Cost-Effectiveness Analysis of Apixaban Versus Edoxaban in Patients with Atrial Fibrillation for Stroke Prevention

OBJECTIVE: Our objective was to assess the cost effectiveness of apixaban versus edoxaban in the prevention of stroke and systemic embolism (SE) in patients with atrial fibrillation (AF) in Spain. METHODS: We customized a Markov model with ten health states to estimate the lifetime economic and clinical outcomes in 6-week cycles. The efficacy (clinical event rates per 100 patient-years) and safety data were derived from a pairwise indirect treatment comparison. The analysis was conducted from both the national health service (NHS) and societal perspectives, and included pharmaceutical costs (retail price plus value-added tax (VAT) and applicable national deductions) according to daily dosages (apixaban 10 mg (5 mg twice daily (bid)) and edoxaban 60 or 30 mg) and complications and disease-management costs, obtained from national databases. Utilities for quality-adjusted life-year (QALY) calculations reflected EuroQoL 5-Dimension scores in patients with AF. An annual discount rate of 3% was applied for costs (euro, year 2019 values) and outcomes. RESULTS: In a 1000-patient cohort, apixaban 5 mg bid versus edoxaban 60 mg could avoid five strokes, six major bleedings and 29 clinically relevant non-major bleedings (CRNMBs). Compared with edoxaban 30 mg, apixaban could avoid 21 strokes and two SEs. An increase in bleedings was observed with apixaban (seven haemorrhagic strokes, 48 major bleedings and 17 CRNMBs). Apixaban yielded 0.04 additional QALYs compared with edoxaban 60 mg or 30 mg. Incremental costs/QALY were euro9639.33 and euro354.22 for apixaban versus edoxaban 60 mg and edoxaban 30 mg, respectively, from the NHS perspective and euro7756.62 for apixaban versus edoxaban 60 mg from the societal perspective. Apixaban was dominant versus edoxaban 30 mg from the societal perspective. Sensitivity analyses confirmed the robustness of the model. CONCLUSIONS: This study suggests that apixaban 5 mg bid is a cost-effective alternative to edoxaban for stroke prevention in the AF population in Spain

La lectura fotogr?fica y el Slide, herramientas did?cticas para fortalecer la oralidad y la escritura

106 P?ginasRecurso Electr?nicoLa lectura fotogr?fica y el Slide, herramientas did?cticas para fortalecer la oralidad y la escritura con estudiantes del grado 7?. Un estudio comprensivo sobre fen?menos orales desde el proceso etnometodol?gico en la Instituci?n Educativa Departamental Policarpa Salavarrieta, hace parte del trabajo que desarrolla el Semillero Lenguaje y Territorio Escolar. Esta investigaci?n toma la Etnometodolog?a porque indaga e interpreta sobre los fen?menos orales que suceden en la escuela y propone alternativas de estudio sobre la diversidad socio - cultural expresada en la territorialidad escolar. Adem?s, asume lo etnometodol?gico y hermen?utico porque busca describir y comprender el mundo social tal y como se construye. El proceso de investigaci?n se inicia con la aplicaci?n de la observaci?n directa, el diario de campo y la entrevista. Estos instrumentos evidenciaron dificultades en la expresi?n oral y escrita de los estudiantes del grado s?ptimo. Para ello, el trabajo toma el siguiente problema: ?C?mo la lectura fotogr?fica y el SLIDE pueden fortalecer la oralidad y la escritura de los estudiantes del grado 7?, a partir del estudio comprensivo sobre fen?menos orales desde el proceso etnometodol?gico en la Instituci?n Educativa Departamental POLICARPA SALAVARRIETA? En consecuencia, esta investigaci?n propone comprender fen?menos orales para fortalecer la oralidad y la escritura con estudiantes del grado 7? a partir del uso de la lectura de fotograf?as y el Slide. Cabe resaltar, que este trabajo de investigaci?n, promueve la lectura desde la fotograf?a, como herramienta did?ctica, para mejorar su expresi?n oral y producci?n de textos escritos.ABSTRACT. The photographic reading and Slide, teaching tools to strengthen orality and writing with 7th grade students. A comprehensive study on oral phenomena from the ethnomethodological process Policarpa Departmental Educational Institution Salvarrieta, is part of the work that the Seed School Language and Territory. This research takes ethnomethodology because it explores and interprets on oral phenomena occurring at school and proposes alternatives study on the socio - cultural diversity expressed in school territoriality. Also assumes the ethnomethodological and hermeneutic because it seeks to describe and understand the social world as it is constructed. The research process begins with the application of direct observation, field diary and interview. These instruments showed difficulties in oral and written expression seventh graders. For this, the work takes the following problem: How photographic SLIDE reading and can strengthen orality and writing graders 7th, from comprehensive study on oral phenomena from the ethnomethodological process in the Departmental Educational Institution Policarpa Salavarrieta? Consequently, this research aims to understand phenomena to strengthen oral orality and writing with 7th grade students from the use of photographs and reading the Slide. It should be noted that this research, promotes reading from photography, as a teaching tool to improve their oral expression and production of written texts. Keywords: Reading, Photography, CapturingINTRODUCCI?N 14 1. PROBLEMA 16 1.1 DESCRIPCI?N DEL PROBLEMA 16 1.2 PLANTEAMIENTO DEL PROBLEMA 17 1.3 FORMULACI?N DEL PROBLEMA 17 2. JUSTIFICACI?N 18 3. OBJETIVOS 20 3.1 OBJETIVO GENERAL 20 3.2 OBJETIVOS ESPECIFICOS 20 4. REFERENTE TEORICO 21 4.1 FEN?MENOS ORALES EN EL TERRITORIO ESCOLAR 21 4.2 VISI?N LEGAL 22 4.3 FEN?MENOS ORALES 23 4.4 TERRITORIO 26 4.5 PENSAMIENTO Y LENGUAJE 28 4.6 DE LA COMPETENCIA Y DE LAS HABILIDADES 31 4.7 PR?CTICAS PEDAG?GICAS 35 4.8 ETNOMETODOLOG?A 36 5. METODOLOG?A 39 5.1 ETAPAS DEL PROCESO DE INTERVENCI?N 41 5.1.1 Primera Etapa 41 5.1.2 Segunda Etapa 41 5.1.3 Tercera Etapa 42 5.1.4 Cuarta Etapa 43 6. AN?LISIS DE LOS RESULTADOS 44 6.1 ARTISTAS EN ACCI?N 44 6.2 LA LECTURA DESCRIPTIVA 50 6.3 INCENTIVAR? LOS ACTOS COMUNICATIVOS 54 7. CONCLUSIONES 57 RECOMENDACIONES 58 REFERENCIAS 6

