Should cost effectiveness analyses for NICE always consider future unrelated medical costs?

When developing guidance on the use of new technologies within the NHS, NICE recommends the use of cost effectiveness. Specifically, an intervention is deemed cost effective by NICE if ‘its health benefits are greater than the opportunity costs of programmes displaced to fund the new technology, in the context of a fixed NHS budget. In other words, the general consequences for the wider group of patients in the NHS are considered alongside the effects for those patients who may directly benefit from the technology.’ We argue that the technical guidelines for health technology assessment used by NICE should change given this definition of cost effectiveness. The point at issue is the handling of “unrelated future medical costs”

GEOmetadb: powerful alternative search engine for the Gene Expression Omnibus

The NCBI Gene Expression Omnibus (GEO) represents the largest public repository of microarray data. However, finding data in GEO can be challenging. We have developed GEOmetadb in an attempt to make querying the GEO metadata both easier and more powerful. All GEO metadata records as well as the relationships between them are parsed and stored in a local MySQL database. A powerful, flexible web search interface with several convenient utilities provides query capabilities not available via NCBI tools. In addition, a Bioconductor package, GEOmetadb that utilizes a SQLite export of the entire GEOmetadb database is also available, rendering the entire GEO database accessible with full power of SQL-based queries from within R

Rapid detection, cloning and molecular cytogenetic characterisation of sequences from an MRP-encoding amplicon by chromosome microdissection.

Chromosome microdissection was utilised for the analysis of cytogenetic markers of gene amplification [homogeneously staining regions (hsrs) and double minutes (dmins)] in two doxorubicin-resistant cell lines, fibrosarcoma HT1080/DR4 and small-cell lung cancer H69AR. Microdissection products from the hsr(7)(p12p15) of HT1080/DR4 were amplified and used for fluorescent in situ hybridisation (micro-FISH) analysis of drug-sensitive HT1080, resistant HT1080/DR4 and normal lymphocytes. The results demonstrated that the hsr contains a domain of DNA amplification of complex origin including sequences derived from 16p11.2-16p13.1, 2q11.2, 7q32-7q34 and 10q22. The amplification was confirmed by converting the micro-dissected probe into a microclone library for probing HT1080 and HT1080/DR4 Southerns. A micro-FISH probe from normal band region 16p11-16p13 further demonstrated amplification of 16p sequences in both HT1080/DR4 and H69AR. During the course of this analysis, Cole et al. (1992) (Science, 258, 1650-1653) published the amplification of the MRP gene in H69AR cells, which maps to chromosome 16p13.1. Our results corroborate the finding of MRP amplification in these doxorubicin-resistant cell lines, but, importantly, they provide information on the composition of the complex amplicon contributions from four different chromosomes. This study demonstrates the potential utility of chromosome microdissection for the rapid recovery of sequences from amplified regions in drug-resistant cells

The hidden burden of adult allergic rhinitis : UK healthcare resource utilisation survey

Funding Funding for this survey was provided by Meda Pharma.Peer reviewedPublisher PD

Effectiveness of dog rabies vaccination programmes: comparison of owner-charged and free vaccination campaigns

We investigated the percentage of dogs that could be vaccinated against rabies by conducting a pilot campaign in N'Djaména, Chad. Owners were charged US$4.13 per dog vaccinated, and 24$7623, resulting in an average of US$19.40 per vaccinated dog. This is five times more expensive than the cost per animal vaccinated during a previous free vaccination campaign for dog-owners, conducted in the same districts. The free campaign, which vaccinated 2605 more dogs than this campaign, cost an additional US$1.45 per extra dog vaccinated. Campaigns in which owners are charged for vaccinations result in lower vaccination rates than in free campaigns. Public health officials can use these results when evaluating the costs and benefits of subsidizing dog rabies vaccination programme

