Valuation of Health States Associated with Age-related Macular Degeneration

Economic evaluation of health technology using cost-utility analysis (CUA) normally applies an extra-welfarist framework in which health, the unit of effectiveness, is maximised. Typically, health status is measured by health-related quality of life (HRQoL) questionnaires to define health states. Preferences for health states are valued on a utility scale and combined with the time spent in the state to calculate quality-adjusted life years (QALYs). This thesis develops methods for measuring and valuing health using the case of age-related macular degeneration (AMD), where there are limitations with current methods for calculating QALYs

Baseline study in environmental risk assessment: Escalating need for computer models to be whole-system approach

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Accepted author version posted online: 12 Dec 2016Despite landfills having the potential to pollute the environment both during their operation and long after they have ceased to receive waste, they remain a dominant waste management option, particularly in the UK. In order to combat the environmental pollution caused by landfills, risk analysis is increasingly being employed through computer models. However, for a risk analysis process to be successful, its foundation has to be well established through a baseline study. This paper aims to identify knowledge gaps in software packages regarding environmental risk assessments in general, and especially those that have been developed specifically for landfills and landfill leachate. The research establishes that there is no holistic computer model for the baseline study of landfills, which risk assessors can use to conduct risk analyses specifically for landfill leachate. This paper also describes a number of factors and features that should be added to the baseline study system in order to render it more integrated—thereby enhancing quantitative risk analysis, and subsequently environmental risk management.The authors acknowledge the financial support of Dundee City Council in this project. We are additionally grateful for the discussion and help received from Mr Peter Goldie of the Environment & Consumer Protection Department, Dundee City Council. The support from Dr I. M. Spence (Consultant Environmental Geologist, Scotland), and colleagues at the University of Abertay Dundee, including Dr Kehinde O. K. Oduyemi and Mr Phillip Jenkins is also highly 39 appreciated. It must be noted that concepts and ideas presented in this article by the authors do not necessarily represent views that of their respective employer organization

Simulation Contact Lenses for AMD Health State Utility Values in NICE Appraisals: A Different Reality

Background/aims: The National Institute for Health and Care Excellence (NICE) has recommended the use of ranibizumab for age-related macular degeneration (AMD) and for diabetic macular oedema (DMO) as part of its health technology appraisal (HTA) process. In the economic evaluations of both interventions, utility values were derived from members of the general public wearing contact lenses with a central opacity that was meant to simulate the blind spot experienced by many patients with advanced retinal disease. This paper tests the validity of the contact lens simulation, and finding it to be invalid, explores the impact on prior economic evaluations. Methods: Visual acuity, contrast sensitivity, and visual fields were assessed with and without simulation lenses in five healthy subjects with normal vision. Results: We identified important differences between the contact lens simulation and vision loss experienced by patients with AMD. The contact lens simulator did not cause the central scotoma which is characteristic of late-stage AMD and which leads to severe difficulty with everyday activities such as reading or recognising faces and objects. The contact lenses instead caused a reduction in retinal illumination experienced by the subjects as a general dimming across the retina. Conclusion: A contact lens with a central opacity does not simulate a central scotoma. The clinical differences between simulated and actual AMD suggests there has been an underestimation of the severity of AMD health states. This brings into question the validity of the economic evaluations of treatments for AMD and DMO used by NICE

High energy emission from microquasars

The microquasar phenomenon is associated with the production of jets by X-ray binaries and, as such, may be associated with the majority of such systems. In this chapter we briefly outline the associations, definite, probable, possible, and speculative, between such jets and X-ray, gamma-ray and particle emission.Comment: Contributing chapter to the book Cosmic Gamma-Ray Sources, K.S. Cheng and G.E. Romero (eds.), to be published by Kluwer Academic Publishers, Dordrecht, 2004. (19 pages

Cellular shear adhesion force measurement and simultaneous imaging by atomic force microscope

