Comparing impact and cost-effectiveness of primary prevention strategies for lipid-lowering.

BACKGROUND: Lipid-lowering therapy is costly but effective at reducing coronary heart disease (CHD) risk. OBJECTIVE: To assess the cost-effectiveness and public health impact of Adult Treatment Panel III (ATP III) guidelines and compare with a range of risk- and age-based alternative strategies. DESIGN: The CHD Policy Model, a Markov-type cost-effectiveness model. DATA SOURCES: National surveys (1999 to 2004), vital statistics (2000), the Framingham Heart Study (1948 to 2000), other published data, and a direct survey of statin costs (2008). TARGET POPULATION: U.S. population age 35 to 85 years. Time Horizon: 2010 to 2040. PERSPECTIVE: Health care system. INTERVENTION: Lowering of low-density lipoprotein cholesterol with HMG-CoA reductase inhibitors (statins). OUTCOME MEASURE: Incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Full adherence to ATP III primary prevention guidelines would require starting (9.7 million) or intensifying (1.4 million) statin therapy for 11.1 million adults and would prevent 20,000 myocardial infarctions and 10,000 CHD deaths per year at an annual net cost of $3.6 billion ($42,000/QALY) if low-intensity statins cost $2.11 per pill. The ATP III guidelines would be preferred over alternative strategies if society is willing to pay $50,000/QALY and statins cost $1.54 to $2.21 per pill. At higher statin costs, ATP III is not cost-effective; at lower costs, more liberal statin-prescribing strategies would be preferred; and at costs less than $0.10 per pill, treating all persons with low-density lipoprotein cholesterol levels greater than 3.4 mmol/L (>130 mg/dL) would yield net cost savings. RESULTS OF SENSITIVITY ANALYSIS: Results are sensitive to the assumptions that LDL cholesterol becomes less important as a risk factor with increasing age and that little disutility results from taking a pill every day. LIMITATION: Randomized trial evidence for statin effectiveness is not available for all subgroups. CONCLUSION: The ATP III guidelines are relatively cost-effective and would have a large public health impact if implemented fully in the United States. Alternate strategies may be preferred, however, depending on the cost of statins and how much society is willing to pay for better health outcomes. FUNDING: Flight Attendants' Medical Research Institute and the Swanson Family Fund. The Framingham Heart Study and Framingham Offspring Study are conducted and supported by the National Heart, Lung, and Blood Institute.

Estadísticas de los desembarques de la pesquería marina peruana 1995-1996

Presenta estadísticas pesqueras de especies por meses, puertos por meses y especies por puertos de los desembarques de las principales 107 especies comerciales mas frecuentes como peces, crustáceos, moluscos, equinodermos y algas. Así mismo se menciona en las tablas la presencia absolutamente incidental y prácticamente nula de quelonios y toninos solamente para demostrar la diversidad biológica del mar peruano.

Common variants near MC4R are associated with fat mass, weight and risk of obesity.

To identify common variants influencing body mass index (BMI), we analyzed genome-wide association data from 16,876 individuals of European descent. After previously reported variants in FTO, the strongest association signal (rs17782313, P = 2.9 x 10(-6)) mapped 188 kb downstream of MC4R (melanocortin-4 receptor), mutations of which are the leading cause of monogenic severe childhood-onset obesity. We confirmed the BMI association in 60,352 adults (per-allele effect = 0.05 Z-score units; P = 2.8 x 10(-15)) and 5,988 children aged 7-11 (0.13 Z-score units; P = 1.5 x 10(-8)). In case-control analyses (n = 10,583), the odds for severe childhood obesity reached 1.30 (P = 8.0 x 10(-11)). Furthermore, we observed overtransmission of the risk allele to obese offspring in 660 families (P (pedigree disequilibrium test average; PDT-avg) = 2.4 x 10(-4)). The SNP location and patterns of phenotypic associations are consistent with effects mediated through altered MC4R function. Our findings establish that common variants near MC4R influence fat mass, weight and obesity risk at the population level and reinforce the need for large-scale data integration to identify variants influencing continuous biomedical traits.

