Applying economic evaluation to public health interventions: The case of interventions to promote physical activity

Copyright @ 2012 The Authors. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been made available through the Brunel Open Access Publishing Fund.BACKGROUND: This paper explores the application of alternative approaches to economic evaluation of public health interventions, using a worked example of exercise referral schemes (ERSs). METHODS: Cost-utility (CUA) and cost-consequence analyses (CCA) were used to assess the cost-effectiveness of ERSs. For the CUA, evidence was synthesized using a decision analytic model that adopts a lifetime horizon and NHS/Personal Social Services perspective. Outcomes were expressed as incremental cost per quality-adjusted life-year (QALY). CCA was conducted from a partial-societal perspective, including health and non-healthcare costs and benefits. Outcomes were reported in natural units, such as cases of strokes or CHD avoided. RESULTS: Compared with usual care, the incremental cost per QALY of ERS is £20 876. Based on a cohort of 100 000 individuals, CCA estimates cost of ERS at £22 million to the healthcare provider and £12 million to participants. The benefits of ERS include additional 3900 people becoming physically active, 51 cases of CHD avoided, 16 cases of stroke avoided, 86 cases of diabetes avoided and a gain of ∼800 QALYs. CONCLUSIONS: CCA might provide greater transparency than CUA in reporting the outcomes of public health interventions and have greater resonance with stakeholders involved in commissioning these interventions.This work was supported by the NIHR Health Technology Assessment programme (project number 08/72/01). This article is made available through the Brunel Open Access Publishing Fund

forall x: Calgary. An Introduction to Formal Logic

forall x: Calgary is a full-featured textbook on formal logic. It covers key notions of logic such as consequence and validity of arguments, the syntax of truth-functional propositional logic TFL and truth-table semantics, the syntax of first-order (predicate) logic FOL with identity (first-order interpretations), translating (formalizing) English in TFL and FOL, and Fitch-style natural deduction proof systems for both TFL and FOL. It also deals with some advanced topics such as truth-functional completeness and modal logic. Exercises with solutions are available. It is provided in PDF (for screen reading, printing, and a special version for dyslexics) and in LaTeX source code

Quantifying physiological influences on otolith microchemistry

Trace element concentrations in fish earstones (‘otoliths’) are widely used to discriminate spatially discrete populations or individuals of marine fish, based on a commonly held assumption that physiological influences on otolith composition are minor, and thus variations in otolith elemental chemistry primarily reflect changes in ambient water chemistry. We carried out a long-term (1-year) experiment, serially sampling seawater, blood plasma and otoliths of mature and immature European plaice (Pleuronectes platessa L.) to test relationships between otolith chemistry and environmental and physiological variables. Seasonal variations in otolith elemental composition did not track seawater concentrations, but instead reflected physiological controls on metal transport and biokinetics, which are likely moderated by ambient temperature. The influence of physiological factors on otolith composition was particularly evident in Sr/Ca ratios, the most widely used elemental marker in applied otolith microchemistry studies. Reproduction also triggered specific variations in otolith and blood plasma metal chemistry, especially Zn/Ca ratios in female fish, which could potentially serve as retrospective spawning indicators. The influence of physiology on the trace metal composition of otoliths may explain the success of microchemical stock discrimination in relatively homogenous marine environments, but could complicate alternative uses for trace element compositions in biominerals of higher organism

The cost-effectiveness of exercise referral schemes

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Exercise referral schemes (ERS) aim to identify inactive adults in the primary care setting. The primary care professional refers the patient to a third party service, with this service taking responsibility for prescribing and monitoring an exercise programme tailored to the needs of the patient. This paper examines the cost-effectiveness of ERS in promoting physical activity compared with usual care in primary care setting.NIHR Health Technology Assessment programm

The analytical singlet αs4\alpha_s^4 QCD contributions into the e+e−e^+e^--annihilation Adler function and the generalized Crewther relations

The generalized Crewther relations in the channels of the non-singlet and vector quark currents are considered. They follow from the double application of the operator product expansion approach to the same axial vector-vector-vector triangle amplitude in two regions, adjoining to the angle sides $(x,y)$ (or $p^2,q^2$). We assume that the generalized Crewther relations in these two kinematic regimes result in the existence of the same perturbation expression for two products of the coefficient functions of annihilation and deep-inelastic scattering processes in the non-singlet and vector channels. Taking into account the 4-th order result for $S_{GLS}$ and the perturbative effects of the violation of the conformal symmetry in the generalized Crewther relation, we obtain the analytical contribution to the singlet $\alpha_s^4$ correction to the $D_A^{V}$-function. Its a-posteriori comparison with the recent result of direct diagram-by-diagram evaluation of the singlet 4-th order corrections to $D_A^{V}$- function demonstrates the coincidence of the predicted and obtained $\zeta_3^2$-contributions to the singlet term. They can be obtained in the conformal invariant limit from the original Crewther relation. On the contrary to previous belief, the appearance of $zeta_3$-terms in perturbative series in gauge models does not contradict to the property of conformal symmetry and can be considered as ragular feature. The Banks-Zaks motivated relation between our predicted and obtained 4-th order corrections is mentioned. This confirms Baikov-Chetyrkin-Kuhn expectation that the generalized Crewther relation in the channel of vector currents receives additional singlet contribution, which in this order of perturbation theory is proportional to the first coefficient of the QCD $\beta$-function.Comment: Concrete new foundations explained, abstract updated, presentation improved, 2 references added, extra acknowledgements added. This work is dedicated to K. G. Chetyrkin on the occasion of his 60th anniversary, to be published in Jetp. Lett supposedly in vol.94, issue 1

