Clinical and economic benefits of extended treatment with apixaban for the treatment and prevention of recurrent venous thromboembolism in Canada

Background and objective Venous thromboembolism (VTE) is associated with long-term clinical and economic burden. Clinical guidelines generally recommend at least 3 months of anticoagulation, but, in clinical practice, concerns over bleeding risk often limit extended treatment. Apixaban was studied for extended VTE treatment in the AMPLIFY-EXT trial, demonstrating superiority to placebo in VTE reduction without increasing risk of major bleeding. This study assessed the long-term clinical and economic benefits of extending treatment with apixaban when clinical equipoise exists compared to standard of care with enoxaparin/warfarin and other novel oral anti-coagulants (NOACs) for the treatment and prevention of recurrent VTE in Canada.

Methods A Markov model was developed to follow patients with VTE over their lifetimes. Efficacy and safety for apixaban and enoxaparin/warfarin were based on AMPLIFY and AMPLIFY-EXT, while relative efficacy to other NOACs was synthesized by network meta-analysis (NMA). Dosages for NOACs and enoxaparin/warfarin were based on their respective trials and were given up to 18 months and up to 6 months, followed by no treatment, respectively. Patient quality adjusted life years (QALYs) were based on published studies, and costs for resource utilization were from a Ministry of Health perspective, expressed as 2014 CAD ($).

Results Extended treatment with apixaban compared to enoxaparin/warfarin resulted in fewer recurrent VTEs, VTE-related deaths, and bleeding events, but at slightly increased cost. The incremental cost-effectiveness ratio was $4828 per QALY gained. Compared to other NOACs, apixaban had the fewest bleeding events, similar recurrent VTE events, and the lowest overall cost, which was driven by the strong bleeding profile. In scenario analyses of acute and lifetime treatments, apixaban was cost-effective against all strategies.

Conclusions Extended treatment with apixaban can offer substantial clinical benefits and is a cost-effective alternative to enoxaparin/warfarin and other NOACs.     

Advertisers’ perceptions regarding the ethical appropriateness of new advertising formats aimed at minors

Although they are key stakeholders, advertisers’ views on the usage of novel (integrated and/or interactive) advertising toward minors has remained largely unexplored in academic research. This study aims to fill this gap by examining advertising professionals’ opinions about the ethical appropriateness of using novel advertising formats aimed at children and teenagers, how to advance advertising literacy in minors, and their views of practices that are potentially privacy-invading, by means of both a quantitative online survey and qualitative in-depth interviews with Belgian advertising professionals. Results show that advertisers perceive that from 12 years onward, minors are capable to understand novel advertising formats and it is ethically justified to use them. Remarkably, advertisers would inform minors already from the age of 10 years onward about the commercial intention behind new advertising formats. Advertisers have strict opinions about collecting information online from minors. They advocate a combination of laws and self-regulation and governmental and educational campaigns to raise awareness and develop advertising literacy.     

人性的探密——评严歌苓的《风筝歌》和《乖乖贝比（A）》

严歌苓在充满动荡的北美社会里对普遍的人性和人类生存状态进行透视与思考。《风筝歌》和《乖乖贝比（A）》两篇小说分别以少女和幼女为主人公,从女性经验出发,以一种理性的升华来表现对人性的宽宥。严歌苓提供给我们的东西,既有性别的,更有超性别的,归根到底是在揭示人性,而且揭示的相当深刻、感人。严歌苓的才华使她的作品完全可以凭借文学性打动读者。     

新冠肺炎疫情对我国农业发展的影响与应对举措

新冠肺炎疫情的爆发对粮食种植业、畜牧养殖业、种业、休闲农业、农产品加工业、蔬菜业、水果业、花卉业等产业发展,都会带来一定的负面影响。为减少新冠肺炎疫情的负面影响,推动农业健康发展,应保障粮食和重要农产品供给,抓好春耕春播工作,保障乡村道路运输通畅,在南方地区推广稻田综合种养模式,发展生态高值农业和"康养业+富硒+农业",尽快推进饲料企业和屠宰加工企业复工复产,加大对农业产业的金融支持力度,降低农业经营成本,鼓励发展以村为单位的农业社会化服务组织,大力培育农产品销售新业态,建立政府、企业和市场互动的农业灾害救助体系。     

香港王敬羲小说的异质性——读《女房客》

王敬羲的小说不同于香港文坛五、六十年代的难民小说和通俗小说，它通过对平常生活中普通人，尤其是小职员、小市民的心理描写．传达普通人对城市生活的体验和感悟．为香港纯文学的发展吹来一股新风。     

书信体小说的独特叙事魅力

书信体小说因其独具一格的叙事特征,在世界文学史上曾有过一段相当辉煌繁盛的时期,其叙事特色主要体现在仿真性、对话性、情节弱化等方面。     

以小说的方式言说文化：文化悬念小说价值阐释——兼评宋耀良《西夏谜城》

与传统悬念小说不同,新悬念小说包括知识悬疑小说和文化悬念小说,在满足读者的解谜欲之外,更多地着眼于人的求知欲,激发人的好奇心。这种类型小说中的文化悬念小说是国外知识悬疑小说中国化后引入的一个概念,传承了＂文以载道＂的传统,以小说的方式言说文化。宋耀良的《西夏谜城》在文化悬念小说作品中颇具代表性。作品以小说的形式来解谜一个消失的王朝———西夏,让被称为＂东方金字塔＂的西夏王陵、拥有过＂中世纪图书馆＂的黑城遗址和＂乍视字皆可识,熟识无一字可识＂的西夏文字等诸多西夏之谜在普通人的眼里绽放出生命的＂音容笑貌、歌舞哀哭＂。     

老舍小说中的文化意识

老舍在小说中以犀利的笔触揭示了民族的恶习,严肃批判了传统文化中存在的弊端。只有从愚昧麻木的状态变成积极主动的现代人,改变落后的社会心理状态,中华民族的优秀传统文化才能在传承中进化前行。     

The Changes in Demographics and Lifestyles and Their Effects on the Coffee Industry

This paper isolates certain key variables to assess their impact on the coffee industry, and to what extent these variables have been addressed. Although approached in a theoretical framework, this paper delineates the environmental forces that are faced by the coffee industry, and how the negative impact of these forces fo unnoticed or are ignored. The coffee industry has a history of little action taken when highly publicized health studies were published. When the demographics and lifestyles of consumers changed, the industry has been slow to respond. Recently these constricting forces have been addressed, thus providing an area for future research. The study of successes and failures of the beverage industry can help many industries in understanding their marketing approaches.