5 research outputs found
Colonoscopy use by Primary Care Physicians and Colorectal Cancer Incidence and Mortality
No full textWe first studied factors associated with the rate of colonoscopy by primary care physicians (PCPs) in Ontario between the years 1996 and 2005. Next, we conducted an Instrumental Variable Analysis (IVA) to estimate the effect of colonoscopy on colorectal cancer (CRC) incidence and mortality on average-risk subjects aged 50-74 years. Finally, we explored two study cohorts, one by including subjects who had the outcomes during the exposure period (unselected cohort) and the other cohort by excluding those subjects (restricted cohort). We estimated the absolute risk reduction associated with colonoscopy in preventing CRC incidence and mortality using traditional regression analysis, propensity score analysis and IVA. PCPs who were Canadian medical graduates and with more years of experience were more likely to use colonoscopy. PCPs were more likely to use colonoscopy if their patient populations were predominantly women, older, had more illnesses, and if their patients resided in less marginalized neighborhoods (lower unemployment, fewer immigrants, higher income, higher education, and higher English/French fluency). Using PCP rate of discretionary colonoscopy as an instrumental variable, receipt of colonoscopy was associated with a 0.60% absolute reduction in 7-year CRC incidence and a 0.17% absolute reduction in 5-year risk of death due to CRC. The unselected cohort showed an increase in CRC incidence and mortality associated with colonoscopy, whereas the restricted cohort showed a reduction in CRC incidence and mortality associated with colonoscopy. In the restricted cohort, using different statistical models, the absolute risk reduction varied from 0.52-0.60% for CRC incidence and 0.08-0.17% for CRC mortality. There were social disparities in the use of colonoscopy by PCPs and this disparity increased as the overall use of colonoscopy increased over time. Colonoscopy is effective in reducing incidence and mortality due to CRC. Different methods of subject selection and statistical analysis provided different estimates of colonoscopy effectiveness.Ph
0002
No full text. PROFESSION AL
mm* e. uLcnx :
ATTOK-aT BT l*«
vorasr rr/Btao
awaSa rtaaa. SISX.
IMII.l PALO ALTOTIXIS8. FRIDAY, 1UI.Y i. iqio
Harry C R-ynoUa
DErCTtST
Bass. Sal Has
Hatiaiial 1:3010 j
ML THOM-Lff r. BJUTMOtlD
Dr. Mel-tyre)
Bear* t to It a. as. (Mat t
ts t ff. as.' t-tdyard BetJdiDg.
EDUCATIONAL
Mite fiatb tf*sgTobam will condscl
her class for tittle tsef^nriata tBrOaffb
tb. month of Jaly. for tb* baaafft of
died m*sfb*re. Ctsss work will ba
eaatlaoed wber* tbts ta daatnd. aad
•mmmmf rBttd-rea wtll be provided
stttb a sen Halgffil *axai»ffrnnnd
At ho-
1 Tbaisd.j*-
-SggSBf** tbst bs bas moved
afses snd JwStfswataSl ta Itt All
street, where fee wttl erect a Ssod-
ara Veterinary Hospital thl* Ita-
mat. fa-Bs_-sw-st Pale Biae lis.
SHAMPOOING
8HAMPOOISO.
Treattnaot aad r*actal
Cam»l.eJoa Pacba a ***aeaslty. At
Mad* of hair wark gi*sa pi-aeaat at
tentlor. Mrs. C BMlrntm Wad.
room No t Msdt-s**w-TSolt. Slor.
Phe.a 13. J*
Supervisors Meet as Gear*' Street Bonds
Equalization Board
A-rORTUNS HUHTSK
; ScAaa—A. lat.tl_.ar. Ofbc.. A
,,aw .proprietor of tb. oSc.l 1.
Are All Subscribed _*£ £ -Jr-^Jr: ._£
carryiag ■ satchel
MAI Ml -TIM. FOB THIS POB- axABltB INVBST SHE., PATRON- Narse
ii*M: WlM. BB HELD ON THBJMTBB TO 1TTTBDBAW |■ w***>
-ill. IS.
THEIR DEPOSITS.
!
