Sediment, water and biomass characteristics along gradients in Kongsfjorden, Svalbard

In contrast to numerous studies on the biomass of marine microphytobenthos from temperate coastal ecosystems, little is known from polar regions. Therefore, microphytobenthos biomass was measured at several coastal sites in Arctic Kongsfjorden (Spitsbergen) during the polar summer (June-August 2006). On sandy sediments, chla varied between 8 and 200 mg/m**2 and was related to water depth, current/wave exposure and geographical location. Biomass was rather independent of abiotic parameters such as sediment properties, salinity, temperature or light availability. At three stations, sediments at water depths of 3-4, 10, 15, 20 and 30 m were investigated to evaluate the effect of light availability on microalgae. Significant differences in distribution patterns of biomass in relation to deeper waters >10 m were found. The productive periods were not as distinct as phytoplankton blooms. Only at 3-4 m water depth at all three stations were two- to threefold increases of biomass measured during the investigation period. Hydrodynamic conditions seemed to be the driving force for differences in sediment colonisation by benthic microalgae. In spite of the extreme Arctic environmental conditions for algal growth, microphytobenthos biomass was comparable to marine temperate waters.

Antarctic sympagic meiofauna in winter

This study of Antarctic sympagic meiofauna in pack ice during late winter compares communities between the perennially ice-covered western Weddell Sea and the seasonally ice-covered southern Indian Ocean. Sympagic meiofauna (proto- and metazoans > 20 µm) and eggs > 20 µm were studied in terms of diversity, abundance and carbon biomass, and with respect to vertical distribution. Metazoan meiofauna had significantly higher abundance and biomass in the western Weddell Sea (medians: 31.1 * 10**3/m**2 and 6.53 mg/m**2, respectively) than in the southern Indian Ocean (medians: 1.0 * 10**3 /m**2 and 0.06 mg/m**2, respectively). Metazoan diversity was also significantly higher in the western Weddell Sea. Furthermore, the two regions differed significantly in terms of meiofauna community composition, as revealed through multivariate analyses. The overall diversity of sympagic meiofauna was high, and integrated abundance and biomass of total meiofauna were also high in both regions (0.6 - 178.6 * 10**3/m**2 and 0.02 - 89.70 mg/m**2, respectively), mostly exceeding values reported earlier from the western Weddell Sea in winter. We attribute the differences in meiofauna communities between the two regions to the older first-year ice and multi-year ice that is present in the western Weddell Sea, but not in the southern Indian Ocean. Our study indicates the significance of perennially ice-covered regions for the establishment of diverse and abundant meiofauna communities. Furthermore, it highlights the potential importance of sympagic meiofauna for the organic matter pool and trophic interactions in sea ice.

Determinação voltamétrica de zinco empregando eletrodos quimicamente modificados com bismuto

This dissertation presents the development of voltammetric methods to zinc determination in multivitamin commercial samples, talc, and art materials for painting (soft pastel) combining an alkaline extraction with 1.0 mol L-1 NaOH aqueous solution and bismuth modified electrodes. Two electrodes were used to zinc quantification in the samples, bismuth film electrode (BiFE) plated in situ onto glassy carbon and carbon paste electrode chemically modified with strongly acidic ion exchange resin Amberlite® IR 120 and bismuth nanostructures (EPCAmbBi). It was verified that the best concentration of Bi3+ for Bi film deposition onto glassy carbon was 4.0 μmol L-1 using an 0.1 mol L-1 acetate buffer aqueous solution (pH = 4.5) as supporting electrolyte. The best condition to formation of Bi nanostructures in the EPC modified with 10 % Amberlite® IR 120 was the use of 30 s to pre-concentration (open circuit) in 0.5 mmol L-1 Bi3+ aqueous solution (pH 5.5) prepared with supporting electrolyte solution. The obtained analytical curve for Zn2+ using BiFE presented linear range from 0.5 to 5.0 μmol L-1, the limit of detection (LD) was 41 nmol L-1. For EPCAmbBi only one linear range was observed for the analytical curve varying the Zn2+ concentration from 0.05 to 8.2 μmol L-1, LD obtained in this curve it was equal to 10 nmol L-1. The EPCAmbBi presented the most intense and sharp anodic stripping peaks for Zn2+ presenting, therefore, a better voltammetric profile, with sensitivity higher than obtained with the BiFE. Moreover, the EPCAmbBi presented a LD lower than that obtained with the BiFE. Alkaline extraction was an efficient sample pretreatment to extract Zn2+ from solid samples, besides that, this procedure was less susceptible to interferences from Cu2+, since it remains at extracting vessel as insoluble Cu(OH)2. The combination of alkaline extraction with the EPCAmbBi is a simple, fast, efficient and low cost for the zinc determination in pharmaceutical formulations and art materials for painting (soft pastel) samples, which can be employed as a low-cost alternative method to the atomic absorption spectroscopy.

