Economic Evaluation Plan (EEP) for A Very Early Rehabilitation Trial (AVERT): An international trial to compare the costs and cost-effectiveness of commencing out of bed standing and walking training (very early mobilization) within 24 h of stroke onset with usual stroke unit care

Rationale: A key objective of A Very Early Rehabilitation Trial is to determine if the intervention, very early mobilisation following stroke, is cost-effective. Resource use data were collected to enable an economic evaluation to be undertaken and a plan for the main economic analyses was written prior to the completion of follow up data collection. Aim and hypothesis To report methods used to collect resource use data, pre-specify the main economic evaluation analyses and report other intended exploratory analyses of resource use data. Sample size estimates: Recruitment to the trial has been completed. A total of 2,104 participants from 56 stroke units across three geographic regions participated in the trial. Methods and design: Resource use data were collected prospectively alongside the trial using standardised tools. The primary economic evaluation method is a cost-effectiveness analysis to compare resource use over 12 months with health outcomes of the intervention measured against a usual care comparator. A cost-utility analysis is also intended. Study outcome: The primary outcome in the cost-effectiveness analysis will be favourable outcome (modified Rankin Scale score 0-2) at 12 months. Cost-utility analysis will use health-related quality of life, reported as quality-adjusted life years gained over a 12 month period, as measured by the modified Rankin Scale and the Assessment of Quality of Life. Discussion: Outcomes of the economic evaluation analysis will inform the cost-effectiveness of very early mobilisation following stroke when compared to usual care. The exploratory analysis will report patterns of resource use in the first year following stroke

The Okavango; a river supporting its people, environment and economic development

The Okavango basin comprises the Cuito and Cubango active catchment areas in Angola, in addition to the Kavango–Okavango non-active catchment in northern Namibia and Botswana. The Okavango River water and its ecosystem resources are critically important sources of livelihoods for people in the basin. Pressures from livelihoods and development are already impacting on the environment. These pressures may increase in the future due to the rapid increase in population, the peace process and associated resettlement activities in Angola, and major development initiatives in Botswana and Namibia. For instance, possible future increase in water abstraction from the Okavango River may affect the long-term environmental sustainability of the Okavango Delta by minimizing channel shifting and thereby reducing spatial biodiversity. The paper argues that while conservation of the natural environment is critical, the pressing development needs must be recognized. The reduction of poverty within the basin should be addressed in order to alleviate adverse effects on the environment. The paper recommends that the development of sustainable tourism and community-based natural resource management initiatives may be appropriate strategies for reaching the Millennium Development Goals of poverty alleviation and achievement of environmental sustainability in the Okavango Basin. These initiatives have a comparative advantage in this area as demonstrated by the performance of the existing projects

Polyphosphate dynamics at Station ALOHA, North Pacific subtropical gyre

Author Posting. © Association for the Sciences of Limnology and Oceanography, 2015. This article is posted here by permission of Association for the Sciences of Limnology and Oceanography for personal use, not for redistribution. The definitive version was published in Limnology and Oceanography 61 (2016): 227–239, doi:10.1002/lno.10206.Polyphosphate (polyP) was examined within the upper water column (≤ 150 m) of Station ALOHA (22° 45′N, 158° 00′W) during two cruises conducted in May–June 2013 and September 2013. Phosphorus molar ratios of particulate polyP to total particulate phosphorus (TPP) were relatively low, similar to previously reported values from the temperate western North Atlantic, and did not exhibit strong vertical gradients, reflecting a lack of polyP recycling relative to other forms of TPP with depth. Furthermore, relationships among polyP:TPP, soluble reactive phosphorus (SRP), and alkaline phosphatase activity (APA) were also consistent with previous observations from the Atlantic Ocean. To ascertain potential mechanisms of biological polyP production and utilization, surface seawater was incubated following nutrient additions. Results were consistent with polyP:TPP enrichment under opposite extremes of APA, suggesting diverse polyP accumulation/retention mechanisms. Addition of exogenous polyP (45 ± 5 P atoms) to field incubations did not increase chlorophyll content relative to controls, suggesting that polyP was not bioavailable to phytoplankton at Station ALOHA. To clarify this result, phytoplankton cultures were screened for the ability to utilize exogenous polyP. PolyP bioavailability was variable among model diatoms of the genus Thalassiosira, yet chain length did not influence polyP bioavailability. Thus, microbial community composition may influence polyP dynamics in the ocean, and vice versa.This work was supported by a Postdoctoral Fellowship from the Ford Foundation (JMD), the National Science Foundation under grants OCE 1225801 (JMD), OCE 1316036 (STD), EF 04-24599 (DMK), the Woods Hole Oceanographic Coastal Ocean Institute, the Center for Microbial Oceanography: Research and Education, and the Gordon and Betty Moore Foundation (DMK). Additional support was provided by grants from the Simons Foundation to DMK and STD

AVERT2(a very early rehabilitation trial, a very effective reproductive trigger): retrospective observational analysis of the number of babies born to trial staff

Objective: To report the number of participants needed to recruit per baby born to trial staff during AVERT, a large international trial on acute stroke, and to describe trial management consequences. Design: Retrospective observational analysis. Setting: 56 acute stroke hospitals in eight countries. Participants: 1074 trial physiotherapists, nurses, and other clinicians. Outcome measures: Number of babies born during trial recruitment per trial participant recruited. Results: With 198 site recruitment years and 2104 patients recruited during AVERT, 120 babies were born to trial staff. Births led to an estimated 10% loss in time to achieve recruitment. Parental leave was linked to six trial site closures. The number of participants needed to recruit per baby born was 17.5 (95% confidence interval 14.7 to 21.0); additional trial costs associated with each birth were estimated at 5736 Australian dollars on average. Conclusion: The staff absences registered in AVERT owing to parental leave led to delayed trial recruitment and increased costs, and should be considered by trial investigators when planning research and estimating budgets. However, the celebration of new life became a highlight of the annual AVERT collaborators’ meetings and helped maintain a cohesive collaborative group

Fibroadenoma in vulval ectopic breast tissue in a patient with PTEN Hamartoma Tumour Syndrome

PTEN is a tumour suppressor gene involved in regulating cell division. Pathogenic germline variants in PTEN predispose to benign and malignant growths of numerous organs, including of the breast. In the following report, we describe the first documented case of a fibroadenoma developing in ectopic breast tissue of the vulva in a patient with a germline pathogenic variant in PTEN. This highlights the risk of hyperplasia developing in any breast tissue, including rare ectopic sites, particularly in patients with underlying germline variants in cancer susceptibility genes

Potential Role of Inorganic Polyphosphate in the Cycling of Phosphorus Within the Hypoxic Water Column of Effingham Inlet, British Columbia

[1] The upper basin of Effingham Inlet possesses permanently anoxic bottom waters, with a water column redox transition zone typically occurring at least 40 m above the sediment‐water interface. During our sampling campaign in April and July 2007, this redox transition zone was associated with sharp peaks in a variety of parameters, including soluble reactive phosphorus (SRP) and total particulate phosphorus (TPP). Based on sequential extraction results, TPP maxima exhibited preferential accumulation of an operationally defined class of loosely adsorbed organic phosphorus (P), which may contain a substantial fraction of polyphosphate (poly‐P). This poly‐P may furthermore be involved in the redox‐dependent remobilization of SRP. For example, direct fluorometric analysis of poly‐P content revealed that particulate inorganic poly‐P was present at concentrations ranging from 1 to 9 nM P within and several meters above the TPP maximum. Below the depth of 1% oxygen saturation, however, particulate inorganic poly‐P was undetectable