Cost effectiveness of photodynamic therapy with verteporfin for age related macular degeneration: the UK case

AIM: To estimate the potential cost effectiveness of photodynamic therapy (PDT) with verteporfin in the UK setting. METHODS: Using data from a variety of sources a Markov model was built to produce estimates of the cost effectiveness (incremental cost per quality adjusted life year (QALY) and incremental cost per vision year gained) of PDT for two cohorts of patients (one with starting visual acuity (VA) of 20/40 and one at 20/100) with predominantly classic choroidal neovascular disease over a 2 year and 5 year time horizon. A government perspective and a treatment cost only perspective were considered. Probabilistic and one way sensitivity analyses were undertaken. RESULTS: From the government perspective, over the 2 year period, the expected incremental cost effectiveness ratios range from £286 000 (starting VA 20/100) to £76 000 (starting VA 20/40) per QALY gained and from £14 000 (20/100) to £34 000 (20/40) per vision year gained. A 5 year perspective yields incremental ratios less than £5000 for vision years gained and from £9000 (20/40) to £30 000 (20/100) for QALYs gained. Without societal or NHS cost offsets included, the 2 year incremental cost per vision year gained ranges from £20 000 (20/100) to £40 000 (20/40), and the 2 year incremental cost per QALY gained ranges from £412 000 (20/100) to £90 000 (20/40). The 5 year time frame shows expected costs of £7000 (20/40) to £10 000 (20/100) per vision year gained and from £38 000 (20/40) to £69 000 (20/100) per QALY gained. CONCLUSION: This evaluation suggests that early treatment (that is, treating eyes at less severe stages of disease) with PDT leads to increased efficiency. When considering only the cost of therapy, treating people at lower levels of visual acuity would probably not be considered cost effective. However, a broad perspective that incorporates other NHS treatment costs and social care costs suggests that over a long period of time, PDT may yield reasonable value for money

The Henize sample of S stars. I. The technetium dichotomy

This paper is the first one in a series investigating the properties of the S stars belonging to the Henize sample (205 S stars with delta<-25 deg. and R<10.5) in order to derive the respective properties (like galactic distribution and relative frequencies) of intrinsic (i.e. genuine asymptotic giant branch) S stars and extrinsic (i.e. post mass-transfer binary) S stars. High-resolution (R=30 000 to 60 000) spectra covering the range 4230-4270AA have been obtained for 76 S stars, 8 M stars and 2 symbiotic stars. The 4262AA and 4238AA blends involving a Tc I line were analysed separately and yield consistent conclusions regarding the presence or absence of technetium. Only one `transition' case (Hen 140 = HD 120179, a star where only weak lines of technetium are detectable) is found in our sample. A resolution greater than R =30 000 is clearly required in order to derive unambiguous conclusions concerning the presence or absence of technetium. The Tc/no Tc dichotomy will be correlated with radial velocity and photometric data in a forthcoming paper.Comment: 10 pages, 5 figures, Latex, accepted for publication in Astronomy and Astrophysics main journal. Also available at http://astro.ulb.ac.be

A Study of Cool White Dwarfs in the Sloan Digital Sky Survey Data Release 12

In this work we study white dwarfs where $30\,000\,\text{K} {>} \mathrm{T}_{\rm{eff}} {>} 5\,000\,\text{K}$ to compare the differences in the cooling of DAs and non-DAs and their formation channels. Our final sample is composed by nearly $13\,000$ DAs and more than $3\,000$ non-DAs that are simultaneously in the SDSS DR12 spectroscopic database and in the \textit{Gaia} survey DR2. We present the mass distribution for DAs, DBs and DCs, where it is found that the DCs are ${\sim}0.15\,\mathrm{M}_\odot$ more massive than DAs and DBs on average. Also we present the photometric effective temperature distribution for each spectral type and the distance distribution for DAs and non-DAs. In addition, we study the ratio of non-DAs to DAs as a function of effective temperature. We find that this ratio is around ${\sim}0.075$ for effective temperature above ${\sim}22\,000\,\text{K}$ and increases by a factor of five for effective temperature cooler than $15\,000\,\text{K}$. If we assume that the increase of non-DA stars between ${\sim}22\,000\,\text{K}$ to ${\sim}15\,000\,\text{K}$ is due to convective dilution, $14{\pm}3$ per cent of the DAs should turn into non-DAs to explain the observed ratio. Our determination of the mass distribution of DCs also agrees with the theory that convective dilution and mixing are more likely to occur in massive white dwarfs, which supports evolutionary models and observations suggesting that higher mass white dwarfs have thinner hydrogen layers.Comment: 9 pages, 10 figures, accepted by MNRA

Solid-phase C60 in the peculiar binary XX Oph?

We present infrared spectra of the binary XX Oph obtained with the Infrared Spectrograph on the Spitzer Space Telescope. The data show some evidence for the presence of solid C60– the first detection of C60 in the solid phase – together with the well-known ‘unidentified infrared’ emission features. We suggest that, in the case of XX Oph, the C60 is located close to the hot component, and that in general it is preferentially excited by stars having effective temperatures in the range 15 000–30 000 K. C60 may be common in circumstellar environments, but unnoticed in the absence of a suitable exciting source

Teachers’ Response to Infants’ Nonverbal Communication and Use of Response to Facilitate a Dialogue

