Cost-effectiveness of nicotine patches for smoking cessation in pregnancy: a placebo randomised controlled trial (SNAP)

Introduction: Smoking during pregnancy is the most important, preventable cause of adverse pregnancy outcomes including miscarriage, premature birth and low birth weight, with huge financial costs to the NHS. However, there are very few published economic evaluations of smoking cessation interventions in pregnancy and previous studies are predominantly US-based and do not present incremental cost-effectiveness ratios (ICER). A number of studies have demonstrated cost-effectiveness of nicotine replacement therapy (NRT) in the general population, but this has yet to be tested among pregnant smokers. Methods: A cost-effectiveness analysis was undertaken alongside the SNAP trial to compare NRT patches plus behavioural support to behavioural support alone, for pregnant women who smoked. Results: At delivery, biochemically verified quit rates were slightly higher at 9.4% in the NRT group compared to 7.6% in the control group (odds ratio: 1.26, 95% CI: 0.82-1.96), at an increased cost of around £90 per participant. Higher costs in the NRT group were mainly attributable to the cost of NRT patches (mean = £46.07). The incremental cost-effectiveness ratio associated with NRT was £4,926 per quitter and a sensitivity analysis including only singleton births yielded an ICER of £4,156 per quitter. However, wide confidence intervals indicated a high level of uncertainty. Conclusions: Without a specific willingness to pay threshold, and due to high levels of statistical uncertainty, it is hard to determine the cost-effectiveness of NRT in this population. Furthermore, future research should address compliance issues, as these may dilute any potential effects of NRT, thus reducing the cost-effectiveness

The Supreme Court Forecasting Project: Legal and Political Science Approaches to Predicting Supreme Court Decision-Making

This Essay reports the results of an interdisciplinary project comparing political science and legal approaches to forecasting Supreme Court decisions. For every argued case during the 2002 Term, we obtained predictions of the outcome prior to oral argument using two methods—one a statistical model that relies on general case characteristics, and the other a set of independent predictions by legal specialists. The basic result is that the statistical model did better than the legal experts in forecasting the outcomes of the Term’s cases: The model predicted 75% of the Court’s affirm/reverse results correctly, while the experts collectively got 59.1% right. These results are notable, given that the statistical model disregards information about the specific law or facts of the cases. The model’s relative success was due in large part to its ability to predict more accurately the important votes of the moderate Justices (Kennedy and O’Connor) at the center of the current Court. The legal experts, by contrast, did best at predicting the votes of the more ideologically extreme Justices, but had difficulty predicting the centrist Justices. The relative success of the two methods also varied by issue area, with the statistical model doing particularly well in forecasting “economic activity” cases, while the experts did comparatively better in the “judicial power” cases. In addition to reporting the results in detail, the Essay explains the differing methods of prediction used and explores the implications of the findings for assessing and understanding Supreme Court decision-making.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/116230/1/columbia04.pd

Experimental Apparatus for Production, Cooling, and Storing Multiply Charged Ions for Charge-Transfer Measurements

A novel method is described that combines the production of ions by laser ablation with an ion‐trap technique for the measurement of thermal‐energy charge‐transfer rates of multiply charged ions and neutrals. The charge‐transfer rate is determined by measuring the rate of loss of stored ions from the trap. Verification of the calibration of the apparatus is demonstrated through investigation of charge transfer of N2 and N2+, which has been studied by another group. We also have made the first measurement on the thermal‐energy charge‐transfer coefficient of Ar and W2+. The rate coefficient is 0.99(0.22)×10−11 cm3 s−1

Treating patients as persons : a capabilities approach to support delivery of person-centered care

Peer reviewedPublisher PD

Twenty-first century vaccinomics innovation systems: capacity building in the global South and the role of Product Development Partnerships (PDPs)

The availability of sequence information from publicly available complete genomes and data intensive sciences, together with next-generation sequencing technologies offer substantial promise for innovation in vaccinology and global public health in the beginning of the 21st century. This article presents an innovation analysis for the nascent field of vaccinomics by describing one of the major challenges in this endeavor: the need for capacities in “vaccinomics innovation systems” to support the developing countries involved in the creation and testing of new vaccines. In particular, we discuss the need for understanding how institutional frameworks can enhance capacities as intrinsic to a systems approach to health technology development. We focus our attention on the global South, meaning the technically less advanced and developing nations in Africa, Asia, and Latin America. This focus is timely and appropriate because the challenge for innovation in postgenomics medicine is markedly much greater in these regions where basic infrastructures are often underresourced and new or the anticipated institutional relationships can be fragile. Importantly, we examine the role of Product Development Partnerships (PDPs) as a 21st century organizational innovation that contributes to strengthening fragile institutions and capacity building. For vaccinomics innovation systems to stand the test of time in a context of global public health, local communities, knowledge, and cultures need to be collectively taken into account at all stages in programs for vaccinomics-guided vaccine development and delivery in the global South where the public health needs for rational vaccine development are urgent

Justice, culture and the political determinants of indigenous Australian health

Indigenous Australian health is distinguished by a median age of death in the order of 20 years less than that of the non-indigenous population (Australian Bureau of Statistics, 2009). This makes Australia unique among comparable post-colonial societies in failing to make substantive reductions to the indigenous/non-indigenous health differential. Relatively poor indigenous housing, educational attainment, labour market participation and access to traditional resources for economic purposes contribute to the differen- tial. These contributing variables have an inherently political character which is integral to examining the just distribution of public authority, the purpose of political activity, equal political participation and cultural responsiveness in the provision of health ser- vices as important theoretical considerations in reducing cross-cultural inequities in the burden of disease

Reproductive rights approach to reproductive health in developing countries

Research on reproductive health in developing countries focuses mostly on the role of economic development on various components of reproductive health. Cross-sectional and empirical research studies in particular on the effects of non-economic factors such as reproductive rights remain few and far between.This study investigates the influence of two components of an empowerment strategy, gender equality, and reproductive rights on women's reproductive health in developing countries. The empowerment strategy for improving reproductive health is theoretically situated on a number of background factors such as economic and social development.Cross-national socioeconomic and demographic data from a number of international organizations on 142 developing countries are used to test a model of reproductive rights and reproductive health.The findings suggest that both economic and democratic development have significant positive effects on levels of gender equality. The level of social development plays a prominent role in promoting reproductive rights. It is found that reproductive rights channel the influences of social structural factors and gender equality on reproductive health