The Debrisoft ® monofilament debridement pad for use in acute or chronic wounds: A NICE medical technology guidance

As part of its Medical Technology Evaluation Programme, the National Institute for Health and Care Excellence (NICE) invited a manufacturer to provide clinical and economic evidence for the evaluation of the Debrisoft ® monofilament debridement pad for use in acute or chronic wounds. The University of Birmingham and Brunel University, acting as a consortium, was commissioned to act as an External Assessment Centre (EAC) for NICE, independently appraising the submission. This article is an overview of the original evidence submitted, the EAC’s findings and the final NICE guidance issued. The sponsor submitted a simple cost analysis to estimate the costs of using Debrisoft® to debride wounds compared with saline and gauze, hydrogel and larvae. Separate analyses were conducted for applications in home and applications in a clinic setting. The analysis took an UK National Health Service (NHS) perspective. It incorporated the costs of the technologies and supplementary technologies (such as dressings) and the costs of their application by a district nurse. The sponsor concluded that Debrisoft® was cost saving relative to the comparators. The EAC made amendments to the sponsor analysis to correct for errors and to reflect alternative assumptions. Debrisoft® remained cost saving in most analyses and savings ranged from £77 to £222 per patient compared with hydrogel, from £97 to £347 compared with saline and gauze, and from £180 to £484 compared with larvae depending on the assumptions included in the analysis and whether debridement took place in a home or clinic setting. All analyses were severely limited by the available data on effectiveness, in particular a lack of comparative studies and that the effectiveness data for the comparators came from studies reporting different clinical endpoints compared with Debrisoft®. The Medical Technologies Advisory Committee made a positive recommendation for adoption of Debrisoft® and this has been published as a NICE medical technology guidance (MTG17).The Birmingham and Brunel Consortium is funded by NICE to act as an External Assessment Centre for the Medical Technologies Evaluation Programme

Rearrangement and Expression of Immunoglobulin Light Chain Genes Can Precede Heavy Chain Expression during Normal B Cell Development in Mice

In mouse mutants incapable of expressing μ chains, VκJκ joints are detected in the CD43+ B cell progenitors. In agreement with these earlier results, we show by a molecular single cell analysis that 4–7% of CD43+ B cell progenitors in wild-type mice rearrange immunoglobulin (Ig)κ genes before the assembly of a productive VHDHJH joint. Thus, μ chain expression is not a prerequisite to Igκ light chain gene rearrangements in normal development. Overall, ∼15% of the total CD43+ B cell progenitor population carry Igκ gene rearrangements in wild-type mice. Together with the results obtained in the mouse mutants, these data fit a model in which CD43+ progenitors rearrange IgH and Igκ loci independently, with a seven times higher frequency in the former. In addition, we show that in B cell progenitors VκJκ joining rapidly initiates κ chain expression, irrespective of the presence of a μ chain

Theories on the beginnings and structure of joint-families ("zadruga")

In this paper the author has a critical standpoint toward the most known theories on joint family communities. The works of the up-to-now called Yugoslav authors were put in the foreground. The works of foreign authors were placed after. They were classified by a general criterion, by how the authors saw the origins of this form of family. The comprehension of the basic characteristics depends, as a rule, on that, as well as the elements structure, changing processes, adjustment to new conditions and extinction of the joint family community. The first part of this article is devoted to theories about family communities as an institution of the Slavs. In this way its origin is connected with elements of a certain ethnic community. The range and consequences of such beliefs are suggested. The second part is reserved to explaining the family community as an institution which appeared in feudalism. It is a consequence of the tax system role. With its termination, the communities fell apart. This kind of social development determination and this type of family is proven to be ahistorical. It is predominantly stressed that the authors neglected that feudalism was a class society and overemphasized the force factor significance. The third part deals with theories which believe joint-family communities as an institution which arose in the transition from tribal to class society. These researchers stress that it is a general, historically determined conditioned form, which originated before class society and terminated with its development. Elements of its structure are especially important, as well as methods of its transformation in new conditions and termination processes. The essence of this belief is the following: a joint-family is a general historical form of family organization which arose in the transition from tribal to class society. The most important characteristics are: 1) blood relationship among men members; 2) common property; 3) undeveloped division of labor, and plain peoples work is the most important for its survival; 4) democratic control; and 5) it is not just mere gathering of simple families it is based on kinship, origin and precedes monogrammed families