Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease

BACKGROUND: The recent recognition that coronary-artery stenting has improved the short- and long-term outcomes of patients treated with angioplasty has made it necessary to reevaluate the relative benefits of bypass surgery and percutaneous interventions in patients with multivessel disease. METHODS: A total of 1205 patients were randomly assigned to undergo stent implantation or bypass surgery when a cardiac surgeon and an interventional cardiologist agreed that the same extent of revascularization could be achieved by either technique. The primary clinical end point was freedom from major adverse cardiac and cerebrovascular events at one year. The costs of hospital resources used were also determined. RESULTS: At one year, there was no significant difference between the two groups in terms of the rates of death, stroke, or myocardial infarction. Among patients who survived without a stroke or a myocardial infarction, 16.8 percent of those in the stenting group underwent a second revascularization, as compared with 3.5 percent of those in the surgery group. The rate of event-free survival at one year was 73.8 percent among the patients who received stents and 87.8 percent among those who underwent bypass surgery (P<0.001 by the log-rank test). The costs for the initial procedure were $4,212 less for patients assigned to stenting than for those assigned to bypass surgery, but this difference was reduced during follow-up because of the increased need for repeated revascularization; after one year, the net difference in favor of stenting was estimated to be$2,973 per patient. CONCLUSION: As measured one year after the procedure, coronary stenting for multivessel disease is less expensive than bypass surgery and offers the same degree of protection against death, stroke, and myocardial infarction. However, stenting is associated with a greater need for repeated revascularization

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Business Productivity and Area Productivity in Rural England

Webber D., Curry N. and Plumridge A. Business productivity and area productivity in rural England, Regional Studies. Rural area productivity and rural business productivity measure different things. This paper presents a empirical analysis of labour productivity differentials across the new Department for Environment, Food and Rural Affairs (DEFRA) definition of 'rural'. Labour productivity is 21% (13%) lower in sparse (less sparse) rural areas compared with urban areas. Labour productivity in less sparse and urban areas appears to depend on similar factors. Labour productivity in sparse areas strongly relates to a different industrial structure and plants in sparse areas gain less benefit from larger capital stocks. Policy needs to be aware of these differences if the urban-rural productivity divide is to be reduced. [image omitted] Webber D., Curry N. et Plumridge A. La productivite du commerce et la productivite des espaces ruraux anglais, Regional Studies. La productivite des espaces ruraux et la productivite du commerce mesurent des choses differentes. Cet article cherche a presenter une analyse empirique des ecarts de la productivite du travail a partir de la nouvelle definition du rural d'apres le Department for Environment, Food and Rural Affairs (DEFRA). Il s'avere que la productivite du travail est de 21% (15%) moins elevee dans les zones rurales moins peuplees (plus peuplees) par rapport aux zones urbaines. Il semble que la productivite du travail dans les zones moins peuplees et dans les zones urbaines dependent des facteurs similaires. La productivite du travail dans les zones moins peuplees se rapporte etroitement a une structure industrielle differente, et les etablissements situes dans les zones moins peuplees profitent moins des stocks de capital plus importants. La politique devrait tenir compte de ces differences dans le but de reduire l'ecart urbano-rural de la productivite. Rural Productivite Competences Structure industrielle Webber D., Curry N. und Plumridge A. Produktivitat von Betrieben und Gebieten im landlichen England, Regional Studies. Bei der Ermittlung der Produktivitat von landlichen Gebieten und der von landlichen Betrieben werden unterschiedliche Dinge gemessen. In diesem Beitrag stellen wir eine empirische Analyse der Differentiale von Arbeitsproduktivitat vor, wobei das gesamte Spektrum der neuen Definition des Begriffs 'landlich' durch die Department for Environment, Food and Rural Affairs (DEFRA) berucksichtigt wird. Wir stellen fest, dass die Arbeitsproduktivitat in dunn (weniger dunn) besiedelten landlichen Gebieten im Vergleich zu Stadtgebieten um 21% (13%) niedriger ausfallt. Die Arbeitsproduktivitat in weniger dunn besiedelten sowie in Stadtgebieten scheint von ahnlichen Faktoren abzuhangen. Die Arbeitsproduktivitat in dunn besiedelten Gebieten steht in einem engen Zusammenhang zur unterschiedlichen industriellen Struktur; die Anlagen in dunn besiedelten Gebieten profitieren weniger von grosserem Fremdkapital. Die Politik muss sich dieser Unterschiede bewusst sein, wenn die Unterschiede in der Produktivitat von landlichen und stadtischen Gebieten verringert werden sollen. Landlich Produktivitat Qualifikationen Industriestruktur Webber D., Curry N. y Plumridge A. Productividad comercial y la productividad segun areas en las zonas rurales de Inglaterra, Regional Studies. Para medir la productividad de zonas rurales y la productividad de negocios rurales se utilizan metodos diferentes. En este articulo presentamos un analisis empirico de los diferenciales de productividad laboral segun la nueva definicion de lo Department for Environment, Food and Rural Affairs (DEFRA) de lo que significa 'rural'. Observamos que la productividad laboral es un 21% menor en zonas rurales poco pobladas (13% menor en zonas rurales mas pobladas) en comparacion con zonas urbanas. La productividad laboral en zonas rurales mas pobladas y en zonas urbanas parece depender de factores similares. La productividad laboral en zonas poco pobladas esta fuertemente ligada a una estructura industrial diferente y las plantas en zonas poco pobladas obtienen menos beneficios de mayor capital social. A fin de poder reducir la division de la productividad en zonas urbanas y rurales es necesario que los lideres politicos esten al corriente de estas diferencias. Rural Productividad Habilidades Estructura industrialRural, Productivity, Skills, Industrial structure,