Costs and effects of on-demand treatment of hereditary angioedema in Italy : a prospective cohort study of 167 patients

Objectives To explore treatment behaviours in a cohort of Italian patients with hereditary angioedema due to complement C1-inhibitor deficiency (C1-INH-HAE), and to estimate how effects and costs of treating attacks in routine practice differed across available on-demand treatments. Design Cost analyses and survival analyses using attack-level data collected prospectively for 1 year. Setting National reference centre for C1-INH-HAE. Participants 167 patients with proved diagnosis of C1-INH-HAE, who reported data on angioedema attacks, including severity, localisation and duration, treatment received, and use of other healthcare services. Interventions Attacks were treated with either icatibant, plasma-derived C1-INH (pdC1-INH) or just supportive care. Main outcome measures Treatment efficacy in reducing attack duration and the direct costs of acute attacks. Results Overall, 133 of 167 patients (79.6%) reported 1508 attacks during the study period, with mean incidence of 11 attacks per patient per year. Only 78.9% of attacks were treated in contrast to current guidelines. Both icatibant and pdC1-INH significantly reduced attack duration compared with no treatment (median times from onset 7, 10 and 47 hours, respectively), but remission rates with icatibant were 31% faster compared with pdC1-INH (HR 1.31, 95% CI 1.14 to 1.51). However, observed treatment behaviours suggest patterns of suboptimal dosing for pdC1-INH. The average cost per attack was \u20ac1183 (SD \u20ac789) resulting in \u20ac1.58 million healthcare costs during the observation period (\u20ac11 912 per patient per year). Icatibant was 54% more expensive than pdC1-INH, whereas age, sex and prophylactic treatment were not associated to higher or lower costs. Conclusions Both icatibant and pdC1-INH significantly reduced attack duration compared with no treatment, however, icatibant was more effective but also more expensive. Treatment behaviours and suboptimal dosing of pdC1-INH may account for the differences, but further research is needed to define their role

HeII emitters in the VIMOS VLT Deep Survey: PopIII star formation or peculiar stellar populations in galaxies at 2<z<4.6?

The aim of this work is to identify HeII emitters at 2<z<4.6 and to constrain the source of the hard ionizing continuum that powers the HeII emission. We have assembled a sample of 277 galaxies with a high quality spectroscopic redshift at 2<z<4.6 from the VVDS survey, and we have identified 39 HeII1640A emitters. We study their spectral properties, measuring the fluxes, equivalent widths (EW) and FWHM for most relevant lines. About 10% of galaxies at z~3 show HeII in emission, with rest frame equivalent widths EW0~1-7A, equally distributed between galaxies with Lya in emission or in absorption. We find 11 high-quality HeII emitters with unresolved HeII line (FWHM_0<1200km/s), 13 high-quality emitters with broad He II emission (FWHM_0>1200km/s), 3 AGN, and an additional 12 possible HeII emitters. The properties of the individual broad emitters are in agreement with expectations from a W-R model. On the contrary, the properties of the narrow emitters are not compatible with such model, neither with predictions of gravitational cooling radiation produced by gas accretion. Rather, we find that the EW of the narrow HeII line emitters are in agreement with expectations for a PopIII star formation, if the episode of star formation is continuous, and we calculate that a PopIII SFR of 0.1-10 Mo yr-1 only is enough to sustain the observed HeII flux. We conclude that narrow HeII emitters are either powered by the ionizing flux from a stellar population rare at z~0 but much more common at z~3, or by PopIII star formation. As proposed by Tornatore et al. (2007), incomplete ISM mixing may leave some small pockets of pristine gas at the periphery of galaxies from which PopIII may form, even down to z~2 or lower. If this interpretation is correct, we measure at z~3 a SFRD in PopIII stars of 10^6Mo yr^-1 Mpc^-3 qualitatively comparable to the value predicted by Tornatore et al. (2007).Comment: accepted for publication in A&

