Interval ratio – ATRX http://atrx.net/ Tue, 17 May 2022 21:17:22 +0000 en-US hourly 1 https://wordpress.org/?v=5.9.3 https://atrx.net/wp-content/uploads/2021/10/icon-3-120x120.png Interval ratio – ATRX http://atrx.net/ 32 32 Trained scent dogs detect air travelers with COVID-19 https://atrx.net/trained-scent-dogs-detect-air-travelers-with-covid-19/ Tue, 17 May 2022 19:17:59 +0000 https://atrx.net/trained-scent-dogs-detect-air-travelers-with-covid-19/ ‘Sniffer dogs’ could use their highly developed sense of smell to identify people infected with COVID-19 whether or not they have symptoms, randomized triple-blind validation shows trial and actual sightings published yesterday in BMJ Global Health. In the spring of 2020, a team led by researchers from the University of Helsinki trained four dogs by […]]]>

‘Sniffer dogs’ could use their highly developed sense of smell to identify people infected with COVID-19 whether or not they have symptoms, randomized triple-blind validation shows trial and actual sightings published yesterday in BMJ Global Health.

In the spring of 2020, a team led by researchers from the University of Helsinki trained four dogs by randomly presenting them with skin swabs from 420 parallel samples from 114 people infected with wild-type SARS-CoV-2 and 306 controls. negative over seven sessions. Each dog had been previously trained to detect illegal drugs, dangerous goods or cancer.

At Helsinki-Vantaa International Airport, dogs sniffed skin swabs from 303 incoming passengers also tested for COVID-19 by polymerase chain reaction (PCR) from September 2020 to April 2021.

Accuracy greater than 90%

Compared to PCR, dogs had an estimated accuracy in detecting SARS-CoV-2 of 92% (95% confidence interval [CI], 90% to 93%), a sensitivity of 92% (95% CI, 89% to 94%) and a specificity of 91% (95% CI, 89% to 93%). They were much less accurate in detecting infections caused by the Alpha variant (89% for wild-type virus versus 36% for Alpha; odds ratio [OR]14.0 [95% CI, 4.5 to 43.4]).

But this latest finding also illustrates how well dogs can distinguish between different smells, the team said. “This observation is remarkable because it proves the powerful discriminatory power of scent dogs,” they wrote.

“The obvious implication is that training samples should cover all epidemiologically relevant variants. Our preliminary observations suggest that dogs primed with one type of virus can within hours be retrained to detect its variants.”

Dogs correctly identified 296 of 300 samples (99%) identified as negative by PCR but incorrectly identified four positives as negative. Twenty-eight samples were from people with asymptomatic cases; only one of them was missed and two were not sniffed, for an accuracy rate of 89%.

In the airport setting, dog identifications matched those from PCR in 98.7% of COVID-negative swabs. A low prevalence of SARS-CoV-2 at the airport (0.47%) did not allow for sensitivity analysis, but ad hoc analysis using protein spike samples from 155 people who tested positive by PCR did estimated a total accuracy of 98% (95% CI, 97% to 99%).

Role in screening many people

The researchers observed only small variations in the dogs’ abilities, with the best performers reaching 93% for sensitivity and 95% for specificity, and the worst performing at 88% and 90%, respectively.

Based on these results, the team calculated the proportion of true positive and true negative results in two hypothetical scenarios reflecting the COVID-19 population prevalence of 40% and 1%.

In the 40% prevalence scenario, the true positive rate was estimated at 88%, with a true negative rate of 94.5%, indicating that the information provided by the dog increased the chance of detection to approximately 90%. . But for a prevalence of 1%, the true positive rate was estimated at just under 10%, while the true negative rate was nearly 100%.

Researchers said scent dogs could allow for more efficient screening of large numbers of people for SARS-CoV-2 in busy environments such as hospitals or ports, as well as detection of other pathogens during future pandemics.

Dogs can detect odors as low as one part per trillion, far beyond any available technology. Although the exact mechanisms of this ability are unknown, the researchers said dogs would detect volatile organic compounds released during different metabolic processes, including bacterial, viral and parasitic infections.

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Trial of a preferential phosphodiesterase 4B inhibitor for idiopathic pulmonary fibrosis https://atrx.net/trial-of-a-preferential-phosphodiesterase-4b-inhibitor-for-idiopathic-pulmonary-fibrosis/ Sun, 15 May 2022 16:32:32 +0000 https://atrx.net/trial-of-a-preferential-phosphodiesterase-4b-inhibitor-for-idiopathic-pulmonary-fibrosis/ Abstract Background Phosphodiesterase 4 (PDE4) inhibition is associated with anti-inflammatory and antifibrotic effects that may be beneficial in patients with idiopathic pulmonary fibrosis. Methods In this phase 2, double-blind, placebo-controlled trial, we investigated the efficacy and safety of BI 1015550, an oral preferential inhibitor of the PDE4B subtype, in patients with idiopathic pulmonary fibrosis. Patients […]]]>

Abstract

Background

Phosphodiesterase 4 (PDE4) inhibition is associated with anti-inflammatory and antifibrotic effects that may be beneficial in patients with idiopathic pulmonary fibrosis.

Methods

In this phase 2, double-blind, placebo-controlled trial, we investigated the efficacy and safety of BI 1015550, an oral preferential inhibitor of the PDE4B subtype, in patients with idiopathic pulmonary fibrosis. Patients were randomized in a 2:1 ratio to receive BI 1015550 at a dose of 18 mg twice daily or placebo. The primary endpoint was the change from baseline in forced vital capacity (FVC) at 12 weeks, which we analyzed separately with a Bayesian approach as a function of agent use or non-use. antifibrotic.

