Cost-effectiveness acceptability curves - facts, fallacies and frequently asked questions

Cost-effectiveness acceptability curves (CEACs) have been widely adopted as a method to quantify and graphically represent uncertainty in economic evaluation studies of health-care technologies. However, there remain some common fallacies regarding the nature and shape of CEACs that largely result from the textbook illustration of the CEAC. This textbook CEAC shows a smooth curve starting at probability 0, with an asymptote to 1 for higher money values of the health outcome (). But this familiar ogive shape which makes the textbook CEAC look like a cumulative distribution function is just one special case of the CEAC. The reality is that the CEAC can take many shapes and turns because it is a graphic transformation from the cost-effectiveness plane, where the joint density of incremental costs and effects may straddle quadrants with attendant discontinuities and asymptotes. In fact CEACs: (i) do not have to cut the y-axis at 0; (ii) do not have to asymptote to 1; (iii) are not always monotonically increasing in ; and (iv) do not represent cumulative distribution functions (cdfs). Within this paper we present a gallery of CEACs in order to identify the fallacies and illustrate the facts surrounding the CEAC. The aim of the paper is to serve as a reference tool to accompany the increased use of CEACs within major medical journals

National counter-terrorism (C-T) policies and challenges to human rights and civil liberties: Case study of United Kingdom

In the UK the rise post-2005 in “home-grown” terrorism, relying to a significant extent on strikes on soft targets by “self-starters,” means that the search for effective preventive measures remains a continuing concern. Below a number of the preventive counter-terror measures adopted post-9/11, and incrementally strengthened in response to the current threat, are found to fall into three categories and represent interventions at the stages in the path toward attacks. This chapter focuses on selected examples of these preventive measures. In terms of three key stages, firstly, there is the attempt to prevent radicalization, under the “Prevent” strategy. A second strategy relies on taking certain measures to control the activities of those considered likely – on the balance of probabilities – to engage in terrorist-related activity. A third preventive strategy relies on the special terrorism offences under the Terrorism Acts 2000 and 2006, as amended, intended to allow for intervention at a very early stage in terrorist plots and in preparing or instigating terrorist acts (“precursor” offences)

Praziquantel coverage in schools and communities targeted for the elimination of urogenital schistosomiasis in Zanzibar: a cross-sectional survey

© 2015 Knopp et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. The attached file is the published version of the article

Effects of negative energy balance on liver gene and protein expression during the early postpartum period and its impacts on dairy cow fertility

End of project reportNegative energy balance (NEB) is a severe metabolic affecting high yielding dairy cows early post partum with both concurrent and latent negative effects on cow fertility as well as on milk production and cow health. The seasonal nature of Irish dairy production necessitates high cow fertility and a compact spring calving pattern in order to maximise grass utilisation. Poor dairy cow reproductive performance currently costs the Irish cattle industry in excess of €400 million annually. High milk yields have been associated with lower reproductive efficiency, and it has been suggested that this effect is probably mediated through its effects on the energy balance of the cow during lactation. The modern high genetic merit dairy cow prioritises nutrient supply towards milk production in early lactation and this demand takes precedence over the provision of optimal conditions for reproduction. In this study we used the bovine Affymetrix 23,000 gene microarray, which contains the most comprehensive set of bovine genes to be assembled and provides a means of investigating the modifying influences of energy balance on liver gene expression. Cows in severe negative energy balance (SNEB) in early lactation showed altered hepatic gene expression in metabolic processes as well as a down regulation of the insulin-like growth factor (IGF) system, where insulin like growth factor-1 (IGF-1), growth hormone receptor variant 1A (GHR1A) and insulin-like growth factor binding protein-acid labile subunit (IGFBP-ALS) were down regulated compared to the cows in the moderate negative energy balance MNEB group, consistent with a five-fold reduction in systemic concentrations of IGF1 in the SNEB group.Cows in SNEB showed elevated expression of key genes involved in the inflammatory response such as interleukin-8 (IL-8). There was a down regulation of genes involved in cellular growth in SNEB cows and moreover a negative regulator of cellular proliferation (HGFIN) was up regulated in SNEB cows, which is likely to compromise adaptation and recovery from NEB. The puma method of analysis revealed that 417 genes were differentially regulated by EB (P<0.05), of these genes 190 were up-regulated while 227 were down-regulated, with 405 genes having known biological functions. From Ingenuity Pathway Analysis (IPA), lipid catabolism was found to be the process most affected by differences in EB status

A Tentative Detection of a Starspot During Consecutive Transits of an Extrasolar Planet from the Ground: No Evidence of a Double Transiting Planet System Around TrES-1

