Age-related macular degeneration is the most common cause of sight impairment in the UK. In neovascular age-related macular degeneration (nAMD), vision worsens rapidly (over weeks) due to abnormal ...blood vessels developing that leak fluid and blood at the macula.
To determine the optimal role of optical coherence tomography (OCT) in diagnosing people newly presenting with suspected nAMD and monitoring those previously diagnosed with the disease.
Databases searched: MEDLINE (1946 to March 2013), MEDLINE In-Process & Other Non-Indexed Citations (March 2013), EMBASE (1988 to March 2013), Biosciences Information Service (1995 to March 2013), Science Citation Index (1995 to March 2013), The Cochrane Library (Issue 2 2013), Database of Abstracts of Reviews of Effects (inception to March 2013), Medion (inception to March 2013), Health Technology Assessment database (inception to March 2013).
Types of studies: direct/indirect studies reporting diagnostic outcomes.
time domain optical coherence tomography (TD-OCT) or spectral domain optical coherence tomography (SD-OCT).
clinical evaluation, visual acuity, Amsler grid, colour fundus photographs, infrared reflectance, red-free images/blue reflectance, fundus autofluorescence imaging, indocyanine green angiography, preferential hyperacuity perimetry, microperimetry. Reference standard: fundus fluorescein angiography (FFA). Risk of bias was assessed using quality assessment of diagnostic accuracy studies, version 2. Meta-analysis models were fitted using hierarchical summary receiver operating characteristic curves. A Markov model was developed (65-year-old cohort, nAMD prevalence 70%), with nine strategies for diagnosis and/or monitoring, and cost-utility analysis conducted. NHS and Personal Social Services perspective was adopted. Costs (2011/12 prices) and quality-adjusted life-years (QALYs) were discounted (3.5%). Deterministic and probabilistic sensitivity analyses were performed.
In pooled estimates of diagnostic studies (all TD-OCT), sensitivity and specificity 95% confidence interval (CI) was 88% (46% to 98%) and 78% (64% to 88%) respectively. For monitoring, the pooled sensitivity and specificity (95% CI) was 85% (72% to 93%) and 48% (30% to 67%) respectively. The FFA for diagnosis and nurse-technician-led monitoring strategy had the lowest cost (£ 39,769; QALYs 10.473) and dominated all others except FFA for diagnosis and ophthalmologist-led monitoring (£ 44,649; QALYs 10.575; incremental cost-effectiveness ratio £ 47,768). The least costly strategy had a 46.4% probability of being cost-effective at £ 30,000 willingness-to-pay threshold.
Very few studies provided sufficient information for inclusion in meta-analyses. Only a few studies reported other tests; for some tests no studies were identified. The modelling was hampered by a lack of data on the diagnostic accuracy of strategies involving several tests.
Based on a small body of evidence of variable quality, OCT had high sensitivity and moderate specificity for diagnosis, and relatively high sensitivity but low specificity for monitoring. Strategies involving OCT alone for diagnosis and/or monitoring were unlikely to be cost-effective. Further research is required on (i) the performance of SD-OCT compared with FFA, especially for monitoring but also for diagnosis; (ii) the performance of strategies involving combinations/sequences of tests, for diagnosis and monitoring; (iii) the likelihood of active and inactive nAMD becoming inactive or active respectively; and (iv) assessment of treatment-associated utility weights (e.g. decrements), through a preference-based study.
This study is registered as PROSPERO CRD42012001930.
The National Institute for Health Research Health Technology Assessment programme.
Several studies have demonstrated that sera from patients with cancer contain antibodies that recognize a unique group of autologous antigens called tumor‐associated antigens (TAA). In the current ...study, we employed an immunoproteomic approach, combining 2DE, Western blot, and MALDI‐MS to identify TAA in the sera of patients diagnosed with infiltrating ductal or in situ carcinoma breast cancer. Sera obtained from 25 newly diagnosed patients with stage II breast cancer and 20 healthy volunteers was evaluated for the presence of novel TAA. Alpha 1‐antitrypsin (A1AT) antibodies were detected in 24 of 25 patients with breast cancer (96%) and in 2 of 20 controls (10%). Sensitivity of detection of autoantibodies against A1AT in patients with breast cancer was 96%. Our preliminary results suggest that A1AT and autoantibodies against alpha 1 antitrypsin may be useful serum biomarkers for early‐stage breast cancer screening and diagnosis.
