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Georgia vegetable growers produce more than 27% of the nation’s fresh-market cucumbers. To maximize yields and profit, fields must be weed-free when planting. Limitations with current burndown herbicide options motivated academic, industry, and U.S. Department of Agriculture partners to search for new tools to assist growers. One possibility, glufosinate, controls many common and troublesome weeds, but its influence on cucumber development through residual activity when applied before or at planting is not understood. Thus, four different studies were each conducted two to four times from 2017 to 2020 to determine 1) transplant cucumber response to preplant glufosinate applications as influenced by rate, overhead irrigation, and interval between application and planting; and 2) seeded cucumber response to preemergence (PRE) glufosinate applications as influenced by rate, overhead irrigation, and planting depth. Glufosinate applied at 330, 660, 980, and 1,640 g ai ha−1 the day before transplanting caused 11% to 53% injury on sandy, low organic matter soils. Cucumber vine lengths and plant biomass were reduced up to 28% and 46%, respectively, with the three highest rates. Early-season yield (harvests 1 to 4) noted a 31% to 60% yield loss with glufosinate at 660 to 1,640 g ha−1 with similar trends observed with total yield (11 to 13 harvests). Irrigation (0.75 cm) after application and before transplanting reduced injury to less than 21%, eliminated vine length and biomass suppression except at the highest rate, and eliminated yield loss. Extending the interval between glufosinate application and transplanting from 1 to 4 d was not beneficial, and further extending the interval to 7 d significantly reduced injury half the time. When applied PRE to seeded cucumber and combining the data across locations, glufosinate caused less than 7% injury even at 1,640 g ha−1. Seeded plant vine lengths, biomass, and marketable yield were not influenced by the PRE application, and neither irrigation nor planting depth influenced seeded crop response to glufosinate.
The 2016–17 European outbreak of H5N8 HPAIV (Clade 2.3.4.4b) affected a wider range of avian species than the previous H5N8 outbreak (2014–15), including an incursion of H5N8 HPAIV into gamebirds in England. Natural infection of captive-reared pheasants (Phasianus colchicus) led to variable disease presentation; clinical signs included ruffled feathers, reluctance to move, bright green faeces, and/or sudden mortality. Several birds exhibited neurological signs (nystagmus, torticollis, ataxia). Birds exhibiting even mild clinical signs maintained substantial levels of virus replication and shedding, with preferential shedding via the oropharyngeal route. Gross pathology was consistent with HPAIV, in gallinaceous species but diphtheroid plaques in oropharyngeal mucosa associated with necrotising stomatitis were novel but consistent findings. However, minimal or modest microscopic pathological lesions were detected despite the systemic dissemination of the virus. Serology results indicated differences in the timeframe of exposure for each case (n = 3). This supported epidemiological conclusions confirming that the movement of birds between sites and other standard husbandry practices with limited hygiene involved in pheasant rearing (including several fomite pathways) contributed to virus spread between premises.
Plans for allocation of scarce life-sustaining resources during the coronavirus disease 2019 (COVID-19) pandemic often include triage teams, but operational details are lacking, including what patient information is needed to make triage decisions.
Methods:
A Delphi study among Washington state disaster preparedness experts was performed to develop a list of patient information items needed for triage team decision-making during the COVID-19 pandemic. Experts proposed and rated their agreement with candidate information items during asynchronous Delphi rounds. Consensus was defined as ≥80% agreement. Qualitative analysis was used to describe considerations arising in this deliberation. A timed simulation was performed to evaluate feasibility of data collection from the electronic health record.
Results:
Over 3 asynchronous Delphi rounds, 50 experts reached consensus on 24 patient information items, including patients’ age, severe or end-stage comorbidities, the reason for and timing of admission, measures of acute respiratory failure, and clinical trajectory. Experts weighed complex considerations around how information items could support effective prognostication, consistency, accuracy, minimizing bias, and operationalizability of the triage process. Data collection took a median of 227 seconds (interquartile range = 205, 298) per patient.
Conclusions:
Experts achieved consensus on patient information items that were necessary and appropriate for informing triage teams during the COVID-19 pandemic.
