Use and cost of disease-modifying therapies by Sonya Slifka Study participants: has anything really changed since 2000 and 2009?

Background:Disease-modifying therapies benefit individuals with relapsing forms of multiple sclerosis, but their utility remains unclear for those without relapses. Objective:To determine disease-modifying therapy use and costs in 2009, compare use in 2009 and 2000, and examine compliance with evidence-based guidelines. Methods:We determined the extent and characteristics of disease-modifying therapy use by participants in the Sonya Slifka Longitudinal Multiple Sclerosis Study (Slifka) in 2000 (n=2156) and 2009 (n=2361) and estimated out-of-pocket and total (payer) costs for 2009. Two multivariable logistic regressions predicted disease-modifying therapy use. Results:Disease-modifying therapy use increased from 55.3% in 2000 to 61.5% in 2009. In 2009, disease-modifying therapy use was reported by 76.5% of participants with relapsing-remitting multiple sclerosis, 73.2% with progressive-relapsing multiple sclerosis, 62.5% with secondary progressive multiple sclerosis, and 41.8% with primary progressive multiple sclerosis. Use was significantly associated with relapsing-remitting multiple sclerosis, shorter duration of illness, one to two relapses per year, non-ambulatory symptoms, using a cane, younger age, higher family income, and having health insurance. Average annual costs in 2009 were US$939-3101 for patients and US$16,302-18,928 for payers. Conclusion:Use rates were highest for individuals with relapsing-remitting multiple sclerosis, but substantial for those with progressive courses although clinical trials have not demonstrated significant benefits for them

Changes in calcification of coccoliths under stable atmospheric CO2

The response of coccolithophore calcification to ocean acidification has been studied in culture experiments as well as in present and past oceans. The response, however, is different between species and strains, and for the relatively small carbonate chemistry changes observed in natural environments, a uniform response of the entire coccolithophore community has not been documented so far. Moreover, previous palaeo-studies basically focus on changes in coccolith weight due to increasing CO2 and the resulting changes in the carbonate system, and only few studies focus on the influence of other environmental factors. In order to untangle changes in coccolithophore calcification due to environmental factors such as temperature and/or productivity from changes caused by increasing pCO2 and decreasing carbonate ion concentration, we here present a study on coccolith calcification from the Holocene North Atlantic Ocean. The pre-industrial Holocene, with its predominantly stable atmospheric CO2, provides the conditions for such a comprehensive analysis. For an analysis on changes in major components of Holocene coccolithophores under natural conditions, the family Noelaerhabdaceae was selected, which constitutes the main part of the assemblage in the North Atlantic. Records of average coccolith weights from three Holocene sediment cores along a north–south transect in the North Atlantic were analysed. During the Holocene, mean weight (and therefore calcification) of Noelaerhabdaceae (Emiliania huxleyi and Gephyrocapsa) coccoliths decreased at the Azores (Geofar KF 16) from around 7 to 6 pg, but increased at the Rockall Plateau (ODP site 980) from around 6 to 8 pg, and at the Vøring Plateau (MD08-3192) from 7 to 10 pg. The amplitude of average weight variability is within the range of glacial–interglacial changes that were interpreted to be an effect of decreasing carbonate ion concentration. By comparison with SEM assemblage counts, we show that weight changes are not only partly due to variations in the coccolithophore assemblage but also an effect of a change in calcification and/or morphotype variability within single species. Our results indicate that there is no single key factor responsible for the observed changes in coccolith weight. A major increase in coccolith weight occurs during a slight decrease in carbonate ion concentration in the late Holocene at the Rockall Plateau and Vøring Plateau. Here, more favourable productivity conditions apparently lead to an increase in coccolith weight, either due to the capability of coccolithophore species, especially E. huxleyi, to adapt to decreasing carbonate ion concentration or due to a shift towards heavier calcifying morphotypes

The Oxygen Abundance of Nearby Galaxies from Sloan Digital Sky Survey Spectra

We have derived the oxygen abundance for a sample of nearby galaxies in the Data Release 5 of the Sloan Digital Sky Survey (SDSS) which possess at least two independent spectra of one or several HII regions with a detected [OIII]4363 auroral line. Since, for nearby galaxies, the [OII]3727 nebular line is out of the observed wavelength range, we propose a method to derive (O/H)_ff abundances using the classic Te method coupled with the ff relation. (O/H)_7325 abundances have also been determined, based on the [OII]7320,7330 line intensities, and using a small modification of the standard Te method. The (O/H)_ff and (O/H)_7325 abundances have been derived with both the one- and two-dimensional t_2 - t_3 relations. It was found that the (O/H)_ff abundances derived with the parametric two-dimensional t_2 - t_3 relation are most reliable. Oxygen abundances have been determined in 29 nearby galaxies, based on 84 individual abundance determinations in HII regions. Because of our selection methods, the metallicity of our galaxies lies in the narrow range 8.2 < 12 + log (O/H) < 8.4. The radial distribution of oxygen abundances in the disk of the spiral galaxy NGC 4490 is determined for the first time.Comment: 39 pages, 10 figures, 4 tables, accepted for publication in the Astrophysical Journa

