Preliminary cruise report ATLANTIS II - cruise 8 : International Indian Ocean Expedition, July 5, 1963 - December 20, 1963

Originally issued as Reference No. 64-11, series later renamed WHOI-.ATLANTIS II was delivered to the Woods Hole Oceanographic Institution on January 31, 1963. After some short cruises she left Woods Hole on July 5 to participate in the International Indian Ocean Expedition, her first major effort of long duration since her delivery. Eight was a strict test of the capabilities , endurance, Cruise facilities and comfort for which she was designed. The investigations in the Indian Ocean were per haps unique among other cruises of the Exped~t ion in that full coverage of the Arabian Sea was obtained during the Southwest Monsoon in August and September. Further coverage to the south was obtained in October and November where southeast winds were predominant. Inclusion of the Red Sea as part of the Expedition, the total number of hydrographic stations completed during this portion of the cruise was 193, consisting of observations more or less at standard depths to the bottom. These observations, together with various meteorological measurements and chemical analyses are being processed and evaluated, Geophysical observations such as bathymetry and magnetometer results are also being processed along with the navigational positions from the VLF Navigation System.Sponsored by Grant NSF-GP 821 from the National Science Foundatio

Bird log data : Atlantis Two - cruise 8, International Indian Ocean Expedition

Originally issued as Reference No. 64-31, series later renamed WHOI-.Following the "Preliminary Guide to the Birds of the Indian Ocean" (Watson, Zusi & Stover, Smithsonian Institution, 1963} our Indian Ocean Bird Log begins at a position (20°N, 37°30'E) in the Red Sea off Port Sudan which we reached on the afternoon of l August, 1963. Thus the southern portion of the Red Sea and the Gulf of Aden are included in the area covered by our Indian Ocean records. The northern boundary line is the southern coast of Arabia, 20°N line to India and the west coast of India from Bombay to Ceylon. The furthest point East that we reached is Colombo (7°N 80°E) and the eastern boundary line runs from there through the Chagos Is. (6°S 71°E) to Mauritius (20°S 57°30'E) and the southern tip of Madagascar. The western boundary is the coast of Africa as far south as cape Delgardo (10°30'S 40°30'E) thence via the Comoros to Madagascar. We quit the region east of Lourenco Marques (26°S 37°E) around noon on the 11 November, 1963. About one third of the area of. the Indian Ocean falls within these bounds.Sponsored by Grant NSF-GP 821 from the National Science Foundatio

Pollutant and Shell Thickness Determinations of Peregrine Eggs from West Greenland

A preliminary survey of breeding peregrine falcons (Falco peregrinus) in West Greenland in 1972 indicated both a high nesting density (one pair per 100 square miles) and a high production rate (2.25 young per pair or 2.57 per pair with young). ... Peregrines in the eastern United States and southern Canada experienced an increasing incidence of reproductive failures throughout the 1950s and early 1960s, culminating in the disappearance of the breeding populations by 1964. Studies were therefore carried out in the Northwest Territories and Alaska in 1966 to determine the status of the northern birds. No apparent abnormalities were found, and the reproduction was considered to be normal. ... Thin eggshells have been a characteristic of all the declining populations. The degree of thinning is closely associated with levels of the DDT compound p,p'-DDE in the eggs .... We have therefore examined the eggshells and shell fragments obtained in Greenland in 1972 for evidence of shell thinning and have measured the chlorinated hydrocarbons in two unhatched eggs. During the 1972 Greenland peregrine survey, 1 unhatched egg was collected from each of 2 eyries. In addition, shell fragments of 7 hatched eggs from 4 different females were collected. The mean thickness of these 9 eggs from 6 females was 0.298 mm ±0.018 (95 per cent C.L.: range 0.26-0.33), 14 per cent lower than the mean thickness of 42 peregrine eggs from Greenland that were collected before 1940 (thickness = 0.347 mm ±0.018 ...). Shell thinning of unhatched and broken eggs obtained from Ungava in 1967 and 1970 was somewhat more severe; the mean thickness was 21 per cent less than that of 59 peregrine egg-shells collected in the eastern Arctic between 1900 and 1940. ... DDE concentrations, expressed on either a wet weight or a lipid weight basis are within the range of those measured in peregrine eggs from Alaska and northern Canada. Polychlorinated biphenyls (PCB) have not previously been determined in peregrine eggs from the Arctic. Levels in the Greenland eggs were comparable to those of DDE .... The composition of the PCB mixture was similar to that of commercial mixtures containing 60 per cent chlorine by weight, Profiles of PCB residues in these eggs are strikingly like those of fat biopsies from peregrines in Chile, a further example of the global nature of the contamination to which this species is exposed. Body burdens of organochlorine compounds in the West Greenland peregrines are not therefore sufficiently high to affect reproductive success; the pollution ecology of this population might be considered comparable to that of other arctic-breeding peregrines in the mid-sixties. These also had comparatively high organochlorine levels with no apparent effect on reproduction, but many eggs approached a critical level of shell thinning. Because of the close relationships found in other populations between DDE concentrations and the degree of shell thinning and associated reproductive failures, we conclude that a comparatively small increase in the DDE levels to which these birds are exposed would endanger the population

