Estimating the cost-effectiveness of fluticasone propionate for treating chronic obstructive pulmonary disease in the presence of missing data

Objectives: To explore the cost-effectiveness of fluticasone propionate (FP) for the treatment of chronic obstructive pulmonary disease (COPD), we estimated costs and qualityadjusted life-years (QALYs) over 3 years, based on an economic appraisal of a previously reported clinical trial (Inhaled Steroids in Obstructive Lung Disease in Europe [ISOLDE]). Methods: Seven hundred forty-two patients enrolled in the ISOLDE trial who received either FP or placebo had data available on health-care costs and quality of life over the period of the study. The SF-36-based utility scores for quality of life were used to calculate QALYs. A combined imputation and bootstrapping procedure was employed to handle missing data and to estimate statistical uncertainty in the estimated cumulative costs and QALYs over the study period. The imputation approach was based on propensity scoring and nesting this approach within the bootstrap ensured that multiple imputations were performed such that statistical estimates included imputation uncertainty. Results: Complete data were available on mortality within the follow-up period of the study and a nonsignificant trend toward improved survival of 0.06 (95% confidence interval [CI] –0.01 to 0.15) life-years was observed. In an analysis based on a propensity scoring approach to missing data we estimated the incremental costs of FP versus placebo to be £1021 (95% CI £619–1338) with an additional effect of 0.11 QALYs (CI 0.04–0.20). Cost-effectiveness estimates for the within-trial period of £17,700 per life-year gained (£6900 to ∞) and £9500 per QALY gained (CI £4300–26,500) were generated that include uncertainty due to the imputation process. An alternative imputation approach did not materially affect these estimates. Conclusions: Previous analyses of the ISOLDE study showed significant improvement on disease-specific health status measures and a trend toward a survival advantage for treatment with FP. This analysis shows that joint considerations of quality of life and survival result in a substantial increase in QALYs favoring treatment with FP. Based on these data, the inhaled corticosteroid FP appears costeffective for the treatment of COPD. Confirmation or refutation of this result may be achieved once the Towards a Revolution in COPD Health (TORCH) study reports, a large randomized controlled trial powered to detect mortality changes associated with the use of FP alone, or in combination with salmeterol, which is also collecting resource use and utility data suitable for estimating cost-effectiveness

Glacis calcisolico y suelos con horizon cálcico en el NE de la provincia de Granada

[Resumen] La importancia del estudio de las zonas semiáridas parece incuestionable ya que constituyen uno de los ecosistemas más extensos del mundo. España en concreto es el país de Europa que tiene las zonas más extensas y además coinciden con los ambientes socialmente más deprimidos, cuyas características derivan de la aridez ambiental. En el sector nororiental de la provincia de Granada se localiza la Depresión de Baza, definida por un altiplano con una altitud media de 950 metros. La geomorfología queda dibujada por dos conjuntos: alineaciones montañosas y altiplanicie, dando ésta última un paisaje singular que por su extrema sequedad constituye uno de los paisajes más característicos de las zonas esteparias peninsulares. La desigual evolución de los suelos nos permite detallar en el presente trabajo la unidad edafogeomorfológica del glacis calcisólico, desarrollada por denudación de la superficie del glacis lúvico antiguo y la materialización de suelos con horizonte cálcico, originado antiguamente por precipitación del carbonato cálcico ante la desecación del suelo en la estación seca, o petrocálcico 9riginado tras repetidas redisoluciones y reprecipitaciones de la caliza, con fuerte cementación final.[Abstract] Semiarid zones are the vastest ecosystems in the world, therefore their study is very important. Spain is the european country supporting mostly european semiarid zones, moreover these areas are underdeveloped because of their arid environment. The Baza Depresion is located at the north-east of Granada province and is a high plateau with 950m altitude average. Geomorphology is composed for two formations: a mountainous area and a high plateau; this offers a singular landscape making up one of the most characteristics Spanish sttepe. In this study, the calcisolic glacis edaphogeomorphological unit is detailed. This unit is developed by denudation of the old luvic glacis and soils with calcic horizon; this horizon was originated by calcium carbonate precipitation during the dry season, or in the case of petrocalcic horizon, originated by repeated redisolutions and reprecipitations of the calcium carbonate

Predictive factors and early biomarkers of response in multiple sclerosis patients treated with natalizumab

There are an increasing number of treatments available for multiple sclerosis (MS). The early identification of optimal responders to individual treatments is important to achieve individualized therapy. With this aim, we performed a multicenter retrospective longitudinal study including 186 MS patients treated with natalizumab who were followed for 2 years. We analyzed the following variables at recruitment: sex, current age, age at disease onset, disease duration, EDSS, number of T2 and Gd + lesions, IgG and IgM oligoclonal bands, HLA class II (DR, DRB, DQA, DQB, and DRB1*15:01), IgG and IgM antibody titers against human herpesvirus 6 (HHV-6) and the antibody response to Epstein–Barr virus (EBV) through the measurement of the anti-EBNA-1 and anti-VCA IgG titers, in relation to clinical response (no relapses or disability progression), and to NEDA-3 (no evidence of disease activity in terms of clinical response and no changes in MRI scans either) after 2-years follow-up. Baseline EDSS score, baseline EBNA-1 IgG titers and percentage change of HHV6 IgG titers between baseline and 6 month visits were significantly different in clinical responders and in NEDA-3 status (all of them remained significant in the multivariate analysis). We identified three variables for the early identification of natalizumab optimal responders in a rapid and cost-effective approach

