Improving the cost-effectiveness of photographic screening for diabetic macular oedema:a prospective, multi-centre, UK study

Background/aims: Retinal screening programmes in England and Scotland have similar photographic grading schemes for background (non-proliferative) and proliferative diabetic retinopathy, but diverge over maculopathy. We looked for the most cost-effective method of identifying diabetic macular oedema from retinal photographs including the role of automated grading and optical coherence tomography, a technology that directly visualises oedema. Methods: Patients from seven UK centres were recruited. The following features in at least one eye were required for enrolment: microaneurysms/dot haemorrhages or blot haemorrhages within one disc diameter, or exudates within one or two disc diameters of the centre of the macula. Subjects had optical coherence tomography and digital photography. Manual and automated grading schemes were evaluated. Costs and QALYs were modelled using microsimulation techniques. Results: 3540 patients were recruited, 3170 were analysed. For diabetic macular oedema, England's scheme had a sensitivity of 72.6% and specificity of 66.8%; Scotland 's had a sensitivity of 59.5% and specificity of 79.0%. When applying a ceiling ratio of £30 000 per quality adjusted life years (QALY) gained, Scotland's scheme was preferred. Assuming automated grading could be implemented without increasing grading costs, automation produced a greater number of QALYS for a lower cost than England's scheme, but was not cost effective, at the study's operating point, compared with Scotland's. The addition of optical coherence tomography, to each scheme, resulted in cost savings without reducing health benefits. Conclusions: Retinal screening programmes in the UK should reconsider the screening pathway to make best use of existing and new technologies.

Lie-szimmetriák egy közgazdasági alkalmazása (An economic application of the Lie symmetries)

Ebben a tanulmányban ismertetjük a Nöther-tétel lényegi vonatkozásait, és kitérünk a Lie-szimmetriák értelmezésére abból a célból, hogy közgazdasági folyamatokra is alkalmazzuk a Lagrange-formalizmuson nyugvó elméletet. A Lie-szimmetriák dinamikai rendszerekre történő feltárása és viselkedésük jellemzése a legújabb kutatások eredményei e területen. Például Sen és Tabor (1990), Edward Lorenz (1963), a komplex kaotikus dinamika vizsgálatában jelent®s szerepet betöltő 3D modelljét, Baumann és Freyberger (1992) a két-dimenziós Lotka-Volterra dinamikai rendszert, és végül Almeida és Moreira (1992) a három-hullám interakciós problémáját vizsgálták a megfelelő Lie-szimmetriák segítségével. Mi most empirikus elemzésre egy közgazdasági dinamikai rendszert választottunk, nevezetesen Goodwin (1967) ciklusmodelljét. Ennek vizsgálatát tűztük ki célul a leírandó rendszer Lie-szimmetriáinak meghatározásán keresztül. / === / The dynamic behavior of a physical system can be frequently described very concisely by the least action principle. In the centre of its mathematical presentation is a specic function of coordinates and velocities, i.e., the Lagrangian. If the integral of the Lagrangian is stationary, then the system is moving along an extremal path through the phase space, and vice versa. It can be seen, that each Lie symmetry of a Lagrangian in general corresponds to a conserved quantity, and the conservation principle is explained by a variational symmetry related to a dynamic or geometrical symmetry. Briey, that is the meaning of Noether's theorem. This paper scrutinizes the substantial characteristics of Noether's theorem, interprets the Lie symmetries by PDE system and calculates the generators (symmetry vectors) on R. H. Goodwin's cyclical economic growth model. At first it will be shown that the Goodwin model also has a Lagrangian structure, therefore Noether's theorem can also be applied here. Then it is proved that the cyclical moving in his model derives from its Lie symmetries, i.e., its dynamic symmetry. All these proofs are based on the investigations of the less complicated Lotka Volterra model and those are extended to Goodwin model, since both models are one-to-one maps of each other. The main achievement of this paper is the following: Noether's theorem is also playing a crucial role in the mechanics of Goodwin model. It also means, that its cyclical moving is optimal. Generalizing this result, we can assert, that all dynamic systems' solutions described by first order nonlinear ODE system are optimal by the least action principle, if they have a Lagrangian.