Studying the evolution of large-scale structure with the VIMOS-VLT Deep Survey

The VIMOS-VLT Deep Survey (VVDS) currently offers a unique combination of depth, angular size and number of measured galaxies among surveys of the distant Universe: ~ 11,000 spectra over 0.5 deg2 to I_{AB}=24 (VVDS-Deep), 35,000 spectra over ~ 7 deg2 to I_{AB}=22.5 (VVDS-Wide). The current ``First Epoch'' data from VVDS-Deep already allow investigations of galaxy clustering and its dependence on galaxy properties to be extended to redshifts ~1.2-1.5, in addition to measuring accurately evolution in the properties of galaxies up to z~4. This paper concentrates on the main results obtained so far on galaxy clustering. Overall, L* galaxies at z~ 1.5 show a correlation length r_0=3.6\pm 0.7. As a consequence, the linear galaxy bias at fixed luminosity rises over the same range from the value b~1 measured locally, to b=1.5 +/- 0.1. The interplay of galaxy and structure evolution in producing this observation is discussed in some detail. Galaxy clustering is found to depend on galaxy luminosity also at z~ 1, but luminous galaxies at this redshift show a significantly steeper small-scale correlation function than their z=0 counterparts. Finally, red galaxies remain more clustered than blue galaxies out to similar redshifts, with a nearly constant relative bias among the two classes, b_{rel}~1.4, despite the rather dramatic evolution of the color-density relation over the same redshift range.Comment: 14 pages. Extended, combined version of two invited review papers presented at: 1) XXVIth Astrophysics Moriond Meeting: "From Dark Halos to Light", March 2006, proc. edited by L.Tresse, S. Maurogordato and J. Tran Thanh Van (Editions Frontieres); 2) Vulcano Workshop 2006 "Frontier Objects in Astrophysics and Particle Physics", May 2006, proc. edited by F. Giovannelli & G. Mannocchi, Italian Physical Society (Editrice Compositori, Bologna

Patient engagement with antibiotic messaging in secondary care: a qualitative feasibility study of the ‘review & revise’ experience

Background: We aimed to investigate and optimise the acceptability and usefulness of a patient leaflet about antibiotic prescribing decisions made during hospitalisation, and to explore individual patient experiences and preferences regarding the process of antibiotic prescription ‘review & revise’ which is a key strategy to minimise antibiotic overuse in hospitals. Methods: In this qualitative study, run within the feasibility study of a large, cluster-randomised stepped wedge trial of 36 hospital organisations, a series of semi-structured, think-aloud telephone interviews were conducted and data were analysed using thematic analysis. Fifteen adult patients who had experienced a recent acute medical hospital admission during which they had been prescribed antimicrobials and offered a patient leaflet about antibiotic prescribing were recruited to the study. Results: Participants reacted positively to the leaflet, reporting that it was both an accessible and important source of information which struck the appropriate balance between informing and reassuring. Participants all valued open communication with clinicians, and were keen to be involved in antibiotic prescribing decisions, with individuals reporting positive experiences regarding antibiotic prescription changes or stopping. Many participants had prior experience or knowledge of antibiotics and resistance, and generally welcomed efforts to reduce antibiotic usage. Overall, there was a feeling that healthcare professionals (HCPs) are trusted experts providing the most appropriate treatment for individual patient conditions. Conclusions: This study offers novel insights into how patients within secondary care are likely to respond to messages advocating a reduction in the use of antibiotics through the ‘review & revise’ approach. Due to the level of trust that patients place in their care provider, encouraging HCPs within secondary care to engage patients with greater communication and information provision could provide great advantages in the drive to reduce antibiotic use. It may also be beneficial for HCPs to view patient experiences as cumulative events that have the potential to impact future behaviour around antibiotic use. Finally, pre-testing messages about antibiotic prescribing and resistance is vital to dispelling any misconceptions either around effectiveness of treatment for patients, or perceptions of how messages may be received

The VIRMOS deep imaging survey: III. ESO/WFI deep U-band imaging of the 0226-04 deep field