Liquid-electron microscopy (EM), the room-temperature correlate to cryo-EM, is a rapidly growing field providing high-resolution insights of macromolecules in solution. Here, we describe how liquid-EM experiments can incorporate automated tools to propel the field to new heights. We demonstrate fresh workflows for specimen preparation, data collection, and computing processes to assess biological structures in liquid. Adeno-associated virus (AAV) and the SARS-CoV-2 nucleocapsid (N) were used as model systems to highlight the technical advances. These complexes were selected based on their major differences in size and natural symmetry. AAV is a highly symmetric, icosahedral assembly with a particle diameter of ~25 nm. At the other end of the spectrum, N protein is an asymmetric monomer or dimer with dimensions of approximately 5–7 nm, depending upon its oligomerization state. Equally important, both AAV and N protein are popular subjects in biomedical research due to their high value in vaccine development and therapeutic efforts against COVID-19. Overall, we demonstrate how automated practices in liquid-EM can be used to decode molecules of interest for human health and disease.
This study aimed to explore effects of adjunctive minocycline treatment on inflammatory and neurogenesis markers in major depressive disorder (MDD). Serum samples were collected from a randomised, placebo-controlled 12-week clinical trial of minocycline (200 mg/day, added to treatment as usual) for adults (n = 71) experiencing MDD to determine changes in interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP) and brain derived neurotrophic factor (BDNF). General Estimate Equation modelling explored moderation effects of baseline markers and exploratory analyses investigated associations between markers and clinical outcomes. There was no difference between adjunctive minocycline or placebo groups at baseline or week 12 in the levels of IL-6 (week 12; placebo 2.06 ± 1.35 pg/ml; minocycline 1.77 ± 0.79 pg/ml; p = 0.317), LBP (week 12; placebo 3.74 ± 0.95 µg/ml; minocycline 3.93 ± 1.33 µg/ml; p = 0.525) or BDNF (week 12; placebo 24.28 ± 6.69 ng/ml; minocycline 26.56 ± 5.45 ng/ml; p = 0.161). Higher IL-6 levels at baseline were a predictor of greater clinical improvement. Exploratory analyses suggested that the change in IL-6 levels were significantly associated with anxiety symptoms (HAMA; p = 0.021) and quality of life (Q-LES-Q-SF; p = 0.023) scale scores. No other clinical outcomes were shown to have this mediation effect, nor did the other markers (LBP or BDNF) moderate clinical outcomes. There were no overall changes in IL-6, LBP or BDNF following adjunctive minocycline treatment. Exploratory analyses suggest a potential role of IL-6 on mediating anxiety symptoms with MDD. Future trials may consider enrichment of recruitment by identifying several markers or a panel of factors to better represent an inflammatory phenotype in MDD with larger sample size.
Schistosomiasis has been subjected to extensive control efforts in the People's Republic of China (China) which aims to eliminate the disease by 2030. We describe baseline results of a longitudinal cohort study undertaken in the Dongting and Poyang lakes areas of central China designed to determine the prevalence of Schistosoma japonicum in humans, animals (goats and bovines) and Oncomelania snails utilizing molecular diagnostics procedures. Data from the Chinese National Schistosomiasis Control Programme (CNSCP) were compared with the molecular results obtained.
Sixteen villages from Hunan and Jiangxi provinces were surveyed; animals were only found in Hunan. The prevalence of schistosomiasis in humans was 1.8% in Jiangxi and 8.0% in Hunan determined by real-time polymerase chain reaction (PCR), while 18.3% of animals were positive by digital droplet PCR. The CNSCP data indicated that all villages harboured S. japonicum-infected individuals, detected serologically by indirect haemagglutination assay (IHA), but very few, if any, of these were subsequently positive by Kato-Katz (KK).
Based on the outcome of the IHA and KK results, the CNSCP incorporates targeted human praziquantel chemotherapy but this approach can miss some infections as evidenced by the results reported here. Sensitive molecular diagnostics can play a key role in the elimination of schistosomiasis in China and inform control measures allowing for a more systematic approach to treatment.
