Cost-effectiveness of stepwise provisional versus systematic dual stenting strategies in patients with distal bifurcation left main stem lesions: Economic analysis of the EBC MAIN trial

\ua9 2024 BMJ Publishing Group. All rights reserved.Background In patients with distal bifurcation left main stem lesions requiring intervention, the European Bifurcation Club Left Main Coronary Stent Study trial found a non-significant difference in major adverse cardiac events (MACEs, composite of all-cause death, non-fatal myocardial infarction and target lesion revascularisation) favouring the stepwise provisional strategy, compared with the systematic dual stenting. Aims To estimate the 1-year cost-effectiveness of stepwise provisional versus systematic dual stenting strategies. Methods Costs in France and the UK, and MACE were calculated in both groups to estimate the incremental cost-effectiveness ratio (ICER). Uncertainty was explored by probabilistic bootstrapping. The analysis was conducted from the perspective of the healthcare provider with a time horizon of 1 year. Results The cost difference between the two groups was €-755 (€5700 in the stepwise provisional group and €6455 in the systematic dual stenting group, p value<0.01) in France and €-647 (€6728 and €7375, respectively, p value=0.08) in the UK. The point estimates for the ICERs found that stepwise provisional strategy was cost saving and improved outcomes with a probabilistic sensitivity analysis confirming dominance with an 80% probability. Conclusion The stepwise provisional strategy at 1 year is dominant compared with the systematic dual stenting strategy on both economic and clinical outcomes

Pumping two dilute gas Bose-Einstein condensates with Raman light scattering

We propose an optical method for increasing the number of atoms in a pair of dilute gas Bose-Einstein condensates. The method uses laser-driven Raman transitions which scatter atoms between the condensate and non-condensate atom fractions. For a range of condensate phase differences there is destructive quantum interference of the amplitudes for scattering atoms out of the condensates. Because the total atom scattering rate into the condensates is unaffected the condensates grow. This mechanism is analogous to that responsible for optical lasing without inversion. Growth using macroscopic quantum interference may find application as a pump for an atom laser.Comment: 4 pages, no figure

Probing quantum phases of ultracold atoms in optical lattices by transmission spectra in cavity QED

Studies of ultracold atoms in optical lattices link various disciplines, providing a playground where fundamental quantum many-body concepts, formulated in condensed-matter physics, can be tested in much better controllable atomic systems, e.g., strongly correlated phases, quantum information processing. Standard methods to measure quantum properties of Bose-Einstein condensates (BECs) are based on matter-wave interference between atoms released from traps which destroys the system. Here we propose a nondestructive method based on optical measurements, and prove that atomic statistics can be mapped on transmission spectra of a high-Q cavity. This can be extremely useful for studying phase transitions between Mott insulator and superfluid states, since various phases show qualitatively distinct light scattering. Joining the paradigms of cavity quantum electrodynamics (QED) and ultracold gases will enable conceptually new investigations of both light and matter at ultimate quantum levels, which only recently became experimentally possible. Here we predict effects accessible in such novel setups.Comment: 6 pages, 3 figure

Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough

Background Cough is a common and distressing symptom in lung cancer patients. The clinical management of cough in lung cancer patients is suboptimal with limited high quality research evidence available. The aim of the present paper is to present a clinical guideline developed in the UK through scrutiny of the literature and expert opinion, in order to aid decision making in clinicians and highlight good practice. Methods Two systematic reviews, one focusing on the management of cough in respiratory illness and one Cochrane review specifically on cancer, were conducted. Also, data from reviews, phase II trials and case studies were synthesized. A panel of experts in the field was also convened in an expert consensus meeting to make sense of the data and make clinical propositions. Results A pyramid of cough management was developed, starting with the treatment of reversible causes of cough/specific pathology. Initial cough management should focus on peripherally acting and intermittent treatment; more resistant symptoms require the addition of (or replacement by) centrally acting and continuous treatment. The pyramid for the symptomatic management starts from the simpler and most practical regimens (demulcents, simple linctus) to weak opioids to morphine and methadone before considering less well-researched and experimental approaches. Conclusion The clinical guidelines presented aim to provide a sensible clinical approach to the management of cough in lung cancer. High quality research in this field is urgently required to provide more evidence-based recommendations

Determinants of adults' intention to vaccinate against pandemic swine flu

This article has been made available through the Brunel Open Access Publishing Fund.This article has been made available through the Brunel Open Access Publishing Fund.Background: Vaccination is one of the cornerstones of controlling an influenza pandemic. To optimise vaccination rates in the general population, ways of identifying determinants that influence decisions to have or not to have a vaccination need to be understood. Therefore, this study aimed to predict intention to have a swine influenza vaccination in an adult population in the UK. An extension of the Theory of Planned Behaviour provided the theoretical framework for the study. Methods: Three hundred and sixty two adults from the UK, who were not in vaccination priority groups, completed either an online (n = 306) or pen and paper (n = 56) questionnaire. Data were collected from 30th October 2009, just after swine flu vaccination became available in the UK, and concluded on 31st December 2009. The main outcome of interest was future swine flu vaccination intentions. Results: The extended Theory of Planned Behaviour predicted 60% of adults’ intention to have a swine flu vaccination with attitude, subjective norm, perceived control, anticipating feelings of regret (the impact of missing a vaccination opportunity), intention to have a seasonal vaccine this year, one perceived barrier: “I cannot be bothered to get a swine flu vaccination” and two perceived benefits: “vaccination decreases my chance of getting swine flu or its complications” and “if I get vaccinated for swine flu, I will decrease the frequency of having to consult my doctor,” being significant predictors of intention. Black British were less likely to intend to have a vaccination compared to Asian or White respondents. Conclusions: Theoretical frameworks which identify determinants that influence decisions to have a pandemic influenza vaccination are useful. The implications of this research are discussed with a view to maximising any future pandemic influenza vaccination uptake using theoretically-driven applications.This article is available through the Brunel Open Access Publishing Fund

