Cost effectiveness of treatments for wet age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of blindness in people aged >= 50 years. Wet AMD in particular has a major impact on patient quality of life and imposes substantial burdens on healthcare systems. This systematic review examined the cost-effectiveness data for current therapeutic options for wet AMD. PubMed and EMBASE databases were searched for all articles reporting original cost-effectiveness analyses of wet AMD treatments. The Centre for Reviews and Dissemination and Cochrane Library databases were searched for all wet AMD health technology assessments (HTAs). Overall, 44 publications were evaluated in full and included in this review. A broad range of cost-effectiveness analyses were identified for the most commonly used therapies for wet AMD (pegaptanib, ranibizumab and photodynamic therapy [PDT] with verteporfin). Three studies evaluated the cost effectiveness of bevacizumab in wet AMD. A small number of analyses of other treatments, such as laser photocoagulation and antioxidant vitamins, were also found. Ranibizumab was consistently shown to be cost effective for wet AMD in comparison with all the approved wet AMD therapies (four of the five studies identified showed ranibizumab was cost effective vs usual care, PDT or pegaptanib); however, there was considerable variation in the methodology for cost-effectiveness modelling between studies. Findings from the HTAs supported those from the PubMed and EM BASE searches; of the seven HTAs that included ranibizumab, six (including HTAs for Australia, Canada and the UK) concluded that ranibizumab was cost effective for the treatment of wet AMD; most compared ranibizumab with PDT and/or pegaptanib. By contrast, HTAs at best generally recommended pegaptanib or PDT for restricted use in subsets of patients with wet AMD. In the literature analyses, pegaptanib was found to be cost effective versus usual/best supportive care (including PDT) or no treatment in one of five studies; the other four studies found pegaptanib was of borderline cost effectiveness depending on the stage of disease and time horizon. PDT was shown to be cost effective versus usual/best supportive care or no treatment in five of nine studies; two studies showed that PDT was of borderline cost effectiveness depending on baseline visual acuity, and two showed that PDT was not cost effective. We identified no robust studies that properly evaluated the cost effectiveness of bevacizumab in wet AMD

Moving Beyond Tyrosine Hydroxylase to Define Dopaminergic Neurons for Use in Cell Replacement Therapies for Parkinson\u27s Disease

Cell replacement therapies are an attractive mode of treatment for neurodegenerative disorders as they have the potential to alleviate or modify disease symptoms and restore function. In Parkinson\u27s disease, the cell type requiring replacement is dopamine-producing neurons of the midbrain. The source of replacement cells is contentious, with opinion still evolving. Clinical trials have previously used fetal brain tissue; however, this will likely be superseded by the use of embryonic or induced pluripotent stem cells, due to their greater availability and homogeneity. One significant caveat in the use of any cell source for therapy is that cells must first be adequately characterised and purified. The gold standard marker in the identification of dopaminergic neurons is tyrosine hydroxylase (TH), the rate limiting enzyme in dopamine synthesis, catalyzing the conversion of L-tyrosine to L-3,4-dihydroxyphenylalanine. However, there are multiple ways of measuring TH readout, and potential flaws in the fidelity of TH expression. This review will look at the complex regulatory mechanisms that govern different facets of TH expression, including reported differences in TH expression in vitro and in vivo. We will also examine the regulation of the TH gene; assessing the which, the where and the when of TH expression. We will look at how knowledge of regulation of the TH gene can be utilised to enhance research efforts. And, finally we will delve into the transcription factors that govern elements of TH expression, and which may prove more effective for defining appropriate dopaminergic neuron precursor cells

Relationship Among Routine Preference and Openness to Experience, During Covid-19, with Rates of Psychological Distress

This study will examine the relationship between preference for routine and psychological distress, and the personality trait openness to experience and psychological distress. Through research, we found that during the Covid-19 pandemic there has been a rise in rates of psychological distress. Psychological distress can be caused by a variety of different elements; however, in this case, we wanted to study how preference for routine and openness to experience relate to undergraduates students psychological distress. Our overall research question is “ Does routine preference and openness to experience have a relationship to rates of psychological distress? †We predict that some participants in our study that had psychological distress had trouble with being able to manage new routines. We also predicted that participants who scored higher on the Big Five Personality traits on openness to experience also scored lower on the Depression Anxiety Stress Scale. We predict there will be a negative relationship between openness to experience and overall psychological distress. We predict there will be a positive relationship between a high score on preference to routine and a high level of overall psychological distress. We tested this by having participants complete a self-report questionnaire that included a shortened version of the Big Five Inventory, the Routinization Inventory, the DASS-21 Inventory, and a few demographic questions. From the research provided we hypothesize that there will be a positive correlation between preference for routine and psychological distress. We also predict that there will be a negative correlation between the personality trait openness to experience and psychological distress

