An illustration of the modelling of cost and efficacy data from a clinical trial

Health care providers, purchasers and policy makers need to make informed decisions regarding the provision of cost-effective care. When a new health care intervention is to be compared with the current standard, an economic evaluation alongside an evaluation of health benefits provides useful information for the decision making process. We consider the information on cost-effectiveness which arises from an individual clinical trial comparing the two interventions. Recent methods for conducting a cost-effectiveness analysis for a clinical trial have focused on the net benefit parameter. The net benefit parameter, a function of costs and health benefits, is positive if the new intervention is cost-effective compared with the standard. In this paper we describe frequentist and Bayesian approaches to cost-effectiveness analysis which have been suggested in the literature and apply them to data from a clinical trial comparing laparoscopic surgery with open mesh surgery for the repair of inguinal hernias. We extend the Bayesian model to allow the total cost to be divided into a number of different components. The advantages and disadvantages of the different approaches are discussed. In January 2001, NICE issued guidance on the type of surgery to be used for inguinal hernia repair. We discuss our example in the light of this information. Copyright © 2003 John Wiley & Sons, Ltd.

Recent developments in genetic data analysis: what can they tell us about human demographic history?

Over the last decade, a number of new methods of population genetic analysis based on likelihood have been introduced. This review describes and explains the general statistical techniques that have recently been used, and discusses the underlying population genetic models. Experimental papers that use these methods to infer human demographic and phylogeographic history are reviewed. It appears that the use of likelihood has hitherto had little impact in the field of human population genetics, which is still primarily driven by more traditional approaches. However, with the current uncertainty about the effects of natural selection, population structure and ascertainment of single-nucleotide polymorphism markers, it is suggested that likelihood-based methods may have a greater impact in the future.

Cleavage and serum reactivity of the severe acute respiratory syndrome coronavirus spike protein

Severe acute respiratory syndrome (SARS) coronavirus (SCoV) spike (S) protein is the major surface antigen of the virus and is responsible for receptor binding and the generation of neutralizing antibody. To investigate SCoV S protein, full-length and individual domains of S protein were expressed on the surface of insect cells and were characterized for cleavability and reactivity with serum samples obtained from patients during the convalescent phase of SARS. S protein could be cleaved by exogenous trypsin but not by coexpressed furin, suggesting that the protein is not normally processed during infection. Reactivity was evident by both flow cytometry and Western blot assays, but the pattern of reactivity varied according to assay and sequence of the antigen. The antibody response to SCoV S protein involves antibodies to both linear and conformational epitopes, with linear epitopes associated with the carboxyl domain and conformational epitopes associated with the amino terminal domain. Recombinant SCoV S protein appears to be a suitable antigen for the development of an efficient and sensitive diagnostic test for SARS, but our data suggest that assay format and choice of S antigen are important considerations.

Autistic symptomatology and language ability in autism spectrum disorder and specific language impairment

Background: Autism spectrum disorders (ASD) and specific language impairment (SLI) are common developmental disorders characterised by deficits in language and communication. The nature of the relationship between them continues to be a matter of debate. This study investigates whether the co-occurrence of ASD and language impairment is associated with differences in severity or pattern of autistic symptomatology or language profile. Methods: Participants (N = 97) were drawn from a total population cohort of 56,946 screened as part of study to ascertain the prevalence of ASD, aged 9 to 14 years. All children received an ICD-10 clinical diagnosis of ASD or No ASD. Children with nonverbal IQ 80 were divided into those with a language impairment (language score of 77 or less) and those without, creating three groups: children with ASD and a language impairment (ALI; N = 41), those with ASD and but no language impairment (ANL; N = 31) and those with language impairment but no ASD (SLI; N = 25). Results: Children with ALI did not show more current autistic symptoms than those with ANL. Children with SLI were well below the threshold for ASD. Their social adaptation was higher than the ASD groups, but still nearly 2 SD below average. In ALI the combination of ASD and language impairment was associated with weaker functional communication and more severe receptive language difficulties than those found in SLI. Receptive and expressive language were equally impaired in ALI, whereas in SLI receptive language was stronger than expressive. Conclusions: Co-occurrence of ASD and language impairment is not associated with increased current autistic symptomatology but appears to be associated with greater impairment in receptive language and functional communication.

