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.     

Progressive fragmentation of a traditional Mediterranean landscape by hazelnut plantations: The impact of CAP over time in the Langhe region (NW Italy)

Land use change is strongly modifying the traditional landscape of hilly productive Mediterranean sites. An example of these circumstances is the Langhe region (Piemonte, NW Italy), where woody plantations such as vineyards and orchards have been cultivated on hillslopes for centuries. In this paper we assess landscape changes occurred in the Diano study area (2651 ha) in the 1954–2000 period and we ascertain land use transition paths and rates of this rural ecosystem. Land use mapping obtained from object-oriented analysis of aerial photographs was used to quantify land use changes between 1954 and 2000. To examine the spatio-temporal patterns of land use change over time, a set of spatial statistics capturing different dimensions of landscape change was identified. An increase of landscape heterogeneity from 1954 to the present was observed due to the expansion of orchards and the fragmentation of field crops. A significant portion (55%) of current orchards surface is represented by former field crops, 24% by vineyards and 15% by forests. The strong expansion of hazelnut orchards concurred to the fragmentation of traditional rural landscape was dominated by vineyards, field crops and forests. Hazelnut orchards expansion was mainly located in places where grapes cultivation was less remunerative. A further expansion of hazelnut in the area should be planned, discussed and carefully monitored through change detection studies in order to avoid potential unsustainable use of the land.     

论税法中公平原则的时间效应--以房产税为例

税法中的公平分为短期公平和长期公平，以房产税法为例，满足短期公平未必不是对长期公平的扭曲。由于我国一直以来存在的土地制度、城镇住房结构以及地区发展不平衡等因素均能在时间效应上影响到房产税的长期公平，因此房产税改革是一个非常综合和复杂的事项，必须将多项因素纳入考虑的范围，以实现税法的长期公平。     

Multi-scale integrated analysis of rural Laos: Studying metabolic patterns of land uses across different levels and scales

This paper presents an application of the Multi-Scale Integrated Analysis of Societal and Ecosystem Metabolism (MuSIASEM) approach to the analysis of rural land uses. Using secondary data on farming systems in Laos, we illustrate how the concept of metabolic pattern can be used to establish links between the various indicators of performance of rural systems. To this purpose, we characterize the socioeconomic activities in rural Laos by a series of quantitative indicators defined across: (i) different hierarchical levels of organization described at different scales (i.e. households, rural villages, administrative regions and the whole country) and (ii) different dimensions of analysis, including economic, agronomic, social, biophysical, and ecological analysis. The MuSIASEM approach simultaneously employs two non-equivalent criteria for quantification. The observed rural system is described in terms of an integrated set of flow elements (money, food, energy, water, fertilizer and other materials), which are mapped against two distinct fund elements: (i) a multi-level matrix of human activity (flows being expressed in terms of intensity per hour) and (ii) a multi-level matrix of land uses (flows being expressed as density per hectare). Our case study shows that in this way it is possible to move across different hierarchical levels, scales and dimensions, to arrive at an integrated representation of the metabolic pattern of farming systems.     

对称性交易：破解农村信贷供需衔接困局的内在逻辑——基于山东农村金融创新案例的分析

摘要：在现有农村土地产权制度下，土地及依附于其上的各类生产要素不具有充分交易的条件，进而因缺乏合格的交易客体而使农村金融交易呈现非对称状态。人民银行济南分行立足于满足枣庄流转土地和寿光蔬菜订单的需求，在谋求对称农村金融交易主体上寻求突破，较好顺应了农村土地规模化和集约化经营的主流趋势，对破解农村金融交易困境有一定借鉴意义。     

Mapping changes in land use/land cover and prediction of future extension of bowé in Benin,West Africa

