Comparing post-operative resource consumption following transcatheter aortic valve implantation (TAVI) and conventional aortic valve replacement in the UK

Objective:

To define the in-hospital and 6-month post-discharge resource use, following Transcatheter Aortic Valve Implantation (TAVI) and conventional Aortic Valve Replacement (AVR) surgery within a single UK hospital.

Methods:

A local service evaluation of patients undergoing TAVI or AVR between January 2011 and May 2012 captured data until 6-months post-procedure, collected from hospital records and via a General Practitioner questionnaire. The main end-points were mortality, time in ITU/HDU, hospital length of stay (LoS), discharge destination, re-admission, and post-discharge primary/secondary care resource use. Sub-group analyses were performed for AVR patients aged ≥80 (AVR?≥?80) and with EuroSCORE of ≥10 (AVR ES?≥?10) to allow more direct comparison with ‘TAVI type’ patients.

Results:

Results are given as means (standard deviation) for TAVI (n?=?51), AVR (n?=?188), AVR?≥?80 (n?=?48), and AVR ES?≥?10 (n?=?47), respectively, unless otherwise stated. Age in years was 83.0 (8.1), 71.2 (13.1), 84.1 (2.7), 79.4 (7.1); EuroSCORE was 24.7 (11.9), 8.1 (6.4), 12.0 (6.0), and 16.5 (6.6); post-operative LoS (days) was 11.5 (11.2), 10.9 (10.8), 14.3 (16.7), and 15.2 (17.7). For discharged patients, 0%, 7%, 13%, and 9% had unplanned cardiac-related re-admissions within 30-days of discharge. Time to first readmission was 74.6 (34.0), 35.0 (34.2), 20.8 (9.7), and 22.6 (14.3) days.

Limitations:

This was a single-center retrospective evaluation, not prospectively powered to confirm differences in outcomes.

Conclusions:

Despite TAVI being performed in an older, higher risk population, LoS was similar to AVR. Most strikingly there were no cardiac-related re-admissions within 30-days for TAVI and time to first re-admission was significantly longer. This evaluation suggests that TAVI is clinically appropriate and provides economic advantages in both the hospital and post-discharge setting in this high risk group. Many patients undergoing TAVI are considered unfit for surgery and, hence, TAVI offers a treatment that delivers similar results to traditional AVR without the high risk associated with surgery.     

The measurement and decomposition of nonuse values: A critical review

We critically review the literature that claims that existence values, or nonuse values in general, are a large and measurable component of total value for certain environmental resources. Our concern is not with the question “do nonuse values exist?” For some individuals they surely do. Rather, our concern is with two interrelated questions: are there operationally meaningful theorems which might lead to the specific measurement of nonuse values, and do we in fact have a body of credible evidence which shows that nonuse values, particularly components of any nonuse value, are “large”? We find nothing in the way of operationally meaningful hypotheses which would permit the estimation of values attributable to specific motives of individuals. We find no credible basis for claims related to either the measurement of existence and other motive-related values or claims for the “large” relative size of such values. In short, we question the conventional wisdom that such values are measurable and that they are significant as a component of total value.     

“生态券”式自然生态空间有偿使用法律制度的提出与规范建构

研究目的：证成“生态券”式自然生态空间有偿使用法律制度,并进行规范建构。研究方法：规范分析法、比较分析法和案例分析法。研究结果：（1）空间公平正义价值观下,“税费”式自然生态空间有偿使用制度有利于保护自然生态空间,一定程度上衡平了自然生态空间利益。因忽视自然生态空间安全价值,该制度在自然生态空间利益全面保护方面仍面临主体涵盖不全、利益混同、补偿滞后以及救济偏离诉求目标等困境。（2）受生态安全价值观影响,自然生态空间利益衡平的理念由“损害最小化”转向“零耗损”。研究结论：应推行“生态券”式自然生态空间有偿使用法律制度,与资源税费制度并行,与生态补偿、碳汇交易等制度协同,保障自然生态空间安全,全面衡平自然生态空间利益。具体制度建构中,应秉持权力制约与权益保障的理念,厘清生态券的法律属性,发掘生态券有偿使用方式下的权力与权利规范;明确自然生态空间占用权,确认与合理配置自然生态空间利益;设定对价支付自然生态空间占用的具体义务,明晰权利的边界;加强“生态券”交易市场的培育与落实,健全制度运行的关键程序。     