In this paper we describe the U-band imaging of the F02 deep field, one of the fields in the VIRMOS Deep Imaging Survey. The observations were done at the ESO/MPG 2.2m telescope at La Silla (Chile) using the 8k x 8k Wide-Field Imager (WFI). The field is centered at alpha(J2000)=02h 26m 00s and delta(J2000)=-04deg 30' 00", the total covered area is 0.9 deg**2 and the limiting magnitude (50% completeness) is U(AB) ~ 25.4 mag. Reduction steps, including astrometry, photometry and catalogue extraction, are first discussed. The achieved astrometric accuracy (RMS) is ~ 0.2" with reference to the I-band catalog and ~ 0.07" internally (estimated from overlapping sources in different exposures). The photometric accuracy including uncertainties from photometric calibration, is < 0.1 mag. Various tests are then performed as a quality assessment of the data. They include: (i) the color distribution of stars and galaxies in the field, done together with the BVRI data available from the VIMOS survey; (ii) the comparison with previous published results of U-band magnitude-number counts of galaxies.Comment: 10 pages, 13 figures, accepted for publication on Astronomy and Astrophysic

The VLA-VIRMOS Deep Field I. Radio observations probing the microJy source population

We have conducted a deep survey (r.m.s noise 17 microJy) with the Very Large Array (VLA) at 1.4 GHz, with a resolution of 6 arcsec, of a 1 square degree region included in the VIRMOS VLT Deep Survey. In the same field we already have multiband photometry down to I(AB)=25, and spectroscopic observations will be obtained during the VIRMOS VLT survey. The homogeneous sensitivity over the whole field has allowed to derive a complete sample of 1054 radio sources (5 sigma limit). We give a detailed description of the data reduction and of the analysis of the radio observations, with particular care to the effects of clean bias and bandwidth smearing, and of the methods used to obtain the catalogue of radio sources. To estimate the effect of the resolution bias on our observations we have modelled the effective angular-size distribution of the sources in our sample and we have used this distribution to simulate a sample of radio sources. Finally we present the radio count distribution down to 0.08 mJy derived from the catalogue. Our counts are in good agreement with the best fit derived from earlier surveys, and are about 50 % higher than the counts in the HDF. The radio count distribution clearly shows, with extremely good statistics, the change in the slope for the sub-mJy radio sources.Comment: 13 pages, Accepted for publication in Astronomy & Astrophysic

The VIMOS VLT Deep Survey - Evolution of the luminosity functions by galaxy type up to z=1.5 from first epoch data

From the first epoch observations of the VVDS up to z=1.5 we have derived luminosity functions (LF) of different spectral type galaxies. The VVDS data, covering ~70% of the life of the Universe, allow for the first time to study from the same sample and with good statistical accuracy the evolution of the LFs by galaxy type in several rest frame bands from a purely magnitude selected sample. The magnitude limit of the VVDS allows the determination of the faint end slope of the LF with unprecedented accuracy. Galaxies have been classified in four spectral classes, using their colours and redshift, and LFs have been derived in the U, B, V, R and I rest frame bands from z=0.05 to z=1.5. We find a significant steepening of the LF going from early to late types. The M* parameter is significantly fainter for late type galaxies and this difference increases in the redder bands. Within each of the galaxy spectral types we find a brightening of M* with increasing redshift, ranging from =< 0.5 mag for early type galaxies to ~1 mag for the latest type galaxies, while the slope of the LF of each spectral type is consistent with being constant with redshift. The LF of early type galaxies is consistent with passive evolution up to z~1.1, while the number of bright early type galaxies has decreased by ~40% from z~0.3 to z~1.1. We also find a strong evolution in the normalization of the LF of latest type galaxies, with an increase of more than a factor 2 from z~0.3 to z~1.3: the density of bright late type galaxies in the same redshift range increases of a factor ~6.6. These results indicate a strong type-dependent evolution and identifies the latest spectral types as responsible for most of the evolution of the UV-optical luminosity function out to z=1.5.Comment: 18 pages with encapsulated figures, revised version after referee's comments, accepted for publication in A&

