The latest Investing Matters Podcast episode featuring financial educator and author Jared Dillian has been released. Listen here.
Morning everyone,
Wasn’t expecting that RNS. Thought the security incident was likely to be the local attacks on villages that have happened recently not a kidnapping.
Mixed feelings. Very pleased it’s all over and everyone is safe now. But does highlight how dangerous the area is. Tbh that is something we probably shouldn’t forget. Unfortunately most of the highest grade gold deposits are in dangerous areas.
If Harry is now able to mitigate the risk with better security, possibly with the help of the government? This could turn out to be a positive (better this happens before the mines up and running and additional security etc is put in place now than when the mine is under construction/running and everything has to stop).
Let’s hope the worst is behind us….
If there has been significant short selling, which recent price movements would suggest, then tomorrow maybe similar to the New World Oil and Gas fiasco 3 years ago. Having said that, if this is the case, I would expect it to be less dramatic than with NEW. Tomorrow will be a very interesting day for NIPT. I am quite excited to see what happens, however, do wish things could be simple with NIPT for once.
I'm glad do you have made a good amount of money in your ISA. Interestingly, I never said like to ramp but that you like a good ramp story. All of those investments are highly speculative. However, Falcon is just as, if not more speculative. I am just struggling to understand the rationale of going round posting negative comments. Each to their own. FAL has an excellent management team behind it who don't mess about. News flow expected to start next week so expecting interest to significantly pick up from here.
Any thoughts on when Share Buy back will start! Also any thoughts on how they will go about it? Thanks and Good Luck. Very exciting Share with lots of potential!
Exciting reading for those invested... Paper by the Royal College of Obstetrics and Gynaecology. Non-invasive Prenatal Testing for Chromosomal Abnormality using Maternal Plasma DNA Scientific Impact Paper No. 15 March 2014 Part of the conclusion: Since women are already accessing these tests, all obstetricians should have knowledge of the counselling issues involved. In addition, major NHS health policy decisions are required. In time, this technology is likely to become the primary screen for chromosomal abnormalities in pregnancy. This will enhance the information available to pregnant women while greatly reducing the loss of uncomplicated pregnancies as a result of miscarriage caused by unnecessary invasive procedures.
Nope I do not think so. Many trials have been done, some clinical and some lab based. The wider public health implications are very large so I believe these are independent trials. NIPT is currently only available in private hospitals but is being considered for use on the NHS by the UK National Screening Committee, which will make a formal recommendation once the results of a trial at Great Ormond Street Hospital for Children in London become known. The trial is being undertaken as part of the RAPID (Reliable Accurate Prenatal Non-Invasive Diagnosis) research programme led by Professor Lyn Chitty - this the main study of interest currently running, I would think this will be an independent study based on it being based at GOSH.
No problem. Quite enjoyed it :-)
When comparing the cost of the current screening blood test and nuchal scan, it is cheaper than NIPT. Therefore, for the majority of women screened, it is more expensive than current practice. When then factoring in the cost saving from unnecessary amnios etc, it still works out more expensive, just because of the vast number of women being screened. Therefore, I can easily see NIPT being used routinely for women scoring high on their initial screening test (the minority) but not as a screening test for every pregnant women. However, with increasing familiarity of doctors, nurses and general population with the test, as well as the likely decreasing cost of the test - it may well be introduced as the standard screening in the future. Have I managed to clarify things? Thanks
Thank you Poetical. I have read much research done by yourself on some of the oil companies. Something that I am much less familiar with so your efforts are much appreciated. In response to your question. When compared directly, i.e. NIPT vs amniocentesis you are correct (NIPT is cheaper) and the values you use are very reasonable. The cost-analysis study I reviewed was not directly comparing one test for a given person versus the other, but the overall cost if implication if implemented the method was introduced in full (i.e. if the whole system was changed) Research methods like this are looking at the overall picture of cost effectiveness and take into consideration many variables etc. From what they find, using NIPT should be more cost effective when used only for people already scoring high on the conventional screening test. Therefore, if based on your blood tests and the nuchal scan, your risk is greater than 1/150, it should prove cost effective (and potentially better on many other levels) to use NIPT rather than going straight for amnio. By using NIPT, you are hoping to avoid the need for amnio, by being able to inform the pregnant lady of the probability of her child having a chromosomal abnormality. The beauty here is being able to inform doctors to a much higher level and therefore, empower women to make their own choices based on the information available. So a lady testing very high on the existing screening