Estimating the impact of single pill combination therapy for hypertension: projections of patient outcomes in Italy

Introduction: Hypertension affects almost a third of the Italian population and is a major risk factor for cardiovascular disease. Management of hypertension is often hindered by poor adherence to complex treatment regimens. This analysis aimed to estimate the 10-year clinical outcomes associated with single pill combination (SPC) therapies compared with other treatment pathways for the management of hypertension in Italy. Methods: A microsimulation modeling approach was used to project health outcomes over a 10-year period for people with hypertension. Input data for four treatment pathways [current treatment practices (CTP), single drug with dosage titration then sequential addition of other agents (start low and go slow, SLGS), free choice combination with multiple pills (FCC) and SPC] were sourced from the Global Burden of Disease 2017 data set. The model simulated clinical outcomes for 1 000 000 individuals in each treatment pathway, including mortality, chronic kidney disease (CKD), stroke, ischemic heart disease (IHD) and disability-adjusted life years (DALYs). Results: Through improved adherence, SPC was projected to improve clinical outcomes versus CTP, SLGS, and FCC. SPC was associated with reductions in mortality, incidence of clinical events, and DALYs versus CTP of 5.4%, 11.5%, and 5.7%, respectively. SLGS and FCC were associated with improvements in clinical outcomes versus CTP, but smaller improvements than those associated with SPC. Conclusions: Over 10 years, combination therapies (including SPC and FCC) were projected to reduce the burden of hypertension compared with conventional management approaches in Italy. Due to higher adherence, SPC was associated with the greatest overall benefits versus other regimen

The Gut Microbiota and Vascular Aging: A State-of-the-Art and Systematic Review of the Literature

The gut microbiota is a critical regulator of human physiology, deleterious changes to its composition and function (dysbiosis) have been linked to the development and progression of cardiovascular diseases. Vascular ageing (VA) is a process of progressive stiffening of the arterial tree associated with arterial wall remodeling, which can precede hypertension and organ damage, and is associated with cardiovascular risk. Arterial stiffness has become the preferred marker of VA. In our systematic review, we found an association between gut microbiota composition and arterial stiffness, with two patterns, in most animal and human studies: a direct correlation between arterial stiffness and abundances of bacteria associated with altered gut permeability and inflammation; an inverse relationship between arterial stiffness, microbiota diversity, and abundances of bacteria associated with most fit microbiota composition. Interventional studies were able to show a stable link between microbiota modification and arterial stiffness only in animals. None of the human interventional trials was able to demonstrate this relationship, and very few adjusted the analyses for determinants of arterial stiffness. We observed a lack of large randomized interventional trials in humans that test the role of gut microbiota modifications on arterial stiffness, and take into account BP and hemodynamic alterations

Characterisation of Hybrid Pixel Detectors with capacitive charge division

In order to fully exploit the physics potential of the future high energy e+ e- linear collider, a Vertex Tracker providing high resolution track reconstruction is required. Hybrid pixel sensors are an attractive technology due to their fast read-out capabilities and radiation hardness. A novel pixel detector layout with interleaved cells between the readout nodes has been developed to improve the single point resolution. The results of the characterisation of the first processed prototypes are reported.Comment: 5 pages, 2 figures, presented at LCWS2000, Linear Collider Workshop, October 24-28 2000, Fermi National Accelerator Laboratory, Batavia, Illinois, U.S.A. Proceedings to be published by the American Institute of Physic

Automated Artifact Retouching in Morphed Images with Attention Maps

open4noMorphing attack is an important security threat for automatic face recognition systems. High-quality morphed images, i.e. images without significant visual artifacts such as ghosts, noise, and blurring, exhibit higher chances of success, being able to fool both human examiners and commercial face verification algorithms. Therefore, the availability of large sets of high-quality morphs is fundamental for training and testing robust morphing attack detection algorithms. However, producing a high-quality morphed image is an expensive and time-consuming task since manual post-processing is generally required to remove the typical artifacts generated by landmark-based morphing techniques. This work describes an approach based on the Conditional Generative Adversarial Network paradigm for automated morphing artifact retouching and the use of Attention Maps to guide the generation process and limit the retouch to specific areas. In order to work with high-resolution images, the framework is applied on different facial crops, which, once processed and retouched, are accurately blended to reconstruct the whole morphed face. Specifically, we focus on four different squared face regions, i.e. the right and left eyes, the nose, and the mouth, that are frequently affected by artifacts. Several qualitative and quantitative experimental evaluations have been conducted to confirm the effectiveness of the proposal in terms of, among the others, pixel-wise metrics, identity preservation, and human observer analysis. Results confirm the feasibility and the accuracy of the proposed framework.openBorghi G.; Franco A.; Graffieti G.; Maltoni D.Borghi G.; Franco A.; Graffieti G.; Maltoni D

How affordances associated with a distractor object affect compatibility effects: a study with the computational model TRoPICALS.

