Modelling the impact of referral guideline changes for mild dyskaryosis on colposcopy services in England

Objectives: This model examines the effects of changing referral strategies within the established structure of NHS cervical screening driven colposcopy practice. It considers the effects of the new strategy on colposcopy workload, patient waiting times, and associated costs and health benefits. Methods: By postal survey, the current operational strategies of colposcopy services were established by questionnaire with respect to referral practices and management protocols. After first-cut piloting, and utilising published and original research, a Markovian model was constructed, and the impact of the new strategy was determined on colposcopy workload and patient waiting times for three hypothetical clinic types. Expected costs and benefits of the new policy were assessed through the adaptation of a previous ScHARR cervical screening model. Results: Clinic workload is expected to increase by between 21% and 35% within three years of the policy change, depending on clinic efficiency in other areas; the majority of this impact would be seen within the first year. It is predicted that particularly inefficient clinics would struggle to meet the existing waiting time requirements for women referred with low-grade disease, owing to the increased level of workload seen throughout the patient pathway as a result of the implementation of the new policy. The impact of the new policy can, however, be mitigated through improving the efficiency of existing clinics, by altering policies relating to surveillance of low grade disease, post-treatment follow-up, treatment policy (whether or not treatment is performed at the initial colposcopy visit), and through adherence to national guidelines. A cost-effectiveness analysis using the ScHARR liquid-based cytology model suggests that the policy change is likely to be have a cost per quality-adjusted lifeyear gained of between £1,400 and £5,500 per quality-adjusted life-year gained (excluding the costs of follow-up), which would be deemed acceptable to organisations such as the National Institute for Health and Clinical Excellence

The psychometric properties of ADCS - activities of daily living inventory and comparison of different ADL scores

Several multi-item activities of daily living (ADL) scales have been developed for assessment of functional status of patients with Alzheimer’s Disease (AD) in the last few decades. A disadvantage of the large number of scales is that scores of different ADL scales cannot be compared directly with each other. ADL scales which are used by McNamee’s (Townsend's disability scale) and Hill’s (Medicare Beneficiary definitions and Katz index of ADL) provide suitable tools for modelling the cost-effectiveness of different treatments in patients with Alzheimer’s disease, since they report empirical results about the relationship between the degree of functional impairment (healthcare costs) and the prevalence of institutionalisation. The IDEAL trial examines the efficacy of Exelon Patch with the ADCS - Activities of Daily Living Inventory (ADCS-ADL). This ADL instrument is not directly comparable to the ADL scales used by McNamee and Hill. However, the use of the ADL scale from the IDEAL study to predict the prevalence of institutionalisation with scales by Hill and McNamee would be desirable. Because of the generic nature of the ADL construct, and considering the fact that these well validated ADL instruments identify the main physical impairments and functional disabilities in Alzheimer's disease, we should expect high overlap in item content between different ADL instruments. The high overlap in item content between instruments, and the similar wording and scoring criteria, makes it possible to pair each impairment with another. The intention of this study was to establish the link between these ADL scales in order to provide appropriate conditions for further economic analyses on the dataset provided by the IDEAL study

A Genome Sequence of Oceanimonas doudoroffii ATCC 27123T

Oceanimonas doudoroffii ATCC 27123T is an obligately aerobic Gram-negative rod of the class Gammaproteobacteria. It was first isolated from surface seawater off the coast of Oahu, HI, USA, in 1972. The predicted genome size is 3,832,938 bp (G+C content, 60.03%), which contains 3,524 predicted coding sequences

PRESENCE AND PREVALENCE OF BD (BATRACHOCHYTRIUM DENDROBATIDIS) IN CENTRAL PENNSYLVANIAN WOODLAND VERNAL POOLS

Batrachochytrium dendrobatidis (Bd), a virulent chytrid fungus responsible for dramatic amphibian declines, has been detected in the northwestern and southeastern regions of Pennsylvania. However, little environmental Bd testing has been performed in central Pennsylvania, particularly in the unique and speciose habitats of woodland vernal pools. Our study included sampling in four vernal pools over a period of three months during amphibian breeding periods. Skin swabs were taken from three caudate and two anuran species, during the course of late winter and spring migrations (n = 143). Low Bd zoospore equivalent loads were detected in only a few individuals, in three of the five species but in all four vernal pools sampled. No significant trends were seen between zoospore loads and ambient temperature or migration timing across the species sampled

