The CelluTome epidermal graft-harvesting system: a patient-reported outcome measure and cost evaluation study

Conventional split skin grafts (SSG) require anaesthesia, specialist equipment and can have high donor site (DS) morbidity. The CelluTome epidermal graft-harvesting device is a novel alternative, providing pain-free epidermal skin grafts (ESG) in the outpatient setting, with projected minimal DS trauma and improved patient satisfaction. This study aimed to compare ESG with SSG by evaluating patient-related outcome measures (PROMs) and the cost implications of both. Twenty patients answered a graft satisfaction questionnaire that evaluated: donor/graft site noticeability, aesthetic concerns, adverse problems and patient satisfaction. Cost/patient was calculated based on total operative expenses and five clinic follow-ups. In 100% of the ESG cases, there were no DS noticeability or adverse problems compared to 25% in the SSG group. Complete satisfaction with DS appearance was observed in 100% of the ESG cases (50% SSG). Noticeability, adverse problems and overall satisfaction were significantly better in ESG cases (P < 0.05). Graft site parameters were comparable with similar healing outcomes. The cost per patient for ESG was £431 and £1489 for SSG, with an annual saving of £126 960 based on 10 grafts/month. For the right patient, CelluTome provides comparable wound healing, with reduced DS morbidity and higher patient satisfaction

The Development of a New Questionnaire to Measure the Burden of Immunoglobulin Treatment in Patients with Primary Immunodeficiencies: The IgBoT-35.

Purpose: To describe the development and psychometric testing of a new questionnaire to measure the burden of immunoglobulin treatment (Ig) from the perspective of patients with primary immunodeficiencies (PID). Patients and Methods: An online, cross-sectional survey was administered to PID patients across 10 countries (nine European and Canada) who were receiving either intravenous (IVIg) or subcutaneous (SCIg) immunoglobulin therapy. The range and distribution of the responses (ie, levels of missing data, floor and ceiling effects), exploratory factor analysis (using factor loadings of 0.4 or greater) and measures of internal consistency reliability (ie, Cronbach's alpha coefficient, inter-item and item-total correlations) were used to identify the domain and item pool. Results: In total, 472 patients completed the questionnaire, of which 395 were included in the analysis (32% underwent IVIg and 67% underwent SCIg). The final instrument contained 34 items across eight domains of treatment burden (time, organisation and planning, leisure and social, interpersonal relationships, employment and education, travel, consequences of treatment and emotional) and an additional Ig treatment burden global question at the end of the measure. All the scales achieved good internal reliability (Cronbach's alpha coefficient ranged from 0.70 to 0.85) and, with the exception of one item exceeded the minimum threshold of 0.35 for item-total correlations. Treatment burden was lower than anticipated across the different treatment routes and countries, although overall was more burdensome for patients undergoing IVIg compared to SCIg treatment. Conclusion: The IgBoT-35 appears to be a reliable, patient-generated questionnaire and may help to identify more individualised and preferred therapies for the PID patient when used in clinical practice. A new survey with a sample of US patients is currently being undertaken to further establish its validity and conceptual model. The overall Ig burden of treatment scores appeared to be low. PID patient preferences are important to guide treatment decisions and ensuring patients receive the right treatment at the right time

A Neural Circuit Arbitrates between Persistence and Withdrawal in Hungry Drosophila

In pursuit of food, hungry animals mobilize significant energy resources and overcome exhaustion and fear. How need and motivation control the decision to continue or change behavior is not understood. Using a single fly treadmill, we show that hungry flies persistently track a food odor and increase their effort over repeated trials in the absence of reward suggesting that need dominates negative experience. We further show that odor tracking is regulated by two mushroom body output neurons (MBONs) connecting the MB to the lateral horn. These MBONs, together with dopaminergic neurons and Dop1R2 signaling, control behavioral persistence. Conversely, an octopaminergic neuron, VPM4, which directly innervates one of the MBONs, acts as a brake on odor tracking by connecting feeding and olfaction. Together, our data suggest a function for the MB in internal state-dependent expression of behavior that can be suppressed by external inputs conveying a competing behavioral drive