Whiteite-(MnMnMn), Mn2+Mn2+Mn2+2Al2(PO4)4(OH)2⋅8H2O, is a new whiteite-subgroup member of the jahnsite group from the Foote Lithium Company mine, Kings Mountain district, Cleveland County, North Carolina, USA. It was found in small vugs of partially oxidised pegmatite minerals on the East dump of the mine, in association with eosphorite, hureaulite, fairfieldite, mangangordonite, whiteite-(CaMnMn) and jasonsmithite. It occurs as sugary aggregates of blade-like crystals up to 0.1 mm long and as epitaxial overgrowths on whiteite-(CaMnMn). The crystals are colourless to very pale brown, with a vitreous lustre and a white streak. The blades are flattened on {001} and elongated along [010], with poor cleavage on {001}. The calculated density is 2.82 g⋅cm–3. Optically it is biaxial (–) with α = 1.599(2), β = 1.605(2), γ = 1.609(2) (white light); 2V (calc.) = 78.2°, having no observable dispersion or pleochroism, and with orientation X = b. Electron microprobe analyses and structure refinement gave the empirical formula (Mn2+0.59Ca0.38Na0.03)Σ1.00Mn1.00(Mn2+1.04Fe3+0.58Fe2+0.23Zn0.16Mg0.08)Σ2.09Al2.04(PO4)3.89(OH)3.18(H2O)7.26. Whiteite-(MnMnMn) is monoclinic, P2/a, a = 15.024(3) Å, b = 6.9470(14) Å, c = 9.999(2) Å, β = 110.71(3)°, V = 976.2(4) Å3 and Z = 2. The crystal structure was refined using synchrotron single-crystal data to wRobs = 0.057 for 2014 reflections with I > 3σ(I). Site occupancy refinements confirm the ordering of dominant Mn in the X, M1 and M2 sites of the general jahnsite-group formula XM1(M2)2(M3)2(H2O)8(OH)2(PO4)4. A review of published crystallochemical data for jahnsite-group minerals shows a consistent chemical pressure effect in these minerals, manifested as a contraction of the unit-cell parameter, a, as the mean size of the X and M1 site cations increases. This is analogous to negative thermal expansion, but with increasing cation size, rather than heating, inducing octahedral rotations that result in an anisotropic contraction of the unit cell.
To review patient satisfaction with the change in practice towards telephone consultations during and after the coronavirus disease 2019 pandemic for head and neck cancer follow up.
Method
A retrospective analysis was conducted of head and neck cancer telephone appointments during a six-month period in a tertiary referral centre.
Results
Patients found the telephone consultations beneficial (98 per cent), with 30 per cent stating they were relieved to not have to attend hospital. Patients who travelled further, those with lower stage disease and patients with a greater interval from initial treatment were most satisfied with the telephone consultations. Sixty-eight per cent of patients stated they would be happy to have telephone consultations as part of their regular follow up after the pandemic.
Conclusion
Patients found the telephone consultations beneficial and 30 per cent considered them preferable to face-to-face appointments. This study demonstrates that telephone consultations can be used as an adjunct to face-to-face appointments in an effort to reduce hospital attendances whilst maintaining close follow up.
Glyphosate and paraquat are effective preplant burndown herbicide options for multicrop vegetable production that uses plastic mulch, but problematic weeds such as wild radish, cutleaf evening primrose, annual morningglory, or horseweed may not be adequately controlled with these herbicides alone. The herbicides 2,4-D and dicamba could help control these troublesome weeds prior to planting if they can be removed from plastic mulch and thus avoid crop damage. Treatments included 2,4-D (1,065 and 2,130 g ae ha−1) and dicamba (560 and 1,120 g ae ha−1) applied broadcast over plastic mulch a day before transplanting. Just before transplanting, treatments received either 0.76 cm of water via overhead irrigation or no irrigation. Plastic mulch samples were collected at application and planting to determine herbicide presence using analytical techniques, and cantaloupe and zucchini squash were subsequently transplanted on the plastic beds. Analytical ultra-high performance liquid chromatography revealed that 88% to 99% of the initial herbicide concentration was present at crop planting when irrigation was not implemented. At most, a 1/50 rate of dicamba and a 1/500 rate of 2,4-D was present at planting when overhead irrigation was applied prior to transplanting. Maximum cantaloupe and squash injury from 2,4-D with irrigation was 10% and did not influence plant growth, biomass, or yield. For dicamba with overhead irrigation, cantaloupe injury was 35%, vine lengths were reduced by 24%, and maturity was delayed, whereas squash injury ranged from 9% to 12%, with no influence on growth or yield. Without irrigation to wash herbicides from the mulch prior to planting, 60% to 100% injury of both crops occurred with both herbicides. Zucchini squash was more tolerant to dicamba than cantaloupe. Results demonstrated that 2,4-D can be adequately removed from the surface of plastic mulch with irrigation, whereas a single irrigation event was not sufficient to remove dicamba.
