Background
: Information is lacking on the relative effectiveness and cost effectiveness — in a primary-care setting — of leukotriene receptor antagonists (LTRAs) as an alternative to inhaled ...corticosteroids (ICS) for initial asthma controller therapy.
Objective
: To compare the cost effectiveness of LTRAs versus ICS for patients initiating asthma controller therapy.
Methods
: An economic evaluation was conducted alongside a 2-year, pragmatic, randomized controlled trial set in 53 primary-care practices in the UK. Patients aged 1280 years with asthma and symptoms requiring regular antiinflammatory therapy (n = 326) were randomly assigned to LTRAs (n = 162) or ICS (n = 164). The main outcome measures were the incremental costs per point improvement in the Mini Asthma Quality of Life Questionnaire, per point improvement in the Asthma Control Questionnaire and per QALY gained from the UK NHS and societal perspectives.
Results
: Over 2 years, resource use was similar between the two treatment groups, but the cost to society per patient was significantly higher for the LTRA group, at £711 versus £433 for the ICS group (adjusted difference £204; 95% CI 74, 308) year 2005 values. Cost differences were driven primarily by differences in prescription drug costs, particularly study drug costs. There was a nonsignificant (imputed, adjusted) difference between treatment groups, favouring ICS, in QALYs gained at 2 years of −0.073 (95% CI −0.143, 0.010). Therapy with LTRAs was, on average, a dominated strategy, and, at a threshold for willingness to pay of £30 000 per QALY gained, the probability of LTRAs being cost effective compared with ICS was approximately 3% from both societal and NHS perspectives.
Conclusions
: There is a very low probability of LTRAs being cost effective in the UK, at 2005 values, compared with ICS for initial asthma controller therapy.
Trial registration
: UK National Research Register N0547145240; Controlled Clinical Trials ISRCTN99132811.
We report 5 of 75 (6.6%) patients with Parkinson's disease (PD) submitted to subthalamic nucleus deep brain stimulation (STN-DBS) who developed transient disabling dyskinesias immediately after ...surgery. Dyskinesias persisted despite levodopa withdrawal, cessation or reduction of stimulation, and resolved spontaneously in a maximum period of 12 weeks without the need to change stimulation active contact. Compared to the rest of our PD patients submitted to STN-DBS, the dyskinesia group needed a lower levodopa-equivalent daily dosage (LEDD) over the time of follow-up. A microlesion in the STN, probably concealed in cerebral MRI by the electrode-related artifact, could have been involved in the etiopathology of our patients' symptoms. The presence of transient disabling dyskinesia in PD patients immediately after STN-DBS might be a predictor of good outcome as measured by a decrease in the LEDD needed.
Results of a first investigation of the response of gallium nitride nanowires to high-Z heavy ion irradiation are reported. Pre-irradiation characterization of the gallium nitride nanowires used in ...these experiments showed that that they had a two-phase coaxial structure, consisting of an outer shell of zinc–blende-phase gallium nitride and a coaxial core of wurtzite-phase gallium nitride. Observed radiation interactions with the two-phase structure are reported. A nanowire-based field effect transistor using these GaN nanowires showed normal real-time operation during irradiation by Krypton-78 heavy ions under high bias conditions.
Snow accumulation can influence soil properties in arctic and alpine tundra, boreal and temperate forests, and temperate grasslands. However, snow may be even more influential in arid ecosystems, ...which by definition are water limited, such as the hyper-arid polar desert of the McMurdo Dry Valleys, Antarctica. Moreover, snow accumulation may be altered by climate change in the future. In order to investigate the impact of changes in snow accumulation on soils in the McMurdo Dry Valleys we experimentally manipulated the quantity of snow at two locations and monitored soil properties over 5 years in relation to a snow depth gradient created by snow fences. We predicted that increased snow depth would be associated with increased soil moisture and a shift in soil animal community structure. While we did not observe changes in soil biochemistry or community structure along the snow depth gradient at either site, increased snow accumulation caused by the snow fence altered soil properties across the entire length of the transects at one site (Fryxell), which collected substantially more snow than the other site. At Fryxell, the presence of the snow fence increased gravimetric soil moisture from 1 to 5-9%. This was associated with a decline in abundance of the dominant animal, Scottnema lindsayae, a nematode typically found in dry soil, and an increase in Eudorylaimus sp. a nematode associated with moist soil. We also observed changes in soil pH, salinity, and concentrations of inorganic nitrogen and chlorophyll a over the course of the experiment, but it was difficult to determine if these were caused by snow accumulation or simply represented temporal variation related to other factors.
The gene DACH is a human homologue of Drosophila melanogaster dachshund (dac), which encodes a nuclear factor essential for determining cell fates in the eye, leg, and nervous system of the fly. To ...investigate possible connections between DACH and inherited developmental disorders, we have characterized the human DACH genomic structure and investigated the tissue and cellular distribution of the mouse DACH1 protein during development. DACH spans 400 kb and is encoded by 12 exons. The predominant DACH transcript is 5.2 kb and encodes a 706-amino-acid protein with an observed molecular weight of 97 kDa.DACH mRNA was detected in multiple adult human tissues including kidney and heart. The mouse DACH1 protein was immunolocalized to specific cell types within the developing kidneys, eyes, cochleae, and limb buds. Data suggest genetic linkage of the limb bud patterning defect postaxial polydactyly type A (designated PAP-A2, MIM 602085) to a 28-cM interval on chromosome 13 that includes DACH. However, mutation analysis of DACH in this PAP-A2 pedigree revealed no sequence differences in the coding region, splice sites, or proximal promoter region. The data presented will allow for the analysis of DACH as a candidate for other developmental disorders affecting the limbs, kidneys, eyes, ears, and other sites of DACH expression.
A model based on two-dimensional (2-D) simulation, for a polysilicon thin-film transistor (poly-Si TFT) with large grains, fabricated in laser recrystallized material, is presented. The importance of ...differentiating between the density of states of traps within grains and traps localized at grain boundaries is demonstrated. It is shown that the observed lack of saturation in the TFT output characteristics arises due to the effect of high interface trap density within the grain boundaries, whereas the subthreshold slope has a strong dependence on the trap density within the grains. Only by differentiating in this way between grain and grain boundary parameters can both output and subthreshold characteristics of an n-channel poly-Si TFT be accurately modeled using the same set of parameters. Appropriate values for the density of states in both grains and grain boundaries are suggested for laser-annealed TFTs.
PDF
