136 research outputs found
Cost-effectiveness of human leukocyte antigen matching in penetrating keratoplasty
Background: The matching of favorable human leukocyte antigen (HLA) combinations is rarely performed in penetrating keratoplasty procedures for primary prophylaxis of immune reactions. However, clinical studies suggest that the incidence of graft rejection decreases substantially when patients receive favorably matched grafts.
Objective: The aim of this study was to assess the cost-effectiveness of HLA matching for patients undergoing penetrating keratoplasty in everyday clinical practice.
Methods: In the absence of a randomized controlled clinical trial, we used administrative data from the Freiburg University Eye Hospital in Germany. Our study population consisted of all patients who underwent their first keratoplasty between 11/2003 and 01/2010 and for whom information on HLA histocompatibility was available. We used propensity score matching to estimate a causal effect of favorable HLA matching, parametric survival regression techniques to predict graft survival and expert opinion to model incremental cost for HLA matching. Because the availability of favorable HLA histocompatibility ultimately depends on the patients’ HLA phenotype, we modeled the incremental cost-effectiveness ratio (ICER) as a function of the probability that a patient will receive a favorably matched HLA, and used expert opinion to set a point estimate.
Results: We predicted that corneal grafts with favorable HLA matching were associated with improved rejection-free graft survival time (more than 1,000 days). We estimated the incremental cost of HLA matching at EUR 1,200 and the ICER at EUR 4.62 per additional day of graft survival.
Conclusions: The ICER of HLA matching is acceptable, given the high cost of alternative treatment and the shortage of corneal donors in Germany
Attitudes Concerning Postmortem Organ Donation : A Multicenter Survey in Various German Cohorts
BACKGROUND
The aim of this study was to characterize postmortem organ donation attitudes in various German cohorts.
MATERIAL AND METHODS
Employees of 2 German cities and 2 German university hospitals, employees of a German automobile enterprise, and members of a German Medical Society were administered a questionnaire about postmortem organ and tissue donation attitudes. Demographic data and general attitudes were questioned and focused on: I) willingness to donate organs, II) holding a donor card, and III) having discussed the topic with the family.
RESULTS
Of 5291 participants, 65.2% reported favoring postmortem organ donation. Missing negative experiences, the idea that donation is helpful, a non-medical professional environment, excellent general health, gender, agreement with the brain-death paradigm, and age significantly influenced the participants’ attitudes. Participants were more likely to possess donor cards and had discussed more often with family members if they agreed with the brain-death paradigm and considered donation to be helpful. Males and older participants were the most likely to neglect donor cards, and Catholics, Protestants, and participants with poor health were the least likely to donate organs. Interest in receiving more information was expressed by 38.1% and 50.6% of participants refusing donation of all or of specific organs, respectively, and suggested the internet (60.0%) and family doctors (35.0%) as preferred sources of information.
CONCLUSIONS
Public campaigns in Germany should focus on males and older people as regards donor cards, and females, younger, and religiously affiliated persons as regards the general willingness to donate organs postmortem
The HYLAN M Study: Efficacy of 0.15% High Molecular Weight Hyaluronan Fluid in the Treatment of Severe Dry Eye Disease in a Multicenter Randomized Trial
The aim of the HYLAN M study was to investigate if symptoms and/or signs of patients
suffering from severe dry eye disease (DED) can be improved by substituting individually optimized
artificial tear therapy by high molecular weight hyaluronan (HMWHA) eye drops. In this international,
multicenter study, patients with symptoms of at least ocular surface disease index (OSDI) 33 and
corneal fluorescein staining (CFS) of at least Oxford grade 3 were included. A total of 84 per-protocol
patients were randomized in two study arms. The control group continued to use their individual
optimum artificial tears over the study period of eight weeks; in the verum group, the artificial tears
were substituted by eye drops containing 0.15% HMWHA. At the week 8 visit, the average OSDI
of the verum group had improved by 13.5 as compared to the control group (p = 0.001). The best