Measurement of single spin asymmetry and fifth structure function for the p( e&ar; ,e'K +)Λ reaction with CEBAF Large Acceptance Spectrometer (CLAS)

The single spin asymmetry, ALT ′, and the polarized structure function, σ LT′, for the p( e&ar; , e′K +)Λ reaction in the resonance region have been measured and extracted using the CEBAF Large Acceptance Spectrometer (CLAS) at Jefferson Lab. Data were taken at an electron beam energy of 2.567 GeV. The large acceptance of CLAS allows for full azimuthal angle coverage over a large range of center-of-mass scattering angles. Results were obtained that span a range in Q 2 from 0.5 to 1.3 GeV2 and W from threshold up to 2.1 GeV and were compared to existing theoretical calculations. The polarized structure function is sensitive to the interferences between various resonant amplitudes, as well as to resonant and non-resonant amplitudes. This measurement is essential for understanding the structure of nucleons and searching for previously undetected nucleon excited states (resonances) predicted by quark models. The W dependence of the σ LT′ in the kinematic regions dominated by s and u channel exchange (cos qcmk = −0.50, −0.167, 0.167) indicated possible resonance structures not predicted by theoretical calculations. The σLT ′ behavior around W = 1.875 GeV could be the signature of a resonance predicted by the quark models and possibly seen in photoproduction. In the very forward angles where the reaction is dominated by the t-channel, the average σLT ′ was zero. There was no indication of the interference between resonances or resonant and non-resonant amplitudes. This might be indicating the dominance of a single t-channel exchange. Study of the sensitivity of the fifth structure function data to the resonance around 1900 MeV showed that these data were highly sensitive to the various assumptions of the models for the quantum number of this resonance. This project was part of a larger CLAS program to measure cross sections and polarization observables for kaon electroproduction in the nucleon resonance region. ^

Star formation in a stellar mass-selected sample of galaxies to z=3 from the GOODS-NICMOS Survey

We present a study of the star-forming properties of a stellar mass-selected sample of galaxies in the GOODS (Great Observatories Origins Deep Survey) NICMOS Survey (GNS), based on deep Hubble Space Telescope (HST) imaging of the GOODS North and South fields. Using a stellar mass-selected sample, combined with HST/ACS and Spitzer data to measure both ultraviolet (UV) and infrared-derived star formation rates (SFRs), we investigate the star forming properties of a complete sample of ∼1300 galaxies down to log M_*= 9.5 at redshifts 1.5 < z < 3. Eight per cent of the sample is made up of massive galaxies with M_*≥ 10^11 M_⊙. We derive optical colours, dust extinctions and UV and infrared SFR to determine how the SFR changes as a function of both stellar mass and time. Our results show that SFR increases at higher stellar mass such that massive galaxies nearly double their stellar mass from star formation alone over the redshift range studied, but the average value of SFR for a given stellar mass remains constant over this ∼2 Gyr period. Furthermore, we find no strong evolution in the SFR for our sample as a function of mass over our redshift range of interest; in particular we do not find a decline in the SFR among massive galaxies, as is seen at z < 1. The most massive galaxies in our sample (log M_*≥ 11) have high average SFRs with values SFR_UV, corr= 103 ± 75 M_⊙ yr^−1, and yet exhibit red rest-frame (U−B) colours at all redshifts. We conclude that the majority of these red high-redshift massive galaxies are red due to dust extinction. We find that A_2800 increases with stellar mass, and show that between 45 and 85 per cent of massive galaxies harbour dusty star formation. These results show that even just a few Gyr after the first galaxies appear, there are strong relations between the global physical properties of galaxies, driven by stellar mass or another underlying feature of galaxies strongly related to the stellar mass.

