The cost-effectiveness of procalcitonin for guiding antibiotic prescribing in individuals hospitalized with COVID-19: part of the PEACH study.

BACKGROUND: Many hospitals introduced procalcitonin (PCT) testing to help diagnose bacterial coinfection in individuals with COVID-19, and guide antibiotic decision-making during the COVID-19 pandemic in the UK. OBJECTIVES: Evaluating cost-effectiveness of using PCT to guide antibiotic decisions in individuals hospitalized with COVID-19, as part of a wider research programme. METHODS: Retrospective individual-level data on patients hospitalized with COVID-19 were collected from 11 NHS acute hospital Trusts and Health Boards from England and Wales, which varied in their use of baseline PCT testing during the first COVID-19 pandemic wave. A matched analysis (part of a wider analysis reported elsewhere) created groups of patients whose PCT was/was not tested at baseline. A model was created with combined decision tree/Markov phases, parameterized with quality-of-life/unit cost estimates from the literature, and used to estimate costs and quality-adjusted life years (QALYs). Cost-effectiveness was judged at a £20 000/QALY threshold. Uncertainty was characterized using bootstrapping. RESULTS: People who had baseline PCT testing had shorter general ward/ICU stays and spent less time on antibiotics, though with overlap between the groups' 95% CIs. Those with baseline PCT testing accrued more QALYs (8.76 versus 8.62) and lower costs (£9830 versus £10 700). The point estimate was baseline PCT testing being dominant over no baseline testing, though with uncertainty: the probability of cost-effectiveness was 0.579 with a 1 year horizon and 0.872 with a lifetime horizon. CONCLUSIONS: Using PCT to guide antibiotic therapy in individuals hospitalized with COVID-19 is more likely to be cost-effective than not, albeit with uncertainty.

Evidence of quality of life for hospitalised patients with COVID-19: a scoping review.

Background: Information on the quality of life of people hospitalised with COVID-19 is important, both in assessing the burden of disease and the cost-effectiveness of treatments. However, there were potential barriers to collecting such evidence. Objective: To review the existing evidence on quality of life for people hospitalised with COVID-19, with a focus on the amount of evidence available and methods used. Design: A scoping review with systematic searches. Results: A total of 35 papers were selected for data extraction. The most common study type was economic evaluation (N = 13), followed by cross-sectional (N = 10). All economic evaluations used published utility values for other conditions to represent COVID-19 inpatients' quality of life. The most popular quality-of-life survey measure was the Pittsburgh Sleep Quality Index (N = 8). There were 12 studies that used a mental health-related survey and 12 that used a sleep-related survey. Five studies used EQ-5D, but only one collected responses from people in the acute phase of COVID-19. Studies reported a negative impact on quality of life for people hospitalised with COVID-19, although many studies did not include a formal comparison group. Limitations: Although it used systematic searches, this was not a full systematic review. Conclusion: Quality-of-life data were collected from people hospitalised with COVID-19 from relatively early in the pandemic. However, there was a lack of consensus as to what survey measures to use, and few studies used generic health measures. Economic evaluations for COVID-19 treatments did not use utilities collected from people with COVID-19. In future health crises, researchers should be vigilant for opportunities to collect quality-of-life data from hospitalised patients but should try to co-ordinate as well as ensuring generic health measures are used more. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR132254.

Quality of life can be measured using short, simple surveys. It is important to assess quality of life in this way, as it can show how health conditions affect people. Quality-of-life surveys can also be used to measure how treatments benefit people and to judge whether it is cost-effective to fund them. COVID-19 is a new disease, with new treatments developed to treat it. COVID-19 also created possible barriers to collecting quality-of-life survey data, especially from people in hospital at the start of the pandemic. This paper reviews studies which report data on quality of life for people hospitalised with COVID-19, especially how much evidence is available and how the studies were carried out. There were 35 studies included in the review. Of these, 13 assessed how cost-effective treatments for COVID-19 were. None of them collected survey responses directly from patients. Instead, they used data previously collected from people with other conditions such as influenza to represent people with COVID-19's quality of life. The studies which did collect data from patients used a wide variety of different surveys, which made comparing their results difficult. Mental health-related surveys were used by 12 studies, and a further 12 used sleep-related surveys. Relatively few studies used general surveys which could assess the overall effect of COVID-19 on people's quality of life. In future health crises, we recommend using more general quality-of-life measures. We also recommend that researchers co-ordinate to reduce the number of different surveys they use, as this will make comparing results easier.

