Cost-benefit analysis of vaccination: a comparative analysis of eight approaches for valuing changes to mortality and morbidity risks.

BACKGROUND: There is increasing interest in estimating the broader benefits of public health interventions beyond those captured in traditional cost-utility analyses. Cost-benefit analysis (CBA) in principle offers a way to capture such benefits, but a wide variety of methods have been used to monetise benefits in CBAs. METHODS: To understand the implications of different CBA approaches for capturing and monetising benefits and their potential impact on public health decision-making, we conducted a CBA of human papillomavirus (HPV) vaccination in the United Kingdom using eight methods for monetising health and economic benefits, valuing productivity loss using either (1) the human capital or (2) the friction cost method, including the value of unpaid work in (3) human capital or (4) friction cost approaches, (5) adjusting for hard-to-fill vacancies in the labour market, (6) using the value of a statistical life, (7) monetising quality-adjusted life years and (8) including both productivity losses and monetised quality-adjusted life years. A previously described transmission dynamic model was used to project the impact of vaccination on cervical cancer outcomes. Probabilistic sensitivity analysis was conducted to capture uncertainty in epidemiologic and economic parameters. RESULTS: Total benefits of vaccination varied by more than 20-fold (£0.6-12.4 billion) across the approaches. The threshold vaccine cost (maximum vaccine cost at which HPV vaccination has a benefit-to-cost ratio above one) ranged from £69 (95% CI £56-£84) to £1417 (£1291-£1541). CONCLUSIONS: Applying different approaches to monetise benefits in CBA can lead to widely varying outcomes on public health interventions such as vaccination. Use of CBA to inform priority setting in public health will require greater convergence around appropriate methodology to achieve consistency and comparability across different studies

Electroconvulsive therapy and seizure: a double-edged sword?

Electroconvulsive therapy (ECT) is a widely used therapeutic option of drug-refractory psychiatric disorders. ECT treats psychiatric symptoms by inducing brief controlled seizures through electrical stimulation, but ECT does not generally cause prolonged seizures or epilepsy. However, several studies have reported cases of prolonged seizures after ECT. This review aimed to determine the mechanism of epileptogenesis with neurobiological changes after ECT. Contrary to epileptogenesis by ECT, several cases have reported that ECT was successfully applied for treatment of refractory status epilepticus. In addition, ECT might be applied to hyperkinetic movement and psychiatric symptoms of encephalitis. We also investigated the anticonvulsant mechanism of ECT and how it controls encephalitis symptoms

Effect of regional medical disparities on complications in patients with hypertension: Cox’s proportional hazard models

ObjectiveComplications associated with hypertension can be alleviated by providing necessary medical services. However, there may be disparities in their provision depending on regional differences. Thus, this study aimed to examine the effects of regional healthcare disparities on complications in patients with hypertension in South Korea.MethodsData from the National Health Insurance Service National Sample Cohort (2004–2019) were analyzed. The position value for the relative composite index was used to identify medically vulnerable regions. The diagnosis of hypertension within the region was also considered. The risk of complications associated with hypertension included cardiovascular, cerebrovascular, and kidney diseases. Cox proportional hazards models were used for statistical analysis.ResultsA total of 246,490 patients were included in this study. Patients who lived in medically vulnerable regions and were diagnosed outside their residential area had a higher risk of complications than those living in non-vulnerable regions and were diagnosed outside the residential area (hazard ratio: 1.156, 95% confidence interval: 1.119–1.195).ConclusionPatients living in medically vulnerable regions who were diagnosed outside their residential areas were more likely to have hypertension complications regardless of the type of complication. Necessary policies should be implemented to reduce regional healthcare disparities

Heterogeneity of Skin Surface Oxygen Level of Wrist in Relation to Acupuncture Point

The distribution of partial oxygen pressure (pO2) is analyzed for the anterior aspect of the left wrist with an amperometric oxygen microsensor composed of a small planar Pt disk-sensing area (diameter = 25 μm). The pO2 levels vary depending on the measurement location over the wrist skin, and they are systematically monitored in the analysis for both one-dimensional single line (along the wrist transverse crease) and two-dimensional square area of the wrist region. Relatively higher pO2 values are observed at certain area in close proximity to the position of acupuncture points with statistical significance, indicating strong relationship between oxygen and acupuncture point. The used oxygen microsensor is sensitive enough to detect the pO2 variation depending on the location. This study may provide information helpful to understand possible physiological roles of the acupuncture points

Age-related risk of household transmission of COVID-19 in Singapore.