Draft Genome Sequence of the Marine Bacterium Oceanimonas baumannii ATCC 700832T

The aerobic phenol-degrading Gram-negative rod Oceanimonas baumannii ATCC 700832T was first isolated from estuary mud from the River Wear, United Kingdom, in 1983. Information on the draft genome sequence for O. baumannii ATCC 700832T is included in this announcement. The predicted genome size is 3,809,332 bp, with 55.88% G+C content

Effect of sugar replacement with stevianna and inulin on the texture and predictive glycaemic response of muffins

The application of sugar replacers used in bakery products is of growing interest to the food industry, as it provides the possibility of delivering products with reduced energy and sugar. The aim of this study was to investigate the textural properties and glycaemic responses of muffins made using stevianna and inulin. Two levels of sugar replacer were used (50% and 100%). Total replacement of sucrose gave muffins with a firmer texture than the control (P < 0.05); 50% replacement, however, gave a similar texture to control. The predicted glycaemic response was reduced in sugar-replaced muffins compared to control samples. In particular, the replacement of sucrose with 100% stevianna caused a significant decrease in the standardised area under the curve values. Therefore, there exists the potential to regulate the glycaemic response of muffins by the incorporation of 50% stevianna or 50% inulin without affecting their textural properties

Cell patterning on photolithographically defined parylene-C:SiO2 substrates

Cell patterning platforms support broad research goals, such as construction of predefined in vitro neuronal networks and the exploration of certain central aspects of cellular physiology. To easily combine cell patterning with Multi-Electrode Arrays (MEAs) and silicon-based ‘lab on a chip’ technologies, a microfabrication-compatible protocol is required. We describe a method that utilizes deposition of the polymer parylene-C on SiO(2 )wafers. Photolithography enables accurate and reliable patterning of parylene-C at micron-level resolution. Subsequent activation by immersion in fetal bovine serum (or another specific activation solution) results in a substrate in which cultured cells adhere to, or are repulsed by, parylene or SiO(2) regions respectively. This technique has allowed patterning of a broad range of cell types (including primary murine hippocampal cells, HEK 293 cell line, human neuron-like teratocarcinoma cell line, primary murine cerebellar granule cells, and primary human glioma-derived stem-like cells). Interestingly, however, the platform is not universal; reflecting the importance of cell-specific adhesion molecules. This cell patterning process is cost effective, reliable, and importantly can be incorporated into standard microfabrication (chip manufacturing) protocols, paving the way for integration of microelectronic technology

Dimensions of oral health related quality of life measured by EQ-5D+ and OHIP-14

BACKGROUND: The aims of the study were to compare the dimensions of oral-health-related quality-of-life measured by a generic health state measure, the EuroQol, and a specific oral health measure, the Oral Health Impact Profile. METHODS: Data were collected in 2001–02 from a random sample of South Australian dentists using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental problems and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D+) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments. RESULTS: Data were available from 375 patients (response rate = 72%). The EuroQol items of mobility, self care and usual activities formed a separate cluster of variables, as did anxiety/depression and cognition, while pain clustered with items from the OHIP physical pain subscale. OHIP items tended to form clusters consistent with the subscales of social disability, physical disability, physical pain, functional limitation and psychological discomfort. The OHIP handicap items clustered between the OHIP social disability and physical disability subscales. The OHIP psychological disability items split between the social disability and psychological discomfort subscales. CONCLUSIONS: The observed clusters of variables empirically supported most of the conceptual dimensions of the OHIP. Both instruments covered symptom experience of pain indicating overlapping domains. However there was partial separation of the generic and specific items, EuroQol covered daily activities such as self-care and usual activities and OHIP covered oral health-specific aspects of functional limitation and physical disability as well as psychological and social aspects of disability and handicap

Rushing to Overpay: The REIT Premium Revisited

We explore the questions of whether and why Real Estate Investment Trusts (REITs) pay more for real estate than non-REIT buyers, consequently breaking the law of one price. We develop a model where REITs optimally pay more for property because (1) they are able, due to capital access advantages and, (2) are occasionally compelled, due to regulatory time constraints on the deployment of capital. We show that the typically large (20 to 60 percent) and statistically significant (p-values less than 0.01) REIT-buyer premiums found in standard empirical hedonic pricing models are biased due to unobserved explanatory variables. Using a repeat-transaction methodology that controls for unobserved independent variables, we find the REIT-buyer premium to be about 5 percent. Furthermore, we show that REITs¿ ability (as measured by access to capital markets) and regulator compulsion (as measured by capital deployment deadlines) are related to the price premium.Real Estate Investment Trusts (REITs), commercial properties, hedonic price analysis, repeat transactions, market efficiency, law of one price, price premium

Mechanical and energetic determinants of optimal cycling cadence

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this recor