A Randomized Phase II Crossover Study of Imatinib or Rituximab for Cutaneous Sclerosis after Hematopoietic Cell Transplantation.

PURPOSE: Cutaneous sclerosis occurs in 20% of patients with chronic graft-versus-host disease (GVHD) and can compromise mobility and quality of life. EXPERIMENTAL DESIGN: We conducted a prospective, multicenter, randomized, two-arm phase II crossover trial of imatinib (200 mg daily) or rituximab (375 mg/m(2) i.v. weekly × 4 doses, repeatable after 3 months) for treatment of cutaneous sclerosis diagnosed within 18 months (NCT01309997). The primary endpoint was significant clinical response (SCR) at 6 months, defined as quantitative improvement in skin sclerosis or joint range of motion. Treatment success was defined as SCR at 6 months without crossover, recurrent malignancy or death. Secondary endpoints included changes of B-cell profiles in blood (BAFF levels and cellular subsets), patient-reported outcomes, and histopathology between responders and nonresponders with each therapy. RESULTS: SCR was observed in 9 of 35 [26%; 95% confidence interval (CI); 13%-43%] participants randomized to imatinib and 10 of 37 (27%; 95% CI, 14%-44%) randomized to rituximab. Six (17%; 95% CI, 7%-34%) patients in the imatinib arm and 5 (14%; 95% CI, 5%-29%) in the rituximab arm had treatment success. Higher percentages of activated B cells (CD27(+)) were seen at enrollment in rituximab-treated patients who had treatment success (P = 0.01), but not in imatinib-treated patients. CONCLUSIONS: These results support the need for more effective therapies for cutaneous sclerosis and suggest that activated B cells define a subgroup of patients with cutaneous sclerosis who are more likely to respond to rituximab.

The geochemistry, mineralogy, and petrology of basalts at DSDP Leg 59 Holes

Legs 59 and 60 of the International Phase of Oceanic Drilling (IPOD) were designed to study the nature and history of volcanism of the active Mariana arc, its currently spreading inter-arc basin (the Mariana Trough), and the series of inactive basins and intervening ridges that lie to the west. The older basins and ridges were drilled during Leg 59 as the first part of a transect of single-bit holes drilled in each major basin and ridge. The eastern part of the transect - the technically active region - was drilled during Leg 60. The evolution of island-arc volcanos and magma genesis associated with lithospheric subduction remain some of the most complex petrologic problems confronting us. Many types of source material (mantle, oceanic crust, continental crust) and an unusually wide range of possible physical conditions at the time of magma genesis must be identified even before the roles of partial melting and subsequent magma fractionation, mixing, and contamination can be assessed.

Meteorological observations and eddy covariance raw data from polygonal tundra in the Lena River Delta, Siberia