Session B6- Installation of Denil fishways and eel ladders at brownfield sites

EA Engineering, Science, and Technology, Inc., the U.S. Department of Agriculture Natural Resources Conservation Service, and the Woonasquatucket River Watershed Council have successfully designed, permitted, and constructed Denil fishways and eel ladders at the Rising Sun Mills and Atlantic Mills Dams, the first and third dams on the Woonasquatucket River, a federally designated American Heritage River. The Woonasquatucket River has a number of low head dams from former industrial uses that prevent passage of diadromous fish. The fish ways at these two dams, combined with the two dam removals at Paragon Mills and Dyerville Dams, thesecond and fourth dams, opened over linear miles and 150 acres of habitat to diadromous fish, including American shad, blueback herring, alewife, and American eel. Providing fish passage at these two urban river settings presented numerous engineering and permitting challenges to address historical and archaeological considerations, contaminated sediment management, and state and federal regulatory requirements. Rising Sun Mills Dam and Atlantic Mills Dam are located adjacent to capped Brownfield sites, and the Denil fishways had to be designed to maintain the integrity of the Brownfield caps. Both fish ways required modifications to the existing dam structures after installation of cofferdams to address unknown conditions. The Rising Sun Mills fish way required modification to the deteriorated timber gate for the fishway exit channel and stabilization of the timber spillwayapron for construction of the fishway entrance. The spillwayabutment at Atlantic Mills Dam was found unstable and had to be replaced with a new concrete abutment between the spillway and the fishway exit channel. Both projects included design and installation of eel fish ways subsequent to completion of the Denil fishways. Solar panels were used to operate the attraction water pumps since there were no nearby power sources

Cost-effectiveness of ranibizumab in treatment of diabetic macular oedema (DME) causing visual impairment : evidence from the RESTORE trial

Background/aims To evaluate the cost-effectiveness of ranibizumab as either monotherapy or combined with laser therapy, compared with laser monotherapy, in the treatment of diabetic macular oedema (DME) causing visual impairment from a UK healthcare payer perspective. Methods A Markov model simulated long-term outcomes and costs of treating DME in one eye (BCVA <= 5 letters) based on data from the RESTORE Phase III trial. Outcomes measured in quality-adjusted life-years (QALYs) were simulated for a 15-year time horizon based on 12-month follow-up from RESTORE and published long-term data. Costs included treatment, disease monitoring, visual impairment and blindness (at 2010 price levels). Results Ranibizumab monotherapy resulted in a 0.17 QALY gain at an incremental cost of 4191 pound relative to laser monotherapy, yielding an incremental cost-effectiveness ratio (ICER) of 24 pound 028. Probabilistic sensitivity analysis showed a 64% probability of being cost-effective at a threshold of 30 pound 000 per QALY. Combined ranibizumab and laser therapy resulted in a 0.13 QALY gain at an incremental cost of 4695 pound relative to laser monotherapy (ICER 36 pound 106; 42% probability of ICER <30 pound 000). Conclusions Based on RESTORE 1-year follow-up data, ranibizumab monotherapy appears to be cost-effective relative to laser monotherapy, the current standard of care. Cost-effectiveness of combination therapy is less certain. Ongoing studies will further inform on disease progression and the need for additional ranibizumab treatment

Protocol for Surveying Bat Use of Lava Tube Caves during Winter in Craters of the Moon National Monument and Preserve, Standard Operating Procedures

Background The Upper Columbia Basin Network I&M (Inventory and Monitoring) program and Craters of the Moon National Monument and Preserve are collaborating to monitor winter bat use in Arco Tunnel, which is a safely accessed cave in the northern portion of the monument that consistently has been found with the largest number of bats (~30/year) among the set of caves recently inventoried. The standard operating procedures documented here and the methods described in the associated protocol narrative will also be used to periodically inventory other caves within the monument and surrounding preserve as park resources and safety (winter environmental and accessibility) conditions permit. This protocol addresses the survey objective to regularly count bats in Arco Tunnel during winter (January-March) and in other caves as environmental conditions and staff resources allow. Purpose This SOP describes the step-by-step procedures for preparing for field work and for preparing and organizing field equipment prior to the personnel training and entry into the field. Adequate preparation of equipment for the field and is crucial to a successful monitoring program

Effects of perceived fitness level of exercise partner on intensity of exertion

Problem statement: Social comparison theory was used to examine if exercising with a research confederate posing as either high fit or low fit would increase the exertion in exercising. Approach: 91 college students were randomly assigned to one of three conditions: Biking alone, biking with a high fit confederate, or biking with a low fit confederate. All participants were instructed to complete 20 min of exercise at 60-70% of their maximum target heart rate. Results: Results indicated that participants in the high fit condition exercised harder than those in the low fit condition. However, no mood differences emerged between conditions. Conclusion: Social comparison theory predicts exercise outcome such that participants gravitate towards the behavior (high fit or low fit) of those around them

Thinking like a Region in Northeast Ohio? Factors that Predict Local Government Participation in Collaborative Policy and Planning

Local governments in Northeast Ohio often collaborate with one another to provide services, pursue regional initiatives, and create regional plans. Collaborative arrangements can create efficiencies, save money, improve service quality, and boost regional vitality. But they also present costs and risks that leaders must weigh against potential benefits

Thinking like a Region in Northeast Ohio? Factors that Predict Local Government Participation in Collaborative Policy and Planning

Local governments in Northeast Ohio often collaborate with one another to provide services, pursue regional initiatives, and create regional plans. Collaborative arrangements can create efficiencies, save money, improve service quality, and boost regional vitality. But they also present costs and risks that leaders must weigh against potential benefits