Optimal search strategies for detecting cost and economic studies in EMBASE

BACKGROUND: Economic evaluations in the medical literature compare competing diagnosis or treatment methods for their use of resources and their expected outcomes. The best evidence currently available from research regarding both cost and economic comparisons will continue to expand as this type of information becomes more important in today's clinical practice. Researchers and clinicians need quick, reliable ways to access this information. A key source of this type of information is large bibliographic databases such as EMBASE. The objective of this study was to develop search strategies that optimize the retrieval of health costs and economics studies from EMBASE. METHODS: We conducted an analytic survey, comparing hand searches of journals with retrievals from EMBASE for candidate search terms and combinations. 6 research assistants read all issues of 55 journals indexed by EMBASE for the publishing year 2000. We rated all articles using purpose and quality indicators and categorized them into clinically relevant original studies, review articles, general papers, or case reports. The original and review articles were then categorized for purpose (i.e., cost and economics and other clinical topics) and depending on the purpose as 'pass' or 'fail' for methodologic rigor. Candidate search strategies were developed for economic and cost studies, then run in the 55 EMBASE journals, the retrievals being compared with the hand search data. The sensitivity, specificity, precision, and accuracy of the search strategies were calculated. RESULTS: Combinations of search terms for detecting both cost and economic studies attained levels of 100% sensitivity with specificity levels of 92.9% and 92.3% respectively. When maximizing for both sensitivity and specificity, the combination of terms for detecting cost studies (sensitivity) increased 2.2% over the single term but at a slight decrease in specificity of 0.9%. The maximized combination of terms for economic studies saw no change in sensitivity from the single term and only a 0.1% increase in specificity. CONCLUSION: Selected terms have excellent performance in the retrieval of studies of health costs and economics from EMBASE

The 2021 outburst of the recurrent nova RS Ophiuchi observed in X-rays by the Neil Gehrels Swift Observatory: a comparative study

On 2021 August 8, the recurrent nova RS Ophiuchi erupted again, after an interval of 15.5 yr. Regular monitoring by the Neil Gehrels Swift Observatory began promptly, on August 9.9 (0.37 day after the optical peak), and continued until the source passed behind the Sun at the start of November, 86 days later. Observations then restarted on day 197, once RS Oph emerged from the Sun constraint. This makes RS Oph the first Galactic recurrent nova to have been monitored by Swift throughout two eruptions. Here we investigate the extensive X-ray datasets from 2006 and 2021, as well as the more limited data collected by EXOSAT in 1985. The hard X-rays arising from shock interactions between the nova ejecta and red giant wind are similar following the last two eruptions. In contrast, the early super-soft source (SSS) in 2021 was both less variable and significantly fainter than in 2006. However, 0.3–1 keV light-curves from 2021 reveal a 35 s quasi-periodic oscillation consistent in frequency with the 2006 data. The Swift X-ray spectra from 2021 are featureless, with the soft emission typically being well parametrized by a simple blackbody, while the 2006 spectra showed much stronger evidence for superimposed ionized absorption edges. Considering the data after day 60 following each eruption, during the supersoft phase the 2021 spectra are hotter, with smaller effective radii and lower wind absorption, leading to an apparently reduced bolometric luminosity. We explore possible explanations for the gross differences in observed SSS behaviour between the 2006 and 2021 outbursts

Pan-Chromatic observations of the Recurrent Nova LMC 2009a (LMC 1971b)

Nova LMC 2009a is confirmed as a Recurrent Nova (RN) from positional coincidence with nova LMC 1971b. The observational data set is one of the most comprehensive for any Galactic or extragalactic RN: optical and near-IR photometry from outburst until over 6 years later; optical spectra for the first 6 months, and Swift satellite Ultraviolet and X-ray observations from 9 days to almost 1 year post-outburst. We find $M_V = -8.4\pm0.8_{\mathrm{r}}\pm0.7_{\mathrm{s}}$ and expansion velocities between 1000 and 4000 km s$^{-1}$. Coronal line emission before day 9 indicates shocks in the ejecta. Strengthening of He II $\lambda$4686 preceded the emergence of the Super-Soft Source (SSS) in X-rays at $\sim63-70$ days, which was initially very variable. Periodic modulations, $P=1.2$ days, most probably orbital in nature, were evident in the UV and optical from day 43. Subsequently, the SSS shows an oscillation with the same period but with a delay of 0.28P. The progenitor system has been identified; the secondary is most likely a sub-giant feeding a luminous accretion disk. Properties of the SSS infer a white dwarf (WD) mass $1.1 \mathrm{M}_\odot \lesssim M_{\rm WD} \lesssim 1.3 \mathrm{M}_\odot$. If the accretion occurs at constant rate, $\dot{\it{M}}_{\rm acc} \simeq 3.6^{+4.7}_{-2.5} \times 10^{-7} \mathrm{M}_\odot$ yr$^{-1}$ is needed, consistent with nova models for an inter-eruption interval of 38 years, low outburst amplitude, progenitor position in the color-magnitude diagram, and spectral energy distribution at quiescence. We note striking similarities between LMC 2009a and the Galactic nova KT Eri, suggesting that KT Eri is a candidate RN

