Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease - A cost-effectiveness analysis

<p>Abstract</p> <p>Background</p> <p>Hypertension is one of the leading causes of cardiovascular disease (CVD). A range of antihypertensive drugs exists, and their prices vary widely mainly due to patent rights. The objective of this study was to explore the cost-effectiveness of different generic antihypertensive drugs as first, second and third choice for primary prevention of cardiovascular disease.</p> <p>Methods</p> <p>We used the Norwegian Cardiovascular Disease model (NorCaD) to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources.</p> <p>Results</p> <p>In single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs.</p> <p>Conclusions</p> <p>Generic antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.</p

The ALICE Transition Radiation Detector: Construction, operation, and performance

The Transition Radiation Detector (TRD) was designed and built to enhance the capabilities of the ALICE detector at the Large Hadron Collider (LHC). While aimed at providing electron identification and triggering, the TRD also contributes significantly to the track reconstruction and calibration in the central barrel of ALICE. In this paper the design, construction, operation, and performance of this detector are discussed. A pion rejection factor of up to 410 is achieved at a momentum of 1 GeV/c in p-Pb collisions and the resolution at high transverse momentum improves by about 40% when including the TRD information in track reconstruction. The triggering capability is demonstrated both for jet, light nuclei, and electron selection. (c) 2017 CERN for the benefit of the Authors. Published by Elsevier B.V

Controversy and consensus on the management of elevated sperm DNA fragmentation in male infertility: A global survey, current guidelines, and expert recommendations

Purpose Sperm DNA fragmentation (SDF) has been associated with male infertility and poor outcomes of assisted reproductive technology (ART). The purpose of this study was to investigate global practices related to the management of elevated SDF in infertile men, summarize the relevant professional society recommendations, and provide expert recommendations for managing this condition. Materials and Methods An online global survey on clinical practices related to SDF was disseminated to reproductive clinicians, according to the CHERRIES checklist criteria. Management protocols for various conditions associated with SDF were captured and compared to the relevant recommendations in professional society guidelines and the appropriate available evidence. Expert recommendations and consensus on the management of infertile men with elevated SDF were then formulated and adapted using the Delphi method. Results A total of 436 experts from 55 different countries submitted responses. As an initial approach, 79.1% of reproductive experts recommend lifestyle modifications for infertile men with elevated SDF, and 76.9% prescribe empiric antioxidants. Regarding antioxidant duration, 39.3% recommend 4–6 months and 38.1% recommend 3 months. For men with unexplained or idiopathic infertility, and couples experiencing recurrent miscarriages associated with elevated SDF, most respondents refer to ART 6 months after failure of conservative and empiric medical management. Infertile men with clinical varicocele, normal conventional semen parameters, and elevated SDF are offered varicocele repair immediately after diagnosis by 31.4%, and after failure of antioxidants and conservative measures by 40.9%. Sperm selection techniques and testicular sperm extraction are also management options for couples undergoing ART. For most questions, heterogenous practices were demonstrated. Conclusions This paper presents the results of a large global survey on the management of infertile men with elevated SDF and reveals a lack of consensus among clinicians. Furthermore, it demonstrates the scarcity of professional society guidelines in this regard and attempts to highlight the relevant evidence. Expert recommendations are proposed to help guide clinicians

nuttallii

Arabis nuttallii (Kuntze) B.L.Rob.Nuttall's rockcressarabette de NuttallBehind Mt. BackusT. ChisholmN.E. facing flat, exposed meadow; across from Lrg. Shell Station; summit of Carbondale and Castle River watersheds1544 mPinus contorta, Delphinium bicolor, Rosa sp., Lupinus lepidus, Comandra umbellata, Sedum lanceolatum, Anemone patens, Amelanchier alnifolia, Oxytropis sp., Cerastium arvense, Achillea millefolium, Galium boreal

nuttallii

Arabis nuttallii (Kuntze) B.L.Rob.arabette de NuttallNuttall's rockcressBehind Mt. BackusT. ChisholmN.E. facing flat, exposed meadow; across from Lrg. Shell Station; summit of Carbondale and Castle River watersheds1544 mPinus contorta, Delphinium bicolor, Rosa sp., Lupinus lepidus, Comandra umbellata, Sedum lanceolatum, Anemone patens, Amelanchier alnifolia, Oxytropis sp., Cerastium arvense, Achillea millefolium, Galium boreal

Hazard ratios (95% confidence intervals) of type 2 diabetes according to frequencies of meals prepared at home in the Nurses’ Health Study (1986–2010) and the Health Professionals Follow-up Study (1986–2010).

<p>Hazard ratios (95% confidence intervals) of type 2 diabetes according to frequencies of meals prepared at home in the Nurses’ Health Study (1986–2010) and the Health Professionals Follow-up Study (1986–2010).</p

Baseline characteristics in the NHS and the HPFS (1986) according to frequencies of consuming MPAH.

<p>Baseline characteristics in the NHS and the HPFS (1986) according to frequencies of consuming MPAH.</p

Rotating night shift work and risk of obesity and weight gain in Nurses' Health Study II.

<p>The figure shows the odds ratio (95% CI) of being obese in 2007 and excessive weight gain between 1989 and 2007 by categories of rotating night shift work in Nurses' Health Study II. Excessive weight gain was defined as weight gain between 1989 and 2007 of more than 5% of the baseline body weight in 1989. The model was adjusted for baseline age, BMI, alcohol consumption, physical activity level, smoking status, ethnicity, menopausal status and hormone use, oral contraceptive use, family history of diabetes, current aspirin use, quintiles of total calorie and dietary score in 1989.</p

Hazard ratios (95% confidence intervals) of type 2 diabetes according to frequencies of consuming meals prepared at home by further adjusting for BMI and dietary factors.

<p>Hazard ratios (95% confidence intervals) of type 2 diabetes according to frequencies of consuming meals prepared at home by further adjusting for BMI and dietary factors.</p

Weight changes and risk of obesity according to frequencies of meals prepared at home, based on the NHS and the HPFS (1986–1994).

<p>Weight changes and risk of obesity according to frequencies of meals prepared at home, based on the NHS and the HPFS (1986–1994).</p