Applying economic evaluation to public health interventions: The case of interventions to promote physical activity

Copyright @ 2012 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: This paper explores the application of alternative approaches to economic evaluation of public health interventions, using a worked example of exercise referral schemes (ERSs). METHODS: Cost-utility (CUA) and cost-consequence analyses (CCA) were used to assess the cost-effectiveness of ERSs. For the CUA, evidence was synthesized using a decision analytic model that adopts a lifetime horizon and NHS/Personal Social Services perspective. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). CCA was conducted from a partial-societal perspective, including health and non-healthcare costs and benefits. Outcomes were reported in natural units, such as cases of strokes or CHD avoided. RESULTS: Compared with usual care, the incremental cost per QALY of ERS is £20 876. Based on a cohort of 100 000 individuals, CCA estimates cost of ERS at £22 million to the healthcare provider and £12 million to participants. The benefits of ERS include additional 3900 people becoming physically active, 51 cases of CHD avoided, 16 cases of stroke avoided, 86 cases of diabetes avoided and a gain of ∼800 QALYs. CONCLUSIONS: CCA might provide greater transparency than CUA in reporting the outcomes of public health interventions and have greater resonance with stakeholders involved in commissioning these interventions.This work was supported by the NIHR Health Technology Assessment programme (project number 08/72/01). This article is made available through the Brunel Open Access Publishing Fund

Public Trust, Deliberative Engagement and Health Data Projects: Beyond Legal Provisions

In England, a new scheme for collating and sharing General Practitioners’ data has faced resistance from various quarters and has been deferred twice. While insufficient communication and ambiguous safeguards explain the widespread dissatisfaction expressed by the public and experts, we argue how dwindling public trust can be the most damaging variable in this picture - with implications not only for this scheme, but for any future project that aims to mobilise health data for medical research and innovation. We also highlight the indispensability of deliberative public engagement on the values being prioritised in health data initiatives, the significance of securing social license in addition to legal assurances, and the lessons in it of global pertinence

Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding : systematic review and meta-analysis of data from individual patients

Peer reviewedPublisher PD

Understanding factors associated with grazing efficiency of perennial ryegrass

Understanding factors associated with grazing efficiency of perennial ryegrass. 10. International Symposium on the Nutrition of Herbivores (ISNH

In vitro development of chemotherapy and targeted therapy drug-resistant cancer cell lines: a practical guide with case studies

The development of a drug-resistant cell line can take from 3 to 18 months. However, little is published on the methodology of this development process. This article will discuss key decisions to be made prior to starting resistant cell line development; the choice of parent cell line, dose of selecting agent, treatment interval, and optimizing the dose of drug for the parent cell line. Clinically relevant drug-resistant cell lines are developed by mimicking the conditions cancer patients experience during chemotherapy and cell lines display between two- and eight-fold resistance compared to their parental cell line. Doses of drug administered are low, and a pulsed treatment strategy is often used where the cells recover in drug-free media. High-level laboratory models are developed with the aim of understanding potential mechanisms of resistance to chemotherapy agents. Doses of drug are higher and escalated over time. It is common to have difficulty developing stable clinically relevant drug-resistant cell lines. A comparative selection strategy of multiple cell lines or multiple chemotherapeutic agents mitigates this risk and gives insight into which agents or type of cell line develops resistance easily. Successful selection strategies from our research are presented. Pulsed-selection produced platinum or taxane-resistant large cell lung cancer (H1299 and H460) and temozolomide-resistant melanoma (Malme-3M and HT144) cell lines. Continuous selection produced a lapatinib-resistant breast cancer cell line (HCC1954). Techniques for maintaining drug-resistant cell lines are outlined including; maintaining cells with chemotherapy, pulse treating with chemotherapy, or returning to master drug-resistant stocks. The heterogeneity of drug-resistant models produced from the same parent cell line with the same chemotherapy agent is explored with reference to P-glycoprotein. Heterogeneity in drug-resistant cell lines reflects the heterogeneity that can occur in clinical drug resistance

First presentation of LPIN1 acute rhabdomyolysis in adolescence and adulthood

LPIN1 mutations are a known common cause of autosomal recessive, recurrent and life-threatening acute rhabdomyolysis of childhood-onset. The first episode of rhabdomyolysis usually happens in nearly all cases before the age of 5 and death is observed in 1/3 of patients. Here we present two cases of acute rhabdomyolysis with a milder phenotype caused by LPIN1 mutation presenting in adolescence (11 years old) and adulthood (40 years old) after Parvovirus infection and metabolic stress, respectively. In our opinion, the mutation types, epigenetic factors, the environment exposition to triggers or the existence of proteins with a similar structure of LPIN1, may have a role in modulating the onset of rhabdomyolysis. LPIN1 should be included on a panel of genes analysed in the investigation of adult individuals with rhabdomyolysis. Metabolic and viral stressors should be included in the list of possible rhabdomyolysis precipitant

A spherical microphone array based system for immersive audio scene rendering

For many applications it is necessary to capture an acoustic field and present it for human listeners, creating the same acoustic perception for them as if they were actually present in the scene. Possible applications of this technique include entertainment, education, military training, remote telepresence, surveillance, and others. Recently, there is much interest on the use of spherical microphone arrays in acoustic scene capture and reproduction application. We describe a 32-microphone spherical array based system implemented for spatial audio capture and reproduction. The array embeds hardware that is traditionally external, such as preamplifiers, filters, digital-to-analog converters, and USB interface adapter, resulting in a portable lightweight solution and requiring no hardware on PC side whatsoever other than a high-speed USB port. We provide capability analysis of the array and describe software suite developed for the application

