Cost-effectiveness of Transcatheter Mitral Valve Leaflet Repair for the Treatment of Mitral Regurgitation in Heart Failure

Contexte: La régurgitation mitrale (RM) est une maladie valvulaire nécessitant une intervention dans les cas les plus grave. Une réparation percutanée de la valve mitrale avec le dispositif MitraClip est un traitement sécuritaire et efficace pour les patients à haut risque chirurgical. Nous voulons évaluer les résultats cliniques et l'impact économique de cette thérapie par rapport à la gestion médicale des patients en insuffisance cardiaque avec insuffisance mitrale symptomatique. Méthodes: L'étude a été composée de deux phases; une étude d'observation de patients souffrant d'insuffisance cardiaque et de régurgitation mitrale traitée avec une thérapie médicale ou le MitraClip, et un modèle économique. Les résultats de l'étude observationnelle ont été utilisés pour estimer les paramètres du modèle de décision, qui a estimé les coûts et les avantages d'une cohorte hypothétique de patients atteints d'insuffisance cardiaque et insuffisance mitrale sévère traitée avec soit un traitement médical standard ou MitraClip. Résultats: La cohorte de patients traités avec le système MitraClip était appariée par score de propension à une population de patients atteints d'insuffisance cardiaque, et leurs résultats ont été comparés. Avec un suivi moyen de 22 mois, la mortalité était de 21% dans la cohorte MitraClip et de 42% dans la cohorte de gestion médicale (p = 0,007). Le modèle de décision a démontré que MitraClip augmente l'espérance de vie de 1,87 à 3,60 années et des années de vie pondérées par la qualité (QALY) de 1,13 à 2,76 ans. Le coût marginal était 52.500 $ dollars canadiens, correspondant à un rapport coût-efficacité différentiel (RCED) de 32,300.00 $ par QALY gagné. Les résultats étaient sensibles à l'avantage de survie. Conclusion: Dans cette cohorte de patients atteints d'insuffisance cardiaque symptomatique et d insuffisance mitrale significative, la thérapie avec le MitraClip est associée à une survie supérieure et est rentable par rapport au traitement médical.

Incidence of Red Water Along South Kerala Coast

Incidence of red water along the Kerala coast at 2 localities, off Quilon and Cochin, in August 1976 and 1977 is reported. High concentrations of Noctiluca miliaris (up to 7.71 x 105/m3 in 1977) are associated with these occurrences. They completely dominate the plankton community contributing > 90 % of the numbers. High production of diatoms initiated by nutrient-rich and fairly high saline upwelled waters appears to cause the bloom of the dinoflagellate Noctiluca

The incidence ,Antibiotic resistence and survival of salmonella and escherichia coli isolated from broiler chicken retail outlets

The incidence of salmonella and escherichia coli in chicken retail outlets in a residential area of coimbatore, Tamilnadu India was studied with the view that accessories may be a source of cross contamination.Accessories like cages,knives ,chopping boards weighing balance trays and the hands of butcher were examined.A toatal of 14 salmonella as well as 31 E.coli were isolated from different sources. The incidence of E.coli was higher than that of Salmonella.The highest incidence of Salmonella was found in chopping boards and the maximum level of E.Coli was detected in cages.

La incidencia de la toma de apuntes sobre el aprendizaje significativo. Un estudio de enseñanza superior.= The incidence of notetaking on meaningful learning. A study of higher education.

En este estudio presentamos una experiencia llevada a cabo con estudiantes de la asignatura “Psicología de la Educación” de diferentes centros universitarios. Tomando como marco de referencia las teorías constructivistas del aprendizaje, el objetivo de nuestro trabajo se centra en comprobar la incidencia de la utilización de diferentes estrategias de enseñanza por parte del profesor y de determinadas estrategias de aprendizaje en el proceso de registrar la información por parte de los estudiantes, en la significatividad del aprendizaje. Los resultados obtenidos muestran que en los grupos donde los profesores han utilizado estrategias de enseñanza diferentes a la clase magistral, se ha producido un cambio positivo en las respuestas de los estudiantes o se ha mantenido el mismo nivel, mientras que el grupo donde se ha utilizado una metodología magistral, el nivel de respuesta es inferior. Así mismo, hemos podido observar como los grupos de estudiantes que utilizan las estrategias de aprendizaje seleccionadas para tomar apuntes mejoran su nivel de respuestas, lo cual no se produce en el grupo control

“Superficial Water Concessions In Light Of The General Theory of the Administrative Act” The Incidence of the Public Law’s Dogmatic Tradition of Public Law Within Environmental Law

This paper seeks the determine the ways in which anomalous decisions derived from the particularization and constitutionalization of environmental law can arise given the general theory of administrative action. This is seen through the lens of a study and characterization of administrative decisions issued by the Regional Autonomous Corporation of Cundinamarca –CAR- within the superficial water concessions procedure. It also discusses the conceptual contents of these licenses.

