Cost effectiveness analysis of different approaches of screening for familial hypercholesterolaemia

Objectives To assess the cost effectiveness of strategies to screen for and treat familial hypercholesterolaemia. Design Cost effectiveness analysis. A care pathway for each patient was delineated and the associated probabilities, benefits, and costs were calculated. Participants Simulated population aged 16­54 years in England and Wales. Interventions Identification and treatment of patients with familial hypercholesterolaemia by universal screening, opportunistic screening in primary care, screening of people admitted to hospital with premature myocardial infarction, or tracing family members of affected patients. Main outcome measure Cost effectiveness calculated as cost per life year gained (extension of life expectancy resulting from intervention) including estimated costs of screening and treatment. Results Tracing of family members was the most cost effective strategy (£3097 (&5066, $4479) per life year gained) as 2.6 individuals need to be screened to identify one case at a cost of £133 per case detected. If the genetic mutation was known within the family then the cost per life year gained (£4914) was only slightly increased by genetic confirmation of the diagnosis. Universal population screening was least cost effective (£13 029 per life year gained) as 1365 individuals need to be screened at a cost of £9754 per case detected. For each strategy it was more cost effective to screen younger people and women. Targeted strategies were more expensive per person screened, but the cost per case detected was lower. Population screening of 16 year olds only was as cost effective as family tracing (£2777 with a clinical confirmation). Conclusions Screening family members of people with familial hypercholesterolaemia is the most cost effective option for detecting cases across the whole population

Evaluation of white spot syndrome virus variable DNA loci as molecular markers of virus spread at intermediate spatiotemporal scales

Variable genomic loci have been employed in a number of molecular epidemiology studies of white spot syndrome virus (WSSV), but it is unknown which loci are suitable molecular markers for determining WSSV spread on different spatiotemporal scales. Although previous work suggests that multiple introductions of WSSV occurred in central Vietnam, it is largely uncertain how WSSV was introduced and subsequently spread. Here, we evaluate five variable WSSV DNA loci as markers of virus spread on an intermediate (i.e. regional) scale, and develop a detailed and statistically supported model for the spread of WSSV. The genotypes of 17 WSSV isolates from along the coast of Vietnam – nine of which were newly characterized in this study – were analysed to obtain sufficient samples on an intermediate scale and to allow statistical analysis. Only the ORF23/24 variable region is an appropriate marker on this scale, as geographically proximate isolates show similar deletion sizes. The ORF14/15 variable region and variable-number tandem repeat (VNTR) loci are not useful as markers on this scale. ORF14/15 may be suitable for studying larger spatiotemporal scales, whereas VNTR loci are probably suitable for smaller scales. For ORF23/24, there is a clear pattern in the spatial distribution of WSSV: the smallest genomic deletions are found in central Vietnam, and larger deletions are found in the south and the north. WSSV genomic deletions tend to increase over time with virus spread in cultured shrimp, and our data are therefore congruent with the hypothesis that WSSV was introduced in central Vietnam and then radiated ou

History, College of Medicine: 1959-1968. Chapter 14: Department of Pharmacology

Prepared for the Centennial of The Ohio State University

The Evolving Role of Systems Analysis in Process and Methods in Large-Scale Public Socio-Technical Systems

The ESD definition of Large-Scale Socio-Technical Systems is large-scale and complex systems in which both human and non-human elements interact where the social and/or management dimensions tend to dominate. The word public has been added here to indicate that subset which are quasi public systems, i.e. the problems of public management of resources such as clean air and water or energy in which public policy is needed to drive and set the context for public investment and regulation which in turn influence private individual and corporate decisions. Systems analysis plays an important role in the formation of strategic policy for managing these resources. The paradigm of systems analysis as applied to large-scale open systems has not changed over the years. It is still the mantra of Problem Identification, Systems Modeling, Generation of Alternatives (Optimization), Evaluation and Implementation. However, both the process by which systems analysis is carried out, and the systems methods used in that process have evolved significantly and for the better. This paper deals with a description of these evolving methods and processes in the context of large-scale energy and environmental systems. In particular, pathways to the future in energy and environmental management are discussed as long-term system analysis problems. Systems Analysis process changes and methods changes, which have occurred and will need evolution in the future, are identified

Toward a Unified Theory of Professional Ethics and Human Rights

This Article offers a novel account of the relationship between the ethical obligations of professionals and international human rights law and practice. The account is motivated by the role that professionals played in the Bush administration\u27s war on terror -in particular, the global detention and interrogation regimes that incarcerated tens of thousands of detainees, and abused many of them. In the most extreme cases, professionals may have committed serious international crimes rendering them liable to criminal prosecution in foreign courts. Serious concerns have also been raised about the ethics of professionals\u27 conduct. Psychologists were the principal architects of the aggressive detention and interrogation regimes operated by both the U.S. Defense Department and the Central Intelligence Agency (CIA). These regimes incorporated a variety of coercive techniques including sleep deprivation, exposure to temperature extremes and loud noise, stress positions, and-in the case of the CIA-dousing with cold water and waterboarding, the now infamous procedure that induces a desperate feeling of suffocation in those exposed to it