ITS rT-XAStSO TO A blAN
efaea he look* ts tbe mirror and
as**, tbe refined sttect «f laaJiJeaaly
le.adsrwd llaea. aacb aa oae alway*
tin tram tba Stanford laendry
*TANPOBD l-At'NI>BT OO.
f-aam tteaOC. Itoaffta Dry IV finil
THB KISS
Something made of ambia*. tatting very awest,
A most dcUciotu compound, witb
iagrcdicaii complete ,
Bot if, as on occasion, tbe heart aod
mind ata-soar.
It ha* no great significance, it lose*
half itt power.
Something xnade of nothing, and
never twice the tame,
Tho* 'lit known Jb evsry country
where love ba. had a name;
It is clearly ggeaat for giving, tho'
'tis some times bought and sold.
And, like coffee asd potatoes, il i
not so ffood when cold."
J EFT.
G. P. 11. went out one day
la aa bbio pretty grand
The (rienda he took all liked hit ws*
Tbey liked hi* open hsnd.
T-hey "took in" all ibe road c.fet
Upon Tbe Kiag'i Highway,"
Tbey met a tree or two,
Said Goy. "Now tail won't do!
I'll phone lo lame T, too.
Aad tbla ia waat I'll aay
Haetl&g la -special ■bs.Ibb yes-, Baa Praaclace. Jsly it.—Wlib s
tarda-r atarnlsff m s board of eqaal-' bid rtnserday morning trom tba
laatloB the twenty .up*rvi*-ir* r**- b-T*la sank for ail tb* beads tbst
calved tbe records ef Ass***or Spll- ar* ML** tb* fall IttO.OtO of tb*
xer and w.re i-repersd to hear com-' 0***T-str*et lass* ba* b**a its-
B-aJat* frem property owner* wbo asrlb*-. Tb* city •utbortu** ar*
felt tbst tb*y bad besa as*a*alry, ao w*Q pleased with the aal* tbat
taxed. Aa so oa. appealed before p they ae* piaaat&g ta pat aa addl-
tbe board aa adjenram*at wa*. tlonal |*lt.««6 of tb* ****** sacarl-
tabaa to Jaly lllb. ties oo Ue market early la Septam-
■torrler la tb. movnlst *T. B. Al- i-sr This win bring sn evea isao..
lea. 'manager or Ibe second natlooat .00 wltb which to Initial* work oa
par* food exposition, appeared be- tb* Haa, *•*
fore tbe beard aad addrteasil the Aftrrr tbe a*b*crtptlOB list- bad
SMBi-er* relstit. to getting an'aa-.l>«*o osmpletad offer, wet* r*eelred
propria lion Of 11,000 from tfee | lor Ifteea mar. of lb. 11.0*.
coaaty lo help carry (be enterprise; r-ond*. Tb« labor union, were pre-
tbroagh .ae*-*-»s-f*lty. Tbe matter; pared to bid for an amoant . tbat
wsa referred lo Ibe commlltee of (weald bsv. carried lb* tSUl over-
lb. whole. ;-tatrwcrlptloa to It00,000.
Tbe bo»rd derided lo bare the a^^. tar. >,_„, M|ir „mofi w(
county ordinance** revlse.|. cod1fl*d
carina* aorta to explain why tba
land Indexed, and author lied rb*1*M rim** held aloof frem Iba bond.
I man Ayer lo order Iba work pro-JTb,r* had been aame suggest.** of
t-wedsd with. Bin.-., tb. ordinance.] 4 mrMm. •entlujaat to dl-coursg.
w.re prlBlvd la 1101 tb*r* bsv**|h_ mmt ownership of Bunfa a wtll*
.■been f*ever*l change* m.de .»d lij,t7. u b-tcame apparent, b**wt>w.
was d**«B*ed advlaable to bsv* lbemt,ha[ „ a,, ^^m dld n-, Wo lh#lf
broaghl up (o dale bsfore ard.rlng I ..„,._.. w(tuW v|Mrn thelr darn, .rr printed, .(poslta aad invret la tbe bonds The
■ ' ' ' ' . j highsat rat. paid by tb* local aatr*
i HIM •*.!-. NATION ADOPTS J ,„„ Hnbm u t p,r* «,,. *,-*
mm liKi-laiti, fXHNAafcjbo.4, carry 4 1*1 per seat.
"When th. city government
I'm a nurse
Proprietor -.witbout Utokiog .p. ah
sent ouadcdly). What caa yos dot
Norte. "Wbat caa I do.* Didn't I
tell yoa 1 waa a nsrse.' Yoa'r*
brillsant".