Locally harvested foods support serum 25-hydroxyvitamin D sufficiency in an indigenous population of Western Alaska

Background: Low serum vitamin D is associated with higher latitude, age, body fat percentage and low intake of fatty fish. Little documentation of vitamin D concentrations is available for Alaska Native populations. Objective: This study was undertaken to investigate serum 25-hydroxyvitamin D (25(OH)D) concentrations of the Yup'ik people of southwestern Alaska in relation to demographic and lifestyle variables, particularly with the use of locally harvested (local) foods. Design: Cross-sectional study. Methods: We estimated 25(OH)D, dietary vitamin D and calcium, percent of energy from local foods and demographic variables in 497 Yup'ik people (43% males) aged 14–92 residing in southwestern Alaska. Sampling was approximately equally divided between synthesizing and non-synthesizing seasons, although the preponderance of samples were drawn during months of increasing daylight. Results: Mean vitamin D intake was 15.1±20.2 µg/d, while local foods accounted for 22.9±17.1% of energy intake. The leading sources of vitamin D were local fish (90.1%) followed by market foods. Mean 25(OH)D concentration was 95.6±40.7 nmol/L. Participants in the upper 50th percentile of 25(OH)D concentration tended to be older, male, of lower body mass index, sampled during the synthesizing season, and among the upper 50th percentile of local food use. Conclusions: A shift away from locally harvested foods will likely increase the risk for serum 25(OH)D insufficiency in this population

An asymmetric shock wave in the 2006 outburst of the recurrent nova RS Ophiuchi

Nova outbursts take place in binary star systems comprising a white dwarf and either a low-mass Sun-like star or, as in the case of the recurrent nova RS Ophiuchi, a red giant. Although the cause of these outbursts is known to be thermonuclear explosion of matter transferred from the companion onto the surface of the white dwarf, models of the previous (1985) outburst of RS Ophiuchi failed to adequately fit the X-ray evolution and there was controversy over a single-epoch high-resolution radio image, which suggested that the remnant was bipolar rather than spherical as modelled. Here we report the detection of spatially resolved structure in RS Ophiuchi from two weeks after its 12 February 2006 outburst. We track an expanding shock wave as it sweeps through the red giant wind, producing a remnant similar to that of a type II supernova but evolving over months rather than millennia. As in supernova remnants, the radio emission is non-thermal (synchrotron emission), but asymmetries and multiple emission components clearly demonstrate that contrary to the assumptions of spherical symmetry in models of the 1985 explosion, the ejection is jet-like, collimated by the central binary whose orientation on the sky can be determined from these observations.Comment: 10 pages, 4 figures, accepted by Natur

Captive reptile mortality rates in the home and implications for the wildlife trade

The trade in wildlife and keeping of exotic pets is subject to varying levels of national and international regulation and is a topic often attracting controversy. Reptiles are popular exotic pets and comprise a substantial component of the live animal trade. High mortality of traded animals raises welfare concerns, and also has implications for conservation if collection from the wild is required to meet demand. Mortality of reptiles can occur at any stage of the trade chain from collector to consumer. However, there is limited information on mortality rates of reptiles across trade chains, particularly amongst final consumers in the home. We investigated mortality rates of reptiles amongst consumers using a specialised technique for asking sensitive questions, additive Randomised Response Technique (aRRT), as well as direct questioning (DQ). Overall, 3.6% of snakes, chelonians and lizards died within one year of acquisition. Boas and pythons had the lowest reported mortality rates of 1.9% and chameleons had the highest at 28.2%. More than 97% of snakes, 87% of lizards and 69% of chelonians acquired by respondents over five years were reported to be captive bred and results suggest that mortality rates may be lowest for captive bred individuals. Estimates of mortality from aRRT and DQ did not differ significantly which is in line with our findings that respondents did not find questions about reptile mortality to be sensitive. This research suggests that captive reptile mortality in the home is rather low, and identifies those taxa where further effort could be made to reduce mortality rate