Plan de control de la tricomonosis y la campilobacteriosis genital bovina en explotaciones de vaca nodriza del Pirineo de Huesca

Publishe

VOLUMEN 16, NÚMERO 30 (1983-1984)

PROYECTO GEOTÉRMICO CHILES - CERRO NEGRO. Lozano, E.; Cruz, L.ZONAS HIDROGEOLÓGICAS DE COLOMBIA. Lobo-Guerrero, A.ESTUDIO GEOQUÍMICO Y PETROGRÁFICO DE ROCAS SUBVOLCÁNICAS ENTRE LA QUEBRADA CHIRAPOTO Y EL RÍO ARQUÍA (DEPARTAMENTO DE ANTIOQUIA Y CALDAS). Sánchez, L. H.; Parra, R. A.; Ortíz, F.GEOLOGÍA Y EXPERIENCIAS CONSTRUCTIVAS EN EL TÚNEL TUNJITA. Tejada, S. E.CONTRIBUCIÓN AL CONOCIMIENTO DEL PALEOZOICO SUPERIOR EN LA SECCIÓN QUETAME - VILLAVICENCIO. Cortés, R.; De La Espriella, R.TECTÓNICA GRAVITACIONAL EN LA CORDILLERA ORIENTAL AL ESTE DE LA FALLA DE BOYACÁ (DEPARTAMENTO DE BOYACÁ). Reyes, Ch. I.AMBIENTES GEOLÓGICOS URANÍFEROS EN COLOMBIA. Ortega Montero, C

Inhibidores de bomba de protones vs. antagonistas del receptor 2 de histamina en la protección gástrica en el paciente anticoagulado: ¿qué ha definido la evidencia?

Objective: to evaluate the latest evidence on the difference in gastroprotection generated by proton pump inhibitors (PPIs) and histamine receptor 2 antagonists (H2RAs) in anticoagulated patients, as well as the associated risk of gastrointestinal bleeding. Methods: narrative review. A literature search was conducted in the PubMed, ScienceDirect, Web of Science, and MEDLINE databases. Results: Among the described mechanisms explaining bleeding in the gastrointestinal tract are mucosal damage, alterations in local pH, platelet inhibition, coagulation factor alteration, and vascular lesions. Depending on the pharmacological group, anticoagulants can act on different targets in the coagulation pathway, altering the factors involved in this pathway and potentially triggering bleeding. Antisecretory drugs, on the other hand, aim to inhibit or reduce gastric acid secretion through interaction with enzymatic systems, altering the local pH. Thus, these drugs influence the risk of bleeding. However, the latest evidence shows that PPIs reduce the likelihood of gastrointestinal bleeding by up to 33% compared to H2RAs, without impacting other outcomes such as mortality or hospitalization. Conclusion: Although the evidence is scarce and heterogeneous, it was observed that there is greater scientific support and gastroprotective benefit against the frequency of gastrointestinal bleeding with the use of PPIs compared to H2RAs in anticoagulated patients who concurrently use gastric acid suppressants.Objetivo: evaluar la evidencia más reciente sobre la diferencia de la gastroprotección generada por los inhibidores de bomba de protones (IBP) y antagonistas del receptor de histamina 2 (ARH2) en el paciente anticoagulado, así como del riesgo de sangrado gastrointestinal asociado. Métodos: revisión narrativa. Se realizó una búsqueda bibliográfica en las bases de datos PubMed, ScienceDirect, Web of Science, y MEDLINE. Resultados: dentro de los mecanismos descritos que explican un sangrado en el tracto gastrointestinal, se encuentran el daño a mucosa, alteraciones en el pH local, inhibición plaquetaria y alteración de factores de la coagulación, y lesiones vasculares. Dependiendo del grupo farmacológico, los anticoagulantes pueden actúan a nivel de diferentes dianas de la vía de la coagulación, alterando los factores involucrados en esta vía, y pudiendo desencadenar sangrado. Por su parte, los antisecretores gástricos, tienen como objetivo inhibir o reducir la secreción de ácido gástrico por medio de la interacción con sistemas enzimáticos, alterando el pH local. De esta forma, estos fármacos influyen sobre el riesgo de sangrado. No obstante, la evidencia más reciente demuestra que los IBP reducen la probabilidad de sangrado gastrointestinal hasta en un 33%, comparado con los ARH2, sin impactar en otros desenlaces como mortalidad u hospitalización. Conclusión: aunque la evidencia es escasa y heterogénea, se pudo observar mayor respaldo científico y beneficio gastroprotector contra la frecuencia de sangrado gastrointestinal, con el uso de IBP comparado a ARH2, en pacientes anticoagulados que concomitantemente, utilizan antisecretores gástricos

