Cost-effectiveness of age-related macular degeneration study supplements in the UK: combined trial and real-world outcomes data

Aims To evaluate the cost-effectiveness of Age-Related Eye Disease Study (AREDS) 1 & 2 supplements in patients with either bilateral intermediate age-related macular degeneration, AREDS category 3, or unilateral neovascular age-related macular degeneration AMD (nAMD), AREDS category 4. Methods A patient-level health state transition model based on levels of visual acuity in the better-seeing eye was constructed to simulate the costs and consequences of patients taking AREDS vitamin supplements. Setting: UK National Health Service (NHS). The model was populated with data from AREDS and real-world outcomes and resource use from a prospective multicentre national nAMD database study containing 92 976 ranibizumab treatment episodes. Interventions Two treatment approaches were compared: immediate intervention with AREDS supplements or no supplements. Main outcome measures: quality-adjusted life years (QALYs) and healthcare costs were accrued for each strategy, and incremental costs and QALYs were calculated for the lifetime of the patient. One-way and probabilistic sensitivity analyses were employed to test the uncertainty of the model. Results For AREDS category 3, the incremental cost-effectiveness ratio was £30 197. For AREDS category 4 compared with no intervention, AREDS supplements are more effective (10.59 vs 10.43 QALYs) and less costly (£52 074 vs 54 900) over the lifetime of the patient. Conclusions The recommendation to publicly fund AREDS supplements to category 3 patients would depend on the healthcare system willingness to pay. In contrast, initiating AREDS supplements in AREDS category 4 patients is both cost saving and more effective than no supplement use and should therefore be considered in public health policy

The Use of an Online Module to Increase Occupational Therapy Practitioners’ Evidence-based Practice Knowledge and Skills

Purpose: To evaluate the effectiveness of an optional, self-paced, online module to increase occupational therapy practitioners’ knowledge and skills related to evidence-based practice (EBP). Method: Participants’ EBP knowledge and skills were evaluated using the Adapted Fresno Test (AFT) after they completed the online module. Results: Twenty-nine occupational therapy practitioners (25 OTR/L, 4 COTA/L) completed the entire 17-month initiative. Nineteen practitioners (65.5%) used the supplemental online module and 10 (34.5%) did not. Analyses of AFT scores revealed a mean test score of 83.00 (n = 19, SD + 31.11) for participants who utilized the online EBP module and a mean test score of 56.20 (n = 10, SD + 36.67) for participants who did not use the module. An independent sample t test (equal variances assumed) revealed that participants who used the online module achieved statistically significantly higher scores ( p = 0.048, \u3c 0.05) on the AFT. Discussion: The findings from this study suggest that the online EBP module was a useful support in significantly improving occupational therapy practitioners’ knowledge and skills related to evidence-based practice. Conclusions: Online modules may be an effective tool to teach practitioners about EBP. More research is needed to identify particular features of online learning modules that are the most effective in increasing practitioners’’ EBP knowledge and skills

Rectified Asteroid Albedos and Diameters from IRAS and MSX

Rectified diameters and albedo estimates of 1517 main belt asteroid selected from the IRAS and MSX asteroid photometry catalogues are derived from updated infrared thermal models, the Standard Thermal Model (STM) and the Near Earth Asteroid Thermal Model (NEATM), and Monte Carlo simulations, using new Minor Planet Center (MPC) compilations of absolute magnitudes (H-values) constrained by occultation and radar derived parameters. The NEATM approach produces a more robust estimate of albedos and diameters, yielding albedos of $p_{v}$(NEATM mean)$=0.081 \pm 0.064$. The asteroid beaming parameter ($\eta$) for the selected asteroids has a mean value of $1.07 \pm 0.27$, and the smooth distribution of $\eta$ suggests that this parameter is independent of asteroid properties such as composition. No trends in $\eta$ due to size-dependent rotation rates are evident. Comparison of derived $\eta$'s as a function of taxonomic type indicates the beaming parameter values for S-type and C-type asteroids are identical within the standard deviation of the population of beaming parameters.Comment: 43 pages in manuscript layout, 9 figures. Submitted to The Astronomical Journa

Luminous AGB stars in nearby galaxies. A study using Virtual Observatory tools

Aims. This study focuses on very luminous Mbol<-6.0 mag AGB stars with J-Ks>1.5 mag and H-Ks>0.4 mag in the LMC, SMC, M31, and M33 from 2MASS data. Methods.The data were taken from the 2MASS All-Sky Point Source catalogue archive. We used Virtual Observatory tools and took advantage of its capabilities at various stages in the analysis. Results. It is well known that stars with the colors we selected correspond mainly to carbon stars. Although the most luminous AGBs detected here contain a large number of carbon stars,they are not included in existing catalogues produced from data in the optical domain, where they are not visible since they are dust-enshrouded. A comparison of the AGB stars detected with combined near and mid-infrared data from MSX and 2MASS in the LMC shows that 10% of the bright AGB stars are bright carbon stars never detected before and that the other 50% are OH/IR oxygen rich stars, whereas the 40% that remain were not cross-matched. Conclusions. The catalogues of the most luminous AGB stars compiled here are an important complement to existing data. In the LMC, these bright AGB stars are centrally located, whereas they are concentrated in an active star-formation ring in M31. In the SMC and M33, there are not enough of them to draw definite conclusions, although they tend to be centrally located. Their luminosity functions are similar for the four galaxies we studied.Comment: 16 pages, 12 figures, 4 tables (Appendix A), accepted in A&