Biogeographical origin and timing of the founder ichthyosis TGM1 c.1187G > A mutation in an isolated Ecuadorian population

An unusually high frequency of the lamellar ichthyosis TGM1 mutation, c.1187G > A, has been observed in the Ecuadorian province of Manabi. Recently, the same mutation has been detected in a Galician patient (Northwest of Spain). By analyzing patterns of genetic variation around this mutation in Ecuadorian patients and population matched controls, we were able to estimate the age of c.1187G > A and the time to their most recent common ancestor (TMRCA) of c.1187G > A Ecuadorian carriers. While the estimated mutation age is 41 generations ago (~1,025 years ago [ya]), the TMRCA of Ecuadorian c.1187G > A carrier haplotypes dates to just 17 generations (~425 ya). Probabilistic-based inferences of local ancestry allowed us to infer a most likely European origin of a few (16% to 30%) Ecuadorian haplotypes carrying this mutation. In addition, inferences on demographic historical changes based on c.1187G > A Ecuadorian carrier haplotypes estimated an exponential population growth starting ~20 generations, compatible with a recent founder effect occurring in Manabi. Two main hypotheses can be considered for the origin of c.1187G > A: (i) the mutation could have arisen in Spain >1,000 ya (being Galicia the possible homeland) and then carried to Ecuador by Spaniards in colonial times ~400 ya, and (ii) two independent mutational events originated this mutation in Ecuador and Galicia. The geographic and cultural characteristics of Manabi could have favored a founder effect that explains the high prevalence of TGM1 c.1187G > A in this region

Coastal high-frequency radars in the Mediterranean ??? Part 2: Applications in support of science priorities and societal needs

International audienceThe Mediterranean Sea is a prominent climate-change hot spot, with many socioeconomically vital coastal areas being the most vulnerable targets for maritime safety, diverse met-ocean hazards and marine pollution. Providing an unprecedented spatial and temporal resolution at wide coastal areas, high-frequency radars (HFRs) have been steadily gaining recognition as an effective land-based remote sensing technology for continuous monitoring of the surface circulation, increasingly waves and occasionally winds. HFR measurements have boosted the thorough scientific knowledge of coastal processes, also fostering a broad range of applications, which has promoted their integration in coastal ocean observing systems worldwide, with more than half of the European sites located in the Mediterranean coastal areas. In this work, we present a review of existing HFR data multidisciplinary science-based applications in the Mediterranean Sea, primarily focused on meeting end-user and science-driven requirements, addressing regional challenges in three main topics: (i) maritime safety, (ii) extreme hazards and (iii) environmental transport process. Additionally, the HFR observing and monitoring regional capabilities in the Mediterranean coastal areas required to underpin the underlying science and the further development of applications are also analyzed. The outcome of this assessment has allowed us to provide a set of recommendations for future improvement prospects to maximize the contribution to extending science-based HFR products into societally relevant downstream services to support blue growth in the Mediterranean coastal areas, helping to meet the UN's Decade of Ocean Science for Sustainable Development and the EU's Green Deal goals