Apollo Lightcraft Project

This second year of the NASA/USRA-sponsored Advanced Aeronautical Design effort focused on systems integration and analysis of the Apollo Lightcraft. This beam-powered, single-stage-to-orbit vehicle is envisioned as the shuttlecraft of the 21st century. The five person vehicle was inspired largely by the Apollo Command Module, then reconfigured to include a new front seat with dual cockpit controls for the pilot and co-pilot, while still retaining the 3-abreast crew accommodations in the rear seat. The gross liftoff mass is 5550 kg, of which 500 kg is the payload and 300 kg is the LH2 propellant. The round trip cost to orbit is projected to be three orders of magnitude lower than the current space shuttle orbiter. The advanced laser-driven 5-speed combined-cycle engine has shiftpoints at Mach 1, 5, 11 and 25+. The Apollo Lightcraft can climb into low Earth orbit in three minutes, or fly to any spot on the globe in less than 45 minutes. Detailed investigations of the Apollo Lightcraft Project this second year further evolved the propulsion system design, while focusing on the following areas: (1) man/machine interface; (2) flight control systems; (3) power beaming system architecture; (4) re-entry aerodynamics; (5) shroud structural dynamics; and (6) optimal trajectory analysis. The principal new findings are documented. Advanced design efforts for the next academic year (1988/1989) will center on a one meter+ diameter spacecraft: the Lightcraft Technology Demonstrator (LTD). Detailed engineering design and analyses, as well as critical proof-of-concept experiments, will be carried out on this small, near-term machine. As presently conceived, the LTD could be constructed using state of the art components derived from existing liquid chemical rocket engine technology, advanced composite materials, and high power laser optics

Seismic imaging of the Northern Andean subduction zone from teleseismic tomography: a torn and fragmented Nazca slab

The Nazca-South America subduction zone in Ecuador is characterized by a complicated along-strike geometry as the slab transitions from flat slab subduction in the south, with the Peruvian flat slab, to what has been characterized as ‘normal’ dipping subduction beneath central Ecuador. Plate convergence additionally changes south to north as the trench takes on a convex shape. Highly heterogeneous bathymetry at the trench, including the aseismic oceanic Carnegie Ridge (CR), and sparse intermediate-depth seismicity has led many to speculate about the behaviour of the downgoing plate at depth. In this study, we present a finite-frequency teleseismic P-wave tomography model of the northern Andes beneath Ecuador and Colombia from 90 to 1200 km depth. Our model builds on prior tomography models in South America by adding relative traveltime residuals recorded at stations in Ecuador. The complete data set is comprised of 114 096 relative traveltime residuals from 1133 stations across South America, with the added data serving to refine the morphology of the Nazca slab in the mantle beneath the northern Andes. Our tomography model shows a Nazca slab with a fragmented along-strike geometry and the first teleseismic images of several proposed slab tears in this region. At the northern edge of the Peruvian flat slab in southern Ecuador, we image a shallow tear at 95–200 km depth that appears to connect mantle flow from beneath the flat slab to the Ecuadorian Arc. Beneath central Ecuador at the latitudes of the CR, the Nazca slab is continuous into the lower mantle. Beneath southern Colombia, the Malpelo Tear breaks the Nazca slab below ∼200 km depth

The “Spirit of New Orleans” : translating a model of intervention with maltreated children and their families for the Glasgow context

Peer reviewedPreprin

The contribution of work and non-work stressors to common mental disorders in the 2007 Adult Psychiatric Morbidity Survey

Evidence for an effect of work stressors on common mental disorders (CMD) has increased over the past decade. However, studies have not considered whether the effects of work stressors on CMD remain after taking co-occurring non-work stressors into account. Method. Data were from the 2007 Adult Psychiatric Morbidity Survey, a national population survey of participants >= 16 years living in private households in England. This paper analyses data from employed working age participants (N=3383: 1804 males; 1579 females). ICD-10 diagnoses for depressive episode, generalized anxiety disorder, obsessive compulsive disorder, agoraphobia, social phobia, panic or mixed anxiety and depression in the past week were derived using a structured diagnostic interview. Questionnaires assessed self-reported work stressors and non-work stressors. Results. The effects of work stressors on CMD were not explained by co-existing non-work stressors. We found independent effects of work and non-work stressors on CMD. Job stress, whether conceptualized as job strain or effort–reward imbalance, together with lower levels of social support at work, recent stressful life events, domestic violence, caring responsibilities, lower levels of non-work social support, debt and poor housing quality were all independently associated with CMD. Social support at home and debt did not influence the effect of work stressors on CMD. Conclusions. Non-work stressors do not appear to make people more susceptible to work stressors ; both contribute to CMD. Tackling workplace stress is likely to benefit employee psychological health even if the employee’s home life is stressful but interventions incorporating non-work stressors may also be effective