E-readiness in construction (ERiC) : self-assessment framework for UK small and medium enterprise building services providers

The construction industry’s ability to innovate in order to improve its practices has been widely debated. As organisations in other sectors globally are addressing technology challenges, is the UK construction industry e-ready? Of particular concern is the plethora of small and medium enterprises (SME) that constitute over 80% of the UK construction industry. There are noticeable SME laggards in the uptake of new processes and technologies. This paper aims to assess the e-readiness levels of UK SME building services provider in order to leverage the advantages of technology opportunities in the future. The resultant self-assessment ERiC framework enables SMEs to quantify and measure e-readiness from an organisation, technical and process perspective

Infrared Dark Clouds in the Small Magellanic Cloud?

We have applied the unsharp-masking technique to the 24 $\mu$m image of the Small Magellanic Cloud (SMC), obtained with the Spitzer Space Telescope, to search for high-extinction regions. This technique has been used to locate very dense and cold interstellar clouds in the Galaxy, particularly infrared dark clouds (IRDCs). Fifty five candidate regions of high-extinction, namely high-contrast regions (HCRs), have been identified from the generated decremental contrast image of the SMC. Most HCRs are located in the southern bar region and mainly distributed in the outskirts of CO clouds, but most likely contain a significant amount of H2. HCRs have a peak-contrast at 24 $\mu$m of 2 - 2.5 % and a size of 8 - 14 pc. This corresponds to the size of typical and large Galactic IRDCs, but Galactic IRDCs are 2 - 3 times darker at 24 $\mu$m than our HCRs. To constrain the physical properties of the HCRs, we have performed NH3, N2H+, HNC, HCO+, and HCN observations toward one of the HCRs, HCR LIRS36-EAST, using the Australia Telescope Compact Array and the Mopra single-dish radio telescope. We did not detect any molecular line emission, however, our upper limits to the column densities of molecular species suggest that HCRs are most likely moderately dense with n ~ 10^{3} cm-3. This volume density is in agreement with predictions for the cool atomic phase in low metallicity environments. We suggest that HCRs may be tracing clouds at the transition from atomic to molecule-dominated medium, and could be a powerful way to study early stages of gas condensation in low metallicity galaxies. Alternatively, if made up of dense molecular clumps < 0.5 pc in size, HCRs could be counterparts of Galactic IRDCs, and/or regions with highly unusual abundance of very small dust grains.Comment: accepted for publication in the Astronomical Journa

Extragalactic millimeter-wave sources in South Pole Telescope survey data: source counts, catalog, and statistics for an 87 square-degree field

We report the results of an 87 square-degree point-source survey centered at R.A. 5h30m, decl. -55 deg. taken with the South Pole Telescope (SPT) at 1.4 and 2.0 mm wavelengths with arc-minute resolution and milli-Jansky depth. Based on the ratio of flux in the two bands, we separate the detected sources into two populations, one consistent with synchrotron emission from active galactic nuclei (AGN) and one consistent with thermal emission from dust. We present source counts for each population from 11 to 640 mJy at 1.4 mm and from 4.4 to 800 mJy at 2.0 mm. The 2.0 mm counts are dominated by synchrotron-dominated sources across our reported flux range; the 1.4 mm counts are dominated by synchroton-dominated sources above ~15 mJy and by dust-dominated sources below that flux level. We detect 141 synchrotron-dominated sources and 47 dust-dominated sources at S/N > 4.5 in at least one band. All of the most significantly detected members of the synchrotron-dominated population are associated with sources in previously published radio catalogs. Some of the dust-dominated sources are associated with nearby (z << 1) galaxies whose dust emission is also detected by the Infrared Astronomy Satellite (IRAS). However, most of the bright, dust-dominated sources have no counterparts in any existing catalogs. We argue that these sources represent the rarest and brightest members of the population commonly referred to as sub-millimeter galaxies (SMGs). Because these sources are selected at longer wavelengths than in typical SMG surveys, they are expected to have a higher mean redshift distribution and may provide a new window on galaxy formation in the early universe.Comment: 35 emulateapj pages, 12 figures, 5 table

