A comparative study of atenolol, nifedipine and their combination in the treatment of hypertension

The antihypertensive effects, as assessed by clinical and ambulatory blood pressure measurement, of nifedipine slowrelease (SR), atenolol and the two In combination were evaluated In 28 known hypertenslv88 In a placebo-controlled, double-blind, randomlsed cross-over trial. Clinical blood pressure was significantly lower on combination therapy (P< 0,025) than on either agent alone, although all therapeutic agents reduced blood pressure significantly when compared with placebo (P< 0,01). All ambulatory blood pressure measurements obtained on any therapeutic agent were significantly lower than those obtained on placebo (P < 0,01). The mean daytime (08h00 17h00) ambulatory blood pressure measurement as well as the percentage of this monitoring period dUring which patients were hypertensive were significantly lower (P < 0,01) on combination therapy than on nifedipine SR. A similar pattern was observed for 24-hour ambulatory blood pressure measurements. Headache was the most significant adverse effect. This was most common with nHedlplne SR, less common with combination therapy and least common with atenolol. Combination therapy with nifedipine SR and atenolol is therefore a viable therapeutic alternative in the treatment of patients with benign essential hypertension

Towards a new philosophy of engineering: structuring the complex problems from the sustainability discourse

This dissertation considers three broad issues which emerge from the sustainability discourse. First is the nature of the discourse itself, particularly the underlying philosophical positions which are represented. Second, is the nature of the highly complex types of problem which the discourse exposes. And third is whether the engineering profession, as it is practised currently, is adequate to deal with such problems. The sustainability discourse exposes two distinct, fundamentally irreconcilable philosophical positions. The first, “sustainable development”, considers humanity to be privileged in relation to all other species and ecosystems. It is only incumbent upon us to look after the environment to the extent to which it is in our interests to do so. The second, “sustainability”, sees humanity as having no special moral privilege and recognises the moral status of other species, ecosystems, and even wilderness areas. Thus, sustainability imposes upon us a moral obligation to take their status into account and not to degrade or to destroy them. These two conflicting positions give rise to extremely complex problems. An innovative taxonomy of problem complexity has been developed which identifies three broad categories of problem. Of particular interest in this dissertation is the most complex of these, referred to here as the Type 3 problem. The Type 3 problem recognises the systemic complexity of the problem situation but also includes differences of the domain of interests as a fundamental, constituent part of the problem itself. Hence, established systems analysis techniques and reductionist approaches do not work. The domain of interests will typically have disparate ideas and positions, which may be entirely irreconcilable. The dissertation explores the development of philosophy of science, particularly in the last 70 years. It is noted that, unlike the philosophy of science, the philosophy of engineering has not been influenced by developments of critical theory, cultural theory, and postmodernism, which have had significant impact in late 20th-century Western society. This is seen as a constraint on the practice of engineering. Thus, a set of philosophical principles for sustainable engineering practice is developed. Such a change in the philosophy underlying the practice of engineering is seen as necessary if engineers are to engage with and contribute to the resolution of Type 3 problems. Two particular challenges must be overcome, if Type 3 problems are to be satisfactorily resolved. First, issues of belief, values, and morals are central to this problem type and must be included in problem consideration. And second, the problem situation is usually so complex that it challenges the capacity of human cognition to deal with it. Consequently, extensive consideration is given to cognitive and behavioural psychology, in particular to choice, judgement and decision-making in uncertainty. A novel problem-structuring approach is developed on three levels. A set philosophical foundation is established; a theoretical framework, based on general systems theory and established behavioural and cognitive psychological theory, is devised; and a set of tools is proposed to model Type 3 complex problems as a dynamic systems. The approach is different to other systems approaches, in that it enables qualitative exploration of the system to plausible, hypothetical disturbances. The problem-structuring approach is applied in a case study, which relates to the development of a water subsystem for a major metropolis (Sydney, Australia). The technique is also used to critique existing infrastructure planning processes and to propose an alternative approach

Changes in and predictors of length of stay in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England: a population-based

BACKGROUND Decreases in length of stay (LOS) in hospital after breast cancer surgery can be partly attributed to the change to less radical surgery, but many other factors are operating at the patient, surgeon and hospital levels. This study aimed to describe the changes in and predictors of length of stay (LOS) in hospital after surgery for breast cancer between 1997/98 and 2004/05 in two regions of England. METHODS Cases of female invasive breast cancer diagnosed in two English cancer registry regions were linked to Hospital Episode Statistics data for the period 1st April 1997 to 31st March 2005. A subset of records where women underwent mastectomy or breast conserving surgery (BCS) was extracted (n = 44,877). Variations in LOS over the study period were investigated. A multilevel model with patients clustered within surgical teams and NHS Trusts was used to examine associations between LOS and a range of factors. RESULTS Over the study period the proportion of women having a mastectomy reduced from 58% to 52%. The proportion varied from 14% to 80% according to NHS Trust. LOS decreased by 21% from 1997/98 to 2004/05 (LOSratio = 0.79, 95%CI 0.77-0.80). BCS was associated with 33% shorter hospital stays compared to mastectomy (LOSratio = 0.67, 95%CI 0.66-0.68). Older age, advanced disease, presence of comorbidities, lymph node excision and reconstructive surgery were associated with increased LOS. Significant variation remained amongst Trusts and surgical teams. CONCLUSION The number of days spent in hospital after breast cancer surgery has continued to decline for several decades. The change from mastectomy to BCS accounts for only 9% of the overall decrease in LOS. Other explanations include the adoption of new techniques and practices, such as sentinel lymph node biopsy and early discharge. This study has identified wide variation in practice with substantial cost implications for the NHS. Further work is required to explain this variation