异质性环境规制对长江经济带工业用水效率的影响

为实现水资源约束下的水资源可持续发展,运用超效率EBM模型测算了2012—2021年长江经济带11个省市工业用水效率,通过空间杜宾模型探究了异质性环境规制对长江经济带工业用水效率的影响。结果表明：长江经济带各省市的工业用水效率有明显差异化,上、中、下游的工业用水效率呈现两端高、中间低的趋势;命令约束型、市场激励型和公众自愿型环境规制促进了工业用水效率的提高;异质性环境规制对工业用水效率具有较强的空间溢出效应,命令约束型和市场激励型环境规制具有污染转移效应,不利于邻近地区工业用水效率的提高。     

不同类型轨道交通站点周边土地利用效益评价

不同类型轨道交通站点周边用地开发所追求的效益目标侧重点不同,需要对不同类型轨道站点周边土地利用效益进行差异化的评价.首先,研究轨道站点的分类及相应的用地开发特征;其次,从土地利用、交通系统、服务水平3个维度选取7个评价指标,构建轨道交通站点周边用地效益评价指标体系,通过模糊层次分析法对不同类型的轨道交通站点评价指标权重进行量化,并结合模糊综合评价法获得不同类型站点具体指标和综合指标的评价结果;最后,以重庆鲤鱼池站点为例,对公服居住型站点周边用地开发综合效益进行应用评价与分析.旨在为不同类型轨道站点周边的土地开发效益综合评价提供参考.     

城市边缘区土地利用总体规划探析

本文在分析大城市边缘区土地利用特征和土地利用问题的基础上，针对城市边缘区土地利用的特殊矛盾性探讨了城市边缘区土地利用总体规划的目标、规划要点。     

Assessing the growth-inducing impact of the Appalachian Development Highway System in southern Ohio: Did policy promote change?

The concept of “inducing growth” is typically considered an adverse consequence of a project on the land use system. In certain instances, however, the desire to induce growth and foster land use change is a focus of land use policy. Such is the example of the Appalachian Highway Development System (AHDS) program initiated by the Appalachian Regional Commission (ARC) during the late 1960s. With the goal of providing highway infrastructure to improve assess to a geographically isolated and historically impoverished region, the ADHS has added nearly 3000 miles of highway to the Appalachian landscape. The degree to which highway investment has contributed to regional growth remains a controversial point and tractable methods to quickly assess landscape change given a project of this magnitude are elusive. In this paper a portion of the AHDS trending through southern Ohio is examined using data acquired from the Landsat series of satellites. Beginning with a pre-highway condition in 1976, a 26 year time horizon, concluding in 2002, was analyzed based on a post-classification change detection methodology. Results of this investigation revealed slight, yet significant, levels of urban expansion within a 10 km corridor along the path of AHDS Corridor D/State Route 32. Beyond this buffer zone the land use system evidenced more stability, suggesting that as distance increased from Corridor D/State Route 32, reduced accessibility also reduced the attractiveness of land for urban uses. Relating these results back to the infrastructure investment policies of the ARC demonstrates that growth did result from the construction of Corridor D and supports previous findings that land development based on highway construction is extremely time-sensitive.     

开发区土地集约利用研究——以江苏省为例

开发区土地资源集约利用关系到区域社会经济和生态环境的可持续发展,也关系到开发区土地利用扩展程度和扩展方式.通过利用江苏省18个开发区调查资料,选取14个指标,构建开发区土地产出驱动力模型.从开发区的角度上来看,土地资源是开发区存在的前提和基础,土地闲置是开发区土地集约利用程度提高的首要限制性因素,开发区的区位很大程度上影响其土地集约程度,也说明苏南地区开发区土地集约利用高于苏中和苏北地区,土地集约利用水平的区域差异较为明显.在评价的基础上,提出提高开发区土地集约利用的建议.     

知识经济与人力资本

知识经济主要是以文化知识和科学技术作为发展经济的主要资源和动力，并逐步取代以往那种单纯依赖消耗自然资源和破坏生态环境为代价而换取经济发展的原型经济模式，这就决定了人力资本在知识经济时代的重要作用。人的创造精神和创造能力及其所拥有的科技水平，是知识经济时代经济发展的原动力。     

敦煌文化旅游创意产品的市场表现与消费者情感分析

敦煌文化旅游创意产品的市场表现与消费者偏好密不可分。通过对网络文创商店和敦煌实体文创商店调研,结合Python数据分析和情感分析,发现消费者情感因素能表现出用户对文创产品的偏好与期望,敦煌文创产品在传递文化价值、唤起游客对目的地文化的记忆方面作用明显;但敦煌文创产品同质化、质量参差不齐、创新不足、开发过度等问题依然存在。因此,加强对敦煌文化艺术元素的研究与创新,关注消费者情感,提高设计师智慧与才情,有助于提高产品设计质量和扩大产品交易,也有利于促进敦煌文化传承与发展。