Desertification and land degradation are worldwide problems affecting soil, vegetation and the livelihoods of rural populations. Bowal (plural bowé) is a particular form of degraded land that occurs in tropical regions and leads to the exposure of ferricretes, which are unsuitable for farming. Bowé are more common on farmland and degraded savanna. Changes in land use/land cover were used to map a region of 6.7 million ha in northern Benin, West Africa in 1975, 1990 and 2010. The changes observed during these periods (1975–1990, 1990–2010 and 1975–2010) were used to predict the occurrence of bowé in the period up to 2050 using Markovian chain analysis. The results showed a considerable change in land use/land cover during the three periods. The types of land on which bowé occur (farmland and degraded savanna) increased in northern Benin by 5.4% per year during the period 1975–1990 and 9.5% per year during the periods 1990–2010, while the natural vegetation (forest, woodland and tree savanna) decreased by the same amount. The future scenarios also predicted the same trend. In the period 1975–1990, 1.28 million ha (26%) of natural vegetation was converted to degraded savanna and farmland while 2.23 million ha (53%) of natural vegetation was converted to degraded savanna and farmland in the period 1990–2010. Based on the dynamics recorded during the period 1975–1990 and 1990–2010 respectively, a total of 1.28 million ha (26% of the natural vegetation that was present in 1975) and 1.29 million ha (31% of the natural vegetation that was present in 1990) will be converted to farmland and degraded savanna in the study area by 2050.Thus bowalization will persist and increase in the period up to 2050. The natural vegetation could disappear if protection and restoration measures are not taken. It is thus important to take measures to stop the degradation and to implement programs to restore soils on bowé based on the soil and water conservation techniques used on highly degraded West African soils, such as zaï pit and stone rows with grass strips. Some native plants species adapted to bowalization and resistant to climate change in northern Benin (e.g. Asparagus africanus, Andropogon pseudapricus and Combretum nigricans) should be used in association with soil and water conservation techniques on bowé.     

Mapping mountain diversity: Ethnic minorities and land use land cover change in Vietnam's borderlands

In the complex agro-ecological conditions of Vietnam's northern borderlands, attempts by ethnic minority farmers to create sustainable livelihoods, along with the impacts of state development policies, have direct consequences for land use and land cover (LULC) change. In this paper we analyse the degree to which LULC has changed and diversified from 1999 to 2009 in Lào Cai Province and the underlying relationships with ethnic minority livelihood diversification strategies. We examine the correlation between LULC diversity and various socioeconomic and biophysical proxies using a spatial autoregressive model. Our findings indicate two major changes in LULC: an increase in closed canopy forest and substantial urban growth. LULC diversity increased between 1999 and 2009, suggesting a transition between land uses and/or a diversification of livelihood strategies. Socioeconomic proxies are significant predictors of LULC diversity in both years, while biophysical proxies are only effective predictors in 2009. In-depth interviews regarding state-led policies and ethnic minority livelihoods reveal some of the underlying mechanisms of such LULC transitions and associations.     

3S技术在国家重点建设工程项目中的应用——以京沪高铁项目(天津段)为例

3S技术是测量技术发展史的一次重大突破,给测量领域带来了新的生命力,并已推广应用在国家基础建设的各个方面。本文以京沪高铁天津段这样的国家重点建设工程项目为例,介绍了3S技术在该项目从土地规划到建设运营方面的应用。     

高房价理性回归的金融通道

近年来,随着我国经济的快速增长和城市化进程的不断深入,我国出现了房价过快上涨的势头。高房价背后有着各种成因,抵押贷款证券化在解决高房价问题上具有合理性和可行性,保持审慎、稳健的监管,通过合理的金融市场建设和金融资源分配,房地产市场能够回归理性,房价回归正常合理的水平。     

Soil is brown gold in the Emilia-Romagna region,Italy

Soil is a natural resource essential to human welfare by virtue of its numerous crucial functions. In the past, soil has been taken for granted because of its widespread, albeit finite, availability. However, now that world's population is projected to exceed ten billion before the end of this century, soil is increasingly perceived as a precious commodity. Consequently, soil is increasingly under pressure by rich private investors and governments within the poorest countries to satisfy appetites for food production and biofuel. A case study is used to explore the plausibility of soil being considered as ‘brown gold’. Based on the comparison of land use maps, we estimated the value in terms of resource from raw material, carbon sink and virtual calories of the productive soil lost during the period 2003–2008 in the Emilia-Romagna Plain, one of the most productive areas of Italy. More than fifteen thousand hectares of cropland underwent land use change – in particular urbanization – over the 6-year period with an implied loss of crop production potential equivalent to the daily calorific requirement of more than 440,000 people. Taking into account that Italy is no longer self-sufficient in food production, such a loss appears to be strategically significant. Perhaps more importantly, urbanization and soil sealing has had negative ramifications on environmental sustainability, on both local and broad scales, with increased consumption of public funds. A logical framework of the socio-economic impact of land use change has been compiled and is presented as a possible example of a policy relevant approach to managing productive soils as a finite resource.