Cost-effectiveness analysis of umeclidinium bromide/vilanterol 62.5/25 mcg versus tiotropium/olodaterol 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease: A Spanish National Healthcare System perspective

Background: A head-to-head study demonstrated the superiority of once-daily umeclidinium bromide/vilanterol (UMEC/VI) 62.5/25 mcg on trough forced expiratory volume in 1 s (FEV1) versus once-daily tiotropium/olodaterol (TIO/OLO) 5/5 mcg in symptomatic patients with chronic obstructive pulmonary disease (COPD). This analysis evaluated the cost effectiveness of UMEC/VI versus TIO/OLO from a Spanish National Healthcare System perspective, using data from this study and Spanish literature. Methods: This analysis was conducted from the perspective of the Spanish National Healthcare System with a 3-year horizon as base case. A disease progression model using a linked risk equation approach was used to estimate disease progression and associated healthcare costs, and quality-adjusted life years (QALYs). The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) study was used to develop the statistical risk equations for clinical endpoints, and costs were calculated using a health state approach (by dyspnea severity). Utilities for QALY calculation were estimated using patient baseline characteristics within a regression fit to Spanish observational data. Treatment effect, expressed as change from baseline in FEV1 was obtained from the head-to-head study and used in the model (UMEC/VI minus TIO/OLO difference: + 52 mL [95% confidence interval: 28, 77]). Baseline patient characteristics were sourced from Spanish literature or the head-to-head study if unavailable. A scenario analysis using only the intent-to-treat (ITT) population from the head-to-head study, and sensitivity analyses (including probabilistic sensitivity analyses), were conducted. Direct healthcare costs (2017 Euro) were obtained from Spanish sources and costs and benefits were discounted at 3% per annum. Results: UMEC/VI was associated with small improvements in QALYs (+ 0.029) over a 3-year time horizon, compared with TIO/OLO, alongside cost savings of €393/patient. The ITT scenario analysis and sensitivity analyses had similar results. All probabilistic simulations resulted in UMEC/VI being less costly and more effective than TIO/OLO. Conclusion: UMEC/VI dominated TIO/OLO (more effective and less expensive). These results may aid payers and decision-makers in Spain when making judgements on which long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) treatments can be considered cost effective in Spain.This study was funded by GSK (study number HO-17-17500). The funders of the study had a role in study design, data analysis, data interpretation, and writing of the report. Data analysis was conducted by ICON Health Economics and funded by GSK. No funding was provided to employees of ICON Health Economics for manuscript developmen

Cost-effectiveness of umeclidinium compared with tiotropium and glycopyrronium as monotherapy for chronic obstructive pulmonary disease: a UK perspective.

BACKGROUND: Cost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective. METHODS: A linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively. Treatment effects [mean (standard error)] at 12 weeks on forced expiratory volume in 1 s and St George's Respiratory Questionnaire score were obtained from the intention-to-treat populations of two head-to-head studies [GSK study identifiers 201316 (NCT02207829) and 201315 (NCT02236611)] which compared UMEC 62.5 mcg with TIO 18 mcg and UMEC 62.5 mcg with GLY 50 mcg, respectively. Treatment costs reflect UK list prices (2016) and NHS unit costs; UMEC and GLY prices being equal and less than TIO. A lifetime horizon, discounted costs and effects at 3.5% were used. Sensitivity analyses were performed to evaluate the robustness of variations in input parameters and assumptions in the model. RESULTS: Over a lifetime horizon, UMEC was predicted to increase LYs (+ 0.195; 95% confidence interval [CI]: 0.069, 0.356) and QALYs (+ 0.118; 95% CI: 0.055, 0.191) and reduce the number of annual exacerbations (- 0.053; 95% CI: - 0.171, 0.028) compared with TIO, with incremental cost savings of £460/patient (95% CI: - £645, - £240). Compared with GLY, UMEC increased LYs (+ 0.124; 95% CI: 0.015, 0.281) and QALYs (+ 0.101; 95% CI: 0.043, 0.179) and reduced annual exacerbation (- 0.033; 95% CI: - 0.135, 0.017) at an additional cost of £132/patient (95% CI: £12, £330), resulting in an incremental cost-effectiveness ratio of £1310/QALY (95% CI: £284, £2060). Similar results were observed in alternative time horizons and additional sensitivity analyses. CONCLUSIONS: For treatment of patients with COPD in the UK over a lifetime horizon, treatment with UMEC dominates treatment with TIO, providing both improved health outcomes and cost savings. In comparison with GLY, treatment with UMEC achieved improved health outcomes but was associated with a higher cost.Trial registration 201316, NCT02207829; 201315, NCT02236611

Cost-effectiveness analysis of a single-inhaler triple therapy for patients with advanced chronic obstructive pulmonary disease (COPD) using the FULFIL trial: A UK perspective