Isotopic ratios and ion composition of massive ground ice on Herschel Island

Herschel Island in the southern Beaufort Sea is a push moraine at the northwestern-most limit of the Laurentide Ice Sheet. Stable water isotope (d18O, dD) and hydrochemical studies were applied to two tabular massive ground ice bodies to unravel their genetic origin. Buried glacier ice or basal regelation ice was encountered beneath an ice-rich diamicton with strong glaciotectonic deformation structures. The massive ice isotopic composition was highly depleted in heavy isotopes (mean d18O: -33 per mil; mean dD: -258 per mil), suggesting full-glacial conditions during ice formation. Other massive ice of unknown origin with a very large d18O range (from -39 to -21 per mil) was found adjacent to large, striated boulders. A clear freezing slope was present with progressive depletion in heavy isotopes towards the centre of the ice body. Fractionation must have taken place during closed-system freezing, possibly of a glacial meltwater pond. Both massive ground ice bodies exhibited a mixed ion composition suggestive of terrestrial waters with a marine influence. Hydrochemical signatures resemble the Herschel Island sediments that are derived from nearshore marine deposits upthrust by the Laurentide ice. A prolonged contact between water feeding the ice bodies and the surrounding sediment is therefore inferred.

Specific mass blance of Aletschgletscher and Hintereisferner, Alps

More than 25 years of mass budget measurements of Hintereisferner allow a correlation with simultaneous observations of the climatological station Vent (1900 m a. s. l.). By this means it is possible to estimate the mass budget of earlier periods. Extreme values in the period between 1934/35 and 1951/52 span a range nearly twice as wide as in the pcriod thereafter.

Understandings of transnational families in debates on Migration and development

International migration sets in motion a range of significant transnational processes that connect countries and people. How migration interacts with development and how policies might promote and enhance such interactions have, since the turn of the millennium, gained attention on the international agenda. The recognition that transnational practices connect migrants and their families across sending and receiving societies forms part of this debate. The ways in which policy debate employs and understands transnational family ties nevertheless remain underexplored. This article sets out to discern the understandings of the family in two (often intermingled) debates concerned with transnational interactions: The largely state and policydriven discourse on the potential benefits of migration on economic development, and the largely academic transnational family literature focusing on issues of care and the micro-politics of gender and generation. Emphasizing the relation between diverse migration-development dynamics and specific family positions, we ask whether an analytical point of departure in respective transnational motherhood, fatherhood or childhood is linked to emphasizing certain outcomes. We conclude by sketching important strands of inclusions and exclusions of family matters in policy discourse and suggest ways to better integrate a transnational family perspective in global migration-development policy.

Development of Imaging Mass Spectrometry Analysis of Lipids in Biological and Clinically Relevant Applications