methods, may have a normal test on NIPT. Therefore, the doctor and patient can say based on this extra information your chance is now X% how would you like to proceed... Based on the extremely high specificity - if positive the test (although not officially) is almost diagnostic. With this information the person can decided if they feel they still would like the amnio. My gut feeling is that it would greatly reduce the number of amnios needed to be done. Very few tests can host these levels of sensitivity and specificity. One of the reasons who it is considered non-diagnostic, is the potential large effect for the <1% people with a erroneous test. I can see why everyone wants to be certain of values to quote etc, as no body wants to tell a mother to be her foetus does not have an chromosomal abnormalities, only to discover this is not the case. Having said that, this happen with the current screening method, just highlighting nothing is perfect. Sorry, back to the question. Regarding using NIPT for ALL pregnancies, this study showed that they felt it would not be cost effective, at least with current cost of NIPT - they based on a value of 500 pounds/test. If this cost was able to be reduced, it may well cost the same. This is because, the majority of pregnant women have a low probability score based on the existing screening metrology (i.e. less that 1/150. maybe 1/500 etc) hence they are not offered amnio etc. When comparing the cost of the current screening blood test and nuchal scan, it is c
In conclusion. This new testing method has huge potential. Initial studies have shown exceptional rates of sensitivity and specificity - although not perfect. There are much wider ethical debates to be had (i.e. will increased ease of testing increase uptake of screening) however, this is not really a discussion for this BB. As screening is already available, there is nothing really ethically new/challenging on the table and I doubt that this would had any effect on whether this form of testing is made available. Potential cost may well effect implementation. Cost analysis has shown that when used in a population testing at high risk (>1/150) this type of test is cost effective with benefit to healthcare professionals and pregnant ladies. The use of this test for general/first line screening is probably a long way off. Cost analysis shows at current test prices it is not likely to be cost efficient and considering the current economic climate within the NHS (which I can say with first hand experience is dire), persuading the introduction of this test may well prove very difficult. I think a lot will ride of the BOD. I think this is a great idea, test and has every probability to genuinely benefit us as people. However, persuading NHS trusts etc to use this product may well prove difficult. Having said that, I can imagine that there would be a domino effect, if one trust starts all may soon follow, esp. if the voice of women in areas where the test is not available were to discus with the media. I hope everyone has a lovely weekend. I am planning to invest here in the future (when I manage to get some money :-) and apologies for the long post, I quite enjoyed researching this).
The BMJ British Medical Journal said last year that: Soon, guidance may change again as the new non- invasive test using cell-free fetal DNA in maternal blood is introduced, initially as a second layer of screening for high risk women, being highly sensitive (>98%) and highly specific (>99.5%) but not yet diagnostic. BMJ 2013 This is where I feels the NHS may start to use NIPT. The cost of generic implementation (as shown later) may exceed that of current practice. Therefore, reluctance from budget holders/managers is to be expected. From my experience, many senior people within the NHS are not able to see the wider impactions of their actions, or the wider cost/benefit analysis. Everyone seems to be very compartmentalised into their own world. In this example, the fact that there will be decreased need for invasive procedures is widely accepted and relatively easy to understand. However, with a dramatic reduction in false positive results, consultants and their teams will all have to do a lot less genetic counselling, explanations of procedures, risks etc to ladies who have a normal pregnancy. This equals time saved, but this is not easy to quantify etc. Introduction of a test like this could potentially save money/resources in many different ways, however, this would take too long to go into. As we all probably assume, but is now shown, research on opinions shows that women’s views towards the availability of NIPT as an alternative to current screening tests are generally favourable (Lewis, Silcock, & Chitty, 2013). Several computer generated cost analysis studies have been done and found that: Finding 1) At a screening risk cut-off of 1:150 (used in the UK) and a cost per NIPT of £500 NIPT as contingent testing (i.e. used if risk >1/150) appears to offer gains over current Down’s syndrome screening in terms of fewer procedure-related miscarriages and at no additional cost. A cost of £500 per NIPT falls within the range that NIPT is currently offered in the private sector in the UK, and so ought to be achievable in the NHS. Finding 2) NIPT used a first time screening - better outcomes in screening for Down’s syndrome in terms of cases detected and procedure-related fetal losses. However, NIPT as first line works out as more expensive than current screening, even at a very low cost per test. Hence, NIPT as first-line testing is unlikely to be attractive to NHS commissioners unless the cost of NIPT was to fall dramatically. Morris, karlsen et al 2014
As previously very well described, the decision as whether or not to have this test can be extremely difficult. The risk miscarriage with amniocentesis is the main risk not want to pursue a diagnosis (Green, Hewison, Bekker et al 2004). The actual process is often very distressing for the pregnant lady and close others. Something that has not been mentioned, and I have no published evidence to support this, but from my own experience, doctors do no like doing this test. They want to help and heal, not perform a procedure where they may cause a miscarriage of a healthy foetus. The American College of Obs and Gynae has describes a non-invasive diagnostic test as the ‘holy grail’ of pre-natal screening. The relatively recent discovery that foetal DNA can be found in the mother’s blood (crosses the placenta) led to the rapid development of cell-free foetal DNA sampling. In very simplistic terms (as I do not fully understand this) this technique effectively isolates for foetal DNA in mum’s blood, amplifies it and looks for extra chromosomes. Currently there is a lot of active research into the sensitivity and specificity of this test. Results so far from good trials show a 98%sensitivity, false positive <0.5% However, this is not fully diagnostic (Twiss, Daley and Chitty 2013), as there is still a margin for error, albeit dramatically reduced from previous. Hence, the American College Obs and Gynae 2012 stated that a positive result should still have the results confirmed on diagnostic sampling (back to amniocentesis…) Currently there is a large trial organised by the National Institute of Health Research into NIPT (non-invasive pre-natal testing) vs current best practice at London Great Ormond St. Hospital. Results are pending. Not test is perfect, even the amniocentesis results are rarely miss a diagnosis. Therefore, as the ability and reliability of the test becomes better known and more widely accepted these opinions may change. Furthermore, the current opinion by many health care professionals, is that this test could be used if the the standard/current method yields a high risk results (greater or equal to 1 in 150). Therefore, if you test below this threshold you will not be offered the test (on the NHS). If you test above you will be offered the NIPT. I presume other high risk groups, for example older pregnant ladies would be offered the test also. If the test was negative this would be extremely reassuring and the need for invasive tests hopefully avoided. With such a low false positive rate, very very few women would go onto further invasive testing of a foetus not effected by a chromosomal disorder. Therefore, significantly reducing the exposure of non-effected foetuses to invasive procedures and iatrogenically aborted healthy foetus.
Good evening to everybody. Only recently signed up to the LSE website and what follows is my first post. I felt compelled to post after reading the many insightful and informed posts below from Poetical and others. Although I do not normally share personal information online in this case it is relevant. I am a junior doctor working within the NHS. Having worked in obstetrics and gynaecology, seeing and assisting in amniocentesis as well as being involved in genetic counselling I hope I have quite a reasonable understanding of the current situation and the potential that the IONA test may hold. I have decided to do a little background research into this topic and post it. I hope nobody minds, it may have already been thoroughly covered, but hopefully I can provided a personal perspective. Current methods for screening for Down’s syndrome trisomy 21 (T21) which incidentally also picks up some other chromosomal abnormalities, namely Edwards trisomy 18 (T18) and Patau’s syndrome trisomy 13 (T13) is based on a blood test and ultrasound scan. The pregnant lady first needs to be counselled as to whether or not they want to be tested. It is not a decision taking lightly, the repercussions following testing can be very significant. If the pregnant lady would like the test they are booked in for a blood test at 10+ weeks to a max of 14+1 which checks beta-human chorionic gonadotrophin (beta-hCG) and pregnancy-associated plasma protein A (PAPP-A) The ultrasound scan can be carried out between 11 weeks + 2 days and 14 weeks + 1 day of pregnancy. If a woman books later in pregnancy (when nuchal translucency is not as accurate, or if it is not technically possible to measure it, the quadruple test can be taken between 14 + 2 to 20 + 0 weeks of gestation. This measures free beta-hCG, alpha fetoprotein (AFP), inhibin-A and unconjugated estriol (uE3). It is less accurate than the combined test. Once a screening test has been performed, the chance of the foetus having Down's syndrome is calculated using software that takes into account maternal factors such as age, weight and family origin, along with gestation of the pregnancy. Note the risk of chromosomal abnormalities increases almost exponentially with age. A healthy 20 year lady with no reason to suspect increase risk (based on family history etc) has a risk of approx. 1/1500 of a live birth to a child with T21, at 30 the risk is 1/900, at 40 the risk is 1/90 and at 44 the risk is 1/30. The screening test is classified as positive if the probability is equal to, or greater than the national cut off, which in the UK is 1 in 150 chance of Down’s syndrome. All of these women are offered diagnostic testing. Either Chorionic villus sampling (CVS) (if earlier gestation) or amniocentesis if later gestation. The risks associated with these tests are around 0.5-1% of iatrogenic miscarriage i.e. the doctor caused it (as an unintentional consequence I might add).