Functional Integration of Ecological Networks through Pathway Proliferation

Large-scale structural patterns commonly occur in network models of complex systems including a skewed node degree distribution and small-world topology. These patterns suggest common organizational constraints and similar functional consequences. Here, we investigate a structural pattern termed pathway proliferation. Previous research enumerating pathways that link species determined that as pathway length increases, the number of pathways tends to increase without bound. We hypothesize that this pathway proliferation influences the flow of energy, matter, and information in ecosystems. In this paper, we clarify the pathway proliferation concept, introduce a measure of the node--node proliferation rate, describe factors influencing the rate, and characterize it in 17 large empirical food-webs. During this investigation, we uncovered a modular organization within these systems. Over half of the food-webs were composed of one or more subgroups that were strongly connected internally, but weakly connected to the rest of the system. Further, these modules had distinct proliferation rates. We conclude that pathway proliferation in ecological networks reveals subgroups of species that will be functionally integrated through cyclic indirect effects.Comment: 29 pages, 2 figures, 3 tables, Submitted to Journal of Theoretical Biolog

Inherent directionality explains the lack of feedback loops in empirical networks

We explore the hypothesis that the relative abundance of feedback loops in many empirical complex networks is severely reduced owing to the presence of an inherent global directionality. Aimed at quantifying this idea, we propose a simple probabilistic model in which a free parameter γ controls the degree of inherent directionality. Upon strengthening such directionality, the model predicts a drastic reduction in the fraction of loops which are also feedback loops. To test this prediction, we extensively enumerated loops and feedback loops in many empirical biological, ecological and socio-technological directed networks. We show that, in almost all cases, empirical networks have a much smaller fraction of feedback loops than network randomizations. Quite remarkably, this empirical finding is quantitatively reproduced, for all loop lengths, by our model by fitting its only parameter γ. Moreover, the fitted value of γ correlates quite well with another direct measurement of network directionality, performed by means of a novel algorithm. We conclude that the existence of an inherent network directionality provides a parsimonious quantitative explanation for the observed lack of feedback loops in empirical networks

Sheldon Spectrum and the Plankton Paradox: Two Sides of the Same Coin : A trait-based plankton size-spectrum model

The Sheldon spectrum describes a remarkable regularity in aquatic ecosystems: the biomass density as a function of logarithmic body mass is approximately constant over many orders of magnitude. While size-spectrum models have explained this phenomenon for assemblages of multicellular organisms, this paper introduces a species-resolved size-spectrum model to explain the phenomenon in unicellular plankton. A Sheldon spectrum spanning the cell-size range of unicellular plankton necessarily consists of a large number of coexisting species covering a wide range of characteristic sizes. The coexistence of many phytoplankton species feeding on a small number of resources is known as the Paradox of the Plankton. Our model resolves the paradox by showing that coexistence is facilitated by the allometric scaling of four physiological rates. Two of the allometries have empirical support, the remaining two emerge from predator-prey interactions exactly when the abundances follow a Sheldon spectrum. Our plankton model is a scale-invariant trait-based size-spectrum model: it describes the abundance of phyto- and zooplankton cells as a function of both size and species trait (the maximal size before cell division). It incorporates growth due to resource consumption and predation on smaller cells, death due to predation, and a flexible cell division process. We give analytic solutions at steady state for both the within-species size distributions and the relative abundances across species

Effectiveness of initiating treatment with valsartan/hydrochlorothiazide in patients with stage-1 or stage-2 hypertension

This prospective, 6-week, multicenter, double-blind study examined the benefits of initiating treatment with combination valsartan/hydrochlorothiazide (HCTZ) compared with initial valsartan monotherapy for 648 patients with stage-1 or stage-2 hypertension (age=52.6±10 years; 54% male; baseline blood pressure (BP)=161/98 mm Hg, 32% stage 1). Patients were randomized to valsartan 80 mg (V-low), valsartan 160 mg (V-high) or valsartan/HCTZ 160/12.5 mg (V/HCTZ), and electively titrated after weeks 2 and 4 to the next dosage level (maximum dose valsartan/HCTZ 160/25 mg) if BP remained >140/90 mm Hg. At end of the study, patients initiated with V/HCTZ required less titration steps compared with the initial valsartan monotherapy groups (63 vs 86% required titration by study end, respectively) and reached the target BP goal of <140/90 mm Hg in a shorter period of time (2.8 weeks) (P<0.0001) vs V-low (4.3 weeks) and V-high (3.9 weeks). Initial combination therapy was also associated with higher BP control rates and greater reductions in both systolic and diastolic BP from baseline (63%, −27.7±13/–15.1±8 mm Hg) compared with V-low (46%, −21.2±13/−11.4±8 mm Hg, P<0.0001) or V-high (51%, −24.0±13/−12.0±10 mm Hg, P<0.01). Overall and drug-related AEs were mild to moderate and were similar between V/HCTZ (53.1 and 14.1%, respectively) and the two monotherapy groups, V-low (50.5 and 13.8%) and V-high (50.7 and 11.8%). In conclusion, initiating therapy with a combination of valsartan and low-dose HCTZ results in early, improved BP efficacy with similar tolerability as compared with starting treatment with a low or higher dose of valsartan for patients with stage-1 and stage-2 hypertension

