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Alexithymia and the anxiolytic effect of endurance running
Get PDFIndividuals high in alexithymia use high-risk sport to regulate their anxiety. Given the conceptual similarities between arduous high-risk sports and extreme endurance running, we investigated the relationship between alexithymia and the anxiolytic effects of endurance running. We measured marathon and ultramarathon runners (n = 35) on alexithymia, and pre- and post-race anxiety. Bootstrapped regression analyses using MEMORE revealed that alexithymia moderated the relationship between pre- and post-race anxiety such that there was a significant anxiety reduction for individuals high in alexithymia only. In conclusion, extreme endurance running provides an emotion regulation function for individuals high in alexithymia. The modest sample size points to the need for replication and further exploration
Choice of oral anticoagulant prescribed by general practices in Wales: Application of Dirichlet regression and linked data
Get PDFAIMS: There has been sustained growth in the prescribing of direct oral anticoagulants (OACs) in primary care in the UK. Given the different indications, properties and prices of OACs, variation between prescribers is expected; however, a high level of variation may be evidence of inappropriate or suboptimal prescribing. This study examined the variation in the relative use of OACs in primary care in Wales.METHODS: Data on total defined daily doses of all community-dispensed OACs in 2019 were linked at the GP practice level with disease registers, patient demographic data and GP and patient numbers. The relative use of each OAC, as a fraction of all OACs prescribed, was analysed using Dirichlet regression to quantify the association between prescribing patterns and practice and area-level characteristics.RESULTS: Across 417 GP practices, the mean (range) in the relative prescribing of warfarin was 37% (6%-64%), apixaban was 32% (2%-65%), rivaroxaban 23% (0%-66%), dabigatran 3% (0%-23%) and edoxaban 6% (0%-59%). Statistical modelling provided strong evidence that prescribing patterns are associated with a GP practice's health board and also their nearest major hospital. Compared to the null model, a model including health board resulted in a 15% fall in Akaike information criterion, increasing to 20% with the addition of nearest major hospital and 27% including further covariates.CONCLUSION: Systematic variation in OAC prescribing, by health board and based on nearest hospital, indicates that factors other than patient clinical characteristics and preferences may be influencing prescribing decisions.</p
Packaging choice and coordinated distribution logistics to reduce the environmental footprint of small-scale beer value chains
Get PDFThis study assesses the extent to which packaging and distribution impacts can be mitigated as environmental hotspots in the life cycle of micro-brewed beer. We conduct life cycle assessment (LCA) of seven breweries and compare their existing packaging and distribution practises with three mitigation options; use of aluminium cans or reusable glass bottles instead of single use glass bottles or use of polyethylene terephthalate (PET) kegs instead of steel kegs. Findings show that all participating breweries can achieve reductions across multiple impact categories if single use glass bottles are changed to aluminium cans or reusable glass, and further reductions are possible if mode of transport is changed from small delivery vans to lorries for distribution to retailers. The use of PET keg as an alternative to reusable steel keg is a less environmentally sustainable option when beer is delivered short distances, but some savings are possible in long distance scenarios using vans. Carbon footprints per litre beer range from 727 to 1336 g CO2 eq. across the case study breweries, with reductions of 6–27% or 3–27% by changing to aluminium can or reusable glass bottle, respectively, when beer is delivered by van. The optimal combination of reusable glass bottle delivered by lorry reduces carbon footprints by between 45 and 55% but will require significant investment and coordination across the wider food and drink sector to implement. Identifying the best packaging material requires a holistic approach that considers interactions and burdens across packaging manufacturing, distribution, use and end-of-life stages
Regulating rating agencies: A conservative behavioural change
Get PDFWe investigate whether the European regulatory reforms of the credit rating industry have been successful in improving the quality of financial institutions’ credit ratings. A shift to more conservative rating behaviour rather than rating quality improvement is identified, which is attributable to increased regulatory scrutiny. This change leads to a reduction in rating inflation and an increase in the number of unwarranted downgrades and false rating warnings in the post-regulatory period. A significant decrease (increase) in the informativeness of rating downgrades (upgrades) is evident. Our findings contrast with prior evidence for US corporates where reputational effects dominated
Assessing the efficacy of coproduction to better understand the barriers to achieving sustainability in NHS chronic kidney services and create alternate pathways
Get PDFHealth utilities and costs for neuromyelitis optica spectrum disorder
Get PDFBackground: Neuromyelitis optica spectrum disorder (NMOSD) is a rare, neurological disease that places a significant burden on patients, their carers, and healthcare systems.Objectives: To estimate patient and carer health utilities and costs of NMOSD within the UK setting.Methods: Patients with NMOSD and their carers, recruited via a regional specialist treatment centre, completed a postal questionnaire that included a resource use measure, the EuroQoL (EQ)-5D-5L, EQ-5D-VAS, Vision and Quality of Life Index (VisQoL), Carer Experience Survey (CES) and the Expanded Disability Status Scale (EDSS). The questionnaire asked about respondents’ use of health and community care services, non-medical costs, informal care and work capacity. Data were analysed descriptively. Uncertainties in costs and utilities were assessed using bootstrap analysis.Results: 117 patients and 74 informal carers responded to the survey. Patients’ mean EQ-5D-5L and VisQoL health utilities (95% central range) were 0.54 (-0.29, 1.00) and 0.79 (0.11, 0.99), respectively. EQ-5D-5L utility decreased with increasing EDSS score bandings, from 0.80 (0.75, 0.85) for EDSS ≤ 4.0, to 0.20 (-0.29, 0.56) for EDSS 8.0 to 9.5. Mean, 3-month total costs were £5,623 (£2,096, £12,156), but ranged from £562 (£381, £812) to £32,717 (£2,888, £98,568) for these EDSS bandings. Carer-reported EQ-5D-5L utility and CES index scores were 0.85 (0.82, 0.89) and 57.67 (52.69, 62.66). Mean, 3-month costs of informal care were £13,150 to £24,560.Conclusions: NMOSD has significant impacts on health utilities and NHS and carer costs. These data can be used as inputs to cost-effectiveness analyses of new medicines for NMOSD.<br/
