Cell Fate Specification and the Regulation of RNA-dependent DNA Methylation in the Arabidopsis Root Meristem

The Arabidopsis root apical meristem (RAM) is a complex tissue capable of generating all the cell types that ultimately make up the root. The work presented in this thesis takes advantage of the versatility of high-throughput sequencing to address two independent questions about the root meristem. Although a lot of information is known regarding the cell fate decisions that occur at the RAM, cortex specification and differentiation remain poorly understood. In the first part of this thesis, I used an ethylmethanesulfonate (EMS) mutagenized marker line to perform a forward genetics screen. The goal of this screen was to identify novel genes involved in the specification and differentiation of the cortex tissue. Mapping analysis from the results obtained in this screen revealed a new allele of BRASSINOSTEROID4 with abnormal marker expression in the cortex tissue. Although this allele proved to be non-cortex specific, this project highlights new technology that allows mapping of EMS-generated mutations without the need to map-cross or back-cross. In the second part of this thesis, using fluorescence activated cell sorting (FACS) coupled with high throughput sequencing, my collaborators and I generated single-base resolution whole genome DNA methylomes, mRNA transcriptomes, and smallRNA transcriptomes for six different populations of cell types in the Arabidopsis root meristem. We were able to discover that the columella is hypermethylated in the CHH context within transposable elements. This hypermethylation is accompanied by upregulation of the RNA-dependent DNA methylation pathway (RdDM), including higher levels of 24-nt silencing RNAs (siRNAs). In summary, our studies demonstrate the versatility of high-throughput sequencing as a method for identifying single mutations or to perform complex comparative genomic analyses.

Development and optimisation of photonic crystal based nanosensors

This thesis involved the development of two Biosensors and their associated assays for the detection of diseases, namely IBR and BVD for veterinary use and C1q protein as a biomarker to pancreatic cancer for medical application, using Surface Plasmon Resonance (SPR) and nanoplasmonics. SPR techniques have been used by a number of groups, both in research [1-3] and commercially [4, 5] , as a diagnostic tool for the detection of various biomolecules, especially antibodies [6-8]. The biosensor market is an ever expanding field, with new technology and new companies rapidly emerging on the market, for both human [8] and veterinary applications [9, 10]. In Chapter 2, we discuss the development of a simultaneous IBR and BVD virus assay for the detection of antibodies in bovine serum on an SPR-2 platform. Pancreatic cancer is the most lethal cancer by organ site, partially due to the lack of a reliable molecular signature for diagnostic testing. C1q protein has been recently proposed as a biomarker within a panel for the detection of pancreatic cancer. The third chapter discusses the fabrication, assays and characterisation of nanoplasmonic arrays. We will talk about developing C1q scFv antibody assays, clone screening of the antibodies and subsequently moving the assays onto the nanoplasmonic array platform for static assays, as well as a custom hybrid benchtop system as a diagnostic method for the detection of pancreatic cancer. Finally, in chapter 4, we move on to Guided Mode Resonance (GMR) sensors, as a low-cost option for potential use in Point-of Care diagnostics. C1q and BVD assays used in the prior formats are transferred to this platform, to ascertain its usability as a cost effective, reliable sensor for diagnostic testing. We discuss the fabrication, characterisation and assay development, as well as their use in the benchtop hybrid system.

Development of a novel probe integrated with a micro-structured impedance sensor for the detection of breast cancer

