Warfarin Genotyping Reduces Hospitalization Rates Results From the MM-WES (Medco-Mayo Warfarin Effectiveness Study)

ObjectivesThis study was designed to determine whether genotype testing for patients initiating warfarin treatment will reduce the incidence of hospitalizations, including those due to bleeding or thromboembolism.BackgroundGenotypic variations in CYP2C9and VKORC1have been shown to predict warfarin dosing, but no large-scale studies have prospectively evaluated the clinical effectiveness of genotyping in naturalistic settings across the U.S.MethodsThis national, prospective, comparative effectiveness study compared the 6-month incidence of hospitalization in patients receiving warfarin genotyping (n = 896) versus a matched historical control group (n = 2,688). To evaluate for temporal changes in the outcomes of warfarin treatment, a secondary analysis compared outcomes for 2 external control groups drawn from the same 2 time periods.ResultsCompared with the historical control group, the genotyped cohort had 31% fewer hospitalizations overall (adjusted hazard ratio [HR]: 0.69, 95% confidence interval [CI]: 0.58 to 0.82, p < 0.001) and 28% fewer hospitalizations for bleeding or thromboembolism (HR: 0.72, 95% CI: 0.53 to 0.97, p = 0.029) during the 6-month follow-up period. Findings from a per-protocol analysis were even stronger: 33% lower risk of all-cause hospitalization (HR: 0.67, 95% CI: 0.55 to 0.81, p < 0.001) and 43% lower risk of hospitalization for bleeding or thromboembolism (HR: 0.57, 95% CI: 0.39 to 0.83, p = 0.003) in patients who were genotyped. During the same period, there was no difference in outcomes between the 2 external control groups.ConclusionsWarfarin genotyping reduced the risk of hospitalization in outpatients initiating warfarin. (The Clinical and Economic Impact of Pharmacogenomic Testing of Warfarin Therapy in Typical Community Practice Settings [MHSMayoWarf1]; NCT00830570

Knowledge-Based Synthesis of Distributed Systems Using Event Structures

To produce a program guaranteed to satisfy a given specification one can synthesize it from a formal constructive proof that a computation satisfying that specification exists. This process is particularly effective if the specifications are written in a high-level language that makes it easy for designers to specify their goals. We consider a high-level specification language that results from adding knowledge to a fragment of Nuprl specifically tailored for specifying distributed protocols, called event theory. We then show how high-level knowledge-based programs can be synthesized from the knowledge-based specifications using a proof development system such as Nuprl. Methods of Halpern and Zuck then apply to convert these knowledge-based protocols to ordinary protocols. These methods can be expressed as heuristic transformation tactics in Nuprl.Comment: A preliminary version of this paper appeared in Proceedings of the 11th International Conference on Logic for Programming, Artificial Intelligence, and Reasoning LPAR 2004, pp. 449-46

The Measurement of Rent Inflation

Providing for shelter represents a large portion of the typical household budget. Accordingly, rent, paid either to a landlord or to oneself as an owner-occupant, has a large weight in the CPI and in the personal consumption expenditures deflator, resulting in substantial scrutiny of how tenant rent and owners' equivalent rent are measured in these price indexes. In this paper, we describe how the Bureau of Labor Statistics (BLS) estimates tenant rent and owners' equivalent rent. We then estimate alternative inflation rates for tenant rent and owners' equivalent rent based on American Housing Survey data, following BLS methodology as closely as possible. Our alternative tenant rent inflation series is generally consistent with the corresponding BLS series. However, our alternative owners' equivalent rent inflation series is consistently lower than the corresponding BLS series by an amount large enough to have a significant effect on the overall inflation rate. This result is driven by the inverse relationship between rent inflation and the level of monthly housing cost evident in the American Housing Survey data

Perceived neighborhood safety and incident mobility disability among elders: the hazards of poverty

<p>Abstract</p> <p>Background</p> <p>We investigated whether lack of perceived neighborhood safety due to crime, or living in high crime neighborhoods was associated with incident mobility disability in elderly populations. We hypothesized that low-income elders and elders at retirement age (65 – 74) would be at greatest risk of mobility disability onset in the face of perceived or measured crime-related safety hazards.</p> <p>Methods</p> <p>We conducted the study in the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE), a longitudinal cohort study of community-dwelling elders aged 65 and older who were residents of New Haven, Connecticut in 1982. Elders were interviewed beginning in 1982 to assess mobility (ability to climb stairs and walk a half mile), perceptions of their neighborhood safety due to crime, annual household income, lifestyle characteristics (smoking, alcohol use, physical activity), and the presence of chronic co-morbid conditions. Additionally, we collected baseline data on neighborhood crime events from the New Haven Register newspaper in 1982 to measure local area crime rates at the census tract level.</p> <p>Results</p> <p>At baseline in 1982, 1,884 elders were without mobility disability. After 8 years of follow-up, perceiving safety hazards was associated with increased risk of mobility disability among elders at retirement age whose incomes were below the federal poverty line (HR 1.56, 95% CI 1.02 – 2.37). No effect of perceived safety hazards was found among elders at retirement age whose incomes were above the poverty line. No effect of living in neighborhoods with high crime rates (measured by newspaper reports) was found in any sub-group.</p> <p>Conclusion</p> <p>Perceiving a safety hazard due to neighborhood crime was associated with increased risk of incident mobility disability among impoverished elders near retirement age. Consistent with prior literature, retirement age appears to be a vulnerable period with respect to the effect of neighborhood conditions on elder health. Community violence prevention activities should address perceived safety among vulnerable populations, such as low-income elders at retirement age, to reduce future risks of mobility disability.</p

Between-Person Disparities in the Progression of Late-Life Well-Being

Throughout adulthood and old age, levels of well-being appear to remain relatively stable. In this chapter, we argue that focusing on a phase of life during which this positive picture does not necessarily prevail promises to help us better understand between-person disparities in the progression of late-life well-being. In a first step, we review empirical evidence from the German Socio-Economic Panel and other large-scale longitudinal data sets to demonstrate that ubiquitous reports of a "stability-despite-loss phenomenon" of well-being do not generalize into years of life immediately preceding death. Instead, mean-level representations of the end of life are characterized by a rapid deterioration in well-being. In a second step, we highlight the vast heterogeneity in how people experience the last years and consider the role of biopsychosocial individual difference factors to account for such disparities. The select factors reviewed here include socio-demographic characteristics, cognitive fitness, pathology, and disability. In a third step, we argue that macro-contextual factors such as the social, service, and physical characteristics of the communities and societies people are living and dying in also profoundly shape the nature and progression of individual late-life well-being. Our conceptual reasoning forecasts some of the insights that can be gained by pursuing this line of research, but also underscores the challenges researchers must deal with

Chemo-mechanical interactions in clay: are the Atterberg limits useful?

peer reviewe

Improvements in Asthma Pharmacotherapy and Self-Management: An Example of a Population-Based Disease Management Program

Background and objective: In day-to-day practice, asthma treatment and self-management often fall short of the objectives defined by clinical practice guidelines. The objective of this study was to determine whether a population-based asthma disease management program, using broad-based educational interventions, can have a favorable impact on physician and patient adherence to guidelines-based care. Methods: A longitudinal, before-and-after design was used to evaluate program impacts on pharmacotherapy and health status. Patients with asthma (n = 35 Main outcome measures and results: The percentage of patients who started controller therapy during the study period was significantly higher for the intervention group than the control group (20.7% versus 18.1%, pAsthma, Disease-management-programmes, Self-medication

Clay - leachate interaction: a first insight

peer reviewe