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The cost-effectiveness of molecular pathology testing is highly context dependent. The field is fast-moving, and national health technology assessment may not be relevant or timely for local decision makers. This study illustrates a method of context-specific economic evaluation that can be carried out in a limited timescale without extensive resources.
We established a multi-disciplinary group including an oncologist, pathologists and a health economist. We set out diagnostic and treatment pathways and costs using registry data, health technology assessments, guidelines, audit data, and estimates from the group. Sensitivity analysis varied input parameters across plausible ranges. The evaluation setting was the West of Scotland and UK NHS perspective was adopted. The evaluation was assessed against the AdHopHTA checklist for hospital-based health technology assessment.
A context-specific economic evaluation could be carried out on a timely basis using limited resources. The evaluation met all relevant criteria in the AdHopHTA checklist. Health outcomes were expected to be at least equal to the current strategy. Annual cost savings of £637,000 were estimated resulting primarily from a reduction in the proportion of patients receiving intravenous infusional chemotherapy regimens. The result was not sensitive to any parameter. The data driving the main cost saving came from a small clinical audit. We recommended this finding was confirmed in a larger population.
The method could be used to evaluate testing changes elsewhere. The results of the case study may be transferable to other jurisdictions where the organization of cancer services is fragmented.
OBJECTIVES/SPECIFIC AIMS: More men than women develop urinary stones and their prevalence alters in women with menopause suggesting a steroidal influence. In men the incidence of stones is highest during July and August suggesting that environmental factors such as Vitamin D (VitD), a steroid, may affect stone formation. Previous studies have found differences in the development of stones between men and women; however, the reasons for sex differences in stone formation and type remain unclear. METHODS/STUDY POPULATION: We examined VitD levels in men and women (n = 18,753) that had no diseases based on a lack of an ICD-9 or ICD-10 code in their electronic medical record. We found that normal, healthy women had significantly higher levels of sera VitD compared to men (p = 6x10-6). We then examined whether sex differences existed for key endpoints/data from the Mayo Clinic Urinary Stone Disease (USD) Registry, which has around 1,600 urinary stone patients that are well-phenotyped according to sex, age and stone type. RESULTS/ANTICIPATED RESULTS: Control women were found to have higher sera VitD levels than men, but the sex difference no longer exists in kidney stone disease patients. When we further separated by race, we found that differences in VitD levels reappeared; this suggests that race also plays a role in sera VitD variances. DISCUSSION/SIGNIFICANCE OF IMPACT: We are developing a disease severity score, which we will use to correlate to sera VitD levels in patients according to sex, age and race. Future analyses will take into account whether subjects had VitD and calcium supplementation. This project begins to explore the mechanism behind the sex differences known to exist in urinary stone disease, which is critically needed to provide improved diagnosis and therapy for this debilitating disease.
In the UK, 11.8% of expectant mothers undergo an elective caesarean section (ELCS) representing 92 000 births per annum. It is not known to what extent this procedure has an impact on mental well-being in the longer term.
To determine the prevalence and postpartum progression of anxiety and depression symptoms in women undergoing ELCS in Wales.
Prevalence of depression and anxiety were determined in women at University Hospital Wales (2015–16; n = 308) through completion of the Edinburgh Postnatal Depression Scale (EPDS; ≥13) and State-Trait Anxiety Inventory (STAI; ≥40) questionnaires 1 day prior to ELCS, and three postpartum time points for 1 year. Maternal characteristics were determined from questionnaires and, where possible, confirmed from National Health Service maternity records.
Using these criteria the prevalence of reported depression symptoms was 14.3% (95% CI 10.9–18.3) 1 day prior to ELCS, 8.0% (95% CI 4.2–12.5) within 1 week, 8.7% (95% CI 4.2–13.8) at 10 weeks and 12.4% (95% CI 6.4–18.4) 1 year postpartum. Prevalence of reported anxiety symptoms was 27.3% (95% CI 22.5–32.4), 21.7% (95% CI 15.8–28.0), 25.3% (95% CI 18.5–32.7) and 35.1% (95% CI 26.3–44.2) at these same stages. Prenatal anxiety was not resolved after ELCS more than 1 year after delivery.
Women undergoing ELCS experience prolonged anxiety postpartum that merits focused clinical attention.
