The Cost Effectiveness of Pharmacological Treatments for Generalized Anxiety Disorder

Background: Generalized anxiety disorder (GAD) is one of the most prevalent anxiety disorders, with important implications for patients and healthcare resources. However, few economic evaluations of pharmacological treatments for GAD have been published to date, and those available have assessed only a limited number of drugs. / Objective: To assess the cost effectiveness of pharmacological interventions for patients with GAD in the UK. / Methods: A decision-analytic model in the form of a decision tree was constructed to compare the costs and QALYs of six drugs used as first-line pharmacological treatments in people with GAD (duloxetine, escitalopram, paroxetine, pregabalin, sertraline and venlafaxine extended release [XL]) and ‘no pharmacological treatment’. The analysis adopted the perspective of the NHS and Personal Social Services (PSS) in the UK. Efficacy data were derived from a systematic literature review of double-blind, randomized controlled trials and were synthesized using network meta-analytic techniques. Two network meta-analyses were undertaken to assess the comparative efficacy (expressed by response rates) and tolerability (expressed by rates of discontinuation due to intolerable side effects) of the six drugs and no treatment in the study population. Cost data were derived from published literature and national sources, supplemented by expert opinion. The price year was 2011. Probabilistic sensitivity analysis was conducted to evaluate the underlying uncertainty of the model input parameters. / Results: Sertraline was the best drug in limiting discontinuation due to side effects and the second best drug in achieving response in patients not discontinuing treatment due to side effects. It also resulted in the lowest costs and highest number of QALYs among all treatment options assessed. Its probability of being the most cost-effective drug reached 75 % at a willingness-to-pay threshold of £20,000 per extra QALY gained. / Conclusion: Sertraline appears to be the most cost-effective drug in the treatment of patients with GAD. However, this finding is based on limited evidence for sertraline (two published trials). Sertraline is not licensed for the treatment of GAD in the UK, but is commonly used by primary care practitioners for the treatment of depression and mixed depression and anxiety

Developing an intervention toolbox for common health problems in the workplace

The project brief was to develop the content for an intervention toolbox for common health problems in the workplace - musculoskeletal, mental health and stress complaints. The intention was to develop a prototype toolbox that can be taken forward to (1) minimise the occurrence of work-relevant common health problems (CHPs) and (2) reduce avoidable sickness absence, healthcare use and long-term disability for CHP complaints that inevitably occur in the workplac

Challenging the power invested in the International English Language Testing System (IELTS): Why determining ‘English’ preparedness needs to be undertaken within the subject context

Higher Education (HE) institutions worldwide base international student recruitment on the assumption their preparedness in ‘English’ is assured if they reach a certain level in tests such as the International English Language Testing System (IELTS). This assumes an abstract objectivist view of language that sees the ‘English’ as removable for testing in any context. However, in an individual subjectivist view of language, ‘English’ is inextricably linked with context, i.e. subject content that symbiotically connects thought and meaning. In this paper, we outline these views of language and consider the ‘English’ of IELTS. Next we detail interviews and focus groups we conducted with lecturers in subject areas of Design, Nursing, Engineering, Business, Computing, and Psychology. These researched the ‘English’ required in subjects and the thinking underpinning it. We then present and discuss results around three themes of ‘How ‘English’ is specific to the content of subjects’; ‘How the ‘English’ of subjects is underpinned by unique ideological and psychological elements’ and; ‘How the non-textual elements of different subjects are intertwined with their ‘English’’. Our results illustrate why we need to challenge the power invested in IELTS, and why determining English preparedness needs to be undertaken within the subject context

Using physical objects as a portal to reveal academic subject identity and thought

We are lecturers who help students studying subjects that use word-based writing, non-word based writing such as Mathematics, and non-text based language such as visual semiotics. To access examples of such language with subject lecturers we have found traditional interviews or focus groups ineffective, and realised that in these, although lecturers could talk about key psychological elements of the language, they had no focus to produce any examples of it. However, we suspected that providing a physical object to describe and discuss would create a context for lecturers to produce the language. Thus, we gave a brightly coloured teapot to Nursing, Psychology, Design, and Engineering lecturers to describe and evaluate in their subjects. This gave us almost instantaneous access to the subject context. For example, Nursing lecturers described and evaluated the teapot for hygiene and patient safety, Engineering lecturers did so for material properties and calculations required. Unexpectedly, many lecturers related how an identity underpinned their language. Thus, the teapot operated as a portal to reveal academic subject identity and thought. We relate how this has helped us in our teaching and suggest ways others can use physical objects in qualitative research to access and research identity and thought

Study Skills: neoliberalism’s perfect Tinkerbell

We argue that current approaches to Study Skills support are presented as being a panacea for resolving the issues presented by neoliberal approaches to educational expansion. We argue that for such a panacea to be believed pedagogically effective, four key tenets must be adhered to: Study skills is a definable entity; it is valuable for every subject; it can be embedded, and; Study Skills helps students succeed in their subjects. We argue these tenets are devoid of any sound pedagogical basis, yet that they are ideal for, and align with, neoliberal ideologies and free market political economy. We consider the organizational structuration of Study Skills as underpinned by Lukes’s third dimension of power, outlining how Study Skills represents a constitutive fantasy, a magical Tinkerbell for all to believe in that solves everyone’s problems. We propose HE dispels this Tinkerbell by ceasing to believe in it, and instead resources subject-based support

Avoiding dialogues of non-discovery through promoting dialogues of discovery.

