46 research outputs found

    Rising Population Cost for Treating People Living with HIV in the UK, 1997-2013

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    Background The number of people living with HIV (PLHIV) is increasing in the UK. This study estimated the annual population cost of providing HIV services in the UK, 1997–2006 and projected them 2007–2013. Methods Annual cost of HIV treatment for PLHIV by stage of HIV infection and type of ART was calculated (UK pounds, 2006 prices). Population costs were derived by multiplying the number of PLHIV by their annual cost for 1997–2006 and projected 2007–2013. Results Average annual treatment costs across all stages of HIV infection ranged from £17,034 in 1997 to £18,087 in 2006 for PLHIV on mono-therapy and from £27,649 in 1997 to £32,322 in 2006 for those on quadruple-or-more ART. The number of PLHIV using NHS services rose from 16,075 to 52,083 in 2006 and was projected to increase to 78,370 by 2013. Annual population cost rose from £104 million in 1997 to £483 million in 2006, with a projected annual cost between £721 and £758 million by 2013. When including community care costs, costs increased from £164 million in 1997, to £683 million in 2006 and between £1,019 and £1,065 million in 2013. Conclusions Increased number of PLHIV using NHS services resulted in rising UK population costs. Population costs are expected to continue to increase, partly due to PLHIV's longer survival on ART and the relative lack of success of HIV preventing programs. Where possible, the cost of HIV treatment and care needs to be reduced without reducing the quality of services, and prevention programs need to become more effective. While high income countries are struggling to meet these increasing costs, middle- and lower-income countries with larger epidemics are likely to find it even more difficult to meet these increasing demands, given that they have fewer resources

    Identification of novel risk loci, causal insights, and heritable risk for Parkinson's disease: a meta-analysis of genome-wide association studies

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    Background Genome-wide association studies (GWAS) in Parkinson's disease have increased the scope of biological knowledge about the disease over the past decade. We aimed to use the largest aggregate of GWAS data to identify novel risk loci and gain further insight into the causes of Parkinson's disease. Methods We did a meta-analysis of 17 datasets from Parkinson's disease GWAS available from European ancestry samples to nominate novel loci for disease risk. These datasets incorporated all available data. We then used these data to estimate heritable risk and develop predictive models of this heritability. We also used large gene expression and methylation resources to examine possible functional consequences as well as tissue, cell type, and biological pathway enrichments for the identified risk factors. Additionally, we examined shared genetic risk between Parkinson's disease and other phenotypes of interest via genetic correlations followed by Mendelian randomisation. Findings Between Oct 1, 2017, and Aug 9, 2018, we analysed 7·8 million single nucleotide polymorphisms in 37 688 cases, 18 618 UK Biobank proxy-cases (ie, individuals who do not have Parkinson's disease but have a first degree relative that does), and 1·4 million controls. We identified 90 independent genome-wide significant risk signals across 78 genomic regions, including 38 novel independent risk signals in 37 loci. These 90 variants explained 16–36% of the heritable risk of Parkinson's disease depending on prevalence. Integrating methylation and expression data within a Mendelian randomisation framework identified putatively associated genes at 70 risk signals underlying GWAS loci for follow-up functional studies. Tissue-specific expression enrichment analyses suggested Parkinson's disease loci were heavily brain-enriched, with specific neuronal cell types being implicated from single cell data. We found significant genetic correlations with brain volumes (false discovery rate-adjusted p=0·0035 for intracranial volume, p=0·024 for putamen volume), smoking status (p=0·024), and educational attainment (p=0·038). Mendelian randomisation between cognitive performance and Parkinson's disease risk showed a robust association (p=8·00 × 10−7). Interpretation These data provide the most comprehensive survey of genetic risk within Parkinson's disease to date, to the best of our knowledge, by revealing many additional Parkinson's disease risk loci, providing a biological context for these risk factors, and showing that a considerable genetic component of this disease remains unidentified. These associations derived from European ancestry datasets will need to be followed-up with more diverse data. Funding The National Institute on Aging at the National Institutes of Health (USA), The Michael J Fox Foundation, and The Parkinson's Foundation (see appendix for full list of funding sources)

    The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

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    Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

