Systolic blood pressure and 6-year mortality in South Africa: a country-wide, population-based cohort study

Background: Improving hypertension control is an important global health priority, yet, to our knowledge, there is no direct evidence on the relationship between blood pressure and mortality in sub-Saharan Africa. We aimed to investigate the relationship between systolic blood pressure and mortality in South Africa and to assess the comparative effectiveness of different systolic blood pressure targets for clinical care and population-wide hypertension management efforts. Methods: In this country-wide, population-based cohort study, we used longitudinal data on adults aged 30 years and older from five waves (2008, 2010–11, 2012, 2014–15, and 2017) of the South African National Income Dynamics Study. We estimated the relationship between systolic blood pressure and 6-year all-cause mortality and compared the mortality reductions associated with lowering systolic blood pressure to different targets (120 mm Hg, 130 mm Hg, 140 mm Hg, 150 mm Hg). We also estimated the mean blood pressure reduction required to achieve each target, the share of the population in need of management, and the number needed to treat (NNT) to avert one death under different hypothetical population-wide scale-up scenarios. Findings: Of the 8338 age-eligible respondents in the 2010–11 survey, 4993 had all required data and were included in our study. We found a weak, non-linear relationship between systolic blood pressure and 6-year mortality, with larger incremental mortality benefits at higher systolic blood pressure values: reducing systolic blood pressure from 160 mm Hg to 150 mm Hg was associated with a relative risk of mortality of 0·95 (95% CI 0·90 to 0·99; p=0·033), reducing systolic blood pressure from 150 mm Hg to 140 mm Hg had a relative risk of 0·96 (0·91 to 1·01; p=0·12), with no evidence of incremental benefits of reducing systolic blood pressure below 140 mm Hg. At the population level, reducing systolic blood pressure to 150 mm Hg among all those with a starting systolic blood pressure of more than 150 mm Hg was associated with the lowest NNT (n=50), 3·3 deaths averted (95% CI −0·6 to 0·3) per 1000 population, blood pressure management for 16% (95% CI 15·2 to 17·3) of individuals, and a −2·7 mm Hg mean change in systolic blood pressure required to achieve the 150 mm Hg scale-up target (−3·0 to −2·5; p<0·0001). Interpretation: The relationship between systolic blood pressure and mortality is weaker in South Africa than in high-income and many low-income and middle-income countries. As such, we do not find compelling evidence in support of targets below 140 mm Hg and find that scaling up management based on a 150 mm Hg target is more efficient in terms of the NNT compared with strategies to reduce systolic blood pressure to lower values. Funding: Non

The Physics of Star Cluster Formation and Evolution

© 2020 Springer-Verlag. The final publication is available at Springer via https://doi.org/10.1007/s11214-020-00689-4.Star clusters form in dense, hierarchically collapsing gas clouds. Bulk kinetic energy is transformed to turbulence with stars forming from cores fed by filaments. In the most compact regions, stellar feedback is least effective in removing the gas and stars may form very efficiently. These are also the regions where, in high-mass clusters, ejecta from some kind of high-mass stars are effectively captured during the formation phase of some of the low mass stars and effectively channeled into the latter to form multiple populations. Star formation epochs in star clusters are generally set by gas flows that determine the abundance of gas in the cluster. We argue that there is likely only one star formation epoch after which clusters remain essentially clear of gas by cluster winds. Collisional dynamics is important in this phase leading to core collapse, expansion and eventual dispersion of every cluster. We review recent developments in the field with a focus on theoretical work.Peer reviewe

PHASE CONJUGATION OF KrF LASER RADIATION

Nous rendons compte de réflexions conjuguées en phase de radiation d'un laser KrF en utilisant un mélange à quatre ondes dégénérées (DFWM) ou une diffusion Brillouin stimulée (SBS). En utilisant DFWM nous avons mesuré des réflectivités de ∼ 300% et les résultats sont en bon accord avec une théorie pour un mécanisme déclenché thermiquement dans le milieu. Le miroir conjugué en phase utilisant la diffusion Brillouin stimulée a été employé dans une variété d'applications qui sont d'un grand intérêt pour le développement des lasers de forte puissance se servant des halogénures de gaz rares.We report observations of phase conjugate reflection of KrF laser radiation using both degenerate four-wave mixing (DFWM) and stimulated Brillouin scattering (SBS). Using DFWM we have measured reflectivities of ∼ 300% and the results are in good agreement with a theory for a thermally induced mechanism in the medium. The SBS phase conjugate mirror has been used in a variety of applications which are of interest to the development of high energy rare-gas halide lasers

Discrepancy Analysis of Complex Objects Using Dissimilarities

In this article we consider objects for which we have a matrix of dissimilarities and we are interested in their links with covariates. We focus on state sequences for which pairwise dissimilarities are given for instance by edit distances. The methods discussed apply however to any kind of objects and measures of dissimilarities. We start with a generalization of the analysis of variance (ANOVA) to assess the link of complex objects (e.g. sequences) with a given categorical variable. The trick is to show that discrepancy among objects can be derived from the sole pairwise dissimilarities, which permits then to identify factors that most reduce this discrepancy. We present a general statistical test and introduce an original way of rendering the results for state sequences. We then generalize the method to the case with more than one factor and discuss its advantages and limitations especially regarding interpretation. Finally, we introduce a new tree method for analyzing discrepancy of complex objects that exploits the former test as splitting criterion. We demonstrate the scope of the methods presented through a study of the factors that most discriminate Swiss occupational trajectories. All methods presented are freely accessible in our TraMineR package for the R statistical environment