Treatment of child anxiety. an exploratory study of the role of maternal anxiety and behaviours in treatment outcome

Anxiety disorders are common among parents of anxious children and have been found to impede child treatment outcomes, yet it is unclear whether it is parental anxiety that needs to be targeted in therapy or associated parental behaviours. Twenty-two children (6-12 years) with a current anxiety disorder and their mothers received cognitive-behavioural treatment (CBT) for child anxiety. In addition, of the 12 mothers who met criteria for a current anxiety disorder, 6 received CBT for their own disorder. Assessments were made of the mother-child interaction. The main findings were: (1) children did less well from treatment where their mothers had a current anxiety disorder; (2) treatment of maternal anxiety disorder did not improve child treatment outcome; and (3) maternal overinvolvement and expression of fear was associated with child treatment outcome. The results suggest that in the context of maternal anxiety disorder, child treatment outcome may be improved by specifically targeting parenting behaviours. Copyright (C) 2008 John Wiley & Sons, Ltd.

Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the special needs and autism project (SNAP)

Background Recent reports have suggested that the prevalence of autism and related spectrum disorders (ASDs) is substantially higher than previously recognised. We sought to quantify prevalence of ASDs in children in South Thames, UK. Methods Within a total population cohort of 56946 children aged 9-10 years, we screened all those with a current clinical diagnosis of ASD (n=255) or those judged to be at risk for being an undetected case (n=1515). A stratified subsample (n=255) received a comprehensive diagnostic assessment, including standardised clinical observation, and parent interview assessments of autistic symptoms, language, and intelligence quotient (IQ). Clinical consensus diagnoses of childhood autism and other ASDs were derived. We used a sample weighting procedure to estimate prevalence. Findings The prevalence of childhood autism was 38.9 per 10000 (95% CI 29.9-47.8) and that of other ASDs was 77.2 per 10000 (52.1-102.3), making the total prevalence of all AS Ds 116.1 per 10000 (90.4-141.8). A narrower definition of childhood autism, which combined clinical consensus with instrument criteria for past and current presentation, provided a prevalence of 24.8 per 10 000 (17.6-32.0). The rate of previous local identification was lowest for children of less educated parents. Interpretation Prevalence of autism and related ASDs is substantially greater than previously recognised. Whether the increase is due to better ascertainment, broadening diagnostic criteria, or increased incidence is unclear. Services in health, education, and social care will need to recognise the needs of children with some form of ASD, who constitute 1% of the child population.

Communicating neurons: a connectionist spiking neuron implementation of stochastic diffusion search

An information processing paradigm in the brain is proposed, instantiated in an artificial neural network using biologically motivated temporal encoding. The network will locate within the external world stimulus, the target memory, defined by a specific pattern of micro-features. The proposed network is robust and efficient. Akin in operation to the swarm intelligence paradigm, stochastic diffusion search, it will find the best-fit to the memory with linear time complexity. information multiplexing enables neurons to process knowledge as 'tokens' rather than 'types'. The network illustrates possible emergence of cognitive processing from low level interactions such as memory retrieval based on partial matching. (C) 2007 Elsevier B.V. All rights reserved.

