Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Mobile Technology and Public Health Organisational System

Information technology has a transformation power and it enables to conquer complexit. Public health system is very complex. Recently with a wide spread of mobile technology globally, public and private health systems have also seen its rapid growth and integration targeting to reduce the existing complexity, costs, human errors and as a result to simplify the processes, increase health professionals mobility and improve patient outcomes. The aim of this paper is to review the socio-economic impact, benefits and challenges of mobile technology integration into the public health system for all the stakeholders and to identify whether it simplifies their existing problems or “complexifies” them

Algorithmization of Bureaucratic Organizations: Using a Practice Lens to Study How Context Shapes Predictive Policing Systems

The current scientific debate on algorithms in the public sector is dominated by a focus on technology rather than organizational patterns. This paper extends our understanding of these patterns by studying the algorithmization of bureaucratic organizations, which is the process in which an organization rearranges its working routines around the use of algorithms. To explore the algorithmization of bureaucratic organizations, we conducted a comparative empirical analysis of predictive policing in Berlin (Germany) and Amsterdam (Netherlands) through in-depth qualitative research. Our study identified two emergent patterns: the ‘algorithmic cage' (Berlin, more hierarchical control) and the ‘algorithmic colleague' (Amsterdam, room for professional judgment). These patterns result from administrative cultures and reinforce existing patterns of organization. The study highlights that two patterns of algorithmization of government bureaucracy can be identified and that these patterns depend on dominant social norms and interpretations rather than the technological features of algorithmic systems

Differential daytime and night-time stomatal behavior in plants from North American deserts

Night-time stomatal conductance (g night) occurs in many ecosystems, but the g night response to environmental drivers is relatively unknown, especially in deserts. Here, we conducted a Bayesian analysis of stomatal conductance (g) (N=5013) from 16 species in the Sonoran, Chihuahuan, Mojave and Great Basin Deserts (North America). We partitioned daytime g (g day) and g night responses by describing g as a mixture of two extreme (dark vs high light) behaviors. Significant g night was observed across 15 species, and the g night and g day behavior differed according to species, functional type and desert. The transition between extreme behaviors was determined by light environment, with the transition behavior differing between functional types and deserts. Sonoran and Chihuahuan C4 grasses were more sensitive to vapor pressure difference (D) at night and soil water potential (ψ soil) during the day, Great Basin C3 shrubs were highly sensitive to D and ψ soil during the day, and Mojave C3 shrubs were equally sensitive to D and ψ soil during the day and night. Species were split between the exhibition of isohydric or anisohydric behavior during the day. Three species switched from anisohydric to isohydric behavior at night. Such behavior, combined with differential D, ψ soil and light responses, suggests that different mechanisms underlie g day and g night regulation