Incidence of Meares-Irlen/visual stress syndrome in reading and learning disorders : Does fluorescent lighting in classrooms affect literacy and numeracy?

Resumen tomado de la publicación

Breast cancer incidence and overdiagnosis in Catalonia (Spain)

Early detection of breast cancer (BC) with mammography may cause overdiagnosis and overtreatment, detecting tumors which would remain undiagnosed during a lifetime. The aims of this study were: first, to model invasive BC incidence trends in Catalonia (Spain) taking into account reproductive and screening data; and second, to quantify the extent of BC overdiagnosis. We modeled the incidence of invasive BC using a Poisson regression model. Explanatory variables were: age at diagnosis and cohort characteristics (completed fertility rate, percentage of women that use mammography at age 50, and year of birth). This model also was used to estimate the background incidence in the absence of screening. We used a probabilistic model to estimate the expected BC incidence if women in the population used mammography as reported in health surveys. The difference between the observed and expected cumulative incidences provided an estimate of overdiagnosis.Incidence of invasive BC increased, especially in cohorts born from 1940 to 1955. The biggest increase was observed in these cohorts between the ages of 50 to 65 years, where the final BC incidence rates more than doubled the initial ones. Dissemination of mammography was significantly associated with BC incidence and overdiagnosis. Our estimates of overdiagnosis ranged from 0.4% to 46.6%, for women born around 1935 and 1950, respectively.Our results support the existence of overdiagnosis in Catalonia attributed to mammography usage, and the limited malignant potential of some tumors may play an important role. Women should be better informed about this risk. Research should be oriented towards personalized screening and risk assessment tools

The role of uncomposted materials, composts, manures, and compost extracts in reducing pest and disease incidence and severity in sustainable temperate agricultural and horticultural crop production - A review

This review evaluates evidence of the impact of uncomposted plant residues, composts, manures, and liquid preparations made from composts (compost extracts and teas) on pest and disease incidence and severity in agricultural and horticultural crop production. Most reports on pest control using such organic amendments relate to tropical or and climates. The majority of recent work on the use of organic amendments for prevention and control of diseases relates to container-produced plants, particularly ornamentals. However, there is growing interest in the potential for using composts to prevent and control diseases in temperate agricultural and horticultural field crops and information concerning their use and effectiveness is slowly increasing. The impact of uncomposted plant residues, composts, manures, and compost extracts/teas on pests and diseases is discussed in relation to sustainable temperate field and protected cropping systems. The factors affecting efficacy or such organic amendments in preventing and controlling pests and disease are examined and the mechanisms through which control is achieved are described.

Uneven distribution of nutrients in the root zone affects the incidence of blossom end rot and concentration of calcium and potassium in fruits of tomato

Tomato plants ( Lycopersicon esculentum Mill. var. DRK) were grown hydroponically to determine the effect of an uneven distribution of nutrients in the root zone on blossomend rot (BER) and Ca and K concentrations in the fruits. The plants were grown in rockwool with their root system divided into two portions. Each portion was irrigated with nutrient solutions with either the same or the different electrical conductivity (EC) in the range 0 to 6 dS m(-1). Solutions with high EC supplied to both sides of the root system significantly increased the incidence of BER. However, when only water or a solution of low EC was supplied to one portion, BER was reduced by 80%. Fruit yields were significantly higher ( P < 0.01) for plants that received solutions of the uneven EC treatments (6/0 or 4.5/0 EC treatment). Plants supplied with solutions of uneven EC generally had higher leaf and fruit concentrations of Ca but lower concentrations of K than those supplied with solutions of high EC. There was no difference in Ca concentration at the distal end of young fruits of the uneven EC treatment but it was reduced in the high EC treatments. The concentration of K in the mature fruits of the uneven EC treatments was lower than that of the high EC treatments and higher or similar that of the 3/3 or 2.5/2.5 EC treatments ( controls). A clear relationship was found between the incidence of BER and the exudation rate. High rate of xylem exudation was observed in the uneven EC treatments. Reduction of BER in the uneven EC treatments is most likely to be the effect of high exudation rate on Ca status in the young fruits. It was concluded that high EC of solution had positive effects on Ca concentration and incidence of BER provided that nutrient solution with low EC or water is supplied to the one portion of the root system.