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The cost-effectiveness of molecular pathology testing is highly context dependent. The field is fast-moving, and national health technology assessment may not be relevant or timely for local decision makers. This study illustrates a method of context-specific economic evaluation that can be carried out in a limited timescale without extensive resources.
We established a multi-disciplinary group including an oncologist, pathologists and a health economist. We set out diagnostic and treatment pathways and costs using registry data, health technology assessments, guidelines, audit data, and estimates from the group. Sensitivity analysis varied input parameters across plausible ranges. The evaluation setting was the West of Scotland and UK NHS perspective was adopted. The evaluation was assessed against the AdHopHTA checklist for hospital-based health technology assessment.
A context-specific economic evaluation could be carried out on a timely basis using limited resources. The evaluation met all relevant criteria in the AdHopHTA checklist. Health outcomes were expected to be at least equal to the current strategy. Annual cost savings of £637,000 were estimated resulting primarily from a reduction in the proportion of patients receiving intravenous infusional chemotherapy regimens. The result was not sensitive to any parameter. The data driving the main cost saving came from a small clinical audit. We recommended this finding was confirmed in a larger population.
The method could be used to evaluate testing changes elsewhere. The results of the case study may be transferable to other jurisdictions where the organization of cancer services is fragmented.
It is shown that upon combining GALEX far-ultraviolet and Johnson B magnitudes a resultant FUV–B colour can be obtained that for red giant stars of luminosity classes III and II correlates well with chromospheric emission in the cores of the Mg iih and k lines. Giant stars throughout the colour range 0.8 ≤ B – V ≤ 1.6 exhibit such a phenomenon. The main result of this paper is to show that GALEX far-ultraviolet photometry can provide information about the degree of chromospheric activity among red giant stars, and as such may offer a tool for surveying the evolution of chromospheric activity from the main sequence into the red giant phases of stellar evolution.
The far-ultraviolet magnitudes of late-F, G and early-K dwarfs with (B − V) ⩾ 0.50 as measured by the GALEX satellite are shown to correlate with soft X-ray luminosity. This result indicates that line and continuum emission from stellar active regions make significant contributions to the flux in the GALEX FUV band for late-F, G and K dwarfs. By contrast, detection of a correlation between FUV brightness and soft X-ray luminosity among early-F dwarfs requires subtraction of the photospheric component from the FUV flux. The range in (B − V) among F and G dwarfs over which a correlation between uncorrected FUV magnitude and X-ray luminosity is detected coincides with the range in colour over which coronal and chromospheric emission correlates with stellar rotation.
Within globular clusters, stars of similar temperatures and gravities commonly exhibit differences in the strength of the λ3883 CN band, the distribution of which is often bimodal. An archetype example of this phenomenon is NGC 6752 (Norris et al. 1981). As documented by Da Costa and Cottrell (1980), and Norris et al. (1981), the CN-rich giants in this cluster possess enhancements in nitrogen abundance by factors of 7–8 relative to the CN-poor giants. This may indicate that chemical enrichment of proto-cluster gas clouds took place as a result of the activity of massive stars, which manufactured nitrogen within their interiors and ejected it into the cluster gas while low mass stars were forming. The aim of this paper is to investigate whether the properties of NGC 6752 mentioned above might be consistent with supernova enrichment. Both the free and adiabatic expansion phases of supernova shells (Spitzer 1968) will be discussed in this context.
Correlations are identified between the strength of the λ10830 He I triplet line and the following tracers of stellar activity amongst FGK dwarfs with colours of (B − V) > 0.47: coronal soft X-ray emission, emission in the λ1549 C IV and λ1335 C II lines originating from the transition region, and Ca II H and K emission from the chromosphere. No such correlations are present amongst dwarfs with spectral type earlier than F6. In addition, G and K dwarfs with strong triplet lines show evidence of excess flux in the GALEX FUV band compared to weak-triplet-line dwarfs. The X-ray spectra of late-F, G, and K dwarfs with He I triplets stronger than 160 mÅ have greater values of the ROSAT hardness ratio HR1 than are typical of weak-triplet dwarfs in the same range of spectral type. In other words, dwarfs later than F7V with strong He I triplet lines tend towards harder 0.1–2.0 keV X-ray spectra than weak-triplet dwarfs, although values of HR1 ~ −0.2 to +0.1 can still be encountered amongst a minority of weak-He-triplet stars. As regards, FGK main sequence stars the observational data on the λ10830 triplet line remains sparse. Progress could be made through spectroscopy of high resolution for samples of hundreds of stars, selected on the basis of having other measures of chromospheric and coronal activity available.