International students and direct entrants—those entering a higher year of a degree—often come from socio-economic or cultural backgrounds different from traditional students, and have different educational backgrounds. It is assumed such students need help with unfamiliar assessment tasks such as essays, reports, and so on, and many sources aim to help with these elements. Further assumptions are that dialogue helps, and that the words used in such dialogue will be understood similarly. Yet, if the assumed meanings of the words actually differ, then such dialogue is based on a false assumption; rather than genuine dialogue, what actually occurs is an exchange of monologic utterances. This article is a structured narrative of our ongoing research into how key assessment task words such as ‘discuss,’ ‘analyse,’ and ‘critically evaluate’ are understood differently in higher education. We describe how such differences are perpetuated through Martin Buber’s (1947) ideas of monologic utterances, and what we call ‘dialogues of non-discovery’. Here we detail a research-based approach to promote genuine and technical dialogue: what we call ‘dialogues of discovery.’ We first introduce a dialogue that led to the genesis of the study and theoretical context of our dialogues with the literature. We then detail our methods of data collection in a section of ‘dialogues of exploration’. We present our findings in the form of categorizations of the different elements underpinning people’s understandings of ‘the word.’ Our own categorizations of these elements encourage dialogue around the elements of language, culture, stakeholder, subject, weight, and development over time. This is an approach we term an ‘anti-glossary approach’ in that it is opposite to, and against, ‘fixing’ or ‘ossifying’ the language in a glossary. In the Bakhtinian tradition of ‘incompletedness,’ we conclude by encouraging readers to take and adapt our findings as an ‘anti-glossary’ approach to engage in genuine and technical dialogue with their students. In this way, we believe the quality and depth of student work can improve

Analysis of microparticle penetration into human and porcine skin: non-invasive imaging with multiphoton excitation microscopy

At the University of Oxford and PowderJect Pharmaceuticals plc, a unique form of needle-free injection technology has been developed. Powdered vaccines and drugs in micro-particle form are accelerated in a high-speed gas flow to sufficient velocity to enter the skin, subsequently achieving a pharmaceutical effect. To optimize the delivery of vaccines and drugs with this method a detailed understanding of the interactive processes that occur between the microparticles and the skin is necessary. Investigations to date of micro-particle delivery into excised human and animal tissue have involved image analyses of histology sections. In the present study, a series of investigations were conducted on excised human and porcine skin using the technique of Multi-Photon fluorescence excitation Microscopy (MPM) to image particles and skin structures post-penetration. Micro-particles of various size and composition were imaged with infrared laser excitation. Three-dimensional images of stratum corneum and epidermal cell deformation due to micro-particle penetration were obtained. Measurements of micro-particle penetration depth taken from z-scan image stacks were used to successfully quantify micro-particle distribution within the skin, without invasively disrupting the skin target. This study has shown that MPM has great potential for the non-invasive imaging of particle skin interactive processes that occur with the transdermal delivery of powdered micro-particle vaccines and drugs

Scotland’s History of Animation: An Exploratory Account of the Key Figures and Influential Events

Scotland’s history of animation is a forgotten past accomplishment in the animation/VFX sector, with key influential animation professionals having had an impact both at home and abroad. Yet, to date, this history has not been meaningfully documented and such documentation can help inform policy initiatives to help nurture and develop the industry. These developments could help ensure that the importance and accomplishments of its achievements will not be forgotten or remain undeveloped. Indeed, it is argued here that Scotland suffers from historical amnesia with regard to the country’s past accomplishments and missed opportunities, but that public funding and further investment in talent development and retention can help establish the industry as a key player in society and economy. This article presents the results from an investigative literature collection and consultation with central figures in the Scottish animation industry, providing for the first time a clearer picture of the importance of animation in Scotland both for the country and for the industry worldwide. Discussing the initiatives and funding models of other European countries such as France, the article concludes by suggesting ways in which future policy initiatives could help assist Scotland’s animation industry grow and establish itself both for the future development of animation in Scotland and worldwide

UK public perceptions of shale gas hydraulic fracturing:The role of audience, message and contextual factors on risk perceptions and policy support

There is growing recognition of the need to understand public attitudes to energy sources, such as shale gas, and to feed these into decision-making. This study represents the first detailed UK experimental survey of public perceptions of shale gas fracking, including analysis of the effects of different messages and the relative influence of different audience, message and contextual factors on support and risk perceptions in respect of shale gas fracking. Using an online survey (N = 1457) of the UK public, we find considerable ambivalence about shale gas, but also greater awareness of potential risks than benefits. Prior knowledge is associated with more favourable attitudes, although demographics, political affiliation and environmental values are strongest influences on perceptions. When provided with environmental or economic information about shale gas, participants became more positive – irrespective of their prior values or whether information is framed in terms of losses or gains. As expected, prior attitudes predict how information is received, with more attitude change amongst the most ambivalent respondents. We conclude that additional information about shale gas is more likely to be effective changing attitudes if focussed on this ’undecided’ group. Studies of this type are important for policy makers and industry alike