Multicore-enabling the MPJ express messaging library

With the transition to multicore processors almost complete, the parallel processing community is seeking efficient ways to port legacy message passing applications on shared memory and multicore processors. MPJ Express is our reference implementation of Message Passing Interface (MPI)-like bindings for the Java language. Starting with the current release, the MPJ Express software can be configured in two modes: the multicore and the cluster mode. In the multicore mode, parallel Java applications execute on shared memory or multicore processors. In the cluster mode, Java applications parallelized using MPJ Express can be executed on distributed memory platforms like compute clusters and clouds. The multicore device has been implemented using Java threads in order to satisfy two main design goals of portability and performance. We also discuss the challenges of integrating the multicore device in the MPJ Express software. This turned out to be a challenging task because the parallel application executes in a single JVM in the multicore mode. On the contrary in the cluster mode, the parallel user application executes in multiple JVMs. Due to these inherent architectural differences between the two modes, the MPJ Express runtime is modified to ensure correct semantics of the parallel program. Towards the end, we compare performance of MPJ Express (multicore mode) with other C and Java message passing libraries---including mpiJava, MPJ/Ibis, MPICH2, MPJ Express (cluster mode)---on shared memory and multicore processors. We found out that MPJ Express performs signicantly better in the multicore mode than in the cluster mode. Not only this but the MPJ Express software also performs better in comparison to other Java messaging libraries including mpiJava and MPJ/Ibis when used in the multicore mode on shared memory or multicore processors. We also demonstrate effectiveness of the MPJ Express multicore device in Gadget-2, which is a massively parallel astrophysics N-body siimulation code.

Bifurcation Analysis of Eigenstructure Assignment Control in a Simple Nonlinear Aircraft Model

Aircraft systems are highly nonlinear and time varying. High-performance aircraft at high angles of incidence experience undesired coupling of the lateral and longitudinal variables, resulting in departure from normal controlled � ight. The construction of a robust closed-loop control that extends the stable and decoupled � ight envelope as far as possible is pursued. For the study of these systems, nonlinear analysis methods are needed. Previously, bifurcation techniques have been used mainly to analyze open-loop nonlinear aircraft models and to investigate control effects on dynamic behavior. Linear feedback control designs constructed by eigenstructure assignment methods at a � xed � ight condition are investigated for a simple nonlinear aircraft model. Bifurcation analysis, in conjunction with linear control design methods, is shown to aid control law design for the nonlinear system.

Closed loop design for a simple nonlinear aircraft model using eigenstructure assignment

Aircraft systems are highly nonlinear and time varying. High-performance aircraft at high angles of incidence experience undesired coupling of the lateral and longitudinal variables, resulting in departure from normal controlled flight. The aim of this work is to construct a robust closed-loop control that optimally extends the stable and decoupled flight envelope. For the study of these systems nonlinear analysis methods are needed. Previously, bifurcation techniques have been used mainly to analyze open-loop nonlinear aircraft models and investigate control effects on dynamic behavior. In this work linear feedback control designs calculated by eigenstructure assignment methods are investigated for a simple aircraft model at a fixed flight condition. Bifurcation analysis in conjunction with linear control design methods is shown to aid control law design for the nonlinear system.

Housing supply and brownfield regeneration in a post-Barker world: is there enough brownfield land in England and Scotland?

The findings of the Barker review, which examined the reasons for the undersupply of UK housing, have important implications for the devolved constituents of the UK, including Scotland. This paper traces the emergence of the brownfi eld regeneration policy agenda across the UK and examines how the Barker review connects with this brownfi eld policy focus. The paper compares housing and brownfi eld policies and practices in England and Scotland, places them in an international context and elicits wider lessons for devolved governance in relation to housing policy, in terms of ‘centrist–local’ tensions. Estimates based on published data suggest that Barker’s emphasis on increased housing supply cannot easily be reconciled with the current emphasis on brownfi eld development and is likely to require a return to greenfield development in both countries.

Climate change and sustainable food production

One of the greatest challenges we face in the twenty-first century is to sustainably feed nine to ten billion people by 2050 while at the same time reducing environmental impact (e.g. greenhouse gas (GHG) emissions, biodiversity loss, land use change and loss of ecosystem services). To this end, food security must be delivered. According to the United Nations definition, ‘food security exists when all people, at all times, have physical and economic access to sufficient,safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life’. At the same time as delivering food security, we must also reduce the environmental impact of food production. Future climate change will make an impact upon food production. On the other hand, agriculture contributes up to about 30% of the anthropogenic GHG emissions that drive climate change. The aim of this review is to outline some of the likely impacts of climate change on agriculture, the mitigation measures available within agriculture to reduce GHG emissions and outlines the very significant challenge of feeding nine to ten billion people sustainably under a future climate, with reduced emissions of GHG. Each challenge is in itself enormous, requiring solutions that co-deliver on all aspects. We conclude that the status quo is not an option, and tinkering with the current production systems is unlikely to deliver the food and ecosystems services we need in the future; radical changes in production and consumption are likely to be required over the coming decades.