Whether the latitudinal distribution of climate-sensitive lithologies is stable through greenhouse and icehouse regimes remains unclear. Previous studies suggest that the palaeolatitudinal distribution of palaeoclimate indicators, including coals, evaporites, reefs and carbonates, has remained broadly similar since the Permian period, leading to the conclusion that atmospheric and oceanic circulation control their distribution rather than the latitudinal temperature gradient. Here we revisit a global-scale compilation of lithologic indicators of climate, including coals, evaporites and glacial deposits, back to the Devonian period. We test the sensitivity of their latitudinal distributions to the uneven distribution of continental areas through time and to global tectonic models, correct the latitudinal distributions of lithologies for sampling- and continental area-bias, and use statistical methods to fit these distributions with probability density functions and estimate their high-density latitudinal ranges with 50% and 95% confidence intervals. The results suggest that the palaeolatitudinal distributions of lithologies have changed through deep geological time, notably a pronounced poleward shift in the distribution of coals at the beginning of the Permian. The distribution of evaporites indicates a clearly bimodal distribution over the past ~400 Ma, except for Early Devonian, Early Carboniferous, the earliest Permian and Middle and Late Jurassic times. We discuss how the patterns indicated by these lithologies change through time in response to plate motion, orography, evolution and greenhouse/icehouse conditions. This study highlights that combining tectonic reconstructions with a comprehensive lithologic database and novel data analysis approaches provide insights into the nature and causes of shifting climatic zones through deep time.
Metallic silver nanoparticles were synthesized using a hydrothermal route for use in high throughput biosensing applications. Particle shape was engineered by varying polyvinyl pyrollidone (PVP) concentration in the precursor mixture, resulting in the emergence of flat triangular shaped nanoparticles with increasing PVP content. The hydrothermal method was found to yield particles with better particle size distribution and longer shelf life relative to polyol synthesis particles.
Objectives: Validated treatments for adults with bulimia nervosa (BN) and related presentations are scarce, and the current most evidenced treatment — cognitive behaviour therapy for eating disorders — is resource intensive and has suboptimal remission rates; there is, therefore, a need to evaluate the effectiveness of other approaches for treating such conditions in routine NHS services. Design: Data from nine patients in an NHS eating disorder service who received compassion-focused therapy (CFT) for BN or bulimic presentations were analysed retrospectively. Methods: Patients routinely completed a validated scale of eating disorder severity (the EDE-Q) at baseline and end of treatment. Results: All five scales of the EDE-Q showed a mean significant reduction (N = 9), indicating a significant reduction in eating disorder symptomatology, and individual analyses showed clinically reliable reduction in seven out of nine patients’ EDE-Q scores. Conclusions: This is the first article to report a case series of patients who benefitted significantly from receiving CFT for their eating disorder. Limitations of this study are considered along with future directions for research into effective treatments for eating disorders.
The sand-dune lizard Liolaemus multimaculatus is an Endangered species endemic to the Pampean coastal dunes of Argentina. To inform the development of a future Action Plan for this species, we investigated the demography and conservation status of all remaining populations, and we suggest management actions appropriate to local needs. We used population viability analysis to assess extinction risk in three inbreeding scenarios and estimate the minimum viable population and the minimum area requirement. To assess the current status of each local population, we used information related to population size, human pressure and connectivity. The results were then used to set and prioritize conservation management actions at local level. Our models indicated that populations of > 2,400 individuals would be viable in the long term and that inbreeding depression has a strong effect on extinction risk. The southern patches of coastal dune contain the largest populations of sand-dune lizards, and they are also better connected and less threatened. We suggest land protection as the priority management action for populations larger than the minimum viable population, whereas habitat recovery, when possible, should be the priority for patches of coastal dune smaller than the minimum area requirement. Supplementation with a small number of individuals could stabilize unviable populations but should be considered only in certain situations.
The long-term conservation of the sand-dune lizard will be feasible only if a conservation action plan is developed and implemented.
Euclid is a Europe-led cosmology space mission dedicated to a visible and near infrared survey of the entire extra-galactic sky. Its purpose is to deepen our knowledge of the dark content of our Universe. After an overview of the Euclid mission and science, this contribution describes how the community is getting organized to face the data analysis challenges, both in software development and in operational data processing matters. It ends with a more specific account of some of the main contributions of the Swiss Science Data Center (SDC-CH).
