Secondary prevention of renal and cardiovascular disease: Results of a renal and cardiovascular treatment program in an Australian aboriginal community

Australian Aborigines are experiencing an epidemic of renal and cardiovascular disease. In late 1995 we introduced a treatment program into the Tiwi community, which has a three- to fivefold increase in death rates and a recent annual incidence of treated ESRD of 2760 per million. Eligible for treatment were people with hypertension, diabetics with micro or overt albuminuria, and all people with overt albuminuria. Treatment centered around use of perindopril (Coversyl, Servier), with other agents added to reach BP goals; attempts to control glucose and lipid levels; and health education. Thirty percent of the adult population, or 267 people, were enrolled, with a mean follow up of 3.39 yr. Clinical parameters were followed every 6 mo, and rates of terminal endpoints were compared with those of 327 historical controls matched for baseline disease severity, followed in the pretreatment program era. There was a dramatic reduction in BP in the treatment group, which was sustained through 3 yr of treatment. Albuminuria and GFR stabilized or improved. Rates of natural deaths were reduced by an estimated 50% (P = 0.012); renal deaths were reduced by 57% (P = 0.038); and nonrenal deaths by 46% (P = 0.085). Survival benefit was suggested at all levels of overt albuminuria, and regardless of diabetes status, baseline BP, or prior administration of angiotensin converting enzyme inhibitors (ACEI). No significant benefit was apparent among people without overt albuminuria, nor among those with GFR less than 60 ml/min. An estimated 13 renal deaths and 10 nonrenal deaths were prevented, with the number-needed-to-treat to avoid one terminal event of only 11.6. Falling deaths and renal failure in the whole community support these estimates. The program was extremely cost-effective. Programs like this should be introduced to all high-risk communities as a matter of urgency.

Chloride as a signature indicator of soil textural and hydrologic stratigraphies in variable charge deep profiles

Soil properties that influence water movement through profiles are important for determining flow paths, reactions between soil and solute, and the ultimate destination of solutes. This is particularly important in high rainfall environments. For highly weathered deep profiles, we hypothesize that abrupt changes in the distribution of the quotient [QT = (silt + sand)/clay] reflect the boundaries between textural units or textural (TS) and hydrologic (HS) stratigraphies. As a result, QT can be used as a parameter to characterize TS and as a surrogate for HS. Secondly, we propose that if chloride distributions were correlated with QT, under non-limiting anion exchange, then chloride distributions can be used as a signature indicator of TS and HS. Soil cores to a depth of 12.5 in were taken from 16 locations in the wet tropical Johnstone River catchment of northeast Queensland, Australia. The cores belong to nine variable charge soil types and were under sugarcane (Saccharun officinarum-S) production, which included the use of potassium chloride, for several decades. The cores were segmented at I m depth increments and subsamples were analysed for chloride, pH, soil water content (theta), clay, silt and sand contents. Selected bores were capped to serve as piezometers to monitor groundwater dynamics. Depth incremented QT, theta and chloride correlated, each individually, significantly with the corresponding profile depth increments, indicating the presence of textural, hydrologic and chloride gradients in profiles. However, rapid increases in QT down the profile indicated abrupt changes in TS, suggesting that QT can be used as a parameter to characterize TS and as a surrogate for HS. Abrupt changes in chloride distributions were similar to QT, suggesting that chloride distributions can be used as a signature indicator of QT (TS) and HS. Groundwater data indicated that chloride distributions depended, at least partially, on groundwater dynamics, providing further support to our hypothesis that chloride distribution can be used as a signature indicator of HS. Copyright (c) 2005 John Wiley & Sons, Ltd.

On aggregation issues in spatial data management

Large amounts of information can be overwhelming and costly to process, especially when transmitting data over a network. A typical modern Geographical Information System (GIS) brings all types of data together based on the geographic component of the data and provides simple point-and-click query capabilities as well as complex analysis tools. Querying a Geographical Information System, however, can be prohibitively expensive due to the large amounts of data which may need to be processed. Since the use of GIS technology has grown dramatically in the past few years, there is now a need more than ever, to provide users with the fastest and least expensive query capabilities, especially since an approximated 80 % of data stored in corporate databases has a geographical component. However, not every application requires the same, high quality data for its processing. In this paper we address the issues of reducing the cost and response time of GIS queries by preaggregating data by compromising the data accuracy and precision. We present computational issues in generation of multi-level resolutions of spatial data and show that the problem of finding the best approximation for the given region and a real value function on this region, under a predictable error, in general is "NP-complete.