This paper presents a sensitive and fast cellular shear adhesion force measurement method using an atomic force microscope (AFM). In the work, the AFM was used both as a tool for the imaging of cells on the nano-scale and as a force sensor for the measurement of the shear adhesion force between the cell and the substrate. After the cell imaging, the measurement of cellular shear adhesion forces was made based on the different positions of the cell on the nano-scale. Moreover, different pushing speeds of probe and various locations of cells were used in experiments to study their influences. In this study, the measurement of the cell adhesion in the upper portion of the cell is different from that in the lower portion. It may reveal that the cancer cells have the metastasis tendency after cultured for 16 to 20 hours, which is significant for preventing metastasis in the patients diagnosed with early cancer lesions. Furthermore, the cellular shear adhesion forces of two types of living cancer cells were obtained based on the measurements of AFM cantilever deflections in the torsional and vertical directions. The results demonstrate that the shear adhesion force of cancer cells is twice as much as the same type of cancer cells with TRAIL. The method can also provide a way for the measurement of the cellular shear adhesion force between the cell and the substrate, and for the simultaneous exploration of cells using the AFM imaging and manipulatio

Stabilization of Peptide Vesicles by Introducing Inter-Peptide Disulfide Bonds

PURPOSE: Previously, we have shown that the amphiphilic oligopeptide SA2 (Ac-Ala-Ala-Val-Val-Leu-Leu-Leu-Trp-Glu-Glu-COOH) spontaneously self-assemble into nano-sized vesicles in aqueous environment. Relative weak individual intermolecular interactions dominate such oligopeptide assemblies. In this study we aimed at improving the stability of such peptide vesicles by covalently crosslinking the oligopeptide vesicles using disulfide bonds. Two and three cysteines were introduced in the SA2 peptide sequence to allow crosslinking (Ac-Ala-Cys-Val-Cys-Leu-(Leu/Cys)-Leu-Trp-Glu-Glu-COOH). RESULTS: Upon disulfide formation the crosslinked vesicles remained stable under conditions that disrupted the non-crosslinked peptide vesicles. The stabilized vesicles were more closely examined in terms of particle size (distribution) using atomic force microscopy, cryogenic electron microscopy, as well as dynamic light scattering analysis, showing an average particle radius in number between 15 and 20 nm. Using entrapment of calcein it was shown that intermolecular crosslinking of peptides within the vesicles did not affect the permeability for calcein. CONCLUSION: Introduction of cysteines into the hydrophobic domain of the SA2 amphiphilic oligopeptides is a feasible strategy for crosslinking the peptide vesicles. Such small crosslinked oligopeptide vesicles may hold promise for drug delivery applications

Nuclear localization and cytosolic overexpression of LASP-1 correlates with tumor size and nodal-positivity of human breast carcinoma

<p>Abstract</p> <p>Background</p> <p>LIM and SH3 protein 1 (LASP-1), initially identified from human breast cancer, is a specific focal adhesion protein involved in cell proliferation and migration, which was reported to be overexpressed in 8–12 % of human breast cancers and thought to be exclusively located in cytoplasm.</p> <p>Methods</p> <p>In the present work we analyzed the cellular and histological expression pattern of LASP-1 and its involvement in biological behavior of human breast cancer through correlation with standard clinicopathological parameters and expression of c-erbB2 (HER-2/neu), estrogen- (ER) and progesterone-receptors (PR). For this purpose immunohistochemical staining intensity and percentage of stained cells were semi-quantitatively rated to define a LASP-1 immunoreactive score (LASP-1-IRS). LASP-1-IRS was determined in 83 cases of invasive ductal breast carcinomas, 25 ductal carcinomas in situ (DCIS) and 18 fibroadenomas. Cellular LASP-1 distribution and expression pattern was visualized by immunofluorescence and confocal microscopy and assessed through separate Western blots of nuclear and cytosol preparations of BT-20, MCF-7, MDA-MB231, and ZR-75/1 breast cancer cells.</p> <p>Results</p> <p>Statistical analysis revealed that the resulting LASP-1-IRS was significantly higher in invasive carcinomas compared to fibroadenomas (p = 0.0176). Strong cytoplasmatic expression of LASP-1 was detected in 55.4 % of the invasive carcinomas, which correlated significantly with nuclear LASP-1-positivity (p = 0.0014), increased tumor size (p = 0.0159) and rate of nodal-positivity (p = 0.0066). However, levels of LASP-1 expression did not correlate with average age at time point of diagnosis, histological tumor grading, c-erbB2-, ER- or PR-expression.</p> <p>Increased nuclear localization and cytosolic expression of LASP-1 was found in breast cancer with higher tumor stage as well as in rapidly proliferating epidermal basal cells. Confocal microscopy and separate Western blots of cytosolic and nuclear preparations confirmed nuclear localization of LASP-1.</p> <p>Conclusion</p> <p>The current data provide evidence that LASP-1 is not exclusively a cytosolic protein, but is also detectable within the nucleus. Increased expression of LASP-1 in vivo is present in breast carcinomas with higher tumor stage and therefore may be related with worse prognosis concerning patients' overall survival.</p