« Li rommans de Godefroy de Buillon et de Salehadin et de tous lez autres roys qui ont esté outre mer jusques a saint Loys qui darrenierement y fu ».

Début : « Si povés vous savoir les sains leus de la terre... — Fin : «... Adonc estoient l'an de l'incarnation Nostre Seigneur mil CCLXI. Explicit les Feiz d'Outremer. Ce livre ci fu complet d'escripture l'an de l'incarnation Nostre Seigneur mil trois cens et trante et VII, le jeudi devant la feste mon seigneur saint Thomas l'apostre devant Noël. » — Nombreuses miniatures. — Au fol. 1, on lit : « Au duc d'Arschot en 1584 ».

L'Écho de Paris

1888/06/08 (Numéro 1539).

L'Écho de Paris

1888/07/23 (Numéro 1584).

Biblia sacra, pars.

BIBLIA SACRA

Biblia sacra, pars III.

Avec prologues et « capitula ». Job (2) ; Tobias (20) ; Judith (27v) ; Esther (37) ; Macchab. I-II (46v) ; Ezechiel (84v) ; XII Proph. min. (122) ; Isaias (151v). — Epist. Pauli, depuis Rom. I, 1, jusqu'à Philipp. 21, et depuis Hebr. II, 18, jusqu'à la fin, avec Epist. ad Laodicenses (184v).

Vetus Testamentum (fin). Novum Testamentum

Ce volume a été relié avec le ms. Latin 50 pour former une bible complète (cf. Berger, Hist. de la Vulg., 401), mais il semble que ces deux manuscrits ont été réalisés séparément, à une date et par un atelier différent. (F. Avril, Dix siècles d'enluminure italienne, notice 11). Avec prologues, arguments et « capitula ». Psalmi (1) ; Proverbia (13v) ; Ecclesiastes (20) ; Cant. canticorum (22v) ; Sapientia (24) ; Ecclesiasticus (29v) ; Oratio Salomonis (42v) ; Paralip. I-II (43) ; Job (62) ; Tobias (69) ; Judith (72) ; Esther (76) ; Esdras I-II (80) ; Macchab. I-II (87v). — Evangeliorum canones (103) ; Evang. Matthaei (106), Marci (112v), Lucae (117v), Johannis (125) ; Actus Apost. (131v) ; VII Epist. canon. (142), Apocalypsis (147v) ; Concordia Epist. Pauli (153) ; XIV Epist. Pauli (154) ; Epist. ad Laodicenses (addit. du XIIe s.) (176). — Quelques leçons indiquées en marge.

Vetus Testamentum, pars II.

Avec prologues et « capitula ». Reg. II,VII,22-XI,14 (2), III,II,46-VIII,29 (5), II,XIX,12-III,II,41 (13), II,VI,19-VII,22 (29), II,XIV,9-XVIII,24 (30), II,XII,10-XIII,5 (36), III,VIII, 30-XXII,54 (37), IV,I,1-XXV,30 (61) ; Job (98v) ; Tobias (120).

Biblia sacra, pars.

Avec prologues et arguments. Genesis (3) ; Reg. I-IV (13) ; Tobias (43) ; Job (45) ; Proverbia (51), etc. — Oratio Salomonis (70v) ; Isaias (71v), etc. — Daniel (99) ; Ezechiel (104v) ; XII Proph. min. (116). — Evang. Matthaei (130), etc. — XIV Epist. Pauli (156) ; Actus Apost. (172), etc. — Interpretationes nominum hebraicorum : « Aaz, apprehendens... — ... consiliatores eorum... secundum Jeronimum. » (188). F. 187 Fragment de liste des épîtres et évangiles, suivi d'hymnes ou proses à la Vierge : « Ave, virgo singularis, mundi splendor... », « Vas auri... », « Ave stella matutina ex qua... », « Oliva virens... », « Murenulis aureis rutilans... », « Mons altissimus... ».