The work described in this thesis focuses on the development of an innovative bioimpedance device for the detection of breast cancer using electrical impedance as the detection method. The ability for clinicians to detect and treat cancerous lesions as early as possible results in improved patient outcomes and can reduce the severity of the treatment the patient has to undergo. Therefore, new technology and devices are continually required to improve the specificity and sensitivity of the accepted detection methods. The gold standard for breast cancer detection is digital x-ray mammography but it has some significant downsides associated with it. The development of an adjunct technology to aid in the detection of breast cancers could represent a significant patient and economic benefit. In this project silicon substrates were pattern with two gold microelectrodes that allowed electrical impedance measurements to be recorded from intact tissue structures. These probes were tested and characterised using a range of in vitro and ex vivo experiments. The end application of this novel sensor device was in a first-in-human clinical trial. The initial results of this study showed that the silicon impedance device was capable of differentiating between normal and abnormal (benign and cancerous) breast tissue. The mean separation between the two tissue types 4,340 Ω with p < 0.001. The cancer type and grade at the site of the probe recordings was confirmed histologically and correlated with the electrical impedance measurements to determine if the different subtypes of cancer could each be differentiated. The results presented in this thesis showed that the novel impedance device demonstrated excellent electrochemical recording potential; was biocompatible with the growth of cultured cell lines and was capable of differentiating between intact biological tissues. The results outlined in this thesis demonstrate the potential feasibility of using electrical impedance for the differentiation of biological tissue samples. The novelty of this thesis is in the development of a new method of tissue determination with an application in breast cancer detection.

Essays on Firm Heterogeneity with Empirical Applications in Economic History and Agricultural Economics

This thesis uses models of firm-heterogeneity to complete empirical analyses in economic history and agricultural economics. In Chapter 2, a theoretical model of firm heterogeneity is used to derive a statistic that summarizes the welfare gains from the introduction of a new technology. The empirical application considers the use of mechanical steam power in the Canadian manufacturing sector during the late nineteenth century. I exploit exogenous variation in geography to estimate several parameters of the model. My results indicate that the use of steam power resulted in a 15.1 percent increase in firm-level productivity and a 3.0-5.2 percent increase in aggregate welfare. Chapter 3 considers various policy alternatives to price ceiling legislation in the market for production quotas in the dairy farming sector in Quebec. I develop a dynamic model of the demand for quotas with farmers that are heterogeneous in their marginal cost of milk production. The econometric analysis uses farm-level data and estimates a parameter of the theoretical model that is required for the counterfactual experiments. The results indicate that the price of quotas could be reduced to the ceiling price through a 4.16 percent expansion of the aggregate supply of quotas, or through moderate trade liberalization of Canadian dairy products. In Chapter 4, I study the relationship between farm-level productivity and participation in the Commercial Export Milk (CEM) program. I use a difference-in-difference research design with inverse propensity weights to test for causality between participation in the CEM program and total factor productivity (TFP). I find a positive correlation between participation in the CEM program and TFP, however I find no statistically significant evidence that the CEM program affected TFP.

AR-based Technoself Enhanced Learning Approach to Improving Student Engagement

The emerging technologies have expanded a new dimension of self – ‘technoself’ driven by socio-technical innovations and taken an important step forward in pervasive learning. Technology Enhanced Learning (TEL) research has increasingly focused on emergent technologies such as Augmented Reality (AR) for augmented learning, mobile learning, and game-based learning in order to improve self-motivation and self-engagement of the learners in enriched multimodal learning environments. These researches take advantage of technological innovations in hardware and software across different platforms and devices including tablets, phoneblets and even game consoles and their increasing popularity for pervasive learning with the significant development of personalization processes which place the student at the center of the learning process. In particular, augmented reality (AR) research has matured to a level to facilitate augmented learning, which is defined as an on-demand learning technique where the learning environment adapts to the needs and inputs from learners. In this paper we firstly study the role of Technology Acceptance Model (TAM) which is one of the most influential theories applied in TEL on how learners come to accept and use a new technology. Then we present the design methodology of the technoself approach for pervasive learning and introduce technoself enhanced learning as a novel pedagogical model to improve student engagement by shaping personal learning focus and setting. Furthermore we describe the design and development of an AR-based interactive digital interpretation system for augmented learning and discuss key features. By incorporating mobiles, game simulation, voice recognition, and multimodal interaction through Augmented Reality, the learning contents can be geared toward learner's needs and learners can stimulate discovery and gain greater understanding. The system demonstrates that Augmented Reality can provide rich contextual learning environment and contents tailored for individuals. Augment learning via AR can bridge this gap between the theoretical learning and practical learning, and focus on how the real and virtual can be combined together to fulfill different learning objectives, requirements, and even environments. Finally, we validate and evaluate the AR-based technoself enhanced learning approach to enhancing the student motivation and engagement in the learning process through experimental learning practices. It shows that Augmented Reality is well aligned with constructive learning strategies, as learners can control their own learning and manipulate objects that are not real in augmented environment to derive and acquire understanding and knowledge in a broad diversity of learning practices including constructive activities and analytical activities.