La spectrométrie de masse mesure la masse des ions selon leur rapport masse sur charge. Cette technique est employée dans plusieurs domaines et peut analyser des mélanges complexes. L’imagerie par spectrométrie de masse (Imaging Mass Spectrometry en anglais, IMS), une branche de la spectrométrie de masse, permet l’analyse des ions sur une surface, tout en conservant l’organisation spatiale des ions détectés. Jusqu’à présent, les échantillons les plus étudiés en IMS sont des sections tissulaires végétales ou animales. Parmi les molécules couramment analysées par l’IMS, les lipides ont suscité beaucoup d'intérêt. Les lipides sont impliqués dans les maladies et le fonctionnement normal des cellules; ils forment la membrane cellulaire et ont plusieurs rôles, comme celui de réguler des événements cellulaires. Considérant l’implication des lipides dans la biologie et la capacité du MALDI IMS à les analyser, nous avons développé des stratégies analytiques pour la manipulation des échantillons et l’analyse de larges ensembles de données lipidiques. La dégradation des lipides est très importante dans l’industrie alimentaire. De la même façon, les lipides des sections tissulaires risquent de se dégrader. Leurs produits de dégradation peuvent donc introduire des artefacts dans l’analyse IMS ainsi que la perte d’espèces lipidiques pouvant nuire à la précision des mesures d’abondance. Puisque les lipides oxydés sont aussi des médiateurs importants dans le développement de plusieurs maladies, leur réelle préservation devient donc critique. Dans les études multi-institutionnelles où les échantillons sont souvent transportés d’un emplacement à l’autre, des protocoles adaptés et validés, et des mesures de dégradation sont nécessaires. Nos principaux résultats sont les suivants : un accroissement en fonction du temps des phospholipides oxydés et des lysophospholipides dans des conditions ambiantes, une diminution de la présence des lipides ayant des acides gras insaturés et un effet inhibitoire sur ses phénomènes de la conservation des sections au froid sous N2. A température et atmosphère ambiantes, les phospholipides sont oxydés sur une échelle de temps typique d’une préparation IMS normale (~30 minutes). Les phospholipides sont aussi décomposés en lysophospholipides sur une échelle de temps de plusieurs jours. La validation d’une méthode de manipulation d’échantillon est d’autant plus importante lorsqu’il s’agit d’analyser un plus grand nombre d’échantillons. L’athérosclérose est une maladie cardiovasculaire induite par l’accumulation de matériel cellulaire sur la paroi artérielle. Puisque l’athérosclérose est un phénomène en trois dimension (3D), l'IMS 3D en série devient donc utile, d'une part, car elle a la capacité à localiser les molécules sur la longueur totale d’une plaque athéromateuse et, d'autre part, car elle peut identifier des mécanismes moléculaires du développement ou de la rupture des plaques. l'IMS 3D en série fait face à certains défis spécifiques, dont beaucoup se rapportent simplement à la reconstruction en 3D et à l’interprétation de la reconstruction moléculaire en temps réel. En tenant compte de ces objectifs et en utilisant l’IMS des lipides pour l’étude des plaques d’athérosclérose d’une carotide humaine et d’un modèle murin d’athérosclérose, nous avons élaboré des méthodes «open-source» pour la reconstruction des données de l’IMS en 3D. Notre méthodologie fournit un moyen d’obtenir des visualisations de haute qualité et démontre une stratégie pour l’interprétation rapide des données de l’IMS 3D par la segmentation multivariée. L’analyse d’aortes d’un modèle murin a été le point de départ pour le développement des méthodes car ce sont des échantillons mieux contrôlés. En corrélant les données acquises en mode d’ionisation positive et négative, l’IMS en 3D a permis de démontrer une accumulation des phospholipides dans les sinus aortiques. De plus, l’IMS par AgLDI a mis en évidence une localisation différentielle des acides gras libres, du cholestérol, des esters du cholestérol et des triglycérides. La segmentation multivariée des signaux lipidiques suite à l’analyse par IMS d’une carotide humaine démontre une histologie moléculaire corrélée avec le degré de sténose de l’artère. Ces recherches aident à mieux comprendre la complexité biologique de l’athérosclérose et peuvent possiblement prédire le développement de certains cas cliniques. La métastase au foie du cancer colorectal (Colorectal cancer liver metastasis en anglais, CRCLM) est la maladie métastatique du cancer colorectal primaire, un des cancers le plus fréquent au monde. L’évaluation et le pronostic des tumeurs CRCLM sont effectués avec l’histopathologie avec une marge d’erreur. Nous avons utilisé l’IMS des lipides pour identifier les compartiments histologiques du CRCLM et extraire leurs signatures lipidiques. En exploitant ces signatures moléculaires, nous avons pu déterminer un score histopathologique quantitatif et objectif et qui corrèle avec le pronostic. De plus, par la dissection des signatures lipidiques, nous avons identifié des espèces lipidiques individuelles qui sont discriminants des différentes histologies du CRCLM et qui peuvent potentiellement être utilisées comme des biomarqueurs pour la détermination de la réponse à la thérapie. Plus spécifiquement, nous avons trouvé une série de plasmalogènes et sphingolipides qui permettent de distinguer deux différents types de nécrose (infarct-like necrosis et usual necrosis en anglais, ILN et UN, respectivement). L’ILN est associé avec la réponse aux traitements chimiothérapiques, alors que l’UN est associé au fonctionnement normal de la tumeur.

Economic Development and Mass Poverty in Africa: Assessment of the Nigerian Experience

The forces surrounding the emerging economies of underdeveloped world, especially Africa has practically stifled its economic progress, growth, development and sustainability. This economic condition brings to the fore the massive onslaught of rural/urban poverty which the African continent grapples with since the post-world war II era to date. The economic misfortunes and incidence of mass poverty in Africa, vis-à-vis Nigeria is used as a point of departure in this study. The paper underscores the ideological and philosophical undertone of international capital manifesting in form of colonialism and imperialism as a major character in the historical process of underdevelopment and mass poverty in peripheral states of Africa, Asia and Latin America, respectively. Of particular interest in this study is the activities of domestic bourgeoisie elite class who have vigorously displayed some degree of lack of much needed vision and abject lack of desires to draw up workable plans to redeem the battered image of African/ Nigerian economic misfortunes. This state of affairs has practically engendered economic underdevelopment, misery and disturbing levels of poverty in the nation-state system. The paper concludes with the forward towards realizing the vision 20-20-20 objectives in the 21t century and beyond.