We present the first ecosystem-scale methane flux data from a northern Siberian tundra ecosystem covering the entire snow-free period from spring thaw until initial freeze-back. Eddy covariance measurements of methane emission were carried out from the beginning of June until the end of September in the southern central part of the Lena River Delta (72°22' N, 126°30' E). The study site is located in the zone of continuous permafrost and is characterized by Arctic continental climate with very low precipitation and a mean annual temperature of -14.7°C. We found relatively low fluxes of on average 18.7 mg/m**2/d, which we consider to be because of (1) extremely cold permafrost, (2) substrate limitation of the methanogenic archaea, and (3) a relatively high surface coverage of noninundated, moderately moist areas. Near-surface turbulence as measured by the eddy covariance system in 4 m above the ground surface was identified as the most important control on ecosystem-scale methane emission and explained about 60% of the variance in emissions, while soil temperature explained only 8%. In addition, atmospheric pressure was found to significantly improve an exponential model based on turbulence and soil temperature. Ebullition from waterlogged areas triggered by decreasing atmospheric pressure and near-surface turbulence is thought to be an important pathway that warrants more attention in future studies. The close coupling of methane fluxes and atmospheric parameters demonstrated here raises questions regarding the reliability of enclosure-based measurements, which inherently exclude these parameters.

Chemical composition of igneous rocks and origin of the sill and pillow-basalt complex at DSDP Site 61-462

The sill and pillow complex cored on Deep Sea Drilling Project Leg 61 (Site 462) is divided into two groups, A and B types, on the basis of chemical composition and volcanostratigraphy. The A-type basalt is characterized by a higher FeO*/MgO ratio and abundant TiO2, whereas the B-type basalt is characterized by a lower FeO*/MgO ratio and scarcity of TiO2. The A type is composed of sills interbedded with hyaloclastic sediments, and the B type consists of basalt sills and pillow basalt with minor amounts of sediment. However, the structure of pillow basalts in the B type is atypical; they might be eruptive. From paleontological study of the interbedded sediments and radiometric age determination of the basalt, the volcanic event of A type is assumed to be Cenomanian to Aptian, and that of B type somewhat older. The oceanic crust in the Nauru Basin was assumed to be Oxfordian, based on the Mesozoic magnetic anomaly. Consequently, two events of intraplate volcanism are recognized. It is thus assumed that the sill-pillow complex did not come from a normal oceanic ridge, and that normal oceanic basement could therefore underlie the complex. The Site 462 basalts are quartz-normative, and strongly hypersthene-normative, and have a higher FeO*/MgO ratio and lower TiO2 content. Olivine from the Nauru Basin basalts has a lower Mg/(Mg + Fe**2+) ratio (0.83-0.84) and coexists with spinel of lower Mg/(Mg + Fe**2+) ratio when compared to olivine-spinel pairs from mid-ocean ridge (MAR) basalt. The glass of spinel-bearing basalts has a higher FeO*/(FeO* + MgO) ratio (0.58-0.60) than that of MAR (<0.575). Therefore, the Nauru Basin basalts are chemically and mineralogically distinct from ocean-ridge tholeiite. That the Nauru Basin basalts are quartz-normative and strongly hypersthene-normative and have a lower TiO2 content suggests that the basaltic liquids of Site 462 were generated at shallower depths (<5 kbar) than ocean-ridge tholeiite: Site 462 basalts are similar to basalts from the Manihiki Plateau and the Ontong-Java Plateau, but different from Hawaiian tholeiite of hot-spot type, with lower K2O and TiO2 content. We propose a new type of basalt, ocean-plateau tholeiite, a product of intraplate volcanism.

Biological impacts of enhanced alkalinity in Carcinus maenas

Further steps are needed to establish feasible alleviation strategies that are able to reduce the impacts of ocean acidification, whilst ensuring minimal biological side-effects in the process. Whilst there is a growing body of literature on the biological impacts of many other carbon dioxide reduction techniques, seemingly little is known about enhanced alkalinity. For this reason, we investigated the potential physiological impacts of using chemical sequestration as an alleviation strategy. In a controlled experiment, Carcinus maenas were acutely exposed to concentrations of Ca(OH)2 that would be required to reverse the decline in ocean surface pH and return it to pre-industrial levels. Acute exposure significantly affected all individuals' acid-base balance resulting in slight respiratory alkalosis and hyperkalemia, which was strongest in mature females. Although the trigger for both of these responses is currently unclear, this study has shown that alkalinity addition does alter acid-base balance in this comparatively robust crustacean species.