Oxygen and Chloride Permeability of Alkali-Activated Natural Pozzolan Concrete

One of the important factors in the use of portland cement concrete is its durability, and most of the situations where durability is lacking have been identifi ed and strategies to manage durability have been implemented. Geopolymer concrete, made from an alkali-activated natural pozzolan (AANP), provides an important opportunity for the reduction of carbon dioxide (CO2) emissions associated with the manufacture of concrete but has a limited history of durability studies. Until its different properties are well understood there is no desire to adopt this new technology of unknown provenance by the concrete industry. This paper presents an experimental study of oxygen and chloride permeability of AANP concrete prepared by activating Taftan andesite and Shahindej dacite (Iranian natural pozzolans), with and without calcining, and the correlations between these properties and compressive strength. The results show that compared to ordinary portland cement (OPC) concrete, AANP concrete has lower oxygen permeability at later ages; but it shows moderate to high chloride ion penetrability.

The Democratic Dynamics of Government Consultations. Speaking Freely and Listening Properly

There is a growing use of consultation and e-consultation procedures by governments. This chapter seeks to examine the role of consultation as part of a new technology of government. Consultation on policy development can reinvigorate democratic engage- ment but often it can silence views through a sort of participatory disempowerment; it can loosen the democratic anchorage of the public service within the state. The chapter develops a governmentality perspective interrogating what participation, democratic engagement and free speech mean in this context, and how ideas of publicness are constructed, managed and controlled. The focus is on the nature of consultation, its relationship to ideas of free speech and speaking freely, and its potential to empower subaltern counterpublics which can formulate oppositional interpretations and urge alternative conclusions. The aim is to develop an idea of the democratic adequacy of the consultation process and draw out a sense of how democratic engagement here can be structured – for good or ill.

Expanding the Design Space: Forging the Transition from 3D Printing to Additive Manufacturing

Thesis (Master's)--University of Washington, 2016-08

Growth and yield of red raspberries cultivated under open field condition vs. high tunnel or rain shelter in the northern canadian climate