The reproductive characteristics of co-occurring freespine flathead, Ratabulus diversidens, and mud flathead, Ambiserrula jugosa, that interact with fisheries across continental shelf waters of eastern Australia were examined. Samples were collected across three depth strata and two locations on a monthly basis over two years. Males of both species matured younger and at smaller total lengths (TL) than females. Estimated TL and age (years) at maturity (L50 and A50, respectively) of R. diversidens also varied between locations, but differences were not related to differential growth. Although some mature individuals of both species occurred year-round, they were most prevalent and gonadosomatic indices greatest, between the austral spring and autumn. Mature R. diversidens almost exclusively occurred in deeper offshore waters, whereas the opposite was evident for A. jugosa. Both species displayed asynchronous oocyte development, and were thus considered capable of spawning more than once throughout each spawning season. Potential batch fecundity was positively related to TL for R. diversidens, but not A. jugosa, possibly due to the small size of the latter species. The sex ratios for R. diversidens varied between locations and length categories, and like A. jugosa the larger categories were skewed towards females, a result of divergent growth between sexes. Macroscopic and microscopic evidence indicated both species were gonochoristic. The data provide new information for fisheries management consideration and contribute to the data-poor international knowledge base of platycephalid biology.
ABSTRACT IMPACT: We hope to provide a more nuanced understanding of the type-III IFN system, thereby exploring its therapeutic potential in the realm of infectious diseases. OBJECTIVES/GOALS: The role of IFNLR1 receptor dynamics and plasticity in regulating the type-III IFN response is largely unknown. As a specific, powerful component of innate immunity, understanding how the type-III IFN system is regulated could lead to the development of novel therapeutic targets and strategies to face a multitude of viral illnesses. METHODS/STUDY POPULATION: To facilitate our investigation, we will generate doxycycline-inducible FLAG-tagged IFNLR1-expression plasmids representing all known transcriptional variants. These plasmids will allow us to: 1) Evaluate the effect of IFNLR1 surface abundance on the type-III IFN transcriptional profile and 2) Assess the extent of IFNLR1-FLAG co-localization with several notable intracellular structures using immunofluorescence, before and after stimulation with IFNL3. RESULTS/ANTICIPATED RESULTS: We have successfully generated three IFNLR1-FLAG transcriptional variants and confirmed inducible-expression and function in vitro. We are currently assessing the role of surface abundance, internalization, differential isoform expression, and trafficking. DISCUSSION/SIGNIFICANCE OF FINDINGS: By completing this study, we hope to provide a more nuanced understanding of the type-III IFN system, thereby exploring its therapeutic potential in the realm of infectious diseases.
