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In this way relatively simple organisms such as bacteria or yeast can be induced to anxiety medications discount phenergan 25mg otc make quantities of human proteins anxiety high blood pressure purchase phenergan cheap, including hormones such as insulin as well as lymphokines and monokines anxiety symptoms 100 buy phenergan cheap online. Gene Therapy Genetic engineering also holds promise for gene therapyreplacing altered or missing genes or adding helpful genes anxiety out of nowhere discount phenergan online visa. A genetically engineered version of the missing gene can be introduced into cells taken from the patients bone marrow. After treated marrow cells begin to produce the enzyme, they can be injected back into the patient. In pioneering experiments, scientists are removing cancer-fighting lymphocytes from the cancer patients tumor, inserting a gene that boosts the lymphocytes ability to make quantities of a natural anticancer product, then growing the restructured cells in quantity in the laboratory. These cells are injected back into the patient, where they can seek out the tumor and deliver large doses of the anticancer chemical. Immunoregulation Research into the delicate checks and balances that control the immune response is increasing knowledge of normal and abnormal immune functions. Someday it may be possible to treat diseases such as systemic lupus erythematosus by suppressing parts of the immune system that are overactive. This animal model promises to be immensely valuable in helping scientists understand the immune system and manipulate it benefit human health. Summary lthough scientists have learned much Aabout the immune system, they continue to study how the body launches attacks that destroy invading microbes, infected cells, and tumors while ignoring healthy tissues. New technologies for identifying individual immune cells are now letting scientists quickly determine which targets are triggering an immune response. Improvements in microscopy are permitting the first-ever observations of B cells, T cells, and other cells as they interact within lymph nodes and other body tissues. In addition, scientists are rapidly unraveling the genetic blueprints that direct the human immune response as well 45 as those that dictate the biology of bacteria, viruses, and parasites. The combination of new technology and expanded genetic information will no doubt teach us even more about how the body protects itself from disease. When an antibody attaches to an antigen, it helps the body destroy or inactivate the antigen. Examples include multiple sclerosis, type I diabetes, rheumatoid arthritis, and systemic lupus erythematosus. Also know as B lymphocytes, they come from bone marrow and develop into blood cells called plasma cells, which are the source of antibodies. They include interferons, interleukins, thymus hormones, and monoclonal antibodies. Complement destroys bacteria, produces inflammation, and regulates immune reactions. Cytokines include lymphokines produced by lymphocytes and monokines produced by monocytes and macrophages. They include the bone marrow, thymus, lymph nodes, spleen, and various other clusters of lymphoid tissue. Macrophages stimulate other immune cells by presenting them with small pieces of the invaders. The contents of mast cells, along with those of basophils, are responsible for the symptoms of allergy. Large molecules such as proteins, fats, carbohydrates, and nucleic acids are the building blocks of a cell, and a gene determines how each molecule is produced. As tools for binding to specific protein molecules, they are invaluable in research, medicine, and industry. T cellssmall white blood cells (also known as T lymphocytes) that recognize antigen fragments bound to cell surfaces by specialized antibody-like receptors. The table that begins on page e28 summarizes the known prenatal risks of antiparasitic drugs. For children and patients unable to take tablets, a pharmacist can crush the tablets and mix them with cherry syrup (Humco, and others). Mebendazole