Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial.

Objective To assess the three year clinical outcomes and cost effectiveness of a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair for patients with suspected ruptured abdominal aortic aneurysm.Design Randomised controlled trial.Setting 30 vascular centres (29 in UK, one in Canada), 2009-16.Participants 613 eligible patients (480 men) with a clinical diagnosis of ruptured aneurysm, of whom 502 underwent emergency repair for rupture.Interventions 316 patients were randomised to an endovascular strategy (275 with confirmed rupture) and 297 to open repair (261 with confirmed rupture).Main outcome measures Mortality, with reinterventions after aneurysm repair, quality of life, and hospital costs to three years as secondary measures.Results The maximum follow-up for mortality was 7.1 years, with two patients in each group lost to follow-up by three years. After similar mortality by 90 days, in the mid-term (three months to three years) there were fewer deaths in the endovascular than the open repair group (hazard ratio 0.57, 95% confidence interval 0.36 to 0.90), leading to lower mortality at three years (48% v 56%), but by seven years mortality was about 60% in each group (hazard ratio 0.92, 0.75 to 1.13). Results for the 502 patients with repaired ruptures were more pronounced: three year mortality was lower in the endovascular strategy group (42% v 54%; odds ratio 0.62, 0.43 to 0.88), but after seven years there was no clear difference between the groups (hazard ratio 0.86, 0.68 to 1.08). Reintervention rates up to three years were not significantly different between the randomised groups (hazard ratio 1.02, 0.79 to 1.32); the initial rapid rate of reinterventions was followed by a much slower mid-term reintervention rate in both groups. The early higher average quality of life in the endovascular strategy versus open repair group, coupled with the lower mortality at three years, led to a gain in average quality adjusted life years (QALYs) at three years of 0.17 (95% confidence interval 0.00 to 0.33). The endovascular strategy group spent fewer days in hospital and had lower average costs of -£2605 (95% confidence interval -£5966 to £702) (about €2813; $3439). The probability that the endovascular strategy is cost effective was >90% at all levels of willingness to pay for a QALY gain.Conclusions At three years, compared with open repair, an endovascular strategy for suspected ruptured abdominal aortic aneurysm was associated with a survival advantage, a gain in QALYs, similar levels of reintervention, and reduced costs, and this strategy was cost effective. These findings support the increasing use of an endovascular strategy, with wider availability of emergency endovascular repair.Trial registration Current Controlled Trials ISRCTN48334791; ClinicalTrials NCT00746122

Effect of hygroscopic growth on the aerosol light-scattering coefficient: A review of measurements, techniques and error sources

Knowledge of the scattering enhancement factor, f(RH), is important for an accurate description of direct aerosol radiative forcing. This factor is defined as the ratio between the scattering coefficient at enhanced relative humidity, RH, to a reference (dry) scattering coefficient. Here, we review the different experimental designs used to measure the scattering coefficient at dry and humidified conditions as well as the procedures followed to analyze the measurements. Several empirical parameterizations for the relationship between f(RH) and RH have been proposed in the literature. These parameterizations have been reviewed and tested using experimental data representative of different hygroscopic growth behavior and a new parameterization is presented. The potential sources of error in f(RH) are discussed. A Monte Carlo method is used to investigate the overall measurement uncertainty, which is found to be around 20 e40% for moderately hygroscopic aerosols. The main factors contributing to this uncertainty are the uncertainty in RH measurement, the dry reference state and the nephelometer uncertainty. A literature survey of nephelometry-based f(RH) measurements is presented as a function of aerosol type. In general, the highest f(RH) values were measured in clean marine environments, with pollution having a major influence on f(RH). Dust aerosol tended to have the lowest reported hygroscopicity of any of the aerosol types studied. Major open questions and suggestions for future research priorities are outlined.This work was supported by the Andalusia Regional Government through projects P10-RNM-6299 and P12-RNM-2409; by the Spanish Ministry of Economy and Competitiveness and FEDER through project CGL2013_45410-R; and by European Union’s Horizon 2020 research and innovation programme under grant agreement No 654109, ACTRIS-2. G. Titos was partially funded by Programa del Plan Propio de Investigación “Contrato Puente” of the University of Granada. We thank the Stockholm International Meteorological Institute (IMI) for travel support of G. Titos

Cooperatives a model to improve organic seed production (Liveseed Practice Abstract)

Building cooperatives sounds easier than it is. Some general recommendations are: - Build trust – an on-going process - Define clear goals – common aims, clear rules - Have a clear timeline – go step by step - Communicate clearly – among members, with customers – to maintain trust - Have the same starting point: 100% organic seed as basic requirement for all members – same values, same attitude - Gain legal advice for establishing a cooperative in your countr

Systemic Strategies to Improve the Readability of the English Version of Indonesian Children Stories

The paper discusses languge exploitation for the children story books and offers several systemic strategies to improve the quality of language exploitation so that the books have a better quality for their readabality. Thirty children story books which are classified as narratives according to the publishers were randomly selected for the analysis. The books are targeted for children from five to twelve years old. The analysis on the text structure shows that all the stories have the three obligatory discourse units, namely orientation, complication, and resolution. Meanwhile, seen from the lexicogrammatical exploitation, most of the books have various grammatical mistakes and difficult words

Selective Breeding to Improve Productive and Reproductive Performances and Survivability of Indigenous Sakini Chicken

Indigenous chickens are quite popular in Family Poultry Production System (FPPS) in Nepal, but are constrained with their low productive performance. The present study evaluated the productive and reproductive performance of Sakini chicken in different filial generations and sexes. In addition, research also aimed at understanding the effect of generations on above performances. Initially, base populations (G-0) of Sakini were maintained by collecting eight weeks old birds from different agro-ecologial zones of Nepal. Performance of the birds of G-0 was evaluated based on weekly body weight (12-24 weeks), laying performance, fertility, hatchability, hatch weight and survivability. Selected birds of base population (G-0) were used to produce first (G-1), second (G-2) and third (G-3) generations through selective breeding in each generation. Similarly, body weights at hatching, 12 weeks, 16 weeks, 20 week and 24 weeks were significantly (p<0.001) improved from G0 to G3 and were also significantly (p<0.001) differ for sex (males were always heavier than females). Likewise, there was significant (p<0.05) improvement in egg production (per hen per year), age at first lay (days), body weight at sexual maturity, egg number and egg weight at 90 days of laying in progressive generations. Fertility, hatchability and survivability significantly (p<0.05) improved in selected generations in comparison to base population, whereas, no significant difference was obtained within the different selected population. Thus, indigenous Sakini chicken under this experiment performed better with respect to survivability, fertility and hatchability in later generations that provides ample scope of advancing selective breeding activities within the indigenous population in order to bring significant improvement in the overall productive performance of Sakini chicken in Nepal