The globular cluster ω Centauri is known to be chemically inhomogeneous, a property that reveals itself via a wide giant branch in the V, B-V color-magnitude diagram (Cannon and Stobie 1973). Typically a color range of δ(B-V) = 0.3 − 0.4 exists among giants with V < 13. However, in the red R, R-I (Norris and Bessell 1975, Bessell and Norris 1976), and I, V-I (Lloyd Evans 1977) diagrams a much tighter giant branch is seen. This has lead to the suggestion (e.g. Bessell and Norris 1976) that molecular absorption in the bandpass of the B filter has significantly reddened the B-V color, and thereby produced an anomalously wide giant branch.
A narrow-band translator and filter system has been constructed for the Parkes Multibeam receiver. This brief note outlines the characteristics of the system and indicates the range of new projects that will be possible in studies of the Magellanic Clouds.
It has been suggested that diffuse X-ray sources observed in globular clusters may arise in bow shocks formed by the interaction of intracluster gas with a tenuous halo medium. This paper presents a study both of the cluster space motions and of the energetics of any possible bow shocks which would seem to rule out this hypothesis.
To examine the association between BMI and folate concentrations in serum and red blood cells (RBC) in pregnant women.
A cross-sectional comparison of folate concentrations in serum and RBC sampled simultaneously from the same individual.
The Ottawa Hospital and Kingston General Hospital, Ontario, Canada.
Pregnant women recruited between 12 and 20 weeks of gestation.
A total of 869 pregnant women recruited from April 2008 to April 2009 were included in the final analysis. Serum folate was inversely associated and RBC folate positively associated with BMI, after adjusting for folic acid supplementation, age, gestational age at blood sample collection, race, maternal education, annual income, smoking and MTHFR 677C→T genotype. In stratified analyses, this differential association was significant in women with the MTHFR CC variant. In women with the CT and TT variants, the differential associations were in the same direction but not significant. Folic acid supplementation during pregnancy did not alter the differential association of BMI with serum and RBC folate concentration. This indicates that the current RBC folate cut-off approach for assessing risk of neural tube defects in obese women may be limited.
BMI is inversely associated with serum folate and positively associated with RBC folate in pregnant women, especially for those with the MTHFR CC variant.
Large-scale trends in planktonic foraminiferal diversity have so far been based on utilization of synoptic biostratigraphic range charts. Although this approach ensures the taxonomic consistency and quality of the data being used, it takes no formal account of any sampling biases that might exist in the fossil record. We demonstrate that the occurrence data of planktonic foraminifera, as recorded in the primary literature, are strongly biased by sampling. We do this by demonstrating that raw diversity curves derived from the land-based and deep-sea records are strikingly different, but that they each correlate with the intensity of sampling in their respective environments, and thus are ultimately controlled by the structure of the geological record in each setting. Because sampling of the Mesozoic record is best in our land record whereas sampling of the Cenozoic is best in our deep-sea record, we combine the two to generate the best-supported estimates of species and genus diversity over time from these data. We correct for sampling bias using shareholder quorum subsampling and a modeling approach. The data are then transformed to generate a range-through plot of species richness that is compared with two earlier estimates of the diversity history where comparable species-in-bin data can be recovered. No robust statistical correlation is found among the three estimates. Although differences in amplitude are to be expected, differences in the actual shape of the curve are surprising. We conclude that these differences stem from the nature of the data themselves, namely the taxonomic scheme adopted and the taxonomic coverage used.
The paper reports on the fourth (2010) season of fieldwork of the Cyrenaican Prehistory Project, and on further results of analyses of artefacts and organic materials collected in the 2009 season. Ground-based LiDar has provided both an accurate 3D scan of the Haua Fteah cave and information on the cave's morphometry or origins. The excavations in the cave focussed on Middle Palaeolithic or Middle Stone Age ‘Pre-Aurignacian’ layers below the base of the Middle Trench beside the McBurney Deep Sounding (Trench D) and on Final Palaeolithic ‘Oranian’ layers beside the upper part of the Middle Trench (Trench M). Although McBurney referred to the upper part of the Deep Sounding as more or less sterile, the 2010 excavations found evidence for small-scale but regular human presence in the form of stone artefacts and debitage, though given the sedimentary context the latter are unlikely to represent in situ knapping. The excavations of Trench M extended from the basal Capsian layers investigated in 2009 through Oranian layers to the transition with the Dabban Upper Palaeolithic. Some 17,000 lithic pieces have been studied from the Capsian and Oranian layers excavated in Trench M, in an area measuring less than 2 m by 1 m by 1.1 m deep, along with numerous animal bones, molluscs, and macrobotanical remains, as well as occasional shell beads. Preliminary studies of the lithics, bones, molluscs, and plant remains are revealing the changing character of late Pleistocene (Oranian) and early Holocene (Capsian) occupation in the Haua Fteah. Alongside the work in the Haua Fteah, the project continued its assessment of the Quaternary and archaeological sequences of the Cyrenaican coastland and completed a transect survey of surface lithic materials and their landform contexts from the pre-desert across the Gebel Akhdar to the coast, with a new focus on the al-Marj basin. Significant differences are emerging in patterns of Middle Palaeolithic and later hominin occupation and palaeodemography.