La culture sous abris avec des infrastructures de type grands tunnels est une nouvelle technologie permettant d’améliorer la production de framboises rouges sous des climats nordiques. L’objectif principal de ce projet de doctorat était d’étudier les performances de ces technologies (grands tunnels vs. abris parapluie de type Voen, en comparaison à la culture en plein champ) et leur effets sur le microclimat, la photosynthèse, la croissance des plantes et le rendement en fruits pour les deux types de framboisiers non-remontants et remontants (Rubus idaeus, L.). Puisque les pratiques culturales doivent être adaptées aux différents environnements de culture, la taille d’été (pour le cultivar non-remontant), l’optimisation de la densité des tiges (pour le cultivar remontant) et l’utilisation de bâches réfléchissantes (pour les deux types des framboisiers) ont été étudiées sous grands tunnels, abris Voen vs. en plein champ. Les plants cultivés sous grands tunnels produisent en moyenne 1,2 et 1,5 fois le rendement en fruits commercialisables que ceux cultivés sous abri Voen pour le cv. non-remontant ‘Jeanne d’Orléans’ et le cv. remontant ‘Polka’, respectivement. Comparativement aux framboisiers cultivés aux champs, le rendement en fruits des plants sous grands tunnels était plus du double pour le cv. ‘Jeanne d’Orléans’ et près du triple pour le cv. ‘Polka’. L’utilisation de bâches réfléchissantes a entrainé un gain significatif sur le rendement en fruits de 12% pour le cv. ‘Jeanne d’Orléans’ et de 17% pour le cv. ‘Polka’. La taille des premières ou deuxièmes pousses a significativement amélioré le rendement en fruits du cv. ‘Jeanne d’Orléans’ de 26% en moyenne par rapport aux framboisiers non taillés. Des augmentations significatives du rendement en fruits de 43% et 71% du cv. ‘Polka’ ont été mesurées avec l’accroissement de la densité à 4 et 6 tiges par pot respectivement, comparativement à deux tiges par pot. Au cours de la période de fructification du cv. ‘Jeanne d’Orléans’, les bâches réfléchissantes ont augmenté significativement la densité de flux photonique photosynthétique (DFPP) réfléchie à la canopée inférieure de 80% en plein champ et de 60% sous grands tunnels, comparativement à seulement 14% sous abri Voen. Durant la saison de fructification du cv. ‘Polka’, un effet positif de bâches sur la lumière réfléchie (jusqu’à 42%) a été mesuré seulement en plein champ. Dans tous les cas, les bâches réfléchissantes n’ont présenté aucun effet significatif sur la DFPP incidente foliaire totale et la photosynthèse. Pour le cv. ‘Jeanne d’Orléans’, la DFPP incidente sur la feuille a été atténuée d’environ 46% sous le deux types de revêtement par rapport au plein champ. Par conséquent, la photosynthèse a été réduite en moyenne de 43% sous grands tunnels et de 17% sous abris Voen. Des effets similaires ont été mesurés pour la DFPP incidente et la photosynthèse avec le cv. Polka. En dépit du taux de photosynthèse des feuilles individuelles systématiquement inférieur à ceux mesurés pour les plants cultivés aux champs, la photosynthèse de la plante entière sous grands tunnels était de 51% supérieure à celle observée au champ pour le cv. ‘Jeanne d’Orléans’, et 46% plus élevée pour le cv. ‘Polka’. Ces résultats s’expliquent par une plus grande (près du double) surface foliaire pour les plants cultivés sous tunnels, qui a compensé pour le plus faible taux de photosynthèse par unité de surface foliaire. Les températures supra-optimales des feuilles mesurées sous grands tunnels (6.6°C plus élevé en moyenne que dans le champ), ainsi que l’atténuation de la DFPP incidente (env. 43%) par les revêtements de tunnels ont contribué à réduire le taux de photosynthèse par unité de surface foliaire. La photosynthèse de la canopée entière était étroitement corrélée avec le rendement en fruits pour les deux types de framboisiers rouges cultivés sous grands tunnels ou en plein champ.

Développement de la polymérisation par (hétéro)arylation directe pour l’électronique organique