A calculation of the Lepage-Mackenzie scale for the lattice axial and vector currents

We calculate the perturbative scales (q*) for the axial and vector currents for the Wilson action, with and without tadpole improvement, using Lepage and Mackenzie's formalism. The scale for the pseudoscalar density (times the mass) is computed as well. Contrary to naive expectation, tadpole improvement reduces q* by only a small amount for the operators we consider. We also discuss the use of a nonperturbative coupling to calculate the perturbative scale.Comment: 13 pages. One postscript figur

Dilepton production in proton-proton collisions at BEVALAC energies

The dilepton production in elementary ${pp\to e^{+}e^{-}X}$ reactions at BEVALAC energies $T_{lab}=1\div 5$ GeV is investigated. The calculations include direct ${e^{+}e^{-}}$ decays of the vector mesons $\rho ^{0}$, $\omega$, and $\phi$, Dalitz decays of the $\pi ^{0}$-, $\eta$-, $$-, $\omega$-, and $\phi$-mesons, and of the baryon resonances $$ $...$ . The subthreshold vector meson production cross sections in $pp$ collisions are treated in a way sufficient to avoid double counting with the inclusive vector meson production. The vector meson dominance model for the transition form factors of the resonance Dalitz decays $R\to e^{+}e^{-}N$ is used in an extended form to ensure correct asymptotics which are in agreement with the quark counting rules. Such a modification gives an unified and consistent description of both $R\to N\gamma$ radiative decays and $R\to N\rho (\omega)$ meson decays. The effect of multiple pion production on the experimental efficiency for the detection of the dilepton pairs is studied. We find the dilepton yield in reasonable agreement with the experimental data for the set of intermediate energies whereas at the highest energy $T_{lab}=4.88$ GeV the number of dilepton pairs is likely to be overestimated experimentally in the mass range $M=300\div 700$ MeV.Comment: 25 pages (IOP style), 5 figures, revised manuscript accepted for publication in JP

Community first responders and responder schemes in the United Kingdom: systematic scoping review

Background: Community First Responder (CFR) schemes support lay people to respond to medical emergencies, working closely with ambulance services. They operate widely in the UK. There has been no previous review of UK literature on these schemes. This is the first systematic scoping review of UK literature on CFR schemes, which identifies the reasons for becoming a CFR, requirements for training and feedback and confusion between the CFR role and that of ambulance service staff. This study also reveals gaps in the evidence base for CFR schemes. Methods: We conducted a systematic scoping review of the published literature, in the English language from 2000 onwards using specific search terms in six databases. Narrative synthesis was used to analyse article content. Results: Nine articles remained from the initial search of 15,969 articles after removing duplicates, title and abstract and then full text review. People were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. There were concerns about the possible emotional impact on CFRs responding to incidents. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low, patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles. There was support for local autonomy of CFR schemes but with greater sharing of best practice. Discussion: Most studies dated from 2005 and were descriptive rather than analytical. In the UK and Australia CFRs are usually lay volunteers equipped with basic skills for responding to medical emergencies, whereas in the US they include other emergency staff as well as lay people. Conclusion: Opportunities for future research include exploring experiences and perceptions of patients who have been treated by CFRs and other stakeholders, while also evaluating the effectiveness and costs of CFR schemes

Two-loop Anomalous Dimensions of Heavy Baryon Currents in Heavy Quark Effective Theory

We present results on the two-loop anomalous dimensions of the heavy baryon HQET currents $J=(q^TC\Gamma\tau q)\Gamma'Q$ with arbitrary Dirac matrices $\Gamma$ and $\Gamma'$. From our general result we obtain the two-loop anomalous dimensions for currents with quantum numbers of the ground state heavy baryons $\Lambda_Q$, $\Sigma_Q$ and $\Sigma_Q^*$. As a by-product of our calculation and as an additional check we rederive the known two-loop anomalous dimensions of mesonic scalar, pseudoscalar, vector, axial vector and tensor currents $(J=\bar q\Gamma q)$ in massless QCD as well as in HQET.Comment: 21 pages, LaTeX, 2 figures are included in PostScript forma