The costs and benefits of a vaccination programme for Haemophilus influenzae type 8 disease

Haemophilus influenzae type b (Hib) infection is a major cause of severe bacterial infection in young children in South Africa and world-wide. These diseases can be prevented by immunisation with conjugate Hib vaccines. In South Africa, unlike some developed countries, Hib vaccines are not part of the routine immunisation schedule. The objective of this study was to measure the expected net benefits from a hypothetical programme of vaccination of the 1992 Cape Town birth cohort (N =46 537). Costs were calculated by summing the estimated direct medical care costs together with the indirect costs of Hib disease. The latter were calculated by valuing human life using alternative, and conservative human capital and willingness-to-pay measures. The difference between Hib disease costs (Le. the benefits which would be gained from a successful vaccination programme) and the costs of the vaccination programme itself (HibTITER, Praxis Biologicals) defined the expected net benefits. In the absence of an immunisation programme, the estimated economic costs of Hib disease in the 1992 Cape Town cohort ranged from R10,7 million to R11 ,8 million. The costs of introducing the vaccine would have amounted to R8,3 million. Had the vaccine been administered to the 1992 birth cohort, benefits would have exceeded costs by between R2,4 million and R3,5 million

Tailored versus generic knowledge brokering to integrate mood management into smoking cessation interventions in primary care settings : Protocol for a cluster randomized controlled trial

Background: Both tobacco smoking and depression are major public health problems associated with high morbidity and mortality. In addition, individuals with depression are almost twice as likely to smoke and less likely to achieve smoking cessation. In the Smoking Treatment for Ontario Patients program, an established smoking cessation program in Ontario, Canada, 38% of smokers in primary care settings have current or past depression with 6-month quit rates that are significantly lower than those without depression (33% versus 40%, P<.001). Integrating self-help mood management (eg, relaxation exercises and mood monitoring) with smoking cessation treatment increases long-term quit rates by 12%-20%. However, integration in real-world settings has not been reported. It is unclear which knowledge translation strategy would be more effective for motivating clinicians to provide resources on mood management to eligible patients. Objective: The objectives of this study are to investigate the following comparisons among depressed smokers enrolled in a smoking cessation program: 1) the effectiveness of generalized, exclusively email-based prompts versus a personalized knowledge broker in implementing mood management interventions; 2) the effectiveness of the two knowledge translation strategies on smoking quit rates; and 3) the incremental costs of the two knowledge translation strategies on the implementation of mood management interventions. Methods: The study design is a cluster randomized controlled trial of Family Health Teams participating in the Smoking Treatment for Ontario Patients program. Family Health Teams will be randomly allocated 1:1 to receive either generalized messages (related to depression and smoking) exclusively via email (group A) or be assigned a knowledge broker who provides personalized support through phone- and email-based check-ins (group B). The primary outcome, measured at the site level, is the proportion of eligible baseline visits that result in the provision of the mood management intervention to eligible patients. Results: Recruitment for the primary outcome of this study will be completed in 2018/2019. Results will be reported in 2019/2020. Conclusions: This study will address the knowledge gap in the implementation strategies (ie, email-based prompts versus a knowledge broker) of mood management interventions for smokers with depression in primary care settings. Trial Registration: ClinicalTrials.gov NCT03130998; https://clinicaltrials.gov/ct2/show/NCT03130998 (Archived on WebCite at www.webcitation.org/6ylyS6RTe)

Dynamics of intracellular free calcium concentration in the presynaptic arbors of individual barnacle photoreceptors

At photoreceptor synapses, transmitter release is continuous and graded. At this type of synapse, the control of presynaptic [Ca2+]i and calcium's role in releasing transmitter might be different than at terminals invaded by all-or-none action potentials. To examine this possibility, we measured the spatial and temporal changes of [Ca2+]i in response to depolarization of individual photoreceptor terminals of the barnacle Balanus nubilus, which had been injected with the Ca2+ indicator Fura-2. Depolarizing pulses produced voltage-dependent Ca2+ entry that was confined to the tips of the arbor where the release sites are located. At increasing distances from the tips, the rate of [Ca2+]i increase was slower and the peak [Ca2+]i occurred later, suggesting that Ca2+ entered the tips and diffused back into the larger processes of the arbor. Consistent with this result, a stable gradient of [Ca2+]i was observed at maintained depolarizations, with the highest values at the tips of the arbor. Removal of external Na+ did not affect the time course of Ca2+ decline in the terminal, indicating that Na+/Ca2+ exchange was not the primary mechanism for restoring [Ca2+]i to basal levels. Computer simulations, assuming only Ca2+ entry at the arbor's tips and diffusion of Ca2+ away from the entry site, qualitatively reproduced these observations. The threshold for Ca2+ entry was near -60 mV, and entry was maintained during prolonged depolarizations, in agreement with previous experiments showing that Ca2+ channels in the terminal region do not inactivate. The time course of the measured [Ca2+]i change in the terminal paralleled voltage changes due to a Ca(2+)-activated K+ conductance, which senses [Ca2+]i just under the membrane. This parallelism is expected since the release sites are located on processes of small-enough diameter to permit radial equilibration of [Ca2+]i within the time course of physiological voltage changes. Therefore, the optical measurements reflect the mean level of [Ca2+]i under the membrane. Whether this mean concentration is also the value at the sites that trigger exocytosis will depend on how close the Ca2+ channels are to these sites

