Applying quantitative methods in the assessment of outcomes of pharmacotherapy of psoriasis

Healthcare providers and policy makers are faced with an ever-increasing number of medical publications. Searching for relevant information and keeping up to date with new research findings remains a constant challenge. It has been widely acknowledged that narrative reviews of the literature are susceptible to several types of bias and a systematic approach may protect against these biases. The aim of this thesis was to apply quantitative methods in the assessment of outcomes of topical therapies for psoriasis. In particular, to systematically examine the comparative efficacy, tolerability and cost-effectiveness of topical calcipotriol in the treatment of mild-to-moderate psoriasis. Over the years, a wide range of techniques have been used to evaluate the severity of psoriasis and the outcomes from treatment. This lack of standardisation complicates the direct comparison of results and ultimately the pooling of outcomes from different clinical trials. There is a clear requirement for more comprehensive tools for measuring drug efficacy and disease severity in psoriasis. Ideally, the outcome measures need to be simple, relevant, practical, and widely applicable, and the instruments should be reliable, valid and responsive. The results of the meta-analysis reported herein show that calcipotriol is an effective antipsoriatic agent. In the short-tenn, the pooled data found calcipotriol to be more effective than calcitriol, tacalcitol, coal tar and short-contact dithranol. Only potent corticosteroids appeared to have comparable efficacy, with less short-term side-effects. Potent corticosteroids also added to the antipsoriatic effect of calcipotriol, and appeared to suppress the occurrence of calcipotriol-induced irritation. There was insufficient evidence to support any large effects in favour of improvements in efficacy when calcipotriol is used in combination with systemic therapies in patients with severe psoriasis. However, there was a total absence of long-term morbidity data on the effectiveness of any of the interventions studied. Decision analysis showed that, from the perspective of the NHS as payer, the relatively small differences in efficacy between calcipotriol and short-contact dithranol lead to large differences in the direct cost of treating patients with mildto-moderate plaque psoriasis. Further research is needed to examine the clinical and economic issues affecting patients under treatment for psoriasis in the UK. In particular, the maintenance value and cost/benefit ratio for the various treatment strategies, and the assessment of patient's preferences has not yet been adequately addressed for this chronic recurring disease.

Challenges and limitations of intercultural training for inpatriates in German multinationals:a case study

Despite the increasing popularity of research on intercultural preparation and its effectiveness, research on training for inpatriates has not been developed with the same level of rigour as research on training for expatriates. Furthermore, research on intercultural training hardly ever includes the aspect of preparing for the corporate culture of a company. For expatriates coming from headquarters’ national culture and equipped with a good knowledge of headquarters’ corporate culture, it might be sufficient to address only the national culture of the location abroad. But can the same be said for inpatriates coming from a foreign subsidiary? Therefore the qualitative research of my thesis was aimed at finding out if intercultural training programmes that address only the national culture of the host country are sufficient to prepare inpatriates for working at headquarters. A case study using a German multinational company has been conducted in order to find out what kind of problems and irritations inpatriates at the company’s headquarters perceive at work. In order to determine whether the findings are related to the national or the corporate culture, Hall’s and Hofstede’s approaches to culture were used. The interview analysis produced the following conclusion: Although the researched company promotes standardised worldwide corporate guidelines, there are many differences between headquarters and subsidiaries regarding the interpretation and realisation of these guidelines. These differences cause irritation, confusion and problems for the inpatriates. Therefore an effective intercultural preparation for inpatriates should be tailor-made and take into account the aspect of corporate culture, as well as the specific roles and functions of inpatriates.

The detection of kinin activity in contact lens wear

Many factors can be, and have been, attributed to the appearance of complications in lens wear, but the greatest is associated with deposition. Reduced acuity, irritation and inflammatory responses are often referred to as adverse reactions arising as a result of deposition. In this study, particular attention was paid to the potential role of adsorbed proteins in activating, mediating and/or stimulating a host immune response, i.e., the hypothesis that the adsorption of certain proteins from the tears and ocular surfaces may actively affect successful lens wear. In particular, the purpose of this study was to investigate the presence of a group of proteins previously undiscovered in the ocular environment. The intention was to target a family of proteins/glycoproteins that have become prominent recently in a variety of inflammatory responses and disorders at many other mucosal associated sites around the body, e.g. in nasal rhinitis and in joint inflammation. The protein cascade in question is the kinin family of inflammatory mediators. The aim was to investigate their presence in the ocular environment, specifically in relation to contact lens wear, and consequently assess the implications of their discovery. High molecular weight kininogen (HMWK), with its central role in kinin responses, was investigated initially as the marker of kinin activity, with subsequent members examined thereafter.

Fibre Bragg gratings fabrication in four core fibres

Due to the limitation of the lens effect of the optical fibre and the inhomogeneity of the laser fluence on different cores, it is still challenging to controllably inscribe different fibre Bragg gratings (FBGs) in multicore fibres. In this article, we reported the FBG inscription in four core fibres (FCFs), whose cores are arranged in the corners of a square lattice. By investigating the influence of different inscription conditions during inscription, different results, such as simultaneous inscription of all cores, selectively inscription of individual or two cores, and even double scanning in perpendicular core couples by diagonal, are achieved. The phase mask scanning method, consisting of a 244nm Argon-ion frequencydoubled laser, air-bearing linear transfer stage and cylindrical lens and mirror setup, is used to precisely control the grating inscription in FCFs. The influence of three factors is systematically investigated to overcome the limitations, and they are the defocusing length between the cylindrical lens and the bare fibre, the rotation geometry of the fibre to the irritation beam, and the relative position of the fibre in the vertical direction of the laser beam.