Exploring the Use of Cost-Benefit Analysis to Compare Pharmaceutical Treatments for Menorrhagia

Background: The extra-welfarist theoretical framework tends to focus on health-related quality of life, whilst the welfarist framework captures a wider notion of well-being. EQ-5D and SF-6D are commonly used to value outcomes in chronic conditions with episodic symptoms, such as heavy menstrual bleeding (clinically termed menorrhagia). Because of their narrow-health focus and the condition’s periodic nature these measures may be unsuitable. A viable alternative measure is willingness to pay (WTP) from the welfarist framework. Objective: We explore the use of WTP in a preliminary cost-benefit analysis comparing pharmaceutical treatments for menorrhagia. Methods: A cost-benefit analysis was carried out based on an outcome of WTP. The analysis is based in the UK primary care setting over a 24-month time period, with a partial societal perspective. Ninety-nine women completed a WTP exercise from the ex-ante (pre-treatment/condition) perspective. Maximum average WTP values were elicited for two pharmaceutical treatments, levonorgestrel-releasing intrauterine system (LNG-IUS) and oral treatment. Cost data were offset against WTP and the net present value derived for treatment. Qualitative information explaining the WTP values was also collected. Results: Oral treatment was indicated to be the most cost-beneficial intervention costing £107 less than LNG-IUS and generating £7 more benefits. The mean incremental net present value for oral treatment compared with LNG-IUS was £113. The use of the WTP approach was acceptable as very few protests and non-responses were observed. Conclusion: The preliminary cost-benefit analysis results recommend oral treatment as the first-line treatment for menorrhagia. The WTP approach is a feasible alternative to the conventional EQ-5D/SF-6D approaches and offers advantages by capturing benefits beyond health, which is particularly relevant in menorrhagia

The Indian family on UK reality television: Convivial culture in salient contexts

This is the author's accepted manuscript. The final published article is available from the link below, copyright 2012 @ the author.This article demonstrates how The Family (2009), a fly-on-the wall UK reality series about a British Indian family, facilitates both current public service broadcasting requirements and mass audience appeal. From a critical cultural studies perspective, the author examines the journalistic and viewer responses to the series where authenticity, universality, and comedy emerge as major themes. Textual analysis of the racialized screen representations also helps locate the series within the contexts of contested multiculturalism, genre developments in reality television and public service broadcasting. Paul Gilroy’s concept of convivial culture is used as a frame in understanding how meanings of the series are produced within a South Asian popular representational space. The author suggests that the social comedy taxonomy is a prerequisite for the making of this particular observational documentary. Further, the popular (comedic) mode of conviviality on which the series depends is both expedient and necessary within the various sociopolitical contexts outlined

Maternally expressed, paternally imprinted, embryonic non-coding RNA are expressed in osteosarcoma, Ewing sarcoma and spindle cell sarcoma

In a human embryo it takes 8 weeks after fertilisation for the skeleton to begin to form, one of the last organs to develop before becoming a foetus. Mesenchymal progenitors, derived from neural crest cells, differentiate into chondrocytes where the skeleton is generated as a mostly cartilage template. Other mesenchymal progenitors envelop the template, activate runt related transcription factor 2 (RUNX2) and bone morphogenetic protein 2 (BMP2) and differentiate into osteoblasts, where an osteoid matrix is secreted and subsequently mineralised to become bone.1 During development and up to late adolescence, cellular proliferation enabling skeletal growth is restricted to the metaphysis and epiphyseal line or “growth plate”. It is in the growth plate of long bones where most bone cancers develop, hence the predominantly childhood incidence of the cancer. Primitive mesenchymal cells undergo transformation to form a heterogeneous group of bone malignancies. The most common type of bone cancer in children is osteosarcoma, mostly initiated by tumour protein p53 (TP53) mutations. The second most common type of bone cancer in children is Ewing sarcoma, mostly initiated by a EWS RNA binding protein 1-Fli-1 proto-oncogene, ETS transcription factor (EWSR1-FLI1) fusion. There are an average of 160 and 55 new cases of osteosarcoma and Ewing sarcoma, respectively, every year in the UK. Five-year survival for both cancer types is 50% when diagnosed early. Five-year survival is 15% when lung metastases are present at diagnosis. Treatment progress for bone cancer is poor when compared to other cancers such as breast where there is a twenty-year survival of 70%. Bone cancer requires extensive and sometimes disabling multimodal treatment. Chemotherapy for osteosarcoma includes methotrexate, cisplatin and doxorubicin, which were developed in the 1940’s and 1970’s. Chemotherapy for Ewing sarcoma includes vincristine, ifosfamide and etoposide, which were developed in the 1960’s and 1980’s. If the tumour responds well to chemotherapy and radiotherapy, wide area resection or amputation is performed. New understanding of bone cancer biology leading to better diagnosis and better treatments is required

