The Costs of Low Birth Weight

Birth weight has emerged as the leading indicator of infant health and welfare and the central focus of infant health policy. This is because low birth weight (LBW) infants experience severe health and developmental difficulties that can impose enormous costs on society. But would the prevention of LBW generate equally sizable cost savings and health improvements? Estimates of the return to LBW-prevention from cross-sectional associations may be biased by omitted variables that cannot be influenced by policy, such as genetic factors. To address this, we compare the hospital costs, health at birth, and infant mortality rates between heavier and lighter infants from all twin pairs born in the United States. We also examine the effect of maternal smoking during pregnancy the leading risk factor for LBW in the United States on health among singleton births after controlling for detailed background characteristics. Both analyses imply substantially smaller effects of LBW than previously thought, suggesting two possibilities: 1) existing estimates overstate the true costs and consequences of LBW by at least a factor of four and by as much as a factor of 20; or 2) different LBW-preventing interventions have different health and cost consequences, implying that policy efforts that presume a single return to reducing LBW will necessarily be suboptimal.

The challenges of renal replacement therapy and renal palliative care in the elderly

Much of the increase in take on rate for dialysis in recent years is accounted for by older patients in whom a treatment as demanding as dialysis was previously thought to be contraindicated. The decision to dialyse the elderly often remains difficult, as recent data suggest that those with significant comorbidities are unlikely to survive more than 4-6 months longer on dialysis than they would have done if treated conservatively. It is also important to recognise that conservative treatment is not simply defined by the decision not to dialyse. Good conservative care comprises active disease management eg treatment of anaemia with erythropoietin stimulating agents and intravenous iron, and supportive care which may become increasingly complex eg pain relief with fentanyl and alfentanyl, towards the end of life. Those older patients who do decide to dialyse must contend with all the usual end of life issues facing older people, in addition to the option, denied to the rest of us, of dialysis withdrawal which effectively allows them to die at a time of their choosing

Phenological trends of vegetation in Southern England From Envisat MERIS Terrestrial Chlorophyll Index (MTCI) data

Given the close association between climate change and vegetation response there is a pressing requirement to monitor the phenology of vegetation and understand how its metrics vary over space and time. This paper explores the viability of the Envisat MTCI dataset for monitoring vegetation phenology via its estimates of chlorophyll content. The MTCI was used to construct the phenological profile of and to extract key phenological dates from mixed woodland in Southern England. Woodland phenological cycles for the time period 2003 to 2007, a period with known temperature anomalies forcing variability in the phenology of the vegetation, were derived from MERIS MTCI data. Comparisons were made with ground indicators of phenology, and furthermore, crosscomparisons with other vegetation indices, namely the NDVI and EVI derived from MODIS data were conducted. Close correspondence between MTCI and canopy phenology as indicated by ground observations was evident. Also observed was a difference between MTCI-derived phenological transition curves and key transition dates and those derived from the NDVI and EVI. Overall the research presented in this paper supports the use of the Envisat MTCI for monitoring vegetation phenology, principally due to its sensitivity to canopy chlorophyll content, a vegetation property that is a useful proxy for the canopy physical and chemical alterations associated with phenological change

Multi-scale analysis and validation of the Envisat MERIS Terrestrial Chlorophyll Index (MTCI) in woodland

Satellite remote sensing can be used to estimate and monitor the chlorophyll content of vegetation canopies which are a key and dynamic component of global terrestrial ecosystems. The red-edge algorithm can be used to estimate chlorophyll content from remotely sensed data but is unsuitable for use with most satellite sensor imagery. To overcome this problem, the new Envisat MERIS Terrestrial Chlorophyll index (MTCI) has been developed. It is the only operational satellite chlorophyll index and MTCI data are available as a Level 2 product from the European Space Agency. However, there is a need to ‘validate’ the MTCI over a wide range of environmental conditions. This paper reports on research that attempts to validate the MTCI using Compact Airborne Spectrographic Imager (CASI) imagery and ground data of chlorophyll content. The study site was predominantly woodland in the south of England (New Forest National Park) and had a wide range of chlorophyll contents. A transfer function derived from CASI data was used to produce a reference map of chlorophyll content, when aggregated it was compared to MERIS MTCI data and used to derive the MTCI – chlorophyll content relationship (R squared = 0.56)

NUCLEIC-ACID BINDING-DRUGS .8. STRUCTURES OF 1-[2-(DIETHYLAMINO)ETHYLAMINO]ANTHRACENE-9,10-DIONE, C20H22N2O2 (I), AND 1,5-BIS[2-(DIETHYLAMINO)ETHYLAMINO]ANTHRACENE-9,10-DIONE, C26H36N4O2(II), MODELS FOR ANTI-TUMOR DRUGS

