Target-D, a new person-centred e-health platform matching depression care to symptom severity prognosis (minimal/mild, moderate or severe) has demonstrated greater improvement in depressive symptoms ...than usual care plus attention control. The aim of this study was to evaluate the cost-effectiveness of Target-D compared to usual care from a health sector and partial societal perspective across 3-month and 12-month follow-up.
A cost-utility analysis was conducted alongside the Target-D randomised controlled trial; which involved 1,868 participants attending 14 general practices in metropolitan Melbourne, Australia. Data on costs were collected using a resource use questionnaire administered concurrently with all other outcome measures at baseline, 3-month and 12-month follow-up. Intervention costs were assessed using financial records compiled during the trial. All costs were expressed in Australian dollars (A$) for the 2018-19 financial year. QALY outcomes were derived using the Assessment of Quality of Life-8D (AQoL-8D) questionnaire. On a per person basis, the Target-D intervention cost between $14 (minimal/mild prognostic group) and $676 (severe group). Health sector and societal costs were not significantly different between trial arms at both 3 and 12 months. Relative to a A$50,000 per QALY willingness-to-pay threshold, the probability of Target-D being cost-effective under a health sector perspective was 81% at 3 months and 96% at 12 months. From a societal perspective, the probability of cost-effectiveness was 30% at 3 months and 80% at 12 months.
Target-D is likely to represent good value for money for health care decision makers. Further evaluation of QALY outcomes should accompany any routine roll-out to assess comparability of results to those observed in the trial. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000537459).
This edited collection tells the story behind a ground-breaking Welsh law which reinforces the human rights of children and young people in Welsh devolved government, examines the impact of this law ...in selected policy areas and shows why the Welsh approach is attracting worldwide interest.
Biodiversity and Ecosystem Functioning Tilman, David; Isbell, Forest; Cowles, Jane M
Annual review of ecology, evolution, and systematics,
11/2014, Volume:
45, Issue:
1
Journal Article
Peer reviewed
Species diversity is a major determinant of ecosystem productivity, stability, invasibility, and nutrient dynamics. Hundreds of studies spanning terrestrial, aquatic, and marine ecosystems show that ...high-diversity mixtures are approximately twice as productive as monocultures of the same species and that this difference increases through time. These impacts of higher diversity have multiple causes, including interspecific complementarity, greater use of limiting resources, decreased herbivory and disease, and nutrient-cycling feedbacks that increase nutrient stores and supply rates over the long term. These experimentally observed effects of diversity are consistent with predictions based on a variety of theories that share a common feature: All have trade-off-based mechanisms that allow long-term coexistence of many different competing species. Diversity loss has an effect as great as, or greater than, the effects of herbivory, fire, drought, nitrogen addition, elevated CO
2
, and other drivers of environmental change. The preservation, conservation, and restoration of biodiversity should be a high global priority.
The use of core outcome sets (COS) ensures that researchers measure and report those outcomes that are most likely to be relevant to users of their research. Several hundred COS projects have been ...systematically identified to date, but there has been no formal quality assessment of these studies. The Core Outcome Set-STAndards for Development (COS-STAD) project aimed to identify minimum standards for the design of a COS study agreed upon by an international group, while other specific guidance exists for the final reporting of COS development studies (Core Outcome Set-STAndards for Reporting COS-STAR).
An international group of experienced COS developers, methodologists, journal editors, potential users of COS (clinical trialists, systematic reviewers, and clinical guideline developers), and patient representatives produced the COS-STAD recommendations to help improve the quality of COS development and support the assessment of whether a COS had been developed using a reasonable approach. An open survey of experts generated an initial list of items, which was refined by a 2-round Delphi survey involving nearly 250 participants representing key stakeholder groups. Participants assigned importance ratings for each item using a 1-9 scale. Consensus that an item should be included in the set of minimum standards was defined as at least 70% of the voting participants from each stakeholder group providing a score between 7 and 9. The Delphi survey was followed by a consensus discussion with the study management group representing multiple stakeholder groups. COS-STAD contains 11 minimum standards that are the minimum design recommendations for all COS development projects. The recommendations focus on 3 key domains: the scope, the stakeholders, and the consensus process.
The COS-STAD project has established 11 minimum standards to be followed by COS developers when planning their projects and by users when deciding whether a COS has been developed using reasonable methods.