Effects of handling regime and sex on changes in cortisol, thyroid hormones and body mass in fasting grey seal pups

Survival of seal pups may be affected by their ability to respond appropriately to stress. Chronic stress can adversely affect secretion of cortisol and thyroid hormones, which contribute to the control of fuel utilisation. Repeated handling could disrupt the endocrine response to stress and/or negatively impact upon mass changes during fasting. Here we investigated the effects of handling regime on cortisol and thyroid hormone levels, and body mass changes, in fasting male and female grey seal pups (Halichoerus grypus). Females had higher thyroid hormone levels than males throughout fasting and showed a reduction in cortisol midway through the fast that was not seen in males. This may reflect sex-specific fuel allocation or development. Neither handling frequency nor cumulative contact time affected plasma cortisol or thyroid hormone levels, the rate of increase in cortisol over the first five minutes of physical contact or the pattern of mass loss during fasting in either sex. The endocrine response to stress and the control of energy balance in grey seal pups appear to be robust to repeated, short periods of handling. Our results suggest that routine handling should have no additional impact on these animals than general disturbance caused by researchers moving around the colony.

Fundamental Modes of Operation for Mass Customization

The concept of Mass Customization (MC) - producing customised goods for a mass market - has received considerable attention in the research literature in recent years. However the literature is limited in providing an understanding of the content of MC strategies (the organizational structures, process technologies, etc., that are best in a particular environment) and the process of MC strategies (the sub-strategy that an enterprise should select and how they should go about implementing an MC strategy). In this paper six published classification schemes of relevance to Mass Customization are reviewed. The classification schemes are applied to five case studies of enterprises operating in an MC environment. The limitations of the schemes are analysed and their failure to distinguish key characteristics is highlighted. Analysis of the findings leads to the development of a taxonomy of operational modes for MC. Five fundamental modes of operation for Mass Customization are identified. These modes are described and justified and their application is illustrated by contrasting the information requirements of two modes. The potential of these modes to provide the foundations for detailed configurations models is discussed.

Consideration of the relevance of standard quality techniques in Mass Customisation

The business philosophy of Mass Customisation (MC) implies rapid response to customer requests, high efficiency and limited cost overheads of customisation. Furthermore, it also implies the quality benefits of the mass production paradigm are guaranteed. However, traditional quality science in manufacturing is premised on volume production of uniform products rather than of differentiated products associated with MC. This creates quality challenges and raises questions over the suitability of standard quality engineering techniques. From an analysis of relevant MC and quality literature it is argued the aims of MC are aligned with contemporary thinking on quality and that quality concepts provide insights into MC. Quality issues are considered along three dimensions - product development, order fulfilment and customer interaction. The applicability and effectiveness of conventional quality engineering techniques are discussed and a framework is presented which identifies key issues with respect to quality for a spectrum of MC strategies.

Numerical investigations on the strain-adaptive bone remodelling in the periprosthetic femur: Influence of the boundary conditions

Background: There are several numerical investigations on bone remodelling after total hip arthroplasty (THA) on the basis of the finite element analysis (FEA). For such computations certain boundary conditions have to be defined. The authors chose a maximum of three static load situations, usually taken from the gait cycle because this is the most frequent dynamic activity of a patient after THA. Materials and methods: The numerical study presented here investigates whether it is useful to consider only one static load situation of the gait cycle in the FE calculation of the bone remodelling. For this purpose, 5 different loading cases were examined in order to determine their influence on the change in the physiological load distribution within the femur and on the resulting strain-adaptive bone remodelling. First, four different static loading cases at 25%, 45%, 65% and 85% of the gait cycle, respectively, and then the whole gait cycle in a loading regime were examined in order to regard all the different loadings of the cycle in the simulation. Results: The computed evolution of the apparent bone density (ABD) and the calculated mass losses in the periprosthetic femur show that the simulation results are highly dependent on the chosen boundary conditions. Conclusion: These numerical investigations prove that a static load situation is insufficient for representing the whole gait cycle. This causes severe deviations in the FE calculation of the bone remodelling. However, accompanying clinical examinations are necessary to calibrate the bone adaptation law and thus to validate the FE calculations.