The VIMOS VLT Deep Survey - First epoch VVDS-Deep survey: 11564 spectra with 17.5<=IAB<=24, and the redshift distribution over 0< z <=5

This paper presents the ``First Epoch'' sample from the VIMOS VLT Deep Survey (VVDS). The VVDS goals, observations, data reduction with VIPGI, and redshift measurement with KBRED are discussed. Data have been obtained with the VIsible Multi Object Spectrograph (VIMOS) on the ESO-VLT UT3, allowing to observe ~600 slits simultaneously at R~230. A total of 11564 objects have been observed in the VVDS-02h and VVDS-CDFS Deep fields over a total area of 0.61deg^2, selected solely on the basis of apparent magnitude 17.5 <=I_{AB} <=24. The VVDS covers the redshift range 0 < z <= 5. It is successfully going through the ``redshift desert'' 1.5<z<2.2, while the range 2.2<z<2.7 remains of difficult access because of the VVDS wavelength coverage.A total of 9677 galaxies have a redshift measurement, 836 are stars, 90 are AGNs, and a redshift could not be measured for 961 objects. There are 1065 galaxies with a measured redshift z>1.4. The survey reaches a redshift measurement completeness of 78% overall (93% including less reliable objects), with a spatial sampling of the population of galaxies of 25% and ~30% in the VVDS-02h and VVDS-CDFS. The redshift accuracy measured from repeated observations with VIMOS and comparison to other surveys is ~276km/s. From this sample we present for the first time the redshift distribution of a magnitude limited spectroscopic sample down to IAB=24. The redshift distribution has a median of z=0.62, z=0.65, z=0.70, and z=0.76, for magnitude limited samples with IAB<=22.5, 23, 23.5, and 24. A high redshift tail above redshift 2 and up to redshift 5 becomes readily apparent for IAB>23.5, probing the bright star forming population of galaxies. This sample provides an unprecedented dataset to study galaxy evolution over 90% of the life of the universeComment: 30 pages, accepted 22-Feb-05 in A&

The VIMOS-VLT Deep Survey - The evolution of galaxy clustering per spectral type to z~1.5

We measure the evolution of clustering for galaxies with different spectral types from 6495 galaxies with 17.5<=I_AB<=24 and measured spectroscopic redshift in the first epoch VIMOS-VLT Deep Survey. We classify our sample into 4 classes, based on the fit of well-defined galaxy spectral energy distributions on observed multi-color data. We measure the projected function wp(rp) and estimate the best-fit parameters for a power-law real-space correlation function. We find the clustering of early-spectral-type galaxies to be markedly stronger than that of late-type galaxies at all redshifts up to z<=1.2. At z~0.8, early-type galaxies display a correlation length r_0=4.8+/-0.9h^{-1}Mpc, while late types have r_0=2.5+/-0.4h^{-1}Mpc. The clustering of these objects increases up to r_0=3.42+/-0.7h^{-1}Mpc for z~1.4. The relative bias between early- and late-type galaxies within our magnitude-limited survey remains approximately constant with b~1.7-1.8 from z~=0.2 up to z~=1, with indications for a decrease at z>1.2, due to the growth in clustering of the star-forming population. We find similar results when splitting the sample into `red' and `blue' galaxies using the observed color bi-modality. When compared to the expected linear growth of mass fluctuations, a natural interpretation of these observations is that: (a) the assembly of massive early type galaxies is already mostly complete in the densest dark matter halos at z~=1; (b) luminous late-type galaxies are located in higher-density, more clustered regions of the Universe at z~=1.5 than at present, indicating that star formation activity is progressively increasing, going back in time, in the higher-density peaks that today are mostly dominated by old galaxies.Comment: 12 pages, Accepted on 11-Feb-06 for publication in Astronomy and Astrophysic