Precision public health – A critical review of the opportunities and obstacles

The term ‘precision public health’ (PPH) refers to a new approach in public health which involves the use of novel data sources and/or computer science-driven methods of data analysis to predict risk or outcomes, in order to improve how interventions are targeted or tailored, with the aim of making them more individualised and therefore more effective and cost-effective than methods currently in use. These data may include, for example, information from social media or devices, genomic or clinical data, and information from healthcare services. In this critical review, which was conducted between March and October 2019, we outline key assumptions underpinning the PPH approach and identify potential challenges in its application. We adopted a pragmatic, non-systematic review methodology to examine: (i) the general principles underlying PPH; (ii) the validity of claims made about PPH in empirical studies and commentaries; and (iii) the potential opportunities and challenges of adopting a PPH approach through examining two case studies: health checks and community-based interventions. Non-empirical studies (commentaries and think-pieces) were included in this review because PPH represents an emerging approach and many of the ideas around the potential of PPH are only described in such studies Commentary studies emphasise that precision can be achieved in targeting interventions towards narrow social profiles of people through the incorporation of data reflecting micro-level day-to-day insights into the lives of individuals. Structured analysis of commentary studies shows that (i) the PPH field may be highly influenced by commentary and non-systematic review pieces that lack transparent methods but make claims about the potential of PPH; (ii) commentators on PPH often attempt to provide evidence for claims but the link between the evidence and the claim is often unsubstantiated when critically examined; and (iii) many of the assumptions underlying PPH are not supported by empirical evidence suggesting that there needs to be a measured approach to adopting PPH approaches. Claims around the effectiveness of PPH and around PPH being an advance on current public health approaches tended not to be supported by empirical evidence. As a relatively new concept therefore, there is limited direct empirical evidence showing PPH to be effective, and the theoretical arguments in its favour are often not well supported by evidence. The more ambitious claims made for PPH in the literature often rest on questionable readings of the evidence – for example, citing the possibility of identifying subgroups of the population through better targeting as though this automatically promises greater effectiveness among interventions targeting those subgroups. In practice, it seems that PPH is less a radically new paradigm and more a range of incremental improvements to public health interventions. Hypothetical case studies outlining the potential of a PPH approach applied to health checks and community-based interventions indicate several ways in which new data or tools could be productively used to inform the design and implementation of public health interventions. Current evidence suggests the impact of these is likely to be fairly modest, although further focused research (e.g. exploring the utility of strategies for targeting or involving communities using PPH) may merit further exploration and evaluation. Defining PPH is contentious and our findings reflect the difficulty in assessing and operationalising the broad ambition of using emerging data and technologies to better understand profiles, predict risk and outcomes, and act upon this evidence. Future work in this area should seek to introduce more focus around the concept of PPH, including being clearer about the goals and breaking down the concept into a series of components that can each be evaluated. The bulk of the work presented here took place between March and October 2019. There is scope for further analysis to understand the potential of PPH in the future, as the number of studies adopting a PPH approach grows. This larger pool of studies may also lend itself to more systematic approaches to reviewing the evidence, particularly if there is an interest in evaluating a particular component or principle of PPH. In addition, the evidence examined in this report predates the COVID-19 global pandemic, and many of the measures taken to mitigate the spread of the pandemic may provide a further source of evidence and data to understand the potential role of PPH in public health decision-making

Comments on alternative calculations of the broadening of spectral lines of neutral sodium by H-atom collisions

With the exception of the sodium D-lines recent calculations of line broadening cross-sections for several multiplets of sodium by Leininger et al (2000) are in substantial disagreement with cross-sections interpolated from the tables of Anstee and O'Mara (1995) and Barklem and O'Mara (1997). The discrepancy is as large as a factor of three for the 3p-4d multiplet. The two theories are tested by using the results of each to synthesize lines in the solar spectrum. It is found that generally the data from the theory of Anstee, Barklem and O'Mara produce the best match to the observed solar spectrum. It is found, using a simple model for reflection of the optical electron by the potential barrier between the two atoms, that the reflection coefficient is too large for avoided crossings with the upper states of subordinate lines to contribute to line broadening, supporting the neglect of avoided ionic crossings by Anstee, Barklem and O'Mara for these lines. The large discrepancies between the two sets of calculations is a result of an approximate treatment of avoided ionic crossings for these lines by Leininger et al (2000).Comment: 18 pages, 5 ps figures included, to appear in J Phys B: At. Mol. Opt. Phy

Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis

Overall, community engagement interventions are effective in improving health behaviours, health consequences, participant self-efficacy and perceived social support for disadvantaged groups. There are some variations in the observed effectiveness, suggesting that community engagement in public health is more likely to require a ‘fit for purpose’ rather than ‘one size fits all’ approach. We identified trends in the evidence that could provide useful directions for future intervention design and evaluation. Although there is a trend to suggest that there is greater effectiveness of peer-/lay-delivered interventions than interventions that take an empowerment approach or those that involve community members in the design of the intervention, this finding was not statistically significant. We cannot, therefore, conclude that one particular model of community engagement or theory of change is clearly more effective than any other. Albeit from a small number of studies, there also appear to be gains to human and social capital. There is evidence of benefits for engagees, including skills acquisition and future employment. Also, there is evidence that interventions improve participants’ perceived social support. There is weak but inconsistent evidence that different types of community engagement interventions can be cost-effective, and that implementation factors may affect intervention success. The new conceptual framework and the identification of three main theories of change can be used in intervention design and evaluation. Community engagement interventions need evaluations to include long-term assessment; the full range of potential beneficiaries; rigorous process evaluation; and collection of costs and resources data. We anticipate that these additions will help to disentangle the relative effectiveness of different models of community engagement and encourage sustainable initiatives with a lasting health legacy for the community

Handsearching had best recall but poor efficiency when exporting to a bibliographic tool: case study

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recordObjective: To compare the effectiveness and efficiency of methods used to identify and export conference abstracts into a bibliographic management tool. Study design and setting: Case study. The effectiveness and efficiency of methods to identify and export conference abstracts presented at the American Society of Hematology (ASH) conference 2016-2018 for a systematic review were evaluated. A reference standard handsearch of conference proceedings was compared to: 1) contacting Blood (the journal who report ASH proceedings); 2) keyword searching; 3) searching Embase; 4) searching MEDLINE via EndNote; and 5) searching CPCI-S. Effectiveness was determined by the number of abstracts identified compared with the reference standard, while efficiency was a comparison between the resources required to identify and export conference abstracts compared to the reference standard. Results: 604 potentially eligible and 15 confirmed eligible conference abstracts (abstracts included in the review) were identified by the handsearch. Comparator 2 was the only method to identify all abstracts and it was more efficient than the reference standard. Comparators 1, and 3-5 missed a number of eligible abstracts. Conclusion: This study raises potentially concerning questions about searching for conferences’ abstracts by methods other than directly searching the original conference proceedings. Efficiency of exporting would be improved if journals permitted bulk downloads.Takeda Pharmaceutical

A double shunt technique for the prevention of ischaemia of a congenital, solitary, pelvic kidney during abdominal aortic aneurysm repair: a case report

<p>Abstract</p> <p>Introduction</p> <p>Congenital solitary pelvic kidney is a rare condition, and its association with an abdominal aortic aneurysm is even more unusual. To the best of our knowledge, only two such cases have been reported in the literature to date.</p> <p>Case presentation</p> <p>We report the case of a 59-year-old Caucasian man with a congenital solitary pelvic kidney, who was found to have an abdominal aortic aneurysm 83 mm in diameter. Abdominal computed tomography angiography clearly identified two renal arteries, one originating from the aortic bifurcation. and the other from the proximal portion of the right common iliac artery. At surgery, renal ischaemia was prevented by introduction of an axillofemoral shunt (consisting of two femoral cannulas and a vent tube of extracorporeal circulation) from the right axillary to the right femoral artery, and a second Argyle shunt from the right common iliac artery to the origin of the left renal artery. A 20 mm Dacron tube graft was then implanted. Our patient's postoperative renal function was normal.</p> <p>Conclusion</p> <p>The renal preservation double shunt technique used in this case seems to be effective during abdominal aortic aneurysm repair.</p

Measurement of the diffractive structure function in deep inelastic scattering at HERA

