Cost effectiveness analysis of larval therapy for leg ulcers

Objective: To assess the cost effectiveness of larval therapy compared with hydrogel in the management of leg ulcers. Design: Cost effectiveness and cost utility analyses carried out alongside a pragmatic multicentre, randomised, open trial with equal randomisation. Population: Intention to treat population comprising 267 patients with a venous or mixed venous and arterial ulcers with at least 25% coverage of slough or necrotic tissue. Interventions: Patients were randomly allocated to debridement with bagged larvae, loose larvae, or hydrogel. Main outcome measure: The time horizon was 12 months and costs were estimated from the UK National Health Service perspective. Cost effectiveness outcomes are expressed in terms of incremental costs per ulcer-free day (cost effectiveness analysis) and incremental costs per quality adjusted life years (cost utility analysis). Results: The larvae arms were pooled for the main analysis. Treatment with larval therapy cost, on average, 96.70 pound ((sic)109.61; $140.57) more per participant per year (95% confidence interval -491.9 pound to 685.8) pound than treatment with hydrogel. Participants treated with larval therapy healed, on average, 2.42 days before those in the hydrogel arm (95% confidence interval -0.95 to 31. 91 days) and had a slightly better health related quality of life, as the annual difference in QALYs was 0.011 (95% confidence interval -0.067 to 0.071). However, none of these differences was statistically significant. The incremental cost effectiveness ratio for the base case analysis was estimated at 8826 pound per QALY gained and 40 pound per ulcer-free day. Considerable uncertainty surrounds the outcome estimates. Conclusions: Debridement of sloughy or necrotic leg ulcers with larval therapy is likely to produce similar health benefits and have similar costs to treatment with hydrogel. Trial registration: Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692

On exact time-averages of a massive Poisson particle

In this work we study, under the Stratonovich definition, the problem of the damped oscillatory massive particle subject to a heterogeneous Poisson noise characterised by a rate of events, \lambda (t), and a magnitude, \Phi, following an exponential distribution. We tackle the problem by performing exact time-averages over the noise in a similar way to previous works analysing the problem of the Brownian particle. From this procedure we obtain the long-term equilibrium distributions of position and velocity as well as analytical asymptotic expressions for the injection and dissipation of energy terms. Considerations on the emergence of stochastic resonance in this type of system are also set forth.Comment: 21 pages, 5 figures. To be published in Journal of Statistical Mechanics: Theory and Experimen

Larval therapy for leg ulcers (VenUS II) : randomised controlled trial

Objective To compare the clinical effectiveness of larval therapy with a standard debridement technique (hydrogel) for sloughy or necrotic leg ulcers. Design Pragmatic, three armed randomised controlled trial. Setting Community nurse led services, hospital wards, and hospital outpatient leg ulcer clinics in urban and rural settings, United Kingdom. Participants 267 patients with at least one venous or mixed venous and arterial ulcer with at least 25% coverage of slough or necrotic tissue, and an ankle brachial pressure index of 0.6 or more. Interventions Loose larvae, bagged larvae, and hydrogel. Main outcome measures The primary outcome was time to healing of the largest eligible ulcer. Secondary outcomes were time to debridement, health related quality of life (SF-12), bacterial load, presence of meticillin resistant Staphylococcus aureus, adverse events, and ulcer related pain (visual analogue scale, from 0 mm for no pain to 150 mm for worst pain imaginable). Results Time to healing was not significantly different between the loose or bagged larvae group and the hydrogel group (hazard ratio for healing using larvae v hydrogel 1.13, 95% confidence interval 0.76 to 1.68; P=0.54). Larval therapy significantly reduced the time to debridement (2.31, 1.65 to 3.2; P<0.001). Health related quality of life and change in bacterial load over time were not significantly different between the groups. 6.7% of participants had MRSA at baseline. No difference was found between larval therapy and hydrogel in their ability to eradicate MRSA by the end of the debridement phase (75% (9/12) v 50% (3/6); P=0.34), although this comparison was underpowered. Mean ulcer related pain scores were higher in either larvae group compared with hydrogel (mean difference in pain score: loose larvae v hydrogel 46.74 (95% confidence interval 32.44 to 61.04), P<0.001; bagged larvae v hydrogel 38.58 (23.46 to 53.70), P<0.001). Conclusions Larval therapy did not improve the rate of healing of sloughy or necrotic leg ulcers or reduce bacterial load compared with hydrogel but did significantly reduce the time to debridement and increase ulcer pain. Trial registration Current Controlled Trials ISRCTN55114812 and National Research Register N0484123692