VOLUMEN 16, NÚMERO 30 (1983-1984)

PROYECTO GEOTÉRMICO CHILES - CERRO NEGRO. Lozano, E.; Cruz, L.ZONAS HIDROGEOLÓGICAS DE COLOMBIA. Lobo-Guerrero, A.ESTUDIO GEOQUÍMICO Y PETROGRÁFICO DE ROCAS SUBVOLCÁNICAS ENTRE LA QUEBRADA CHIRAPOTO Y EL RÍO ARQUÍA (DEPARTAMENTO DE ANTIOQUIA Y CALDAS). Sánchez, L. H.; Parra, R. A.; Ortíz, F.GEOLOGÍA Y EXPERIENCIAS CONSTRUCTIVAS EN EL TÚNEL TUNJITA. Tejada, S. E.CONTRIBUCIÓN AL CONOCIMIENTO DEL PALEOZOICO SUPERIOR EN LA SECCIÓN QUETAME - VILLAVICENCIO. Cortés, R.; De La Espriella, R.TECTÓNICA GRAVITACIONAL EN LA CORDILLERA ORIENTAL AL ESTE DE LA FALLA DE BOYACÁ (DEPARTAMENTO DE BOYACÁ). Reyes, Ch. I.AMBIENTES GEOLÓGICOS URANÍFEROS EN COLOMBIA. Ortega Montero, C

Inhibidores de bomba de protones vs. antagonistas del receptor 2 de histamina en la protección gástrica en el paciente anticoagulado: ¿qué ha definido la evidencia?

Objetivo: evaluar la evidencia más reciente sobre la diferencia de la gastroprotección generada por los inhibidores de bomba de protones (IBP) y antagonistas del receptor de histamina 2 (ARH2) en el paciente anticoagulado, así como del riesgo de sangrado gastrointestinal asociado. Métodos: revisión narrativa. Se realizó una búsqueda bibliográfica en las bases de datos PubMed, ScienceDirect, Web of Science, y MEDLINE. Resultados: dentro de los mecanismos descritos que explican un sangrado en el tracto gastrointestinal, se encuentran el daño a mucosa, alteraciones en el pH local, inhibición plaquetaria y alteración de factores de la coagulación, y lesiones vasculares. Dependiendo del grupo farmacológico, los anticoagulantes pueden actúan a nivel de diferentes dianas de la vía de la coagulación, alterando los factores involucrados en esta vía, y pudiendo desencadenar sangrado. Por su parte, los antisecretores gástricos, tienen como objetivo inhibir o reducir la secreción de ácido gástrico por medio de la interacción con sistemas enzimáticos, alterando el pH local. De esta forma, estos fármacos influyen sobre el riesgo de sangrado. No obstante, la evidencia más reciente demuestra que los IBP reducen la probabilidad de sangrado gastrointestinal hasta en un 33%, comparado con los ARH2, sin impactar en otros desenlaces como mortalidad u hospitalización. Conclusión: aunque la evidencia es escasa y heterogénea, se pudo observar mayor respaldo científico y beneficio gastroprotector contra la frecuencia de sangrado gastrointestinal, con el uso de IBP comparado a ARH2, en pacientes anticoagulados que concomitantemente, utilizan antisecretores gástricos

Hunt for new phenomena using large jet multiplicities and missing transverse momentum with ATLAS in 4.7 fb−1 of s√=7TeV proton-proton collisions

Results are presented of a search for new particles decaying to large numbers of jets in association with missing transverse momentum, using 4.7 fb−1 of pp collision data at s√=7TeV collected by the ATLAS experiment at the Large Hadron Collider in 2011. The event selection requires missing transverse momentum, no isolated electrons or muons, and from ≥6 to ≥9 jets. No evidence is found for physics beyond the Standard Model. The results are interpreted in the context of a MSUGRA/CMSSM supersymmetric model, where, for large universal scalar mass m 0, gluino masses smaller than 840 GeV are excluded at the 95% confidence level, extending previously published limits. Within a simplified model containing only a gluino octet and a neutralino, gluino masses smaller than 870 GeV are similarly excluded for neutralino masses below 100 GeV

Measurements of Higgs boson production and couplings in diboson final states with the ATLAS detector at the LHC

Measurements are presented of production properties and couplings of the recently discovered Higgs boson using the decays into boson pairs, H →γ γ, H → Z Z∗ →4l and H →W W∗ →lνlν. The results are based on the complete pp collision data sample recorded by the ATLAS experiment at the CERN Large Hadron Collider at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV, corresponding to an integrated luminosity of about 25 fb−1. Evidence for Higgs boson production through vector-boson fusion is reported. Results of combined fits probing Higgs boson couplings to fermions and bosons, as well as anomalous contributions to loop-induced production and decay modes, are presented. All measurements are consistent with expectations for the Standard Model Higgs boson