Background: Cognitive Behavioural Therapy (CBT) aims to teach people skills to help them self-manage their depression. Trial evidence shows that CBT is an effective treatment for depression and individuals may experience benefits long-term. However, there is little research about individuals’ continued use of CBT skills once treatment has finished. Aims: To explore whether individuals who had attended at least 12 sessions of CBT continued to use and value the CBT skills they had learnt during therapy. Method: Semi-structured interviews were held with participants from the CoBalT trial who had received CBT, approximately 4 years earlier. Interviews were audio-recorded, transcribed and analysed thematically. Results: 20 participants were interviewed. Analysis of the interviews suggested that individuals who viewed CBT as a learning process, at the time of treatment, recalled and used specific skills to manage their depression once treatment had finished. In contrast, individuals who viewed CBT only as an opportunity to talk about their problems did not appear to utilize any of the CBT skills they had been taught and reported struggling to manage their depression once treatment had ended. Conclusions: Our findings suggest individuals may value and use CBT skills if they engage with CBT as a learning opportunity at the time of treatment. Our findings underline the importance of the educational model in CBT and the need to emphasize this to individuals receiving treatment.
Reports of bloodstream infections caused by methicillin-resistant Staphylococcus aureus among chronic hemodialysis patients to 2 Centers for Disease Control and Prevention surveillance systems (National Healthcare Safety Network Dialysis Event and Emerging Infections Program) were compared to evaluate completeness of reporting. Many methicillin-resistant S. aureus bloodstream infections identified in hospitals were not reported to National Healthcare Safety Network Dialysis Event.
Infect. Control Hosp. Epidemiol. 2016;37(2):205–207
Background: Cognitive behaviour therapy (CBT) for patients with treatment-resistant depression (TRD) aims to reframe underlying conditional beliefs that are thought to maintain depression. Aim: To systematically explore conditional beliefs expressed by primary-care based patients with TRD, defined as non-response to at least 6 weeks of antidepressants. Method: Conditional beliefs (stated in an “If. . .then. . .” format) were extracted from a random sample of 50 sets of therapist notes from the CoBalT trial, a large randomized controlled trial of CBT for TRD in primary care. The beliefs were separated into their two constituent parts; the demands (Ifs) and consequences (thens). An approach based on framework analysis provided a systematic way of organizing the data, and identifying key themes. Results: Four main themes emerged from the demand part of the conditional beliefs (Ifs): 1. High standards; 2. Putting others first/needing approval; 3. Coping; and 4. Hiding “true” self. Three main themes emerged from the consequence part of the conditional beliefs (thens): 1. Defectiveness; 2. Responses of others; 3. Control of emotions. Conclusions: Identifying common themes in the conditional beliefs of patients with TRD adds to our clinical understanding of this client group, providing useful information to facilitate the complex process of collaborative case conceptualization and working with conditional beliefs within CBT interventions.
Ascension Island in the South Atlantic Ocean is renowned for its globally-important nesting population of green turtles (Chelonia mydas) that has been the subject of long-term research. By comparison, very little is known about the apparently small population of hawksbill turtles (Eretmochelys imbricata) that have been recorded in its waters, thousands of kilometres from known nesting beaches. Here, we collate 10 years of in-water tagging data, opportunistic public sighting records and underwater observations to provide a baseline for future research, and present preliminary data on habitat use derived from two individuals fitted with GPS transmitters. Although public sightings were inevitably biased towards popular recreation areas, the resulting distribution suggests that hawksbill turtles occur year round in Ascension Island's waters along the entire 65 km of coastline. Hawksbills were observed feeding on benthic algae and encrusting sponges, and were frequently seen scavenging on fish discards around the Island's pier at night aided by anthropogenic lighting. Between 2003 and 2013, 35 turtles were captured, measured, tagged and then released. Curved carapace lengths ranged from 33.5 to 85 cm (mean = 48.8 cm) indicating that most (if not all) individuals encountered around Ascension are post-pelagic juveniles. Four individuals were recaptured at least once giving a mean minimum residence time of 4.2 yr (range: 2.8–7.3 yr) and a mean growth rate of 2.8 cm yr−1. Turtles fitted with Fastloc™ GPS devices remained at Ascension Island for the duration of the study (>90 days) and occupied restricted home ranges with an average area of 2.5 km2 and an average ‘core use area’ (50% utilization distribution) of 0.05 km2. Together, these results suggest that Ascension Island serves as a mid-Atlantic developmental habitat for benthic-feeding, juvenile hawksbill turtles on extended oceanic migrations before recruiting to their adult foraging grounds, likely to be located in Brazil or tropical West Africa.