The impacts avoided with a 1.5 °C climate target: a global and regional assessment

The 2015 Paris Agreement commits countries to pursue efforts to limit the increase in global mean temperature to 1.5 °C above pre-industrial levels. We assess the consequences of achieving this target in 2100 for the impacts that are avoided, using several indicators of impact (exposure to drought, river flooding, heat waves and demands for heating and cooling energy). The proportion of impacts that are avoided is not simply equal to the proportional reduction in temperature. At the global scale, the median proportion of projected impacts avoided by the 1.5 °C target relative to a rise of 4 °C ranges between 62 and 95% across sectors: the greatest reduction is for heat wave impacts. The 1.5 °C target results in impacts that would be between 27 and 62% lower than with the 2 °C target. For each indicator, there are differences in the proportions of impacts avoided between regions depending on exposure and the regional changes in climate (particularly precipitation). Uncertainty in the proportion of impacts that are avoided for a specific sector depends on the range in the shape of the relationship between global temperature change and impact, and this varies between sectors

Follow-up of internal mammary artery stent with 64-slice CT

We present a case of 81-year-old woman complaining chest pain after minimal efforts who underwent multiple coronary artery bypass grafts (CABGs) during the last 15 years. A significant in-stent re-stenosis was found at ostium of left internal mammary artery (LIMA). A non-invasive CT coronary angiography (CT-CA) was performed after 6-month follow-up. CT-CA is a reliable non-invasive technique for the follow-up of stents in coronary artery bypass grafts

Reconciled climate response estimates from climate models and the energy budget of Earth

Climate risks increase with mean global temperature, so knowledge about the amount of future global warming should better inform risk assessments for policymakers. Expected near-term warming is encapsulated by the transient climate response (TCR), formally defined as the warming following 70 years of 1% per year increases in atmospheric CO2 concentration, by which point atmospheric CO2 has doubled. Studies based on Earth’s historical energy budget have typically estimated lower values of TCR than climate models, suggesting that some models could overestimate future warming. However, energy-budget estimates rely on historical temperature records that are geographically incomplete and blend air temperatures over land and sea ice with water temperatures over open oceans. We show that there is no evidence that climate models overestimate TCR when their output is processed in the same way as the HadCRUT4 observation-based temperature record3, 4. Models suggest that air-temperature warming is 24% greater than observed by HadCRUT4 over 1861–2009 because slower-warming regions are preferentially sampled and water warms less than air5. Correcting for these biases and accounting for wider uncertainties in radiative forcing based on recent evidence, we infer an observation-based best estimate for TCR of 1.66 °C, with a 5–95% range of 1.0–3.3 °C, consistent with the climate models considered in the IPCC 5th Assessment Report

New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial

Background: There is limited information on the incidence and prognostic impact of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD). Objectives: This study sought to determine the incidence of NOAF following PCI and CABG for LMCAD and its effect on 3-year cardiovascular outcomes. Methods: In the EXCEL (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial, 1,905 patients with LMCAD and low or intermediate SYNTAX scores were randomized to PCI with everolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. Results: Among 1,812 patients without atrial fibrillation on presentation, NOAF developed at a mean of 2.7 ± 2.5 days after revascularization in 162 patients (8.9%), including 161 of 893 (18.0%) CABG-treated patients and 1 of 919 (0.1%) PCI-treated patients (p < 0.0001). Older age, greater body mass index, and reduced left ventricular ejection fraction were independent predictors of NOAF in patients undergoing CABG. Patients with versus without NOAF had a significantly longer duration of hospitalization, were more likely to be discharged on anticoagulant therapy, and had an increased 30-day rate of Thrombolysis In Myocardial Infarction major or minor bleeding (14.2% vs. 5.5%; p < 0.0001). By multivariable analysis, NOAF after CABG was an independent predictor of 3-year stroke (6.6% vs. 2.4%; adjusted hazard ratio [HR]: 4.19; 95% confidence interval [CI]: 1.74 to 10.11; p = 0.001), death (11.4% vs. 4.3%; adjusted HR: 3.02; 95% CI: 1.60 to 5.70; p = 0.0006), and the primary composite endpoint of death, MI, or stroke (22.6% vs. 12.8%; adjusted HR: 2.13; 95% CI: 1.39 to 3.25; p = 0.0004). Conclusions: In patients with LMCAD undergoing revascularization in the EXCEL trial, NOAF was common after CABG but extremely rare after PCI. The development of NOAF was strongly associated with subsequent death and stroke in CABG-treated patients. Further studies are warranted to determine whether prophylactic strategies to prevent or treat atrial fibrillation may improve prognosis in patients with LMCAD who are undergoing CABG. (Evaluation of XIENCE Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularizatio