Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve

BACKGROUND The Fractional Flow Reserve Versus Angiography for Multivessel Evaluation (FAME) 2 trial demonstrated a significant reduction in subsequent coronary revascularization among patients with stable angina and at least 1 coronary lesion with a fractional flow reserve ≤0.80 who were randomized to percutaneous coronary intervention (PCI) compared with best medical therapy. The economic and quality-of-life implications of PCI in the setting of an abnormal fractional flow reserve are unknown. METHODS AND RESULTS We calculated the cost of the index hospitalization based on initial resource use and follow-up costs based on Medicare reimbursements. We assessed patient utility using the EQ-5D health survey with US weights at baseline and 1 month and projected quality-adjusted life-years assuming a linear decline over 3 years in the 1-month utility improvements. We calculated the incremental cost-effectiveness ratio based on cumulative costs over 12 months. Initial costs were significantly higher for PCI in the setting of an abnormal fractional flow reserve than with medical therapy ($9927 versus $3900, P<0.001), but the $6027 difference narrowed over 1-year follow-up to $2883 (P<0.001), mostly because of the cost of subsequent revascularization procedures. Patient utility was improved more at 1 month with PCI than with medical therapy (0.054 versus 0.001 units, P<0.001). The incremental cost-effectiveness ratio of PCI was $36 000 per quality-adjusted life-year, which was robust in bootstrap replications and in sensitivity analyses. CONCLUSIONS PCI of coronary lesions with reduced fractional flow reserve improves outcomes and appears economically attractive compared with best medical therapy among patients with stable angina.

Rotation Grazing Demonstrations With Beef Cows on HEL - Adams County Conservation Reserve Program (CRP) Project

Two grazing systems were demonstrated on Conservation Reserve Program (CRP) land in southwestern Iowa near Corning in the summers of 1991, 1992, 1993, 1994, and 1995. This report summarizes the 1995 data and compares them to results from the four previous years. The systems, a 13-paddock intensive-rotational grazing system and a 4-paddock more traditional rotation, both established in 1991, are aimed at showing economically sustainable grass alternatives for steeply sloping (9-14% slope), highly erodible land (HEL) once the 10-year CRP ends. In a 147-day grazing season in 1995, nursing crossbred calves with no creep gained 2.36 pounds and 2.38 pounds per day on the 13- and 4-paddock systems, respectively. The rotations were stocked at 1.65 acres per cow-calf pair on the 13-paddock system and 1.72 acres per pair on the 4-paddock system. This produced 210.2 pounds of calf gain per acre on the 13-paddock system and 203.2 pounds of calf gain per acre on the 4- paddock system.. Similar calves gained 2.37 pounds and 2.50 pounds per day for 155 days, yielding a total gain per acre of 222.7 pounds on the 13-paddock system and 224.9 pounds on the 4-paddock system in 1994. Results for 1992 remain the highest from both systems in the five years of grazing, with calf gain per head per day at 2.45 for 155 days netting 241.9 pounds per acre on the 13- paddock system and calf gain per head per day at 2.38 for 154 days on the 4-paddock system yielding 263.6 pounds per acre. Cows maintained both their weight and condition scores in both systems again in 1995. A third system, the 18-paddock intensive-rotational grazing system, was stocked with stocker steers in 1995, and the results are reported in a second article in the 1996 ISU Beef Research Report entitled “Intensive- Rotational Grazing Steers on Highly Erodible Land at the Adams County CRP Project.” Concerning grazing management, paddocks were grazed four, five, or six times in the 13-paddock intensive- rotational grazing system during the 147-day grazing season of 1995. This number of times grazed per paddock was nearly equal to times grazed per paddock in 1994. However, several paddocks were subdivided temporarily to equalize paddock size and increase grazing uniformity. This increased the total number of cattle moves in the 13-paddock system from 78 in 1994 to 109 in 1995. The average length of stay on each paddock or subdivision of a paddock per grazing time was 1 to 2.2 days. This was less than in any of the other four grazing years in this project. The principle of not grazing more than half the standing forage during any one grazing period was closely followed in 1995. All paddocks in the 13-paddock system were also rested approximately the recommended 30 days between each grazing cycle in 1995.

Ethiopia's Food Reserve Policies and Practice

Ethiopia has for a long time been one of the world’s most food-insecure countries. Efforts by the government and a multitude of sponsors including NGOs have developed an array of institutions and instruments to mitigate the negative impact of production and supply disruptions. Public stockpiles are one such tool, the use of which is rapidly increasing worldwide. This brief field study examines the Ethiopian policies and practice in context, including various instruments operated by farmers, processors and traders. The study finds that the multiple objectives assigned to food reserves as well as the present management structure may not be well-suited at a time of high world market prices and when international food aid is dwindling, and as the international regulatory trade and investment environment remains a matter of unfinished business from a global food security perspective. A comprehensive study of various options for improvements would lay out policy alternatives for public authorities and stakeholders.

Kundmachung: Die nothwendige Errichtung von Infanterie-Reserve-Bataillons in Böhmen, Mähren und Inner-Oesterreich ...

Welsch (Projektbearbeiter): Ankündigung von Waffentransporten für Infanteriereservebataillone in Böhmen, Mähren und Innerösterreich

Does the Federal Reserve Follow a Non-Linear Taylor Rule?

The Taylor rule has become one of the most studied strategies for monetary policy. Yet, little is known whether the Federal Reserve follows a non-linear Taylor rule. This paper employs the smooth transition regression model and asks the question: does the Federal Reserve change its policy-rule according to the level of inflation and/or the output gap? I find that the Federal Reserve does follow a non-linear Taylor rule and, more importantly, that the Federal Reserve followed a non-linear Taylor rule during the golden era of monetary policy, 1985-2005, and a linear Taylor rule throughout the dark age of monetary policy, 1960-1979. Thus, good monetary policy is associated with a non-linear Taylor rule: once inflation approaches a certain threshold, the Federal Reserve adjusts its policy-rule and begins to respond more forcefully to inflation.

Conservation Reserve Program to Row Crop Demonstration

The demonstration project was designed to examine one way of preparing Conservation Reserve Program (CRP) land for row crop production. Many producers have successfully converted CRP land for this purpose; additionally, there was an opportunity for the research farm to gain experience in this area. The goal of the project was to document one way of going through the process.