Tracking Virus-Specific CD4+ T Cells during and after Acute Hepatitis C Virus Infection

CD4+ T cell help is critical in maintaining antiviral immune responses and such help has been shown to be sustained in acute resolving hepatitis C. In contrast, in evolving chronic hepatitis C CD4+ T cell helper responses appear to be absent or short-lived, using functional assays. Here we used a novel HLA-DR1 tetramer containing a highly targeted CD4+ T cell epitope from the hepatitis C virus non-structural protein 4 to track number and phenotype of hepatitis C virus specific CD4+ T cells in a cohort of seven HLA-DR1 positive patients with acute hepatitis C in comparison to patients with chronic or resolved hepatitis C. We observed peptide-specific T cells in all seven patients with acute hepatitis C regardless of outcome at frequencies up to 0.65% of CD4+ T cells. Among patients who transiently controlled virus replication we observed loss of function, and/or physical deletion of tetramer+ CD4+ T cells before viral recrudescence. In some patients with chronic hepatitis C very low numbers of tetramer+ cells were detectable in peripheral blood, compared to robust responses detected in spontaneous resolvers. Importantly we did not observe escape mutations in this key CD4+ T cell epitope in patients with evolving chronic hepatitis C. During acute hepatitis C a CD4+ T cell response against this epitope is readily induced in most, if not all, HLA-DR1+ patients. This antiviral T cell population becomes functionally impaired or is deleted early in the course of disease in those where viremia persists

Reversal of stress fibre formation by Nitric Oxide mediated RhoA inhibition leads to reduction in the height of preformed thrombi

Evidence has emerged to suggest that thrombi are dynamic structures with distinct areas of differing platelet activation and inhibition. We hypothesised that Nitric oxide (NO), a platelet inhibitor, can modulate the actin cytoskeleton reversing platelet spreading, and therefore reduce the capability of thrombi to withstand a high shear environment. Our data demonstrates that GSNO, DEANONOate, and a PKG-activating cGMP analogue reversed stress fibre formation and increased actin nodule formation in adherent platelets. This effect is sGC dependent and independent of ADP and thromboxanes. Stress fibre formation is a RhoA dependent process and NO induced RhoA inhibition, however, it did not phosphorylate RhoA at ser188 in spread platelets. Interestingly NO and PGI2 synergise to reverse stress fibre formation at physiologically relevant concentrations. Analysis of high shear conditions indicated that platelets activated on fibrinogen, induced stress fibre formation, which was reversed by GSNO treatment. Furthermore, preformed thrombi on collagen post perfused with GSNO had a 30% reduction in thrombus height in comparison to the control. This study demonstrates that NO can reverse key platelet functions after their initial activation and identifies a novel mechanism for controlling excessive thrombosis