corrected visual acuity (BCVA) had improved by 0.04 logMAR (p = 0.033). CFS, tear film break-up
time (TBUT), Schirmer I, lid wiper epitheliopathy (LWE), mucocutaneous junction (Yamaguchi score),
and tear osmolarity were not significantly different between the verum and control groups (p > 0.050). We conclude that for most patients with severe DED, 0.15% HMWHA eye drops provide excellent
improvement of symptoms without impairment of dry eye signs
The Observed Growth of Massive Galaxy Clusters III: Testing General Relativity on Cosmological Scales
This is the third of a series of papers in which we derive simultaneous
constraints on cosmological parameters and X-ray scaling relations using
observations of the growth of massive, X-ray flux-selected galaxy clusters. Our
data set consists of 238 clusters drawn from the ROSAT All-Sky Survey, and
incorporates extensive follow-up observations using the Chandra X-ray
Observatory. Here we present improved constraints on departures from General
Relativity (GR) on cosmological scales, using the growth index, gamma, to
parameterize the linear growth rate of cosmic structure. Using the method of
Mantz et al. (2009a), we simultaneously and self-consistently model the growth
of X-ray luminous clusters and their observable-mass scaling relations,
accounting for survey biases, parameter degeneracies and systematic
uncertainties. We combine the cluster growth data with gas mass fraction, SNIa,
BAO and CMB data. This combination leads to a tight correlation between gamma
and sigma_8. Consistency with GR requires gamma~0.55. Under the assumption of
self-similar evolution and constant scatter in the scaling relations, and for a
flat LCDM model, we measure gamma(sigma_8/0.8)^6.8=0.55+0.13-0.10, with
0.79<sigma_8<0.89. Relaxing the assumptions on the scaling relations by
introducing two additional parameters to model possible evolution in the
normalization and scatter of the luminosity-mass relation, we obtain consistent
constraints on gamma that are only ~20% weaker than those above. Allowing the
dark energy equation of state, w, to take any constant value, we simultaneously
constrain the growth and expansion histories, and find no evidence for
departures from either GR or LCDM. Our results represent the most robust
consistency test of GR on cosmological scales to date. (Abridged)Comment: Accepted for publication in MNRAS. 11 pages, 5 figures, 1 table. New
figure added: Fig. 4 shows the tight constraints on gamma from the cluster
growth data alone compared with those from the other data sets combined
Multimodality in galaxy clusters from SDSS DR8: substructure and velocity distribution
We search for the presence of substructure, a non-Gaussian, asymmetrical
velocity distribution of galaxies, and large peculiar velocities of the main
galaxies in galaxy clusters with at least 50 member galaxies, drawn from the
SDSS DR8. We employ a number of 3D, 2D, and 1D tests to analyse the
distribution of galaxies in clusters: 3D normal mixture modelling, the
Dressler-Shectman test, the Anderson-Darling and Shapiro-Wilk tests and others.
We find the peculiar velocities of the main galaxies, and use principal
component analysis to characterise our results. More than 80% of the clusters
in our sample have substructure according to 3D normal mixture modelling, the
Dressler-Shectman (DS) test shows substructure in about 70% of the clusters.
The median value of the peculiar velocities of the main galaxies in clusters is
206 km/s (41% of the rms velocity). The velocities of galaxies in more than 20%
of the clusters show significant non-Gaussianity. While multidimensional normal
mixture modelling is more sensitive than the DS test in resolving substructure
in the sky distribution of cluster galaxies, the DS test determines better
substructure expressed as tails in the velocity distribution of galaxies.
Richer, larger, and more luminous clusters have larger amount of substructure
and larger (compared to the rms velocity) peculiar velocities of the main
galaxies. Principal component analysis of both the substructure indicators and
the physical parameters of clusters shows that galaxy clusters are complicated
objects, the properties of which cannot be explained with a small number of
parameters or delimited by one single test. The presence of substructure, the
non-Gaussian velocity distributions, as well as the large peculiar velocities
of the main galaxies, shows that most of the clusters in our sample are
dynamically young.Comment: 15 pages, 11 figures, 2 online tables, accepted for publication in
Astronomy and Astrophysic
Functional antigen matching in corneal transplantation: matching for the HLA-A, -B and -DRB1 antigens (FANCY) – study protocol
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