Long-term health conditions and UK labour market outcomes during the COVID-19 pandemic.

BACKGROUND: Long-term health conditions can affect labour market outcomes. COVID-19 may have increased labour market inequalities, e.g. due to restricted opportunities for clinically vulnerable people. Evaluating COVID-19's impact could help target support. AIM: To quantify the effect of several long-term conditions on UK labour market outcomes during the COVID-19 pandemic and compare them to pre-pandemic outcomes. METHODS: The Understanding Society COVID-19 survey collected responses from around 20,000 UK residents in nine waves from April 2020-September 2021. Participants employed in January/February 2020 with a variety of long-term conditions were matched with people without the condition but with similar baseline characteristics. Models estimated probability of employment, hours worked and earnings. We compared these results with results from a two-year pre-pandemic period. We also modelled probability of furlough and home-working frequency during COVID-19. RESULTS: Most conditions (asthma, arthritis, emotional/nervous/psychiatric problems, vascular/pulmonary/liver conditions, epilepsy) were associated with reduced employment probability and/or hours worked during COVID-19, but not pre-pandemic. Furlough was more likely for people with pulmonary conditions. People with arthritis and cancer were slower to return to in-person working. Few effects were seen for earnings. CONCLUSION: COVID-19 had a disproportionate impact on people with long-term conditions' labour market outcomes.

Damage to tropical forests caused by cyclones is driven by wind speed but mediated by topographical exposure and tree characteristics.

Each year, an average of 45 tropical cyclones affect coastal areas and potentially impact forests. The proportion of the most intense cyclones has increased over the past four decades and is predicted to continue to do so. Yet, it remains uncertain how topographical exposure and tree characteristics can mediate the damage caused by increasing wind speed. Here, we compiled empirical data on the damage caused by 11 cyclones occurring over the past 40 years, from 74 forest plots representing tropical regions worldwide, encompassing field data for 22,176 trees and 815 species. We reconstructed the wind structure of those tropical cyclones to estimate the maximum sustained wind speed (MSW) and wind direction at the studied plots. Then, we used a causal inference framework combined with Bayesian generalised linear mixed models to understand and quantify the causal effects of MSW, topographical exposure to wind (EXP), tree size (DBH) and species wood density (ρ) on the proportion of damaged trees at the community level, and on the probability of snapping or uprooting at the tree level. The probability of snapping or uprooting at the tree level and, hence, the proportion of damaged trees at the community level, increased with increasing MSW, and with increasing EXP accentuating the damaging effects of cyclones, in particular at higher wind speeds. Higher ρ decreased the probability of snapping and to a lesser extent of uprooting. Larger trees tended to have lower probabilities of snapping but increased probabilities of uprooting. Importantly, the effect of ρ decreasing the probabilities of snapping was more marked for smaller than larger trees and was further accentuated at higher MSW. Our work emphasises how local topography, tree size and species wood density together mediate cyclone damage to tropical forests, facilitating better predictions of the impacts of such disturbances in an increasingly windier world.

The Effects of Different Zilpaterol Hydrochloride Feed Supplements and Extended Aging Periods on the Meat Quality of Feedlot Bulls.

