Estimating the economic burden of cardiovascular events in patients receiving lipid-modifying therapy in the UK.

OBJECTIVES: To characterise the costs to the UK National Health Service of cardiovascular (CV) events among individuals receiving lipid-modifying therapy. DESIGN: Retrospective cohort study using Clinical Practice Research Datalink records from 2006 to 2012 to identify individuals with their first and second CV-related hospitalisations (first event and second event cohorts). Within-person differences were used to estimate CV-related outcomes. SETTING: Patients in the UK who had their first CV event between January 2006 and March 2012. PARTICIPANTS: Patients ≥18 years who had a CV event and received at least 2 lipid-modifying therapy prescriptions within 180 days beforehand. PRIMARY AND SECONDARY OUTCOME MEASURES: Direct medical costs (2014 £) were estimated in 3 periods: baseline (pre-event), acute (6 months afterwards) and long-term (subsequent 30 months). Primary outcomes included incremental costs, resource usage and total costs per period. RESULTS: There were 24 093 patients in the first event cohort of whom 5274 were included in the second event cohort. The mean incremental acute CV event costs for the first event and second event cohorts were: coronary artery bypass graft/percutaneous transluminal coronary angioplasty (CABG/PTCA) £5635 and £5823, myocardial infarction £4275 and £4301, ischaemic stroke £3512 and £4572, heart failure £2444 and £3461, unstable angina £2179 and £2489 and transient ischaemic attack £1537 and £1814. The mean incremental long-term costs were: heart failure £848 and £2829, myocardial infarction £922 and £1385, ischaemic stroke £973 and £682, transient ischaemic attack £705 and £1692, unstable angina £328 and £677, and CABG/PTCA £-368 and £599. Hospitalisation accounted for 95% of acute and 61% of long-term incremental costs. Higher comorbidity was associated with higher long-term costs. CONCLUSIONS: Revascularisation and myocardial infarction were associated with the highest incremental costs following a CV event. On the basis of real-world data, the economic burden of CV events in the UK is substantial, particularly among those with greater comorbidity burden

Roles of atmospheric and land surface data in dynamic regional downscaling

In studies dealing with the impact of land use changes on atmospheric processes, a key methodological step is the validation of simulated current conditions. However, regions lacking detailed atmospheric and land use data provide limited information with which to accurately generate control simulations. In this situation, the difference between baseline control simulations and different land use change simulations can be quite different owing to the quality of the atmospheric and land use data sets. Using multiple simulations at the Monteverde cloud forest region of Costa Rica as an example, we show that when a regional climate model is used to study the effect of land use change, it can produce distinctly different results at regional scales, depending on the amount of data available to run the climate simulations. We show that for the specific case of land use change impact studies, the simulation results are very sensitive to the prescribed atmospheric information (e.g., lateral boundary conditions) compared to the land use (surface boundary) information

The One Quail Per Acre Myth

Data are presented which conflict with the 1-bird-per-acre saturation point concept for bobwhites (Colinus virginianus). Conclusions are that if a saturation point exists it is at a level greater than 2 bobwhites per acre

On Composite Two Higgs Doublet Models

We investigate composite two Higgs doublet models realized as pseudo Goldstone modes, generated through the spontaneous breaking of a global symmetry due to strong dynamic at the TeV scale. A detailed comparative survey of two possible symmetry breaking patterns, SU(5) -> SU(4) x U(1) and SU(5) x SU(4), is made. We point out choices for the Standard Model fermion representations that can alleviate some phenomenological constraints, with emphasis towards a simultaneous solution of anomalous Zb\bar{b} coupling and Higgs mediated Flavor Changing Neutral Currents. We also write down the kinetic lagrangian for several models leading to Two Higgs Doublets and identify the anomalous contributions to the T parameter. Moreover, we describe a model based on the breaking $SO(9)/SO(8)$ in which there is no tree-level breaking of custodial symmetry, discussing also the possible embeddings for the fermion fields.Comment: 17 pages. Mistake corrected, added one section on a T- and flavor safe model based on SO(9)/SO(8). Matches published versio

Qualitative evaluation of a deferred consent process in paediatric emergency research: a PREDICT study

Background: A challenge of conducting research in critically ill children is that the therapeutic window for the intervention may be too short to seek informed consent prior to enrolment. In specific circumstances, most international ethical guidelines allow for children to be enrolled in research with informed consent obtained later, termed deferred consent (DC) or retrospective consent. There is a paucity of data on the attitudes of parents to this method of enrolment in paediatric emergency research. Objectives: To explore the attitudes of parents to the concept of DC and to expand the knowledge of the limitations to informed consent and DC in these situations.MethodChildren presenting with uncomplicated febrile seizures or bronchiolitis were identified from three separate hospital emergency department databases. Parents were invited to participate in a semistructured telephone interview exploring themes of limitations of prospective informed consent, acceptability of the DC process and the most appropriate time to seek DC. Transcripts underwent inductive thematic analysis with intercoder agreement, using Nvivo 11 software. Results: A total of 39 interviews were conducted. Participants comprehended the limitations of informed consent under emergency circumstances and were generally supportive of DC. However, they frequently confused concepts of clinical care and research, and support for participation was commonly linked to their belief of personal benefit. Conclusion: Participants acknowledged the requirement for alternatives to prospective informed consent in emergency research, and were supportive of the concept of DC. Our results suggest that current research practice seems to align with community expectations.</jats:sec

