995 resultados para 517
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BACKGROUND: According to recent guidelines, patients with coronary artery disease (CAD) should undergo revascularization if significant myocardial ischemia is present. Both, cardiovascular magnetic resonance (CMR) and fractional flow reserve (FFR) allow for a reliable ischemia assessment and in combination with anatomical information provided by invasive coronary angiography (CXA), such a work-up sets the basis for a decision to revascularize or not. The cost-effectiveness ratio of these two strategies is compared. METHODS: Strategy 1) CMR to assess ischemia followed by CXA in ischemia-positive patients (CMR + CXA), Strategy 2) CXA followed by FFR in angiographically positive stenoses (CXA + FFR). The costs, evaluated from the third party payer perspective in Switzerland, Germany, the United Kingdom (UK), and the United States (US), included public prices of the different outpatient procedures and costs induced by procedural complications and by diagnostic errors. The effectiveness criterion was the correct identification of hemodynamically significant coronary lesion(s) (= significant CAD) complemented by full anatomical information. Test performances were derived from the published literature. Cost-effectiveness ratios for both strategies were compared for hypothetical cohorts with different pretest likelihood of significant CAD. RESULTS: CMR + CXA and CXA + FFR were equally cost-effective at a pretest likelihood of CAD of 62% in Switzerland, 65% in Germany, 83% in the UK, and 82% in the US with costs of CHF 5'794, euro 1'517, £ 2'680, and $ 2'179 per patient correctly diagnosed. Below these thresholds, CMR + CXA showed lower costs per patient correctly diagnosed than CXA + FFR. CONCLUSIONS: The CMR + CXA strategy is more cost-effective than CXA + FFR below a CAD prevalence of 62%, 65%, 83%, and 82% for the Swiss, the German, the UK, and the US health care systems, respectively. These findings may help to optimize resource utilization in the diagnosis of CAD.
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We construct a new family of semi-discrete numerical schemes for the approximation of the one-dimensional periodic Vlasov-Poisson system. The methods are based on the coupling of discontinuous Galerkin approximation to the Vlasov equation and several finite element (conforming, non-conforming and mixed) approximations for the Poisson problem. We show optimal error estimates for the all proposed methods in the case of smooth compactly supported initial data. The issue of energy conservation is also analyzed for some of the methods.
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We study conformal deformations of a uniform space that satisfies the Ahlfors Q-regularity condition on balls of Whitney type. We verify the Gehring–Hayman Theorem by using a Whitney Covering of the space.
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The McMillan map is a one-parameter family of integrable symplectic maps of the plane, for which the origin is a hyperbolic fixed point with a homoclinic loop, with small Lyapunov exponent when the parameter is small. We consider a perturbation of the McMillan map for which we show that the loop breaks in two invariant curves which are exponentially close one to the other and which intersect transversely along two primary homoclinic orbits. We compute the asymptotic expansion of several quantities related to the splitting, namely the Lazutkin invariant and the area of the lobe between two consecutive primary homoclinic points. Complex matching techniques are in the core of this work. The coefficients involved in the expansion have a resurgent origin, as shown in [MSS08].
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A sequence of “inner equations” attached to certain perturbations of the McMillan map was considered in [MSS09], their solutions were used in that article to measure an exponentially small separatrix splitting. We prove here all the results relative to these equations which are necessary to complete the proof of the main result of [MSS09]. The present work relies on ideas from resurgence theory: we describe the formal solutions, study the analyticity of their Borel transforms and use ´Ecalle’s alien derivations to measure the discrepancy between different Borel-Laplace sums.
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