Pr--pri*ttor. (ariok* off). -Ob. a
case.*
Naur**. "Naiurallj."
I'ropncior. lop*as book, tarns
least*, MJicbaug foe case/. Htr.s
• boy witb scailet fever."
Nurss "Ooat take coeugvoa—ev«
—or boy-."
Propnetnr. i (turaa twee loavo*).
"A lady witb (oosumptsocL
Narta. "No Itmale labertslasi* "
1'ropn.tor. "Kjit*"
Nurse "No female tubrrcaJc-Mi,"
I'roportui "Uh."—uuia* lesvstj.
--.Veil, bora'* a gfilsmt.
Nsn*. "Waal's thc tastier with
binU" (show, mors' ioier.it. putt
down Michel).
Proprietor. "Old »ge."
Nana. "Is good elrcummoceir"
Proprieor. -_Ur- (look* at nana
Bharpiyj, -H« caa pay tor nil
ttarae. If that, wbat' you're after.
And if be can't, hi* folk* caa,"
Nurse "Won't answer Anything
e.**.»-
■ Proprietor, (tarn* leaves rapidly,
searching lor mors ca**a). "Yonag
buy with sprained ankle More a
companion wamtd, however, tbto a;
f-lb. ba. ,... aid lb. tiat-tt-aa* fa .-a- r-Urda, .era- TarT TbU U a ..,, , ed XM IkiVerHlV TfaBtf-t C '
****** *** -»«"—' " •"P.'ASi.l., I...... aertb « U,. bead. «- will, ar.1 .bl. I el,TbAataS? 11 *"" * W ***
Nsrse. "Now If tbla were only •
"■Sore, I'ee gat baaap* on a
Scretcbes an say tort,
A face tbe girls cant 1-ik
And li-ofaVtss so •
So coenc to ata. doctor dear.
And bring (ws p*aM— *%mj'
III ride SO rat-ore -in t-ii *dTt of ihty
And is** tb* first tod-y"
With my (rieads sa gay.
Nay, n»y 1 -
(To "Ringt oa my nngrri")
—KATHLEEN
nodlty tb. Ajserloan *y*t*m of ded* -j^,^ lo ^ g\apomad of. "tadlvld-
mal celnare. wttb the dollar aa tbe|,al h„ator. applied la tb* *sm off!-,-, t„.-'
aall of valae An In-eriil f*cr*i, *T,H., *»„,„ ttl.etO oa bsnd.l Proari,,-. (i
dated Hay 1Kb. prvjetne. tbat. sf. L^ WM lhf _-,„,,__ J 10 o*eltr-*b Lf'T*'^'^ " ™" "^
fr on. y»r. tb* old co.tv. of tbsj ywtsrday m.rnla. At tbat gmwt423&» ^ ^c . u * mali iZ
empire ah.ll be ao longer legs! tea- „ .-„», or ^ mbtrmto ^^ »* HSw J tee." 7st-.! J_r_rl UT
a,, fa. "tax*. stss*h* aa.l lata- - - -TT.. ■■ ~ ._ I**»t l"« g« too. I shut I book Sll
_a*aTwaraa'• aT^belVL Z'*2**\*2 . !!. "^r. **.>*»* » • "• '"• "«' "" «*
SraabK raanaa. All -oiam rt bou4 ^ nuarrieere. .talia,, taal'_,lW _, ._,_.. \_
aaa rela. aar ..rb.a„ -.ea. a-1,. a«l,,t»„ Satfral all tbe bead, i ,T,.V__- '
torebU, II. 1111. far lb. a. «.!-!,h« ^. an. A M ^ Ula' n"~".„^,. ,. „
Ian aal fratllea.l camar. ■' a.__-..._ ..
J w. de Veal
' alaa ta ud fre. Saa fru
aato aad etaa alaa I* 1
re. b.r. • taaa a? art a a
Nura
, ..jaal.ted .1 mt-
ISU. le b. d«.r.ia-l br lb. a«- n. „, WA. .n'reaalUd HI
AM alu ef -araa.- m la ol- __, w aaa tt.l lb. baa. ban ,
■a. Tb. T. CblM Bab. I. •al_.)b-M-t . amaa .1 a. |'""' •■'.•"a-.aab
... p,.-,..... eaea a IM. -a», ,_. _- _. j|aa-< aalol,
...t laurMt .111 "
Propmtor.
