Economic evaluation of ASCOT-BPLA: Antihypertensive treatment with an amlodipine-based regimen is cost-effective compared to an atenolol-based regimen

Copyright © 2010 BMJ Publishing Group Ltd & British Cardiovascular Society. Internal or personal use of this material is permitted. However, permission to reprint/republish this material must be obtained from the Publisher.Objective: To compare the cost effectiveness of an amlodipine-based strategy and an atenolol-based strategy in the treatment of hypertension in the UK and Sweden. Design: A prospective, randomised trial complemented with a Markov model to assess long-term costs and health effects. Setting: Primary care. Patients: Patients with moderate hypertension and three or more additional risk factors. Interventions: Amlodipine 5–10 mg with perindopril 4–8 mg added as needed or atenolol 50–100 mg with bendroflumethiazide 1.25–2.5 mg and potassium added as needed Main outcome measures: Cost per cardiovascular event and procedure avoided, and cost per quality-adjusted life-year gained. Results: In the UK, the cost to avoid one cardiovascular event or procedure would be €18 965, and the cost to gain one quality-adjusted life-year would be €21 875. The corresponding figures for Sweden were €13 210 and €16 856. Conclusions: Compared with the thresholds applied by NICE and in the Swedish National Board of Health and Welfare’s Guidelines for Cardiac Care, an amlodipine-based regimen is cost effective for the treatment of hypertension compared with an atenolol-based regimen in the population studied.The study was supported by the principal funding source, Pfizer, New York, USA

American Association of University Women: Branch Operations Data Modeling Case

A nationally prominent woman’s advocacy organization is featured in this case study. The scenario may be used as a teaching case, an assignment, or a project in systems analysis and design as well as database design classes. Students are required to document the system operations and requirements, apply logical data modeling concepts, and design an appropriate data structure for a relational database. The case focuses on a membership administration system with several extended components to keep track of entities such as the Board of Directors and branch committees. The case has been used successfully in the classroom at both individual and group levels. Feedback from students and instructors who have utilized the case indicate that it is an effective instrument that provides a realistic illustration of real-world data modeling without being unreasonably complex. Teaching notes and a suggested solution including data flow diagrams, an entity-relationship diagram (ERD), and a data dictionary are available through the JISE web site

Lowveld Savanna Bush Cutting Alters Tree-Grass Interactions

Savannas are characterized by the coexistence of trees and grasses, and their interactions are modified by water availability and herbivore activity. Many savannas are experiencing bush encroachment, resulting in reduced herbaceous productivity and shifts in savanna structure. This study aims to understand the effects of tree density and tree cutting on herbaceous productivity, water use, and herbivore abundance in a mopane-dominated lowveld savanna. We present data from a 4-year mopane-cutting experiment in the Mthimkhulu Game Reserve bordering Kruger National Park (South Africa). We established three 60x60 m plots for experimental manipulation where mopane stems and re-sprouting shoots were cut 2-3 times per year (2015-2019). We established transects within the plots to measure grass productivity and herbivore activity (counts of tracks and dung). Additionally, we measured root non-structural carbohydrates within cut and uncut mopane to assess the impact of cutting on energy storage. We used stable isotopes of xylem and soil water at multiple depths to infer changes in functional water use of coexisting mopane and grass species. Cutting had limited effects on mopane survival during this 5-year period, but re-sprouting stems had reduced height and starch concentrations than uncut trees. Cutting mopane resulted in shallower-soil water use in 2017 and tended to increase variability in root water uptake across multiple soil depths. The cut treatment tended to have higher grass cover and productivity than the control treatment by the 3rd growing season. Visitation of grazers increased in the cut plots relative to uncut plots by 2017, suggesting increased grass cover promotes grazer visitation. These results emphasize the importance of top-down drivers on savanna tree cover and the impacts of bush encroachment on grass biomass and herbivore presence. We suggest repeated cutting or browsing pressure is needed to suppress woody cover and increase grass production in lowveld savannas

Modeling Unobserved Consideration Sets for Household Panel Data

We propose a new method to model consumers' consideration and choice processes. We develop a parsimonious probit type model for consideration and a multinomial probit model for choice, given consideration. Unlike earlier models of consideration ours is not prone to the curse of dimensionality, while we allow for very general structures of unobserved dependence in consideration among brands. In addition, our model allows for state dependence and marketing mix effects on consideration. Unique to this study is that we attempt to establish the validity of existing practice to infer consideration sets from observed choices in panel data. To this end, we use data collected in an on-line choice experiment involving interactive supermarket shelves and post-choice questionnaires to measure the choice protocol and stated consideration levels. We show with these experimental data that underlying consideration sets can be successfully retrieved from choice data alone and that there is substantial convergent validity of the stated and inferred consideration sets. We further find that consideration is a function of point-of-purchase marketing actions such as display and shelf space, and of consumer memory for recent choices. Next, we estimate the model on IRI panel data. We have three main results. First, compared with the single-stage probit model, promotion effects are larger and are inferred with smaller variances when they are included in the consideration stage of the two-stage model. Promotion effects are significant only in the two-stage model that includes consideration, whereas they are not in a single-stage choice model. Second, the price response curves of