Art Follows Empire: new scholarship in Early American art history

Wendy Bellion │ Introduction The following essays presented in this collaborative study of early American art developed from a session at the conference, “London and the Americas, 1492-1812,” organized by the Society of Early Americanists (SEA) at Kingston University, United Kingdom, in July 2014. For a roundtable entitled “Art Follows Empire,” I invited participants to discuss an object of their choice. The caveat: speakers had to identify a single object that epitomized or problematized the..

« Art Follows Empire » : un état des lieux des connaissances sur l’histoire de l’art américain à ses débuts

Introduction | Wendy Bellion Les essais suivants présentés dans cette étude collaborative sur l’art américain à ses débuts sont tirés d’une séance de travail qui a eu lieu lors de la conférence « London and the Americas, 1492-1812 ». Celle-ci avait été organisée par la Society of Early Americanists (SEA) à Kingston University, au Royaume-Uni, en juillet 2014. Pour cette table ronde intitulée « Art Follows Empire », j’avais invité tous les participants à présenter un objet de leur choix. Avec ..

Clinical response and symptomatic remission in short- and long-term trials of lisdexamfetamine dimesylate in adults with attention-deficit/hyperactivity disorder

BackgroundDespite the overall high degree of response to pharmacotherapy, consensus is lacking on how to judge clinical response or define optimal treatment/remission when treating adults with attention-deficit/hyperactivity disorder (ADHD). This study examined clinical response and symptomatic remission in analyses of 2 studies of lisdexamfetamine dimesylate (LDX) in adults with ADHD.MethodsIn a 4-week, double-blind, forced-dose trial, adults with ADHD were randomized to LDX 30, 50, and 70 mg/day (mg/d) or placebo. In a second, open-label, follow-up trial, adults entering from the 4-week study were titrated to an “optimal” LDX dose (30 mg/d [n=44], 50 mg/d [n=112], and 70 mg/d [n=171]) over 4 weeks, and maintained for 11 additional months. The ADHD Rating Scale IV (ADHD-RS-IV) with adult prompts and the Clinical Global Impressions-Improvement (CGI-I) scale assessed efficacy. Clinical response was defined, post hoc, as ≥30% reduction from baseline in ADHD-RS-IV and CGI-I rating of 1 or 2; symptomatic remission was defined as ADHD-RS-IV total score ≤18. Log rank analysis examined overall significance among the treatment groups in time to response or remission.ResultsFour hundred and fourteen participants in the 4-week study and 345 in the open-label, extension study were included in the efficacy populations. All LDX groups improved by ADHD-RS-IV and CGI-I scores in both studies. In the 4-week study (n=414), 69.3% responded and 45.5% achieved remission with LDX (all doses); 37.1% responded and 16.1% achieved remission with placebo; time (95% CI) to median clinical response (all LDX doses) was 15.0 (15.0, 17.0) days and to remission was 31.0 (28.0, 37.0) days (P<.0001 overall). In the open-label study, with LDX (all doses), 313 (95.7%) and 278 (85.0%) of 327 participants with evaluable maintenance-phase data met criteria for response and remission, respectively. Of participants who completed dose optimization, 75.2% remained responders and 65.7% remained in remission in the 12-month study. Overall, 285 (82.6%) and 227 (65.8%) of 345 participants were responders and remitters, respectively, at their final visits.ConclusionIn the long-term study, with open-label, dose-optimized LDX treatment, most adults with ADHD achieved clinical response and/or symptomatic remission; almost two-thirds maintained symptomatic remission over the remaining 11 months.Trial registrationClinical Trial Numbers: NCT00334880 and NCT01070394Clinical Trial Registry: clinicaltrials.govURLshttp://www.clinicaltrials.gov/show/NCT00334880http://www.clinicaltrials.gov/ct2/show/NCT01070394?term=NCT01070394&rank=