Cost effectiveness of photodynamic therapy with verteporfin for age related macular degeneration: the UK case

AIM: To estimate the potential cost effectiveness of photodynamic therapy (PDT) with verteporfin in the UK setting. METHODS: Using data from a variety of sources a Markov model was built to produce estimates of the cost effectiveness (incremental cost per quality adjusted life year (QALY) and incremental cost per vision year gained) of PDT for two cohorts of patients (one with starting visual acuity (VA) of 20/40 and one at 20/100) with predominantly classic choroidal neovascular disease over a 2 year and 5 year time horizon. A government perspective and a treatment cost only perspective were considered. Probabilistic and one way sensitivity analyses were undertaken. RESULTS: From the government perspective, over the 2 year period, the expected incremental cost effectiveness ratios range from £286 000 (starting VA 20/100) to £76 000 (starting VA 20/40) per QALY gained and from £14 000 (20/100) to £34 000 (20/40) per vision year gained. A 5 year perspective yields incremental ratios less than £5000 for vision years gained and from £9000 (20/40) to £30 000 (20/100) for QALYs gained. Without societal or NHS cost offsets included, the 2 year incremental cost per vision year gained ranges from £20 000 (20/100) to £40 000 (20/40), and the 2 year incremental cost per QALY gained ranges from £412 000 (20/100) to £90 000 (20/40). The 5 year time frame shows expected costs of £7000 (20/40) to £10 000 (20/100) per vision year gained and from £38 000 (20/40) to £69 000 (20/100) per QALY gained. CONCLUSION: This evaluation suggests that early treatment (that is, treating eyes at less severe stages of disease) with PDT leads to increased efficiency. When considering only the cost of therapy, treating people at lower levels of visual acuity would probably not be considered cost effective. However, a broad perspective that incorporates other NHS treatment costs and social care costs suggests that over a long period of time, PDT may yield reasonable value for money

James bundles

We study cubical sets without degeneracies, which we call {square}-sets. These sets arise naturally in a number of settings and they have a beautiful intrinsic geometry; in particular a {square}-set C has an infinite family of associated {square}-sets Ji(C), for i = 1, 2, ..., which we call James complexes. There are mock bundle projections pi: |Ji(C)| -> |C| (which we call James bundles) defining classes in unstable cohomotopy which generalise the classical James–Hopf invariants of {Omega}(S2). The algebra of these classes mimics the algebra of the cohomotopy of {Omega}(S2) and the reduction to cohomology defines a sequence of natural characteristic classes for a {square}-set. An associated map to BO leads to a generalised cohomology theory with geometric interpretation similar to that for Mahowald orientation

Doodles on surfaces

Doodles were introduced in but were restricted to embedded circles in the 2-sphere. Khovanov, extended the idea to immersed circles in the 2-sphere. In this paper we further extend the range of doodles to any closed oriented surfaces. Uniqueness of minimal representatives is proved, and various example of doodles are given with their minimal representatives. We also introduce the notion of virtual doodles, and show that there is a natural one-to-one correspondence between doodles on surfaces and virtual doodles on the plane

“Tales and Adventures”: G.A. Henty’s Union Jack and the Competitive World of Publishing for Boys in the 1880s’

In the competitive publishing environment of the late nineteenth century, writers and magazines had to distinguish themselves carefully from potential rivals. This article examines how G.A. Henty’s quality boys’ weekly, Union Jack (1880-83), attempted to secure a niche in the juvenile publishing market by deliberately distinguishing itself from other papers as a literary, imperialist and “healthy” publication. The article explores the design and marketing techniques of the magazine, its status as a fiction paper, the high calibre of its contributors, and its aggressive rhetoric in targeting an exclusively masculine audience. It argues that while Union Jack was marketed as a niche publication, it eventually failed to distinguish itself sufficiently to survive in an extremely competitive environment

Stability and instability in parametric resonance and quantum Zeno effect

A quantum mechanical version of a classical inverted pendulum is analyzed. The stabilization of the classical motion is reflected in the bounded evolution of the quantum mechanical operators in the Heisenberg picture. Interesting links with the quantum Zeno effect are discussed.Comment: 6 pages, 3 figure

Homology of Distributive Lattices

We outline the theory of sets with distributive operations: multishelves and multispindles, with examples provided by semi-lattices, lattices and skew lattices. For every such a structure we define multi-term distributive homology and show some of its properties. The main result is a complete formula for the homology of a finite distributive lattice. We also indicate the answer for unital spindles and conjecture the general formula for semi-lattices and some skew lattices. Then we propose a generalization of a lattice as a set with a number of idempotent operations satisfying the absorption law.Comment: 30 pages, 3 tables, 3 figure

An assessment of western North Pacific ozone photochemistry based on springtime observations from NASA's PEM-West B (1994) and TRACE-P (2001) field studies

The current study provides a comparison of the photochemical environments for two NASA field studies focused on the western North Pacific (PEM-West-B (PWB) and TRACE-P (TP)). These two studies were separated in calendar time by approximately 7 years. Both studies were carried out under springtime conditions, with PWB being launched in 1994 and TP being deployed in 2001 (i.e., 23 February - 15 March 1994 and 10 March-15 April 2001, respectively). Because of the 7-year time separation, these two studies presented a unique scientific opportunity to assess whether evidence could be found to support the Department of Energy\u27s projections in 1997 that increases in anthropogenic emissions from East Asia could reach 5%/yr. Such projections would lead one to the conclusion that a significant shift in the atmospheric photochemical properties of the western North Pacific would occur. To the contrary, the findings from this study support the most recent emission inventory data [Streets et al., 2003] in that they show no significant systematic trend involving increases in any O3 precursor species and no evidence for a significant shift in the level of photochemical activity over the western North Pacific. This conclusion was reached in spite of there being real differences in the concentration levels of some species as well as differences in photochemical activity between PWB and TP. However, nearly all of these differences were shown to be a result of a near 3-week shift in TP\u27s sampling window relative to PWB, thus placing it later in the spring season. The photochemical enhancements seen during TP were most noticeable for latitudes in the range of 25-45°N. Most important among these were increases in J(O1D), OH, and HO2 and values for photochemical ozone formation and destruction, all of which were typically two times larger than those calculated for PWB. A comparison of these airborne results with ozonesonde data from four Japanese stations provided further evidence showing that the 3-week shift in the respective sampling windows of PWB and TP was a likely cause for the differences seen in O3 levels and in photochemical activity between the two airborne studies. Copyright 2003 by the American Geophysical Union

U.S. stock market interaction network as learned by the Boltzmann Machine

We study historical dynamics of joint equilibrium distribution of stock returns in the U.S. stock market using the Boltzmann distribution model being parametrized by external fields and pairwise couplings. Within Boltzmann learning framework for statistical inference, we analyze historical behavior of the parameters inferred using exact and approximate learning algorithms. Since the model and inference methods require use of binary variables, effect of this mapping of continuous returns to the discrete domain is studied. The presented analysis shows that binarization preserves market correlation structure. Properties of distributions of external fields and couplings as well as industry sector clustering structure are studied for different historical dates and moving window sizes. We found that a heavy positive tail in the distribution of couplings is responsible for the sparse market clustering structure. We also show that discrepancies between the model parameters might be used as a precursor of financial instabilities.Comment: 15 pages, 17 figures, 1 tabl