Trends in greenhouse gas emissions from dairy cattle in Mexico between 1970 and 2010

The objective of the present work was to estimate and assess trends in greenhouse gas (GHG) emissions, particularly methane (CH4) and nitrous oxide (N2O), from dairy cows in Mexico from the base year of 1970 to 2010. Empirical and mechanistic models were used to estimate enteric methane emissions based on chemical composition of diets. Methane from manure was calculated using Intergovernmental Panel for Climate Change (IPCC) and US Environmental Protection Agency recommended equations. N2O emission was calculated according to IPCC recommendations. Compared with the 1970s, current management practices using modern dairy cows increased feed conversion efficiency 32% and milk yield 62%. GHG emission intensity (i.e. emissions per unit of product) was reduced 30%, 25% and 30% for CH4, N2O and total emissions, respectively. The study showed that although GHG emissions in absolute terms increased in the past 40 years, emission intensity decreased due to higher level of production. This trend is likely to continue in the future, assuming milk production follows the same increasing trend as in other countries in North America. © 2014 CSIRO

Anti-tumour necrosis factor discontinuation in inflammatory bowel disease patients in remission: study protocol of a prospective, multicentre, randomized clinical trial

Background: Patients with inflammatory bowel disease who achieve remission with anti-tumour necrosis factor (anti-TNF) drugs may have treatment withdrawn due to safety concerns and cost considerations, but there is a lack of prospective, controlled data investigating this strategy. The primary study aim is to compare the rates of clinical remission at 1?year in patients who discontinue anti-TNF treatment versus those who continue treatment. Methods: This is an ongoing, prospective, double-blind, multicentre, randomized, placebo-controlled study in patients with Crohn?s disease or ulcerative colitis who have achieved clinical remission for ?6?months with an anti-TNF treatment and an immunosuppressant. Patients are being randomized 1:1 to discontinue anti-TNF therapy or continue therapy. Randomization stratifies patients by the type of inflammatory bowel disease and drug (infliximab versus adalimumab) at study inclusion. The primary endpoint of the study is sustained clinical remission at 1?year. Other endpoints include endoscopic and radiological activity, patient-reported outcomes (quality of life, work productivity), safety and predictive factors for relapse. The required sample size is 194 patients. In addition to the main analysis (discontinuation versus continuation), subanalyses will include stratification by type of inflammatory bowel disease, phenotype and previous treatment. Biological samples will be obtained to identify factors predictive of relapse after treatment withdrawal. Results: Enrolment began in 2016, and the study is expected to end in 2020. Conclusions: This study will contribute prospective, controlled data on outcomes and predictors of relapse in patients with inflammatory bowel disease after withdrawal of anti-TNF agents following achievement of clinical remission. Clinical trial reference number: EudraCT 2015-001410-1

Geostatistical Models for the Prediction of Water Supply Network Failures in Bogotá, Integrating Machine Learning Algorithms

[EN] Currently new strategies of spatial referencing, data analysis, and machine learning methods are integrated with Geographical Information Systems (GISs) to understand specific characteristics and water supply dynamics. This work explores the variables that can cause spacial failures and potential risk areas with application to a zone in the Bogotá water supply network. Machine learning algorithms are proposed to generate prediction models and potential failure maps. A sensitivity analysis was held to identify the model with the best fit for the estimation. This study will allow water supply decisions makers to focalize their efforts in the field.[ES] Actualmente se buscan nuevas estrategias y/o metodologías basadas en la integración de los Sistemas de Información Geográfica (SIGs) como forma de georeferenciacion espacial y visualización de las variables analizadas, junto con métodos de aprendizaje automático (Machine Learning) que permitan entender características puntuales, variables influyentes y dinámicas de los sistemas de abastecimiento de agua potable.En este trabajo se hace la identificación espacial de los fallos y zonas potenciales de riesgo que se presentan en una zona de la red de abastecimiento de Bogotá, explorando las variables que puedan tener mayor incidencia en los mismos. Se propone el uso de algoritmos de aprendizaje automático para la generación de modelos de predicción y la elaboración de mapas de fallos potenciales, identificando, a través de un análisis de sensibilidad, cuál de estos modelos presenta un mejor ajuste en la estimación. Este estudio permite a los gestores del abastecimiento una localización precisa y eficiente de los fallos en la red, apoyando el proceso de toma de decisiones.Navarrete-López, CF.; Calderón-Rivera, D.; Díaz Arévalo, JL.; Herrera Fernández, AM.; Izquierdo Sebastián, J. (2018). Modelos geoestadísticos para la predicción de fallos de una zona de la red de abastecimiento de agua de Bogotá, integrando algoritmos de Machine Learning. Social Science Research Network. 1-8. https://doi.org/10.2139/ssrn.3113048S1