This study researched the effects of two commercially available zilpaterol hydrochloride (ZH) ß-adrenergic agonists, denoted as ZH-A and ZH-B, on the meat quality characteristics of typical South African feedlot bulls (taurine × indicus composites), over extended aging periods of up to 120 days. The effects of ZH were studied to address concerns about the possible adverse effects of ZH on beef quality following extended aging, which typically occurs during the exportation of beef by boat. The completely randomized control study consisted of 3 homogenous experimental groups, with 3 replicates per treatment and 50 bulls per replicate = 450 animals. Treatments were a negative control (CT) with no ZH supplementation added to the basal diet or a basal diet supplemented with either zilpaterol hydrochloride A (ZH-A) or zilpaterol hydrochloride B (ZH-B), both at 105 g ZH/ton, fed from the first day of the finishing period (D0) for 30 days. Subsamples were collected from 38 random carcasses from each treatment for proximate analysis and meat quality analysis using Longissimus dorsi samples. ZH supplementation decreased meat tenderness (Warner-Bratzler shear force values (WBSF)) of bulls fed ZH-A or ZH-B, compared to those fed the CT diet (p < 0.05; η2 = 0.24). The WBSF values of both ZH treatments were about 0.5-0.8 kg higher during the aging periods compared to the CT, but ZH did not affect post-mortem meat aging or meat quality characteristics differently compared to the CT. Post-mortem aging per se influenced all meat quality characteristics investigated (p < 0.001; η2 > 0.30), showing improvements in WBSF, a decrease in meat colour and an increase in drip and cooking losses. L*-values increased from 3 to 56 days of aging and then decreased to day 120 (p < 0.001; η2 = 032). Chroma values decreased from day 3 to day 120 (p < 0.001; η2 = 0.50). Hue° decreased from day 3 to day 7 and stabilized until day 120 (p < 0.001; η2 = 0.40). Moisture and cooking loss (CL) increased to 56 days and then decreased to 120 days.

COVID-19 and EQ-5D-5L health state valuation.

BACKGROUND: We investigate whether and how general population health state values were influenced by the initial stages of the COVID-19 pandemic. Changes could have important implications, as general population values are used in health resource allocation. DATA: In Spring 2020, participants in a UK general population survey rated 2 EQ-5D-5L states, 11111 and 55555, as well as dead, using a visual analogue scale (VAS) from 100 = best imaginable health to 0 = worst imaginable health. Participants answered questions about their pandemic experiences, including COVID-19's effect on their health and quality of life, and their subjective risk/worry about infection. ANALYSIS: VAS ratings for 55555 were transformed to the full health = 1, dead = 0 scale. Tobit models were used to analyse VAS responses, as well as multinomial propensity score matching (MNPS) to create samples balanced according to participant characteristics. RESULTS: Of 3021 respondents, 2599 were used for analysis. There were statistically significant, but complex associations between experiences of COVID-19 and VAS ratings. For example, in the MNPS analysis, greater subjective risk of infection implied higher VAS ratings for dead, yet worry about infection implied lower ratings. In the Tobit analysis, people whose health was affected by COVID-19 rated 55555 higher, whether the effect on health was positive or negative. CONCLUSION: The results complement previous findings that the onset of the COVID-19 pandemic may have impacted EQ-5D-5L health state valuation, and different aspects of the pandemic had different effects.

Something for everybody? Assessing the suitability of AAC systems for children using stated preference methods.

Little is known about what features of AAC systems are regarded by AAC professionals as more suitable for children with different characteristics. A survey was conducted in which participants rated the suitability of hypothetical AAC systems on a Likert scale from 1 (very unsuitable) to 7 (very suitable) alongside a discrete choice experiment. The survey was administered online to 155 AAC professionals in the United Kingdom of Great Britain and Northern Ireland. Statistical modeling was used to estimate how suitable 274 hypothetical AAC systems were for each of 36 child vignettes. The proportion of AAC systems rated at least 5 out of 7 for suitability varied from 51.1% to 98.5% for different child vignettes. Only 12 out of 36 child vignettes had any AAC systems rated at least 6 out of 7 for suitability. The features of the most suitable AAC system depended on the characteristics of the child vignette. The results show that, while every child vignette had several systems that had a good suitability rating, there were variations, that could potentially lead to inequalities in provision.

Decision Making About Disease-Modifying Treatments for Relapsing-Remitting Multiple Sclerosis: Stated Preferences and Real-World Choices.