The Southern dietary pattern, derived within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, is characterised by high consumption of added fats, fried food, organ meats, processed meats and sugar-sweetened beverages and is associated with increased risk of several chronic diseases. The aim of the present study was to identify characteristics of individuals with high adherence to this dietary pattern. We analysed data from REGARDS, a national cohort of 30 239 black and white adults ≥45 years of age living in the USA. Dietary data were collected using the Block 98 FFQ. Multivariable linear regression was used to calculate standardised beta coefficients across all covariates for the entire sample and stratified by race and region. We included 16 781 participants with complete dietary data. Among these, 34·6 % were black, 45·6 % male, 55·2 % resided in stroke belt region and the average age was 65 years. Black race was the factor with the largest magnitude of association with the Southern dietary pattern (Δ = 0·76 sd, P < 0·0001). Large differences in Southern dietary pattern adherence were observed between black participants and white participants in the stroke belt and non-belt (stroke belt Δ = 0·75 sd, non-belt Δ = 0·77 sd). There was a high consumption of the Southern dietary pattern in the US black population, regardless of other factors, underlying our previous findings showing the substantial contribution of this dietary pattern to racial disparities in incident hypertension and stroke.
The loss of methyl bromide led vegetable growers to rely more heavily on herbicides to control weeds. Although herbicides can be effective, limited options in vegetable production challenge growers. Identifying new, effective tools to be applied over plastic mulch before planting, for improved weed control with minimal crop injury, would be beneficial. The objective of these experiments was to evaluate the persistence of preplant applications of glyphosate (1,125 or 2,250 g ae ha−1) plus 2,4-D (1,065 or 2,130 g ae ha−1) or dicamba (560 g ae ha−1) over plastic mulch, using analytical techniques and subsequent yellow squash and watermelon response. Glyphosate and 2,4-D were not analytically detected at damaging concentrations on plastic mulch when at least 3.5 cm of rainfall was received after application and before planting. In addition, bioassay results showing less than 10% visual injury for either squash and watermelon, with no growth or yield suppression observed, supported analytical results. In contrast, dicamba concentrations on plastic mulch, regardless of rainfall amount or time between application and planting, remained at damaging levels. Squash yields were reduced by dicamba applied 1 to 30 d before planting, whereas watermelon was more resilient. 2,4-D plus glyphosate applied preplant over plastic mulch can provide an additional herbicide option for vegetable growers. More research is needed to understand the impact of residual activity of 2,4-D when transplants land directly in holes in plastic mulch at the time of application. The relationship of dicamba with plastic mulch is complex, because the herbicide cannot be easily removed by rainfall. Thus, dicamba should not be included in a weed management system in plasticulture vegetable production.
An early economic evaluation to inform the translation into clinical practice of a spectroscopic liquid biopsy for the detection of brain cancer. Two specific aims are (1) to update an existing economic model with results from a prospective study of diagnostic accuracy and (2) to explore the potential of brain tumor-type predictions to affect patient outcomes and healthcare costs.
Methods
A cost-effectiveness analysis from a UK NHS perspective of the use of spectroscopic liquid biopsy in primary and secondary care settings, as well as a cost–consequence analysis of the addition of tumor-type predictions was conducted. Decision tree models were constructed to represent simplified diagnostic pathways. Test diagnostic accuracy parameters were based on a prospective validation study. Four price points (GBP 50-200, EUR 57-228) for the test were considered.
Results
In both settings, the use of liquid biopsy produced QALY gains. In primary care, at test costs below GBP 100 (EUR 114), testing was cost saving. At GBP 100 (EUR 114) per test, the ICER was GBP 13,279 (EUR 15,145), whereas at GBP 200 (EUR 228), the ICER was GBP 78,300 (EUR 89,301). In secondary care, the ICER ranged from GBP 11,360 (EUR 12,956) to GBP 43,870 (EUR 50,034) across the range of test costs.
Conclusions
The results demonstrate the potential for the technology to be cost-effective in both primary and secondary care settings. Additional studies of test use in routine primary care practice are needed to resolve the remaining issues of uncertainty—prevalence in this patient population and referral behavior.
Social inequality is ubiquitous in contemporary human societies, and has deleterious social and ecological impacts. However, the factors that shape the emergence and maintenance of inequality remain widely debated. Here we conduct a global analysis of pathways to inequality by comparing 408 non-industrial societies in the anthropological record (described largely between 1860 and 1960) that vary in degree of inequality. We apply structural equation modelling to open-access environmental and ethnographic data and explore two alternative models varying in the links among factors proposed by prior literature, including environmental conditions, resource intensification, wealth transmission, population size and a well-documented form of inequality: social class hierarchies. We found support for a model in which the probability of social class hierarchies is associated directly with increases in population size, the propensity to use intensive agriculture and domesticated large mammals, unigeniture inheritance of real property and hereditary political succession. We suggest that influence of environmental variables on inequality is mediated by measures of resource intensification, which, in turn, may influence inequality directly or indirectly via effects on wealth transmission variables. Overall, we conclude that in our analysis a complex network of effects are associated with social class hierarchies.
