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Economic evaluation of a trial exploring the effects of a web-based support tool for parents of children with Juvenile Idiopathic Arthritis.
Full text linkAbstract
Objective
To explore the cost-effectiveness of a web-based support tool for parents of children with Juvenile Idiopathic Arthritis.
Methods
A multi-centred randomised controlled trial was conducted in paediatric rheumatology centres in England. The WebParC intervention consisted of online information about JIA and its treatment and a toolkit using cognitive-behavioural therapy principles to support parents manage their child’s JIA. An economic evaluation was performed alongside the randomised controlled trial involving 220 parents. The primary outcome was the self-report Pediatric Inventory for Parents measure of illness-related parenting stress, with two dimensions; difficulty and frequency. These measures along with costs were assessed post intervention at 4 months and at 12 months follow up. Costs were calculated for healthcare usage using a UK NHS economic perspective. Some data was also collected and analysed on the impact of caring costs on families. Uncertainty around cost effectiveness was explored using bootstrapping and cost-effectiveness acceptability curves.
Results
At 4 months, the intervention arm showed improved Pediatric Inventory for Parents (PIP) scores with a mean difference between trial arms in the dimensions of frequency and difficulty scores of 1.5 and 3.6 respectively. At 12 months, the mean difference between trial arms in frequency and difficulty scores were 0.35 and 0.39, again representing improved PIP scores for the intervention arm.
At both 4 and 12 month follow up the average total cost per case was higher in the control group when compared to the intervention arm with mean differences of £360 (95% CI £29.6 to £691) at 4 months and £203 (95% CI £16 to £390) at 12 months.
At both 4 month and 12 month follow up, the majority of costs associated with health service use were found to belong to secondary care for both arms.
Cost data was further analysed in combination with effectiveness data from the Pediatric Inventory for Parents measure. The probability of being cost effective ranged between 49% and 54%.
Conclusion
The WebParC online intervention led to reductions in primary and secondary healthcare resource use that translated into reduced costs at 4 and 12 months. The intervention demonstrated particular savings for rheumatology services at both follow ups. Future economies of scale could be realised by health providers with increased opportunities for cost effectiveness over time.
Keywords
Juvenile arthritis, cost effectiveness, parent support, telehealth, economic evaluation.
Key Messages
1. This study reports on a relatively low-cost, online digital intervention for reducing parental stress.
2. Cost savings within the National Health Service were achieved particularly within rheumatology services.
3. Further reductions in parental stress and online support operating costs could extend cost effectiveness
Influenza H1N2 - first human case detected in the UK
Full text linkIn November 2023 the UK notified the World Health Organization (WHO) of a human case of swine-origin influenza A(H1N2)v clade 1B.1.1 virus infection. The infection was detected as part of the routine national flu surveillance undertaken by the UK Health Security Agency (UKHSA) and the Royal College of General Practitioners (RCGP) and was the first case of human influenza A(H1N2) infection detected in the UK. The case was an otherwise well person, over 75 years of age, who has since fully recovered. What makes the case intriguing is that the case reported no direct contact with pigs, pets or farms; however, pig farms are located within a few miles of where the case resides. As of December 2023, no virological confirmed transmission was reported and the source of the infection is still under investigation
Stress concentration targeted reinforcement using multi-material based 3D printing
Full text linkTopological engineering (3D printing into complex geometry) has emerged as a pragmatic approach to develop high specific strength (high strength and low density) lightweight structures. These complex lightweight structures fail at high-stress concentration regions, which can be, replaced with soft/tough material using 3D printing. It can improve mechanical properties such as strength, toughness and energy absorption etc. Here, we have developed stress concentration targeted multi-material schwarzite structures by 3D printing technique. The soft (Thermoplastic Polyurethane) material is reinforced at high-stress concentration regions of hard (Polylactic acid) schwarzite structures to enhance the specific yield strength and resilience. The mechanical properties and responses of these structures were then assessed via uniaxial compression tests. The multi-materials 3D printed composite structure shows improved mechanical properties compared to single materials architecture. The specific resilience of composites demonstrates remarkable enhancements, with percentage increases of 204.70 %, 596.50 %, and 1530.99 % observed when compared to hard primitives, and similarly impressive improvements of 182.45 %, 311.64 %, and 477.75 % observed in comparison to hard gyroids. The obtained experimental findings were comprehensively examined and validated with molecular dynamics (MD) simulations. The promising characteristics of these lightweight multi-material-based Schwarzites structures can be utilized in various fields such as energy harvesting devices, protective, safety gears, and aerospace components
