Current Knowledge and Attitudes Concerning Cost-Effectiveness in Glaucoma Pharmacotherapy: A Glaucoma Specialists Focus Group Study.

Background:Rising healthcare costs motivate continued cost-reduction efforts. To help lower costs associated with open-angle glaucoma (OAG), a prevalent, progressive disease with substantial direct and indirect costs, clinicians need to understand the cost-effectiveness of intraocular pressure (IOP)-lowering pharmacotherapies. There is little published information on clinicians' knowledge and attitudes about cost-effectiveness in glaucoma treatment. Purpose:This pilot focus group study aimed to explore clinician attitudes and perspectives around the costs and cost drivers of glaucoma therapy; the implementation of cost-effectiveness decisions; the clinical utility of cost-effectiveness studies; and the cost-effectiveness of available treatments. Methods:Six US glaucoma specialists participated in two separate teleconferencing sessions (three participants each), managed by an independent, skilled moderator (also a glaucoma specialist) using a discussion guide. Participants reviewed recent publications (n=25) on health economics outcomes research in glaucoma prior to the sessions. Results:Participants demonstrated a clear understanding of the economic burden of glaucoma therapy and identified medications, diagnostics, office visits, and treatment changes as key cost drivers. They considered cost-effectiveness an appropriate component of treatment decision-making but identified the need for additional data to inform these decisions. Participants indicated that there were only a few recent studies on health economics outcomes in glaucoma which evaluate parameters important to patient care, such as quality of life and medication adherence, and that longitudinal data were scant. In addition to efficacy, participants felt patient adherence and side-effect profile should be included in economic evaluations of glaucoma pharmacotherapy. Recently approved medications were evaluated in this context. Conclusion:Clinicians deem treatment decisions based on cost-effectiveness data as clinically appropriate. Newer IOP-lowering therapies with potentially greater efficacy and favorable side-effect and adherence profiles may help optimize cost-effectiveness. Future studies should include: clinicians' perspectives; lack of commercial bias; analysis of long-term outcomes/costs; more comprehensive parameters; real-world (including quality-of-life) data; and a robust Markov model

Plumbophyllite, a new species from the Blue Bell claims near Baker, San Bernardino County, California

The new mineral plumbophyllite, Pb2Si4O10·H2O, orthorhombic with space group Pbcn and cell parameters a = 13.2083(4), b = 9.7832(3), c = 8.6545(2) Å, V = 1118.33(5) Å^3, and Z = 4. It occurs as colorless to pale blue prismatic crystals to 3 mm, with wedge-shaped terminations at the Blue Bell claims, about 11 km west of Baker, San Bernardino County, California. It is found in narrow veins in a highly siliceous hornfels in association with cerussite, chrysocolla, fluorite, goethite, gypsum, mimetite, opal, plumbotsumite, quartz, sepiolite, and wulfenite. The streak is white, the luster is vitreous, the Mohs hardness is about 5, and there is one perfect cleavage, {100}. The measured density is 3.96(5) g/cm^3 and the calculated density is 3.940 g/cm^3. Optical properties (589 nm): biaxial (+), {alpha} = 1.674(2), β = 1.684(2), {gamma} = 1.708(2), 2V = 66(2)°, dispersion r > v (strong); X = b, Y = c, Z = a. Electron microprobe analysis provided PbO 60.25, CuO 0.23, SiO_2 36.22 wt%, and CHN analysis provided H_2O 3.29 wt% for a total of 99.99 wt%. Powder IR spectroscopy confirmed the presence of H_2O and single-crystal IR spectroscopy indicated the H_2O to be oriented perpendicular to the b axis. Raman spectra were also obtained. The strongest powder X-ray diffraction lines are [d (hkl) I]: 7.88(110)97, 6.63(200)35, 4.90(020)38, 3.623(202)100, 3.166(130)45, 2.938(312/411/222)57, 2.555(132/213)51, and 2.243(521/332)50. The atomic structure (R1 = 2.04%) consists of undulating sheets of silicate tetrahedra between which are located Pb atoms and channels containing H_2O (and Pb^(2+) lone-pair electrons). The silicate sheets can be described as consisting of zigzag pyroxene-like (SiO_3)_n chains joined laterally into sheets with the unshared tetrahedral apices in successive chains pointed alternately up and down, a configuration also found in pentagonite

The correlation between far-IR and radio continuum emission from spiral galaxies

A sample of 30 galaxies selected for their intense IRAS flux at 60 and 100 micron using the Arecibo telescope at 21 cm to measure the continuum and HI line luminosities were observed. The centimeter wave continuum correlates very well with the far-infrared flux, with a correlation coefficient as high as that found for other samples, and the same ratio between FIR and radio luminosities. Weaker correlations are seen between the FIR and optical luminosity and between the FIR and radio continuum. There is very little correlation between the FIR and the HI mass deduced from the integral of the 21 cm line. The strength of the radio continuum correlation suggests that there is little contribution to either the radio and FIR from physical processes not affecting both. If they each reflect time integrals of the star formation rate then the time constants must be similar, or the star formation rate must change slowly in these galaxies