Rhipicephalus (Boophilus) microplus ticks are obligatory hematophagous ectoparasites of cattle and act as vectors for disease-causing microorganisms. Conventional tick control is based on the use of ...chemical acaricides; however, their uncontrolled use has increased tSresistant tick populations, as well as food and environmental contamination. Alternative immunological tick control has shown to be partially effective. The only anti-tick vaccine commercially available at present in the world is based on intestinal Bm86 protein, and shows a variable effectiveness depending on tick strains or geographic isolates. Therefore, there is a need to characterize new antigens in order to improve immunological protection. The aim of this work was to identify immunogenic proteins from ovarian tissue extracts of R. microplus, after cattle immunization. Results showed that ovarian proteins complexed with the adjuvant Montanide ISA 50 V generated a strong humoral response on vaccinated cattle. IgG levels peaked at fourth post-immunization week and remained high until the end of the experiment. 1D and 2D SDS-PAGE-Western blot assays with sera from immunized cattle recognized several ovarian proteins. Reactive bands were cut and analyzed by LC-MS/MS. They were identified as Vitellogenin, Vitellogenin-2 precursor and Yolk Cathepsin. Our findings along with bioinformatic analysis indicate that R. microplus has several Vitellogenin members, which are proteolytically processed to generate multiple polypeptide fragments. This apparent complexity of vitellogenic tick molecular targets gives the opportunity to explore their potential usefulness as vaccine candidates but, at the same time, imposes a challenge on the selection of the appropriate set of antigens.
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•A classical approach immunizing cattle with total ovarian proteins was followed.•The detection of ovarian proteins was achieved by ELISA plates coated with proteins from larval homogenates.•Several immunogenic proteins such as Vitellogenins and yolk Cathepsin were identified.•Vitellogenin-1 and Vitellogenin-2 transcripts are synthesized in the ovaries of R. microplus.•Vitellogenins represent attractive candidates for development of anti-tick vaccines.
In this work we present preliminary results on the canonical quantization of spin 1 matter fields, i.e. massive fields transforming in the (1, 0) ⊕ (0,1) representation of the Homogeneous Lorentz ...Group. The classical field theory is based on the projection onto subspaces of well defined parity in this representation.
A bstract We compute a theoretically driven prediction for the hadronic contribution to the electromagnetic running coupling at the Z scale using lattice QCD and state-of-the-art perturbative QCD. We ...obtain $$ {\displaystyle \begin{array}{cc}\Delta {\alpha}^{(5)}\left({M}_Z^2\right)=\left279.5\pm 0.9\pm 0.59\right\times {10}^{-4}& \left(\textrm{Mainz}\ \textrm{Collaboration}\right)\\ {}\Delta {\alpha}^{(5)}\left({M}_Z^2\right)=\left278.42\pm 0.22\pm 0.59\right\times {10}^{-4}& \left(\textrm{BMW}\ \textrm{Collaboration}\right),\end{array}} $$ Δ α 5 M Z 2 = 279.5 ± 0.9 ± 0.59 × 10 − 4 Mainz Collaboration Δ α 5 M Z 2 = 278.42 ± 0.22 ± 0.59 × 10 − 4 BMW Collaboration , where the first error is the quoted lattice uncertainty. The second is due to perturbative QCD, and is dominated by the parametric uncertainty on $$ {\hat{\alpha}}_s $$ α ̂ s , which is based on a rather conservative error. Using instead the PDG average, we find a total error on $$ \Delta {\alpha}^{(5)}\left({M}_Z^2\right) $$ Δ α 5 M Z 2 of 0 . 4 × 10 − 4 . Furthermore, with a particular emphasis on the charm quark contributions, we also update $$ \Delta {\alpha}^{(5)}\left({M}_Z^2\right) $$ Δ α 5 M Z 2 when low-energy cross-section data is used as an input, obtaining $$ \Delta {\alpha}^{(5)}\left({M}_Z^2\right) $$ Δ α 5 M Z 2 = 276 . 29 ± 0 . 38 ± 0 . 62 × 10 − 4 . The difference between lattice QCD and cross-section-driven results reflects the known tension between both methods in the computation of the anomalous magnetic moment of the muon. Our results are expressed in a way that will allow straightforward modifications and an easy implementation in electroweak global fits.