A New Spectroscopic and Photometric Analysis of the Transiting Planet Systems TrES-3 and TrES-4

We report new spectroscopic and photometric observations of the parent stars of the recently discovered transiting planets TrES-3 and TrES-4. A detailed abundance analysis based on high-resolution spectra yields [Fe/H] $= -0.19\pm 0.08$, $T_\mathrm{eff} = 5650\pm 75$ K, and $\log g = 4.4\pm 0.1$ for TrES-3, and [Fe/H] $= +0.14\pm 0.09$, $T_\mathrm{eff} = 6200\pm 75$ K, and $\log g = 4.0\pm0.1$ for TrES-4. The accuracy of the effective temperatures is supported by a number of independent consistency checks. The spectroscopic orbital solution for TrES-3 is improved with our new radial-velocity measurements of that system, as are the light-curve parameters for both systems based on newly acquired photometry for TrES-3 and a reanalysis of existing photometry for TrES-4. We have redetermined the stellar parameters taking advantage of the strong constraint provided by the light curves in the form of the normalized separation $a/R_\star$ (related to the stellar density) in conjunction with our new temperatures and metallicities. The masses and radii we derive are M_\star=0.928_{-0.048}^{+0.028} M_{\sun},R_\star = 0.829_{-0.022}^{+0.015} R_{\sun}, and M_\star = 1.404_{-0.134}^{+0.066} M_{\sun}, R_\star=1.846_{-0.087}^{+0.096} R_{\sun} for TrES-3 and TrES-4, respectively. With these revised stellar parameters we obtain improved values for the planetary masses and radii. We find $M_p = 1.910_{-0.080}^{+0.075} M_\mathrm{Jup}$, $R_p=1.336_{-0.036}^{+0.031} R_\mathrm{Jup}$ for TrES-3, and $M_p=0.925 \pm 0.082 M_\mathrm{Jup}$, $R_p=1.783_{-0.086}^{+0.093} R_\mathrm{Jup}$ for TrES-4. We confirm TrES-4 as the planet with the largest radius among the currently known transiting hot Jupiters.Comment: 42 pages, 10 tables, 8 figures. Accepted for publication in the Astrophysical Journa

Methylation panel is a diagnostic biomarker for Barrett’s oesophagus in endoscopic biopsies and non-endoscopic cytology specimens

Objective Barrett’s Oesophagus is a premalignant condition that occurs in the context of gastro-oesophageal reflux. However, most Barrett’s cases are undiagnosed because of reliance on endoscopy. We have developed a non-endoscopic tool; the Cytosponge™ which when combined with TFF3 immunohistochemistry can diagnose Barrett’s. We investigated whether a quantitative methylation test that is not reliant on histopathological analysis could be used to diagnose Barrett’s oesophagus. Design Differentially methylated genes between Barrett’s and normal squamous oesophageal biopsies were identified from whole methylome data and confirmed using MethyLight PCR in biopsy samples of squamous oesophagus, gastric cardia and Barrett’s oesophagus. Selected genes were then tested on Cytosponge™ BEST2 trial samples comprising a pilot cohort (n=20 cases, n=10 controls) and a validation cohort (n=149 cases, n=129 controls). Results Eighteen genes were differentially methylated in patients with Barrett’s compared to squamous controls. Hypermethylation of TFPI2, TWIST1, ZNF345 and ZNF569 was confirmed in Barrett’s biopsies compared with biopsies from squamous oesophagus and gastric cardia (p<0.05). When tested in Cytosponge™ samples these four genes were hypermethylated in patients with Barrett’s oesophagus compared to patients with reflux symptoms (p<0.001). The optimum biomarker to diagnose Barrett’s was TFPI2 with a sensitivity and specificity of 82.2% and 95.7 % respectively. Conclusion TFPI2, ZNF345 and ZNF569 CpG methylation has promise as a diagnostic biomarker panel for Barrett’s when used in combination with a simple and cost effective non-endoscopic cell collection device.The BEST2 study was funded by Cancer Research UK (C14478/ A12088). RCF receives core funding from the Medical Research Council. The study received infrastructure support from the Cambridge Human Research Tissue Bank, which is supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre and the Experimental Cancer Medicine Centre

Social moderation and calibration versus codification: a way forward for academic standards in higher education?

A key responsibility of higher education providers is the accurate certification of the knowledge and skills attained by their students. However, despite an intense focus on developing relevant quality assurance regulations, academic standards in higher education have remained resistant to explication and consistent application. In this paper, we initially deconstruct and evaluate academic standards and dominant practitioner perspectives on their nature and use, including techno-rational, sociocultural and sociomaterial approaches. The limited prior research on the effectiveness of calibration and social moderation processes is reviewed, highlighting the significant challenges in sharing tacitly held understandings of assessment criteria (attributes of quality) and standards (levels of achievement). Further complications are considered that arise from the varying expertise and power relationships of assessors and the complexities inherent in the development and use of codified artefacts for capturing and sharing standards. We opine that because of the difficulties in clearly representing and agreeing standards, it is unsurprising that there is little evidence of marking consistency to be found in the literature even in contexts where carefully crafted artefacts, such as rubrics, are in use. We conclude that effectiveness would be enhanced through sharing understandings more widely and refocusing the use of assessment codifications towards how they may catalyse effective social moderation and calibration dialogues. Dialogues that foreground individuals’ positions of consensus and dissensus at significant points of interpretation in the assessment process are identified within the paper