or albendazole each with or without a corticosteroid appear to shorten the course of infection. Surgery may be needed in the event of intestinal obstruction or peritonitis (A Repiso Ortega et al, Gastroenterol Hepatol 2003; 26:341). Nitazoxanide is available in 500-mg tablets and an oral suspension; it should be taken with food. Clindamycin plus quinine is also the treatment of choice for infections caused by B. Exchange tranfusion should be considered for severely ill patients and those with high (>10%) parasitemia or pulmonary, renal or hepatic compromise when infection is caused by B. Ocular baylisascariasis has been treated successfully using laser photocoagulation therapy to destroy the intraretinal larvae. Drug Adult dosage Pediatric dosage Drug of choice: Clinical significance of these organisms is controversial. In one study, single-dose ornidazole, a nitroimidazole similar to metronidazole that is available in Europe, was effective and better tolerated than 5 days of metronidazole (O Kurt, Clin Microbiol Infect 2008; 14:601). A single dose of 6 mg/kg is used in endemic areas for mass treatment, but there are no studies directly comparing the efficacy of the single-dose regimen to a 12-day course. One review concluded that the 12-day regimen did not have a higher macrofilaricidal effect than single dose (A Hoerauf, Curr Opin Infect Dis 2008; 21: 673; J Figueredo-Silva et al, Trans R Soc Trop Med Hyg 1996; 90:192; J Noroes et al, Trans R Soc Trop Med Hyg 1997; 91:78). These parasites have been shown to contain Wolbachia which suggests doxycycline might be effective. Skin reactions after ivermectin treatment are often reported in persons with high microfilarial skin densities. Unlike infections with other flukes, Fasciola hepatica infections may not respond to praziquantel. Medical Letter reviewers recommend consultation with physicians experienced in management of this disease. Some of the listed drugs and regimens are effective only against certain Leishmania species/strains and only in certain areas of the world (S Sundar and J Chakravarty, Expert Opin Pharmacother 2013; 14:53). There is limited experience in paromomycin in South America or the Mediterranean where it has been tried as second-line combination therapy with sodium stibogluconate. Topical paromomycin should be used only in geographic regions where cutaneous leishmaniasis species have low potential for mucosal spread. Pyrethrins with piperonyl butoxide are recommended for use in children >2 years old; permethrin for children >2 months old. Not ovicidal but lice that hatch from treated eggs die within 48 hours after hatching. Benzyl alcohol prevents lice from closing their respiratory spiracles and the lotion vehicle then obstructs their airway causing them to asphyxiate. In one study of treatment of body lice, a regimen of 3 doses of ivermectin (12 mg each) administered at 7-day intervals was effective (C Fouault et al, J Infect Dis 2006; 193:474). The drug should not be given to patients with severe renal impairment (creatinine clearance <30 mL/min). The tablets should be taken with fatty food (tablets may be crushed, mixed with 1-2 tsp water, and taken with milk). Oral clindamycin should be taken with a full glass of water to minimize esophageal ulceration. Disturbed sense of balance, ringing of the ears, toxic psychosis (and other psychiatric effects) and seizures can also occur. Combination therapy with dihydroartemisinin/piperaquine (Euartesim, Sigma-Tau) plus primaquine has demonstrated safety, efficacy and tolerability for treatment of P. If chloroquine phosphate is not available, hydroxychloroquine sulfate is as effective; 400 mg of hydroxychloroquine sulfate is equivalent to 500 mg of chloroquine phosphate. The loading dose should be decreased or omitted in patients who have received quinine or mefloquine. If more than 48 hours of parenteral treatment is required, the quinine or quinidine dose should be reduced by 30-50%. Insect repellents, insecticide-impregnated bed nets and proper clothing are important adjuncts for malaria prophylaxis (Treat Guidel Med Lett 2009; 7:83).