Optimizing countershading camouflage

Countershading, the widespread tendency of animals to be darker on the side that receives strongest illumination, has classically been explained as an adaptation for camouflage: obliterating cues to 3D shape and enhancing background matching. However, there have only been two quantitative tests of whether the patterns observed in different species match the optimal shading to obliterate 3D cues, and no tests of whether optimal countershading actually improves concealment or survival. We use a mathematical model of the light field to predict the optimal countershading for concealment that is specific to the light environment and then test this prediction with correspondingly patterned model “caterpillars” exposed to avian predation in the field. We show that the optimal countershading is strongly illumination-dependent. A relatively sharp transition in surface patterning from dark to light is only optimal under direct solar illumination; if there is diffuse illumination from cloudy skies or shade, the pattern provides no advantage over homogeneous background-matching coloration. Conversely, a smoother gradation between dark and light is optimal under cloudy skies or shade. The demonstration of these illumination-dependent effects of different countershading patterns on predation risk strongly supports the comparative evidence showing that the type of countershading varies with light environment

Needs analysis report following the sexual exploitation of children in Rotherham

It has been an immense honour to listen to the experiences of the people of Rotherham. The project team received a warm welcome and felt humbled at the extraordinary courage of victims, survivors and their families. We wish to express our heartfelt thanks to everyone who took part in the study. The knowledge and opinions shared by our participants are the foundation of this report. No-one wants to think about what child sexual abuse and exploitation really means. Recognising that children have been humiliated, raped and tortured is extremely distressing. As such, it is no surprise that many felt anger and rage when they understood that those with authority failed to protect vulnerable children and young people. There is a need to face the awful reality that child sexual abuse has always happened. However, in the age of the internet, the number of children at risk of sexual abuse has increased. Those who sexually abuse children are mostly, but not always, men. Not discounting the vast number of boys who have suffered abuse, most of the known victims of sexual abuse are girls. Both victims and perpetrators come from every walk of life. The threat is such that we all have a responsibility to consider what we can do to protect every child in our family and communities. The public criticism of Rotherham Metropolitan Borough Council (RMBC) and South Yorkshire Police, following Professor Jay’s report was right and inevitable. Positively, there have been several examples of how RMBC and South Yorkshire Police have responded to criticism and improved the way they respond to victims and survivors. However, there have also been negative consequences of public scrutiny, with many people in the study reporting that they want to regain pride in their hometown. Those who took part in this study did not shy away from exploring the difficulties they face. Naturally, participants continue to talk about issues of trust, as past mistakes created a sense of vulnerability. However, there is also evidence that healing is taking place. Many participants made suggestions of how they and RMBC could and should collaborate to strengthen, individuals, families and their communities Indeed, there is a determination to meet current and future needs with a sense of collective rigour. Some of these tasks involve developing internal structures, such as communication and the provision of appropriate resources. Rotherham, like many other towns and cities in Britain, is also faced with external threats which can exacerbate internal challenges. An example of this is how recognition of the involvement of some men of Asian Pakistani heritage, in the abuse of children in Rotherham, led some political groups to capitalise on fears. However, it is clear that children are best protected in resilient families and communities. Thankfully, Rotherham and its people continue to demonstrate resilience. In addition, there is also a strong sense of realism, no-one in Rotherham expects perfection, but they do expect to do everything possible to protect children and young people. One woman made the distinction between surviving and thriving: “…I don’t want to survive, I want to thrive…” We hope this report contributes to that aim and welcome your views on the findings from data collected between April and June 2015. We recognise that the data is reflective of views expressed at that time and that RMBC and the people of Rotherham, have continued to respond to needs throughout the course of this analysis process

VLBA polarimetric observations of the CSS quasar 3C147

Aims. We report new VLBA polarimetric observations of the compact steep-spectrum (CSS) quasar 3C147 (B0538+498) at 5 and 8.4GHz. Methods. By using multifrequency VLBA observations, we derived milliarcsecond-resolution images of the total intensity, polarisation, and rotation measure distributions, by combining our new observations with archival data. Results. The source shows a one-sided structure, with a compact region, and a component extending about 200 mas to the south-west. The compact region is resolved into two main components with polarised emission, a complex rotation measure distribution, and a magnetic field dominated by components perpendicular to the source axis. Conclusions. By considering all the available data, we examine the possible location of the core component, and discuss two possible interpretations of the observed structure of this source: core-jet and lobe-hot spot. Further observations to unambiguously determine the location of the core would help distinguish between the two possibilities discussed here.Comment: 11 pages, 12 figure