Should NICE reconsider the 2016 UK guidelines on TB contact tracing? A cost-effectiveness analysis of contact investigations in London.

BACKGROUND: In January 2016, clinical TB guidance in the UK changed to no longer recommend screening contacts of non-pulmonary, non-laryngeal (ETB) index cases. However, no new evidence was cited for this change, and there is evidence that screening these contacts may be worthwhile. The objective of this study was to estimate the cost-effectiveness of screening contacts of adult ETB cases and adult pulmonary or laryngeal TB (PTB) cases in London, UK. METHODS: We carried out a cross-sectional analysis of data collected on TB index cases and contacts in the London TB register and an economic evaluation using a static model describing contact tracing outcomes. Incremental cost-effectiveness ratios (ICERs) were calculated using no screening as the baseline comparator. All adult TB cases (≥15 years old) in London from 2012 to 2015, and their contacts, were eligible (2465/5084 PTB and 2559/6090 ETB index cases were included). RESULTS: Assuming each contact with PTB infects one person/month, the ICER of screening contacts of ETB cases was £78 000/quality-adjusted life-years (QALY) (95% CI 39 000 to 140 000), and screening contacts of PTB cases was £30 000/QALY (95% CI 18 000 to 50 000). The ICER of screening contacts of ETB cases was £30 000/QALY if each contact with PTB infects 3.4 people/month. Limitations of this study include the use of self-reported symptomatic periods and lack of knowledge about onward transmission from PTB contacts. CONCLUSIONS: Screening contacts of ETB cases in London was almost certainly not cost-effective at any conventional willingness-to-pay threshold in England, supporting recent changes to National Institute for Health and Care Excellence national guidelines

NMDA spikes enhance action potential generation during sensory input

Recent evidence in vitro suggests that the tuft dendrites of pyramidal neurons are capable of evoking local NMDA receptor–dependent electrogenesis, so-called NMDA spikes. However, it has so far proved difficult to demonstrate their existence in vivo. Moreover, it is not clear whether NMDA spikes are relevant to the output of pyramidal neurons. We found that local NMDA spikes occurred in tuft dendrites of layer 2/3 pyramidal neurons both spontaneously and following sensory input, and had a large influence on the number of output action potentials. Using two-photon activation of an intracellular caged NMDA receptor antagonist (tc-MK801), we found that isolated NMDA spikes typically occurred in multiple branches simultaneously and that sensory stimulation substantially increased their probability. Our results demonstrate that NMDA receptors have a vital role in coupling the tuft region of the layer 2/3 pyramidal neuron to the cell body, enhancing the effectiveness of layer 1 input

WASP-42 b and WASP-49 b: two new transiting sub-Jupiters

We report the discovery of two new transiting planets from the WASP survey. WASP-42 b is a 0.500 +/- 0.035 M_jup planet orbiting a K1 star at a separation of 0.0548 +/- 0.0017 AU with a period of 4.9816872 +/- 7.3 x 10^-6 days. The radius of WASP-42 b is 1.080 +/- 0.057 R_jup while its equilibrium temperature is T_eq = 995 +/- 34 K. We detect some evidence for a small but non-zero eccentricity of e=0.060 +/- 0.013. WASP-49 b is a 0.378 +/- 0.027 M_jup planet around an old G6 star. It has a period of 2.7817387 +/- 5.6 x 10^-6 days and a separation of 0.0379 +/- 0.0011 AU. This planet is slightly bloated, having a radius of 1.115 +/- 0.047 R_jup and an equilibrium temperature of T_eq = 1369 +/- 39 K. Both planets have been followed up photometrically, and in total we have obtained 5 full and one partial transit light curves of WASP-42 and 4 full and one partial light curves of WASP-49 using the Euler-Swiss, TRAPPIST and Faulkes South telescopes

Spatially resolved spectroscopy of Cassiopeia A with MECS on board BeppoSAX

We have performed the first detailed spatially resolved spectroscopy of Cas A in the 1.6-10 keV energy range, using data taken with the MECS spectrometer on board the BeppoSAX Observatory. We performed a spatial deconvolution of the data and eventually generated a set of spectra, covering a region of about 3 arcmin radius around the centre of Cas A. The results obtained by fitting these spectra using a non-equilibrium ionisation plasma model and a power law, are: (i) a single thermal component is sufficient to fit all the spectra; (ii) kT is rather uniformly distributed with a minimum in the east and a maximum in the west, and no evidence is found for high kT expected from the interaction of the main shock with the ISM; (iii) from the distribution of the values of the ionisation parameter n_et we infer the presence of two distinct components: the first (a) in the range 1-10 cm^(-3), the second (b) with values ten times higher; if we associate component a to the CSM and component b to the ejecta, the mass ratio M(a)/M(b)<= 1/10 indicates a progenitor star that lost only a small fraction of the envelope during its pre-SN life. In this hypothesis the distribution of component b across the remnant suggests that the explosion was not spherically symmetric; (iv) the distribution of abundances indicates that we are detecting a CSM component with almost solar composition, and an ejecta component enriched in heavier elements. Abundances found for alpha-elements are consistent with the current view that Cas A was produced by the explosion of a massive star.Comment: 16 pages, 9 PostScript figures, 4 tables, Accepted for publication on Astronomy & Astrophysics (submitted July 12, 2000; accepted December 20, 2000