Arch., ReoM-.lt .n. oec ..k^l
by .nether Ud jut wbat eon of . aae
hU father ... "Why ha*, lei. ...
of . man." th. km i. r.pon.d te h.r.
r«elU_ ~It b. -ait to . w*ldl.f
h«'d waat to e. tbe ertd.. .ed il hr
w.at to . laa.r.l had warn lo a. tb.
cona.-
... aaat Ln,,h. _.!.•■ mU H A: Hmm. lb,
tbU .....«., Tb. aw re.o. .Ul | aa a.n a ta bead ef aia
be eaaa .1 aaa talr.1 alal aal.aaa -Tbo- mb .be bar.
*Uaad to U. nrMt br.arb- albasbl tb. baa. b.a aua. A .ood
A. bub. All ol Ih. Pto'larlel | |,-a»..t. Tb. laa. .Ill rartala-
A.AU Ar, to b. .bolabed. aad the „ mM, . pnaU... Ea.r, aaaa
ro.n.ia ef mm., b, .rial. ba... ._„ __, aroaaid will a .bl. to
aad ladl.Maab i. aal. aa-.f—.jatj at a paBt H b. daba
Tke na. .uadard dell.r.
IAS le the derra. ol Mar lltb. -will
ba .aaip.ir.rUT ef .ll.er." wblrh
pbraa. ...al. lo fl.e a blat that tbe
eB.horltl-a at, Pehlas ar, tblahles
Summer Excursions East {
I..* tntre to all y*«_-ds*l BtMttwn pcwMts. Bole a few
N*w Tork SlisxaJxff
Omabs
Boaton Ht-B
KSBBM Clly
Pbllsdelphla ISSaJB*
War_felBStoa 107JIS
ttt. Loots
HoMrrel .. tswVI*
New Orleans
T-ror.l'i . .
BALE DATBS—
Jaly SS. SO. ST.
A-Bgwst I. ffs, ff, d. IS. to, IS, 17. IS
I S.jr *-- I. B, A. tl. IB. IS, 14.
IS susd Hr^a*mber Bl, SS, SS. Oeavd via atay direct -rwatr.
i amSsaff-ff.
£. SHILLINGSBURC. Dist. Pass. Acent.
San Jose, Calif.,
a* or
ANY AGENT.
j: SOUTHERN PACIFIC
Palo Alto Construction Co.
OENERAL ICONTRACTORS
Fine Garden Loam for Sale
_>58a*.Hif.h Street, corner Charninj-rAvt.
Phone'iPalo Alto 823
day Tor tb* *ebnol i*rm **dlng
Jnly-T. ItlO. tt^ta upon dally attend.ace that apportionment Is "~
B red. The total a mount rscelved
frrtrri tb* poll tag** waa Ittl,-
Ift.tl. Tb. .veras. dally attend
inc. for 117 secondary schools was
17,410. Tb. amouat fpportlosed
-ws* 11.16 par pupil ua attandaBce
hasls .
Among th* large amoanta appov
!1one*S f-jr el^mert!.ry -****>eols mrrn:
Bam r'ranristfi. ||07.t<3 .'.«. AUnie-
d.. HI1.Hl.ri4 ■ LO* Atlfeii-s.
tlt?,Btf.40. Por"secondsry schools
(b.-largeal amounts go lo Alameda,
(wltb II 1.171.1*;; Los AngrI*-., with
I |tl,ltf.7T, far. Fr.nr Isrii. wttb
f..t:*i :*< aad SaaU riara. wlib
tl.tlt.tl.
ef palling tb* carreory of tba *m
plre. at Bd.r-i* not dlstart date, opoa
a gold basis. It will cnntalB aavaa
mar* and two '.ndarwens of fine
■ il.i-r. wblcb wtll make 11* Intrinsic
valae. at tbe prvaent prlc. of sliver.
about CO or 10 east.. Tbe .u.1,.1-
dlarr colas will cloeely Imitate tho**
of tb* foiled Ststs*. Tbat la to
aay. tb* dollar will b. divided into
100 rents, and there will be sliver
plecr-t of r.o. It and 10 rent, de-
i.onttristlfife There will be. in addition', a nickel --east \p\aoa. a ***>*>
per t-ceat piece. Ilk* tbst wbtcb
Ibe United State, coined a few year*
ago. and a ropper rest. Tb. east
will b* divided Into 10 cnab, tn'tj:_ .
mlBs representing f. rash, or half a r'UlJ
cent, and 1 cent will b* provided. |
Th. taller will be almost ttrlre a*i
valuable ss tbe present cslh of Cbr-j
bs. wblrh la worth from one-twentieth to •m*-flft*-*-*.ts of a east.