L’électronique organique suscite un intérêt grandissant en recherche grâce aux nouvelles possibilités qu’elle offre pour faciliter l’intégration de dispositifs électroniques dans nos vies. Grâce à elle, il est possible d’envisager des produits légers, flexibles et peu coûteux à produire. Les classes majeures de dispositifs étudiées sont les cellules photovoltaïques organiques (CPO) et les transistors organiques à effet de champ (TOEC). Dans les dernières années, une attention particulière a été portée sur les méthodes de polymérisation des matériaux organiques entrant dans la fabrication de ces dispositifs. La polymérisation par (hétéro)arylation directe (PHAD) catalysée au Pd offre une synthèse sans dérivé organométallique utilisant simplement un lien C-H aromatique, ce qui facilite la purification, diminue le nombre d’étapes et rend possible la production de matériaux à plus faible coût. De plus, la PHAD permet la préparation de matériaux qui était difficile, voire impossible, à obtenir auparavant. Cependant, l’inconvénient majeur de la PHAD reste sa limitation à certaines classes de polymères possédant des monomères ayant des positions bloquées favorisant qu’une seule paire de liaisons C-H. Dans le cadre de ces travaux de doctorat, l’objectif général est d’étudier la polymérisation par PHAD afin d’accéder à des classes de monomères qui n’étaient pas envisageables auparavant et à étendre l’application de cet outil dans le domaine des polymères conjugués. Plus spécifiquement, nous avons étudié l’utilisation de groupements protecteurs et partants sur des unités de benzodithiophènes et de bithiophène-silylés. Suivant ces résultats, nos travaux ont porté sur la polymérisation de dérivés de bithiophènes avec des bromo(aryle)s, une classe de polymères fréquemment utilisée en électronique organique mais qui était jugée impossible à polymériser par PHAD auparavant. Cette étude a montré l’importance de contrôler la PHAD afin d’obtenir le polymère souhaité. Finalement, nous avons étudié l’effet du système catalytique sur le taux de β−ramifications lors de la synthèse de polymères à base de thiophènes. Dans cette dernière étude, nous avons démontré l’importance d’utiliser des outils de caractérisation adéquats afin de confirmer la qualité des polymères obtenus.

Drones y el orden legal internacional. Tecnología, estrategia y largas cadenas de acción

The main thesis of this article is that the increasing recourse to the use of unmanned aerial systems in asymmetric warfare and the beginning routinization of U.S. drone operations represent part of an evolutionary change in the spatial ordering of global politics -- Using a heuristic framework based on actor-network theory, it is argued that practices of panoptic observation and selective airstrikes, being in need of legal justification, contribute to a reterritorialization of asymmetric conflicts -- Under a new normative spatial regime, a legal condition of state immaturity is constructed, which establishes a zone of conditional sovereignty subject to transnational aerial policing -- At the same time, this process is neither a deterministic result of the new technology nor a deliberate effect of policies to which drones are merely neutral instruments -- Rather, military technology and political decisions both form part of a long chain of action which has evolved under the specific circumstances of recent military interventions

Neurorehabilitation of hand functions using brain computer interface

Introduction: Brain computer interface (BCI) is a promising new technology with possible application in neurorehabilitation after spinal cord injury. Movement imagination or attempted movement-based BCI coupled with functional electrical stimulation (FES) enables the simultaneous activation of the motor cortices and the muscles they control. When using the BCI- coupled with FES (known as BCI-FES), the subject activates the motor cortex using attempted movement or movement imagination of a limb. The BCI system detects the motor cortex activation and activates the FES attached to the muscles of the limb the subject is attempting or imaging to move. In this way the afferent and the efferent pathways of the nervous system are simultaneously activated. This simultaneous activation encourages Hebbian type learning which could be beneficial in functional rehabilitation after spinal cord injury (SCI). The FES is already in use in several SCI rehabilitation units but there is currently not enough clinical evidence to support the use of BCI-FES for rehabilitation. Aims: The main aim of this thesis is to assess outcomes in sub-acute tetraplegic patients using BCI-FES for functional hand rehabilitation. In addition, the thesis explores different methods for assessing neurological rehabilitation especially after BCI-FES therapy. The thesis also investigated mental rotation as a possible rehabilitation method in SCI. Methods: Following investigation into applicable methods that can be used to implement rehabilitative BCI, a BCI based on attempted movement was built. Further, the BCI was used to build a BCI-FES system. The BCI-FES system was used to deliver therapy to seven sub-acute tetraplegic patients who were scheduled to receive the therapy over a total period of 20 working days. These seven patients are in a 'BCI-FES' group. Five more patients were also recruited and offered equivalent FES quantity without the BCI. These further five patients are in a 'FES-only' group. Neurological and functional measures were investigated and used to assess both patient groups before and after therapy. Results: The results of the two groups of patients were compared. The patients in the BCI-FES group had better improvements. These improvements were found with outcome measures assessing neurological changes. The neurological changes following the use of the BCI-FES showed that during movement attempt, the activation of the motor cortex areas of the SCI patients became closer to the activation found in healthy individuals. The intensity of the activation and its spatial localisation both improved suggesting desirable cortical reorganisation. Furthermore, the responses of the somatosensory cortex during sensory stimulation were of clear evidence of better improvement in patients who used the BCI-FES. Missing somatosensory evoked potential peaks returned more for the BCI-FES group while there was no overall change in the FES-only group. Although the BCI-FES group had better neurological improvement, they did not show better functional improvement than the FES-only group. This was attributed mainly to the short duration of the study where therapies were only delivered for 20 working days. Conclusions: The results obtained from this study have shown that BCI-FES may induce cortical changes in the desired direction at least faster than FES alone. The observation of better improvement in the patients who used the BCI-FES is a good result in neurorehabilitation and it shows the potential of thought-controlled FES as a neurorehabilitation tool. These results back other studies that have shown the potential of BCI-FES in rehabilitation following neurological injuries that lead to movement impairment. Although the results are promising, further studies are necessary given the small number of subjects in the current study.