During the last fifteen years there has been a paradigm shift in the continuum modelling of granular materials; most notably with the development of rheological models, such as the $\mu (I)$-rheology (where $\mu$ is the friction and I is the inertial number), but also with significant advances in theories for particle segregation. This paper details theoretical and numerical frameworks (based on OpenFOAM) which unify these currently disconnected endeavours. Coupling the segregation with the flow, and vice versa, is not only vital for a complete theory of granular materials, but is also beneficial for developing numerical methods to handle evolving free surfaces. This general approach is based on the partially regularized incompressible $\mu (I)$-rheology, which is coupled to the gravity-driven segregation theory of Gray & Ancey (J. Fluid Mech., vol. 678, 2011, pp. 353–588). These advection–diffusion–segregation equations describe the evolving concentrations of the constituents, which then couple back to the variable viscosity in the incompressible Navier–Stokes equations. A novel feature of this approach is that any number of differently sized phases may be included, which may have disparate frictional properties. Further inclusion of an excess air phase, which segregates away from the granular material, then allows the complex evolution of the free surface to be captured simultaneously. Three primary coupling mechanisms are identified: (i) advection of the particle concentrations by the bulk velocity, (ii) feedback of the particle-size and/or frictional properties on the bulk flow field and (iii) influence of the shear rate, pressure, gravity, particle size and particle-size ratio on the locally evolving segregation and diffusion rates. The numerical method is extensively tested in one-way coupled computations, before the fully coupled model is compared with the discrete element method simulations of Tripathi & Khakhar (Phys. Fluids, vol. 23, 2011, 113302) and used to compute the petal-like segregation pattern that spontaneously develops in a square rotating drum.
Galeaclolusite, [Al6(AsO4)3(OH)9(H2O)4]⋅8H2O, is a new secondary hydrated aluminium arsenate mineral from Cap Garonne, Var, France. It forms crusts and spheroids of white fibres up to 50 μm long by 0.4 μm wide and only 0.1 μm thick. The fibres are elongated along [001] and flattened on (100). The calculated density is 2.27 g⋅cm–3. Optically, galeaclolusite is biaxial with α = 1.550(5), β not determined, γ = 1.570(5) (white light) and partial orientation: Z = c (fibre axis). Electron microprobe analyses coupled with crystal structure refinement results gives an empirical formula based on 33 O atoms of Al5.72Si0.08As2.88O33H34.12. Galeaclolusite is orthorhombic, Pnma, with a = 19.855(4), b = 17.6933(11), c = 7.7799(5) Å, V = 2733.0(7) Å3 and Z = 4. The crystal structure of galeaclolusite was established from its close relationship to bulachite and refined using synchrotron powder X-ray diffraction data. It is based on heteropolyhedral layers, parallel to (100), of composition Al6(AsO4)3(OH)9(H2O)4 and with H-bonded H2O between the layers. The layers contain [001] spiral chains of edge-shared octahedra, decorated with corner-connected AsO4 tetrahedra, that are the same as in the mineral liskeardite.
Emotional cognition and effective interpretation of affective information is an important factor in social interactions and everyday functioning, and difficulties in these areas may contribute to aetiology and maintenance of mental health conditions. In younger people with depression and anxiety, research suggests significant alterations in behavioural and brain activation aspects of emotion processing, with a tendency to appraise neutral stimuli as negative and attend preferentially to negative stimuli. However, in ageing, research suggests that emotion processing becomes subject to a ‘positivity effect’, whereby older people attend more to positive than negative stimuli.
Aims
This review examines data from studies of emotion processing in Late-Life Depression and Late-Life Anxiety to attempt to understand the significance of emotion processing variations in these conditions, and their interaction with changes in emotion processing that occur with ageing.
