AN ANALYTICAL METHOD TO CALCULATE THE ERGODIC AND DIFFERENCE MATRICES OF THE DISCOUNTED MARKOV DECISION PROCESSES

In the paper, a theorem about the existence of the ergodic and difference matrices of the finite state discounted Markov decision processes had been formulated and proved. On the basis of this theorem an analytical method to calculate these matrices is presented. The theorem allows the distribution of the overall value into two parts: the so-called "constant" part, which represents a part of the value related to the ergodic matrix and the "variable" part which represents a sum of the difference matrices. On the basis of the mentioned analytical method a new performance index to the discounted optimal control Markov problem is proposed and some interpretation of the received results is given. The proposed new performance index is formulated as a quotient of the distinguished parts of the overall value. The method is illustrated by two simple examples.

The Role of Glycoprotein IIb/IIIa Inhibitors- A Promise Not Kept?

For over one decade Glycoproteins IIb/IIIa inhibitors (GPI) have been administered to prevent coronary artery thrombosis. Initially these agents were used for acute coronary syndromes and subsequently as adjunctive pharmacotherapy for percutaneous coronary interventions (PCIs)

Reforming the Ukrainian Health System at a time of crisis

Ukraine has retained the extensive Semashko model health care system it inherited on gaining independence from the Soviet Union in 1991 and it is largely unreformed. A large proportion of total health expenditure is paid out of pocket (42.8% in 2013) and households face inadequate protection from impoverishing and catastrophic health care costs. These weaknesses have been exacerbated by the strain of caring for conlict-affected populations since 2014. The government faces the challenge of implementing fundamental reform in the health care system to rebuild universal health coverage against a background of resource constraints and ongoing conlict

Association of Lowering Low‐Density Lipoprotein Cholesterol With Contemporary Lipid‐Lowering Therapies and Risk of Diabetes Mellitus: A Systematic Review and Meta‐Analysis

Background The relationship between lowering LDL (low‐density lipoprotein) cholesterol with contemporary lipid‐lowering therapies and incident diabetes mellitus (DM) remains uncertain. Methods and Results Thirty‐three randomized controlled trials (21 of statins, 12 of PCSK9 [proprotein convertase subtilisin/kexin type 9] inhibitors, and 0 of ezetimibe) were selected using Medline, Embase, and the Cochrane Central Register of Controlled Trials (inception through November 15, 2018). A total of 163 688 nondiabetic patients were randomly assigned to more intensive (83 123 patients) or less intensive (80 565 patients) lipid‐lowering therapy. More intensive lipid‐lowering therapy was defined as the more potent pharmacological strategy (PCSK9 inhibitors, higher intensity statins, or statins), whereas less intensive therapy corresponded to active control group or placebo/usual care of the trial. Metaregression and meta‐analyses were conducted using a random‐effects model. No significant association was noted between 1‐mmol/L reduction in LDL cholesterol and incident DM for more intensive lipid‐lowering therapy (risk ratio: 0.95; 95% CI, 0.87–1.04; P=0.30; R2=14%) or for statins or PCSK9 inhibitors. More intensive lipid‐lowering therapy was associated with a higher risk of incident DM compared with less intensive therapy (risk ratio: 1.07; 95% CI, 1.03–1.11; P\u3c0.001; I2=0%). These results were driven by higher risk of incident DM with statins (risk ratio: 1.10; 95% CI, 1.05–1.15; P\u3c0.001; I2=0%), whereas PCSK9 inhibitors were not associated with incident DM (risk ratio: 1.00; 95% CI, 0.93–1.07; P=0.96; I2=0%; P=0.02 for interaction). Conclusions Among intensive lipid‐lowering therapies, there was no independent association between reduction in LDL cholesterol and incident DM. The risk of incident DM was higher with statins, whereas PCSK9 inhibitors had no association with risk of incident DM

Ukraine: Health system review. Health Systems in Transition

This analysis of the Ukrainian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Since the country gained independence from the Soviet Union in 1991, successive governments have sought to overcome funding shortfalls and modernize the health care system to meet the needs of the population’s health. However, no fundamental reform of the system has yet been implemented and consequently it has preserved the main features characteristic of the Semashko model; there is a particularly high proportion of total health expenditure paid out of pocket (42.3% in 2012), and incentives within the system do not focus on quality or outcomes. The most recent health reform programme began in 2010 and sought to strengthen primary and emergency care, rationalize hospitals and change the model of health care financing from one based on inputs to one based on outputs. Fundamental issues that hampered reform efforts in the past re-emerged, but conf lict and political instability have proved the greatest barriers to reform implementation and the programme was abandoned in 2014. More recently, the focus has been on more pressing humanitarian concerns arising from the conflict in the east of Ukraine. It is hoped that greater political, social and economic stability in the future will provide a better environment for the introduction of deep reforms to address shortcomings in the Ukrainian health system