Incomplete information games of conflict and collective action

My thesis consists of three essays that investigate strategic interactions between individuals engaging in risky collective action in uncertain environments. The first essay analyzes a broad class of incomplete information coordination games with a wide range of applications in economics and politics. The second essay draws from the general model developed in the first essay to study decisions by individuals of whether to engage in protest/revolution/coup/strike. The final essay explicitly integrates state response to the analysis. The first essay, Coordination Games with Strategic Delegation of Pivotality, exhaustively analyzes a class of binary action, two-player coordination games in which players receive stochastic payoffs only if both players take a ``stochastic-coordination action''. Players receive conditionally-independent noisy private signals about the normally distributed stochastic payoffs. With this structure, each player can exploit the information contained in the other player's action only when he takes the “pivotalizing action”. This feature has two consequences: (1) When the fear of miscoordination is not too large, in order to utilize the other player's information, each player takes the “pivotalizing action” more often than he would based solely on his private information, and (2) best responses feature both strategic complementarities and strategic substitutes, implying that the game is not supermodular nor a typical global game. This class of games has applications in a wide range of economic and political phenomena, including war and peace, protest/revolution/coup/ strike, interest groups lobbying, international trade, and adoption of a new technology. My second essay, Collective Action with Uncertain Payoffs, studies the decision problem of citizens who must decide whether to submit to the status quo or mount a revolution. If they coordinate, they can overthrow the status quo. Otherwise, the status quo is preserved and participants in a failed revolution are punished. Citizens face two types of uncertainty. (a) non-strategic: they are uncertain about the relative payoffs of the status quo and revolution, (b) strategic: they are uncertain about each other's assessments of the relative payoff. I draw on the existing literature and historical evidence to argue that the uncertainty in the payoffs of status quo and revolution is intrinsic in politics. Several counter-intuitive findings emerge: (1) Better communication between citizens can lower the likelihood of revolution. In fact, when the punishment for failed protest is not too harsh and citizens' private knowledge is accurate, then further communication reduces incentives to revolt. (2) Increasing strategic uncertainty can increase the likelihood of revolution attempts, and even the likelihood of successful revolution. In particular, revolt may be more likely when citizens privately obtain information than when they receive information from a common media source. (3) Two dilemmas arise concerning the intensity and frequency of punishment (repression), and the frequency of protest. Punishment Dilemma 1: harsher punishments may increase the probability that punishment is materialized. That is, as the state increases the punishment for dissent, it might also have to punish more dissidents. It is only when the punishment is sufficiently harsh, that harsher punishment reduces the frequency of its application. Punishment Dilemma 1 leads to Punishment Dilemma 2: the frequencies of repression and protest can be positively or negatively correlated depending on the intensity of repression. My third essay, The Repression Puzzle, investigates the relationship between the intensity of grievances and the likelihood of repression. First, I make the observation that the occurrence of state repression is a puzzle. If repression is to succeed, dissidents should not rebel. If it is to fail, the state should concede in order to save the costs of unsuccessful repression. I then propose an explanation for the “repression puzzle” that hinges on information asymmetries between the state and dissidents about the costs of repression to the state, and hence the likelihood of its application by the state. I present a formal model that combines the insights of grievance-based and political process theories to investigate the consequences of this information asymmetry for the dissidents' contentious actions and for the relationship between the magnitude of grievances (formulated here as the extent of inequality) and the likelihood of repression. The main contribution of the paper is to show that this relationship is non-monotone. That is, as the magnitude of grievances increases, the likelihood of repression might decrease. I investigate the relationship between inequality and the likelihood of repression in all country-years from 1981 to 1999. To mitigate specification problem, I estimate the probability of repression using a generalized additive model with thin-plate splines (GAM-TPS). This technique allows for flexible relationship between inequality, the proxy for the costs of repression and revolutions (income per capita), and the likelihood of repression. The empirical evidence support my prediction that the relationship between the magnitude of grievances and the likelihood of repression is non-monotone.