BACKGROUND: People with relapsing-remitting multiple sclerosis can benefit from disease-modifying treatments (DMTs). Several DMTs are available that vary in their efficacy, side-effect profile and mode of administration. OBJECTIVE: We aimed to measure the preferences of people with relapsing-remitting multiple sclerosis for DMTs using a discrete choice experiment and to assess which stated preference attributes correlate with the attributes of the DMTs they take in the real world. METHODS: Discrete choice experiment attributes were developed from literature reviews, interviews and focus groups. In a discrete choice experiment, participants were shown two hypothetical DMTs, then chose whether they preferred one of the DMTs or no treatment. A mixed logit model was estimated from responses and individual-level estimates of participants' preferences conditional on their discrete choice experiment choices calculated. Logit models were estimated with stated preferences predicting current real-world on-treatment status, DMT mode of administration and current DMT. RESULTS: A stated intrinsic preference for taking a DMT was correlated with currently taking a DMT, and stated preferences for mode of administration were correlated with the modes of administration of the DMTs participants were currently taking. Stated preferences for treatment effectiveness and adverse effects were not correlated with real-world behaviour. CONCLUSIONS: There was variation in which discrete choice experiment attributes correlated with participants' real-world DMT choices. This may indicate patient preferences for treatment efficacy/risk are not adequately taken account of in prescribing. Treatment guidelines must ensure they take into consideration patients' preferences and improve communication around treatment efficacy/risk.

How does arthritis affect employment? Longitudinal evidence on 18,000 British adults with arthritis compared to matched controls.

INTRODUCTION: One in ten working age people in the UK live with arthritis or a similar condition affecting their joints. This impacts their quality of life, including through their work. But little is known about how arthritis affects labour market outcomes and the types of people most likely to be affected. METHODS: Data from three population-representative household panel surveys (BHPS, ELSA, UKHLS) collected in 2001-2019 was harmonised. Propensity score matching was used to match 18,014 UK adults aged 18-80 who have arthritis with comparable adults without arthritis. The relationship between arthritis and employment, and earnings and work hours conditional on employment, were assessed using multilevel regression modelling. Heterogeneity in these relationships were assessed by age, gender, degree-level education status, NS-SEC job classification and employer type. RESULTS: On average, arthritis was associated with a 3 percentage point reduction in the probability of employment. The effect size varied over people's life course and was larger amongst females, people without a degree, and those in routine or intermediate occupations (when compared to those in professional occupations) or working for small private companies (when compared to large private companies and non-private employers). Our models predict, for instance, that arthritis is associated with an 11 percentage point reduction in the probability of employment among 50-year-old women without a degree. This contrasts with a 5 percentage point reduction among 50-year-old men without a degree. If employed, men with a degree earned less if they had arthritis, whereas others (including women with a degree and men without a degree) had similar earnings regardless of their arthritis status. Those in professional occupations with arthritis also earnt less, especially if they were women aged over 40, with indications that this was driven by reduced work hours. CONCLUSION: Policy interventions to support people with arthritis who wish to remain in work might be designed with people in routine work in mind, and targeted at those working in smaller private firms. More research on the cost-effectiveness of those interventions is needed.

Effect of Temperature and Humidity on Milk Urea Nitrogen Concentration.

This study investigated the effect of ambient temperature and humidity on milk urea nitrogen (MUN) concentration in Holstein cows. Meteorological data corresponding to the dates of milk sampling were collected over six years. A linear mixed-effects model including a random effect term for cow identification was used to assess whether temperature and humidity were predictive of MUN concentration. Age, days in milk, temperature humidity index (THI), ration, milk yield, parity and somatic cell count were also evaluated as main effects in the model. A general linear model including all variables as random effects was then fitted to assess the contribution of each variable towards the variability in MUN concentration. Maximum daily temperature and humidity on the sampling day were positively associated with MUN concentration, but their interaction term was negatively associated, indicating that their effects were not independent and additive. Variables that contributed the most to the variability of MUN concentration were dietary crude protein (21%), temperature (18%) and other factors (24%) that were not assessed in the model (error term). Temperature has a significant influence on urea nitrogen concentration and should therefore always be considered when urea nitrogen concentration data are used to make inferences about the dietary management of dairy cows.

An Item-Response Mapping from General Health Questionnaire Responses to EQ-5D-3L Using a General Population Sample from England.