Perfectionism in patients with eating disorders: The role of metacognitive beliefs and repetitive negative thinking
Full text linkAbstractIntroductionUsing the Self‐Regulatory Executive Function model as a basis, this study explored whether, in patients with eating disorders (EDs), metacognitions and repetitive negative thinking are associated with higher levels of perfectionisms.MethodsOne hundred twenty‐three outpatients with EDs were recruited. Perfectionism, metacognitive beliefs, worry, rumination, anger rumination, affective and eating symptoms were assessed. Correlation and hierarchal regression analyses were run.ResultsHigher endorsement of positive beliefs about worry was associated with higher levels of ‘personal standards perfectionism’. Higher endorsement of positive beliefs about worry, need to control thoughts, worry and rumination was associated with higher levels of ‘concern over mistakes perfectionism’.ConclusionsAmong patients with EDs, perfectionism appears to be associated with the endorsement of dysfunctional metacognitive beliefs, worry and rumination. Dysfunctional metacognitive beliefs and repetitive negative thinking could be suitable therapeutic targets to reduce the levels of perfectionism among patients with EDs
“The Pandemic is Just Happening on Top of a Pandemic for Us”. Unpaid Carers’ Experiences of Lockdown in the UK: A Thematic Analysis
Full text linkContext: With reduced access to medical and social support during the COVID-19 pandemic, the level of support provided by unpaid carers over the lockdown period in the UK was higher than ever. However, the experience of unpaid carers during this period is often overlooked.
Objective: The aim of this study was to explore the question ‘what has been the experience of unpaid carers during lockdown?’.
Method: Eighteen unpaid carers, caring for a family member(s) with physical, learning, mental health, or behavioral disabilities, were interviewed about their experience of lockdown in the UK. Thematic analysis was utilized.
Findings: Three overarching themes created: (a) The value of support, (b) Non-stop care, and (c) Risk to health. A central theme of mental health was also created and discussed across the three overarching themes, rather than individually, due to its extensivity. Support for unpaid carers during the lockdown became more important than ever due to the higher risk to physical and mental health (of both the carer and dependent) and the lack of respite available.
Limitations: Due to volunteer sampling, the evidence in this report is largely based on the perspectives of female carers’, with all but two participants being female.
Implications: Findings raise implications for prioritizing the return of in-person medical appointments post-pandemic and ensuring the continuation of support services for unpaid carers during a pandemic
Neuroinflammation in post-acute sequelae of COVID-19 (PASC) as assessed by [11C]PBR28 PET correlates with vascular disease measures
Full text linkThe COVID-19 pandemic caused by SARS-CoV-2 has triggered a consequential public health crisis of post-acute
sequelae of COVID-19 (PASC), sometimes referred to as long COVID. The mechanisms of the heterogeneous
persistent symptoms and signs that comprise PASC are under investigation, and several studies have pointed to
the central nervous and vascular systems as being potential sites of dysfunction. In the current study, we
recruited individuals with PASC with diverse symptoms, and examined the relationship between neuroinflammation and circulating markers of vascular dysfunction. We used [
11C]PBR28 PET neuroimaging, a marker
of neuroinflammation, to compare 12 PASC individuals versus 43 normative healthy controls. We found
significantly increased neuroinflammation in PASC versus controls across a wide swath of brain regions including
midcingulate and anterior cingulate cortex, corpus callosum, thalamus, basal ganglia, and at the boundaries of
ventricles. We also collected and analyzed peripheral blood plasma from the PASC individuals and found significant positive correlations between neuroinflammation and several circulating analytes related to vascular
dysfunction. These results suggest that an interaction between neuroinflammation and vascular health may
contribute to common symptoms of PASC
Allometric Scaling Reveals Evolutionary Constraint on Odonata Wing Cellularity via Critical Crack Length
Full text linkScaling in insect wings is a complex phenomenon that seems pivotal in maintaining wing functionality. In this study, the relationship between wing size and the size, location, and shape of wing cells in dragonflies and damselflies (Odonata) is investigated, aiming to address the question of how these factors are interconnected. To this end, WingGram, the recently developed computer‐vision‐based software, is used to extract the geometric features of wing cells of 389 dragonflies and damselfly wings from 197 species and 16 families. It has been found that the cell length of the wings does not depend on the wing size. Despite the wide variation in wing length (8.42 to 56.5 mm) and cell length (0.1 to 8.5 mm), over 80% of the cells had a length ranging from 0.5 to 1.5 mm, which was previously identified as the critical crack length of the membrane of locust wings. An isometric scaling of cells is also observed with maximum size in each wing, which increased as the size increased. Smaller cells tended to be more circular than larger cells. The results have implications for bio‐mimetics, inspiring new materials and designs for artificial wings with potential applications in aerospace engineering and robotics
Zooming in on Justice: The Case for Virtual Bioethics Conferencing.