Impfung gegen humane Papillomaviren (HPV) zur Prävention HPV 16/18 induzierter Zervixkarzinome und derer Vorstufen

Einleitung: Notwendige Voraussetzung für die Entstehung von Zervixkarzinomen ist eine persistierende Infektion mit humanen Papillomaviren (HPV). Die HPV-Typen 16 und 18 verursachen mit etwa 70% den überwiegenden Teil der Zervixkarzinome. Seit 2006/2007 stehen zwei Impfstoffe gegen HPV 16 und 18 zur Verfügung. Fragestellung: Wie effektiv ist die HPV-Impfung hinsichtlich der Reduktion von Zervixkarzinomen bzw. ihren Vorstufen (CIN)? Stellt die HPV-Impfung eine kosteneffektive Ergänzung zur derzeitigen Screeningpraxis dar? Gibt es Unterschiede bezüglich der Kosten-Effektivität zwischen den beiden verfügbaren Impfstoffen? Sollte aus gesundheitsökonomischer Perspektive eine Empfehlung für den Einsatz der HPV-Impfung gegeben werden? Falls ja, welche Empfehlungen bezüglich der Ausgestaltung einer Impfstrategie lassen sich ableiten? Welche ethischen, sozialen und juristischen Implikationen sind zu berücksichtigen? Methoden: Basierend auf einer systematischen Literaturrecherche werden randomisierte kontrollierte Studien zur Wirksamkeit der HPV-Impfungen für die Prävention von Zervixkarzinomen bzw. deren Vorstufen, den zervikalen intraepithelialen Neoplasien, identifiziert. Gesundheitsökonomische Modellierungen werden zur Beantwortung der ökonomischen Fragestellungen herangezogen. Die Beurteilung der Qualität der medizinischen und ökonomischen Studien erfolgt mittels anerkannter Standards zur systematischen Bewertung wissenschaftlicher Studien Ergebnisse: Bei zu Studienbeginn HPV 16/18 negativen Frauen, die alle Impfdosen erhalten haben, liegt die Wirksamkeit der Impfungen gegen HPV 16/18-induzierten CIN 2 oder höher bei 98% bis 100%. Nebenwirkungen der Impfung sind vor allem mit der Injektion assoziierte Beschwerden (Rötungen, Schwellungen, Schmerzen). Es gibt keine signifikanten Unterschiede für schwerwiegende unerwünschte Ereignisse zwischen Impf- und Placebogruppe. Die Ergebnisse der Basisfallanalysen der gesundheitsökonomischen Modellierungen reichen bei ausschließlicher Berücksichtigung direkter Kostenkomponenten von ca. 3.000 Euro bis ca. 40.000 Euro pro QALY (QALY = Qualitätskorrigiertes Lebensjahr), bzw. von ca. 9.000 Euro bis ca. 65.000 Euro pro LYG (LYG = Gewonnenes Lebensjahr). Diskussion: Nach den Ergebnissen der eingeschlossenen Studien sind die verfügbaren HPV-Impfstoffe wirksam zur Prävention gegen durch HPV 16/18 verursachte prämaligne Läsionen der Zervix. Unklar ist derzeit noch die Dauer des Impfschutzes. Hinsichtlich der Nebenwirkungen ist die Impfung als sicher einzustufen. Allerdings ist die Fallzahl der Studien nicht ausreichend groß, um das Auftreten sehr seltener Nebenwirkungen zuverlässig zu bestimmen. Inwieweit die HPV-Impfung zur Reduktion der Inzidenz und Mortalität des Zervixkarzinoms in Deutschland führen wird, hängt nicht allein von der klinischen Wirksamkeit der Impfstoffe