Incorporating ex-vivo lung perfusion into the UK adult lung transplant service: an economic evaluation and decision analytic model

Background: An estimated 20–30% of end-stage lung disease patients awaiting lung transplant die whilst on the waiting list due to a shortage of suitable donor lungs. Ex-Vivo Lung Perfusion is a technique that reconditions donor lungs initially not deemed usable in order to make them suitable for transplantation, thereby increasing the donor pool. In this study, an economic evaluation was conducted as part of DEVELOP-UK, a multi-centre study assessing the clinical and cost-effectiveness of the Ex-Vivo Lung Perfusion technique in the United Kingdom. Methods: We estimated the cost-effectiveness of a UK adult lung transplant service combining both standard and Ex-Vivo Lung Perfusion transplants compared to a service including only standard lung transplants. A Markov model was developed and populated with a combination of DEVELOP-UK, published and clinical routine data, and extrapolated to a lifetime horizon. Probabilistic sensitivity and scenario analyses were used to explore uncertainty in the final outcomes. Results: Base-case model results estimated life years gained of 0.040, quality-adjusted life-years (QALYs) gained of 0.045 and an incremental cost per QALY of £90,000 for Ex-Vivo Lung Perfusion. Scenario analyses carried out suggest that an improved rate of converting unusable donor lungs using Ex-Vivo Lung Perfusion, similar resource use post-transplant for both standard and EVLP lung transplant and applying increased waiting list costs would reduce ICERs to approximately £30,000 or below. Conclusion: DEVELOP-UK base-case results suggest that incorporating Ex-Vivo Lung Perfusion into the UK adult lung transplant service is more effective, increasing the number of donor lungs available for transplant, but would not currently be considered cost-effective in the UK using the present NICE threshold. However, results were sensitive to change in some model parameters and in several plausible scenario analyses results indicate that a service incorporating Ex-vivo lung perfusion would be considered cost-effective . Trial registration: ISRCTN registry number: ISRCTN44922411. Date of registration: 06/02/2012. Retrospectively registered

Well-promising outcomes with vacuum-assisted closure in an infected wound following laparotomy: A case report

Introducation: Negative pressure wound therapy (NPWT) represents an alternative method to optimize conditions for wound healing. Delayed wound closure is a significant health problem, which is directly associated with pain and suffering from patient's aspect, as well with social and financial burden. Presentation of case: We report a case of vacuum-assisted wound therapy with hypertonic solution distillation and continuous negative pressure application, in an infected wound after laparotomy for incisional hernia reconstruction with mesh placement. Negative pressure was initiated at the wound margins after failure of conventional treatment with great outcomes, achieving a total closure of the incision within two weeks. Discussion: Each wound has particular characteristics which must be managed. Vacuum assisted closure (VAC) with continuous negative pressure and simultaneous wound instillation and cleanse can provide optimum results, reducing the cavity volume, by newly produced granulated tissue. Conclusion: The simultaneous use of instillation and constant pressure seemed to be superior in comparison with NPWT alone. Compared to conventional methods, the use of VAC ends to better outcomes, in cases of infected wounds following laparotomy

The 3D Menpo Facial Landmark Tracking Challenge

This is the final version of the article. It is the open access version, provided by the Computer Vision Foundation. Except for the watermark, it is identical to the IEEE published version. Available from IEEE via the DOI in this record.Test descriptionRecently, deformable face alignment is synonymous to the task of locating a set of 2D sparse landmarks in intensity images. Currently, discriminatively trained Deep Convolutional Neural Networks (DCNNs) are the state-of-the-art in the task of face alignment. DCNNs exploit large amount of high quality annotations that emerged the last few years. Nevertheless, the provided 2D annotations rarely capture the 3D structure of the face (this is especially evident in the facial boundary). That is, the annotations neither provide an estimate of the depth nor correspond to the 2D projections of the 3D facial structure. This paper summarises our efforts to develop (a) a very large database suitable to be used to train 3D face alignment algorithms in images captured "in-the-wild" and (b) to train and evaluate new methods for 3D face landmark tracking. Finally, we report the results of the first challenge in 3D face tracking "in-the-wild".The work of S. Zafeiriou and A. Roussos has been partially funded by the EPSRC Project EP/N007743/

The Menpo benchmark for multi-pose 2D and 3D facial landmark localisation and tracking

In this article, we present the Menpo 2D and Menpo 3D benchmarks, two new datasets for multi-pose 2D and 3D facial landmark localisation and tracking. In contrast to the previous benchmarks such as 300W and 300VW, the proposed benchmarks contain facial images in both semi-frontal and profile pose. We introduce an elaborate semi-automatic methodology for providing high-quality annotations for both the Menpo 2D and Menpo 3D benchmarks. In Menpo 2D benchmark, different visible landmark configurations are designed for semi-frontal and profile faces, thus making the 2D face alignment full-pose. In Menpo 3D benchmark, a united landmark configuration is designed for both semi-frontal and profile faces based on the correspondence with a 3D face model, thus making face alignment not only full-pose but also corresponding to the real-world 3D space. Based on the considerable number of annotated images, we organised Menpo 2D Challenge and Menpo 3D Challenge for face alignment under large pose variations in conjunction with CVPR 2017 and ICCV 2017, respectively. The results of these challenges demonstrate that recent deep learning architectures, when trained with the abundant data, lead to excellent results. We also provide a very simple, yet effective solution, named Cascade Multi-view Hourglass Model, to 2D and 3D face alignment. In our method, we take advantage of all 2D and 3D facial landmark annotations in a joint way. We not only capitalise on the correspondences between the semi-frontal and profile 2D facial landmarks but also employ joint supervision from both 2D and 3D facial landmarks. Finally, we discuss future directions on the topic of face alignment