Particle fluxes of the bathypelagic sediment trap CVOO-3 in the eastern tropical North Atlantic for the period December 2009 until May 2011

Particle fluxes at the Cape Verde Ocean Observatory (CVOO) in the eastern tropical North Atlantic for the period December 2009 until May 2011 are discussed based on bathypelagic sediment trap time-series data collected at 1290 and 3439 m water depth. The typically oligotrophic particle flux pattern with weak seasonality is modified by the appearance of a highly productive and low oxygen (minimum concentration below 2 µmol kg**-1 at 40 m depth) anticyclonic modewater eddy (ACME) in winter 2010. The eddy passage was accompanied by unusually high mass fluxes of up to 151 mg m**-2 d**-1, lasting from December 2009 to May 2010. Distinct biogenic silica (BSi) and organic carbon flux peaks of ~15 and 13.3 mg m**-2 d**-1, respectively, were observed in February-March 2010 when the eddy approached the CVOO. The flux of the lithogenic component, mostly mineral dust, was well correlated with that of organic carbon, in particular in the deep trap samples, suggesting a tight coupling. The lithogenic ballasting obviously resulted in high particle settling rates and, thus, a fast transfer of epi-/meso-pelagic signatures to the bathypelagic traps. We suspect that the two- to three-fold increase in particle fluxes with depth as well as the tight coupling of mineral dust and organic carbon in the deep trap samples might be explained by particle focusing processes within the deeper part of the eddy. Molar C : N ratios of organic matter during the ACME passage were around 18 and 25 for the upper and lower trap samples, respectively. This suggests that some productivity under nutrient (nitrate) limitation occurred in the euphotic zone of the eddy in the beginning of 2010 or that a local nitrogen recycling took place. The d15N record showed a decrease from 5.21 to 3.11 per mil from January to March 2010, while the organic carbon and nitrogen fluxes increased. The causes of enhanced sedimentation from the eddy in February/March 2010 remain elusive, but nutrient depletion and/or an increased availability of dust as a ballast mineral for organic-rich aggregates might have contributed. Rapid remineralisation of sinking organic-rich particles could have contributed to oxygen depletion at shallow depth. Although the eddy formed in the West African coastal area in summer 2009, no indications of coastal flux signatures (e.g. from diatoms) were found in the sediment trap samples, confirming the assumption that the suboxia developed within the eddy en route. However, we could not detect biomarkers indicative of the presence of anammox (anaerobic ammonia oxidation) bacteria or green sulfur bacteria thriving in photic zone suboxia/hypoxia, i.e. ladderane fatty acids and isorenieratene derivatives, respectively. This could indicate that suboxic conditions in the eddy had recently developed and/or the respective bacterial stocks had not yet reached detection thresholds. Another explanation is that the fast-sinking organic-rich particles produced in the surface layer did not interact with bacteria from the suboxic zone below. Carbonate fluxes dropped from -52 to 21.4 mg m**-2 d**-1 from January to February 2010, respectively, mainly due to reduced contribution of shallow-dwelling planktonic foraminifera and pteropods. The deep-dwelling foraminifera Globorotalia menardii, however, showed a major flux peak in February 2010, most probably due to the suboxia/hypoxia. The low oxygen conditions forced at least some zooplankton to reduce diel vertical migration. Reduced "flux feeding" by zooplankton in the epipelagic could have contributed to the enhanced fluxes of organic materials to the bathypelagic traps during the eddy passage. Further studies are required on eddy-induced particle production and preservation processes and particle focusing.

Ecophysiology of Adonis distorta, a high-mountain species endemic of the Central Apennines