Rossiter-McLaughlin Effect Measurements for WASP-16, WASP-25 and WASP-31

We present new measurements of the Rossiter-McLaughlin (RM) effect for three WASP planetary systems, WASP-16, WASP-25 and WASP-31, from a combined analysis of their complete sets of photometric and spectroscopic data. We find a low amplitude RM effect for WASP-16 (Teff = 5700 \pm 150K), suggesting that the star is a slow rotator and thus of an advanced age, and obtain a projected alignment angle of lambda = -4.2 degrees +11.0 -13.9. For WASP-25 (Teff = 5750\pm100K) we detect a projected spin-orbit angle of lambda = 14.6 degrees \pm6.7. WASP-31 (Teff = 6300\pm100K) is found to be well-aligned, with a projected spin-orbit angle of lambda = 2.8degrees \pm3.1. A circular orbit is consistent with the data for all three systems, in agreement with their respective discovery papers. We consider the results for these systems in the context of the ensemble of RM measurements made to date. We find that whilst WASP-16 fits the hypothesis of Winn et al. (2010) that 'cool' stars (Teff < 6250K) are preferentially aligned, WASP-31 has little impact on the proposed trend. We bring the total distribution of the true spin-orbit alignment angle, psi, up to date, noting that recent results have improved the agreement with the theory of Fabrycky & Tremaine (2007) at mid-range angles. We also suggest a new test for judging misalignment using the Bayesian Information Criterion, according to which WASP-25 b's orbit should be considered to be aligned.Comment: 20 pages, 14 tables, 10 figures. Accepted to MNRA

A Multi-Wavelength Study of Parent Volatile Abundances in Comet C/2006 M4 (SWAN)

Volatile organic emissions were detected post-perihelion in the long period comet C/2006 M4 (SWAN) in October and November 2006. Our study combines target-of-opportunity, observations using the infrared Cryogenic Echelle Spectrometer (CSHELL) at the NASA-IRTF 3-m telescope, and millimeter wavelength observations using the Arizona Radio Observatory (ARO) 12-m telescope. Five parent volatiles were measured with CSHELL (H2O, CO, CH3OH, CH4, and C2H6), and two additional species (HCN and CS) were measured with the ARID 12-m. These revealed highly depleted CO and somewhat enriched CH3OH compared with abundances observed in the dominant group of long-period (Oort cloud) comets in our sample and similar to those observed recently in Comet 8P/Tuttle. This may indicate highly efficient H-atom addition to CO at very low temperature (approx.10-20 K) on the surfaces of interstellar (pre-cometary) grains. Comet C12006 M4 had nearly "normal" C2H6, and CH4, suggesting a processing history similar to that experienced by the dominant group. When compared with estimated water production at the time of the millimeter observations, HCN was slightly depleted compared with the normal abundance in comets based on 1R observations but was consistent with the majority of values from the millimeter. The ratio CS/HCN in C/2006 M4 was within the range measured in ten comets at millimeter wavelengths. The higher apparent H-atom conversion efficiency compared with most comets may indicate that the icy grains incorporated into C/2006 M4 were exposed to higher H-atom densities, or alternatively to similar densities but for a longer period of time

Pulmonary Mycobacterium avium-intracellulare is the main driver of the rise in non-tuberculous mycobacteria incidence in England, Wales and Northern Ireland, 2007–2012

BACKGROUND: The incidence of non-tuberculous mycobacteria (NTM) isolation from humans is increasing worldwide. In England, Wales and Northern Ireland (EW&NI) the reported rate of NTM more than doubled between 1996 and 2006. Although NTM infection has traditionally been associated with immunosuppressed individuals or those with severe underlying lung damage, pulmonary NTM infection and disease may occur in people with no overt immune deficiency. Here we report the incidence of NTM isolation in EW&NI between 2007 and 2012 from both pulmonary and extra-pulmonary samples obtained at a population level. METHODS: All individuals with culture positive NTM isolates between 2007 and 2012 reported to Public Health England by the five mycobacterial reference laboratories serving EW&NI were included. RESULTS: Between 2007 and 2012, 21,118 individuals had NTM culture positive isolates. Over the study period the incidence rose from 5.6/100,000 in 2007 to 7.6/100,000 in 2012 (p < 0.001). Of those with a known specimen type, 90 % were pulmonary, in whom incidence increased from 4.0/100,000 to 6.1/100,000 (p < 0.001). In extra-pulmonary specimens this fell from 0.6/100,000 to 0.4/100,000 (p < 0.001). The most frequently cultured organisms from individuals with pulmonary isolates were within the M. avium-intracellulare complex family (MAC). The incidence of pulmonary MAC increased from 1.3/100,000 to 2.2/100,000 (p < 0.001). The majority of these individuals were over 60 years old. CONCLUSION: Using a population-based approach, we find that the incidence of NTM has continued to rise since the last national analysis. Overall, this represents an almost ten-fold increase since 1995. Pulmonary MAC in older individuals is responsible for the majority of this change. We are limited to reporting NTM isolates and not clinical disease caused by these organisms. To determine whether the burden of NTM disease is genuinely increasing, a standardised approach to the collection of linked national microbiological and clinical data is required