Diseases

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The tumor spreading in these 12 regions has a greater impact on patients overall survival compared to physical anxiety symptoms 24 7 buy 25mg phenergan mastercard other regions inside the brain anxiety symptoms 6 days order phenergan 25mg with mastercard. Our network architecture was inspired by the Unet and has been modified to anxiety young living discount phenergan 25mg amex increase brain tumor segmentation performance anxiety symptoms 6 weeks phenergan 25 mg cheap. On the challenge validation dataset, our system achieved a mean enhancing tumor, whole tumor, and tumor core dice score of 0. However, segmenting brain tumor manually is not only challenging task but also a time-consuming one, favoring therefore, the emergence of computerized approaches. Despite considerable research works and encouraging results in the medical imaging domain, fast and precise 3D computerized brain tumors segmentation remains until now a challenging process and a very difficult task to achieve because brain tumors may appear in any size, shape, location and image intensity [2-5]. The transformations comprise rotation, translation, and horizontal flipping and mirroring. For downsampling, a convolution layer with a 2 x 2 filter and a stride of 2 is applied. At the last layer of the expanding path, a 1 x 1 convolution with the Softmax activation function is used to map the multi-channel feature maps to the desired number of classes. The goal is to find the network parameters (weights and biases) that minimize a loss function. Employing Sensitivity with Specificity can provide a good assessment of the segmentation result. Mean, standard deviation, median and 25th and 75th percentile are given for Dice and Sensitivity metrics in Table 1 and for Specificity and Hausdorff distance in Table 2. In this1 context, we can compare our segmentation results with those of other participants. Also, other interesting perspective consists to use ensemble learning methods, like Stacking and Blending, to improve segmentation performance in tumor core and active tumor regions. The training dataset comprises of 210 high grade glioma volumes and 75 low grade gliomas. The Table 1 lists the features extracted for survival analysis which is further elaborated below. Hence, this is the ratio of edema and enhancing tumor regions volume to the whole tumor. Hence, this feature gives the ratio of volume of the tumor core to the volume of the whole tumor. In images d and e, Green, Yellow & Red represent Edema,Enhancing Tumor and Necrosis present in the lesion. In images d and e, Green, Yellow & Red represent Edema, Enhancing Tumor and Necrosis present in the lesion. The false positives generated by the network were minimized by using 3-D connected component analysis. Spyridon Bakas, Hamed Akbari, Aristeidis Sotiras, Michel Bilello, Martin Rozycki, Justin S Kirby, John B Freymann, Keyvan Farahani, and Christos Davatzikos. Bjoern H Menze, Andras Jakab, Stefan Bauer, Jayashree Kalpathy-Cramer, Keyvan Farahani, Justin Kirby, Yuliya Burren, Nicole Porz, Johannes Slotboom, Roland Wiest, et al. On the other hand time consuming 3D evaluation like segmentation is able to provide precise estimation of a number of valuable spatial characteristics giving us understanding about the course of the disease. Among its difierent applications, it is mainly used for decease diagnostics and treatment planing. Test dataset is split into two parts: validation data proposed methods can be evaluated with throughout the challenge and testing data. The performance of the methods is evaluated using Dice coeficient, Sensitivity, Specificity and Hausdor distance. Above-named challenge made a significant impact on the evolution of computational approaches for tumor segmentation. In the last few years variety of algorithms addressed to solve this problem were proposed. In this paper we present two-stage convolutional neural network based pipeline for brain tumor segmentation. We compare multiple approaches for defining localization network and report their performance. Besides this, we compare 3d unet [5] with its cascaded counterpart described later in this paper. Regression of the spatial characteristics is done using Resnet18 [6] model and Resnet10 model with Difierentiable Spatial to Numeric Transform [11]. We use unet [5, 12] and proposed cascaded unet variant as a second type of algorithms that are able to implicitly estimate values described above. U-net For the purpose of brain tumor localization we tried 3D variant of unet [5] described below, its architecture is shown in figure 2. Every convolution uses 3x3x3 kernel and 1x1x1 padding to keep the size of feature map the same. Corresponding feature maps of encoding and decoding parts are linked using skip connections. Cascaded U-net Proposed network is illustrated in figure 3 and consists of three basic blocks. Each block by itself is unet network [5, 12] with its own loss function in the end, the only difierence is the feature maps size on the decoding path. After that we are eliminating outliers and noise by clamping all values to the range from -5 to 5. At the final step we shift brain voxels to the range [0;10] and assign zeros to background. Here we are especially interested in intersection over union and overlap ratio since these two characteristics refiect number of rejected voxels that can possibly be tumor voxels. We implemented and compared difierent localization methods and showed their performance for brain tumor localization. Both methods achieved the same accuracy on validation data provided by organizers, however proposed method showed better performance on local validation. Our four-stage system attempts to follow the layered structure of tumor tissues provided in the annotation protocol. In each segmentation stage we dealt with four major difculties: feature selection, determination of training database used, optimization of classifer performances and image post-processing. The most important advantage of medical imaging is the fact that examination performed non-intrusively. Lefkovits in this article was supported by the Communitas Foundation and the work of L. The segmentation results obtained showed that the tumor region is well detected, but the contours of the whole tumor and the interior tumor tissues are not well delimited. The source of the aforementioned errors could be the choice of training samples used, the unbalanced database provided, and its enormous size. Another defciency in our previous model is that it considered almost any spatial relationship between the tumor tissues, according to the annotation protocol described in [11, 15]. The feature database generation process is identical both for the segmentation (classifcation) and the training phases, as well. Intensity normalization was done by histogram linear transformation in such a way that the frst and third quartiles had predefned values. In voxel-wise segmentation it is necessary to defne a set of intensityand local neighboring features. Each classifer is trained and evaluated on its own feature database during its training process (Fig. The global training consists of four training stages and each stage is composed of the following four steps: 1. Therefore, this large amount of data was handled by taking advantage of the random forest variable importance evaluation. The main idea of the algorithm is to evaluate the variable importance several times on a randomly chosen part of the feature database (Fig. Averaging the variable importances in the iterations the algorithm was able to eliminate the most unimportant 20-40% of variables in each run. In consequence we must obtain a well-defned database for training our random forest classifer.