There have been numerous reports of anomalies during transits of the planet TrES-1b. Recently, Rabus and coworkers' analysis of HST observations lead them to claim brightening anomalies during transit might be caused by either a second transiting planet or a cool starspot. Observations of two consecutive transits are presented here from the University of Arizona's 61-inch Kuiper Telescope on May 12 and May 15, 2008 UT. A 5.4 +/- 1.7 mmag (0.54 +/- 0.17%) brightening anomaly was detected during the first half of the transit on May 12 and again in the second half of the transit on May 15th. We conclude that this is a tentative detection of a r greater than or equal to 6 earth radii starspot rotating on the surface of the star. We suggest that all evidence to date suggest TrES-1 has a spotty surface and there is no need to introduce a second transiting planet in this system to explain these anomalies. We are only able to constrain the rotational period of the star to 40.2 +22.9 -14.6 days, due to previous errors in measuring the alignment of the stellar spin axis with the planetary orbital axis. This is consistent with the previously observed P_obs = 33.2 +22.3 -14.3 day period. We note that this technique could be applied to other transiting systems for which starspots exist on the star in the transit path of the planet in order to constrain the rotation rate of the star. (abridged)Comment: 21 pages, 3 tables, 6 figures, Accepted to Ap

The seroprevalence and factors associated with Ross River virus infection in Western Grey Kangaroos (Macropus fuliginosus) in Western Australia

A serosurvey was undertaken in 15 locations in the midwest to southwest of Western Australia (WA) to investigate the seroprevalence of Ross River virus (RRV) neutralizing antibodies and factors associated with infection in western grey kangaroos (Macropus fuliginosus). The estimated seroprevalence in 2632 kangaroo samples, using a serum neutralization test, was 43.9% (95% CI 42.0, 45.8). Location was significantly associated with seroprevalence (p 0.05). The results of this study indicate that kangaroos in WA are regularly infected with RRV and may be involved in the maintenance and transmission of RRV

Study and implementation of urogenital schistosomiasis elimination in Zanzibar (Unguja and Pemba islands) using an integrated multidisciplinary approach

ABSTRACT: BACKGROUND: Schistosomiasis is a parasitic infection that continues to be a major public health problem in many developing countries being responsible for an estimated burden of at least 1.4 million disability-adjusted life years (DALYs) in Africa alone. However, morbidity due to schistosomiasis has been greatly reduced in some parts of the world, including Zanzibar. The Zanzibar government is now committed to eliminate urogenital schistosomiasis. Over the next 3--5 years, the whole at-risk population will be administered praziquantel (40 mg/kg) biannually. Additionally, snail control and behaviour change interventions will be implemented in selected communities and the impact measured in a randomized intervention trial. METHODS: In this 5-year research study, on both Unguja and Pemba islands, urogenital schistosomiasis will be assessed in 45 communities with urine filtration and reagent strips in 4,500 schoolchildren aged 9--12 years annually, and in 4,500 first-year schoolchildren and 2,250 adults in years 1 and 5. Additionally, from first-year schoolchildren, a finger-prick blood sample will be collected and examined for Schistosoma haematobium infection biomarkers. Changes in prevalence and infection intensity will be assessed annually. Among the 45 communities, 15 were randomized for biannual snail control with niclosamide, in concordance with preventive chemotherapy campaigns. The reduction of Bulinus globosus snail populations and S. haematobium-infected snails will be investigated. In 15 other communities, interventions triggering behaviour change have been designed and will be implemented in collaboration with the community. A change in knowledge, attitudes and practices will be assessed annually through focus group discussions and in-depth interviews with schoolchildren, teachers, parents and community leaders. In all 45 communities, changes in the health system, water and sanitation infrastructure will be annually tracked by standardized questionnaire-interviews with community leaders. Additional issues potentially impacting on study outcomes and all incurring costs will be monitored and recorded. DISCUSSION: Elimination of schistosomiasis has become a priority on the agenda of the Zanzibar government and the international community. Our study will contribute to identifying what, in addition to preventive chemotherapy, needs to be done to prevent, control, and ultimately eliminate schistosomiasis, and to draw lessons for current and future schistosomiasis elimination programmes in Africa and elsewhere.Trial registrationISRCTN4883768

Same...same but different: Expectations of graduates from two midwifery education courses in Australia

Aims and objectives. To identify the expectations and workforce intentions of new graduate midwives from two different pre-registration educational courses at one Australian university. Background. In Australia there are two different educational pathways to midwifery qualification, one offered for registered nurses, commonly at a postgraduate level and the other for non-nurses, at an undergraduate level. The knowledge about midwifery graduates in general is reasonably limited and there is no specific research that examines the similarities and differences between graduates from the two different courses. Design. A cross-sectional design was used. Method. Data were collected by questionnaire from both undergraduate and postgraduate midwifery graduates in 2007 and 2008 at one Australian university. Data were analysed using descriptive statistics. Results. Almost all the graduates from the two different pre-registration courses intended to enter the midwifery workforce with both groups rating the factors that influenced this decision similarly. There were, however, significant differences in graduates age and their intention to work part time. Their views of their ideal roles and subsequent uptake into formal new graduate transition programmes differed. Graduates from the two courses also reported philosophical differences regarding their concepts of job satisfaction and ways their jobs could be improved. Conclusions. The graduates from the two different courses showed sufficient significant differences to warrant consideration in current workforce planning for midwifery. Relevance to clinical practice. The factors that influence the career decisions of new graduate midwives can positively impact educational and workforce planning. The findings may be able to help inform strategies to address turnover and attrition in midwifery. © 2011 Blackwell Publishing Ltd