Objectives: The clinical benefit of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) versus twice-daily budesonide/formoterol (BUD/FOR) for patients with symptomatic chronic obstructive pulmonary disease (COPD) was demonstrated in a clinical trial setting (FULFIL [NCT02345161]). The lifetime cost-effectiveness analysis of FF/UMEC/VI versus BUD/FOR, based on FULFIL data, is reported here. Methods: A previously developed and validated GALAXY-COPD linked-risk equation model was used to assess the cost-effectiveness of FF/UMEC/VI from the UK National Health Service (NHS) perspective. Baseline characteristics and efficacy results from FULFIL and UK NHS reference cost data (2017) were included as inputs. Exacerbation rates (undiscounted), costs, life years (LYs; undiscounted) and quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were calculated over a lifetime horizon. Costs and QALYs were discounted at 3.5% per year, beyond one year, in accordance with National Institute for Health and Care Excellence (NICE) guidelines. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of the results. Results: Predicted cumulative exacerbations per patient over a lifetime were 8.393 with FF/UMEC/VI and 10.456 with BUD/FOR. Patients receiving FF/UMEC/VI gained an additional 0.764 LYs and 0.492 QALYs, at an additional mean cost of £1,652, resulting in an ICER of £3,357 per QALY gained (95% confidence interval: £1,816, £5,194) compared with BUD/FOR. The ICER remained below £6,000 in all but one of the scenario and sensitivity analyses. Conclusions: Compared with BUD/FOR, treatment with FF/UMEC/VI was predicted to improve health outcomes at an additional cost that suggests it would be cost-effective for patients with COPD in the UK

Long-term cost and utility consequences of short-term clinically important deterioration in patients with chronic obstructive pulmonary disease: results from the TORCH study.

Purpose: Clinically important deterioration (CID) in chronic obstructive pulmonary disease (COPD) is a novel composite endpoint that assesses disease stability. The association between short-term CID and future economic and quality of life (QoL) outcomes has not been previously assessed. This analysis considers 3-year data from the TOwards a Revolution in COPD Health (TORCH) study, to examine this question. Patients and methods: This post hoc analysis of TORCH (NCT00268216) compared costs and utilities at 3 years among patients without CID (CID-) and with CID (CID+) at 24 weeks. A positive CID status was defined as either: a deterioration in forced expiratory volume in 1 second (FEV1) of ≥100 mL from baseline; or a ≥4-unit increase from baseline in St George's Respiratory Questionnaire (SGRQ) total score; or the incidence of a moderate/severe exacerbation. Patients from all treatment arms were included. Utility change was based on the EQ-5D utility index. Costs were based on healthcare resource utilization from 24 weeks to end of follow-up combined with unit costs for the UK (2016 GBP), and reported as per patient per year (PPPY). Adjusted estimates were generated controlling for baseline characteristics, treatment assignment, and number of CID criteria met. Results: Overall, 3,769 patients completed the study and were included in the analysis (stable CID- patients, n=1,832; unstable CID+ patients, n=1,937). At the end of follow-up, CID- patients had higher mean (95% confidence interval [CI]) utility scores than CID+ patients (0.752 [0.738, 0.765] vs 0.697 [0.685, 0.71]; difference +0.054; P<0.001), and lower costs PPPY (£538 vs £916; difference: £378 [95% CI: £244, £521]; P<0.001). The cost differential was primarily driven by the difference in general hospital ward days (P=0.003). Conclusion: This study demonstrated that achieving early stability in COPD by preventing short-term CID is associated with better preservation of future QoL alongside reduced healthcare service costs

Making economic evaluations more helpful for treatment choices in haemophilia

Aim: Poorly conducted economic evaluations have the potential to mislead both clinicians, leading to inappropriate treatment choices, and payers who must decide on the reimbursement of treatment costs. This paper reviews the methods used in economic evaluations in haemophilia and proposes standards for conducting and reporting such evaluations in the future. Methods: A systematic review of economic evaluations in haemophilia published since 2008 was conducted. The reporting and methods of the studies were assessed using the recently published Consolidated Health Economic Evaluation Reporting Guidelines (CHEERS) checklist. The key methodological deficiencies in the studies were recorded. Results: Twenty-one studies met the inclusion criteria, classified as follows: prophylaxis vs. treatment on-demand (five studies); use of bypassing therapy (six); immune tolerance induction (four); and other topics (six). In general, the quality of reporting was good. However, it was poorest for the CHEERS item of patient heterogeneity, with most studies lacking discussion of heterogeneity in the patient population. The main recurring methodological deficiencies were the evaluation of single episodes of care rather than entire treatment strategies; inadequate control for confounders when comparing treatment options; the frequent use of expert opinion to determine drug doses and treatment patterns; lack of consideration of patient heterogeneity; failure to identify patient subgroups; and the inadequate exploration of uncertainty in estimates. Conclusions: A set of twelve standards for future reporting and conduct of economic evaluations within haemophilia is proposed, with the objective of making such evaluations more relevant and reliable for those making treatment and reimbursement decisions in the future