Results

A total of 147 patients were randomized to receive BI 1015550 or placebo. Among patients without background antifibrotic therapy, the median change in FVC was 5.7 ml (95% credibility interval, –39.1 to 50.5) in the BI 1015550 group and –81.7 ml (95% credibility interval, –133.5 to –44.8) in the BI 1015550 group. placebo group (median difference, 88.4 ml; 95% credibility interval, 29.5 to 154.2; probability that BI 1015550 is superior to placebo, 0.998). Among patients with background antifibrotic use, the median change in FVC was 2.7 ml (95% credibility interval, -32.8 to 38.2) in the BI 1015550 group and -59.2 ml (95% credibility interval, -111.8 to -17.9) in the placebo group (median difference, 62.4 ml; 95% credibility interval, 6.3 to 125.5; probability that BI 1015550 is superior to placebo, 0.986). A mixed model with repeated measures analysis provided results consistent with those of the Bayesian analysis. The most common adverse event was diarrhea. A total of 13 patients discontinued treatment with BI 1015550 due to adverse events. The percentages of patients with serious adverse events or serious adverse events were similar in the two trial groups.

conclusion

In this placebo-controlled trial, treatment with BI 1015550, alone or with background use of an antifibrotic agent, prevented a decrease in lung function in patients with idiopathic pulmonary fibrosis. (Funded by Boehringer Ingelheim; number 1305-0013 ClinicalTrials.gov, NCT04419506.)

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Tactical analysis: how the San Diego Wave beat Gotham FC (4-0) https://atrx.net/tactical-analysis-how-the-san-diego-wave-beat-gotham-fc-4-0/ Fri, 13 May 2022 23:36:51 +0000 https://atrx.net/tactical-analysis-how-the-san-diego-wave-beat-gotham-fc-4-0/ The San Diego Wave FC followed up their victory against the Houston Dash beating Gotham FC at home. The team crushed Gotham 4-0 in front of a crowd of 5,000 and broke several records in the process. It was a truly memorable performance from the team and the perfect way to christen their homecoming. Here’s […]]]>

The San Diego Wave FC followed up their victory against the Houston Dash beating Gotham FC at home. The team crushed Gotham 4-0 in front of a crowd of 5,000 and broke several records in the process. It was a truly memorable performance from the team and the perfect way to christen their homecoming.

Here’s a breakdown of how the wave was able to win this game.

Training

San Diego lined up in a 4-2-3-1 and maintained that form for most of the game. Even with the substitutions of players like Kaleigh Riehl and Kelsey Turnbow in the game, they haven’t lost their form. Gotham, on the other hand, started in a 4-3-3 formation but eventually changed to 4-2-3-1 around the 61st minute. This may have been done to mirror the shape of the wave and cancel them out.

This maneuver, however, did not work for the East Coast side as they ended up conceding three goals in the second half.

San Diego: Sheridan; McGrady, Girma, Dahlkemper, Westphal; McNabb, VanEgmond; Morgan, Kornieck, Jakobsson; taylor

FC Gotham: Harris; Dorsey, Johnson, Krieger, Dydasco; Mewis, Zerboni, Kawasumi; Monaghan, Onumonu, Purce

wyscout

The game

The match started with Gotham kicking off in the center half of the pitch. They would also have the first chance of the game as Midge Purce had a shot on target in the first minute of the game. His shot went over the bar.

After conceding a corner to their guests in the second minute, San Diego would eventually turn things around and get their first chance of the game two minutes later. Jodie Taylor directed a shot on goal but it was cleared off the line by Kristie Mewis. Despite this failed attempt, San Diego would gradually take over.

One of the ways they did that was to pressure Gotham in midfield. The wave used high pressure and used a keen sense of positional awareness to intercept his opponent’s passes. They would then move the ball quickly uphill to begin an attacking sequence.

Although Gotham also tried to employ high pressure and move the ball faster, San Diego remained calm and dictated the tempo. They would avoid their opponent’s attempts to press them by moving the ball from side to side. The wave would also go around the middle sending long balls over its attackers.


NWSL

During the few times Gotham was able to get the ball back and launch a counterattack, the wave defense was smothering those attacks. In particular, goalkeeper Kailen Sheridan was one of the heroines of the match, as she made four crucial saves. Sheridan played a pivotal role in the surge by keeping back-to-back clean sheets in their first two games.


Sheridan’s Stop
NWSL

San Diego’s defense would continue to hold up, despite the loss of its captain, Abby Dahlkemper, to injury. Kaleigh Riehl took over as defender in the 35th minute. What helped the wave in its ability to maintain defensive stability was how Gotham’s formation unwittingly benefited the team. Due to the absence of key players like Allie Long (who is on maternity leave) and the non-replacement of Carli Lloyd after her retirement, the New Jersey team had to find some solutions to these problems. One of the ways they did this was to employ Mewis as a false nine and drop her deep into midfield.

However, each time she did, Gotham would lose her form as she moved forward. The wave also nullified Zerboni by forcing her into awkward places on the pitch which would prevent her from making passes. This would allow the team to collect the ball and then throw it forward. San Diego kept Gotham stuck in their back half and didn’t allow them to turn around and get out of the zone.

San Diego also neutralized Mewis and Nahomi Kawasumi in the middle and did not allow them to settle on the ball. This would prevent the duo from creating many scoring chances for their side. While the wave managed to use its press to cancel its guests, Gotham’s big Achilles heel was its lack of communication. Whether it was a lack of clarity on which defender would clear the ball and being disorganized at the back, or Midge Purce and Ifeoma Onumonu not being on the same page for Gotham’s best chance half-time, the lack of communication would prove costly for them. .


Gotham’s Bad Clearance
NWSL

Around the 12th minute of the game, you can hear Gotham coach Scott Parkinson telling his team to “get organized”. Parkison had good reason for this, as the lack of defensive organization at the back would allow San Diego to outrun their guests at a 31-8 ratio, with 17 of those shots coming inside the box. 14 of these 31 shots were taken by Alex Morgan.

One of the ways San Diego was able to achieve this was by overloading the box. The wave would overload his opponent’s 18-yard zone with numbers and crosses in the zone. These twin maneuvers would overwhelm their opponents and allow the wave to take 17 shots in one half.

Wave sending crosses

Despite all their scoring chances, the wave couldn’t find a breakthrough. Their frustration was further compounded when Caprice Dydasco blocked Taylor Kornieck’s shot in the 36th minute. However, it wouldn’t take long for them to end up on the scoresheet.

As the half drew to a close, Onumonu conceded a penalty by handling the ball in front of goal. Alex Morgan would then step in to take the kick, which she then scored. The first half would end and San Diego would enter the locker room with a 1-0 lead.