A polyphasic approach for black Aspergillus identification using MALDI-TOF MS

The Aspergillus section Nigri is among the best studied fungi, having different commercial applications, but also causing biodeterioration of commodities and food spoilage. Although being well studied, their identification is not straightforward, and, recently, new species have been described in this section. These new species were not only separated from their relatives in the section by morphological distinction but also from molecular point of view. Recently, Matrix-Assisted Laser Desorption/Ionisation Time-Of-Flight Mass Spectrometry (MALDI-TOF MS) has been used to generate spectrum of protein masses in a range of 2000 to 20000 Da that is a taxon specific fingerprinting. This approach could be employed as an alternative to the molecular techniques

A Pandemia da COVID-19 impactou o ENEM? Uma Análise Comparativa de Dados dos Anos de 2019 e 2020

O Ministério da Educação do Brasil avalia o desempenho escolar dos estudantes ao término da educação básica através do Exame Nacional do Ensino Médio (ENEM), o qual é tambémm usado para a entrada dos estudantes no ensino superior. Com a pandemia da COVID-19, muitas escolas tiveram que pausar as aulas ou manter o ensino de forma remota, o que afetou o processo de ensino e aprendizagem. Este artigo objetiva identificar se a pandemia impactou o ENEM, utilizando os microdados do ENEM de 2019, ano anterior ao início da pandemia, e do ENEM de 2020, primeiro ano da pandemia. O estudo realiza uma análise exploratória baseada em mineração de dados para comparar os dados dos dois anos. Os resultados apontam para uma melhoria nas notas médias gerais e aumento da disparidade de notas entre os candidatos de maior e menor renda

Modern polyphasic methods that include MALDI-TOF analyses for fungal identifications and authentications

[Excerpt] The identification of species is an important goal in taxonomic mycology. Information about each fungus (e.g. morphological description, physiological and biochemical properties, ecological roles, and societal risks or benefits) is the key element in this process. Identifications can be a long and seemingly never-ending process with frequent revisions of the taxonomic schemes. These changes make identifications even more complicated for the non specialised researchers as each taxonomic group has specialized literature, terminology and characters. This occurs to the extend that identifications can only be undertaken by a narrow group of scientists especially skilled in the "art", which can make the procedures appear to be subjective. [...

in silico verification and parallel reaction monitoring prevalidation of potential prostate cancer biomarkers

Purpose: Targeted proteomics of potential biomarkers is often challenging. Hence, we developed an intermediate workflow to streamline potential urinary biomarkers of prostate cancer (PCa). Materials & methods: Using previously discovered potential PCa biomarkers; we selected proteotypic peptides for targeted validation. Preliminary in silico immunohistochemical and single reaction monitoring (SRM) verification was performed. Successful PTPs were then prevalidated using parallel reaction monitoring (PRM) and reconfirmed in 15 publicly available databases. Results: Stringency-based targetable potential biomarkers were shortlisted following in silico screening. PRM reveals top 12 potential biomarkers including the top ranking seven in silico verification-based biomarkers. Database reconfirmation showed differential expression between PCa and benign/normal prostatic urine samples. Conclusion: The pragmatic penultimate screening step, described herein, would immensely improve targeted proteomics validation of ..

Contributions of micoteca da Universidade do Minho to food mycology

Micoteca da Universidade do Minho (MUM) is a collection of fungi established in 1996 where research into secondary metabolites in the form of mycotoxins is paramount. An objective is to maintain and provide authentic strains for research in biotechnology, life sciences and challenge testing. Knowledge, information and training in mycology are promulgated by the biological resource centre. MUM is involved in projects which address the health and quality risks from fungal contamination of grape products (e.g. wine), apples, cheese, chillies, nuts and corn: Fungi in drinking water are of particular concern. Aspergillus ochraceous, Aspergillus flavus, Penicillium expansum and Fusarium graminearum especially are relevant to our work: Associated mycotoxins are ochratoxin A, aflatoxins, patulin, citrinin and zearalenone. We study the earthy off-flavours in wine from Botrytis cinearum and P. expansum. The analytical techniques employed are PCR, HPLC, GC-MS and MALDITOF MS for strain characterization. MUM participates in several European and national projects. Post-graduate studies on mycotoxigenic fungi and food security particularly are important. A key objective is international collaboration. MUM strains are well characterized for toxigenicity, making the collection relevant to its mission and industry. This presentation will describe the progress made in this innovative Portuguese laboratory over 10 years