ab, sondern wird von einer Reihe weiterer Faktoren wie der Impfquote oder den Auswirkungen der Impfungen auf die Teilnahmerate an den bestehenden Screeningprogrammen determiniert. Infolge der Heterogenität der methodischen Rahmenbedingungen und Inputparameter variieren die Ergebnisse der gesundheitsökonomischen Modellierungen erheblich. Fast alle Modellanalysen lassen jedoch den Schluss zu, dass die Einführung einer Impfung mit lebenslanger Schutzdauer bei Fortführung der derzeitigen Screeningpraxis als kosteneffektiv zu bewerten ist. Eine Gegenüberstellung der beiden verschiedenen Impfstoffe ergab, dass die Modellierung der tetravalenten Impfung bei der Berücksichtigung von QALY als Ergebnisparameter in der Regel mit einem niedrigeren (besseren) Kosten-Effektivitäts-Verhältnis einhergeht als die Modellierung der bivalenten Impfung, da auch Genitalwarzen berücksichtigt werden. In Sensitivitätsanalysen stellten sich sowohl die Schutzdauer der Impfung als auch die Höhe der Diskontierungsrate als wesentliche Einflussparameter der Kosten-Effektivität heraus. Schlussfolgerung: Die Einführung der HPV-Impfung kann zu einem verringerten Auftreten von Zervixkarzinomen bei geimpften Frauen führen. Jedoch sollten die Impfprogramme von weiteren Evaluationen begleitet werden, um die langfristige Wirksamkeit und Sicherheit beurteilen sowie die Umsetzung der Impfprogramme optimieren zu können. Von zentraler Bedeutung sind hohe Teilnahmeraten sowohl an den Impfprogrammen als auch - auch bei geimpften Frauen - an den Früherkennungsuntersuchungen. Da die Kosten-Effektivität entscheidend von der Schutzdauer, die bislang ungewiss ist, beeinflusst wird, ist eine abschließende Beurteilung der Kosten-Effektivität der HPV-Impfung nicht möglich. Eine langfristige Schutzdauer ist eine bedeutende Vorraussetzung für die Kosten-Effektivität der Impfung. Der Abschluss einer Risk-Sharing-Vereinbarung zwischen Kostenträgern und Herstellerfirmen stellt eine Option dar, um die Auswirkungen der Unsicherheit der Schutzdauer auf die Kosten-Effektivität zu begrenzen.

The Sugar Factory

Luke Banas is a young video artist who lives illegally in the disused Domino sugar refinery in Williamsburg, Brooklyn. While his art is an attempt to fully record and share his own life story, developers want to tear down the building where he works; a building that’s a monument to his hip neighborhood’s industrial past. The novel’s narrator, Lila Fairfax, is a journalist writing her first feature article about Luke and the fate of the factory. Observant and astute, she soon realizes that, despite his obsessive self-revelation, Luke is hiding a secret. Lila’s rational, detached approach to life is disrupted as, in the course of her reporting, she falls in love with Luke and as a result, learns far more than she anticipated. Though primarily a love story, The Sugar Factory is also an investigation of art, and art’s interaction with commerce, history, and new technology.