PSO-GWO Optimized Fractional Order PID Based Hybrid Shunt Active Power Filter for Power Quality Improvements

This paper presents a Hybrid Shunt Active Power Filter (HSAPF) optimized by hybrid Particle Swarm Optimization-Grey Wolf Optimization (PSO-GWO) and Fractional Order Proportional-Integral-Derivative Controller (FOPIDC) for reactive power and harmonic compensation under balance and unbalance loading conditions. Here, the parameters of FOPID controller are tuned by PSO-GWO technique to mitigate the harmonics. Comparing Passive with Active Filters, the former is tested to be bulky and design is complex and the later is not cost effective for high rating. Hence, a hybrid structure of shunt active and passive filter is designed using MATLAB/Simulink and in real time experimental set up. The compensation process for shunt active filter is different from predictable methods such as (p-q) or (id-i ) theory, in which only the source current is to be sensed. The performance of the proposed controller is tested under different operating conditions such as steady and transient states and indices like Total Harmonic Distortion (THD), Input Power Factor (IPF), Real Power (P) and Reactive Power (Q) are estimated and compared with that of other controllers. The parameters of FOPIDC and Conventional PID Controller (CPIDC) are optimized by the techniques such as PSO, GWO and hybrid PSO-GWO. The comparative simulation/experiment results reflect the better performance of PSO-GWO optimized FOPIDC based HSAPF with respect to PSO/GWO optimized FOPIDC/CPIDC based HSAPF under different operating conditions.

Condensate cosmology in O'Raifeartaigh models

Flat directions charged under an R-symmetry are a generic feature of O'Raifeartaigh models. Non-topological solitons associated with this symmetry, R-balls, are likely to form through the fragmentation of a condensate, itself created by soft terms induced during inflation. In gravity mediated SUSY breaking R-balls decay to gravitinos, reheating the universe. For gauge mediation R-balls can provide a good dark matter candidate. Alternatively they can decay, either reheating or cooling the universe. Conserved R-symmetry permits decay to gravitinos or gauginos, whereas spontaneously broken R-symmetry results in decay to visible sector gauge bosons.Comment: 29 pages, 5 figures. Comments and references added, accepted for publication in JHE

Tree Level Metastability and Gauge Mediation in Baryon Deformed SQCD

We investigate supersymmetric QCD with gauge group SU(2) and a baryon deformation to the superpotential. The existence of an uplifted vacuum at the origin with tree level metastability is demonstrated. When this model is implemented in a direct gauge mediation scenario we therefore find gaugino masses which are comparable to sfermion masses and parameterised by an effective number of messengers 1/8. All deformations are well motivated by appealing to the electric theory and an R-symmetry. This R-symmetry is explicitly broken by the same term responsible for supersymmetry breaking. Moreover, the model does not suffer from the Landau pole problem and we find that it can be described in terms of just two scales: the weak scale and a high scale like the Planck or GUT scale. The model can be tested by searching for new particles at the TeV scale charged under the visible sector gauge group.Comment: 17 pages, 7 figures, updated reference

Global health partnerships: building multi-national collaborations to achieve lasting improvements in maternal and neonatal health

Abstract Background In response to health care challenges worldwide, extensive funding has been channeled to the world’s most vulnerable health systems. Funding alone is not sufficient to address the complex issues and challenges plaguing these health systems. To see lasting improvement in maternal and infant health outcomes in the developing world, a global commitment to the sharing of knowledge and resources through international partnerships is critical. But partnerships that merely introduce western medical techniques and protocols to low resource settings, without heeding the local contexts, are misguided and unsustainable. Forming partnerships with mutual respect, shared vision, and collaborative effort is needed to ensure that all parties, irrespective of whether they belong to resource rich or resource poor settings, learn from each other so that meaningful and sustained system strengthening can take place. Methods In this paper, we describe the partnership building model of an international NGO, Kybele, which is committed to achieving childbirth safety through sustained partnerships in low resource settings. The Kybele model adapts generic stages of successful partnerships documented in the literature to four principles relevant to Kybele’s work. A multiple-case study approach is used to demonstrate how the model is applied in different country settings. Results The four principle of Kybele’s partnership model are robust drivers of successful partnerships in diverse country settings. Conclusions Much has been written about the need for multi-country partnerships to achieve sustainable outcomes in global health, but few papers in the literature describe how this has been achieved in practice. A strong champion, support and engagement of stakeholders, co-creation of solutions with partners, and involvement of partners in the delivery of solutions are all requirements for successful and sustained partnerships

Solitonic supersymmetry restoration

Q-balls are a possible feature of any model with a conserved, global U(1) symmetry and no massless, charged scalars. It is shown that for a broad class of models of metastable supersymmetry breaking they are extremely influential on the vacuum lifetime and make seemingly viable vacua catastrophically short lived. A net charge asymmetry is not required as there is often a significant range of parameter space where statistical fluctuations alone are sufficient. This effect is examined for two supersymmetry breaking scenarios. It is found that models of minimal gauge mediation (which necessarily have a messenger number U(1)) undergo a rapid, supersymmetry restoring phase transition unless the messenger mass is greater than 10^8 GeV. Similarly the ISS model, in the context of direct mediation, quickly decays unless the perturbative superpotential coupling is greater than the Standard Model gauge couplings.Comment: 17 pages, 3 figures, minor comments added, accepted for publication in JHE