Morphological, anatomical and physiological plant and leaf traits of A. distorta, an endemic species of the Central Apennines on the Majella Massif, growing at 2,675 m a.s.l, were analyzed. The length of the phenological cycle starts immediately after the snowmelt at the end of May, lasting 128 ± 10 days. The low A. distorta height  (Hmax= 64 ± 4 mm) and total leaf area (TLA= 38 ± 9 cm2) associated to a high leaf mass area (LMA =11.8±0.6 mg cm−2) and a relatively high leaf tissue density (LTD = 124.6±14.3 mg cm−3) seem to be adaptive traits to the stress factors of the environment where it grows. From a physiological point of view, the high A. distorta photosynthetic rates (PN =19.6 ± 2.3 µmol m−2 s−1) and total chlorophyll content (Chla+b = 0.88 ± 0.13 mg g−1) in July are justified by the favorable temperature. PN decreases by 87% in September at the beginning of plant senescence. Photosynthesis and leaf respiration (RD) variations allow A. distorta to maintain a positive carbon balance during the growing season becoming indicative of the efficiency of plant carbon use. The results could be an important tool for conservation programmes of the A. distorta wild populations.

Late cardiac effects of chemotherapy in breast cancer survivors treated with adjuvant doxorubicin: 10-year follow-up

Doxorubicin (Dox), a mainstay of adjuvant breast cancer treatment, is associated with cardiac toxicity in the form of left ventricular dysfunction (LVD), LV diastolic dysfunction, or LV systolic dysfunction. Study objectives were to evaluate the prevalence of LVD in long-term breast cancer survivors treated with Dox and determine if brain-type natriuretic peptide (BNP) may help identify patients at risk for LVD. Patients who participated in prospective clinical trials of adjuvant Dox-based chemotherapy for breast cancer with a baseline left ventricular (LV) ejection fraction evaluation from 1999 to 2006 were retrospectively identified from the St Vincent's University Hospital database. Patients were invited to undergo transthoracic echocardiography, BNP analysis, and cardiovascular (CV) risk factor assessment. LVDD was defined as left atrial volume index >34 mL/m(2) and/or lateral wall E prime <10 m/s, and LVSD as LVEF <50 %. Of 212 patients identified, 154 participated, 19 patients had died (no cardiac deaths), and 39 declined. Mean age was 60.7 [55:67] years. A majority of the patients (128, 83 %) had low CV risk (0/1 risk factors), 21 (13.6 %) had 2 RFs, and 5 (3.2 %) ≥3 RFs. BMI was 27.2 ± 4.9 kg/m(2). Median Dox dose was 240 mg/m(2) [225-298]; 92 patients (59.7 %) received ≤240 mg/m(2) and 62 (40.3 %) > 240 mg/m(2). Baseline LVEF was 68.2 ± 8 %. At follow-up of 10.8 ± 2.2 years, LVEF was 64.4 ± 6 %. Three (1.9 %) subjects had LVEF <50 % and one (0.7 %) had LVDD. Dox >240 mg/m2 was associated with any LVEF drop. BNP levels at follow-up were 20.3 pg/ml [9.9-36.5] and 21.1 pg/ml [9.8-37.7] in those without LVD and 61.5 pg/ml [50-68.4] in those with LVD (p = 0.04). Long-term prospective data describing the impact of Dox on cardiotoxicity are sparse. At over 10 years of follow-up, decreases in LVEF are common, and dose related, but LVD as defined is infrequent (2.6 %). Monitoring with BNP for subclinical LVD needs further evaluation.

Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for patients with previously untreated advanced oesophagogastric cancer (REAL3): a randomised, open-label phase 3 trial.