After halftime, the wave would pick up where it left off. The main difference between the two halves was the introduction of the team’s “game changers” in the second half. Kelsey Turnbow and Amirah Ali were both substituted in the game in the 64th minute, replacing Taylor and Jakobsson. Substituting Ali would prove crucial as, shortly after being sent off, the creative striker would win a penalty after being fouled by Zerboni inside the box. Once again, it was Morgan who stepped up and transformed it (66th).

Turnbow would ultimately be the team’s most advanced player as she took Taylor’s place in the roster. Kornieck would then occupy the space behind her to provide defensive cover. Eventually, Katie Johnson was substituted in the game in the 81st minute, and she would take Kornieck’s place as the player behind the lone striker. Alex Morgan then moved into a more central role and became the pivot of their attack.

Instate

The formation change would suit Morgan particularly well, as the striker would score two more goals before the end of the game. After forcing Zerboni into a turnover, Morgan would get his hat-trick in the 70th minute. She then continued by scoring a fourth goal in added time (90’+1′).

Shortly after, the ref would blow his whistle full time and San Diego would emerge victorious from this contest. They would also be history makers as they broke several records along the way. San Diego would be the first expansion team to win back-to-back games and keep two clean sheets. Alex Morgan would also be the first player to score a hat-trick for an expansion team in his debut season and only the third player to NWSL history of scoring four goals in a single match.

It was truly a monumental evening for them and a night they will never forget.

Statistics

Unsurprisingly, the wave dominated possession. They had the ball 56% of the time and even had it up to 60% of the time in the first half. Dominating wave possession not only allowed them to create their own chances, but also kept Gotham from developing their offense. And it worked effectively.

wyscout

San Diego also hit more crosses into the box than their opponents. According to Wyscout, the wave had 31 crosses of which 13 connected with their targets. Tegan McGrady was the most successful and accurate cruiser in the wave, as she had six the entire game.

wyscout

Now compare the number of crosses in San Diego to the number of crosses in Gotham. You will see that there is a clear difference between the two teams, as the wave defense has limited their opponent’s ability to move the ball. This included inhibiting their ability to send passes into the box.

wyscout

Passing cards for both teams showed how effective the wave was at moving the ball. This chart from Wyscout shows how San Diego was able to utilize more of the width of the field with their passing combinations. Complex pass combinations between players are the reason the wave was able to create so many scoring opportunities.

wyscout

Gotham, on the other hand, had much shorter passing combinations. This is mainly due to the wave cutting off its overtaking channels and causing the team to make mistakes. With that in mind, it’s safe to say that San Diego executed their game plan pretty well, as they got the desired result.

wyscout

And there are other stats to consider — like San Diego breaking the record for most shots in a single game (31). Alex Morgan also holds the record for most shots taken in a single game (14). She is also the current league Golden Boot leader with four goals, all scored in a single match. San Diego also leads the league in goals, as they now have five overall.

All in all, it was a truly remarkable performance from the team and a glimpse of what the team is truly capable of. This team has a high ceiling and it will be absolutely exciting to see them reach their potential.

Following

The Wave will play the Chicago Red Stars at home. The game will take place this Sunday and kick-off time will be at 2:00 p.m. PDT. You will be able to watch the match on Twitch (international viewers only) and on Paramount+ domestically.

So what do you think? Leave a comment below.

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Fossils reveal tropically warm North America 95 million years ago https://atrx.net/fossils-reveal-tropically-warm-north-america-95-million-years-ago/ Tue, 10 May 2022 13:14:00 +0000 https://atrx.net/fossils-reveal-tropically-warm-north-america-95-million-years-ago/ Cretaceous oysters of the genus Pycnodont studied in the new study. These specimens were collected from San Miguel County, Colorado (top left), Kane County, Utah (top right), Big Horn County, Wyoming (bottom left), and Natrona, Wyoming (lower right), with a penny for scale. Image credit: Matt Jones A new study from the University of Michigan […]]]>

Cretaceous oysters of the genus Pycnodont studied in the new study. These specimens were collected from San Miguel County, Colorado (top left), Kane County, Utah (top right), Big Horn County, Wyoming (bottom left), and Natrona, Wyoming (lower right), with a penny for scale. Image credit: Matt Jones

A new study from the University of Michigan that used fossil oyster shells as paleothermometers has found that the shallow sea that covered much of western North America 95 million years ago was as warm as the tropics today.

The study provides the first direct data on the temperature of this vast mid-latitude sea at the height of the Cretaceous Thermal Maximum, one of the warmest climatic intervals on the planet over the past hundreds of millions of years.

The findings, published online May 9 in the journal Geology, also hint at what could be in store for future generations unless emissions of heat-trapping greenhouse gases are brought under control.

“These data indicate that the interior of North America during the peak of the Cretaceous greenhouse was as warm as the hottest conditions in the modern tropics – imagine the climate of Bali, Indonesia, in places like the Utah or Wyoming,” the study’s lead author said. Matt Jones, former postdoctoral researcher at the University of Michigan, currently at the National Museum of Natural History at the Smithsonian Institution.

The study found that average water temperatures in the Western Interior Seaway during the mid-Cretaceous ranged from 28 to 34 degrees Celsius (82 F to 93 F), as warm as modern tropical extremes like the Indo-Pacific hot pool, which consistently exhibits the highest water temperatures over the largest expanse of the Earth’s surface.

Atmospheric concentrations of carbon dioxide during the mid-Cretaceous are still debated among researchers, but numerous studies have shown levels above 1,000 parts per million. Current levels are just over 420ppm but could exceed 1,000 by the end of this century unless fossil fuel emissions are reduced, climate scientists say.

“These new findings help resolve temperatures in North America during a maximum greenhouse heat interval in the geological past, which in turn may help us better predict how hot the Earth might be in the past. future under higher atmospheric CO2 conditions,” said UM geochemist and study co-author Sierra Petersen, assistant professor in the Department of Earth and Environmental Sciences.

To determine how hot North America was during the global greenhouse peak of the Cretaceous 95 million years ago, researchers analyzed 29 well-preserved oyster shells from a fossil collection from the US Geological Survey.

The fossils came from sandstone and shale outcrops in Wyoming, Colorado, Utah, New Mexico and Arizona, places that were at a latitude similar to today’s, but were underwater during the Cretaceous. At that time, the Western Interior Seaway stretched from the Gulf of Mexico to the Arctic and from present-day Utah to Iowa.