Balancing the demands of two tasks: an investigation of cognitive-motor dual-tasking in relapsing remitting multiple sclerosis

Background: People with relapsing remitting MS (PwRRMS) suffer disproportionate decrements in gait under dual-task conditions, when walking and a cognitive task are combined. There has been much less investigation of the impact of cognitive demands on balance. This study investigated whether: (1) PwRRMS show disproportionate decrements in postural stability under dual-task conditions compared to healthy controls; (2) dual-task decrements are associated with everyday dual-tasking difficulties. In addition, the impact of mood, fatigue and disease severity on dual-tasking were also examined. Methods: 34 PwRRMS and 34 matched controls completed cognitive (digit span) and balance (movement of centre of pressure on a Biosway, on stable and unstable surfaces) tasks under single and dual-task conditions. Everyday dual-tasking was measured using the DTQ. Mood was measured by the HADS. Fatigue was measured via the MFIS. Results: No differences in age, gender, years of education, estimated pre-morbid IQ or baseline digit span between the groups. Compared to healthy controls, PwRRMS showed a significantly greater decrement in postural stability under dual-task conditions on an unstable surface (p=0.007), but not a stable surface (p=0.679). PwRRMS reported higher levels of everyday dual-tasking difficulties (p<0.001). Balance decrement scores were not correlated with everyday dual-tasking difficulties, or with fatigue. Stable surface balance decrement scores were significantly associated with levels of anxiety (rho=0.527, p=0.001) and depression (rho=0.451, p=0.007). Conclusion: RRMS causes difficulties with dual-tasking, impacting balance, particularly under challenging conditions, which may contribute to an increased risk of gait difficulties and falls. The striking relationship between anxiety/depression and dual-task decrement suggests that worry may be contributing to dual-task difficulties.

Relationship between internal derangement of temporomandibular joint and changes in body posture

Background: The presence of body posture changes among patients with temporomandibular disorders (TMD) has been a controversial issue in the literature, in which it supporters point out the muscular origin as the main etiological factors, mainly associated with postural changes in head. Due to this controversy, it is pertinent to check whether this relationship exists on the most common etiology of TMD, the disk displacement, which translates a biomechanical internal disorder of the temporomandibular joint (TMJ). Objectives: Assess body posture changes in subjects with internal derangement of the TMJ when compared to subjects without this biomechanical dysfunction, characterize the patterns of the jaw movements and assess to the muscle activation during jaw movements. Methods: 21 subjects with TMJ disc displacement (DD) (test group) and 21 subjects without any TMD (control group) was assessed for body posture changes through evaluation of several body segments by posturography and also was evaluated the postural balance reactions through the center of mass during jaw movements using a balance platform. For the characterization of the jaw movement patterns it was done a kinematic analysis during jaw movements (active ROM and path of the jaw). For the muscle activation during jaw movements it was evaluated the masseter, sternocleidomastoid and spinae erector muscles by surface electromyography (EMG). Results Discussion: Both groups show forward head posture and extension of the cervical spine, not noticing any other significant body posture changes in subjects with DD, and if we had to see in detail, in general, subjects without TMD shows more body posture changes than subjects with DD. The pattern of jaw movements is similar in both groups, but in subjects with DD the closing movements are more instable than the opening movements, related to a less effective movement control to counteract the force of gravity and the disk displacement. The bilateral muscle activation during jaw movements is higher in subjects with DD, likely related to a less stable pattern of movement which leads in a higher muscle activation to guide the movement and ensure the best as possible articular stability. Conclusion: The disk displacement with reduction should be viewed as part of a set of signs and symptoms that require an accurate musculoskeletal and psychosocial assessment towards an earlier diagnosis for reduction and control of the functional limiting factors. In this direction, it seems that the relevant set of limiting signs and symptoms deserve a particular attention by health care practitioners involved in the assessment and treatment of TMD, in order to define effective therapeutic options.