Cost-effectiveness of paediatric central venous catheters in the UK:A secondary publication from the CATCH clinical trial

Background: Antibiotic-impregnated central venous catheters (CVCs) reduce the risk of bloodstream infections (BSIs) in patients treated in pediatric intensive care units (PICUs). However, it is unclear if they are cost-effective from the perspective of the National Health Service (NHS) in the UK.Methods: Economic evaluation alongside the CATCH trial (ISRCTN34884569) to estimate the incremental cost effectiveness ratio (ICER) of antibiotic-impregnated (rifampicin and minocycline), heparin-bonded and standard polyurethane CVCs. The 6-month costs of CVCs and hospital admissions and visits were determined from administrative hospital data and case report forms.Results: BSIs were detected in 3.59% (18/502) of patients randomized to standard, 1.44% (7/486) to antibiotic and 3.42% (17/497) to heparin CVCs. Lengths of hospital stay did not differ between intervention groups. Total mean costs (95% confidence interval) were: £45,663 (£41,647–£50,009) for antibiotic, £42,065 (£38,322–£46,110) for heparin, and £44,503 (£40,619–£48,666) for standard CVCs. As heparin CVCs were not clinically effective at reducing BSI rate compared to standard CVCs, they were considered not to be cost-effective. The ICER for antibiotic vs. standard CVCs, of £54,057 per BSI avoided, was sensitive to the analytical time horizon.Conclusions: Substituting standard CVCs for antibiotic CVCs in PICUs will result in reduced occurrence of BSI but there is uncertainty as to whether this would be a cost-effective strategy for the NHS

Building resilience through improving groundwater management for sustainable agricultural intensification in African Sahel

Background: This paper examines the role of improved groundwater access and management in providing opportunities for sustainable agricultural intensification and building the resilience of community farmers in Southern Burkina Faso. The findings contribute to current debates about pathways of commercialisation and adaptation in the African Sahel, especially those seeking to find responses to managing the impacts of climate change and delivering on the Sustainable Development Goals. Methods: This paper presents data that has been thematically analysed based on the Framework for Sustainable Intensification developed by Pretty and Bharucha (Ann Bot 114:1571–1596, 2014). The data used includes 144 Vulnerability Baseline Assessments which were conducted at the start of the project with the four target Burkinabe communities (Kado, Poa, Tomo, and Zhilivele), and 33 monitoring interviews and vulnerability assessments from the Burkinabe communities of Poa and Tomo to track progress and behaviour change resulting from the BRAVE project interventions. Results: The data analysis showed that Burkinabe communities are already making some use of groundwater to support their agricultural livelihoods; most do this through accessing groundwater from shallow wells. It was also shown that there were improvements in the four main themes Identified by the Sustainable Intensification Framework. These included improved information sharing through increased peer-to-peer learning and improvements in confidence levels; improved social cohesion through reduction in community conflict over water resource management; asset improvements shown by tangible improvement of yields; and increased awareness exemplified by behaviour change. Conclusions: Through using the Sustainable Intensification framework, this paper argues that such an approach improves essential aspects of resilience building such as information sharing, improved local governance and increased social capital and income. We argue that such changes provide essential pathways to reducing vulnerability and increasing resilience of at-risk communities in the Sahel, but that national policy alignment and investment is essential for long term change and sustainability

Against Motivational Efficacy of Beliefs

Bromwich (2010) argues that a belief is motivationally efficacious in that, other things being equal, it disposes an agent to answer a question in accordance with that belief. I reply that what we are disposed to do is largely determined by our genes, whereas what we believe is largely determined by stimuli from the environment. We have a standing and default disposition to answer questions honestly, ceteris paribus, even before we are exposed to environmental stimuli. Since this standing and default disposition is innate, and our beliefs have their source in environmental stimuli, our beliefs cannot be the source of the disposition. Moreover, a recent finding in neuroscience suggests that motivation is extrinsic to belief

Conducting Economic Evaluations Alongside Randomised Trials: Current Methodological Issues and Novel Approaches

Trial-based economic evaluations are an important aspect of health technology assessment. The availability of patient-level data coupled with unbiased estimates of clinical outcomes means that randomised controlled trials are effective vehicles for the generation of economic data. However there are methodological challenges to trial-based evaluations, which include the collection of reliable data on resource use and cost, choice of health outcome measure, calculating minimally important differences, dealing with missing data, extrapolating outcomes and costs over time and the analysis of multinational trials. This review focuses on the state of the art of selective elements concerning the design, conduct, analysis and reporting of trial-based economic evaluations. The limitations of existing approaches are detailed and novel methods introduced. The review is internationally relevant but with a focus towards practice in the UK

Frequency spectrum of toroidal Alfv\'en mode in a neutron star with Ferraro's form of nonhomogeneous poloidal magnetic field

Using the energy variational method of magneto-solid-mechanical theory of a perfectly conducting elastic medium threaded by magnetic field, the frequency spectrum of Lorentz-force-driven global torsional nodeless vibrations of a neutron star with Ferraro's form of axisymmetric poloidal nonhomogeneous internal and dipole-like external magnetic field is obtained and compared with that for this toroidal Alfv\'en mode in a neutron star with homogeneous internal and dipolar external magnetic field. The relevance of considered asteroseismic models to quasi-periodic oscillations of the X-ray flux during the ultra powerful outbursts of SGR 1806-20 and SGR 1900+14 is discussed.Comment: Accepted for publication in Astrophysics & Space Scienc

Year in review in Intensive Care Medicine 2010: III. ARDS and ALI, mechanical ventilation, noninvasive ventilation, weaning, endotracheal intubation, lung ultrasound and paediatrics

SCOPUS: re.jinfo:eu-repo/semantics/publishe

A course of mathematics for engineers and scientists: theoretical mechanics

A Course of Mathematics for Engineers and Scientist