    Characterization of two paralogous muscleblind-like genes from the tiger pufferfish (<em>Takifugu rubripes</em>)

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    Muscleblind-like (Mbnl) proteins are required for terminal muscle differentiation in mammals. In this study we have identified two mbnl paralogues from the tiger pufferfish, tmbnl2a and tmbnl3, which are the first examples of non-mammalian mbnl genes. Tmbnl2a and tmbnl3 were found in regions of conserved synteny and had a high degree of global conservation with their mammalian homologues. Phylogenetic analysis showed that the T rubripes genome contains one mbnl3 gene and two copies of mbnl1 and mbnl2. Moreover, the mbnl1 and mbnl3 paralogues are derived from duplication of a common ancestral gene. The average rates of synonymous substitutions between T rubripes, mouse and human mbnl2 and mbnl3 genes were much higher than the corresponding rates of non-synonymous mutations, suggesting that Mbnl2 and Mbnl3 are subjected to strong purifying selection. Quantitation of tmbnl2a and tmbnl3 transcripts by real-time PCR revealed that these two paralogues are differentially expressed in fast and slow myotomal muscle, heart, liver, skin, brain and testes. Tmbnl2a was expressed at similar levels in all tissues examined, as was the mouse orthologue. Tmbnl3 was expressed at higher levels than tmbnl2a, with a ubiquitous tissue distribution. Expression of tmbnl3 remained high in adult pufferfish muscle whereas the mouse orthologue was down-regulated in adults, perhaps reflecting the indeterminate and determinate growth patterns of these taxa, respectively. (c) 2006 Elsevier Inc. All rights reserved.</p

    Differential regulation of multiple alternatively spliced transcripts of <em>MyoD</em>

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    Splice variants of the basic helix-loop-helix myoblast determination factor (myoD) have not been previously found in vertebrates. Here we report the identification and characterization of three alternative transcripts of a myoD paralogue from the tiger pufferfish (Takifugu rubripes). The T rubripes myoD1 gene (TmyoD1) has 3 exons and 2 introns and it is present on scaffold 104, in a region of conserved synteny with zebrafish. The isoform TMyoD1-alpha is a putative protein of 281 residues that contains the basic, helix-loop-helix and helix III domains and shares 61%, 56%, 51%, 49% and 56% overall identity with zebrafish, Xenopus, mouse, human and chicken MyoD1, respectively. TMyoD1-beta arises from an alternative 3' splice site and differs from TMyoD1-alpha by a 26-residue insertion adjacent to helix 111, which is one of the functional domains required for chromatin remodelling. The third alternative transcript, TmyoD1-gamma, retains intron I and has two premature termination codons far from the 3'-most exon-exon junction. TmyoD1-gamma is therefore likely to be degraded by nonsense-mediated decay, an important widespread post-transcriptional mechanism that regulates transcript levels. Analysis of gene expression by qPCR revealed that TmyoD1-alpha was the most abundant transcript in fast and slow myotomal muscle. TmyoD1-alpha expression was 2-fold higher in fast muscle of juvenile fish that were actively producing new myotubes compared to adult stages that had stopped recruiting fast muscle fibres. A similar expression pattern was observed for TmyoD1-alpha in slow muscle but the differences were not significant. Transcript levels of TmyoD1-gamma only varied significantly in fast muscle and were 5-fold higher in adult compared to juvenile stages. Significant differences in expression of TmyoD1 splice variants were also observed during embryonic development. The differential expression of three alternative transcripts of myoD1 in developing and adult myotomal muscle of T rubripes supports the hypothesis that diversity generated by alternative splicing may be of functional significance in muscle development in this species. (c) 2006 Elsevier B.V. All rights reserved.</p

    Differential regulation of multiple alternatively spliced transcripts of <em>MyoD</em>