La denominada economía colaborativa o economía p2p, concepto multifacético de creciente relevancia, constituye nuestro objeto de estudio como resultante de la traducción del vocablo anglosajón ...“sharing economy”. El presente artículo se plantea metodológicamente como una revisión crítica y una síntesis de las principales tendencias de la economía del siglo XXI del principio del nuevo fenómeno del neo-capitalismo de plataformas digitales. Desde el marco de la contradicción tradicional de trabajo y capital, se realiza un análisis pormenorizado del concepto de “colaboración” como traducción de “sharing”. Se realiza una revisión cronológica de la literatura, identificando los principales trabajos de investigación y monografías seminales que conforma la base a partir de la que se proyecta la dinámica del nuevo paradigma económico, en un marco de mayor eficiencia consecuente de mayor descentralización y heterogeneidad.Los resultados indican que hay mucha literatura anglosajona no consultada ni traducida para el hispano-hablante; incluso con omisión de conceptos relevantes que resultan cruciales para interpretar los nuevos escenarios a los que se enfrentan las economías. A modo de conclusión, se plantean tres propuestas. Primero la necesidad de crear políticas económicas activas y una planificación consciente respecto de los nuevos retos. Segundo, impulsar acciones públicas, más allá de la simple regulación, especialmente en el ámbito de los datos masivos y creando plataformas digitales públicas. Tercero, la promoción de una nueva generación de cooperativas de plataforma que posibilite alcanzar un nuevo equilibrio en valores dentro del futuro que se adivina en la nueva era del turbo-capitalismo y del pos-trabajo del siglo XXI.
Introduction. The use of biological controllers as alternatives to traditional chemicals is an ecological and
economic option for farmers. Fungi of the genus Trichoderma can confer resistance to ...plants and increase the absorption of nutrients, reducing a wide variety of crop diseases. Objective. To evaluate pineapple stubble wastes as
a substrate for the solid fermentation growth of two Trichoderma strains to produce a spore solution for agricultural
purposes. Materials and methods. The experiment was carried out at the Laboratory of Research in Chemistry
and Applied Biosciences of the Universidad Tecnica Nacional of Costa Rica, in the period between April 2018 and
October 2019. Two variants of fungus T. viride and T. harzianum were used, these were grown in natural potato
dextrose agar (PDA) and pineapple stubble. A conidia count was performed in a 1/10 mm Neubauer chamber. Results.
T. viride and T. harzianum showed uniform growth in reseeding plates with color changes in time, from white to green.
T. viride showed better development in wet substrate, while T. harzianum in low moisture stubble. The maximum
cell concentration in the liquid solution of T. harzianum and T. viride was 1 132 750 cell ml-1 and 1 023 250 cell ml-1,
respectively. Conclusion. Both strains of Trichoderma developed adequately in the pineapple stubble, however, the
efficient growth of the strains is associated with the management of external factors such as the amount of substrate,
oxygen, and moisture.
Introducción. El uso de controladores biológicos como alternativas a los productos químicos tradicionales resulta
una opción ecológica y económica para los agricultores. Hongos del género Trichoderma son capaces de conferir
resistencia a las plantas y aumentar la absorción de nutrientes, disminuyendo a su vez gran variedad de enfermedades
en los cultivos. Objetivo. Evaluar los desechos de rastrojo de piña como sustrato para el crecimiento en fermentación
sólida de dos cepas de Trichoderma para la producción de una solución de esporas con fines agrícolas. Materiales
y métodos. El ensayo se llevó a cabo en el Laboratorio de Investigación en Química y Biociencias Aplicadas de la
Universidad Técnica Nacional de Costa Rica, en el periodo entre abril del 2018 y octubre del 2019. Se utilizaron dos
variantes del hongo T. viride y T. harzianum, estas se cultivaron en un medio natural de agar papa dextrosa (PDA) y
rastrojo de piña. Se realizó un conteo de conidios en una cámara de Neubauer de 1/10 mm. Resultados. T. viride y T.
harzianum presentaron un crecimiento uniforme en las placas de resiembra con cambios de coloración en el tiempo, de
blanco a verde. T. viride presentó un mejor desarrollo en sustrato húmedo, mientras que T. harzianum en rastrojo con
poca humedad. La concentración celular máxima en la solución líquida de T. harzianum y T. viride fue de 1 132 750 cél
ml-1 y 1 023 250 cél ml-1, respectivamente. Conclusión. Ambas cepas de Trichoderma se desarrollaron adecuadamente
en el rastrojo de piña, sin embargo, el crecimiento eficiente de las cepas está asociado al manejo de factores externos
como la cantidad de sustrato, oxígeno y humedad.