BACKGROUND: EGFR overexpression occurs in 27-55% of oesophagogastric adenocarcinomas, and correlates with poor prognosis. We aimed to assess addition of the anti-EGFR antibody panitumumab to epirubicin, oxaliplatin, and capecitabine (EOC) in patients with advanced oesophagogastric adenocarcinoma. METHODS: In this randomised, open-label phase 3 trial (REAL3), we enrolled patients with untreated, metastatic, or locally advanced oesophagogastric adenocarcinoma at 63 centres (tertiary referral centres, teaching hospitals, and district general hospitals) in the UK. Eligible patients were randomly allocated (1:1) to receive up to eight 21-day cycles of open-label EOC (epirubicin 50 mg/m(2) and oxaliplatin 130 mg/m(2) on day 1 and capecitabine 1250 mg/m(2) per day on days 1-21) or modified-dose EOC plus panitumumab (mEOC+P; epirubicin 50 mg/m(2) and oxaliplatin 100 mg/m(2) on day 1, capecitabine 1000 mg/m(2) per day on days 1-21, and panitumumab 9 mg/kg on day 1). Randomisation was blocked and stratified for centre region, extent of disease, and performance status. The primary endpoint was overall survival in the intention-to-treat population. We assessed safety in all patients who received at least one dose of study drug. After a preplanned independent data monitoring committee review in October, 2011, trial recruitment was halted and panitumumab withdrawn. Data for patients on treatment were censored at this timepoint. This study is registered with ClinicalTrials.gov, number NCT00824785. FINDINGS: Between June 2, 2008, and Oct 17, 2011, we enrolled 553 eligible patients. Median overall survival in 275 patients allocated EOC was 11.3 months (95% CI 9.6-13.0) compared with 8.8 months (7.7-9.8) in 278 patients allocated mEOC+P (hazard ratio [HR] 1.37, 95% CI 1.07-1.76; p=0.013). mEOC+P was associated with increased incidence of grade 3-4 diarrhoea (48 [17%] of 276 patients allocated mEOC+P vs 29 [11%] of 266 patients allocated EOC), rash (29 [11%] vs two [1%]), mucositis (14 [5%] vs none), and hypomagnesaemia (13 [5%] vs none) but reduced incidence of haematological toxicity (grade ≥ 3 neutropenia 35 [13%] vs 74 [28%]). INTERPRETATION: Addition of panitumumab to EOC chemotherapy does not increase overall survival and cannot be recommended for use in an unselected population with advanced oesophagogastric adenocarcinoma. FUNDING: Amgen, UK National Institute for Health Research Biomedical Research Centre.

A Phase II Biomarker-Embedded Study of Lapatinib plus Capecitabine as First-line Therapy in Patients with Advanced or Metastatic Gastric Cancer

An exploratory phase II biomarker-embedded trial (LPT109747; NCT00526669) designed to determine the association of lapatinib-induced fluoropyrimidine gene changes with efficacy of lapatinib plus capecitabine as first-line treatment for advanced gastric cancer or gastroesophageal junction adenocarcinoma independent of tumor HER2 status. Tumor biopsies obtained before and after 7-day lapatinib (1,250 mg) to analyze changes in gene expression, followed by a 14-day course of capecitabine (1,000 mg/m(2) twice daily, 14/21 days) plus lapatinib 1,250 mg daily. Blood samples were acquired for pharmacokinetic analysis. Primary clinical objectives were response rate (RR) and 5-month progression-free survival (PFS). Secondary objectives were overall survival (OS), PFS, time to response, duration of response, toxicity, and identification of associations between lapatinib pharmacokinetics and biomarker endpoints. Primary biomarker objectives were modulation of 5-FU-pathway genes by lapatinib, effects of germline SNPs on treatment outcome, and trough steady-state plasma lapatinib concentrations. Sixty-eight patients were enrolled; (75% gastric cancer, 25% gastroesophageal junction). Twelve patients (17.9%) had confirmed partial response, 31 (46.3%) had stable disease, and 16 (23.9%) had progressive disease. Median PFS and OS were 3.3 and 6.3 months, respectively. Frequent adverse events included diarrhea (45%), decreased appetite (39%), nausea (36%), and fatigue (36%). Lapatinib induced no changes in gene expression from baseline and no significant associations were found for SNPs analyzed. Elevated baseline HER3 mRNA expression was associated with a higher RR (33% vs. 0%; P = 0.008). Lapatinib plus capecitabine was well tolerated, demonstrating modest antitumor activity in patients with advanced gastric cancer. The association of elevated HER3 and RR warrants further investigation as an important player for HER-targeted regimens in combination with capecitabine