Beginning with birth, typically developing children use strategies to communicate, and the functions of their language change with maturation and interaction. Since communication cannot exist if both parties do not participate, it is important to not only study the ability of the child, but also the behavior of the adult. Numerous studies have examined the behavior of the parent or other domestic adult, but few have included the study of teacher behaviors. This study investigated teachers’ response to four types of nonverbal communication attempts made by infants. The gestures included: deictic, affect signaling, object-related, and conventional. The type of response was also documented as facilitating dialogue or discouraging dialogue. Thirty infant teachers and/or teacher assistants from 11 centers in Northeast Tennessee were videotaped for 30 minutes. Videos were coded to determine which of the defined functions teachers were most likely to respond to and if the response facilitated or discouraged dialogue. The results showed that overall, teachers responded to 25% of nonverbal attempts; 75% of the infants’ nonverbal attempts teacher offered a non-facilitative response or missed the gesture. Pearson correlations determined that there were relationships between children’s attempt to communicate and teachers’ response in all four types of nonverbal communication, including deictic, r (30) = .659, p = .000; affect signaling, r (30) = .917, p = .000; object-related, r (30) =.848, p = .000; and conventional, r (30) = .794, p = .000. There were several relationships between the number of nonverbal attempts by children and teachers offering a facilitative responses including affect signaling, r (30) = .776, p = .000; object-related, r (30) = .635, p = .000; and conventional, r (30) = .514, p = .004, but not with deictic attempts. There were relationships between the number of nonverbal attempts by children and teachers offering discouraging responses in all 4 types of nonverbal language, including deictic, r (30) = .706, p = .000; affect signaling, r (30) = .630, p = .000; object-related, r (30) = .582, p = .001; and conventional, r (30) = .439, p = .015

Variability in size and characteristics of primary care networks in England

Background General practices in England have been encouraged by national policy to work together on a larger scale by creating primary care networks (PCNs). Policy guidance recommended that they should serve populations of 30 000-50 000 people to perform effectively. Aim To describe variation in the size and characteristics of PCNs and their populations. Design and setting Cross-sectional analysis in England. Method Using published information from January 2020, PCNs were identified that contained &lt;30 000, between 30 000-50 000, and &gt;50 000 people. Percentiles were calculated to describe variation in size and population characteristics. PCN composition within each commissioning region was also examined. Results In total, 6758 practices had formed 1250 PCNs. Seven hundred and twenty-six (58%) PCNs had the recommended population of 30 000-50 000 people. Eighty-four (7%) PCNs contained &lt;30 000 people. Four hundred and forty (35%) PCNs contained &gt;50 000 people. Thirty-four (3%) PCNs comprised just one practice and 77 (6%) PCNs contained &gt;10 practices. Some PCNs contained more than double the proportions of older people and people with chronic conditions compared to other PCNs. More than half of the population were from very socioeconomically deprived areas in 172 (14%) PCNs. Only six (4%) of the 135 commissioning regions ensured all PCNs were in the recommended population range. All practices had joined a single PCN in three (2%) commissioning regions. Conclusion More than 40% of the PCNs were not of the recommended size, and there was substantial variation in their composition and characteristics. This high variability between PCNs is a risk to their future performance

Plant density and nitrogen studies with irrigated hybrid maize in the Lock-yer Valley, Queensland

In 3 trials using standard 36-in. row spacing and plant populations of 12, 000-24, 000/ac, higher plant populations gave the highest yields; in 2 trials with row spacings of 30-42 in. and plant populations of 12, 000-28, 000/ac, yields increased as populations increased up to 24, 000 in one trial, and up to 16, 000 in the other. In only 1 of 3 trials was there a significant response to row width; in this trial, yields from 30-in. rows were significantly higher than from greater row widths. Applications of N depressed yields, probably as a result of early lodging. Ear percentages decreased with increasing plant density and were highest for the 30-in. row width. Grain weight/ear rose with plant density but was not affected by row width or applied N. % of nubbins (poor-quality ears) increased as plant density was reduced to 16, 000, but row spacing and N had no significant effect.-F.A.S

Hot DAVs : a probable new class of pulsating white dwarf stars

We have discovered a pulsating DA white dwarf at the lower end of the temperature range 45 000–30 000 K where a few helium atmosphere white dwarfs are known. There are now three such pulsators known, suggesting that a new class of theoretically predicted pulsating white dwarf stars exists. We name them the hot DAV stars. From high-speed photometric observations with the ULTRACAM photometer on the 4.2-m William Herschel Telescope, we show that the hydrogen atmosphere white dwarf star WD1017−138 pulsates in at least one mode with a frequency of 1.62 mHz (a period of 624 s). The amplitude of that mode was near 1 mmag at a 10σ confidence level on one night of observation and an 8.4σ confidence level on a second night. The combined data have a confidence level of 11.8σ. This supports the two other detections of hot DAV stars previously reported. From three Very Large Telescope Ultraviolet and Visual Echelle Spectrograph spectra we confirm also that WD1017−138 is a hydrogen atmosphere white dwarf with no trace of helium or metals with Teff = 32 600 K, log g = 7.8 (cgs) and M = 0.55 M⊙. The existence of pulsations in these DA white dwarfs at the cool edge of the 45 000–30 000 K temperature range supports the thin hydrogen layer model for the deficit of helium atmosphere white dwarfs in this range. DA white dwarfs with thick hydrogen layers do not have the superadiabatic, chemically inhomogeneous (μ-gradient) zone that drives pulsation in this temperature range. The potential for higher amplitude hot DAV stars exists; their discovery would open the possibility of a direct test of the explanation for the deficit of helium atmosphere white dwarfs at these temperatures by asteroseismic probing of the atmospheric layers of the hot DAV stars. A search for pulsation in a further 22 candidates with ULTRACAM on the European Southern Observatory New Technology Telescope gave null results for pulsation at precisions in the range 0.5–3 mmag, suggesting that the pulsation amplitudes in such stars are relatively low, hence near the detection limit with the ground-based telescopes used in the surve