(I) M r = 322.41, P21/n, a = 7.118 (1), b = 26.873(2), c=8.886(1)A, fl=97.74(1)°, ~ V= 1684.3 (6) A 3, Z = 4, D m = 1.27, D x = 1.271 Mg m -3, 2 (Cu Ka) = 1.54178 A,/~ = 6.67 cm -1, F(000) = 688, T= 298 K, R w= 0.049 for 981 unique significant reflections. (II) Mr=436.61, P21/c, a= 15.360 (2), b = 5.245 (1), c= 15.483 (1)A, fl= 94.23 (1) °, V= 1244.0 (5)/~3, Z = 2, D m -- 1.17, D x = 1.165 Mg m -s, 2(Cu Kt~) = 1.54178/k, /t = 5.98 cm -1, F(000) = 472, T= 298 K, R w = 0.090 for 457 unique significant reflections. The chromophore is highly planar in both compounds

Mediating punitiveness: understanding public attitudes towards work-related fatality cases

This paper concerns an empirical investigation into public attitudes towards work-related fatality cases, where organizational offenders cause the death of workers or members of the public. This issue is particularly relevant following the introduction of the Corporate Manslaughter and Corporate Homicide Act 2007 into UK law. Here, as elsewhere, the use of criminal law against companies reflects governmental concerns over public confidence in the law’s ability to regulate risk. The empirical findings demonstrate that high levels of public concern over these cases do not translate into punitive attitudes. Such cases are viewed rationally and constructively, and lead to instrumental rather than purely expressive enforcement preferences

P109 The impact of tb nice guidance on resource capacity and contact screening outcomes: a retrospective, observational study within a central london tb centre

Introduction and objectives: Recently published NICE guidance has significantly expanded the approach to adult tuberculosis (TB) contact screening by recommending tuberculin skin testing (TST) for pulmonary and laryngeal contacts only, increasing the age threshold for screening and treatment to 65 years and defining a positive TST as induration ≥5 mm, regardless of BCG vaccination status. Interferon Gamma Release Assay (IGRA) is recommended only in situations where more evidence of infection is needed. Our institution has previously adopted an approach comprising a chest radiograph, TST and IGRA. The aim of our study was to evaluate the impact of NICE guidance on screening outcomes and resource capacity by applying the criteria to a well-defined historic cohort of TB contacts. Methods: This was a retrospective, observational study carried out at a central London teaching hospital. The study population comprised 593 consecutive, adult TB contacts screened between 1/1/2008 and 31/12/2010. Data was collected through a retrospective review of TST and IGRA tests. Results: Of the 593 contacts screened, 358 pulmonary contacts had TST and IGRA results. 56% had a TST ≥5 mm, regardless of BCG status, qualifying them for treatment as per the new NICE guidance. Of these, 61% were IGRA negative (discordant) and may therefore include false positive diagnoses, resulting in the potential for over treatment. In those with TST 5–14 mm, discordance rises to 84%. Conversely, 6% of those with TST < 5 mm are IGRA positive representing potentially missed cases. 16% of screened individuals were contacts of extra pulmonary TB. Not screening this group would reduce the demand for outpatient appointments by 151* in our cohort. In contrast, testing contacts > 35 years would require capacity for an additional 165* appointments. Furthermore, there were 162 additional LTBI cases in comparison to previous guidance requiring an additional 648* appointments. 72% of this group were IGRA negative. (*Approximate) Conclusions: Our results show the revised guidance will require increased resource capacity largely due to more patients being classified as having latent TB. In addition to workforce planning to meet these demands, further debate is needed to decide if this new approach truly reduces the incidence of active TB or results in unnecessary treatment

Regulation of the Membrane Insertion and Conductance Activity of the Metamorphic Chloride Intracellular Channel Protein CLIC1 by Cholesterol

The Chloride Intracellular ion channel protein CLIC1 has the ability to spontaneously insert into lipid membranes from a soluble, globular state. The precise mechanism of how this occurs and what regulates this insertion is still largely unknown, although factors such as pH and redox environment are known contributors. In the current study, we demonstrate that the presence and concentration of cholesterol in the membrane regulates the spontaneous insertion of CLIC1 into the membrane as well as its ion channel activity. The study employed pressure versus area change measurements of Langmuir lipid monolayer films; and impedance spectroscopy measurements using tethered bilayer membranes to monitor membrane conductance during and following the addition of CLIC1 protein. The observed cholesterol dependent behaviour of CLIC1 is highly reminiscent of the cholesterol-dependent-cytolysin family of bacterial pore-forming proteins, suggesting common regulatory mechanisms for spontaneous protein insertion into the membrane bilayer. © 2013 Valenzuela et al

The changing patterns of group politics in Britain

Two interpretations of ways in which group politics in Britain have presented challenges to democracy are reviewed: neo-corporatism or pluralistic stagnation and the rise of single issue interest groups. The disappearance of the first paradigm created a political space for the second to emerge. A three-phase model of group activity is developed: a phase centred around production interests, followed by the development of broadly based 'other regarding' groups, succeeded by fragmented, inner directed groups focusing on particular interests. Explanations of the decay of corporatism are reviewed. Single issue group activity has increased as party membership has declined and is facilitated by changes in traditional media and the development of the internet. Such groups can overload the policy-making process and frustrate depoliticisation. Debates about the constitution and governance have largely ignored these issues and there is need for a debate