JOINT LOADING OF LOWER EXTREMITIES DURING NORDIC WALKING COMPARED TO WALKING BASED ON KINETIC AND KINEMATIC DATA

Based on a higher cardio-pulmonary and cardio-vascular benefit and a promised reduction of mechanical load of the musculoskeletal system Nordic Walking (NW) shows an increased market potential. The present study should investigate whether there are differences in joint loading of lower extremities using an inverse dynamics approach between NW and Walking. In this experiment 15 subjects participated, who were already experienced with the NW technique. Kinematic data were collected using a 6-camera 3-dimensional Vicon System. Kinetic data were recorded using a Kistler force plate. Based on the findings it is to summarize, that the use of the poles during NW, performing the diagonal technique, do not lead to a reduction of joint loading of the lower extremities compared to Walking in general. Moreover for NW a higher knee joint loading during landing could be observed which is caused by the specific NW technique

Improved ventricular function during inhalation of PGI(2) aerosol partly relies on enhanced myocardial contractility

Inhaled prostacyclin (PGI(2)) aerosol induces selective pulmonary vasodilation. Further, it improves right ventricular ( RV) function, which may largely rely on pulmonary vasodilation, but also on enhanced myocardial contractility. We investigated the effects of the inhaled PGI(2) analogs epoprostenol (EPO) and iloprost (ILO) on RV function and myocardial contractility in 9 anesthetized pigs receiving aerosolized EPO (25 and 50 ng center dot kg(-1) center dot min(-1)) and, consecutively, ILO (60 ng center dot kg(-1) center dot min(-1)) for 20 min each. We measured pulmonary artery pressure ( PAP), RV ejection fraction (RVEF) and RV end-diastolic-volume (RV-EDV), and left ventricular end-systolic pressure-volume-relation (end-systolic elastance, E-es). EPO and ILO reduced PAP, increased RVEF and reduced RVEDV. E-es was enhanced during all doses tested, which reached statistical significance during EPO25ng and ILO, but not during EPO50ng. PGI(2) aerosol enhances myocardial contractility in healthy pigs, contributing to improve RV function. Copyright (C) 2005 S. Karger AG, Basel

Retrieving unobserved consideration sets from household panel data

We propose a new model to describe consideration, consisting of a multivariate probit model component for consideration and a multinomial probit model component for choice, given consideration. The approach allows one to analyze stated consideration set data, revealed consideration set (choice) data or both, while at the same time it allows for unobserved dependence in consideration among brands. In addition, the model accommodates different effects of the marketing mix on consideration and choice, an error process that is correlated over time, and unobserved consumer heterogeneity in both processes. We attempt to establish the validity of existing practice to infer consideration sets from observed choices in panel data. To this end, we collect data in an on-line choice experiment involving interactive supermarket shelves and post-choice questionnaires to measure the choice protocol and stated consideration levels. We show with these experimental data that underlying consideration sets can be reliably retrieved from choice data alone. Next, we estimate the model on IRI panel data. We have two main results. First, compared with the single-stage multinomial probit model, promotion effects are larger when they are included in the consideration stage of the two-stage model. Second, we find that consideration of brands does not covary greatly across brands once we account for observed effects

Identification of Swine Salmonella serotypes Using Pulsed-field Gel Electrophoresis of Conserved Xba1 Fragments

Swine Salmonella isolates (n=674) from various locations throughout the United States and Canada were analyzed via pulsed-field gel electrophoresis (PFGE) with Xba1. PFGE subtypes were analyzed by cluster analysis and compared to conventional serotyping results. The analysis showed a correlation of serotype to PFGE subtype. In addition, conserved fragments were identified within the restriction patterns that were unique to each serotype. PFGE using Xba1 restriction provides a screening method for identifying swine Salmonella serotypes

ASCORE: an up-to-date cardiovascular risk score for hypertensive patients reflecting contemporary clinical practice developed using the (ASCOT-BPLA) trial data.

A number of risk scores already exist to predict cardiovascular (CV) events. However, scores developed with data collected some time ago might not accurately predict the CV risk of contemporary hypertensive patients that benefit from more modern treatments and management. Using data from the randomised clinical trial Anglo-Scandinavian Cardiac Outcomes Trial-BPLA, with 15 955 hypertensive patients without previous CV disease receiving contemporary preventive CV management, we developed a new risk score predicting the 5-year risk of a first CV event (CV death, myocardial infarction or stroke). Cox proportional hazard models were used to develop a risk equation from baseline predictors. The final risk model (ASCORE) included age, sex, smoking, diabetes, previous blood pressure (BP) treatment, systolic BP, total cholesterol, high-density lipoprotein-cholesterol, fasting glucose and creatinine baseline variables. A simplified model (ASCORE-S) excluding laboratory variables was also derived. Both models showed very good internal validity. User-friendly integer score tables are reported for both models. Applying the latest Framingham risk score to our data significantly overpredicted the observed 5-year risk of the composite CV outcome. We conclude that risk scores derived using older databases (such as Framingham) may overestimate the CV risk of patients receiving current BP treatments; therefore, 'updated' risk scores are needed for current patients