BACKGROUND: The 12-item General Health Questionnaire (GHQ-12) is widely used to measure mental health and well-being; however, it is not possible to estimate values on the full health = 1, dead = 0 scale used to construct quality-adjusted life-years (QALYs) from GHQ-12 responses as it is not preference-based. OBJECTIVE: The aim of this study was to create an item-response mapping between GHQ-12 and EQ-5D-3L health states, for which several value sets exist. METHODS: Data from the 2012 Health Survey for England with complete GHQ-12 and EQ-5D-3L descriptive system responses were used for analysis. Data were split 70/30 into estimation/test samples. Four modelling approaches, with EQ-5D-3L levels on each dimension as dependent variables and GHQ-12 responses as independent variables were assessed: non-parametric, simple ordered logit (OL), extended OL, and least absolute shrinkage and selection operator (LASSO). Approaches were assessed using Akaike and Bayesian information criteria, predictive accuracy measured using root mean squared error (RMSE), and simplicity. RESULTS: A total of 8114 responses became 6924 after discarding missing values, with 4847 used in estimation and 2077 used for testing. LASSO had a better model fit on the pain/discomfort dimension, but no model had markedly superior predictive accuracy. The non-parametric approach was chosen for the mapping algorithm based on simplicity. Predicted and observed EQ-5D-3L values for the test sample had a correlation of 0.488. Prediction accuracy was better for GHQ-12 scores below 20 than scores above 20. CONCLUSION: The mapping allows EQ-5D-3L responses to be predicted using GHQ-12 responses, which may be useful in estimating utility values and QALYs. An R script and Microsoft Excel spreadsheet are provided to facilitate calculations.

Effect of Dietary Inclusion of Azadirachta indica and Moringa oleifera Leaf Extracts on the Carcass Quality and Fatty Acid Composition of Lambs Fed High Forage Total Mixed Rations.

There is an increased interest in the use of medicinal plants as alternatives to antibiotic growth promoters and as agents for methane production mitigation. This study investigated the effects of Azadirachta indica and Moringa oleifera feed additives on the carcass and meat quality of lambs. Forty South African Mutton Merino lambs, weighing between 29 and 43 kg, were randomly assigned to four treatment groups (n = 10 lambs/treatment) and fed a basal total mixed ration (TMR) containing soybean meal (17%), yellow maize (28%), Alfalfa hay (20%), Eragrostis curvula hay (22.2%), molasses (6.0%), wheat offal (5%), urea (0.8%) and vitamin premix (0.5%) on a DM basis. The dietary treatments: TMR diet (control); TMR diet with A. indica leaf extract (A. indica leaf extract at a dosage of 50 mg per kg of feed: neem); TMR diet with M. oleifera leaf extract (M. oleifera leaf extract at a dosage of 50 mg per kg DM of feed: moringa); TMR diet with monensin (at a dosage of 50 mg monensin sodium per kg of feed: positive control). After an adaptation period of 10 days to the experimental conditions, the lambs from all treatment groups were fed ad libitum with the experimental diets. The lambs were slaughtered at a live weight of 60−65 kg after a 23 week trial period. The plant extract dietary additives had no significant effects on the carcass characteristics of the lambs. In comparison to monensin, supplementing with moringa leaf extracts resulted in a higher proportion of C18:1n9c (45.0% ± 0.57 vs. 40.5% ± 0.80; p < 0.05), total MUFAs (47.3% ± 0.66 vs. 42.6% ± 0.87; p < 0.05), and UFA:SFA ratio (1.01 ± 0.03 vs. 0.85 ± 0.03; p < 0.05), which may be beneficial for human health. Our results suggest that natural feed additives, such as A. indica and M. oleifera leaf extracts, can be included in lamb diets without compromising meat fatty acid composition. The negative economic impacts of such technologies on animal production and farm profitability should not be expected.

A Phase II trial of Higher RadiOtherapy Dose In The Eradication of early rectal cancer (APHRODITE): protocol for a multicentre, open-label randomised controlled trial.

