The UK NHS Economic Evaluation Database : Economic issues in evaluations of health technology

Objective: The U.K. NHS Economic Evaluation Database (EED) project is commissioned to identify papers on economic evaluations of health technologies and to disseminate their findings to NHS decision makers by means of structured abstracts that are available through a public database and the Cochrane Library. This paper discusses current issues relating to the economic aspects of producing NHS EED abstracts. Methods: A review of NHS EED was undertaken between 1994 and 1999 to determine the methodologies adopted and issues that influence the usefulness of economic evaluations. Methods adopted to improve the quality of NHS EED abstracts are also reported. Results: Eighty-five percent of NHS EED abstracts are cost-effectiveness analyses (CEAs), 9.3% are cost-utility analyses (CUAs), and only 1.4% are cost-benefit analyses (CBAs). Of the total abstracts, 65.9% are based on single studies, 19.5% on reviews, 3.9% on estimates of effectiveness, and 10.7% on combinations of these sources. Models are utilized in 16.7% of CEAs, 60.2% of CUAs, and 20% of CBAs. Analyses of CBA studies reveal a degree of misuse of well-established definitions. NHS EED internal control mechanisms are reported that provide a means of ensuring that abstracts are based on sound academic principles. Conclusions: Most economic evaluations are conducted by means of CEA, followed by CUA, while CBA accounts for an extreme minority of cases. Single studies form the principal source of effectiveness data, although models are widely used, principally in CUA. The structure of NHS EED abstracts provides decision makers with the principal results and an interpretation of the relative strengths and weaknesses of economic evaluations

Screening of the transcriptional regulatory regions of vascular endothelial growth factor receptor 2 (VEGFR2) in amyotrophic lateral sclerosis

Background Vascular endothelial growth factor (VEGF) has neurotrophic activity which is mediated by its main agonist receptor, VEGFR2. Dysregulation of VEGF causes motor neurone degeneration in a mouse model of amyotrophic lateral sclerosis (ALS), and expression of VEGFR2 is reduced in motor neurones and spinal cord of patients with ALS. Methods We have screened the promoter region and 4 exonic regions of functional significance of the VEGFR2 gene in a UK population of patients with ALS, for mutations and polymorphisms that may affect expression or function of this VEGF receptor. Results No mutations were identified in the VEGFR2 gene. We found no association between polymorphisms in the regulatory regions of the VEGFR2 gene and ALS. Conclusion Mechanisms other than genetic variation may downregulate expression or function of the VEGFR2 receptor in patients with ALS

A comparison of the responses of mature and young clonal tea to drought.

To assist commercial producers with optimising the use of irrigation water, the responses to drought of mature and young tea crops (22 and 5 years after field planting respectively) were compared using data from two adjacent long-term irrigation experiments in Southern Tanzania. Providing the maximum potential soil water deficit was below about 400-500 mm for mature, and 200-250 mm for young plants (clone 6/8), annual yields of dry tea from rainfed or partially irrigated crops were similar to those from the corresponding well-watered crops. At deficits greater than this, annual yields declined rapidly in young tea (up to 22 kg (ha mm)-1) but relatively slowly in mature tea (up to 6.5 kg (ha mm)- 1). This apparent insensitivity of the mature crop to drought was due principally to compensation that occurred during the rains for yield lost in the dry season. Differences in dry matter distribution and shoot to root ratios contributed to these contrasting responses. Thus, the total above ground dry mass of well-irrigated, mature plants was about twice that for young plants. Similarly, the total mass of structural roots (>1 mm diameter), to 3 m depth, was four times greater in the mature crop than in the young crop and, for fine roots (<1 mm diameter), eight times greater. The corresponding shoot to root ratios (dry mass) were about 1:1 and 2:1 respectively. In addition, each unit area of leaf in the canopy of a mature plant had six times more fine roots (by weight) available to extract and supply water than did a young plant. Despite the logistical benefits resulting from more even crop distribution during the year when crops are fully irrigated, producers currently prefer to save water and energy costs by allowing a substantial soil water deficit to develop prior to the start of the rains, up to 250 mm in mature tea, knowing that yield compensation will occur later

Modeling quasar accretion disc temperature profiles

Microlensing observations indicate that quasar accretion discs have half-light radii larger than expected from standard theoretical predictions based on quasar fluxes or black hole masses. Blackburne and colleagues have also found a very weak wavelength dependence of these half-light radii. We consider disc temperature profile models that might match these observations. Nixon and colleagues have suggested that misaligned accretion discs around spinning black holes will be disrupted at radii small enough for the Lense-Thirring torque to overcome the disc's viscous torque. Gas in precessing annuli torn off a disc will spread radially and intersect with the remaining disc, heating the disc at potentially large radii. However, if the intersection occurs at an angle of more than a degree or so, highly supersonic collisions will shock-heat the gas to a Compton temperature of T~10^7 K, and the spectral energy distributions (SEDs) of discs with such shock-heated regions are poor fits to observations of quasar SEDs. Torn discs where heating occurs in intermittent weak shocks that occur whenever the intersection angle reaches a tenth of a degree pose less of a conflict with observations, but do not have significantly larger half-light radii than standard discs. We also study two phenomenological disc temperature profile models. We find that discs with a temperature spike at relatively large radii and lowered temperatures at radii inside the spike yield improved and acceptable fits to microlensing sizes in most cases. Such temperature profiles could in principle occur in sub-Keplerian discs partially supported by magnetic pressure. However, such discs overpredict the fluxes from quasars studied with microlensing except in the limit of negligible continuum emission from radii inside the temperature spike.Comment: Submitted to MNRAS. Comments welcome. 20 pages, 5 figure