Fossils collected across the western interior of the United States show that the seaway was teeming with marine life, including massive clams, spiral-shelled ammonites, and extinct types of oysters. Dinosaurs roamed the adjacent coastal plains.


Sectional view of the cut and polished surface of a Cretaceous oyster (Exogyra trigeri) from the Mancos Shale Formation in McKinley County, New Mexico, with a penny for scale.  Image credit: Jon Hoffman

Sectional view of the cut and polished surface of a Cretaceous oyster (Exogyra trigeri) from the Mancos Shale Formation in McKinley County, New Mexico, with a penny for scale. Image credit: Jon Hoffman

For the current study, the researchers used fossil oyster shells collected over several decades by Bill Cobban, one of the most prominent American paleontologists of the 20th century, and his colleagues. As oysters grew, their shells incorporated various forms, or isotopes, of the elements oxygen and carbon, in proportions that reveal the temperature of the surrounding seawater.

With a small Dremel drill, Jones sampled the fossil shells and collected the powdered calcite. Using a state-of-the-art mass spectrometer in Petersen’s UM lab, the researchers measured the isotope ratios of carbon and oxygen. Specifically, they looked at the presence of the heavy carbon isotope carbon-13 and the heavy oxygen isotope oxygen-18, and how often they were found bound together in the crystal structure of calcite.


The map shows the coastline of the Western Interior Seaway of North America 94 million years ago.  Dots indicate sites where fossil specimens of oyster shells have been collected.  Samples of these shells were analyzed at the University of Michigan using a technique called clustered isotope paleothermometry.  Illustration credit: Matt Jones

The map shows the coastline of the Western Interior Seaway of North America 94 million years ago. Dots indicate sites where fossil specimens of oyster shells have been collected. Samples of these shells were analyzed at the University of Michigan using a technique called clustered isotope paleothermometry. Illustration credit: Matt Jones

This binding frequency of the two heavy isotopes, called isotopic aggregation, is very sensitive to ambient temperature during the formation of a mineral, allowing scientists to reconstruct past temperatures using a recently developed technique called clumped isotope paleothermometry.

“Many generations of geologists have studied the paleontology and stratigraphy of the Western Interior Seaway, providing different insights into past climate and a knowledge base that made this study possible,” Jones said. “However, no direct paleothermometer measurements existed – until now – from the interior of North America for the peak of this Cretaceous greenhouse world.

“This lack of records has hindered a solid understanding of the temperature evolution of North America through the Cretaceous and the influence of temperature on the continent’s marine biota in the Seaway, as well as on terrestrial fauna such as the dinosaurs that inhabit the adjacent coastal plains.”

According to the authors, the North American data from the new study is consistent with previous studies that used traditional oxygen isotope paleothermometry techniques at deep sea sites around the world. These earlier studies, which measured the ratio of stable oxygen isotopes, inferred sea surface temperatures in the subantarctic 20 s C (lower 80 F) to the mid 30 s C (upper 90 s F) of the tropics and south. middle latitudes.

In addition to specific findings quantifying past global heat in the Western Interior Seaway, the new study also demonstrates how this particular geochemical technique can be used to reveal climatic conditions in the distant past, where earlier techniques have had some success. evil.

“Even after working with the clumped isotope paleothermometer for 15 years, I still find it amazing that, given the right samples, we could basically dip a thermometer into a 95 million year old ocean and figure out how bad it was. warm.” said Peterson. “If we want to be able to better predict how different life on Earth might respond to future warming, concrete estimates of temperature during past warm periods can help us set upper limits on survivability.”

The other author of the geology article is UM graduate student Allison Curley. The work was funded by the National Science Foundation, the University of Michigan, and the National Museum of Natural History’s Peter Buck Fellowship.

/Public release. This material from the original organization/authors may be ad hoc in nature, edited for clarity, style and length. The views and opinions expressed are those of the author or authors.View Full here.

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Less frequent post-EVAR monitoring may be safe in some patient groups https://atrx.net/less-frequent-post-evar-monitoring-may-be-safe-in-some-patient-groups/ Sun, 08 May 2022 09:33:25 +0000 https://atrx.net/less-frequent-post-evar-monitoring-may-be-safe-in-some-patient-groups/ Anna CM Geraedts The results of the retrospective multicentre ODYSSEUS study conducted in the Netherlands suggest that less frequent monitoring after endovascular aneurysm repair (EVAR) may be warranted. However, authors Anna CM Geraedts (University Medical Centers Amsterdam, Amsterdam, The Netherlands) and colleagues point out that future studies are needed to determine the patient groups in […]]]>
Anna CM Geraedts

The results of the retrospective multicentre ODYSSEUS study conducted in the Netherlands suggest that less frequent monitoring after endovascular aneurysm repair (EVAR) may be warranted. However, authors Anna CM Geraedts (University Medical Centers Amsterdam, Amsterdam, The Netherlands) and colleagues point out that future studies are needed to determine the patient groups in which this would be safe.

The study, recently published in the European Journal of Vascular and Endovascular Surgery (EJVES), highlighted the fact that discontinuation of post-EVAR imaging surveillance is common in the Netherlands. It also shows that discontinuing annual follow-up in patients with initial postoperative computed tomography (CTA) angiography without abnormalities is not associated with poor outcomes.

“EVAR has become the predominant modality for the treatment of infrarenal abdominal aortic aneurysms (AAAs) in the Netherlands,” the authors write, adding that lifelong monitoring is recommended after the procedure. However, they also note that there are concerns about the long-term durability of EVAR, lifelong follow-up routines, and adherence to monitoring programs. This study therefore aimed to examine the association between adherence to postoperative monitoring and survival and secondary interventions in patients with an initial postoperative CTA without abnormalities.

Between 2007 and 2012, all consecutive patients undergoing EVAR for intact AAA at 16 hospitals were retrospectively identified, the authors write, noting that the patients were followed through December 2018.

Geraedts et al specify that patients were included if the initial postoperative CTA showed no type I-III endoleak, kink, infection or limb occlusion. The primary outcomes were aneurysm-related mortality and secondary interventions, and the secondary outcome was all-cause mortality.