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However anxiety nursing diagnosis discount phenergan line, it is always advisable to anxiety symptoms images order 25 mg phenergan fast delivery minimize exposure to anxiety symptoms jaw spasms quality phenergan 25mg other patients with highly transmissible infections anxiety weight loss 25mg phenergan with amex, such as respiratory and gastrointestinal infections. There are other patients that are at increased risk for numerous types of opportunistic infections while receiving health care. Examples of patients and conditions include but are not limited to: congenital or acquired immunodeficiency immunodeficiency due to chemotherapeutic agents immunodeficiency due to hematologic malignancies or solid organ transplants neutropenic patients A protective environment is designed to minimize fungal spore counts in the air and reduce the risk of invasive environmental fungal infections. Organizations with these types of patients should develop specific protocols to outline the precautions required. Changing Populations and Health Care Delivery Systems Health care systems are constantly evolving and going through restructuring. New technologies and aggressive treatments, many of which compromise host defences, have permitted patients with previously fatal diseases to survive. Transfers of patients between facilities and across different levels of care within facilities, as well as transfers back to Canada of patients exposed to infectious agents in foreign countries. They remain a patient safety issue, represent a significant adverse outcome of Canadas health care system and a barrier to timely access to care for all Canadians. In turn, this influenced relationships, resulting in a distancing from family, friends and colleagues at work, with many patients afraid to disclose their diagnosis for fear of rejection. Health care associated infections are therefore a significant barrier to access to care for other health conditions of Canadians. All health care interventions have potential risks, including risk of infection, as well as potential benefits. Balancing Risk and Benefit in Preventing Cross-Transmission Ideally, care should be provided in a manner that maximizes the likelihood that all transmission of potential microorganisms from all patients asymptomatically colonized, as well as symptomatic in all health care settings, will be prevented. However, transmission of microorganisms in the health care setting cannot always be prevented, and attempts to do so would entail additional costs and restrictive measures that interfere with the quality of life for the patient or restrict beneficial medical procedures or interventions. Isolation practices can be stigmatizing and psychologically damaging, which may adversely affect the quality of health care delivered. Furthermore, unnecessary isolation practices are expensive and consume limited health care resources that could be used for other purposes to benefit other patients. In most instances, the precautions to apply are clear-cut, based on the evidence available. In other situations, certain measures may need to be modified for different types of health care settings, based on assessment of risks and benefits. The benefit of reducing risk of transmission must be balanced against the cost (in quality of life, adequacy of medical care, and monetary outlay) of the precautions required to achieve this reduction in risk. Chain of Infection Epidemiologic analysis is essential to prevent disease by describing the distribution of illness (in terms of person, place and time) and identifying modifiable factors that affect occurrence and outcomes. Transmission of microorganisms may result in transient carriage or long-term colonization, asymptomatic infection or clinical disease. The presence of microorganisms in or on a host, with growth and multiplication, but without tissue invasion or cellular injury, is referred to as colonization. Infection is the condition in which microorganisms multiply within the body, and there is a response from the hosts immune defences. The establishment of infection involves complex interrelationships between the source of the infectious agent (microorganism), the susceptible host, and the environment and requires the transmission of microorganisms from the source to a susceptible host. One framework for understanding this complex relationship is the chain of infection, which can have six links (Figure 1a), including the: infectious agent reservoir portal of exit mode of transmission portal of entry susceptible host Breaking any one of the links in the chain of infection will prevent infection from occurring (Figure 1b). Infectious Agents (microorganisms) these are bacteria, viruses, fungi, parasites and prions and can be either endogenous flora. Regardless of source, they are transient if they are temporarily carried by the patient. The characteristics of a particular microorganism affect the ease of its transmission. Microorganisms that can survive environmental conditions and remain viable on inanimate objects, such as patient care equipment, are more likely to be transmitted. Reservoirs in Health Care Humans, animals and the environment are reservoirs of infectious