Tb* Cbiaese goraram.a't Is tmr-
Ula I. aaia a ,~d o~l of "',"** »*" »**" « ***•
dl*r.llr la fraalw lb, ^ Mm\"*'"M; ~*f" "«-**> *»
.pa tb. aal. Tb. pmrtaall **•***"*• '*'*"*"• *** •**,"*
wa. will ^.. ap .bar ai.ra.l—'' «*--*-* laa.rl.la
privilege ealy aaiat protest. It
ban b**a, la tb* past, a potest
mesne of earleblBg them TBay
bate pal Into clrcelatloa enormoe.
aaotbar* of debasad coin*, both silver .ad ,copS*r. n-hlnd their
Value and
Service in the
"Easy"
i*. ir' tr*
dry oat and leek, or fall apart.
seed* ao aitenttea between waab*
dsys. Il baa all tba element*
service and durability ao noticeably
lacking la wc*od-ctave tab*
wood-box washlBg machiae*
twean wood sod »t**I la ronlact
with soap and water (bare la aa
comparlaOB for darabtiity Tba
wood laat. for a few months.
per celD*. Ib trntb. there ha. bsea
ao vala* wb.levvr. *av» tb* Ingni-
la-sl_nal vaT*. ef the copper. Bat
tbe peopl. or Cblaa—(hat I.-to say.
the ps-a-.pl* remcrt* from tb. greet
(radlog renter.—have accepted thta
private Sat rnooey with little **«*-
lion Wltb Ih* growth of r-omma-
ali-atton. bow.ver. It Sob b*sgan to
dsprvsrl.t.. .nd Ihoee hold.rs of Itj „ -^^ *_!-*.■*-*_.» n
who -re WlM wilt ciu'chly eieh.og. P A C A 1\ IT TV \
It for eola* beariag tbe governmast M **-**■ **** ********** * "•»*
stamp.—H.itimors Evening Saa.
P, P. OsTutT V
llfid nytnn St.. Pale Alto.
l**beme 74 11.
•U-t*miI*4TKXDKNT As*1*t>RTB)NH
HKMIANNI'AL *-' int-n i I M>.
H*v. yoa been to Paaadesa
not aat mm os* wbo has asd
tbey wtll admit tbat Pasadeo* pos*-
i-i.ti* ao sucji oatoral haaaty aa
doe. tb. town of Lee Altos, where
yoa can gst . saperb view of tb.
mnant.lns, tb* bay and tbe Santa
Clara valley Ton will alt* • rar.
opportonliy If yon do not get la
We are growing, aad growth
valnes. Let ut
I Sacramentn. Joly *l& -State Ss-
lperlnlend.nl Hyatt bas tent oat no-
| tire, ot tbe BemlanBaal appbrtlea-*
-ment nf (H-haol moneys for tb. ele- now
m.nt.ry and swa-ondary scboots of means
tbe ataie lo coanty .aperiotendeat. ■**«»»-*■ ***** b**ot\tm\ bungalow*
SSD rlerks of .he afhaal l__.rel. *** i****** ranging In price from
aad clerk* of tb* achool troards ,, fW lo |7i,0g# „ ,f ron gm^tn
t1.54t.W4.7I Is allotted to eletoea- to bond com* aad am oar ball-
Ury aad I1S», 14* IS lo blgb acre tot* c»v*r*d wttb trait treee,
arbool dtalrirtB "*e oaks, pappers sad' wild rhcr-
TW -re ,...«, rbUdr.. .,. JJ « »«»= *™m?£j£8g*"
tri.dl.g lb* element.'.! .rhools taeb f>_ q. BMg-. latst Altee.
Proprieor. "Yes,
m.-Joat lab* ii tm'
Narse. "I. ibe ess* well to d*>r*
Proprietor. Mercy, yet! alillsooar
Nor**. (Mian b.r aatcbsl} "Wbar. fl|r_ ™ TOCB
ihe address.* Wkaa caa I ff*r
Pro*a--4a->r -Ks« Uighi sassy and yea sat ywaw
Kosh order."
N.r*e- "1*0* omT* (surf* for *b*
door).