Abundance determinations in HII regions: model fitting versus Te-method

The discrepancy between the oxygen abundances in high-metallicity HII regions determined through the Te-method (and/or through the corresponding "strong lines - oxygen abundance" calibration) and that determined through the model fitting (and/or through the corresponding "strong lines - oxygen abundance" calibration) is discussed. It is suggested to use the interstellar oxygen abundance in the solar vicinity, derived with very high precision from the high-resolution observations of the weak interstellar absorption lines towards the stars, as a "Rosetta stone" to verify the validity of the oxygen abundances derived in HII regions with the Te-method at high abundances. The agreement between the value of the oxygen abundance at the solar galactocentric distance traced by the abundances derived in HII regions through the Te-method and that derived from the interstellar absorption lines towards the stars is strong evidence in favor of that i) the two-zone model for Te seems to be a realistic interpretation of the temperature structure within HII regions, and ii) the classic Te-method provides accurate oxygen abundances in HII regions. It has been concluded that the "strong lines - oxygen abundance" calibrations must be based on the HII regions with the oxygen abundances derived with the Te-method but not on the existing grids of the models for HII regions.Comment: 5 pages, 3 figures, accepted for publication in Astronomy and Astrophysic

The impact of the National HIV Health Care Worker Hotline on patient care in South Africa

<p>Abstract</p> <p>Background</p> <p>South Africa has a huge burden of illness due to HIV infection. Many health care workers managing HIV infected patients, particularly those in rural areas and primary care health facilities, have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail.</p> <p>Results</p> <p>A questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the 2-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. 96% of the callers surveyed took an action based on the advice received from the National HIV HCW Hotline. The majority of actions concerned the start, dose adaption, change, or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients.</p> <p>Conclusions</p> <p>The information provided by the National HIV HCW Hotline on patient-specific requests has a direct impact on the management of patients.</p

Evidence of distributed subpial T2* signal changes at 7T in multiple sclerosis : an histogram based approach

Subpial lesions are the most frequent type of cortical lesion in multiple sclerosis (MS), and are thought to be closely associated with poor clinical outcome. Neuropathological studies report that subpial lesions may come in two major types: they may appear as circumscribed, focal lesions, or extend across multiple adjacent gyri leading to a phenomenon termed “general subpial demyelination” [1]. The in vivo evaluation of diffuse subpial disease is challenging – signal changes may be subtle, and extend across large regions where signal inhomogeneities due to B1 and RF receive coil non-uniformities become more pronounced. Here, we investigate whether a histogram-based analysis of T2* signal intensity in the cortex, at 7T MRI, can show evidence of distributed subpial cortical changes in patients with MS, as described histopathologically. We hypothesized that this phenomenon would be associated with significantly increased T2* signal intensity in patients compared to age-matched controls.Center Algoritm

Abundance determination in HII regions from spectra without the [OII]3727+3729 line

We suggest an empirical calibration for determination of oxygen and nitrogen abundances and electron temperature in HII regions where the [OII]3727+3729 line (R_2) is not available. The calibration is based on the strong emission lines of OIII, NII, and SII (NS calibration) and derived using the spectra of HII regions with measured electron temperatures as calibration datapoints. The NS calibration makes it possible to derive abundances for HII regions in nearby galaxies from the SDSS spectra where R_2 line is out of the measured wavelength range, but can also be used for the oxygen and nitrogen abundances determinations in any HII region independently whether the nebular oxygen line [OII]3727+3729 is available or not. The NS calibration provides reliable oxygen and nitrogen abundances for HII regions over the whole range of metallicities.Comment: 6 pages, 4 figures, accepted for publication in the MNRA

The Composition Gradient in M101 Revisited. II. Electron Temperatures and Implications for the Nebular Abundance Scale

(Abridged) We use high S/N spectra of 20 HII regions in the giant spiral galaxy M101 to derive electron temperatures for the HII regions and robust metal abundances over radii R = 0.19-1.25 Ro (6-41 kpc). We compare the consistency of electron temperatures measured from the [O III]4363, [N II]5755, [S III]6312, and [O II]7325 auroral lines. Temperatures from [O III], [S III], and [N II] are correlated with relative offsets that are consistent with expectations from nebular photoionization models. However, the temperatures derived from the [O II]7325 line show a large scatter and are nearly uncorrelated with temperatures derived from other ions. Our derived oxygen abundances O/H are well fitted by an exponential distribution over six disk scale lengths, from approximately 1.3 solar in the center to 1/15 solar in the outermost region studied (for solar 12 + log (O/H)=8.7). We measure significant radial gradients in N/O and He/H abundance ratios, but relatively constant S/O and Ar/O. Our abundances are systematically lower by 0.2-0.5 dex than those derived from the most widely used strong-line "empirical" abundance indicators. We suspect that most of the disagreement with the strong-line abundances arises from uncertainties in the nebular models that are used to calibrate the "empirical" scale, and that strong-line abundances derived for HII regions and emission-line galaxies are as much as a factor of two higher than the actual oxygen abundances. However other explanations, such as the effects of temperature fluctuations on the auroral line based abundances cannot be completely ruled out. These results point to the need for direct abundance determinations of a larger sample of extragalactic HII regions, especially for objects more metal-rich than solar.Comment: 50 pages, 14 figures, 8 tables. Accepted by Ap

Conceptualizing Community Oriented Primary Care (COPC) - the Tshwane, South Africa, health post model

Health sector reforms initiated in South Africa in 1994 adopted a primary health care approach to strengthen the health system and achieve public health outcomes through disease prevention and health promotion.1 This led to the building of many new clinics to make health services more accessible, affordable and equitable. However, the pressures of a predominantly hospitalcentric health care system and emerging epidemics prevented the successful provision of quality comprehensive, integrated primary care to millions of South Africans. Also, little attention was given to community partnerships and multi-sectoral collaboration.The authors thank the Foundation for Professional Development for the financial support.http://www.phcfm.orgam201