Full text linkJecker et al. discuss principles for international bioethics conferencing that purportedly seek to make bioethics more global in scope. In particular, they address what they have perceived to be Islamophobia within bioethics. We agree that anti-discrimination and inclusivity should serve as core commitments for the field. Yet, we also see the need for the conversation to be broadened. So, while Islamophobia may be a real occurrence within mainstream bioethics, it may be better understood within a context of generalized religious aversion. In response, we propose an alternative interpretation of their principles for international bioethics conferencing—no longer holding in-person bioethics conferences. Whilst this proposal has some limitations, they are outweighed by the benefits of widening participation for minority and disadvantaged groups, removing significant cost barriers to attendance, promoting epistemic justice, and resulting in significantly diminished environmental degradation. If an obligation to move towards virtual conferencing is rejected, conference organizers must propose an alternative ethical framework for conferencing that avoids the implications of Jecker et al’s framework. Personal preference is not a sufficiently weighty reason to continue organizing in-person bioethics conferences
Retrofitting a Fifth Generation District Heating and Cooling Network for Heating and Cooling in a UK Hospital Campus
Full text linkThere is an increasingly rich literature on the decarbonisation of heat and the evolution of heat networks. This paper investigates whether a novel fifth Generation District Heating and Cooling Network (5GDHC) could be retrofitted to an existing National Health Service (NHS) hospital campus for the purpose of heating and cooling. The building load was simulated and input into a custom-written script to carry out a series of parametric studies and optimise design options. The model was calibrated against site data available from hospital facilities management. The research found that it is feasible to use a 5GDHC consisting of a large single mass of water to utilise inter-seasonal thermal storage. A natural water resource such as an aquifer was not required. The model tested sizing options and found that larger thermal storage, heat pumps and chillers reduce operating costs and improve flexibility. The paper closes with a discussion of the practical factors in retrofitting 5GDHC networks to a densely occupied and highly constrained campus environment. The findings are novel in further describing the circumstances for which 5GDHC networks are suitable
Harnessing Digital Transformation: A Pathway to Achieving the 2030 UNSDGs and Ensuring Sustainable Corporate Performance
Full text linkThis chapter explores the essential intersection of digital transformation and sustainability within the context of contemporary business enterprises. It is based on the urgent need for the United Nations' Sustainable Development Goals (UNSDGs) 2030, and it underscores the transformative potential of digital technologies such as Artificial Intelligence, the Internet of Things, and blockchain in reshaping sustainable business practices. This focuses on the switch from traditional, profit-driven models to models that prioritize people, profits, and the planet. The critical conclusion is the emancipation of stakeholders who have evolved from being passive receivers of CSR activities to become active collaborators in sustainability initiatives enabled by digital advances. In addition to that, the barriers that naturally occur because of the digital divide and ethical hurdles must be collectively resolved. Ultimately, it reverts back to the narrow, yet arduous path that leads to the shared value; cooperation and innovation as a way forward to a sustainable digital future