Of the 1,596 patients included in the study, the authors report that the cumulative aneurysm-related, overall, intervention-free survival was 99.4/94.8/96.1%, 98.5/72.9 /85.9% and 96.3/45.4/71.1% at one, five and ten years respectively. They note that the American Society of Anesthesiologists (ASA) classification (ASA IV risk ratio [HR], 3.810; 95% confidence interval [CI], 1.296-11.198), increase in AAA diameter (HR, 3.299; 95% CI, 1.408-7.729) and continued follow-up (HR, 3.611; 95% CI, 1.780-7.323) were independently associated with aneurysm-related mortality. The same variables and age (HR, 1.063 per year; 95% CI, 1.052-1.074) were significantly associated with all-cause mortality, the authors add.

In terms of secondary interventions, Geraedts and colleagues report that no difference was observed between patients with continuous and interrupted follow-up (89/552; 15% versus 136/1044; 13%; p=0.091) .

write in EJVES, the authors acknowledge various limitations of their study, including its retrospective observational study design. This carries a risk of information bias, they state, noting for example that “it was unclear if patients were lost to follow-up, if imaging studies were discontinued after uncomplicated monitoring or if of patients had been monitored by imaging elsewhere”.

Additionally, they acknowledge that including patients only up to 2012 limits the ability to draw conclusions from newer devices, there were no clear protocols as to when a patient might be discharged. further follow-up, information on the cause of death was missing. , as well as the fact that the reasons why the patients were no longer under surveillance were not noted.

Despite these limitations, Geraedts et al also point to some notable research strengths, such as the use of population-based data with long-term follow-up and the accuracy of death verification through the National Death Registry. Additionally, they note that the survey includes all imaging studies performed as a result of EVAR, and thus “provides a comprehensive overview of national practice and adherence to ESVS.” [European Society for Vascular Surgery] guidelines”.

Geraedts and colleagues conclude that “discontinuation of follow-up is not associated with poor outcomes”, however noting that “future prospective studies are indicated to determine in which patient groups follow-up can be safely reduced”.

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Knotless barbed wire versus conventional suture for closing the uterine incision during cesarean section: a systematic review and meta-analysis https://atrx.net/knotless-barbed-wire-versus-conventional-suture-for-closing-the-uterine-incision-during-cesarean-section-a-systematic-review-and-meta-analysis/ Sat, 07 May 2022 00:39:24 +0000 https://atrx.net/knotless-barbed-wire-versus-conventional-suture-for-closing-the-uterine-incision-during-cesarean-section-a-systematic-review-and-meta-analysis/ Goal To compare perioperative outcomes between knotless barbed sutures (KBS) and conventional smooth sutures for closure of the uterine incision during caesarean section (CS). The data source MEDLINE, EMBASE, Web of Sciences, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from inception through March 2021 with no language restrictions. The search terms were: [“Stratafix” OR […]]]>

Goal

To compare perioperative outcomes between knotless barbed sutures (KBS) and conventional smooth sutures for closure of the uterine incision during caesarean section (CS).

The data source

MEDLINE, EMBASE, Web of Sciences, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from inception through March 2021 with no language restrictions. The search terms were: [“Stratafix” OR “Quill” OR “V-Loc” OR “Barbs” OR “barbed”]
AND [“Cesarean” OR “Caesarean”] AND [“Suturing” OR “Suture” OR “Closure” OR “Repair”]. These terms were then combined to complete the search.

Study selection methods

Retrospective, randomized, peer-reviewed studies comparing the use of KBS and conventional sutures for uterine incision closure at CS were included. The quality of the studies was assessed by the Cochrane Risk of Bias tool. The primary endpoint was time to uterine incision closure in seconds. Secondary outcomes included total operative time (minutes), use of additional haemostatic sutures, blood transfusion rates, and postoperative complications.

Tabulation, integration and results

Of 20 identified reports, four representing 3332 women (1473 and 1859 with KBS and conventional sutures, respectively) were eligible. All were judged to be at low risk of bias. The time to close the uterine incision was significantly lower in the KBS group (p=0.001; mean difference -110.58; 95% CI: -127.37, -93.79). Similarly, the rate of use of additional haemostatic sutures was significantly lower in the KBS group (p=0.001; OR 0.14; 95% CI: 0.07, 0.26). Total operative time, blood transfusion rates, febrile morbidity and postoperative length of stay were comparable. The incidence of postoperative ileus was significantly lower in the KBS group (p=0.029; OR 0.31; 95% CI: 0.11, 0.89).

Conclusion

The use of KBS for uterine incision closure was associated with a decrease in hysterotomy closure time and a less frequent need for additional haemostatic sutures. Other perioperative outcomes were unaffected, although the risk of postoperative ileus was reduced.

Registration

This study is registered with PROSPERO, CRD42021219750.

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Protection by a fourth dose of BNT162b2 against Omicron in Israel https://atrx.net/protection-by-a-fourth-dose-of-bnt162b2-against-omicron-in-israel/ Thu, 05 May 2022 01:07:13 +0000 https://atrx.net/protection-by-a-fourth-dose-of-bnt162b2-against-omicron-in-israel/ Study population For this analysis, we included people who, as of January 1, 2022, were 60 years of age or older and had received three doses of BNT162b2 at least 4 months before the end of the study period (March 2). We excluded the following people from the analysis: those who died before the start […]]]>

Study population

For this analysis, we included people who, as of January 1, 2022, were 60 years of age or older and had received three doses of BNT162b2 at least 4 months before the end of the study period (March 2). We excluded the following people from the analysis: those who died before the start of the study period (January 10); those for whom no information regarding their age or gender was available; those who had a confirmed SARS-CoV-2 infection before the start of the study, determined using a polymerase chain reaction (PCR) test or a rapid l-regulated antigen test ‘state ; those who had received a third dose before its approval for all elderly residents (i.e. before July 30, 2021); those who had been abroad for the entire study period (January 10 to March 2; individuals were considered to be abroad 10 days before traveling until 10 days after returning to Israel); and those who had received a dose of vaccine of a type other than BNT162b2.

