Cost-Effectiveness of Different Diagnostic Strategies in Suspected Stable Coronary Artery Disease in Portugal

BACKGROUND: Cost-effectiveness is an increasingly important factor in the choice of a test or therapy. OBJECTIVE: To assess the cost-effectiveness of various methods routinely used for the diagnosis of stable coronary disease in Portugal. METHODS: Seven diagnostic strategies were assessed. The cost-effectiveness of each strategy was defined as the cost per correct diagnosis (inclusion or exclusion of obstructive coronary artery disease) in a symptomatic patient. The cost and effectiveness of each method were assessed using Bayesian inference and decision-making tree analyses, with the pretest likelihood of disease ranging from 10% to 90%. RESULTS: The cost-effectiveness of diagnostic strategies was strongly dependent on the pretest likelihood of disease. In patients with a pretest likelihood of disease of ≤50%, the diagnostic algorithms, which include cardiac computed tomography angiography, were the most cost-effective. In these patients, depending on the pretest likelihood of disease and the willingness to pay for an additional correct diagnosis, computed tomography angiography may be used as a frontline test or reserved for patients with positive/inconclusive ergometric test results or a calcium score of >0. In patients with a pretest likelihood of disease of ≥ 60%, up-front invasive coronary angiography appears to be the most cost-effective strategy. CONCLUSIONS: Diagnostic algorithms that include cardiac computed tomography angiography are the most cost-effective in symptomatic patients with suspected stable coronary artery disease and a pretest likelihood of disease of ≤50%. In high-risk patients (pretest likelihood of disease ≥ 60%), up-front invasive coronary angiography appears to be the most cost-effective strategy. In all pretest likelihoods of disease, strategies based on ischemia appear to be more expensive and less effective compared with those based on anatomical tests.info:eu-repo/semantics/publishedVersio

Sweet’s Syndrome and Inflammatory Bowel Disease - uncommon association

O Síndrome de Sweet (SSw) é uma dermatose neutrofílica caracterizada pela presença de febre, neutrofilia e lesões cutâneas cuja histologia revela um infiltrado inflamatório difuso neutrofílico da derme. A fisiopatologia deste Síndrome ainda não foi totalmente esclarecida. Pode ser idiopático ou associar-se a diversas patologias (infecciosas, neoplásicas, inflamatórias) pelo que deve ser primariamente considerado como manifestação sistémica de uma doença subjacente. A associação entre a síndrome de Sweet e a doença inflamatória intestinal não é muito frequente, e o primeiro não parece reflectir a actividade da última, partilhando, sim, um mesmo mecanismo fisiopatológico

Computed tomography angiography for the interventional cardiologist

WOS:000339902400002In recent years, coronary CT angiography (CCTA) has become a widely adopted technique, not only due to its high diagnostic accuracy, but also to the fact that CCTA provides a comprehensive evaluation of the total (obstructive and non-obstructive) coronary atherosclerotic burden. More recently, this technique has become mature, with a large body of evidence addressing its prognostic validation. In addition, CT angiography has moved from the field of `imagers' and clinicians and entered the interventional cardiology arena, aiding in the planning of both coronary and structural heart interventions, being transcatheter aortic valve implantation one of its most successful examples. It is therefore of utmost importance that interventional cardiologists become familiar with image interpretation and up-to-date regarding several CTA features, taking advantage of this information in planning the procedure, ultimately leading to improvement in patient outcomes. On the other hand, the increasing use of CCTA as a gatekeeper for invasive coronary angiography is expected to lead to an increase in the ratio of interventional to diagnostic procedures and significant changes in the daily cath-lab routine. In a foreseeable future, cath-labs will probably offer an invasive procedure only to patients expected to undergo an intervention, perhaps becoming in this change true interventional-labs.publishersversionpublishe

Micro-simulation of the impact of different speeds on safety road travel and urban travel time: case study in the city of Guimarães

In recent days, the use of micro-simulation as an additional tool for the study of the network makes this management faster and more efficient, avoiding in situ studies. However, although it is a useful tool, it is necessary that the model under study is the best represented possible in order to obtain results that best fit the reality of the road, and a poor calibration of the model can provide results that do not fit the good management of the road under study. In this sense, using micro-simulation, more precisely to the VISSIM PTV software, a road network at the microscopic level will be evaluated as well as the parameters that most influence the route of the users within that network. The parameters will be modified according to the modeler so as to obtain a model as close to reality as possible. The most appropriate criteria for the calibration and validation of the model will also be chosen. The road safety of the network will also be analyzed using the SSAM software. Here the network's points of conflict will be analyzed, characterizing them as to the type and its severity. Subsequently, a sensitivity analysis will be introduced, where some parameters will be modified individually or together, in order to assess their influence on the network, thus assessing the importance of each in the vehicles.(undefined

On the nature of the (de)coupling of the magnetostructural transition in Er5_5Si4_4

In this report, a successful thermodynamical model was employed to understand the structural transition in Er$_5$Si$_4$, able to explain the decoupling of the magnetic and structural transition. This was achieved by the DFT calculations which were used to determine the energy differences at 0 K, using a LSDA+U approximation. It was found that the M structure as the stable phase at low temperatures as verified experimentally with a $\Delta F_0 = -$0.262 eV. Finally, it was achieved a variation of Seebeck coefficient ($\sim$ 6 $\mu$V) at the structural transition which allow to conclude that the electronic entropy variation is negligible in the transition.Comment: 17 pages, 3 figures, 1 tabl

Tolerância de conídios de isolados de Beauveria bassiana (Balsam) Vuill. a radiação UV e temperatura.

O objetivo desse trabalho foi avaliar a influência destas variáveis sobre a germinação de isolados de B. bassiana.SICONBIOL 2013

Ordenamento ambiental e época de plantio da mamoneira (Ricinus communis L.) para a região Norte de Minas Gerais.

Ordenamento ambiental e época de plantio da mamoneirabitstream/CNPA/19621/1/COMTEC207.PD

Simple strategies for stable aqueous suspensions of carbon nanotubes

Carbon nanotubes (CNT) are attractive nanoparticles for biological applications due to their broad absorption of light in the UV-Vis-NIR, NIR photoluminescence, unique Raman signature, photothermal response, and large surface area for the covalent and non-covalent conjugation of contrast agents and drugs, DNA/RNA. However, pristine CNT are highly hydrophobic and not biocompatible, requiring functionalization with hydrophilic molecules in order to form stable aqueous suspensions. Here, simple functionalization methods of perylene bisimides and pyrene, to render these polyaromatic molecules amphiphilic, will be presented. Bolaamphiphilic perylene bisimides (PBI) were prepared by the reaction of perylenetetracarboxylic dianhydride with -amino acids in good yield, using a simple protocol and avoiding complex purification methods. [1] Pyrene was modified by nitration followed by amination, and further reacted with maleic anhydride yielding carboxylic acid-functionalized pyrene. The CNT aqueous suspensions were studied by absorption and emission spectroscopy. Theoretical calculations were used to support the experimental observations. The possibility of CNT double functionalization (covalent and non-covalent) will be discussed based on CNT solubility studies in surfactant aqueous solutions. Pristine and covalently functionalized CNT, at different functionalization yields, were compared. The CNT were functionalized by the 1,3-dipolar cycloaddition of azomethine ylides. [2] The ability of CNT to adsorb surfactant molecules was reduced by the covalent functionalization. Nevertheless, depending on the extent of covalent functionalization, a high concentration of CNT in water could be attained, in comparison to that of pristine CNT.Fundação para a Ciência e a Tecnologia (FCT