[Review] Anders Blok and Torben Elgaard Jensen (2011) Bruno Latour: hybrid thoughts in a hybrid world

A review of Blok and Jensen's introduction to the thought of Bruno Latour

Howard Caygill: author of 'Resistance: a philosophy of defiance' - interviewed by Alastair Gray and Philip Holmburg

An interview with the philosopher Howard Caygill, primarily concerning his book 'Resistance', conducted in December 201

Economic evaluation using decision analytical modelling : design, conduct, analysis, and reporting

Economic evaluations are increasingly conducted alongside randomised controlled trials, providing researchers with individual patient data to estimate cost effectiveness. However, randomised trials do not always provide a sufficient basis for economic evaluations used to inform regulatory and reimbursement decisions. For example, a single trial might not compare all the available options, provide evidence on all relevant inputs, or be conducted over a long enough time to capture differences in economic outcomes (or even measure those outcomes). In addition, reliance on a single trial may mean ignoring evidence from other trials, meta-analyses, and observational studies. Under these circumstances, decision analytical modelling provides an alternative framework for economic evaluation. Decision analytical modelling compares the expected costs and consequences of decision options by synthesising information from multiple sources and applying mathematical techniques, usually with computer software. The aim is to provide decision makers with the best available evidence to reach a decision—for example, should a new drug be adopted? Following on from our article on trial based economic evaluations, we outline issues relating to the design, conduct, analysis, and reporting of economic evaluations using decision analytical modelling

Liability, insurance and defensive medicine: new evidence

For the first time, we test for effects of liability on hospital care using measures of current perceptions of litigation risk at hospital level; in particular, the risk-sharing arrangements agreed between hospitals and their insurers. GMM and ML estimators are used to allow for possible endogeneity of risksharing arrangements. Our findings are consistent with the exercise of liabilityinduced discretion by hospitals, especially regarding use of costly diagnostic imaging. Hospitals facing higher expected litigation costs also use these tests more frequently, after controlling for activity levels, casemix and treatment outcome; the latter indicating that defensive medicine may be present. We also find evidence of fewer new claims against these hospitals, given adverse events, which may indicate the increased use of claims management processes by hospital managers concerned at the expected cost of litigation.Medical malpractice, defensive care, insurance, litigation

The reform of Legal Aid in England and Wales

Legal aid expenditure has risen dramatically in recent years, prompting attention from successive governments. A prominent theme of past and present government reform proposals has been the shifting of risk away from the taxpayer towards lawyers, clients and insurers by altering the means by which legal aid lawyers are paid. This paper explores this theme by presenting information on legal aid expenditure trends over the last two decades and then considering whether payment mechanisms have contributed to this performance. Finally, it reviews previous and current reform proposals in this area. It concludes that, because risk-shifting also alters incentives, it is essential that reform recognises and monitors these.

Socioeconomic status as an effect modifier of alcohol consumption and harm: an analysis of linked cohort data

Background: Alcohol-related mortality and morbidity are higher in socioeconomically disadvantaged populations. It is unclear if elevated harm reflects differences in consumption, reverse causation or greater risk of harm following similar consumption. We investigated whether the harmful effects differed by socioeconomic status accounting for alcohol consumption and other health-related factors. Methods: Alcohol consumption (weekly units and binge drinking) data (n=50,236; 429,986 person-years of follow-up) were linked to deaths, hospitalisations and prescriptions. The primary outcome was alcohol-attributable hospitalisation/death. The relationship between alcohol attributable harm and socioeconomic status was investigated for four measures (education level, social class, household income and area-based deprivation) using Cox proportional hazards models. The potential for alcohol consumption and other risk factors mediating the social patterning was explored. Downward social selection for high-risk drinkers (reverse causation) was tested by comparing change in area deprivation over time. Findings: Low socioeconomic status was consistently associated with markedly elevated alcohol-attributable harms, including after adjustment for weekly consumption, binge drinking, body mass index and smoking. There was evidence of effect modification: for example, relative to light drinkers living in advantaged areas, the hazard ratio for excessive drinkers was 6.75 (95% CI 5.09-8.93) in advantaged and 11.06 (95% CI 8.53-14.35) in deprived areas. We found little support for downward social selection. Interpretation: Disadvantaged social groups experience greater alcohol-attributable harms compared to the advantaged for given levels of alcohol consumption, even after accounting for different drinking patterns, obesity and smoking status at the individual level

New BMJ policy on economic evaluations - Will the Lancet play ball?

Health economists have been grateful for the BMJ's hitherto supportive stance towards the publication of economic evaluations. The proposed new policy not to publish economic evaluations unless also offered the clinical results is disappointing and misjudged.Copyright Gray et al. Re-use of this article is permitted in accordance with the Creative Commons Attribution Non Commercial licence (CC BY-NC 3.0

Positive regulation of meiotic DNA double-strand break formation by activation of the DNA damage checkpoint kinase Mec1(ATR)

During meiosis, formation and repair of programmed DNA double-strand breaks (DSBs) create genetic exchange between homologous chromosomes-a process that is critical for reductional meiotic chromosome segregation and the production of genetically diverse sexually reproducing populations. Meiotic DSB formation is a complex process, requiring numerous proteins, of which Spo11 is the evolutionarily conserved catalytic subunit. Precisely how Spo11 and its accessory proteins function or are regulated is unclear. Here, we use Saccharomyces cerevisiae to reveal that meiotic DSB formation is modulated by the Mec1(ATR) branch of the DNA damage signalling cascade, promoting DSB formation when Spo11-mediated catalysis is compromised. Activation of the positive feedback pathway correlates with the formation of single-stranded DNA (ssDNA) recombination intermediates and activation of the downstream kinase, Mek1. We show that the requirement for checkpoint activation can be rescued by prolonging meiotic prophase by deleting the NDT80 transcription factor, and that even transient prophase arrest caused by Ndt80 depletion is sufficient to restore meiotic spore viability in checkpoint mutants. Our observations are unexpected given recent reports that the complementary kinase pathway Tel1(ATM) acts to inhibit DSB formation. We propose that such antagonistic regulation of DSB formation by Mec1 and Tel1 creates a regulatory mechanism, where the absolute frequency of DSBs is maintained at a level optimal for genetic exchange and efficient chromosome segregation

Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom

<p>Abstract</p> <p>Background</p> <p>To estimate life years and quality-adjusted life years (QALYs) lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom including healthcare and non-healthcare costs from a societal perspective.</p> <p>Methods</p> <p>All UK residents in 2005 with aSAH (International Classification of Diseases 10^threvision (ICD-10) code I60). Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL) data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death.</p> <p>Results</p> <p>A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS) £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses) of a SAH in the United Kingdom was estimated to be £510 million annually.</p> <p>Conclusion</p> <p>The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories.</p

Lung cancer deaths from indoor radon and the cost effectiveness and potential of policies to reduce them

Objective To determine the number of deaths from lung cancer related to radon in the home and to explore the cost effectiveness of alternative policies to control indoor radon and their potential to reduce lung cancer mortality