The Menpo benchmark for multi-pose 2D and 3D facial landmark localisation and tracking

In this article, we present the Menpo 2D and Menpo 3D benchmarks, two new datasets for multi-pose 2D and 3D facial landmark localisation and tracking. In contrast to the previous benchmarks such as 300W and 300VW, the proposed benchmarks contain facial images in both semi-frontal and profile pose. We introduce an elaborate semi-automatic methodology for providing high-quality annotations for both the Menpo 2D and Menpo 3D benchmarks. In Menpo 2D benchmark, different visible landmark configurations are designed for semi-frontal and profile faces, thus making the 2D face alignment full-pose. In Menpo 3D benchmark, a united landmark configuration is designed for both semi-frontal and profile faces based on the correspondence with a 3D face model, thus making face alignment not only full-pose but also corresponding to the real-world 3D space. Based on the considerable number of annotated images, we organised Menpo 2D Challenge and Menpo 3D Challenge for face alignment under large pose variations in conjunction with CVPR 2017 and ICCV 2017, respectively. The results of these challenges demonstrate that recent deep learning architectures, when trained with the abundant data, lead to excellent results. We also provide a very simple, yet effective solution, named Cascade Multi-view Hourglass Model, to 2D and 3D face alignment. In our method, we take advantage of all 2D and 3D facial landmark annotations in a joint way. We not only capitalise on the correspondences between the semi-frontal and profile 2D facial landmarks but also employ joint supervision from both 2D and 3D facial landmarks. Finally, we discuss future directions on the topic of face alignment

Changing gears to neutral in a polymorph of one-dimensional arrays of cogwheel-like pairs of molecular rotors

We report on a polymorph (2) of an amphidynamic crystal of molecular rods with two helical 1,4-bis(ethynyl)bicyclo[2.2.2]octane rotators where half of the rod-like molecules appear to be shifted with respect to their closest neighbours. This translation takes cogwheel-like pairs of rotators apart in the lattice in such a way that their motion becomes uncorrelated. This property is to be contrasted with the highly correlated motion found to govern the rotators in a recently-published polymorph 1 of the same material. As with polymorph 1, this motion is shown to take place independently of mutations in the handedness of the rotators and of the ‘mutamer’-induced second harmonic generation

Reversible Control of Crystalline Rotors by Squeezing Their Hydrogen Bond Cloud Across a Halogen Bond-Mediated Phase Transition

  We report on a crystalline rotor that undergoes a reversible phase transition at 145 K. Variable-temperature X-ray and 1H spin −lattice relaxation experiments, and calculations of rotational barriers, provide a description (i) of the way in which the rotators’ dynamics changes back and forth at the onset of the phase transition and (ii) of the mechanism responsible for the abrupt switching of the crystalline rotors from a very low-energy 4-fold degenerate equilibrium state, in which the rotation is ultrafast (9.6 GHz at 145 K), to a single higher-energy state associated with a slower motion (2.3 GHz at 145 K). Our results provide evidence that the reversible change observed in the rotational barriers at the transition is due to a cooperative modulation of the C −Hrotator···Istator hydrogen bond cloud across a C −I stator···Istator−C halogen bond-mediated phase transition. In addition, we report evidence for second-harmonic generation from this material, thereby confirming with a second example the benefit of using polarized light to probe the torsional degree of freedom of chiral helix blades, as well as symmetry and dimensionality of large collections of chiral rotors in the solid state.

Crystalline Arrays of Pairs of Molecular Rotors: Correlated Motion, Rotational Barriers, and Space-Inversion Symmetry Breaking Due to Conformational Mutations

The rod-like molecule bis 4-(4-pyridyl)ethynyl)bicyclo[2.2.2]oct-1-yl)buta-1,3-diyne, 1, contains two 1,4-bis(ethynyl)bicyclo[2.2.2]octane (ethynyl) chiral rotators linked by a diyne fragment and self assembles in a one-dimensional, monoclinic C2/c centrosymmetric structure where two equilibrium positions with large occupancy imbalance (88% versus 12%) are identified on a single rotor site Combining variable temperature (70-300 K) proton spin-lattice relaxation, H-1 T-1(-1), at two different H-1 Larmor frequencies (55 and 210 MHz) and DFT calculations of rotational barriers, we were able to assign two types of Brownian rotators with different activation energies, 1.85 and 6.1 kcal mol(-1), to the two H-1 spin-lattice relaxation processes on the single rotor site. On the basis of DFT calculations, the low-energy process has been assigned to adjacent rotors in a well-correlated synchronous motion, whereas the high-energy process is the manifestation of an abrupt change in their kinematics once two blades of adjacent rotors are seen to rub together. Although crystals of 1 should be second harmonic inactive, a large second-order optical response is recorded when the electric field oscillates in a direction parallel to the unique rotor axle director. We conclude that conformational mutations by torsional interconversion of the three blades of the BCO units break space-inversion symmetry in sequences of mutamers in dynamic equilibrium in the crystal in domains at a rnesoscopic scale comparable with the wavelength of light used A control experiment was performed with a crystalline film of a similar tetrayne molecule, 1,4-bis(3-((trimethylsilyl)ethynyl)bicyclo-[1.1.1]pent-1-yObuta-1,3-diyne, whose bic-ydopentane units can rotate but are achiral and produce no second-order optical response