosystem collapse. Impacts of large turtle populations on seagrasses are reduced in the presence of intact shark populations. Healthy populations of sharks and turtles, therefore, are likely vital to restoring or maintaining seagrass ecosystem structure, function, and their value in supporting fisheries and as a carbon sink

The origins of redistributive policy preferences: political socialisation with and without a welfare state

Research on the impact of the macroeconomy on individual-level preferences for redistribution has produced varying results. This paper presents a new theory on the presence of an expansive welfare state during one’s formative years as a source of heterogeneity in the effect that macroeconomic conditions have on individuals’ preferences for redistributive policy. This theory is tested using cohort analysis via the British Social Attitudes surveys (1983–2010), with generations coming of age between the end of World War I and today. Findings confirm that cohorts that were socialised before and after the introduction of the welfare state react differently to economic crises: the former become less supportive of redistribution, while the latter become more supportive. The research sheds light on the long-term shifts of support for the welfare state due to generational replacement

Quantifying measures to limit wind driven resuspension of sediments for improvement of the ecological quality in some shallow Dutch lakes

Although phosphorus loadings are considered the main pressure for most shallow lakes, wind-driven resuspension can cause additional problems for these aquatic ecosystems. We quantified the potential effectiveness of measures to reduce the contribution of resuspended sediments, resulting from wind action, to the overall light attenuation for three comparable shallow peat lakes with poor ecological status in the Netherlands: Loosdrecht, Nieuwkoop, and Reeuwijk (1.8–2.7 m depth, 1.6–2.5 km fetch). These measures are: 1. wave reducing barriers, 2. water level fluctuations, 3. capping of the sediment with sand, and 4. combinations of above. Critical shear stress of the sediments for resuspension (Vcrit), size distribution, and optical properties of the suspended material were quantified in the field (June 2009) and laboratory. Water quality monitoring data (2002–2009) showed that light attenuation by organic suspended matter in all lakes is high. Spatial modeling of the impact of these measures showed that in Lake Loosdrecht limiting wave action can have significant effects (reductions from 6% exceedance to 2% exceedance of Vcrit), whereas in Lake Nieuwkoop and Lake Reeuwijk this is less effective. The depth distribution and shape of Lake Nieuwkoop and Lake Reeuwijk limit the role of wind-driven resuspension in the total suspended matter concentration. Although the lakes are similar in general appearance (origin, size, and depth range) measures suitable to improve their ecological status differ. This calls for care when defining the programme of measures to improve the ecological status of a specific lake based on experience from other lakes.

Providing a Framework for Seagrass Mapping in United States Coastal Ecosystems Using High Spatial Resolution Satellite Imagery

Seagrasses have been widely recognized for their ecosystem services, but traditional seagrass monitoring approaches emphasizing ground and aerial observations are costly, time-consuming, and lack standardization across datasets. This study leveraged satellite imagery from Maxar\u27s WorldView-2 and WorldView-3 high spatial resolution, commercial satellite platforms to provide a consistent classification approach for monitoring seagrass at eleven study areas across the continental United States, representing geographically, ecologically, and climatically diverse regions. A single satellite image was selected at each of the eleven study areas to correspond temporally to reference data representing seagrass coverage and was classified into four general classes: land, seagrass, no seagrass, and no data. Satellite-derived seagrass coverage was then compared to reference data using either balanced agreement, the Mann-Whitney U test, or the Kruskal-Wallis test, depending on the format of the reference data used for comparison. Balanced agreement ranged from 58% to 86%, with better agreement between reference- and satellite-indicated seagrass absence (specificity ranged from 88% to 100%) than between reference- and satellite-indicated seagrass presence (sensitivity ranged from 17% to 73%). Results of the Mann-Whitney U and Kruskal-Wallis tests demonstrated that satellite-indicated seagrass percentage cover had moderate to large correlations with reference-indicated seagrass percentage cover, indicative of moderate to strong agreement between datasets. Satellite classification performed best in areas of dense, continuous seagrass compared to areas of sparse, discontinuous seagrass and provided a suitable spatial representation of seagrass distribution within each study area. This study demonstrates that the same methods can be applied across scenes spanning varying seagrass bioregions, atmospheric conditions, and optical water types, which is a significant step toward developing a consistent, operational approach for mapping seagrass coverage at the national and global scales. Accompanying this manuscript are instructional videos describing the processing workflow, including data acquisition, data processing, and satellite image classification. These instructional videos may serve as a management tool to complement field- and aerial-based mapping efforts for monitoring seagrass ecosystems