Background Gallstone disease is a common gastrointestinal disorder in industrialised societies. The prevalence of gallstones in the adult population is estimated to be approximately 10–15%, and ...around 80% remain asymptomatic. At present, cholecystectomy is the default option for people with symptomatic gallstone disease. Objectives To assess the clinical and cost-effectiveness of observation/conservative management compared with laparoscopic cholecystectomy for preventing recurrent symptoms and complications in adults presenting with uncomplicated symptomatic gallstones in secondary care. Design Parallel group, multicentre patient randomised superiority pragmatic trial with up to 24 months follow-up and embedded qualitative research. Within-trial cost–utility and 10-year Markov model analyses. Development of a core outcome set for uncomplicated symptomatic gallstone disease. Setting Secondary care elective settings. Participants Adults with symptomatic uncomplicated gallstone disease referred to a secondary care setting were considered for inclusion. Interventions Participants were randomised 1: 1 at clinic to receive either laparoscopic cholecystectomy or observation/conservative management. Main outcome measures The primary outcome was quality of life measured by area under the curve over 18 months using the Short Form-36 bodily pain domain. Secondary outcomes included the Otago gallstones’ condition-specific questionnaire, Short Form-36 domains (excluding bodily pain), area under the curve over 24 months for Short Form-36 bodily pain domain, persistent symptoms, complications and need for further treatment. No outcomes were blinded to allocation. Results Between August 2016 and November 2019, 434 participants were randomised (217 in each group) from 20 United Kingdom centres. By 24 months, 64 (29.5%) in the observation/conservative management group and 153 (70.5%) in the laparoscopic cholecystectomy group had received surgery, median time to surgery of 9.0 months (interquartile range, 5.6–15.0) and 4.7 months (interquartile range 2.6–7.9), respectively. At 18 months, the mean Short Form-36 norm-based bodily pain score was 49.4 (standard deviation 11.7) in the observation/conservative management group and 50.4 (standard deviation 11.6) in the laparoscopic cholecystectomy group. The mean area under the curve over 18 months was 46.8 for both groups with no difference: mean difference –0.0, 95% confidence interval (–1.7 to 1.7); p -value 0.996; n = 203 observation/conservative, n = 205 cholecystectomy. There was no evidence of differences in quality of life, complications or need for further treatment at up to 24 months follow-up. Condition-specific quality of life at 24 months favoured cholecystectomy: mean difference 9.0, 95% confidence interval (4.1 to 14.0), p < 0.001 with a similar pattern for the persistent symptoms score. Within-trial cost–utility analysis found observation/conservative management over 24 months was less costly than cholecystectomy (mean difference –£1033). A non-significant quality-adjusted life-year difference of –0.019 favouring cholecystectomy resulted in an incremental cost-effectiveness ratio of £55,235. The Markov model continued to favour observation/conservative management, but some scenarios reversed the findings due to uncertainties in longer-term quality of life. The core outcome set included 11 critically important outcomes from both patients and healthcare professionals. Conclusions The results suggested that in the short term (up to 24 months) observation/conservative management may be a cost-effective use of National Health Service resources in selected patients, but subsequent surgeries in the randomised groups and differences in quality of life beyond 24 months could reverse this finding. Future research should focus on longer-term follow-up data and identification of the cohort of patients that should be routinely offered surgery. Trial registration This trial is registered as ISRCTN55215960. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/192/71) and is published in full in Health Technology Assessment ; Vol. 28, No. 26. See the NIHR Funding and Awards website for further award information.
Resumen: Esta investigación tiene como objetivo, conocer la representación de la imagen de Dios en estudiantes de enseñanza media en el contexto escolar del Área Metropolitana de Santiago. Para estos ...fines se construyó un cuestionario como instrumento de investigación. El instrumento se aplicó en 26 establecimientos del Área Metropolitana de Santiago, obteniendo una muestra final de 1299 casos. Se consideró la distribución del tipo de sistema educativo que caracteriza el modelo chileno, es decir los datos se recuperaron respetando los porcentajes correspondientes a matricula particular; subvencionado y municipal, así como colegio religioso y colegio laico. Para efectos de la entrega de los resultados, se exponen los datos considerando su proveniencia de colegios católicos o laicos.
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