Using Evidence in the development of local health policies : Some Evidence from the United Kingdom

Objectives: This paper explores the use of evidence, focusing on economic evidence in particular, in the development of local health policies through an in-depth study of Health Improvement Programmes (HImPs) in England. Methods: A questionnaire was sent to the person responsible for coordinating the development of the HImP in each of the 102 English health authorities. In addition, semi-structured interviews were conducted with 10 HImP leaders, and a random sample of 26 HImP documents was reviewed using a standard pro forma. Results: Of the 102 mail questionnaires sent out, 68 (67%) were returned. It was found that those developing HImPs had multiple objectives, only some of which (e.g., efficiency in healthcare provision) would necessarily require evidence.Where evidence was used, this was a mixture of internal (experiential) and external (empirical) evidence, with the balance (66%) being in favor of the latter. Government reports and guidance from the National Institute for Clinical Excellence (NICE), were the main sources of external evidence, rather than published papers. Key barriers to the use of economic evidence were lack of time and availability and the difficulties in synthesizing information at the local level. Conclusions: Based on responses to our survey, the main ways of increasing the use of evidence in the development of local health policies in England are to produce more evidence-based national guidance and to produce accessible summaries of the available literature for local decision makers

Are policy decisions on surgical procedures informed by robust economic evidence? A systematic review

Objectives: The aim of this study was to examine the empirical and methodological cost-effectiveness evidence of surgical interventions for breast, colorectal, or prostate cancer. Methods: A systematic search of seven databases including MEDLINE, EMBASE, and NHSEED, research registers, the NICE Web site and conference proceedings was conducted in April 2012. Study quality was assessed in terms of meeting essential, preferred and UK NICE specific requirements for economic evaluations. Results: The seventeen (breast = 3, colorectal = 7, prostate = 7) included studies covered a broad range of settings (nine European; eight non-European) and six were published over 10 years ago. The populations, interventions and comparators were generally well defined. Very few studies were informed by literature reviews and few used synthesized clinical evidence. Although the interventions had potential differential effects on recurrence and mortality rates, some studies used relatively short time horizons. Univariate sensitivity analyses were reported in all studies but less than a third characterized all uncertainty with a probabilistic sensitivity analysis. Although a third of studies incorporated patients' health-related quality of life data, only four studies used social tariff values. Conclusions: There is a dearth of recent robust evidence describing the cost-effectiveness of surgical interventions in the management of breast, colorectal and prostate cancers. Many of the recent publications did not satisfy essential methodological requirements such as using clinical evidence informed by a systematic review and synthesis. Given the ratio of potential benefit and harms associated with cancer surgery and the volume of resources consumed by these, there is an urgent need to increase economic evaluations of these technologies

A STUDY OF THE PSYCHO-GRAPHS OF FIFTY-FIVE HIGH SCHOOL STUDENTS TO DETERMINE THE RELATIONSHIP BETWEEN MUSICAL TALENT AND VARIOUS DEGREES OF INTELLIGENCE

From time immemorial music has played an important part in the life of the race; but it has been incidental rather than purposive. This incidental process meant that only those persons who had extreme talent and the inner urge became musicians. Frequently, these persons were either highly intellectual or at the other extremity of mentality, so the belief arose that musical talent was associated with great intelligence and to be a successful musician one must have wide experience, a liberal education, broad purpose and high ideals; or that a musician was among the most un-intelligent of men, sometimes near the border of idiocy

Measurements of the atmospheric neutrino flux by Super-Kamiokande: energy spectra, geomagnetic effects, and solar modulation

A comprehensive study on the atmospheric neutrino flux in the energy region from sub-GeV up to several TeV using the Super-Kamiokande water Cherenkov detector is presented in this paper. The energy and azimuthal spectra of the atmospheric ${\nu}_e+{\bar{\nu}}_e$ and ${\nu}_{\mu}+{\bar{\nu}}_{\mu}$ fluxes are measured. The energy spectra are obtained using an iterative unfolding method by combining various event topologies with differing energy responses. The azimuthal spectra depending on energy and zenith angle, and their modulation by geomagnetic effects, are also studied. A predicted east-west asymmetry is observed in both the ${\nu}_e$ and ${\nu}_{\mu}$ samples at 8.0 {\sigma} and 6.0 {\sigma} significance, respectively, and an indication that the asymmetry dipole angle changes depending on the zenith angle was seen at the 2.2 {\sigma} level. The measured energy and azimuthal spectra are consistent with the current flux models within the estimated systematic uncertainties. A study of the long-term correlation between the atmospheric neutrino flux and the solar magnetic activity cycle is also performed, and a weak indication of a correlation was seen at the 1.1 {\sigma} level, using SK I-IV data spanning a 20 year period. For particularly strong solar activity periods known as Forbush decreases, no theoretical prediction is available, but a deviation below the typical neutrino event rate is seen at the 2.4 {\sigma} level.Comment: 30 pages, 31 figure

