Patterns of antihypertensive prescribing, discontinuation and switching among a Hong Kong Chinese population from over one million prescriptions

Hypertension is an alarming public health problem among Chinese. The present study evaluated the prescribing patterns, discontinuation and switching profiles of antihypertensive agents and their associated factors in one Hong Kong Chinese population. Data were retrieved from computerized records for patients prescribed anti-hypertensive agents in government primary care clinics of Hong Kong from January, 2004 to June, 2007. A total of 1,069,836 antihypertensive drug visits, representing 67,028 patients, were analyzed. The most commonly prescribed drugs were Calcium Channel Blockers (CCBs) (49%), b-Blockers (BBs) (46%) and Angiotensin-Converting Enzyme Inhibitors (ACEIs) (19%). Thiazide diuretic prescribing was low (13%) and on the decline (14% in 2004 to 12% in 2007). Prescribing of ACEIs was rising (16% in 2004 to 23% in 2007). Patients’ age, gender, and socio-economic status were independent predictors of class of anti-hypertensive prescribed but explained less than 3.5% of the variation observed. Drug discontinuation was highest for BBs (21%) and lowest for CCBs (12%). The high rates of discontinuation in BBs remained apparent after controlling for confounding variables. Switching was less common than discontinuation and was most likely with thiazide diuretics. To summarize, prescribing of CCBs and BBs were high and that of thiazide diuretics particularly low in this Chinese population when compared with international trends. CCBs may be a particularly favorable antihypertensive treatment in Chinese, given the high discontinuation rates of BBs and international guidelines advising against the use of BBs as first-line therapy. The low use of thiazide diuretics warrants further clinical and cost effectiveness studies among Chinese

Elliptic Flow from a Transversally Thermalized Fireball

The agreement of elliptic flow data at RHIC at central rapidity with the hydrodynamic model has led to the conclusion of very rapid thermalization. This conclusion is based on the intuitive argument that hydrodynamics, which assumes instantaneous local thermalization, produces the largest possible elliptic flow values and that the data seem to saturate this limit. We here investigate the question whether incompletely thermalized viscous systems may actually produce more elliptic flow than ideal hydrodynamics. Motivated by the extremely fast primordial longitudinal expansion of the reaction zone, we investigate a toy model which exhibits thermalization only in the transverse directions but undergoes collisionless free-streaming expansion in the longitudinal direction. For collisions at RHIC energies, elliptic flow results from the model are compared with those from hydrodynamics. With the final particle yield and \kt-distribution fixed, the transversally thermalized model is shown not to be able to produce the measured amount of elliptic flow. This investigation provides further support for very rapid local kinetic equilibration at RHIC. It also yields interesting novel results for the elliptic flow of massless particles such as direct photons.Comment: revtex4, 15 pages + 10 embedded EPS figure

Relativistic Modification of the Gamow Factor

In processes involving Coulomb-type initial- and final-state interactions, the Gamow factor has been traditionally used to take into account these additional interactions. The Gamow factor needs to be modified when the magnitude of the effective coupling constant increases or when the velocity increases. For the production of a pair of particles under their mutual Coulomb-type interaction, we obtain the modification of the Gamow factor in terms of the overlap of the Feynman amplitude with the relativistic wave function of the two particles. As a first example, we study the modification of the Gamow factor for the production of two bosons. The modification is substantial when the coupling constant is large.Comment: 13 pages, in LaTe

Laboratory observation of a nonlinear interaction between shear Alfv\'{e}n waves

An experimental investigation of nonlinear interactions between shear Alfv\'{e}n waves in a laboratory plasma is presented. Two Alfv\'{e}n waves, generated by a resonant cavity, are observed to beat together, driving a low frequency nonlinear psuedo-mode at the beat frequency. The psuedo-mode then scatters the Alfv\'{e}n waves, generating a series of sidebands. The observed interaction is very strong, with the normalized amplitude of the driven psuedo-mode comparable to the normalized magnetic field amplitude ($\delta B/B$) of the interacting Alfv\'{e}n waves.Comment: 10 pages, 4 figures, submitted to Phys. Rev. Let

Telemonitoring after discharge from hospital with heart failure: cost-effectiveness modelling of alternative service designs.

Objectives To estimate the cost-effectiveness of remote monitoring strategies versus usual care for adults recently discharged after a heart failure (HF) exacerbation. Design Decision analysis modelling of cost-effectiveness using secondary data sources. Setting Acute hospitals in the UK. Patients Patients recently discharged (within 28 days) after a HF exacerbation. Interventions Structured telephone support (STS) via human to machine (STS HM) interface, (2) STS via human to human (STS HH) contact and (3) home telemonitoring (TM), compared with (4) usual care. Main outcome measures The incremental cost per quality-adjusted life year (QALY) gained by each strategy compared to the next most effective alternative and the probability of each strategy being cost-effective at varying willingness to pay per QALY gained. Results TM was the most cost-effective strategy in the scenario using these base case costs. Compared with usual care, TM had an estimated incremental cost effectiveness ratio (ICER) of £11 873/QALY, whereas STS HH had an ICER of £228 035/QALY against TM. STS HM was dominated by usual care. Threshold analysis suggested that the monthly cost of TM has to be higher than £390 to have an ICER greater than £20 000/QALY against STS HH. Scenario analyses performed using higher costs of usual care, higher costs of STS HH and lower costs of TM do not substantially change the conclusions. Conclusions Cost-effectiveness analyses suggest that TM was an optimal strategy in most scenarios, but there is considerable uncertainty in relation to clear descriptions of the interventions and robust estimation of costs

Growth Laws for Phase Ordering

We determine the characteristic length scale, $L(t)$, in phase ordering kinetics for both scalar and vector fields, with either short- or long-range interactions, and with or without conservation laws. We obtain $L(t)$ consistently by comparing the global rate of energy change to the energy dissipation from the local evolution of the order parameter. We derive growth laws for O(n) models, and our results can be applied to other systems with similar defect structures.Comment: 12 pages, LaTeX, second tr

Indistinguishability of independent single photons

The indistinguishability of independent single photons is presented by decomposing the single photon pulse into the mixed state of different transform limited pulses. The entanglement between single photons and outer environment or other photons induces the distribution of the center frequencies of those transform limited pulses and makes photons distinguishable. Only the single photons with the same transform limited form are indistinguishable. In details, the indistinguishability of single photons from the solid-state quantum emitter and spontaneous parametric down conversion is examined with two-photon Hong-Ou-Mandel interferometer. Moreover, experimental methods to enhance the indistinguishability are discussed, where the usage of spectral filter is highlighted.Comment: 6 pages, 3 figure