Preparatory study for the revaluation of the EQ-5D tariff: methodology report.

BACKGROUND: EQ-5D is a widely used generic measure of health with a 'tariff', or preference weights, obtained from the general population, using time trade-off (TTO). PRET (Preparatory study for the Re-valuation of the EQ-5D Tariff project) contributes towards the methodology for its revaluation. METHODS: Stage 1 examined key assumptions typically involved in health-state valuations through a series of binary choice exercises, namely that health-state preferences are independent of (1) duration of the state; (2) whose health it is (i.e. perspective); (3) length of 'lead time' (a mechanism to value all states on the same scale, including those who are worse than being dead); (4) when health events take place (time preference); and (5) satisfaction associated with the state. Further topics addressed were (6) exhaustion of lead time in the worst state; (7) health-state valuation using discrete choice experiments (DCEs) with a duration attribute; and (8) binary choice administration of lead time - time trade-off (LT-TTO). Stage 1 consisted of an online survey with 6000 respondents. Stage 2 compared the results above to those of an identical survey conducted in 200 face-to-face computer-assisted personal interviews (CAPIs), covering topics (1) to (7). Stages 3 and 4 examined - in more detail and depth - issues taken from stage 1. Stage 3 consisted of CAPI surveys of a representative UK sample of 300, using examples of TTO, LT-TTO, and DCE with duration, each followed by extensive feedback questions. Stage 4 was a more intensive exercise involving a qualitative analysis of people's thought processes during both binary choice and iterative health-state valuation exercises. Data were collected through 'think-aloud' methods in 30 interviews of a convenience sample. RESULTS: Stage 1 found that health-state values are not independent of (1) duration of the state but there is no clear pattern; (2) whose health it is; (3) the duration of 'lead time' but there was no clear pattern; (4) when health events take place; or (5) satisfaction associated with the state. Furthermore, (6) exhaustion of lead time in the worst state was subject to substantial framing effects; (7) the five-level version of the EQ-5D (EQ-5D-5L) can be valued using DCE with duration as an attribute; and (8) binary choice LT-TTO can be administered in an online environment. Stage 2 found that although online surveys and CAPI surveys resulted in different compositions of respondents, at the aggregate, their responses to the experimental questions covering (1) to (7) above were not statistically significantly different from each other. Stages 3 and 4 found that TTO and LT-TTO were easier than DCE with duration; respondents did not necessarily trade across all attributes of EQ-5D; some respondents found it difficult to distinguish between the two worst levels of EQ-5D-5L, and some respondents may be thinking about the impact of their ill health on their family. CONCLUSIONS: In order for the National Institute for Health and Care Excellence to make the most appropriate decisions, the EQ-5D tariff needs to incorporate the latest understanding of health-state preferences. PRET contributed to the knowledge base on the conduct of health-state valuation studies. FUNDING: The Medical Research Council (MRC)-National Institute for Health Research (NIHR) Methodology Research Programme funded the PRET project (MRC ref. G0901500), and the EuroQol Group funded the PRET-AS project (Preparatory study for the Re-valuation of the EQ-5D Tariff project - Additional Sample) as an extension to the PRET project with formal agreement from the MRC

Interactions between Plasmodium falciparum skeleton-binding protein 1 and the membrane skeleton of malaria-infected red blood cells

During development inside red blood cells (RBCs), Plasmodium falciparum malaria parasites export proteins that associate with the RBC membrane skeleton. These interactions cause profound changes to the biophysical properties of RBCs that underpin the often severe and fatal clinical manifestations of falciparum malaria. P. falciparum erythrocyte membrane protein 1 (PfEMP1) is one such exported parasite protein that plays a major role in malaria pathogenesis since its exposure on the parasitised RBC surface mediates their adhesion to vascular endothelium and placental syncytioblasts. En route to the RBC membrane skeleton, PfEMP1 transiently associates with Maurer\u27s clefts (MCs), parasite-derived membranous structures in the RBC cytoplasm. We have previously shown that a resident MC protein, skeleton-binding protein 1 (SBP1), is essential for the placement of PfEMP1 onto the RBC surface and hypothesised that the function of SBP1 may be to target MCs to the RBC membrane. Since this would require additional protein interactions, we set out to identify binding partners for SBP1. Using a combination of approaches, we have defined the region of SBP1 that binds specifically to defined sub-domains of two major components of the RBC membrane skeleton, protein 4.1R and spectrin. We show that these interactions serve as one mechanism to anchor MCs to the RBC membrane skeleton, however, while they appear to be necessary, they are not sufficient for the translocation of PfEMP1 onto the RBC surface. The N-terminal domain of SBP1 that resides within the lumen of MCs clearly plays an essential, but presently unknown role in this process