Solar Neutrino Measurements in Super-Kamiokande-IV

Upgraded electronics, improved water system dynamics, better calibration and analysis techniques allowed Super-Kamiokande-IV to clearly observe very low-energy 8B solar neutrino interactions, with recoil electron kinetic energies as low as 3.49 MeV. Super-Kamiokande-IV data-taking began in September of 2008; this paper includes data until February 2014, a total livetime of 1664 days. The measured solar neutrino flux is (2.308+-0.020(stat.) + 0.039-0.040(syst.)) x 106/(cm2sec) assuming no oscillations. The observed recoil electron energy spectrum is consistent with no distortions due to neutrino oscillations. An extended maximum likelihood fit to the amplitude of the expected solar zenith angle variation of the neutrino-electron elastic scattering rate in SK-IV results in a day/night asymmetry of (-3.6+-1.6(stat.)+-0.6(syst.))%. The SK-IV solar neutrino data determine the solar mixing angle as sin2 theta_12 = 0.327+0.026-0.031, all SK solar data (SK-I, SK-II, SK III and SKIV) measures this angle to be sin2 theta_12 = 0.334+0.027-0.023, the determined mass-squared splitting is Delta m2_21 = 4.8+1.5-0.8 x10-5 eV2.Comment: Submitted to Physical Review D; 23 pages, 40 figure

Search for astronomical neutrinos from blazar TXS 0506+056 in super-kamiokande

We report a search for astronomical neutrinos in the energy region from several GeV to TeV in the direction of the blazar TXS 0506+056 using the Super-Kamiokande detector following the detection of a 100 TeV neutrinos from the same location by the IceCube collaboration. Using Super-Kamiokande neutrino data across several data samples observed from 1996 April to 2018 February we have searched for both a total excess above known backgrounds across the entire period as well as localized excesses on smaller timescales in that interval. No significant excess nor significant variation in the observed event rate are found in the blazar direction. Upper limits are placed on the electron- and muon-neutrino fluxes at the 90% confidence level as 6.0 × 10−7 and 4.5 × 10−7–9.3 × 10−10 [erg cm−2 s−1], respectively

Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee

BACKGROUND: There is limited information on the costs and benefits of alternative adjunct non-pharmacological treatments for knee osteoarthritis and little guidance on which should be prioritised for commissioning within the NHS. This study estimates the costs and benefits of acupuncture, braces, heat treatment, insoles, interferential therapy, laser/light therapy, manual therapy, neuromuscular electrical stimulation, pulsed electrical stimulation, pulsed electromagnetic fields, static magnets and transcutaneous electrical nerve Stimulation (TENS), based on all relevant data, to facilitate a more complete assessment of value. METHODS: Data from 88 randomised controlled trials including 7,507 patients were obtained from a systematic review. The studies reported a wide range of outcomes. These were converted into EQ-5D index values using prediction models, and synthesised using network meta-analysis. Analyses were conducted including firstly all trials and secondly only trials with low risk of selection bias. Resource use was estimated from trials, expert opinion and the literature. A decision analytic model synthesised all evidence to assess interventions over a typical treatment period (constant benefit over eight weeks or linear increase in effect over weeks zero to eight and dissipation over weeks eight to 16). RESULTS: When all trials are considered, TENS is cost-effective at thresholds of £20-30,000 per QALY with an incremental cost-effectiveness ratio of £2,690 per QALY vs. usual care. When trials with a low risk of selection bias are considered, acupuncture is cost-effective with an incremental cost-effectiveness ratio of £13,502 per QALY vs. TENS. The results of the analysis were sensitive to varying the intensity, with which interventions were delivered, and the magnitude and duration of intervention effects on EQ-5D. CONCLUSIONS: Using the £20,000 per QALY NICE threshold results in TENS being cost-effective if all trials are considered. If only higher quality trials are considered, acupuncture is cost-effective at this threshold, and thresholds down to £14,000 per QALY

Search for dinucleon decay into pions at Super-Kamiokande

A search for dinucleon decay into pions with the Super-Kamiokande detector has been performed with an exposure of 282.1 kiloton-years. Dinucleon decay is a process that violates baryon number by two units. We present the first search for dinucleon decay to pions in a large water Cherenkov detector. The modes $^{16}$O$(pp) \rightarrow$ $^{14}$C$\pi^{+}\pi^{+}$, $^{16}$O$(pn) \rightarrow$ $^{14}$N$\pi^{+}\pi^{0}$, and $^{16}$O$(nn) \rightarrow$ $^{14}$O$\pi^{0}\pi^{0}$ are investigated. No significant excess in the Super-Kamiokande data has been found, so a lower limit on the lifetime of the process per oxygen nucleus is determined. These limits are: $\tau_{pp\rightarrow\pi^{+}\pi^{+}} > 7.22 \times 10^{31}$ years, $\tau_{pn\rightarrow\pi^{+}\pi^{0}} > 1.70 \times 10^{32}$ years, and $\tau_{nn\rightarrow\pi^{0}\pi^{0}} > 4.04 \times 10^{32}$ years. The lower limits on each mode are about two orders of magnitude better than previous limits from searches for dinucleon decay in iron.Comment: 20 pages, 17 figures. Accepted for publication in Physical Review D on March 30, 201