INTRODUCTION: The standard of care for patients with localised rectal cancer is radical surgery, often combined with preoperative neoadjuvant (chemo)radiotherapy. While oncologically effective, this treatment strategy is associated with operative mortality risks, significant morbidity and stoma formation. An alternative approach is chemoradiotherapy to try to achieve a sustained clinical complete response (cCR). This non-surgical management can be attractive, particularly for patients at high risk of surgical complications. Modern radiotherapy techniques allow increased treatment conformality, enabling increased radiation dose to the tumour while reducing dose to normal tissue. The objective of this trial is to assess if radiotherapy dose escalation increases the cCR rate, with acceptable toxicity, for treatment of patients with early rectal cancer unsuitable for radical surgery. METHODS AND ANALYSIS: APHRODITE (A Phase II trial of Higher RadiOtherapy Dose In The Eradication of early rectal cancer) is a multicentre, open-label randomised controlled phase II trial aiming to recruit 104 participants from 10 to 12 UK sites. Participants will be allocated with a 2:1 ratio of intervention:control. The intervention is escalated dose radiotherapy (62 Gy to primary tumour, 50.4 Gy to surrounding mesorectum in 28 fractions) using simultaneous integrated boost. The control arm will receive 50.4 Gy to the primary tumour and surrounding mesorectum. Both arms will use intensity-modulated radiotherapy and daily image guidance, combined with concurrent chemotherapy (capecitabine, 5-fluorouracil/leucovorin or omitted). The primary endpoint is the proportion of participants with cCR at 6 months after start of treatment. Secondary outcomes include early and late toxicities, time to stoma formation, overall survival and patient-reported outcomes (European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires QLQ-C30 and QLQ-CR29, low anterior resection syndrome (LARS) questionnaire). ETHICS AND DISSEMINATION: The trial obtained ethical approval from North West Greater Manchester East Research Ethics Committee (reference number 19/NW/0565) and is funded by Yorkshire Cancer Research. The final trial results will be published in peer-reviewed journals and adhere to International Committee of Medical Journal Editors guidelines. TRIAL REGISTRATION NUMBER: ISRCTN16158514.

Sustained Effects of Muscle Calpain System Genotypes on Tenderness Phenotypes of South African Beef Bulls during Ageing up to 20 Days.

The most important factor that determines beef tenderness is its proteolytic activity, and the balance between calpain-1 protease activity and calpastatin inhibition is especially important, while contributions can also arise from calpain-2 and, possibly, calpain-3. The meat ageing process itself affects these processes. To determine whether genotypes in the calpain-calpastatin system can enhance tenderness through a 20-day ageing period, South African purebred beef bulls (n = 166) were genotyped using the Illumina BovineHD SNP BeadChip through a gene-based association analysis targeting the cast, capn3, capn2 and capn1 genes. The Warner-Bratzler shear force (WBSF) and myofibril fragment length (MFL) of Longissimus thoracis et lumborum (LTL) steaks were evaluated between d 3 and d 20 of ageing, with protease enzyme activity in the first 20 h post-mortem. Although several of the 134 SNPs are associated with tenderness, only seven SNP in the cast, capn2 and capn1 genes sustained genetic associations, additive to the ageing-associated increases in tenderness for at least three of the four ageing periods. While most genomic associations were relatively stable over time, some genotypes within the SNP responded differently to ageing, resulting in altered genomic effects over time. The level of ageing at which genomic associations are performed is an important factor that determines whether SNPs affect tenderness phenotypes.

The path towards herd immunity: Predicting COVID-19 vaccination uptake through results from a stated choice study across six continents.

