Cost effectiveness of the implantable cardioverter defibrillator: a preliminary analysis

Background-An implantable cardioverter defibrillator (ICD) maybe effective in reducing the risk of sudden cardiac death. The high cost of ICD treatment, however, compared with alternatives raises the question of whether this new technology is an efficient use of scarce health care resources. Objective-To estimate the incremental cost effectiveness of the implantable cardioverter defibrillator compared with drug treatment with amiodarone in the management of patients at high risk of sudden cardiac death. Design-A cost effectiveness model was constructed from data already published and other secondary sources. Differences in patient survival were calculated from life tables for comparable ICD and amiodarone patient series. Costs were based on typical patient management protocols derived from current United Kingdom practice and interviews with physicians. Main outcome measures-Cost effectiveness of ICD treatment was computed over 20 years; all future costs and effects were discounted at 6% per year. Results-Estimated life expectancy was 111 and 6-7 years with ICD and amiodarone respectively; the discounted 20 year difference lies in the range 1P7 to 3*7 years. Discounted 20 year treatment costs were £28 400 for the ICD and £2300 for amiodarone. Cost effectiveness ofICD treatment lies in the range of £15 400 to £8200 per life-year gained. Conclusions-Cost effectiveness ofICD treatment is similar to some existing cardiac programmes funded under the NHS but uncertainty exists due to limitations of the data. Costs of ICD treatment may fall in the future as the life of the device increases and less invasive implantation methods are needed. The effectivess of ICD compared with amiodarone is currently being studied by a randomised controlled trial

Optimalisasi Pemungutan Pajak Bumi dan Bangunan di Kecamatan Teluk Meranti Kabupaten Pelalawan Ditinjau Menurut Ekonomi Islam

Pajak bumi dan bangunan menjadi sumber penerimaan pajak yang cukup besar jumlahnya serta sangat menunjang proses pembangunan karena diketahui sebagian besar penduduk Indonesia dan masyarakat suatu daerah khususnya merupakan subjek dan objek pajak bumi dan bangunan, sehingga memungkinkan sekali penerimaan sektor pajak ini terus ditingkatkan. Optimalisasi adalah suatu proses menjadikan paling baik pemungutan PBB. Dari hasil penelitian dapat disimpulan bahwa pemungutan pajak bumi dan bangunan di Kecamatan Teluk Meranti tidak terlaksana secara optimal. Hal ini dikarenakan tindakan yang kurang tegas terhadap sanksi, kurang nya kesadaran masyarakat untuk membayar pajak serta masih banyaknya masyarakat wajib pajak yang tingkat pendidikannya relatif rendah. Ditinjau menurut ekonomi Islam pemungutan pajak diperbolehkan

Single shot, temporally and spatially resolved measurements of fast electron dynamics using a chirped optical probe

A new approach to rear surface optical probing is presented that permits multiple, time-resolved 2D measurements to be made during a single, ultra-intense ( > 1018 W cm−2) laser-plasma interaction. The diagnostic is capable of resolving rapid changes in target reflectivity which can be used to infer valuable information on fast electron transport and plasma formation at the target rear surface. Initial results from the Astra-Gemini laser are presented, with rapid radial sheath expansion together with detailed filamentary features being observed to evolve during single shots

Comparison of Coulomb Blockade Thermometers with the International Temperature Scale PLTS-2000

The operation of the primary Coulomb blockade thermometer (CBT) is based on a measurement of bias voltage dependent conductance of arrays of tunnel junctions between normal metal electrodes. Here we report on a comparison of a CBT with a high accuracy realization of the PLTS-2000 temperature scale in the range from 0.008 K to 0.65 K. An overall agreement of about 1% was found for temperatures above 0.25 K. For lower temperatures increasing differences are caused by thermalization problems which are accounted for by numerical calculations based on electron-phonon decoupling.Comment: 6 pages, 5 figure

The influence of Incentives on Work Achivement of agents in Takapul Keluarga Insurance at Riau Agrncy Reoresentative Office of Pekanbaru City (Indonesia)

This study was conducted to investigate the influence of incentives on the work performance of agents in Takaful “Keluarga” Insurance at Riau Agency Representative office of Pekanbaru city. The sampling technique used was saturating sampling, while the data collection technique used was questionnaires. To analyze the data, it was used quantitative descriptive method. In analyzing the quantitative data, simple linear regression analysis was used in which the calculation process using SPSS for windows version 17.0. The results of this study found that the relationship between incentives and the work achievement of agents has a strong relationship, it is known from the value of correlation coefficient of 85%. Meanwhile, the partial test results showed that there is a significant influence of incentives on work performance of the agents, it is known from a significant level of 8,232. Then, there is a considerable contribution of incentives to work achievement of the agents, it is known from the value of the coefficient of determination of 71.2%. In general, it can be concluded that there is the influence of incentives on work achievement of agents in Takaful Keluarga Insurance at Riau Agency Representative Office in Pekanbaru city

High efficiency proton beam generation through target thickness control in femtosecond laser-plasma interactions

Bright proton beams with maximum energies of up to 30MeV have been observed in an experiment investigating ion sheath acceleration driven by a short pulse (21 W cm-2 was investigated, with the interplay between target thickness and laser pre-pulse found to be a key factor. While the maximum proton energies observed were maximised for lm-thick targets, the total proton energy content was seen to peak for thinner, 500 nm, foils. The total proton beam energy reached up to 440 mJ (a conversion efficiency of 4%), marking a significant step forward for many laser-driven ion applications. The experimental results are supported by hydrodynamic and particle-in-cell simulations