Prior to the implementation of social distancing measures, we monitored the close family contacts of the first 400 cases of COVID-19 in Singapore for SARS-CoV-2 infection to determine the risk of infection with age. Adjusting for gender and household size, the risk of COVID-19 infection in household contacts was found to increase with age

A soft, transparent, freely accessible cranial window for chronic imaging and electrophysiology

Chronic in vivo imaging and electrophysiology are important for better understanding of neural functions and circuits. We introduce the new cranial window using soft, penetrable, elastic, and transparent, silicone-based polydimethylsiloxane (PDMS) as a substitute for the skull and dura in both rats and mice. The PDMS can be readily tailored to any size and shape to cover large brain area. Clear and healthy cortical vasculatures were observed up to 15 weeks post-implantation. Real-time hemodynamic responses were successfully monitored during sensory stimulation. Furthermore, the PDMS window allowed for easy insertion of microelectrodes and micropipettes into the cortical tissue for electrophysiological recording and chemical injection at any location without causing any fluid leakage. Longitudinal two-photon microscopic imaging of Cx3Cr1+/− GFP transgenic mice was comparable with imaging via a conventional glass-type cranial window, even immediately following direct intracortical injection. This cranial window will facilitate direct probing and mapping for long-term brain studies.112121sciescopu

VEGF-A regulated by progesterone governs uterine angiogenesis and vascular remodelling during pregnancy

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Cellular uptake of magnetic nanoparticle is mediated through energy-dependent endocytosis in A549 cells

Biocompatible silica-overcoated magnetic nanoparticles containing an organic fluorescence dye, rhodamine B isothiocyanate (RITC), within a silica shell [50 nm size, MNP@SiO2(RITC)s] were synthesized. For future application of the MNP@SiO2(RITC)s into diverse areas of research such as drug or gene delivery, bioimaging, and biosensors, detailed information of the cellular uptake process of the nanoparticles is essential. Thus, this study was performed to elucidate the precise mechanism by which the lung cancer cells uptake the magnetic nanoparticles. Lung cells were chosen for this study because inhalation is the most likely route of exposure and lung cancer cells were also found to uptake magnetic nanoparticles rapidly in preliminary experiments. The lung cells were pretreated with different metabolic inhibitors. Our results revealed that low temperature disturbed the uptake of magnetic nanoparticles into the cells. Metabolic inhibitors also prevented the delivery of the materials into cells. Use of TEM clearly demonstrated that uptake of the nanoparticles was mediated through endosomes. Taken together, our results demonstrate that magnetic nanoparticles can be internalized into the cells through an energy-dependent endosomal-lysosomal mechanism

Modelling lockdown and exit strategies for COVID-19 in Singapore.

BACKGROUND: With at least 94 countries undergoing or exiting lockdowns for contact suppression to control the COVID-19 outbreak, sustainable and public health-driven exit strategies are required. Here we explore the impact of lockdown and exit strategies in Singapore for immediate planning. METHODS: We use an agent-based model to examine the impacts of epidemic control over 480 days. A limited control baseline of case isolation and household member quarantining is used. We measure the impact of lockdown duration and start date on final infection attack sizes. We then apply a 3-month gradual exit strategy, immediately re-opening schools and easing workplace distancing measures, and compare this to long-term social distancing measures. FINDINGS: At baseline, we estimated 815 400 total infections (21.6% of the population). Early lockdown at 5 weeks with no exit strategy averted 18 500 (2.27% of baseline averted), 21 300 (2.61%) and 22 400 (2.75%) infections for 6, 8 and 9-week lockdown durations. Using the exit strategy averted a corresponding 114 700, 121 700 and 126 000 total cases, representing 12.07-13.06% of the total epidemic size under baseline. This diminishes to 9 900-11 300 for a late 8-week start time. Long-term social distancing at 6 and 8-week durations are viable but less effective. INTERPRETATION: Gradual release exit strategies are critical to maintain epidemic suppression under a new normal. We present final infection attack sizes assuming the ongoing importation of cases, which require preparation for a potential second epidemic wave due to ongoing epidemics elsewhere. FUNDING: Singapore Ministry of Health, Singapore Population Health Improvement Centre