Physical activity and medicine use: evidence from a population-based study

BACKGROUND: Few studies have investigated the association between physical activity practice and medicine use; data from these studies are inconsistent. The aim of this study was to evaluate the association between level of physical activity and medicine use in adults aged 20 years or more. METHODS: A population-based cross-sectional study was carried out in the first semester of 2002 in the urban area of Pelotas; a medium-sized Southern Brazilian city. Physical activity was assessed with the short version of the International Physical Activity Questionnaire. A physical activity score was created as the weekly time spent in moderate-intensity activities plus twice the weekly time spent in vigorous-intensity activities. Medicine use in the 15 days prior to the interview was also assessed. Adjusted analyses taking into account the sampling design was carried out using Poisson regression. Wald tests for heterogeneity and linear trend were used to calculate significance. RESULTS: Out of the 3,182 individuals interviewed, 41% were not sufficiently active according to current physical activity guidelines. Only 34% of the subjects did not use medicines in the previous 15 days, and 18% used three or more drugs in the same period. Level of physical activity was inversely associated with the number of medicines used both in the crude and in the adjusted analyses. CONCLUSION: There are well-documented benefits of physical activity for several chronic diseases in the literature. Data from the present study suggest that medicine use is also positively affected by physical activity behavior

Compartments revealed in food-web structure

Compartments(1) in food webs are subgroups of taxa in which many strong interactions occur within the subgroups and few weak interactions occur between the subgroups(2). Theoretically, compartments increase the stability in networks(1-5), such as food webs. Compartments have been difficult to detect in empirical food webs because of incompatible approaches(6-9) or insufficient methodological rigour(8,10,11). Here we show that a method for detecting compartments from the social networking science(12-14) identified significant compartments in three of five complex, empirical food webs. Detection of compartments was influenced by food web resolution, such as interactions with weights. Because the method identifies compartmental boundaries in which interactions are concentrated, it is compatible with the definition of compartments. The method is rigorous because it maximizes an explicit function, identifies the number of non-overlapping compartments, assigns membership to compartments, and tests the statistical significance of the results(12-14). A graphical presentation(14) reveals systemic relationships and taxa-specific positions as structured by compartments. From this graphic, we explore two scenarios of disturbance to develop a hypothesis for testing how compartmentalized interactions increase stability in food webs(15-17).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/62960/1/nature02115.pd

Prostate cancer, treatment modalities and complications: an evaluation of the scientific literature

Prostate (PR) cancer (CA) is one of the most common malignant neoplasms in men all over the world. In general, if prostate cancer (PC) is detected early, treatment usually involves either surgical removal of the prostate or radiotherapy (RT). Hormone Therapy (HT) or chemotherapy (CH) is the preferred treatment for more advanced cases of PC or if CA spreads beyond the PT. A number of complications, such as urinary incontinence (IU) or erectile dysfunction (ED), can be associated with some modalities of treatment of the PC. The aim of this work is to evaluate, in PubMed, the number of publications related with prostate cancer and the main modalities of treatment, as well as some clinical complications. The searches were performed in PubMed (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) in the period 1950 to 2008 using the words: (i) CA, (ii) CA and PR or penis or testis, (iii) CA and PR and RT, CA and PR and surgery (SU), CA and PR and CH and, CA and PR and HT and (iv) CA and PR and RT and IU or ED, CA and PR and SU and IU or ED, CA and PR and CH and IU or ED and, CA and PR and HT and CH and IU or ED, and (V) PC and the same modalities of treatment. The data was obtained on July 20th, 2008. PC, as expected has been cited extensively and surgery has been identified as the most widely referenced modality of treatment. Furthermore, urinary incontinence and erectile dysfunction are important complications that have attracted significant scientific interest. In conclusion, these findings have shown the relevance of the PubMed to analyze quantitatively the publications in cancer and this information could be worthwhile in aiding the comprehension of some clinical aspects related with PC, as well as the development of preventative actions. The analysis of the scientific interest, considering the number of publications in the PubMed, reveals research trends in the field and demonstrates the importance of the surgical procedures in the treatment of the prostate cancer. Moreover, this finding is relevant due to the fact that surgery is the treatment of choice when early detection of PC is achieved. However, it is important to consider clinical complications related to such procedures, such as urinary incontinence and erectile dysfunctions that can reduce the quality of life of the patient