agents (microorganisms) relevant to health care. Routes of Transmission Routes of transmission of infectious agents (microorganisms) are conventionally categorized into five routes. These are: contact droplet airborne common vehicle vectorborne Transmission of the many varieties of microorganisms cannot always be circumscribed within a limited number of transmission modes. Nevertheless these transmission categories have proven useful in describing the spread of microorganisms in populations. The appropriate use of barriers and adherence to hand hygiene break this link in the chain of infection. Portals of Entry A portal of entry is the route by which an infectious agent enters the host. Examples include mucous membranes of the respiratory tract, the gastrointestinal tract, the urinary tract, breaks in the skin. Portals of Exit Portal of exit are the route by which an infectious agent (microorganism) leaves the reservoir (not all reservoirs have an obvious portal of exit. Infectious agents are contained in blood, body fluids, excretions, secretions and skin of human reservoirs, depending on the agent, and leave the reservoir through the respiratory, gastrointestinal or integumentary (skin and mucous membranes) system. Susceptible Host An individual must be susceptible to the infectious agent (microorganism) for an infection to occur. This link inthe chain of infection can be broken by ensuring host defences are maximized. Sources or Reservoirs of Infectious Agents (microorganisms) the sources or reservoirs of infectious agents transmitted in health care may be human, animal or environmental. Human Sources Source individuals may have active clinical disease, be in the asymptomatic or incubation period of an infection, or may be transiently or indefinitely colonized with microorganisms, particularly on the skin and mucous membranes. Transmission of microorganisms in health care is increased by the presence of: patients who visibly soil the environment or cannot maintain appropriate hygiene, including respiratory hygiene patients who are cognitively impaired patients with uncontained secretions or excretions patients with wound drainage that cannot be contained by a dressing patients with fecal incontinence, if stools cannot be contained in incontinence products or diapers patients with viral respiratory or gastrointestinal infections, especially infants 2. Environmental Sources Environmental factors may either assist or impede the transmission of microorganisms. The environment may play a larger role in the survival and growth of certain microorganisms than previously appreciated, reinforcing the importance of minimizing environmental contamination by patient secretions and excretions, avoiding unnecessary hand contact with environmental surfaces and ensuring high standards for environmental cleaning are maintained. Examples of items implicated in the transmission of infection or known to be an environmental source of contamination are listed in Table 1. Exposure to Infectious Agents (microorganisms) Exposure occurs when a susceptible host comes into contact with an infected source or contaminated environment. Research has demonstrated that both droplet and airborne-sized particles can be found in the air at close proximity (up to two metres) to a coughing or sneezing source. In addition, a portion of larger particles (droplets) may desiccate and become smaller while in the air, becoming in effect, droplet nuclei. Particles with a diameter of 1 m to 10 m may penetrate as far as the alveolar ducts (beyond the vocal cords) but may also be deposited at any point in the respiratory tract, as shown in Figure 3. These include the particle sizes containing the infectious agent, the viability of the infectious agent, and the animate and inanimate environment of a room. Particles of a variety of sizes are expelled from the human airway during coughing, sneezing, talking and medical procedures. The size of these particles and the distance they will be propelled is dependent on the force generated by the individual or the procedure. Large particles (greater than 10 m) will fall quickly (in a few seconds) to the ground. However, smaller particles may remain suspended for a significantly longer time: tens of seconds for a droplet of 10 m diameter and minutes or hours longer for small droplet nuclei. The particles that remain aloft for minutes or hours (less than 10 m diameter) can be carried by air currents over a measurable distance, including beyond the room, and are considered to represent an airborne exposure. Routes of Transmission Routes of transmission of microorganisms have conventionally been classified as contact, droplet, airborne, common vehicle and vectorborne. For most microorganisms, transmission may primarily be by one route, such as direct or indirect contact. Contact Exposure and Transmission Contact exposure occurs when microorganisms are transferred through physical contact between an infected source and a host, or through the passive transfer of the microorganisms to a host, via an intermediate object. Hands can be contaminated by contact with an infected source, or by contact with contaminated inanimate surfaces, or objects in the immediate environment of an infected source.