Cabazitaxel for Hormone-Relapsed Metastatic Prostate Cancer Previously Treated With a Docetaxel-Containing Regimen: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the company that manufactures cabazitaxel (Jevtana(®), Sanofi, UK) to submit evidence for the clinical and cost effectiveness of cabazitaxel for treatment of patients with metastatic hormone-relapsed prostate cancer (mHRPC) previously treated with a docetaxel-containing regimen. The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology based upon the company's submission to NICE. Clinical evidence for cabazitaxel was derived from a multinational randomised open-label phase III trial (TROPIC) of cabazitaxel plus prednisone or prednisolone compared with mitoxantrone plus prednisone or prednisolone, which was assumed to represent best supportive care. The NICE final scope identified a further three comparators: abiraterone in combination with prednisone or prednisolone; enzalutamide; and radium-223 dichloride for the subgroup of people with bone metastasis only (no visceral metastasis). The company did not consider radium-223 dichloride to be a relevant comparator. Neither abiraterone nor enzalutamide has been directly compared in a trial with cabazitaxel. Instead, clinical evidence was synthesised within a network meta-analysis (NMA). Results from TROPIC showed that cabazitaxel was associated with a statistically significant improvement in both overall survival and progression-free survival compared with mitoxantrone. Results from a random-effects NMA, as conducted by the company and updated by the ERG, indicated that there was no statistically significant difference between the three active treatments for both overall survival and progression-free survival. Utility data were not collected as part of the TROPIC trial, and were instead taken from the company's UK early access programme. Evidence on resource use came from the TROPIC trial, supplemented by both expert clinical opinion and a UK clinical audit. List prices were used for mitoxantrone, abiraterone and enzalutamide as directed by NICE, although commercial in-confidence patient-access schemes (PASs) are in place for abiraterone and enzalutamide. The confidential PAS was used for cabazitaxel. Sequential use of the advanced hormonal therapies (abiraterone and enzalutamide) does not usually occur in clinical practice in the UK. Hence, cabazitaxel could be used within two pathways of care: either when an advanced hormonal therapy was used pre-docetaxel, or when one was used post-docetaxel. The company believed that the former pathway was more likely to represent standard National Health Service (NHS) practice, and so their main comparison was between cabazitaxel and mitoxantrone, with effectiveness data from the TROPIC trial. Results of the company's updated cost-effectiveness analysis estimated a probabilistic incremental cost-effectiveness ratio (ICER) of £45,982 per quality-adjusted life-year (QALY) gained, which the committee considered to be the most plausible value for this comparison. Cabazitaxel was estimated to be both cheaper and more effective than abiraterone. Cabazitaxel was estimated to be cheaper but less effective than enzalutamide, resulting in an ICER of £212,038 per QALY gained for enzalutamide compared with cabazitaxel. The ERG noted that radium-223 is a valid comparator (for the indicated sub-group), and that it may be used in either of the two care pathways. Hence, its exclusion leads to uncertainty in the cost-effectiveness results. In addition, the company assumed that there would be no drug wastage when cabazitaxel was used, with cost-effectiveness results being sensitive to this assumption: modelling drug wastage increased the ICER comparing cabazitaxel with mitoxantrone to over £55,000 per QALY gained. The ERG updated the company's NMA and used a random effects model to perform a fully incremental analysis between cabazitaxel, abiraterone, enzalutamide and best supportive care using PASs for abiraterone and enzalutamide. Results showed that both cabazitaxel and abiraterone were extendedly dominated by the combination of best supportive care and enzalutamide. Preliminary guidance from the committee, which included wastage of cabazitaxel, did not recommend its use. In response, the company provided both a further discount to the confidential PAS for cabazitaxel and confirmation from NHS England that it is appropriate to supply and purchase cabazitaxel in pre-prepared intravenous-infusion bags, which would remove the cost of drug wastage. As a result, the committee recommended use of cabazitaxel as a treatment option in people with an Eastern Cooperative Oncology Group performance status of 0 or 1 whose disease had progressed during or after treatment with at least 225 mg/m(2) of docetaxel, as long as it was provided at the discount agreed in the PAS and purchased in either pre-prepared intravenous-infusion bags or in vials at a reduced price to reflect the average per-patient drug wastage.

Adsorption Calorimetry for Energy Conversion Technologies: Applications in Organic Photovoltaics, Catalysis, and Atomic Layer Deposition

Thesis (Ph.D.)--University of Washington, 2016-07