Despite unprecedented progress in developing COVID-19 vaccines, global vaccination levels needed to reach herd immunity remain a distant target, while new variants keep emerging. Obtaining near universal vaccine uptake relies on understanding and addressing vaccine resistance. Simple questions about vaccine acceptance however ignore that the vaccines being offered vary across countries and even population subgroups, and differ in terms of efficacy and side effects. By using advanced discrete choice models estimated on stated choice data collected in 18 countries/territories across six continents, we show a substantial influence of vaccine characteristics. Uptake increases if more efficacious vaccines (95% vs 60%) are offered (mean across study areas = 3.9%, range of 0.6%-8.1%) or if vaccines offer at least 12 months of protection (mean across study areas = 2.4%, range of 0.2%-5.8%), while an increase in severe side effects (from 0.001% to 0.01%) leads to reduced uptake (mean = -1.3%, range of -0.2% to -3.9%). Additionally, a large share of individuals (mean = 55.2%, range of 28%-75.8%) would delay vaccination by 3 months to obtain a more efficacious (95% vs 60%) vaccine, where this increases further if the low efficacy vaccine has a higher risk (0.01% instead of 0.001%) of severe side effects (mean = 65.9%, range of 41.4%-86.5%). Our work highlights that careful consideration of which vaccines to offer can be beneficial. In support of this, we provide an interactive tool to predict uptake in a country as a function of the vaccines being deployed, and also depending on the levels of infectiousness and severity of circulating variants of COVID-19.

Effects of Milk Urea Nitrogen (MUN) and Climatological Factors on Reproduction Efficiency of Holstein Friesian and Jersey Cows in the Subtropics.

This study investigated the effects of MUN and climatological factors on the inter calving period (ICP), reproductive performance (RP%), and reproductive index (RI) in Holstein Friesian (n = 1177) and Jersey cows (n = 3305) in different seasons in the subtropics. Threshold values for MUN on the reproduction of dairy cows in the subtropics remain controversial due to complex environmental interactions, especially with high environmental temperatures. A retrospective analysis was conducted of data obtained from the National Milk Recording scheme of the Agricultural Research Council (ARC) in South Africa. The results confirm that MUN influences the reproduction of dairy cows in the subtropics. MUN concentrations exceeding 18.1 ± 4.28 mg/dL in Holstein Friesian cows and 13.0 ± 4.70 mg/dL in Jersey cows extended the inter calving period (ICP), and decreased RP% and RI. Jersey cows have a lower threshold MUN concentration compared to Holstein Friesian cows, but they are not adversely affected by high humidity or temperatures, while Holstein Friesian cows are.

Does a health crisis change how we value health?

General population health state values are used in healthcare resource allocation, including health technology assessment. We examine whether UK general population health valuations changed during the COVID-19 pandemic. Ratings of EQ-5D-5L health states 11111 (no problems), 55555 (extreme problems), and dead were collected in a UK general population survey during the pandemic (April-May 2020) using the 0 = worst imaginable health, 100 = best imaginable health visual analog scale (EQ-VAS). Ratings for 55555 were transformed to a full health = 1, dead = 0 scale. Responses were compared to similar data collected pre-pandemic (2018). After propensity score matching to minimize sample differences, EQ-VAS responses were analyzed using Tobit regressions. On the 0-100 scale, 11111 was rated on average 8.67 points lower, 55555 rated 9.56 points higher, and dead rated 7.45 points lower post-pandemic onset compared to pre-pandemic. On the full health = 1, dead = 0 scale, 55555 values were 0.09 higher post-pandemic onset. There was evidence of differential impacts of COVID-19 by gender, age, and ethnicity, although only age impacted values on the 1-0 scale. COVID-19 may have affected how people value health. It is unknown whether the effect is large enough to have policy relevance, but caution should be taken in assuming pre-COVID-19 values are unchanged.

Rarity patterns of woody plant species are associated with life form and diversification rates in Pacific islands forests.

PREMISE: Rarity is a complex and central concept in ecology and conservation biology. Yet, it is still poorly understood why some species are rare and others common. Here, we aimed to understand the drivers of species rarity patterns in woody plant communities. METHODS: We analyzed the local abundance and landscape frequency of 121 woody plant species across 238 plots on American Samoa and Hawaiian islands. We first assessed whether taxonomy, life form (shrub, small tree, large tree), and dispersal syndrome (dispersed by animals or by other means) are associated with the rarity of species. We then analyzed phylogenetic patterns in plant rarity and tested whether rarity patterns are associated with species evolutionary distinctiveness and the number of species within genera and families. RESULTS: Large trees were less abundant but more frequent than shrub species. Animal-dispersed species tended to be less abundant than species dispersed by other means, while species frequency was not associated with dispersal syndromes. Relative frequency in Hawai'i exhibited a more robust phylogenetic signal than did abundance. Both evolutionary distinctiveness and taxa species richness were significantly associated with the frequency of shrub species in Hawai'i. CONCLUSIONS: Life form appears consistently associated with the rarity of species. High diversification rate is probably a key factor explaining landscape-scale rarity of native species on isolated archipelagos like Hawai'i. At the landscape scale, rarity appears to be inversely associated with evolutionary distinctiveness, but at the local scale, species abundance may be not associated with evolutionary distinctiveness.