Linear mixed models to handle missing at random data in trial-based economic evaluations
Get PDFTrial-based cost-effectiveness analyses (CEAs) are an important source of evidence in the assessment of health interventions. In these studies, cost and effectiveness outcomes are commonly measured at multiple time points, but some observations may be missing. Restricting the analysis to the participants with complete data can lead to biased and inefficient estimates. Methods, such as multiple imputation, have been recommended as they make better use of the data available and are valid under less restrictive Missing At Random (MAR) assumption. Linear mixed effects models (LMMs) offer a simple alternative to handle missing data under MAR without requiring imputations, and have not been very well explored in the CEA context. In this manuscript, we aim to familiarize readers with LMMs and demonstrate their implementation in CEA. We illustrate the approach on a randomized trial of antidepressants, and provide the implementation code in R and Stata. We hope that the more familiar statistical framework associated with LMMs, compared to other missing data approaches, will encourage their implementation and move practitioners away from inadequate methods
The clinical effectiveness and cost effectiveness of clozapine for inpatients with severe borderline personality disorder (CALMED study): A randomised placebo-controlled trial
Get PDFBackground:Data from case series suggest that clozapine may benefit inpatients with borderline personality disorder (BPD), but randomised trials have not been conducted.Methods:Multicentre, double-blind, placebo-controlled trial. We aimed to recruit 222 inpatients with severe BPD aged 18 or over, who had failed to respond to other antipsychotic medications. We randomly allocated participants on a 1:1 ratio to receive up to 400 mg of clozapine per day or an inert placebo using a remote web-based randomisation service. The primary outcome was total score on the Zanarini Rating scale for Borderline Personality Disorder (ZAN-BPD) at 6 months. Secondary outcomes included self-harm, aggression, resource use and costs, side effects and adverse events. We used a modified intention to treat analysis (mITT) restricted to those who took one or more dose of trial medication, using a general linear model fitted at 6 months adjusted for baseline score, allocation group and site.Results:The study closed early due to poor recruitment and the impact of the COVID-19 pandemic. Of 29 study participants, 24 (83%) were followed up at 6 months, of whom 21 (72%) were included in the mITT analysis. At 6 months, 11 (73%) participants assigned to clozapine and 6 (43%) of those assigned to placebo were still taking trial medication. Adjusted difference in mean total ZAN-BPD score at 6 months was -3.86 (95% Confidence Intervals = -10.04 to 2.32). There were 14 serious adverse events; 6 in the clozapine arm and 8 in the placebo arm of the trial. There was little difference in the cost of care between groups.Interpretation:We recruited insufficient participants to test the primary hypothesis. The study findings highlight problems in conducting placebo-controlled trials of clozapine and in using clozapine for people with BPD, outside specialist inpatient mental health units.Trial registrationISRCTN18352058. https://doi.org/10.1186/ISRCTN1835205
Evaluation of the ESFR End of Equilibrium Cycle State: Spatial Distributions of Reactivity Coefficients
Get PDFThe Horizon 2020 European Sodium-cooled Fast Reactor Safety Measures Assessment and Research Tools (ESFR-SMART) project investigates the behavior of the commercial-size ESFR throughout its lifetime. This paper reports work focused on the end of equilibrium cycle (EOEC) loading of the ESFR, including neutronic analysis, core- and zone-wise reactivity coefficients, and more detailed local mapping of important safety-relevant parameters. Sensitivity and uncertainty analysis on these parameters have also been performed, and a detailed investigation into decay heat mapping was carried out. Due to the scope of this work, the results have been split into three papers. The nominal operating conditions and both zone-wise and local mapping of reactivity coefficients are considered in this paper. The work was performed across four institutions using both continuous-energy Monte Carlo (MC) and deterministic reactor physics codes. A good agreement is observed between the methods, verifying the suitability of these codes for simulation of large, complicated reactor configurations and giving confidence in the results for the most limiting ESFR EOEC core state for safety analysis. The results from this work will serve as the basis for the transient calculations planned for the next stage of work on the ESFR, allowing for more in-depth studies to be performed on the multiphysics behavior of the reactor
RAMPVIS: Answering the Challenges of Building Visualisation Capabilities for Large-scale Emergency Responses
Get PDFThe effort for combating the COVID-19 pandemic around the world has resulted in a huge amount of data, e.g., from testing, contact tracing, modelling, treatment, vaccine trials, and more. In addition to numerous challenges in epidemiology, healthcare, biosciences, and social sciences, there has beenan urgent need to develop and provide visualisation and visual analytics (VIS) capacities to support emergency responses under difficult operational conditions. In this paper, we report the experience of a group of VIS volunteers who have been working in a large research and development consortiumand providing VIS support to various observational, analytical, model-developmental, and disseminative tasks. In particular, we describe our approaches to the challenges that we have encountered in requirements analysis, data acquisition, visual design, software design, system development, team organisation, and resource planning. By reflecting on our experience, we propose a set of recommendations as the first step towards a methodology for developing and providing rapid VIS capacities to support emergency responses