Preeclampsia (PE) is a multisystem disorder of human pregnancy, affecting about 6% of all pregnancies worldwide, and is one of the leading causes of maternal and infant morbidity and mortality. Despite decades of research into the pathogenesis of this complex disease, the underlying mechanisms remain unclear. As a result, the options for prevention and management of PE are limited. In recent years, there has been a growing body of evidence suggesting that folate deficiency is associated with PE, and folic acid supplementation may reduce the risk of developing PE in certain populations. Folate contributes to cell division and growth, and folate metabolism is involved in a large number of physiological and pathophysiological processes in human development. Sufficient supply of folate is therefore particularly important during pregnancy. Nevertheless, the exact mechanisms of folic acid deficiency increasing the risk of developing PE are still unclear. This article reviews what is understood about the aetiology of PE and the relationship between folate metabolism and PE so as to enhance further discussions on the subject.
The target adopted by world leaders of significantly reducing the rate of biodiversity loss by 2010 was not met but this stimulated a new suite of biodiversity targets for 2020 adopted by the Parties to the Convention on Biological Diversity (CBD) in October 2010. Indicators will be essential for monitoring progress towards these targets and the CBD will be defining a suite of relevant indicators, building on those developed for the 2010 target. Here we argue that explicitly linked sets of indicators offer a more useful framework than do individual indicators because the former are easier to understand, communicate and interpret to guide policy. A Response-Pressure-State-Benefit framework for structuring and linking indicators facilitates an understanding of the relationships between policy actions, anthropogenic threats, the status of biodiversity and the benefits that people derive from it. Such an approach is appropriate at global, regional, national and local scales but for many systems it is easier to demonstrate causal linkages and use them to aid decision making at national and local scales. We outline examples of linked indicator sets for humid tropical forests and marine fisheries as illustrations of the concept and conclude that much work remains to be done in developing both the indicators and the causal links between them.
I first arrived in Kandahar in 2005 by car, descending out of the rough hills around Kabul and onto the plains of southern Afghanistan via Highway 1, the country's main artery. In those days, the road was smooth and freshly tarmacked. We travelled without fear. The following year, with reports of Taliban roadblocks on the highway, it was considered too dangerous for a foreigner to drive – but I could still make the trip by bus, wearing Afghan clothes and hiding myself among the passengers. By 2007, however, the insurgents were also stopping the buses, as the gunmen felt confident enough about their control of the rural districts to conduct leisurely searches. The year after, I stopped allowing my Afghan staff to travel by road, preferring to buy them air tickets rather than expose them to the possibility that some Taliban fighter would get suspicious about their haircuts, their clothes, a name in their cell phone, or any of the other causes of suspicion that could get a person kidnapped or killed. Those who did venture onto the highway found it pockmarked with bomb craters and littered with the husks of burned vehicles.
During my years in southern Afghanistan (2005–09), we did not need the UN risk maps or NATO's incident data to understand that things were getting worse. The growing insurgency shaped the lives of everybody in the south, myself included.
Combination of SAXS and USAXS measurements provide an extended q-range (0.006–3.0 nm-1) to study fractal growth of both aging silica gel as well as precursors of zeolite-A. Mass (silica) and surface (zeolite) fractals are observed. Scanning transmission X-ray microscopy (STXM) proves to be an extremely useful technique to obtain direct images of wet samples in the 0.1–100 micron range, confirming the SAXS/USAXS results on even larger length scales.
Over the last decade, rural township governments have been subjected to intensive streamlining and rationalization programmes. This article examines which ongoing reforms and processes are causing township governments to become “hollow shells,” and explores the effects of “hollowing out” on township government leaders, staff and rural residents. While the aim of local government reform was to transform extractive township governments into “service-oriented” agencies, this article finds that the current logic of rural governance has produced township governments which are squeezed from above and below. From above, township leaders face the political imperatives of inspections, annual assessments, the need to attract industrial investment and an ongoing process of “soft centralization” by higher levels of government. From below, township staff are drawn out to the villages to enforce family planning policies and maintain social stability. Unprecedented numbers are working as “sent-down cadres” in villages where their capacity to deliver services has been weakened by village amalgamations and the lifting of agricultural taxes and fees. Despite significant boosts to rural health and education investment, rural residents still face a level of government that regards them as problems to be dealt with, rather than citizens to be served.