Association of Lowering Low�Density Lipoprotein Cholesterol With Contemporary Lipid�Lowering Therapies and Risk of Diabetes Mellitus: A Systematic Review and Meta�Analysis

Background The relationship between lowering LDL (low�density lipoprotein) cholesterol with contemporary lipid�lowering therapies and incident diabetes mellitus (DM) remains uncertain. Methods and Results Thirty�three randomized controlled trials (21 of statins, 12 of PCSK9 [proprotein convertase subtilisin/kexin type 9] inhibitors, and 0 of ezetimibe) were selected using Medline, Embase, and the Cochrane Central Register of Controlled Trials (inception through November 15, 2018). A total of 163 688 nondiabetic patients were randomly assigned to more intensive (83 123 patients) or less intensive (80 565 patients) lipid�lowering therapy. More intensive lipid�lowering therapy was defined as the more potent pharmacological strategy (PCSK9 inhibitors, higher intensity statins, or statins), whereas less intensive therapy corresponded to active control group or placebo/usual care of the trial. Metaregression and meta�analyses were conducted using a random�effects model. No significant association was noted between 1�mmol/L reduction in LDL cholesterol and incident DM for more intensive lipid�lowering therapy (risk ratio: 0.95; 95% CI, 0.87–1.04; P=0.30; R2=14%) or for statins or PCSK9 inhibitors. More intensive lipid�lowering therapy was associated with a higher risk of incident DM compared with less intensive therapy (risk ratio: 1.07; 95% CI, 1.03–1.11; P<0.001; I2=0%). These results were driven by higher risk of incident DM with statins (risk ratio: 1.10; 95% CI, 1.05–1.15; P<0.001; I2=0%), whereas PCSK9 inhibitors were not associated with incident DM (risk ratio: 1.00; 95% CI, 0.93–1.07; P=0.96; I2=0%; P=0.02 for interaction). Conclusions Among intensive lipid�lowering therapies, there was no independent association between reduction in LDL cholesterol and incident DM. The risk of incident DM was higher with statins, whereas PCSK9 inhibitors had no association with risk of incident DM

Trends in premature mortality from acute myocardial infarction in the United States, 1999 to 2019

Pagination are not provided by the author/publisher. This work was published before the author joined Aga Khan University

A new device to seal large coronary aneurysms: a case report

<p>Abstract</p> <p>Introduction</p> <p>Coronary artery aneurysm is an uncommon disease. It is defined as a coronary artery dilatation, exceeding the diameter of the normal adjacent segment or the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Coronary artery aneurysms are typically diagnosed by coronary angiography. The prognosis of coronary artery aneurysm is not well known and the management is challenging.</p> <p>Case presentation</p> <p>A 68-year-old Italian-Caucasian man presented to our hospital with angina. Coronary angiography revealed a large coronary aneurysm of the right coronary artery, which was successfully treated by the percutaneous implantation of an MGuard™stent.</p> <p>Conclusion</p> <p>This case report provides evidence that coronary artery aneurysms, even if very large, can be safely treated by MGuard™stent implantation. We strongly emphasize the high flexibility and good deliverability of this device, which leads to the complete exclusion of the aneurysm mediated by the process of endothelization of its thin mesh sleeves.</p

Pest categorisation of Longidorus diadecturus

The Panel on Plant Health performed a pest categorisation of Longidorus diadecturus (Nematoda: Longidoridae) for the EU. The nematode is a well-defined taxon and was described from Ontario, Canada and later reported from some states in the USA. The nematode is not present in the EU. It is regulated by Council Directive 2000/29/EC, listed in Annex I A I as L. diadecturus Eveleigh and Allen. It is a migratory ectoparasitic nematode species puncturing cells of plant roots thereby able to transmit the nepovirus Peach rosette mosaic virus (PRMV). The pest is found in soil associated with plant species belonging to different families. L. diadecturus is able to cause direct damage to plants, but its main damage is caused by vectoring PRMV. Soil is a potential pathway for this nematode for entry into the EU. The nematode is able to survive adverse conditions, but the virus may not persist inside the nematode for extended periods. Climatic conditions in the EU are similar to those found in the countries where the pest is currently present. Hosts of the nematode (and the associated virus) are, e.g. peaches and grapes; those crops are also widely cultivated in the EU. The nematode only moves short distances (around 1 m) but may be spread with soil moving activities. Measures are available to inhibit entry via soil as such. Entry of the nematode with soil attached to plants for planting that are not regulated is possible. L. diadecturus does satisfy all the criteria that are within the remit of EFSA to assess to be regarded as a potential Union quarantine pest