For individuals who met the inclusion criteria, we extracted information on March 4, 2022 regarding SARS-CoV-2 infection (confirmed either by state-regulated rapid antigen test or PCR) and severe Covid-19 (defined with use of the National Institutes of Health Definition2 such as a resting respiratory rate > 30 breaths per minute, oxygen saturation < 94% when breathing room air, or a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen < 300) during 14 days following confirmation of infection. During the study period, infections were overwhelmingly dominated by the omicron variant.3 We also extracted data regarding vaccination (dates and brands of first, second, third, and fourth doses) and demographic variables such as age, gender, and demographic group (generally Jewish, Arab, or ultra-Orthodox Jew) , as determined by the person’s statistical area of ​​residence (similar to a census block4).

study design

The study period began on January 10, 2022 and ended on March 2, 2022 for confirmed infection and ended on February 18, 2022 for severe illness. The start date was set at 7 days after the start of the vaccination campaign (January 3, 2022) so that at least the first group of four doses (days 8 to 14 after vaccination) would be represented throughout the campaign. study period (Fig. S1 in the Supplementary Appendix, available with the full text of this article on NEJM.org). End dates were chosen to minimize the effects of missing data on outcomes due to delays in reporting PCR or antigen test results and to allow time for the development of severe disease.

The study design was similar to that of a previous study in which we assessed the protection conferred by the third dose of vaccine compared to the second dose.5 We calculated the total number of person-days at risk and the incidence of confirmed infections and severe cases of Covid-19 during the defined study period for each outcome. For people who received the fourth dose, the treatment groups were defined according to the number of weeks that had passed since receiving that dose, starting from the second week (8 to 14 days after vaccination). These four-dose groups were compared to two control groups. The first control group included people who were eligible for a fourth dose but had not yet received it (three-dose group). Because people who received the fourth dose might differ from those who did not on unmeasured confounding variables, a second control group was defined as people who received a fourth dose 3 to 7 days earlier. (internal control group). This control group included the same people as the four-dose groups, but for a period in which the fourth dose was not expected to affect the rate of confirmed infection or severe disease. Membership in these groups was dynamic, and participants contributed risk days to different study groups on different calendar days, depending on their vaccination status.

Surveillance

The study was approved by the Sheba Medical Center Institutional Review Board. All authors contributed to the conceptualization of the study, critically reviewed the results, approved the final version of the manuscript, and made the decision to submit the manuscript for publication. The authors guarantee the accuracy and completeness of the data contained in this report. The Israeli Ministry of Health and Pfizer have a data sharing agreement, but only the final results of this study have been shared.

Statistical analyzes

Using quasi-Poisson regression, we estimated rates of confirmed infection and severe Covid-19 per 100,000 person-days for each study group (included as factors in the model), with adjustment for demographic variables following: age group (60-69, 70-79, or ≥ 80), gender, and demographic group (generally Jewish, Arab, or ultra-Orthodox Jew). Because the incidence of confirmed infections and serious illness increased rapidly in January 2022, the risk of exposure at the start of the study period was lower than at the end of the study period. Moreover, the fraction of the population in each study group changed throughout the study period (Fig. S1). Therefore, we included calendar date as an additional covariate to account for changes in exposure risk.6 The end of the study period for severe Covid-19 was set at 14 days before the data retrieval date (March 4), allowing at least 14 days of follow-up time for the development of severe disease. To ensure the same follow-up time for severe Covid-19 in all people, we only considered cases of severe illness that developed within 14 days of confirmation of infection. The date used to count severe Covid-19 events was defined as the date of the test confirming infection which then led to severe illness.

People who received four doses were divided into groups based on the number of weeks since receiving the fourth dose; for each outcome, we estimated the incidence rate in each of these four dose groups and in the two control groups. We calculated two rate ratios for each treatment group and each outcome: first, the ratio of the rate in the three-dose group to that in each four-dose group; and second, the ratio of the rate in the internal control group to that in each four-dose group. It should be noted that the higher this rate ratio, the greater the protection conferred by the fourth dose of vaccine. Additionally, the adjusted rate differences per 100,000 person-days over the study period were estimated with a method similar to that used in our previous analysis.7 Confidence intervals were calculated by exposing the 95% confidence intervals for the regression coefficients, without adjusting for multiplicity. Thus, confidence intervals should not be used to infer differences between study groups.

To check for possible biases, we performed several sensitivity analyses. First, we estimated the confirmed infection rate ratios using an alternative matching-based statistical method (similar to that used by Dagan et al.8), as detailed in the Supplementary Appendix; this approach could not be applied to the analysis of severe Covid-19 cases due to the small number of cases. Second, we examined the results of using data on infections confirmed only by PCR testing and excluding data on those confirmed by state-regulated antigen testing. Third, we repeated the analyzes with data from the general Jewish population only. Fourth, we analyzed the data taking into account the risk of exposure over time in each person’s area of ​​residence. Fifth, we analyzed the data taking into account the time of vaccination since the third dose. Further details on the sensitivity analyzes are provided in the supplementary appendix.

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Study reports overdiagnosis of melanoma in white patients https://atrx.net/study-reports-overdiagnosis-of-melanoma-in-white-patients/ Sun, 01 May 2022 05:55:19 +0000 https://atrx.net/study-reports-overdiagnosis-of-melanoma-in-white-patients/ The results of studies recently published in JAMA Dermatology found that approximately 60% of melanomas in white men and women were overdiagnosed.1These findings have implications in areas ranging from screening strategies to patient counseling and genetic research, according to the study’s lead author. 59% of white women and 60% of white men are overdiagnosed “Overdiagnosis […]]]>

The results of studies recently published in JAMA Dermatology found that approximately 60% of melanomas in white men and women were overdiagnosed.1These findings have implications in areas ranging from screening strategies to patient counseling and genetic research, according to the study’s lead author.

59% of white women and 60% of white men are overdiagnosed

“Overdiagnosis is a problem,” said Adewole Adamson, MD, MPP, “and we need more research to try to determine the extent of the problem and what we should do if anything about it.” He is an assistant professor in the Division of Dermatology, Department of Internal Medicine, at the University of Texas, Austin’s Dell Medical School in Austin, Texas.