Interface dynamics in planar neural field models

Neural field models describe the coarse-grained activity of populations of interacting neurons. Because of the laminar structure of real cortical tissue they are often studied in two spatial dimensions, where they are well known to generate rich patterns of spatiotemporal activity. Such patterns have been interpreted in a variety of contexts ranging from the understanding of visual hallucinations to the generation of electroencephalographic signals. Typical patterns include localized solutions in the form of traveling spots, as well as intricate labyrinthine structures. These patterns are naturally defined by the interface between low and high states of neural activity. Here we derive the equations of motion for such interfaces and show, for a Heaviside firing rate, that the normal velocity of an interface is given in terms of a non-local Biot-Savart type interaction over the boundaries of the high activity regions. This exact, but dimensionally reduced, system of equations is solved numerically and shown to be in excellent agreement with the full nonlinear integral equation defining the neural field. We develop a linear stability analysis for the interface dynamics that allows us to understand the mechanisms of pattern formation that arise from instabilities of spots, rings, stripes and fronts. We further show how to analyze neural field models with linear adaptation currents, and determine the conditions for the dynamic instability of spots that can give rise to breathers and traveling waves.

The treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: a randomised controlled trial

Background Promising evidence has emerged of clinical gains using guided self-help cognitive-behavioural therapy (CBT) for child anxiety and by involving parents in treatment; however, the efficacy of guided parent-delivered CBT has not been systematically evaluated in UK primary and secondary settings. Aims To evaluate the efficacy of low-intensity guided parent-delivered CBT treatments for children with anxiety disorders. Method A total of 194 children presenting with a current anxiety disorder, whose primary carer did not meet criteria for a current anxiety disorder, were randomly allocated to full guided parent-delivered CBT (four face-to-face and four telephone sessions) or brief guided parent-delivered CBT (two face-to-face and two telephone sessions), or a wait-list control group (trial registration: ISRCTN92977593). Presence and severity of child primary anxiety disorder (Anxiety Disorders Interview Schedule for DSM-IV, child/parent versions), improvement in child presentation of anxiety (Clinical Global Impression-Improvement scale), and change in child anxiety symptoms (Spence Children’s Anxiety Scale, child/parent version and Child Anxiety Impact scale, parent version) were assessed at post-treatment and for those in the two active treatment groups, 6 months post-treatment. Results Full guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not: at post-treatment, 25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list (relative risk (RR) 1.85, 95% CI 1.14-2.99); and in the brief guided CBT group, 18 participants (39%) had recovered from their primary diagnosis post-treatment (RR = 1.56, 95% CI 0.89-2.74). Level of therapist training and experience was unrelated to child outcome. Conclusions Full guided parent-delivered CBT is an effective and inexpensive first-line

Breaking the impasse: towards a new regime for international climate governance

The reality of the current international order makes it imperative that a just and effective climate regime balance the historical responsibility of developed countries with the increasing absolute emissions from many developing nations. In this short outlook article, key pillars are proposed for a new international climate architecture that envisions replacing the current annex system with two new annexes –Annex α, for countries with high current emissions and historically high emissions, and Annex β, for countries with high current emissions and historically low emissions. Countries in both annexes would implement legally binding targets under this framework. Additionally, this proposal includes tweaks and revisions to funding and technology transfer mechanisms to correct for weaknesses and inequities under the current Kyoto architecture. The proposed framework stems from a belief that a top-down, international approach to climate policy remains the most effective for ensuring environmental integrity. Given the slow rate of institutional learning, reforming and improving the current system is held as a more efficient course of action than abandoning the progress already achieved. It is argued that the proposed framework effectively accommodates key equity, environmental integrity and political feasibility concerns.