c-Src drives intestinal regeneration and transformation

The non‐receptor tyrosine kinase c‐Src, hereafter referred to as Src, is overexpressed or activated in multiple human malignancies. There has been much speculation about the functional role of Src in colorectal cancer (CRC), with Src amplification and potential activating mutations in up to 20% of the human tumours, although this has never been addressed due to multiple redundant family members. Here, we have used the adult &lt;i&gt;Drosophila&lt;/i&gt; and mouse intestinal epithelium as paradigms to define a role for Src during tissue homeostasis, damage‐induced regeneration and hyperplasia. Through genetic gain and loss of function experiments, we demonstrate that Src is necessary and sufficient to drive intestinal stem cell (ISC) proliferation during tissue self‐renewal, regeneration and tumourigenesis. Surprisingly, Src plays a non‐redundant role in the mouse intestine, which cannot be substituted by the other family kinases Fyn and Yes. Mechanistically, we show that Src drives ISC proliferation through upregulation of EGFR and activation of Ras/MAPK and Stat3 signalling. Therefore, we demonstrate a novel essential role for Src in intestinal stem/progenitor cell proliferation and tumourigenesis initiation &lt;i&gt;in vivo.&lt;/i&gt

Placing the transfer of learning at the heart of HRD Practice

Training evaluation is a key area of Human Resource Development, however, measuring the effectiveness of training and the transfer of learning from a training programme to the workplace can be a challenging activity. This is even more problematic for a training provider who does not have the continuous relationship or access to performance measures of an in-house training department. This paper reports on the evaluation of a training model, assessing the impact from introduction to completion of the cycle. There are three partners in this research project: the training company, the client organisation and the university researchers. Synaptic Change Ltd is a training consultancy delivering bespoke training to organisations. Utilising a case study approach, this project reports on the evaluation of their training model through its introduction at Connect Housing, a charitable housing and support provider. This presents an interesting context for the study as researchers have suggested the distinctive value led culture of the Voluntary Sector can support a strong learning culture within the organisation. The project seeks to assess the value of learning to the organisation derived from the introduction of the model. The paper explores theoretical and empirical research concerning the evaluation of training and discusses the context of the case study organisation. It then positions the methodology employed and how data will be collected. As a working paper, the findings are not available at this time but will be presented and discussed at the UFHRD conference

Measurement of CH3_3D on Titan at Submillimeter Wavelengths

We present the first radio/submillimeter detection of monodeuterated methane (CH$_3$D) in Titan's atmosphere, using archival data from of the Atacama Large Millimeter/submillimeter Array (ALMA). The $J_K=2_1-1_1$ and $J_K=2_0-1_0$ transitions at 465.235 and 465.250 GHz ($\sim0.644$ mm) were measured at significance levels of $4.6\sigma$ and $5.7\sigma$, respectively. These two lines were modeled using the Non-linear optimal Estimator for MultivariatE spectral analySIS (NEMESIS) radiative transfer code to determine the disk-averaged CH$_3$D volume mixing ratio = $6.157\times10^{-6}$ in Titan's stratosphere (at altitudes $\gt130$ km). By comparison with the CH$_4$ vertical abundance profile measured by Cassini-Huygens mass spectrometry, the resulting value for D/H in CH$_4$ is $(1.033\pm0.081)\times10^{-4}$. This is consistent with previous ground-based and in-situ measurements from the Cassini-Huygens mission, though slightly lower than the average of the previous values. Additional CH$_3$D observations at higher spatial resolution will be required to determine a value truly comparable with the Cassini-Huygens CH$_4$ measurements, by measuring CH$_3$D with ALMA close to Titan's equator. In the post-Cassini era, spatially resolved observations of CH$_3$D with ALMA will enable the latitudinal distribution of methane to be determined, making this an important molecule for further studies.Comment: 9 pages, 4 figure

Methods of editing cloud and atmospheric layer affected pixels from satellite data

The location and migration of cloud, land and water features were examined in spectral space (reflective VIS vs. emissive IR). Daytime HCMM data showed two distinct types of cloud affected pixels in the south Texas test area. High altitude cirrus and/or cirrostratus and "subvisible cirrus" (SCi) reflected the same or only slightly more than land features. In the emissive band, the digital counts ranged from 1 to over 75 and overlapped land features. Pixels consisting of cumulus clouds, or of mixed cumulus and landscape, clustered in a different area of spectral space than the high altitude cloud pixels. Cumulus affected pixels were more reflective than land and water pixels. In August the high altitude clouds and SCi were more emissive than similar clouds were in July. Four-channel TIROS-N data were examined with the objective of developing a multispectral screening technique for removing SCi contaminated data