X-Ray Emitting Blast Wave from the Recurrent Nova RS Ophiuchi

Stellar explosions such as novae and supernovae produce most of the heavy elements in the Universe. Although the onset of novae from runaway thermonuclear fusion reactions on the surface of a white dwarf in a binary star system is understood[1], the structure, dynamics, and mass of the ejecta are not well known. In rare cases, the white dwarf is embedded in the wind nebula of a red-giant companion; the explosion products plow through the nebula and produce X-ray emission. Early this year, an eruption of the recurrent nova RS Ophiuchi[2,3] provided the first opportunity to perform comprehensive X-ray observations of such an event and diagnose conditions within the ejecta. Here we show that the hard X-ray emission from RS Ophiuchi early in the eruption emanates from behind a blast wave, or outward-moving shock wave, that expanded freely for less than 2 days and then decelerated due to interaction with the nebula. The X-rays faded rapidly, suggesting that the blast wave deviates from the standard spherical shell structure[4-6]. The early onset of deceleration indicates that the ejected shell had a low mass, the white dwarf has a high mass[7], and that RS Ophiuchi is a progenitor of the type of supernova integral to studies of the expansion of the universe.Comment: To appear in Nature; 7 pages, including 2 color figures; removed incorrect statement of embargo polic

Equity-oriented toolkit for health technology assessment and knowledge translation: application to scaling up of training and education for health workers

Human resources for health are in crisis worldwide, especially in economically disadvantaged areas and areas with high rates of HIV/AIDS in both health workers and patients. International organizations such as the Global Health Workforce Alliance have been established to address this crisis. A technical working group within the Global Health Workforce Alliance developed recommendations for scaling up education and training of health workers. The paper will illustrate how decision-makers can use evidence and tools from an equity-oriented toolkit to scale up training and education of health workers, following five recommendations of the technical working group. The Equity-Oriented Toolkit, developed by the World Health Organization Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, has four major steps: (1) burden of illness; (2) community effectiveness; (3) economic evaluation; and (4) knowledge translation/implementation. Relevant tools from each of these steps will be matched with the appropriate recommendation from the technical working group

Pneumococcal carriage in sub-Saharan Africa--a systematic review.

BACKGROUND: Pneumococcal epidemiology varies geographically and few data are available from the African continent. We assess pneumococcal carriage from studies conducted in sub-Saharan Africa (sSA) before and after the pneumococcal conjugate vaccine (PCV) era. METHODS: A search for pneumococcal carriage studies published before 2012 was conducted to describe carriage in sSA. The review also describes pneumococcal serotypes and assesses the impact of vaccination on carriage in this region. RESULTS: Fifty-seven studies were included in this review with the majority (40.3%) from South Africa. There was considerable variability in the prevalence of carriage between studies (I-squared statistic = 99%). Carriage was higher in children and decreased with increasing age, 63.2% (95% CI: 55.6-70.8) in children less than 5 years, 42.6% (95% CI: 29.9-55.4) in children 5-15 years and 28.0% (95% CI: 19.0-37.0) in adults older than 15 years. There was no difference in the prevalence of carriage between males and females in 9/11 studies. Serotypes 19F, 6B, 6A, 14 and 23F were the five most common isolates. A meta-analysis of four randomized trials of PCV vaccination in children aged 9-24 months showed that carriage of vaccine type (VT) serotypes decreased with PCV vaccination; however, overall carriage remained the same because of a concomitant increase in non-vaccine type (NVT) serotypes. CONCLUSION: Pneumococcal carriage is generally high in the African continent, particularly in young children. The five most common serotypes in sSA are among the top seven serotypes that cause invasive pneumococcal disease in children globally. These serotypes are covered by the two PCVs recommended for routine childhood immunization by the WHO. The distribution of serotypes found in the nasopharynx is altered by PCV vaccination