Percutaneous coronary interventions in Europe: Prevalence, numerical estimates, and projections based on data up to 2004

Aims : A registry mandated by the European Society of Cardiology collects data on trends in interventional cardiology within Europe. Special interest focuses on relative increases and ratios in new techniques and their distributions across Europe. We report the data through 2004 and give an overview of the development of coronary interventions since the first data collection in 1992. Methods and results : Questionnaires were distributed yearly to delegates of all national societies of cardiology represented in the European Society of Cardiology. The goal was to collect the case numbers of all local institutions and operators. The overall numbers of coronary angiographies increased from 1992 to 2004 from 684 000 to 2 238 000 (from 1250 to 3930 per million inhabitants). The respective numbers for percutaneous coronary interventions (PCIs) and coronary stenting procedures increased from 184 000 to 885 000 (from 335 to 1550) and from 3000 to 770 000 (from 5 to 1350), respectively. Germany was the most active country with 712 000 angiographies (8600), 249 000 angioplasties (3000), and 200 000 stenting procedures (2400) in 2004. The indication has shifted towards acute coronary syndromes, as demonstrated by rising rates of interventions for acute myocardial infarction over the last decade. The procedures are more readily performed and perceived safer, as shown by increasing rate of "ad hoc" PCIs and decreasing need for emergency coronary artery bypass grafting (CABG). In 2004, the use of drug-eluting stents continued to rise. However, an enormous variability is reported with the highest rate in Switzerland (70%). If the rate of progression remains constant until 2010 the projected number of coronary angiographies will be over three million, and the number of PCIs about 1.5 million with a stenting rate of almost 100%. Conclusion : Interventional cardiology in Europe is ever expanding. New coronary revascularization procedures, alternative or complementary to balloon angioplasty, have come and gone. Only stenting has stood the test of time and matured to the default technique. Facilitated access to PCI, more complete and earlier detection of coronary artery disease promise continued growth of the procedure despite the uncontested success of preventio

Paper, power, and procedure: reflections on Amazonian appropriations of bureaucracy and documents

The creative and ever-expanding appropriations of bureaucracy and documents on the part of Amazonian peoples today transcend simple dichotomies between orality and literacy, state and non-state power, and domination and resistance. The papers collected here highlight the specific forms taken by such engagements and the ways in which they assume a key role in local political processes, offering new perspectives on issues ranging from the everyday workings of the state to local theories of language and materiality. In this introductory essay we draw particular attention to the importance of documents as mediators which facilitate new forms of communication; to the prevalence of bureaucratic magic and ritual; and to the ways in which regional bureaucratic and documentary processes are closely linked to both wealth and violence

Products of primes in arithmetic progressions: a footnote in parity breaking

We prove that, if $x$ and $q\leqslant x^{1/16}$ are two parameters, then for any invertible residue class $a$ modulo $q$ there exists a product of exactly three primes, each one below $x^{1/3}$, that is congruent to $a$ modulo $q$.The first author has been partly supported by the Indo-French Centre for the Promotion of Advanced Research – CEFIPRA, project No 5401-1. The second author was supported by the EPSRC Grant EP/M50659X/1

Directing diarrhoeal disease research towards disease-burden reduction

Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research questions, the efficacy and effectiveness of the intervention resulting from the research, the maximal potential for disease-burden reduction of the interventions derived from the research, the affordability, deliverability, and sustainability of the intervention supported by the research, and the overall effect of the research-derived intervention on equity. Experts scored each research option independently to delineate the best investments for diarrhoeal disease control in the developing world to reduce the burden of disease by 2015. Priority scores obtained for health policy and systems research obtained eight of the top 10 rankings in overall scores, indicating that current investments in health research are significantly different from those estimated to be the most effective in reducing the global burden of diarrhoeal disease by 2015

Ethical hurdles in the prioritization of oncology care

With finite resources, healthcare payers must make difficult choices regarding spending and the ethical distribution of funds. Here, we describe some of the ethical issues surrounding inequity in healthcare in nine major European countries, using cancer care as an example. To identify relevant studies, we conducted a systematic literature search. The results of the literature review suggest that although prevention, access to early diagnosis, and radiotherapy are key factors associated with good outcomes in oncology, public and political attention often focusses on the availability of pharmacological treatments. In some countries this focus may divert funding towards cancer drugs, for example through specific cancer drugs funds, leading to reduced expenditure on other areas of cancer care, including prevention, and potentially on other diseases. In addition, as highly effective, expensive agents are developed, the use of value-based approaches may lead to unacceptable impacts on health budgets, leading to a potential need to re-evaluate current cost-effectiveness thresholds. We anticipate that the question of how to fund new therapies equitably will become even more challenging in the future, with the advent of expensive, innovative, breakthrough treatments in other therapeutic areas

The feasibility and acceptability of using a novel wrist worn cueing device to self-manage drooling problems in people with Parkinson’s disease: A pilot study

Introduction: Daytime drooling is experienced by around 50% of Parkinson’s patients, who fail to swallow saliva in sufficient volume or regularity, despite normal production. This research explored the feasibility and acceptability of using a cueing device, to improve drooling. Methods: During a 4-week intervention, 28 participants were asked to use a cueing device for one hour per day. During this time, the device vibrated once-per-minute, reminding the participant to swallow their saliva. A daily diary was used to collect self-report around swallowing severity, frequency and duration. This was filled out by participants for 1 week before, 4 weeks during, and for 1 week immediately after intervention. Diaries were also collected for 1 week during a follow up, carried out 4 weeks after intervention finished. Results: Participants self-reported benefits in drooling severity (p=0.031), frequency (p=<0.001), and duration (p=0.001) after using the device. Improvements were maintained at follow up. Twenty-two participants explicitly reported a positive benefit to their drooling during exit interview. All felt the intervention and device were acceptable and usable. Conclusions: Using a cueing device for 1 month had perceived benefit to drooling severity, frequency and duration in patients with Parkinson’s. Participants accepted the device and treatment protocol

SMOS L1C and L2 Validation in Australia

Extensive airborne field campaigns (Australian Airborne Cal/val Experiments for SMOS - AACES) were undertaken during the 2010 summer and winter seasons of the southern hemisphere. The purpose of those campaigns was the validation of the Level 1c (brightness temperature) and Level 2 (soil moisture) products of the ESA-led Soil Moisture and Ocean Salinity (SMOS) mission. As SMOS is the first satellite to globally map L-band (1.4GHz) emissions from the Earth?s surface, and the first 2-dimensional interferometric microwave radiometer used for Earth observation, large scale and long-term validation campaigns have been conducted world-wide, of which AACES is the most extensive. AACES combined large scale medium-resolution airborne L-band and spectral observations, along with high-resolution in-situ measurements of soil moisture across a 50,000km2 area of the Murrumbidgee River catchment, located in south-eastern Australia. This paper presents a qualitative assessment of the SMOS brightness temperature and soil moisture products