Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomised controlled trial (RCT). OBJECTIVES: To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP. METHODS: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective RESULTS: In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline-initiated therapy with prednisolone-initiated therapy (net cost: £959, 95% CI -£24 to £1941; net QALYs: -0.024, 95% CI -0.088 to 0.041). However, findings varied by baseline blister severity. For patients with mild or moderate blistering (≤30) net costs and outcomes were similar. For patients with severe blistering (>30) net costs were higher (£2558, 95% CI -£82 to £5198) and quality of life poorer (-0.090 QALYs, 95% CI-0.222 to 0.042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1.5% at a willingness to pay of £20,000/QALY. CONCLUSIONS: Consistent with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering

Weird exoskeletons: propositional politics and the making of home in underground Bucharest

The article explores the politics of life underground in Bucharest, Romania. It focuses on a tunnel passing under Bucharest's central train station, where a community of drug users and so‐called ‘homeless’ have made a long‐standing home, using a space that many others considered uninhabitable. Relying on extensive ethnographic observations and interviews undertaken within the tunnels, the article traces and illustrates the socio‐material entanglements characterizing life underground. It frames this assemblage of bodies, veins, syringes, substances and various relationships of power and affect, as a ‘propositional politics’ of home and life at the margins. Such a politics speaks of drug addiction and extreme marginalization, but also of a sense of belonging, reciprocal trust and care. In tracing such a politics, the article does not aim to romanticize the status of home in the underground or to treat it as the marginal antithesis of normative homeliness, but to reveal the ways in which an affirmative, self‐grounding politics of home emerges from the immanence of tunnel life within the fabric of the city. As such, the article contributes to debates around homing practices in conditions of uninhabitability and proposes a radical approach to the politics of life at the margins in the contemporary urban

Evaluation of a 23-cm (9-in) Minimum Length Limit for Black and White Crappies in Lake Alvin, South Dakota

The South Dakota Department of Game, Fish and Parks (SDGFP) implemented a 23-cm (9-in) minimum length limit for black Pomoxis nigromaculatus and white P. annularis crappies in 36-ha Lake Alvin , South Dakota beginning 1 January 1996. Both relative abundance [catch per unit effort (CPUE)] and size structure [e .g., proportional stock density (PSD)] increased following implementation of the length limit. However, these changes were more related to recruitment patterns than to regulation effects. Age structure and harvest of both crappie populations increased slightly after the regulation was enacted . However, relative weight (Wr) values declined with increasing length for both species, likely indicating limited prey availability for larger fish. Growth of both species declined after implementation of the length limit. In 1999, incremental growth of 6- to 19-cm fish was similar to or faster than growth from pre-treatment samples. However, annual growth increments of 20-cm and mortality will likely negate any benefits of the regulation. Harvest of legal-sized crappies has declined from 1998 to 1999, indicating that slowed growth has resulted in fish being unavailable to anglers. Therefore, the regulation was removed 1 January 2000 to allow anglers the opportunity to catch and harvest crappies that were stockpiling just below 23 cm

New Monomers from Vegetable Oils

Novel vegetable oil derived macromonomers were synthesized by the chemical modification of castor, lesquerella and vernonia oils. The castor oil derivative has been successfully copolymerized into vinyl-acrylic and all-acrylic latexes designed for use as architectural coatings. The castor oil derived monomer provides latex polymers with good film formation without the use of coalescing solvent. Furthermore, its presence in the copolymer improves dry times, and provides reactive functionality for ambient cure. In yet another phase of the investigation of novel monomers, UV curable coatings were developed from methacrylic macromonomers synthesized from lesquerella and vernonia oils. The resulting coatings exhibited good gloss, pencil hardness, and adhesion to steel substrates

‹smail Hakk› TEKKÖK Ruptured Blister-Like Aneurysm of Distal Internal Carotid Artery: A Distinct Entity

ABSTRACT OBJECTIVE: Blister-like aneurysms are small hemispherical bulges that usually originate from the anteromedial wall of the distal internal carotid artery and cause significant subarachnoid hemorrhage. It is very important to recognize this novel lesion as a different type of aneurysm than ordinary berry aneurysms. CASE DESCRIPTION: We report the case of a 43-year-old man who underwent a diagnostic procedure and was awaiting surgery elsewhere before being transferred to our institution. A right sided blister-like aneurysm was seen on angiograms. Although the aneurysm bled intraoperatively, 2 clips were placed with one slightly catching the medial artery wall. The outcome was excellent. CONCLUSIONS: Since blister-like aneurysms are different than saccular aneurysms both morphologically and histologically, their treatment also differs making surgical exploration and standard clipping a more hazardous situation than usual. In fact, surgical decision for blister aneurysms should be individual with alternative plans in case the initial treatment strategy fails. Such a flexible strategy also necessitates preoperative cerebrovascular flow testing and a variety of additional hardware like encircling graft clips, microsutures or wrapping material ready in the operating room on top of traditional aneurysm clips. KEY WORDS: Blood-blister like aneurysm, Clipping, Subarachnoid hemorrhage, Treatment ÖZ Blister anevrizmalar genelde internal karotid arterin anteromedial duvarından köken alan ve çok ciddi subaraknoid kanamaya neden olabilen vezikül ya da yarım daire şeklinde küçük kabartılardır. Bu özel anevrizma tipini tanımak ve sakküler anevrizmalardan farklı olduğunu bilmek önemlidir. Bu yazıda subaraknoid kanama akabinde başka bir merkezde etiyolojisi araştırılmış ve cerrahi tedavi beklerken hastanemize nakledilmiş 43 yaşında erkek hastanın tedavisi ile ilgili bilgi verilmektedir. Anjiyografilerde sağ internal karotid arter distalinde blister şeklinde görünen anevrizma, ameliyat sırasında kanadığı halde biri normal damar duvarını da tutan 2 adet klip ile başarılı bir şekilde tedavi edildi. Blister anevrizmalar hem morfolojik, hem de histolojik olarak sakküler anevrizmalardan farklı olduklarından cerrahi eksplorasyon ve klipleme işlemi de daha risklidir. Aslında blister anevrizmalar için tedavi, olgu bazlı planlanmalı ve ana stratejinin başarısız olduğu durumlarda kullanılabilecek alternatif planlar da yapılmalıdır. Böyle esnek bir strateji hem karotis oklüzyonu durumunda beynin kollateral dolaşımı ve iskemi direncini gösteren preoperatif tetkiklerin yapılmasını, hem de ameliyathanede standart klip setleri içinde bulunmayabilecek greft klipler, anevrizmayı sarmak için kullanılabilecek malzeme ve mikrosütür gibi ek materyallerin bulunmasını gerektirmektedir