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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.
The efficacy of pitfall traps baited with pheromone and cereal oil in capturing Tribolium confusum Jacquelin du Val and T. castaneum (Herbst) (Coleoptera: Tenebrionidae) was low (trap catch) in mill and simulated warehouse settings. In a simulated warehouse experiment, strains of Tribolium Macleay recently taken from mills were caught 24% less often in traps than were laboratory strains, and T. confusum was caught 40% less often than T. castaneum. Both species were found together in all flour samples taken from a Canadian flour mill. A comparison of the species ratio in flour samples with that found in traps revealed that T. confusum was caught less often in traps than was T. castaneum. In flour, T. castaneum burrowed more than did T. confusum, and there were differences in burrowing behaviour between the four T. castaneum strains. Mills infested with T. confusum may have higher levels of infestation than was previously thought, indicating that further research into beetle behaviour in mills is needed.
The identity of a dotillid intertidal crab from exposed sandy beaches within the Laem Son National Park along the Andaman Coast in Thailand was investigated. The species was identified as Dotilla intermedia De Man, 1888, which represents the first record of this species from Thailand. A description of the species is provided and a lectotype is designated from the type series.
There is a growing need for optical fiber coatings that can sustain higher temperatures than present materials permit. To date, polyimides are used predominantly but they generally are difficult to process and usually require multiple depositions to achieve the desired film thickness. Perfluorocyclobutyl (PFCB) aryl ether polymers have demonstrated much success as processable and amorphous fluoropolymers, with particular emphasis on high performance optical applications. This work discusses recent efforts into perfluorocyclobutyl aryl ether polymer-based optical fiber coatings. A series of silica-based optical fibers were drawn with differing PFCB polymer coatings compositions and molecular weights on a Heathway draw tower. Results include a more than doubled usage temperature of coating (decomposition temperatures (Td) in nitrogen and air were above 450 °C) without affecting fiber mechanical properties and comparable isothermal stability to conventional coatings, except with a >150 °C higher temperature. Preliminary results of the first successful coating of optical fibers by PFCB polymers will be presented herein, as well as future endeavors.
Microlensing searches for planets are sensitive to small, cold exoplanets from 1–6 AU from their host stars and therefore probe an important part of parameter space. Other techniques would require many years of observations, often from space, to detect similar systems. Microlensing events can be characterised from only ground-based observations over a relatively short (≤100d) timescales. LCOGT and SUPA/St Andrews are building a robotic global network of telescopes that will be well suited to follow these events. Here we present preliminary results of the Galactic Bulge observing season 2010 March–October.
The Honduran Emerald Amazilia luciae is endemic to dry forests of Honduras and currently recognised as ‘Critically Endangered.’ Here we present the first modern assessment of its distribution, ecology, and conservation, based partly on our rediscovery of the species in western Honduras and on our observations in three Honduran departments. We found that dry forests inhabited by the emerald differed in structure and species composition between eastern and western Honduras, where we observed emeralds in open-canopied deciduous thorn forests and closed-canopied semi-deciduous woodlands, respectively. We interpret these differences in light of the geological and anthropogenic origins of dry forests in Honduras, and discuss the implications of such origins for the conservation of dry forests. Although our findings expand the known distribution and population size of the species, its status as ‘Critically Endangered’ is warranted due to its restricted distribution in dry forest fragments and increasing human pressures on this habitat.
The widespread geographical distributions of mammalian carnivores such as the Carnivora and the Dasyuridae have often been erroneously equated with abundance. Their low densities and high demands on habitat area can render mammalian carnivores especially vulnerable to habitat fragmentation and destruction. The fossa Cryptoprocta ferox (Viverridae) is a mammalian carnivore threatened by the rapid loss of Madagascar's forests, to which it is endemic. A 3-year mark-recapture study, comprising four censuses, generated an estimate of fossa population density at 0.18 adults km−2, or 0.26 individuals km−2. This was supported by a similar estimate from home range data. The fossa is thought to be unusually common in the study area, yet the estimated density was lower than that predicted for a typical tropical carnivorous mammal of the body mass of a fossa. Ecologists are frequently under pressure to provide estimates of local and global population numbers of their study species; we discuss the numerous factors that limit our ability to do this on the basis of a single population estimate. Nonetheless, our findings are sufficient to suggest that none of Madagascar's 46 protected areas supports a viable population of fossas, indicating a demand for corridors and enlarged reserves to ensure this species' long-term survival. Loss of the top predator can have a knock-on effect on an ecosystem. The findings indicate that, to maintain intact tropical forest ecosystems, it may be essential to consider the requirements of their often little-known mammalian carnivores. These requirements could be far greater than previously assumed.
Epidemiological and experimental evidence suggests that maternal undernutrition during pregnancy may alter development of fetal organ systems. We have demonstrated previously that fetal hypothalamic-pituitary-adrenal (HPA) axis responses to exogenous corticotropin-releasing hormone (CRH) + arginine vasopressin (AVP), or adrenocorticotrophin hormone (ACTH), are reduced in fetuses of mildly undernourished ewes. To examine these effects further we tested HPA axis responses to acute isocapnic hypoxaemia in fetal sheep at 114-129 days gestation (dGA), following 15 % reduction in maternal nutritional intake between 0 and 70 dGA. Fetuses from control (C) and nutrient-restricted (R) ewes were chronically catheterised and plasma ACTH and cortisol responses were determined at 114-115, 120-123 and 126-129 dGA during hypoxaemia (1 h) induced by lowering the maternal inspired O2 fraction (FI,O2). Basal plasma cortisol concentrations and HPA axis responses at 114-115 and 120-123 dGA did not differ between C and R fetuses. At 126-129 dGA, both plasma ACTH (P < 0.01) and cortisol (P < 0.05) responses were smaller in R fetuses compared to C fetuses. Fetal blood gas status, fetal body weight, body proportions and organ weights did not differ between the groups. We conclude that mild maternal undernutrition alters development of the fetal HPA axis producing a reduction in pituitary and adrenal responsiveness to endogenous stimuli.
Discriminant analysis is concerned with the problem of classifying an object of unknown origin into one of two or more distinct groups or populations on the basis of observations made on it. As evidenced by the examples given below, this problem occurs frequently in various fields as diverse as medicine, anthropology and mining, and the techniques of discriminant analysis have been used successfully in many situations. Computer packages for performing the necessary calculations involved in applying some of the techniques have been readily available for some time, although there are still some serious omissions in most of these packages.
1. Haemophilia is a sex-linked genetic disease which is transmitted only by females, but whose symptoms are manifest only in males. Under normal medical examination it is impossible to distinguish between females carrying the disease and those not. In order to try and identify female carriers, the levels of a coagulant factor and its related antigen (Factor VIII and Factor VIII RA) in the blood have been suggested as possible discriminators between carriers and non-carriers.
A pilot study was carried out by Gomperts et al (1976) to test how well Factor VIII and its related antigen discriminate between carriers and non-carriers. A sample of 26 white females, of which 11 were known, for genetic reasons, to be carriers and 15 were known to be non-carriers was selected and the Factor VIII and Factor VIII RA levels measured in each subject.
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