Since the 1970s, increased public awareness and screenings for skin cancer have delivered a double-edged sword of increasing melanoma diagnoses that have had no apparent effect on death rates.2 “When we screen for cancers,” Adamson said, “we end up finding a lot of things that we call cancer that, if we hadn’t been looking, wouldn’t have harmed the patient at all.” Diagnosing people with cancers that would never have harmed them has implications for future surveillance efforts and healthcare system costs, he added, not to mention patients’ physical, mental and financial health. .3.4

“But it’s also possible that by screening people for cancer you could improve mortality. Therefore, harm from overdiagnosis might be (acceptable) if some people benefit from having their cancer caught early and avoiding death or further morbidity,” Adamson said. “You have to balance those 2 things when thinking about diagnosing melanoma, especially in relation to melanoma screening.”

Melanoma incidence up about 4-fold and 6-fold in Caucasian men and women

To approximate true cancer trends among white Americans, investigators compared Surveillance, Epidemiology, and Endline Outcomes (SEER) incidence and mortality data from 1975 to 2014 for these patients to those of black patients on the same interval. Compared to 1975, the 2014 incidence rate ratios (IRRs) for white males and females were 4.01 and 5.97, respectively, while the IRRs for black females (1.21) and men (1.17) remained relatively stable.1 Investigators only analyzed data up to 2014, because after that targeted therapy and immunotherapy began to reduce melanoma death rates, making estimates less reliable.

In a previous article, Adamson and colleagues argue against routine, population-wide skin cancer screening, while acknowledging the reduced clinical and pathological thresholds and skewed financial incentives that help drive this strategy.2 Restricting screening to high-risk populations who are more likely to benefit could mitigate some of the harms of overdiagnosis, Adamson said. Dermatology Times®.

However, counseling low-risk patients can be tricky. “When I talk to patients who are at low risk for melanoma, I explain that there are potential harms and benefits to screening, and that’s something they should consider,” he said. . “But it’s also a difficult topic to bring up with patients because most people culturally think any screening is good.” Additionally, he noted that compared to breast and prostate exams, patients find the skin exam relatively easy and painless, “so why not do it?” »

In breast cancer and prostate cancer, validated decision aids can help patients make informed choices about screening. “There’s very little work in dermatology to try to do that,” Adamson said. “And that should be an active area of ​​investigation.”

Mortality rate (MRR) up 50% among white men

While white patients benefited from early detection efforts throughout the study period, the fact that black patients generally did not allow researchers to adjust white incidence and mortality rates to this which might have been expected if medical care had not been improved. While black men’s and women’s RMR decreased by about 25% (0.76 and 0.72, respectively) between 1975 and 2014, white women’s RMR remained stable (1.02). For white men, however, the MRR increased by almost 50% (1.49).

Besides the implications for public health, he added, the study has implications for the genetic exploration of early melanomas. Since many such melanomas can never hurt or kill anyone, he explained, it would be ideal to be able to identify genetic markers for these nonaggressive melanomas. When asked if that will happen soon, Adamson replied, “I don’t know for the next few years. But this should be an active area of ​​research – not only which tumors are certain to cause damage, but also what is the genetic signature of overdiagnosed melanoma? Adamson called for further study of this issue and its ripple effect on patients and the health care system.

Disclosure:

Adamson reports no relevant financial interests.

References:

1. Adamson AS, Suarez EA, Welch HG. Estimating Melanoma Overdiagnosis Using Trends in Black and White Patients in the United States. JAMA Dermatol. 2022;158(4):426-431. doi:10.1001/jamadermatol.2022.0139

2. Welch HG, Mazer BL, Adamson AS. The rapid increase in cutaneous melanoma diagnoses. N English J med. 2021;384(1):72-79. doi:10.1056/NEJMsb2019760

3. Shapiro CL. Cancer survival. N English J med. 2018;379(25):2438-2450. doi:10.1056/NEJMra1712502

4. Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or debt? National estimates of financial toxicity in people with newly diagnosed cancer. Am J Med. 2018;131(10):1187-1199.e5. doi:10.1016/j.amjmed.2018.05.020

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Dapagliflozin is well tolerated in patients with COVID-19, regardless of eGFR – Consumer Health News https://atrx.net/dapagliflozin-is-well-tolerated-in-patients-with-covid-19-regardless-of-egfr-consumer-health-news/ Fri, 29 Apr 2022 15:34:51 +0000 https://atrx.net/dapagliflozin-is-well-tolerated-in-patients-with-covid-19-regardless-of-egfr-consumer-health-news/ FRIDAY, April 29, 2022 (HealthDay News) — The effects of dapagliflozin are similar for hospitalized patients with COVID-19 with estimated glomerular filtration rate (eGFR)]]>

FRIDAY, April 29, 2022 (HealthDay News) — The effects of dapagliflozin are similar for hospitalized patients with COVID-19 with estimated glomerular filtration rate (eGFR) <60 and ≥60 mL/min per 1.73 m2according to a study published online April 28 in the Clinical Journal of the American Society of Nephrology.

Hiddo JL Heerspink, Ph.D., Pharm.D., of University Medical Center Groningen in the Netherlands, and colleagues conducted a secondary analysis of the Dapagliflozin in Respiratory Failure in Patients with COVID-19 (DARE-19 ), which 1,250 hospitalized patients with COVID-19 with cardiometabolic risk factors were randomly assigned to dapagliflozin or placebo. Dual primary outcomes (time to onset or worsening of organ dysfunction or death and a hierarchical composite endpoint of recovery) and secondary primary outcomes for kidney were been evaluated in individuals whose baseline eGFR was < 60 and ≥ 60 mL/min per 1.73 m2.

The researchers found that across all eGFR subgroups, the effect of dapagliflozin compared to placebo was consistent on the primary prevention outcome (hazard ratio, 0.80; 95% confidence interval, 0.58 to 1.10), primary recovery outcome (win ratio, 1.09; 95% confidence interval, 0.97 to 1.22), and composite kidney outcome (relative risk, 0 .74; 95% confidence interval, 0.50 to 1.07; P for interaction, 0.98, 0.67 and 0.44, respectively). The effects of dapagliflozin on acute kidney injury were also similar for people with an eGFR <60 mL/min per 1.73 m2 (relative risk, 0.71; 95% confidence interval, 0.29 to 1.77) and ≥ 60 mL/min per 1.73 m2 (relative risk, 0.69; 95% confidence interval, 0.37 to 1.29). In patients with an eGFR < 60 and ≥ 60 mL/min per 1.73 m2dapagliflozin was well tolerated.