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A Maurer's cleft–associated protein is essential for expression of the major malaria virulence antigen on the surface of infected red blood cells

The high mortality of Plasmodium falciparum malaria is the result of a parasite ligand, PfEMP1 (P. falciparum) erythrocyte membrane protein 1), on the surface of infected red blood cells (IRBCs), which adheres to the vascular endothelium and causes the sequestration of IRBCs in the microvasculature. PfEMP1 transport to the IRBC surface involves Maurer's clefts, which are parasite-derived membranous structures in the IRBC cytoplasm. Targeted gene disruption of a Maurer's cleft protein, SBP1 (skeleton-binding protein 1), prevented IRBC adhesion because of the loss of PfEMP1 expression on the IRBC surface. PfEMP1 was still present in Maurer's clefts, and the transport and localization of several other Maurer's cleft proteins were unchanged. Maurer's clefts were altered in appearance and were no longer found as close to the periphery of the IRBC. Complementation of mutant parasites with sbp1 led to the reappearance of PfEMP1 on the IRBC surface and the restoration of adhesion. Our results demonstrate that SBP1 is essential for the translocation of PfEMP1 onto the surface of IRBCs and is likely to play a pivotal role in the pathogenesis of P. falciparum malaria

Disciplinary Tribunal Cases Involving New Zealand Lawyers with Physical or Mental Impairment, 2009 – 2013

The purpose of this study was to examine disciplinary proceedings in the New Zealand Lawyers and Conveyancers Disciplinary Tribunal (NZLCDT) which involved lawyers with physical or mental impairments. International research has documented the high rates of depression, anxiety and substance misuse in the legal profession. Australian and American research has found that disciplinary cases often involve lawyers who are impaired by medical conditions, or substance misuse. Their impairment either contributed to, or was responsible for, their misconduct. In the present study, the disciplined lawyers’ demographics, and the nature of the impairments, were described for NZLCDT cases from 2009 to 2013. Twenty one of the 74 decisions involved impaired lawyers. The main types of impairment were depression, anxiety, substance misuse, and stress. This study reinforces the importance of the NZ Law Society’s 2009 initiative “Practising Well”, which aims to minimise the adverse impact that impaired lawyers have on themselves, their families, clients, and the profession.Peer Reviewe

Myoblast differentiation during mammalian somitogenesis is dependent upon a community effect.

The differentiation potential of early mammalian myogenic cells was tested under clonal culture conditions. Cells were isolated from paraxial mesoderm and limb buds of transgenic mouse embryos at 9.5 days after conception and grown in culture at clonal density either on collagen-coated dishes or on various feeder cell layers. The transgene used contained a reporter gene encoding beta-galactosidase with a nuclear localization signal under the control of regulatory sequences from the gene for fast myosin light chain 3, so that beta-galactosidase staining indicated the presence of differentiated muscle cells. After 5 days in culture, the number and size of beta-galactosidase-positive (beta-gal+) clones were recorded. Cells isolated from somites I-V (the last five somites to have formed) or from unsegmented paraxial mesoderm did not give rise to any beta-gal+ clones. Cells isolated from somites VI-X or from the forelimb bud gave rise to beta-gal+ clones, but only on feeder cells. Cells from somites XI or older gave rise to beta-gal+ clones independently of the substrate. However, when cells isolated from unsegmented paraxial mesoderm or somites I-V were cultured with nontransgenic cells from the trunk (including neural tube and notochord), differentiation occurred on condition that the cells were in a three-dimensional aggregate, even though their specific position in the somite had been lost. By culturing explants ranging in size from 1 to < 100 cells in the presence of an inhibitor of cell division, we determined that a minimal number of 30-40 cells is required for mesodermal cells to differentiate

Interaction of the exported malaria protein Pf332 with the red blood cell membrane skeleton

AbstractIntra-erythrocytic Plasmodium falciparum malaria parasites synthesize and export numerous proteins into the red blood cell (RBC) cytosol, where some bind to the RBC membrane skeleton. These interactions are responsible for the altered antigenic, morphological and functional properties of parasite-infected red blood cells (IRBCs). Plasmodium falciparum protein 332 (Pf332) is a large parasite protein that associates with the membrane skeleton and who's function has recently been elucidated. Using recombinant fragments of Pf332 in in vitro interaction assays, we have localised the specific domain within Pf332 that binds to the RBC membrane skeleton to an 86 residue sequence proximal to the C-terminus of Pf332. We have shown that this region partakes in a specific and saturable interaction with actin (Kd=0.60µM) but has no detectable affinity for spectrin. The only exported malaria protein previously known to bind to actin is PfEMP3 but here we demonstrate that there is no competition for actin-binding between PfEMP3 and Pf332, suggesting that they bind to different target sequences in actin