Cladoceran birth and death rates estimates

I. Birth and death rates of natural cladoceran populations cannot be measured directly. Estimates of these population parameters must be calculated using methods that make assumptions about the form of population growth. These methods generally assume that the population has a stable age distribution. 2. To assess the effect of variable age distributions, we tested six egg ratio methods for estimating birth and death rates with data from thirty-seven laboratory populations of Daphnia pulicaria. The populations were grown under constant conditions, but the initial age distributions and egg ratios of the populations varied. Actual death rates were virtually zero, so the difference between the estimated and actual death rates measured the error in both birth and death rate estimates. 3. The results demonstrate that unstable population structures may produce large errors in the birth and death rates estimated by any of these methods. Among the methods tested, Taylor and Slatkin's formula and Paloheimo's formula were most reliable for the experimental data. 4. Further analyses of three of the methods were made using computer simulations of growth of age-structured populations with initially unstable age distributions. These analyses show that the time interval between sampling strongly influences the reliability of birth and death rate estimates. At a sampling interval of 2.5 days (equal to the duration of the egg stage), Paloheimo's formula was most accurate. At longer intervals (7.5–10 days), Taylor and Slatkin's formula which includes information on population structure was most accurate

Numerical Investigation of a Coronal Mass Ejection from an Anemone Active Region: Reconnection and Deflection of the 2005 August 22 Eruption

We present a numerical investigation of the coronal evolution of a coronal mass ejection (CME) on 2005 August 22 using a 3-D thermodynamics magnetohydrodynamic model, the SWMF. The source region of the eruption was anemone active region (AR) 10798, which emerged inside a coronal hole. We validate our modeled corona by producing synthetic extreme ultraviolet (EUV) images, which we compare to EIT images. We initiate the CME with an out-of-equilibrium flux rope with an orientation and chirality chosen in agreement with observations of a H-alpha filament. During the eruption, one footpoint of the flux rope reconnects with streamer magnetic field lines and with open field lines from the adjacent coronal hole. It yields an eruption which has a mix of closed and open twisted field lines due to interchange reconnection and only one footpoint line-tied to the source region. Even with the large-scale reconnection, we find no evidence of strong rotation of the CME as it propagates. We study the CME deflection and find that the effect of the Lorentz force is a deflection of the CME by about 3 deg/Rsun towards the East during the first 30 minutes of the propagation. We also produce coronagraphic and EUV images of the CME, which we compare with real images, identifying a dimming region associated with the reconnection process. We discuss the implication of our results for the arrival at Earth of CMEs originating from the limb and for models to explain the presence of open field lines in magnetic clouds.Comment: 14 pages, 8 Figures, accepted to Astrophysical Journa

Systematic effects on dark energy from 3D weak shear

We present an investigation into the potential effect of systematics inherent in multi-band wide field surveys on the dark energy equation of state determination for two 3D weak lensing methods. The weak lensing methods are a geometric shear-ratio method and 3D cosmic shear. The analysis here uses an extension of the Fisher matrix framework to jointly include photometric redshift systematics, shear distortion systematics and intrinsic alignments. We present results for DUNE and Pan-STARRS surveys. We show that assuming systematic parameters are fixed, but possibly biased, results in potentially large biases in dark energy parameters. We quantify any potential bias by defining a Bias Figure of Merit. We also show the effect on the dark energy Figure of Merit of marginalising over each systematic parameter individually. We find that the largest effect on the Figure of Merit comes from uncertainty in the photometric redshift systematic parameters. These can reduce the Figure of Merit by up to a factor of 2 to 4 in both 3D weak lensing methods, if no informative prior on the systematic parameters is applied. Shear distortion systematics have a smaller overall effect. Intrinsic alignment effects can reduce the Figure of Merit by up to a further factor of 2. This, however, is a worst case scenario. By including prior information on systematic parameters the Figure of Merit can be recovered to a large extent. We conclude that, as a rule of thumb, given a realistic current understanding of intrinsic alignments and photometric redshifts, then including all three primary systematic effects reduces the Figure of Merit by at most a factor of 2, but that in reality this factor should be much less. [abridged]Comment: 20 pages, 11 figures, submitted to MNRA