Cost effectiveness of photodynamic therapy with verteporfin for age related macular degeneration: the UK case

AIM: To estimate the potential cost effectiveness of photodynamic therapy (PDT) with verteporfin in the UK setting. METHODS: Using data from a variety of sources a Markov model was built to produce estimates of the cost effectiveness (incremental cost per quality adjusted life year (QALY) and incremental cost per vision year gained) of PDT for two cohorts of patients (one with starting visual acuity (VA) of 20/40 and one at 20/100) with predominantly classic choroidal neovascular disease over a 2 year and 5 year time horizon. A government perspective and a treatment cost only perspective were considered. Probabilistic and one way sensitivity analyses were undertaken. RESULTS: From the government perspective, over the 2 year period, the expected incremental cost effectiveness ratios range from £286 000 (starting VA 20/100) to £76 000 (starting VA 20/40) per QALY gained and from £14 000 (20/100) to £34 000 (20/40) per vision year gained. A 5 year perspective yields incremental ratios less than £5000 for vision years gained and from £9000 (20/40) to £30 000 (20/100) for QALYs gained. Without societal or NHS cost offsets included, the 2 year incremental cost per vision year gained ranges from £20 000 (20/100) to £40 000 (20/40), and the 2 year incremental cost per QALY gained ranges from £412 000 (20/100) to £90 000 (20/40). The 5 year time frame shows expected costs of £7000 (20/40) to £10 000 (20/100) per vision year gained and from £38 000 (20/40) to £69 000 (20/100) per QALY gained. CONCLUSION: This evaluation suggests that early treatment (that is, treating eyes at less severe stages of disease) with PDT leads to increased efficiency. When considering only the cost of therapy, treating people at lower levels of visual acuity would probably not be considered cost effective. However, a broad perspective that incorporates other NHS treatment costs and social care costs suggests that over a long period of time, PDT may yield reasonable value for money

Spatial dependence of gain nonlinearities in InGaAs semiconductor optical amplifier

Counter-propagating sub-picosecond pulses are used to monitor gain saturation along the waveguide of an InGaAs superlattice semiconductor optical amplifier at 1550 nm wavelength. The functional form of the spatial dependence of gain saturation is found to depend on pulse energy. These observations are interpreted by combining the optical nonlinearities associated with interband carrier dynamics and carrier heating together and their respective time constants. We show that the results are consistent with the predictions of a propagation model. Implications for all-optical switching, particularly in the limit of full saturation across the whole amplifier, are discussed. (c) 2005 American Institute of Physics.</p

British investment in South America and the financial crisis of 1825 – 1826

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Performance of a Brayton power system with a space type radiator

Test results of an experimental investigation to measure Brayton engine performance while operating at the sink temperatures of a typical low earth orbit are presented. The results indicate that the radiator area was slightly oversized. The steady state and transient responses of the power system to the sink temperatures in orbit were measured. During the orbital operation, the engine did not reach the steady state operation of either sun or shade conditions. The alternator power variation during orbit was + or - 4 percent from its mean value of 9.3 kilowatts

&#039;mat&#039;: A new media annotation tool with an interactive learning cycle for application in tertiary education

This paper provides an overview of the design process of a new online media annotation tool. This work-in-progress report will step through some design decisions as aided by reviewing learning theory and related experiences outlined in the literature; design principles from a user interface perspective; and user testing of the first design iteration. The first of a three stage development of the media annotation tool, &#039;mat&#039; (MAT), is designed for learning from video, with later stages enabling other media (audio, image, other) plus assignment building with media inserts. User testing reinforced several design decisions plus initiated some change

The Mirage of Triangular Arbitrage in the Spot Foreign Exchange Market

We investigate triangular arbitrage within the spot foreign exchange market using high-frequency executable prices. We show that triangular arbitrage opportunities do exist, but that most have short durations and small magnitudes. We find intra-day variations in the number and length of arbitrage opportunities, with larger numbers of opportunities with shorter mean durations occurring during more liquid hours. We demonstrate further that the number of arbitrage opportunities has decreased in recent years, implying a corresponding increase in pricing efficiency. Using trading simulations, we show that a trader would need to beat other market participants to an unfeasibly large proportion of arbitrage prices to profit from triangular arbitrage over a prolonged period of time. Our results suggest that the foreign exchange market is internally self-consistent and provide a limited verification of market efficiency

The Kervaire-Laudenbach conjecture and presentations of simple groups

The statement ``no nonabelian simple group can be obtained from a nonsimple group by adding one generator and one relator" 1) is equivalent to the Kervaire--Laudenbach conjecture; 2) becomes true under the additional assumption that the initial nonsimple group is either finite or torsion-free. Key words: Kervaire--Laudenbach conjecture, relative presentations, simple groups, car motion, cocar comotion. AMS MSC: 20E32, 20F05, 20F06.Comment: 20 pages, 13 figure

The structure of one-relator relative presentations and their centres

Suppose that G is a nontrivial torsion-free group and w is a word in the alphabet G\cup\{x_1^{\pm1},...,x_n^{\pm1}\} such that the word w' obtained from w by erasing all letters belonging to G is not a proper power in the free group F(x_1,...,x_n). We show how to reduce the study of the relative presentation \^G= to the case n=1. It turns out that an "n-variable" group \^G can be constructed from similar "one-variable" groups using an explicit construction similar to wreath product. As an illustration, we prove that, for n>1, the centre of \^G is always trivial. For n=1, the centre of \^G is also almost always trivial; there are several exceptions, and all of them are known.Comment: 15 pages. A Russian version of this paper is at http://mech.math.msu.su/department/algebra/staff/klyachko/papers.htm . V4: the intoduction is rewritten; Section 1 is extended; a short introduction to Secton 5 is added; some misprints are corrected and some cosmetic improvements are mad