Cannabinoids Inhibit Insulin Receptor Signaling in Pancreatic β\beta-Cells

Objective: Optimal glucose homeostasis requires exquisitely precise adaptation of the number of insulin-secreting $\beta$-cells in the islets of Langerhans. Insulin itself positively regulates $\beta$-cell proliferation in an autocrine manner through the insulin receptor (IR) signaling pathway. It is now coming to light that cannabinoid 1 receptor (CB1R) agonism/antagonism influences insulin action in insulin-sensitive tissues. However, the cells on which the CB1Rs are expressed and their function in islets have not been firmly established. We undertook the current study to investigate if intraislet endogenous cannabinoids (ECs) regulate $\beta$-cell proliferation and if they influence insulin action. Research Design and Methods: We measured EC production in isolated human and mouse islets and $\beta$-cell line in response to glucose and KCl. We evaluated human and mouse islets, several $\beta$-cell lines, and CB1R-null (CB1R$^{−/−}$) mice for the presence of a fully functioning EC system. We investigated if ECs influence $\beta$-cell physiology through regulating insulin action and demonstrated the therapeutic potential of manipulation of the EC system in diabetic (db/db) mice. Results: ECs are generated within $\beta$-cells, which also express CB1Rs that are fully functioning when activated by ligands. Genetic and pharmacologic blockade of CB1R results in enhanced IR signaling through the insulin receptor substrate 2-AKT pathway in $\beta$-cells and leads to increased $\beta$-cell proliferation and mass. CB1R antagonism in db/db mice results in reduced blood glucose and increased $\beta$-cell proliferation and mass, coupled with enhanced IR signaling in $\beta$-cells. Furthermore, CB1R activation impedes insulin-stimulated IR autophosphorylation on $\beta$-cells in a G$\alpha_i$-dependent manner. Conclusions: These findings provide direct evidence for a functional interaction between CB1R and IR signaling involved in the regulation of $\beta$-cell proliferation and will serve as a basis for developing new therapeutic interventions to enhance $\beta$-cell function and proliferation in diabetes

The United Kingdom Diabetic Retinopathy Electronic Medical Record Users Group: Report 3: Baseline Retinopathy and Clinical Features Predict Progression of Diabetic Retinopathy

Purpose To determine the time and risk factors for developing proliferative diabetic retinopathy (PDR) and vitreous hemorrhage (VH). Design Multicenter, national cohort study. Methods Anonymized data of 50 254 patient eyes with diabetes mellitus at 19 UK hospital eye services were extracted at the initial and follow-up visits between 2007 and 2014. Time to progression of PDR and VH were calculated with Cox regression after stratifying by baseline diabetic retinopathy (DR) severity and adjusting for age, sex, race, and starting visual acuity. Results Progression to PDR in 5 years differed by baseline DR: no DR (2.2%), mild (13.0%), moderate (27.2%), severe nonproliferative diabetic retinopathy (NPDR) (45.5%). Similarly, 5-year progression to VH varied by baseline DR: no DR (1.1%), mild (2.9%), moderate (7.3%), severe NPDR (9.8%). Compared with no DR, the patient eyes that presented with mild, moderate, and severe NPDR were 6.71, 14.80, and 28.19 times more likely to develop PDR, respectively. In comparison to no DR, the eyes with mild, moderate, and severe NPDR were 2.56, 5.60, and 7.29 times more likely to develop VH, respectively. In severe NPDR, the eyes with intraretinal microvascular abnormalities (IRMA) had a significantly increased hazard ratio (HR) of developing PDR (HR 1.77, 95% confidence interval [CI] 1.25–2.49, P = .0013) compared with those with venous beading, whereas those with 4-quadrant dot-blot hemorrhages (4Q DBH) had 3.84 higher HR of developing VH (95% CI 1.39–10.62, P = .0095). Conclusions Baseline severities and features of initial DR are prognostic for PDR development. IRMA increases risk of PDR whereas 4Q DBH increases risk of VH

Assessment of Real-Time 3D Visualization for Cardiothoracic Diagnostic Evaluation and Surgery Planning

RATIONALE AND OBJECTIVES: Three-dimensional (3D) real-time volume rendering has demonstrated improvements in clinical care for several areas of radiological imaging. We test whether advanced real-time rendering techniques combined with an effective user interface will allow radiologists and surgeons to improve their performance for cardiothoracic surgery planning and diagnostic evaluation. MATERIAL AND METHODS: An interactive combination 3D and 2D visualization system developed at the University of North Carolina at Chapel Hill was compared against standard tiled 2D slice presentation on a viewbox. The system was evaluated for 23 complex cardiothoracic computed tomographic (CT) cases including heart-lung and lung transplantation, tumor resection, airway stent placement, repair of congenital heart defects, aortic aneurysm repair, and resection of pulmonary arteriovenous malformation. Radiologists and surgeons recorded their impressions with and without the use of the interactive visualization system. RESULTS: The cardiothoracic surgeons reported positive benefits to using the 3D visualizations. The addition of the 3D visualization changed the surgical plan (65% of cases), increased the surgeon's confidence (on average 40% per case), and correlated well with the anatomy found at surgery (95% of cases). The radiologists reported fewer and less major changes than the surgeons in their understanding of the case due to the 3D visualization. They found new findings or additional information about existing findings in 66% of the cases; however, they changed their radiology report in only 14% of the cases. CONCLUSION: With the appropriate choice of 3D real-time volume rendering and a well-designed user interface, both surgeons and radiologists benefit from viewing an interactive 3D visualization in addition to 2D images for surgery planning and diagnostic evaluation of complex cardiothoracic cases. This study finds that 3D visualization is especially helpful to the surgeon in understanding the case, and in communicating and planning the surgery. These results suggest that including real-time 3D visualization would be of clinical benefit for complex cardiothoracic CT cases