WASP-31b: a low-density planet transiting a metal-poor, late-F-type dwarf star

We report the discovery of the low-density, transiting giant planet WASP-31b. The planet is 0.48 Jupiter masses and 1.55 Jupiter radii. It is in a 3.4-day orbit around a metal-poor, late-F-type, V = 11.7 dwarf star, which is a member of a common proper motion pair. In terms of its low density, WASP-31b is second only to WASP-17b, which is a more highly irradiated planet of similar mass.Comment: 6 pages, 5 figures, 4 tables. As accepted for publication in A&A; bibcode = 2011A&A...531A..60

Are people with chronic diseases interested in using telehealth?: a cross-sectional postal survey

Background There is growing interest in telehealth—the use of technology to support the remote delivery of health care and promote self-management—as a potential alternative to face-to-face care for patients with chronic diseases. However, little is known about what precipitates interest in the use of telehealth among these patients. Objective This survey forms part of a research program to develop and evaluate a telehealth intervention for patients with two exemplar chronic diseases: depression and raised cardiovascular disease (CVD) risk. The survey was designed to explore the key factors that influence interest in using telehealth in these patient groups. Methods Thirty-four general practices were recruited from two different regions within England. Practice records were searched for patients with (1) depression (aged 18+ years) or (2) 10-year risk of CVD ≥20% and at least one modifiable risk factor (aged 40-74 years). Within each general practice, 54 patients in each chronic disease group were randomly selected to receive a postal questionnaire. Questions assessed five key constructs: sociodemographics, health needs, difficulties accessing health care, technology-related factors (availability, confidence using technology, perceived benefits and drawbacks of telehealth), and satisfaction with prior use of telehealth. Respondents also rated their interest in using different technologies for telehealth (phone, email and Internet, or social media). Relationships between the key constructs and interest in using the three mediums of telehealth were examined using multivariable regression models. Results Of the 3329 patients who were sent a study questionnaire, 44.40% completed it (872/1740, 50.11% CVD risk; 606/1589, 38.14% depression). Overall, there was moderate interest in using phone-based (854/1423, 60.01%) and email/Internet-based (816/1425, 57.26%) telehealth, but very little interest in social media (243/1430, 16.99%). After adjusting for health needs, access difficulties, technology-related factors, and prior use of telehealth, interest in telehealth had largely no association with sociodemographic variables. For both patient groups and for each of the three technology mediums, the most important constructs related to interest in telehealth were having the confidence to use the associated technology, as well as perceiving greater advantages and fewer disadvantages from using telehealth. To illustrate, greater confidence using phone technologies (b=.16, 95% CI 0.002-0.33), while also perceiving more benefits (b=.31, 95% CI 0.21-0.40) and fewer drawbacks (b=-.23, 95% CI -0.28 to -0.17) to using telehealth were associated with more interest in using phone-based telehealth technologies for patients with depression. Conclusions There is widespread interest in using phone-based and email/Internet-based telehealth among patients with chronic diseases, regardless of their health status, access difficulties, age, or many other sociodemographic factors. This interest could be increased by helping patients gain confidence using technologies and through highlighting benefits and addressing concerns about telehealth. While the same pattern exists for social media telehealth, interest in using these technologies is minimal

Mathematics difficulties in extremely preterm children : evidence of a specific deficit in basic mathematics processing

Background: Extremely preterm (EP, <26 wk gestation) children have been observed to have poor academic achievement in comparison to their term-born peers, especially in mathematics. This study investigated potential underlying causes of this difficulty. Methods: A total of 219 EP participants were compared with 153 term-born control children at 11 y of age. All children were assessed by a psychologist on a battery of standardized cognitive tests and a number estimation test assessing children’s numerical representations. Results: EP children underperformed in all tests in comparison with the term controls (the majority of Ps < 0.001). Different underlying relationships between performance on the number estimation test and mathematical achievement were found in EP as compared with control children. That is, even after controlling for cognitive ability, a relationship between number representations and mathematical performance persisted for EP children only (EP: r = 0.346, n = 186, P < 0.001; control: r = 0.095, n = 146, P = 0.256). Conclusion: Interventions for EP children may target improving children’s numerical representations in order to subsequently remediate their mathematical skills