    No full text
    Splice variants of the basic helix-loop-helix myoblast determination factor (myoD) have not been previously found in vertebrates. Here we report the identification and characterization of three alternative transcripts of a myoD paralogue from the tiger pufferfish (Takifugu rubripes). The T rubripes myoD1 gene (TmyoD1) has 3 exons and 2 introns and it is present on scaffold 104, in a region of conserved synteny with zebrafish. The isoform TMyoD1-alpha is a putative protein of 281 residues that contains the basic, helix-loop-helix and helix III domains and shares 61%, 56%, 51%, 49% and 56% overall identity with zebrafish, Xenopus, mouse, human and chicken MyoD1, respectively. TMyoD1-beta arises from an alternative 3' splice site and differs from TMyoD1-alpha by a 26-residue insertion adjacent to helix 111, which is one of the functional domains required for chromatin remodelling. The third alternative transcript, TmyoD1-gamma, retains intron I and has two premature termination codons far from the 3'-most exon-exon junction. TmyoD1-gamma is therefore likely to be degraded by nonsense-mediated decay, an important widespread post-transcriptional mechanism that regulates transcript levels. Analysis of gene expression by qPCR revealed that TmyoD1-alpha was the most abundant transcript in fast and slow myotomal muscle. TmyoD1-alpha expression was 2-fold higher in fast muscle of juvenile fish that were actively producing new myotubes compared to adult stages that had stopped recruiting fast muscle fibres. A similar expression pattern was observed for TmyoD1-alpha in slow muscle but the differences were not significant. Transcript levels of TmyoD1-gamma only varied significantly in fast muscle and were 5-fold higher in adult compared to juvenile stages. Significant differences in expression of TmyoD1 splice variants were also observed during embryonic development. The differential expression of three alternative transcripts of myoD1 in developing and adult myotomal muscle of T rubripes supports the hypothesis that diversity generated by alternative splicing may be of functional significance in muscle development in this species. (c) 2006 Elsevier B.V. All rights reserved.</p

    Characterization of two paralogous muscleblind-like genes from the tiger pufferfish (<em>Takifugu rubripes</em>)

    No full text
    Muscleblind-like (Mbnl) proteins are required for terminal muscle differentiation in mammals. In this study we have identified two mbnl paralogues from the tiger pufferfish, tmbnl2a and tmbnl3, which are the first examples of non-mammalian mbnl genes. Tmbnl2a and tmbnl3 were found in regions of conserved synteny and had a high degree of global conservation with their mammalian homologues. Phylogenetic analysis showed that the T rubripes genome contains one mbnl3 gene and two copies of mbnl1 and mbnl2. Moreover, the mbnl1 and mbnl3 paralogues are derived from duplication of a common ancestral gene. The average rates of synonymous substitutions between T rubripes, mouse and human mbnl2 and mbnl3 genes were much higher than the corresponding rates of non-synonymous mutations, suggesting that Mbnl2 and Mbnl3 are subjected to strong purifying selection. Quantitation of tmbnl2a and tmbnl3 transcripts by real-time PCR revealed that these two paralogues are differentially expressed in fast and slow myotomal muscle, heart, liver, skin, brain and testes. Tmbnl2a was expressed at similar levels in all tissues examined, as was the mouse orthologue. Tmbnl3 was expressed at higher levels than tmbnl2a, with a ubiquitous tissue distribution. Expression of tmbnl3 remained high in adult pufferfish muscle whereas the mouse orthologue was down-regulated in adults, perhaps reflecting the indeterminate and determinate growth patterns of these taxa, respectively. (c) 2006 Elsevier Inc. All rights reserved.</p

    Use of Molecular Markers in Genetic Evaluation of Animals with Applications in Australian Merinos

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    This thesis has examined aspects of detection and utilisation of genetic marker technology in animal breeding systems. Models have been proposed to include genetic marker information into mixed model equations for estimating major gene, or Quantitative Trait Loci (QTL) effects. These involve building a Gametic Relationship Matrix (GRM) with probabilities of identity by descent of QTL alleles between gametes. Algorithms to build the GRM were compared and a further method was proposed to build the GRM based on simulated QTL information. The simulated QTL method was identified as an approximation of the true GRM, as it involved simulating all possible QTL-marker genotype combinations. Detection of linkage between genetic markers and QTL is usually based on data collected from animals in the field which are assumed to be unselected. The effect of this assumption on parameter estimates is unknown. Results from use of a restricted maximum likelihood detection method and a granddaughter design population, show that in the presence of within family (or sire) selection, large underestimates of variance occur and QTL position and effect estimates are inaccurate. However, selection of grandsires only has little effect on estimation of variance
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