A CASE OF CHRONIC INTERNAL HYDROCEPHALUS.: Read before the Medical Society of the. District of Columbia, February 22, 1888.

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Statin prescribing for prevention of cardiovascular disease amongst people with severe mental illness: Cohort study in UK primary care

BACKGROUND: Severe mental illness (SMI) is associated with excess cardiovascular disease (CVD) morbidity, but little is known on provision of preventative interventions. We investigated statin initiation for primary CVD prevention in individuals with and without SMI. METHODS: We used primary care data from The Health Improvement Network from 2006 to 2015 for UK patients aged 30-99years with no pre-existing CVD conditions and selected individuals with schizophrenia (n=13,252) or bipolar disorder (n=11,994). In addition, we identified samples of individuals without schizophrenia (n=66,060) and bipolar disorder (n=59,765), but with similar age and gender distribution. Missing data on CVD covariates were estimated using multiple imputation. Statin prescribing differences between individuals with and without SMI were investigated using multivariable Poisson regression models. RESULTS: Initiation of statin prescribing was between 2 and 3 fold higher in people aged 30-59years with SMI than in those without after adjusting for CVD covariates. The rates in those aged 60-74years with SMI were similar or slightly higher relative to those without SMI. The incidence rate ratio (IRR) was 1.15 (95% CI 1.03-1.28) for bipolar disorder and 1.00 (0.91-1.11) for schizophrenia. The rate of statin prescribing was lower (IRR 0.81 (0.66-0.98)) amongst the oldest (aged 75+years) with schizophrenia relative to those without schizophrenia. CONCLUSIONS: Despite higher rates of new statin prescriptions to younger individuals with SMI relative to individuals without SMI, there was evidence of lower rates of statin initiation for older individuals with schizophrenia, and this group may benefit from additional measures to prevent CVD

Taking the Stem Cell Debate to the Public

In response to the Blackburn and Rowley essay on the President's Council on Bioethics, several thought-provoking opinions on ethical challenges in biomedical research are expressed by prominent stakeholder

Statin prescribing for people with severe mental illnesses: a staggered cohort study of 'real-world' impacts

OBJECTIVES: To estimate the 'real-world effectiveness of statins for primary prevention of cardiovascular disease (CVD) and for lipid modification in people with severe mental illnesses (SMI), including schizophrenia and bipolar disorder. DESIGN: Series of staggered cohorts. We estimated the effect of statin prescribing on CVD outcomes using a multivariable Poisson regression model or linear regression for cholesterol outcomes. SETTING: 587 general practice (GP) surgeries across the UK reporting data to The Health Improvement Network. PARTICIPANTS: All permanently registered GP patients aged 40-84 years between 2002 and 2012 who had a diagnosis of SMI. Exclusion criteria were pre-existing CVD, statin-contraindicating conditions or a statin prescription within the 24 months prior to the study start. EXPOSURE: One or more statin prescriptions during a 24-month 'baseline' period (vs no statin prescription during the same period). MAIN OUTCOME MEASURES: The primary outcome was combined first myocardial infarction and stroke. All-cause mortality and total cholesterol concentration were secondary outcomes. RESULTS: We identified 2944 statin users and 42 886 statin non-users across the staggered cohorts. Statin prescribing was not associated with significant reduction in CVD events (incident rate ratio 0.89; 95% CI 0.68 to 1.15) or all-cause mortality (0.89; 95% CI 0.78 to 1.02). Statin prescribing was, however, associated with statistically significant reductions in total cholesterol of 1.2 mmol/L (95% CI 1.1 to 1.3) for up to 2 years after adjusting for differences in baseline characteristics. On average, total cholesterol decreased from 6.3 to 4.6 in statin users and 5.4 to 5.3 mmol/L in non-users. CONCLUSIONS: We found that statin prescribing to people with SMI in UK primary care was effective for lipid modification but not CVD events. The latter finding may reflect insufficient power to detect a smaller effect size than that observed in randomised controlled trials of statins in people without SMI

High-Reynolds-number wall-modelled large eddy simulations of turbulent pipe flows using explicit and implicit subgrid stress treatments within a spectral element solver

We present explicit and implicit large eddy simulations for fully developed turbulent pipe flows using a continuous-Galerkin spectral element solver. On the one hand, the explicit stretched-vortex model (by Misra & Pullin [45] and Chung & Pullin [14]), accounts for an explicit treatment of unresolved stresses and is adapted to the high-order solver. On the other hand, an implicit approach based on a spectral vanishing viscosity technique is implemented. The latter implicit technique is modified to incorporate Chung & Pullin virtual-wall model instead of relying on implicit dissipative mechanisms near walls. This near-wall model is derived by averaging in the wall-normal direction and relying in local inner scaling to treat the time-dependence of the filtered wall-parallel velocity. The model requires space-time varying Dirichlet and Neumann boundary conditions for velocity and pressure respectively. We provide results and comparisons for the explicit and implicit subgrid treatments and show that both provide favourable results for pipe flows at Re_τ = 2×10^3 and Re_τ = 1.8×10^5 in terms of turbulence statistics. Additionally, we conclude that implicit simulations are enhanced when including the wall model and provide the correct statistics near walls

High-Reynolds-number wall-modelled large eddy simulations of turbulent pipe flows using explicit and implicit subgrid stress treatments within a spectral element solver

We present explicit and implicit large eddy simulations for fully developed turbulent pipe flows using a continuous-Galerkin spectral element solver. On the one hand, the explicit stretched-vortex model (by Misra & Pullin [45] and Chung & Pullin [14]), accounts for an explicit treatment of unresolved stresses and is adapted to the high-order solver. On the other hand, an implicit approach based on a spectral vanishing viscosity technique is implemented. The latter implicit technique is modified to incorporate Chung & Pullin virtual-wall model instead of relying on implicit dissipative mechanisms near walls. This near-wall model is derived by averaging in the wall-normal direction and relying in local inner scaling to treat the time-dependence of the filtered wall-parallel velocity. The model requires space-time varying Dirichlet and Neumann boundary conditions for velocity and pressure respectively. We provide results and comparisons for the explicit and implicit subgrid treatments and show that both provide favourable results for pipe flows at Re_τ = 2×10^3 and Re_τ = 1.8×10^5 in terms of turbulence statistics. Additionally, we conclude that implicit simulations are enhanced when including the wall model and provide the correct statistics near walls

Single Or Multiple Competitive Strategies For Small Businesses?

This research focuses upon the association between external environments, planning, and the development of competitive strategy in small business firms. The population ecology model l of organizations and their environments emphasizes that only some organizations, e.g., those with the right characteristics, will be selected for survival. While management is not impotent, this model clearly emphasizes ways in which external environments directly influence the fate of organizations (Aldrich, 1979)