Method
We conducted a systematic review following PRISMA guidelines. Articles that used an emotion-based processing task, examined older persons with depression or an anxiety disorder and included a healthy control group were included.
Results
In Late-Life Depression, there is little consistent behavioural evidence of impaired emotion processing, but there is evidence of altered brain circuitry during these processes. In Late-Life Anxiety and Post-Traumatic Stress disorder, there is evidence of interference with processing of negative or threat-related words.
Conclusions
How these findings fit with the positivity bias of ageing is not clear. Future research is required in larger groups, further examining the interaction between illness and age and the significance of age at disease onset.
Despite advances in endovascular interventions, including the introduction of drug-eluting stents (DES), high target lesion revascularization (TLR) rates still burden the treatment of symptomatic lower-limb peripheral arterial disease (PAD). EluviaTM, a novel, sustained-release, paclitaxel-eluting DES, was shown to further reduce TLRs when compared with the paclitaxel-coated Zilver® PTX® stent, in the IMPERIAL randomized controlled trial. This evaluation estimated the cost-effectiveness of Eluvia when compared with Zilver PTX in Australia, based on 12-month clinical outcomes from the IMPERIAL trial.
Methods
A state-transition, decision-analytic model with a 12-month time horizon was developed from an Australian public healthcare system perspective. Cost parameters were obtained from the Australian National Hospital Cost Data Collection Cost Report (2016–17). All costs were captured in Australian dollars (AUD), where AUD 1 = USD 0.69 (June 2020). Complete sets of clinical parameters (primary patency loss, TLR, amputation, and death) and cost parameters from their respective distributions were bootstrapped in samples of 1,000 patients, for each intervention arm of the model. One-way and probabilistic sensitivity analyses were performed.
Results
At 12 months, modeled TLR rates were 4.5 percent for Eluvia and 8.9 percent for Zilver PTX, and mean total direct costs were AUD 6,537 [USD 4,511] and AUD 6,908 [USD 4,767], respectively (Eluvia average per patient savings; overall cohort=AUD 371 [USD 256]; diabetic cohort=AUD 625 [USD 431]). In probabilistic sensitivity analyses, Eluvia was cost-effective relative to Zilver PTX in 92.0 percent of all simulations at a threshold of $10,000 per TLR avoided. Eluvia was more effective and less costly (dominant) than Zilver PTX in 76.0 percent of simulations.
Conclusions
In the first year after the intervention, Eluvia was more effective and less costly than Zilver PTX, making Eluvia the dominant treatment strategy for treatment of symptomatic lower-limb PAD, from an Australian public healthcare system perspective. These findings should be considered when formulating policy and practice guidelines in the context of priority setting and making evidence-based resource allocation decisions for treatment of PAD in Australia.
Children and young people with intellectual disability and/or Autism Spectrum Disorder (autism) experience higher rates of mental health problems, including depression, than their typically developing peers. Although international guidelines suggest psychological therapies as first-line intervention for children and young people, there is limited evidence for psychological therapy for depression in children and young people with intellectual disability and/or autism.
Aims
To evaluate the current evidence base for psychological interventions for depression in children and young people with intellectual disability and/or autism, and examine the experiences of children and young people with intellectual disability and/or autism, their families and therapists, in receiving and delivering psychological treatment for depression.
Method
Databases were searched up to 30 April 2020 using pre-defined search terms and criteria. Articles were independently screened and assessed for risk of bias. Data were synthesised and reported in a narrative review format.
Results
A total of 10 studies met the inclusion criteria. Four identified studies were clinical case reports and six were quasi-experimental or experimental studies. All studies were assessed as being of moderate or high risk of bias. Participants with intellectual disability were included in four studies. There was limited data on the experiences of young people, their families or therapists in receiving or delivering psychological treatment for depression.
Conclusions
Well-designed, randomised controlled trials are critical to develop an evidence base for psychological treatment for young people with intellectual disability and/or autism with depression. Future research should evaluate the treatment experiences of young people, their families and therapists.