This paper presents an analysis of the inclusive properties of diffractive deep inelastic scattering events produced in $ep$ interactions at HERA. The events are characterised by a rapidity gap between the outgoing proton system and the remaining hadronic system. Inclusive distributions are presented and compared with Monte Carlo models for diffractive processes. The data are consistent with models where the pomeron structure function has a hard and a soft contribution. The diffractive structure function is measured as a function of \xpom, the momentum fraction lost by the proton, of $\beta$, the momentum fraction of the struck quark with respect to \xpom, and of $Q^2$. The \xpom dependence is consistent with the form \xpoma where $a~=~1.30~\pm~0.08~(stat)~^{+~0.08}_{-~0.14}~(sys)$ in all bins of $\beta$ and $Q^2$. In the measured $Q^2$ range, the diffractive structure function approximately scales with $Q^2$ at fixed $\beta$. In an Ingelman-Schlein type model, where commonly used pomeron flux factor normalisations are assumed, it is found that the quarks within the pomeron do not saturate the momentum sum rule.Comment: 36 pages, latex, 11 figures appended as uuencoded fil

High BMI is significantly associated with positive progesterone receptor status and clinico-pathological markers for non-aggressive disease in endometrial cancer

Background: Endometrial cancer incidence is increasing in industrialised countries. High body mass index (BMI, kg m−2) is associated with higher risk for disease. We wanted to investigate if BMI is related to clinico-pathological characteristics, hormone receptor status in primary tumour, and disease outcome in endometrial cancer. Patients and methods: In total, 1129 women primarily treated for endometrial carcinoma at Haukeland University Hospital during 1981–2009 were studied. Body mass index was available for 949 patients and related to comprehensive clinical and histopathological data, hormone receptor status in tumour, treatment, and follow-up. Results: High BMI was significantly associated with low International Federation of Gynaecology and Obstetrics (FIGO) stage, endometrioid histology, low/intermediate grade, and high level of progesterone receptor (PR) mRNA by qPCR (n=150; P=0.02) and protein expression by immunohistochemistry (n=433; P=0.003). In contrast, oestrogen receptor (ERα) status was not associated with BMI. Overweight/obese women had significantly better disease-specific survival (DSS) than normal/underweight women in univariate analysis (P=0.035). In multivariate analysis of DSS adjusting for age, FIGO stage, histological subtype, and grade, BMI showed no independent prognostic impact. Conclusion: High BMI was significantly associated with markers of non-aggressive disease and positive PR status in a large population-based study of endometrial carcinoma. Women with high BMI had significantly better prognosis in univariate analysis of DSS, an effect that disappeared in multivariate analysis adjusting for established prognostic markers. The role of PR in endometrial carcinogenesis needs to be further studied

Observation of hard scattering in photoproduction events with a large rapidity gap at HERA

Events with a large rapidity gap and total transverse energy greater than 5 GeV have been observed in quasi-real photoproduction at HERA with the ZEUS detector. The distribution of these events as a function of the $\gamma p$ centre of mass energy is consistent with diffractive scattering. For total transverse energies above 12 GeV, the hadronic final states show predominantly a two-jet structure with each jet having a transverse energy greater than 4 GeV. For the two-jet events, little energy flow is found outside the jets. This observation is consistent with the hard scattering of a quasi-real photon with a colourless object in the proton.Comment: 19 pages, latex, 4 figures appended as uuencoded fil

The MLH1 polymorphism rs1800734 and risk of endometrial cancer with microsatellite instability

© The Author(s) 2020. Both colorectal (CRC, 15%) and endometrial cancers (EC, 30%) exhibit microsatellite instability (MSI) due to MLH1 hypermethylation and silencing. The MLH1 promoter polymorphism, rs1800734 is associated with MSI CRC risk, increased methylation and reduced MLH1 expression. In EC samples, we investigated rs1800734 risk using MSI and MSS cases and controls. We found no evidence that rs1800734 or other MLH1 SNPs were associated with the risk of MSI EC. We found the rs1800734 risk allele had no effect on MLH1 methylation or expression in ECs. We propose that MLH1 hypermethylation occurs by different mechanisms in CRC and EC.National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC

Aryl urea substituted fatty acids: a new class of protonophoric mitochondrial uncoupler that utilises a synthetic anion transporter

A new mitochondrial uncoupler that forms membrane permeable dimers through interactions of remote acidic and anion receptor groups.</p