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These dynamics are utilized to anxiety effects on the body discount phenergan amex assess the overall activity of the sector and interest by venture capitalists anxiety symptoms 247 purchase 25mg phenergan free shipping, strategic players and the public market anxiety symptoms at night cheap phenergan 25mg free shipping. Substantial Clinical Development and refractive error are highly opportunity as several rare anxiety symptoms for 2 weeks buy phenergan 25 mg without a prescription, genetic Focused on Leading Causes of prevalent, clinical trial activity diseases result in blindness and Blindness is relatively limited (Table 1 and the eyes accessibility makes it an Figure 1), likely due to the fact ideal location for gene therapy. Assessment of active clinical that current therapeutic modalities Sparks Luxturna, the first gene trials is key in evaluating clinical are satisfactory. This is due to a lack of therefore has been combined into the non-orphan drug market3. While cataracts Rare diseases represent a unique risk of severe vision loss with 1 Indication Number of Americans Afficted (in Millions) Refraction Error (Near/Far-Sighted) 34. A notable the clouded lens is replaced with an counterexample is glaucoma, Of note, the majority of intraocular lens. As a consequence, where therapeutics account for clinical trials are dominated the majority of clinical trials seek 59% of therapies compared to by a single intervention type to improve this process. Gov (data pulled 2/29/2019), all active, recruiting and enrolling interventional industry-sponsored trials, removed oncology indications. Gov (data puled 2/28/2019), all active, recruiting and enrolling interventional industry-sponsored trials, removed oncology indications, some trials are co-sponsored. Glaucoma is a chronic sponsorship from industry giants type due to the specific expertise disease where treatment options are and specialized companies alike, necessary to clinically develop a stratified based on disease stage, with Novartis and subsidiaries drug versus a device. Glaucoma, macular degeneration and rare diseases present as areas of opportunity for cutting edge technologies, such as regenerative medicine and gene therapy. Gov (data pulled 2/28/2019), all active, recruiting and enrolling interventional industry-sponsored trials, removed oncology indications. The second intense clinical activity supported therapeutic approaches is largely most acquired indication was by strategic players, there was driven by strategic players. Surgery proves to be an an uncoupling between risk and Device acquisitions (Figure lively sub-sector driven by more acquisition price. First-in-class 6B) demonstrated an average deal than 20 million cataract surgeries therapeutics see interest from value of $215 million, surpassing performed annually10. One of the largest biotech/pharmaceutical average pharmaceutical acquisitions in the valuation. In line with glaucoma Figure 6 depicts pharma and space was that of Encore Vision clinical trial activity, there has been device M&A activity in various by Novartis. Encore Vision is heavy interest in glaucoma devices ophthalmology sub-segments and developing a disease-modifying from large players. The largest deal was with other life science sectors, no Alcons acquisition of Transcend clear relationship between phase Pharma players are heavily Medical, with a marketed product invested in the segment (Figure of development and acquisition in Europe and pre-market approval 1). Date Company Acquirer Deal Value Capital Invested Exit Intervention Type Lead Most Advanced ($M) ($M) Multiple Indication Stage 30-Jul-2015 Foresight Shire 300 17 17. Transcend developed a Estimated exit multiples order to trigger a liquidity event. These examples highlight provided a return on capital capital invested were disclosed. While devices the Public Market Supports stage device acquisitions, as 70% had a higher average deal Ophthalmology Companies of acquisitions had marketed assets value compared to biotech/ prior to acquisition. The majority companies, M&A provides GenSight Biologics, NightstaRx, of companies demonstrated superior exit multiples. Summary innovative approaches for the Encore and Transcend, Figure leading causes of blindness. The public market supported big pharma and specialized pharma ophthalmology companies, are heavily investing in the space especially those developing gene through clinical trials (Figure 1 and therapies (Table 3). However, additional oversight is multiples are supported through necessary through the requirement potential for large exits (Table 4). Modest M&A companies, M&A provides activity was focused on glaucoma superior exit multiples. However, large deal values across both drugs and devices were represented in companies that had developed 8 Bouta is an Associate at Scott Terchiak participated in Director at Outcome Capital and Outcome Capital. A scientist by Outcome Capitals Internship co-lead of its life sciences practice. He is passionate about guiding cutting-edge life science companies through disciplined marketdriven decisions toward strategic value enhancement and a path to liquidity. The firm uses its proven strategy-led execution approach to value enhancement by assisting boards and management teams in navigating both the financial and strategic markets and in implementing the best path for success. Outcome Capitals strength stems from its unique ability to draw on its wide range of operational, strategic and investment experience, its expertise across the life science value chain, and its broad industry relationships. Mild glaucoma may be asymptomatic but as damage to the optic nerve increases, the individual experiences difficulty with peripheral vision, contrast sensitivity, glare, and light variations, and 2 eventually this affects day to day activities and impacts quality of life. In the healthy eye, the ciliary body secretes aqueous humour into the eye and this fluid is drained out through the 2 trabecular meshwork. Other factors that may play a role in the development and progression glaucoma include retinal ischemia, and 4 reduced or deregulated blood flow. Medications include a variety of drug types such as fi2-adrenergic agonist, fi6 adrenergic antagonist, carbonic anhydrase inhibitors and prostaglandin analogues. The prostaglandin analogues include bimatoprost, latanaprost, travoprost and tafluprost. They are used as monotherapy or in combination with other drugs such as timolol, which is a fiadrenergic antagonist. Considering limited health care resources and variation in the costs of these prostaglandin analogues with the availability of generic brands for latanoprost and travoprost, an assessment of the clinical effectiveness and cost-effectiveness of these drugs is needed to assist with decision making with respect to the use of these drugs. It reported that not all prostaglandin analogues were the same and that there could be cost savings with prostaglandin analogues depending on the alternatives used. Rapid responses are based on a limited literature search and are not comprehensive, systematic reviews. Rapid responses should be considered along with other types of information and health care considerations. The information included in this response is not intended to replace professional medical advice, nor should it be construed as a recommendation for or against the use of a particular health technology. Readers are also cautioned that a lack of good quality evidence does not necessarily mean a lack of effectiveness particularly in the case of new and emerging health technologies, for which little information can be found, but which may in future prove to be effective. Links: this report may contain links to other information available on the websites of third parties on the Internet. The report also stated that from the standpoint of cost-effectiveness, timolol would be the preferred choice in patients for whom timolol is not contraindicated. Since then, several studies on the comparison of the different prostaglandin analogues have been published. This current rapid response report is focussed on prostaglandin analogues, including bimatoprost. The purpose of this report is to review the comparative clinical effectiveness and cost effectiveness of bimatoprost versus other prostaglandin analogues for the treatment of glaucoma and ocular hypertension. What is the cost effectiveness of bimatoprost versus other prostaglandin analogues for ophthalmic usefi There were inconsistencies in the findings of the economic studies and definitive conclusions were not possible. The search was also limited to English language documents published between January 1, 2010 and June 30, 2015. Selection Criteria and Methods One reviewer screened citations and selected studies. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in Table 1.

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