Proprislor. "Ok, do yoe'ri" not I
Come back If* very urios* -«car- [
Ict-frver. whooping conffb, meatles, j
II at lb* urn* ihne" (smile* io her-1
self)-' "1 must know if yon are'
rilling io do everything."
SOCIETY NOTES
(By special leased wire to (he tth of
Jaly Democrat—Sao Bruno papers please copy.)
Th* von Joneses and th*
Srayihythi have gone 10 Ibcir cottn-
try place, We*k-End-By*Tbe-Ses
The de Courcy-Cosrcy*,' though in
mourning, art tnteititly enjoying
(heir auto-trip through Ibe Highlit
Hltnalayai.
• shall joyfully welcome borne
i Guggini wbo ba* been visiting
the Muggins—and also the Loggia. I
.nd the Mogguit sod thc Juggim—all'
lose family ccmncction* with tbe ex-
cpit.ii of (be first letter.
Cm/icma that tb* Bmwn* .re Oat-
tog at ao Inn! . .
Of coarse Const Ktobakt KtmbttU
ill soon br o**r, for matmnoew!
rcseota*. at be ha* lost Ik* few bo-
prk. be possessed
Molti-biUic-aaira aad Mrs
ka*c gone oa.a toar ta their asw
» bortr power atvoplastr. -I*
Mar*, m Ibey b*v* nmthrd ibe earth
— Lady Sm.M-Set
The Patimct Man
There is a maa wbo ntaar drinks,
.Nor imukci. nor chews, st
Who never ■ambles, never tirti
And thuns all sinful snares—
He's parslyaed'
There ii a maa wbo never do**
A thing thai ia not ri*jht,
"»• wife can tell jutt wber* he Is
t morning, noon snd nighl—
Hi', dead'
A Kuls of Heal th
{Am aat forth by Redwoods ic-d-ag
f*by*lci*n)
Don't «.( or drink >
M*T -ass* tar -ale.
We bsv* tb* oaly -ytMaslve tar*
Palo Alto Transfer Ct.
101 University Ave.
-ffBr*--t PATtBI
tisis.ee** ts* wyts, ssslsr* X*. il.|Hi*a sat
Hello. Andyt" shouted Btllj,
Where'v. yoo been.* Sho.-nn'"
"Yep." Mid Aady
"What did yoa abdatr .
"D-ff.*'
-Yoordr.' My! Wa* be mad.
"Well, he didn't look to dartfed matt
sJrsted" ,
Regulatory Strategies for a Resilient Smart Grid: Cybersecurity Compliance in the Electric Energy Sector
No full textRapid innovation in a digitally enabled electric grid requires attention to cybersecurity and resilience. This doctoral thesis is a multidisciplinary study exploring regulatory strategies toward compliance with smart grid resilience goals. Security regulation in the form of legislation, consultation, and audits is essential in the path to a desired future state of resilience. This doctoral work has identified smart-grid-enabled business cases with very high consequence potential, explored the development and coverage of relevant cybersecurity legislation, and investigated the effects of key legal requirements and audit methodologies for smart grid resilience. This is a descriptive work, pointing out weaknesses in current policy structures and regulatory regimes. However, this work also has normative ambitions in providing recommendations to optimize regulatory compliance strategies.
This study has developed a conceptual model for regulatory compliance based on available research on regulatory strategies and the use of hard and soft law. The model links components of regulation to factors impacting regulatory compliance. Frey’s Motivation Crowding Theory is utilized to discuss these factors. The results show that regulatory compliance strategies should include both managerial and technical requirements. Further, it may be advantageous to introduce a differentiated focus on regulatory strategies depending on the size of the regulated entity and the knowledge level of the authority in the field.
The reason why it may be advantageous to differentiate regulatory strategies is that detailed compulsory regulation may trigger a compliance focus instead of a security focus and even reduce motivation to reach compliance for large entities with a motivated security team. Regulatory strategies may also be differentiated based on the authority’s competence level. In cases where the authority’s competence level is low, it may be better to rely on strategies such as Enforced self-regulation, letting the regulated entity take more responsibility for choosing the most effective security measures
Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure
No full textBACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)
Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure
No full textBackground:
The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown.
Methods:
We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes.
Results:
During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P=0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro–B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups.
Conclusions:
Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329. opens in new tab; EudraCT number, 2016-002299-28. opens in new tab.