Seeing an object activates both visual and action codes in the brain. Crucial evidence supporting this view is the observation of object to response compatibility effects: perception of an object can facilitate or interfere with the execution of an action (e.g., grasping) even when the viewer has no intention of interacting with the object. TRoPICALS is a computational model that proposes some general principles about the brain mechanisms underlying compatibility effects, in particular the idea that top-down bias from prefrontal cortex, and whether it conflicts or not with the actions afforded by an object, plays a key role in such phenomena. Experiments on compatibility effects using a target and a distractor object show the usual positive compatibility effect of the target, but also an interesting negative compatibility effect of the distractor: responding with a grip compatible with the distractor size produces slower reaction times than the incompatible case. Here, we present an enhanced version of TRoPICALS that reproduces and explains these new results. This explanation is based on the idea that the prefrontal cortex plays a double role in its top-down guidance of action selection producing: (a) a positive bias in favour of the action requested by the experimental task; (b) a negative bias directed to inhibiting the action evoked by the distractor. The model also provides testable predictions on the possible consequences of damage to volitional circuits such as in Parkinsonian patients

A Pixel Vertex Tracker for the TESLA Detector

In order to fully exploit the physics potential of a e+e- linear collider, such as TESLA, a Vertex Tracker providing high resolution track reconstruction is required. Hybrid Silicon pixel sensors are an attractive sensor technology option due to their read-out speed and radiation hardness, favoured in the high rate TESLA environment, but have been so far limited by the achievable single point space resolution. A novel layout of pixel detectors with interleaved cells to improve their spatial resolution is introduced and the results of the characterisation of a first set of test structures are discussed. In this note, a conceptual design of the TESLA Vertex Tracker, based on hybrid pixel sensors is presentedComment: 20 pages, 11 figure

Effectiveness comparison between carbon spring and hinged ankle-foot orthoses in crouch gait treatment of children with diplegic cerebral palsy: A randomized crossover trial

BACKGROUND: Children with cerebral palsy (CP) often present a loss of effectiveness of the plantarflexors/knee-extensors couple that leads to crouch gait. When treating a child with crouch gait by means of ankle foot orthoses, preserving or restoring push off power is a key issue.AIM: To compare carbon-fiber spring (Carbon Ankle Seven (R) [CAFO], Ottobock (R) HealthCare, Duderstadt, Germany) and hinged ankle-foot orthoses (HAFO) effectiveness in improving functionality and walking ability in children with diplegic CP and crouch gait.DESIGN: Randomized crossover trial.SETTING: Hospital center.POPULATION: Ten children with diplegic CP and crouch gait, 5 males and 5 females, aged 11 (4) years.METHODS: The gait of each child was evaluated by means of instrumental gait analysis with both CAFO and HAFO, in a randomized order and after a 4-week adaptation period. The primary outcome measure was the change in ankle power generation. As secondary outcome measures, knee joint kinematics, stride length, walking speed, Observational Gait Scale, and preferred orthosis were considered.RESULTS: The median of the energy produced in stance was superior with CAFO (+2.2 J/kg, IQR 4.7, P=0.006), and the energy absorbed inferior (-3.3 J/kg, IQR 4.3, P=0.011). No statistically significant difference was found for any other parameter. Preference of the children was equally distributed between the two orthoses.CONCLUSIONS: No evident superiority of CAFO with respect to HAFO was found in improving gait performance of children with CP and crouch gait. Nevertheless, the results suggest the possibility that CAFO permits an energy saving and reduction of the more compromising deficits.CLINICAL REHABILITATION IMPACT: The final choice of the participants indicates that CAFOs are preferred by older and heavier children, but the preference does not correlate with the performance of the orthoses during gait