Changing the eligibility criteria for welfare payments at the end of life - a budget impact analysis for England and Wales.

BACKGROUND: Terminal illness can cause a financial burden for many households. In England and Wales, fast-track access to welfare payments is available through special rules for the terminally ill (SRTI). Individuals are eligible for SRTI if they are judged to have 6 months or less to live. This criterion has been criticised as lacking a clinical basis, and being unfair for people with conditions where life-expectancy is difficult to accurately assess. AIM: To conduct a budget impact analysis on the possible increase in expenditure of personal independence payments (PIP) following a change in England and Wales to SRTI so that everyone with a terminal illness is eligible. METHODS: The fraction of individuals with a given long-term condition was estimated by combining data from the Health Survey for England, the Office for National Statistics (ONS) and the Department for Work and Pensions. Logistic growth modelling and ONS population projections were used to project PIP expenditure from 2020 to 2025. The increased expenditure was calculated for hypothetical scenarios which may occur following an SRTI regime change, specifically an increase of 1, 2 and 3 percentage points in the fraction of individuals claiming PIP under SRTI. Data from the literature on the projected prevalence of mild, moderate and severe dementia was used to calculate the cost if everyone with a given severity of dementia claimed PIP under SRTI. RESULTS: Under the current SRTI regime, PIP expenditure under SRTI was projected to increase from £0.231bn in 2020 to £0.260bn in 2025, compared to equivalent figures of £11.1bn and £12.7bn under non-SRTI. Expenditure in 2025 following an increase in the fraction claiming of 1, 2 and 3 percentage points was projected to be £1.1bn, £1.9bn and £2.7bn respectively. In 2025, PIP expenditure was estimated to be £7.4bn if everyone with dementia claimed under SRTI, compared to £6.4bn if only individuals with moderate and severe dementia claimed, and £4.7bn if only individuals with severe dementia claimed. CONCLUSION: Changes in SRTI are projected to lead to increases in PIP expenditure. However, the increased cost is small compared to expenditure under non-SRTI, especially as the highest costs were associated with extreme scenarios.

Attribute Selection for a Discrete Choice Experiment Incorporating a Best-Worst Scaling Survey.

OBJECTIVES: Although literature exists on using qualitative methods to generate potential attributes for a discrete choice experiment (DCE), there is little on selecting which attributes to include. We present a case study in which a best-worst scaling case 1 (BWS-1) survey was used to guide attribute selection for a DCE. The case study's context was the decision making of professionals around the choice of augmentative and alternative communication (AAC) systems for children with limited natural speech. METHODS: BWS-1 survey attributes were generated from literature reviews and focus groups. DCE attributes were selected from BWS-1 attributes. The selection criteria were: include mostly important attributes; create coherent descriptions of children and AAC systems; address the project's research aims; have an appropriate respondent burden. Attributes' importance was judged using BWS-1 relative importance scores. RESULTS: The BWS-1 survey included 19 child and 18 AAC device/system attributes and was administered to N = 93 AAC professionals. Four child and five device/system attributes were selected for the DCE, administered to N = 155 AAC professionals. CONCLUSIONS: In this case study BWS-1 results were useful in DCE attribute selection. Four recommendations are made for future studies: define selection criteria for DCE attributes a priori; consider the impact participant's perspective will have on BWS-1 and DCE results; clearly define key terminology at the start of the study and refine it as the study progresses to reflect interim findings; BWS will be useful when there is little existing stated preference work on a topic and/or qualitative work is difficult.