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in late 2019, and its resulting coronavirus disease, COVID-19, was declared a pandemic by the World ...Health Organization on March 11, 2020. The rapid global spread of COVID-19 represents perhaps the most significant public health emergency in a century. As the pandemic progressed, a continued paucity of evidence on routes of SARS-CoV-2 transmission has resulted in shifting infection prevention and control guidelines between classically-defined airborne and droplet precautions. During the initial isolation of 13 individuals with COVID-19 at the University of Nebraska Medical Center, we collected air and surface samples to examine viral shedding from isolated individuals. We detected viral contamination among all samples, supporting the use of airborne isolation precautions when caring for COVID-19 patients.
Alors que, depuis les années 1960, les États-Uniens puisent dans la culture amérindienne dans l’espoir de redonner un sens à leur vie dans une société matérialiste, le programme spatial de la NASA ...reflète une cosmologie et un ethos auxquels se heurte la cosmologie zuni. Loin de la compréhension occidentale de l’espace comme un ensemble de corps inanimés, celle-ci témoigne notamment d’une vision englobante de l’individu dans l’univers, lequel comporte des corps célestes personnifiés selon une mythologie riche et ancienne. En cela, le programme Apollo peut être appréhendé non seulement comme son antithèse, mais également comme la traduction de l’opposition historique entre Anglo-Américains et Amérindiens. Parce que l’analyse d’une cosmologie permet de mettre à nu les mécanismes idéologiques intervenant dans l’organisation d’une société et de ses politiques, la définition du programme spatial ne peut finalement être indépendante de la manière dont une culture conçoit l’organisation de l’univers et la place qu’y détient l’être humain.
Aryl hydrocarbon receptor (AhR) is a member of the basic helix-loop-helix-(bHLH) superfamily of transcription factors, which are associated with cellular responses to environmental stimuli, such as ...xenobiotics and oxygen levels. Unlike other members of bHLH, AhR is the only bHLH transcription factor that is known to be ligand activated. Early AhR studies focused on understanding the role of AhR in mediating the toxicity and carcinogenesis properties of the prototypic ligand 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). In recent years, however, it has become apparent that, in addition to its toxicological involvement, AhR is highly receptive to a wide array of endogenous and exogenous ligands, and that its activation leads to a myriad of key host physiological functions. In this study, we review the current understanding of the functions of AhR in the mucosal immune system with a focus on its role in intestinal barrier function and intestinal immune cells, as well as in intestinal homeostasis.
Urban geographies I Jacobs, Jane M.
Progress in human geography,
06/2012, Volume:
36, Issue:
3
Journal Article
Peer reviewed
This review essay revisits recent scholarship within urban geography that has been shaped by relational theory, looking specifically at the scholarship on urban policy mobilities and urban ...assemblages. As will be shown, current urban geographies of relationality operate with irreconcilable grammars.
Since bull fertility may be adversely affected by hot humid conditions, the current increase in global temperature is of concern for future livestock production. Heat stress occurs when the body’s ...normal physiological mechanisms to regulate body temperature cannot cope with external conditions. The testes and scrotum have their own complex regulatory mechanisms to protect developing sperm during their most vulnerable stages, but even these may be overwhelmed by unfavourable external conditions. The effects of mild, moderate and severe heat stress are somewhat different, with cattle exposed to mild and moderate heat stress apparently showing an adverse effect on fertility, whereas cattle in very hot, humid climates almost continuously may not exhibit any difference in sperm quality throughout the year. This apparent paradox may be due to differences in the cattle populations being studied, since they could differ in breed, age, purpose (beef versus dairy), or even in the methods used to assess sperm quality. The adverse effects on fertility may occur through the effects of reactive oxygen species on sperm DNA, or through perturbation of the production of antioxidants that usually protect sperm from oxidative attack. These effects can be mitigated to some extent by choosing breed and age of bulls with care, and adopting breeding strategies that avoid semen collection or ejaculation at the most adverse times of year. Husbandry measures such as controlled ventilation, misting, provision of shade or cool surfaces for lying down, could aid temperature regulation. Avoiding heat stress during late pregnancy aids calf growth in early life; careful feeding regimens for young bull calves create good conditions for sperm quality after puberty. Bull fertility is too important to be left to chance. Breeds should be chosen according to climate conditions and the purpose of livestock production.
•Bull fertility may be adversely affected by hot humid conditions.•Manifestation of heat stress represents a complex interaction of factors.•Effects of natural mild, moderate and severe heat stress differ.•Scrotal insulation is not a representative model for climate change.•Heat stress can be mitigated to some extent by management and husbandry.
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