“These new data from DARE-19 reinforce the safety of dapagliflozin in critically ill patients hospitalized with COVID-19, even in those with reduced kidney function who are at particularly high risk of acute kidney injury,” Heerspink said. in a press release.

Several authors disclosed financial ties to pharmaceutical companies, including AstraZeneca, which manufactures dapagliflozin and funded the study.

Summary/Full text

Editorial

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Yangarra Resource Stock: Still No Impairment Charges (OTCMKTS: YGRAF) https://atrx.net/yangarra-resource-stock-still-no-impairment-charges-otcmkts-ygraf/ Sun, 24 Apr 2022 12:06:00 +0000 https://atrx.net/yangarra-resource-stock-still-no-impairment-charges-otcmkts-ygraf/ pechkov/iStock via Getty Images Yangarra Resources (OTCPK:YGRAF) management had earlier announced that the reserves assumptions would change now that the company has enough history for the interval from which it produces oil and gas. The price is robust enough for the company to avoid an impairment charge. Most of the time, these types of adjustments […]]]>

pechkov/iStock via Getty Images

Yangarra Resources (OTCPK:YGRAF) management had earlier announced that the reserves assumptions would change now that the company has enough history for the interval from which it produces oil and gas. The price is robust enough for the company to avoid an impairment charge. Most of the time, these types of adjustments affect later years much more than the initial production. That’s why management needed time to get the history.

The latter years often represent a much smaller share of the total reserves and they are produced at a much lower production rate. When all of this is properly discounted as a future value, the change is probably not as big as some would have thought.

Yet this company manages to evade the accusations of depreciation that seem to regularly plague its competitors. This is a possible sign (but not the only one) of low costs. Taking an impairment charge generally undermines a low cost argument by management. This company is able to make that low cost argument for a long time into the future.

(Canadian dollars unless otherwise specified)

Yangarra Resource Assessment and Debt Measures

Yangarra Resources Key Valuation and Debt Metrics Overview (Yangarra Resources March 2022, corporate presentation)

The beautiful thing low-cost production is the ability to increase both free cash flow and production. The result of this capacity is the significant increase in debt illustrated above combined with a rapid rate of growth. This company will have much higher production levels to provide greater cash flow during the next downturn in the industry.

The share price has changed considerably since the date indicated above. But the enterprise value is not as affected because the debt has probably gone down a bit. The company still has a decent value relative to cash flow.

One of the debt reduction goals is to maintain a debt-to-equity ratio below 2.0 during the next recession. There is a perception that the debt ratio was too high during the last recession in 2020 (although the severity of another recession is unlikely to match that of 2020). As a result, much of the industry is moving towards lower debt levels. This company included.

A company the size of this can easily hedge to protect the cash flow forecast shown above if management feels this step is necessary. Right now, exposure to current prices looks like quite an upside. It is therefore unlikely that management is currently hedging more than it needs to.

The other notable topic on the slide above has to be evaluation. Despite skyrocketing prices today, valuation is absolutely ridiculously cheap for a company that is increasing both production and cash flow. It will take a lot more runups to come close to a reasonable valuation. If it were a technology company, the stock price would likely be over $100 per share with the characteristics shown above.

(Canadian dollars unless otherwise specified)

Yangarra Resource Netback

Yangarra Resources Company netback calculation and comparison (Yangarra Resources, Fourth Quarter 2021, Earnings Press Release)

One thing I’ve said many times to many readers is that profitable businesses enjoy huge increases in profits when selling prices rise. This company illustrates this point very well. It was one of the very few companies to report a profit in any form in fiscal 2020. The company also reported enough cash flow from operating activities to verify that the profit was real (and not aggressive but allowed accounting).

Now that cash flow becomes a flood of cash. Interestingly, net net income in fiscal year 2021 is very high for the oil and gas industry. The average business in general brings in about 5% of sales as net income. This company is so above that. One could easily confuse this margin with a pharmaceutical company. Given that oil and gas prices have increased since the end of the year, this margin could increase further for the current fiscal year.

The key to profitability lies in production costs that would be typical of a producer of dry gas (or at least much less liquids). Management has found a very low cost interval that produces liquids to make an extremely profitable mix. Some would not consider this Tier 1 acreage due to the relatively high amount of natural gas production. Yet this acreage has been profitable at very low natural gas prices, as this liquid production is sufficient for decent profitability.

(Canadian dollars unless otherwise specified)

Yangarra Resources Well Operating and Profit Characteristics

Yangarra Resources Well Operating and Profit Characteristics (Yangarra Resources March 2022, corporate presentation)

Investors should keep in mind that the well cost shown above is in Canadian dollars. If that same well were priced in US dollars, it would be about 20% cheaper. This obviously makes a very cheap well given the production curve shown above. The rate of decline is very different from what the market is used to seeing with unconventional wells.

This means that the relatively high production lasts more than a year. This is much longer than many unconventional wells. More money up front through higher production increases the rate of return in good times and bad. Clearly, this direction has found an interval gem to produce from.

The best part is that the rate of return could withstand some unfavorable news when management finally had enough history to adjust the reserve ratio and probably a lot of other things to match the actual experience of the company. Today, with rising commodity prices, the performance of drilled wells is still fantastic. This rate of return always implies good performance during the inevitable cyclical downturns.

The future

This profitable business needed to finish reaching a sufficient amount of production to weather the downturns in decent shape. This will clearly be the case for the next recession. Many companies that started drilling after acquiring leases (and exploring leases) were taken earlier in the transition.

Fortunately, much of the industry learned from the experience of 2015, so the severe downturn in 2020 didn’t do as much damage as expected.

Now, surviving businesses like this can grow at an accelerated rate in the current environment while reducing debt balances. The market is still obsessed with debt ratios in 2020 when oil prices “bottomed out”. It is unlikely to happen again. Again, a little financial conservatism doesn’t hurt in this industry.

Management has plenty of Canadian acreage to drill for at least a decade to come. So far, the company has developed an interval. There is much more on the acreage to explore in the future. This business probably won’t need more square footage for decades.

As I’ve said in the past, this leadership has built and sold businesses before. The level of management experience is therefore exceptional for a company of this size. Combined with low debt and highly profitable wells, the investment risk is much lower than it would be for a typical junior oil and gas company. The stock is extremely undervalued as shown by the relatively high cash flow to company value.

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