Blood pressure and LDL-cholesterol targets for prevention of recurrent strokes and cognitive decline in the hypertensive patient: design of the European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment randomized trial.

BACKGROUND AND OBJECTIVES: The SBP values to be achieved by antihypertensive therapy in order to maximize reduction of cardiovascular outcomes are unknown; neither is it clear whether in patients with a previous cardiovascular event, the optimal values are lower than in the low-to-moderate risk hypertensive patients, or a more cautious blood pressure (BP) reduction should be obtained. Because of the uncertainty whether 'the lower the better' or the 'J-curve' hypothesis is correct, the European Society of Hypertension and the Chinese Hypertension League have promoted a randomized trial comparing antihypertensive treatment strategies aiming at three different SBP targets in hypertensive patients with a recent stroke or transient ischaemic attack. As the optimal level of low-density lipoprotein cholesterol (LDL-C) level is also unknown in these patients, LDL-C-lowering has been included in the design. PROTOCOL DESIGN: The European Society of Hypertension-Chinese Hypertension League Stroke in Hypertension Optimal Treatment trial is a prospective multinational, randomized trial with a 3 × 2 factorial design comparing: three different SBP targets (1, <145-135; 2, <135-125; 3, <125 mmHg); two different LDL-C targets (target A, 2.8-1.8; target B, <1.8 mmol/l). The trial is to be conducted on 7500 patients aged at least 65 years (2500 in Europe, 5000 in China) with hypertension and a stroke or transient ischaemic attack 1-6 months before randomization. Antihypertensive and statin treatments will be initiated or modified using suitable registered agents chosen by the investigators, in order to maintain patients within the randomized SBP and LDL-C windows. All patients will be followed up every 3 months for BP and every 6 months for LDL-C. Ambulatory BP will be measured yearly. OUTCOMES: Primary outcome is time to stroke (fatal and non-fatal). Important secondary outcomes are: time to first major cardiovascular event; cognitive decline (Montreal Cognitive Assessment) and dementia. All major outcomes will be adjudicated by committees blind to randomized allocation. A Data and Safety Monitoring Board has open access to data and can recommend trial interruption for safety. SAMPLE SIZE CALCULATION: It has been calculated that 925 patients would reach the primary outcome after a mean 4-year follow-up, and this should provide at least 80% power to detect a 25% stroke difference between SBP targets and a 20% difference between LDL-C targets.

National public investment systems in Barbados, Guyana, Jamaica and Trinidad and Tabago

Includes bibliography

The impact of climate change on the water sector in the Caribbean

This study econometrically analyses the projected impact of climate change on the water sector of nine Caribbean countries to 2100: Aruba, Barbados, Dominican Republic, Guyana, Montserrat, Jamaica, Netherlands Antilles, Saint Lucia, and Trinidad and Tobago. Overall, all countries, with the exception of Trinidad and Tobago, are expected to suffer aggregate losses as result of climate change in the early periods ca. 2020 under one or more scenarios. Over time, some countries experience declining negative impacts, as in the case of Guyana under the B2 scenario. Some countries, such as the Dominican Republic, is projected to suffer increasing losses under the B2 scenario and, for others, the impacts do not follow a defined trend. The A2 scenario offers the best outcome for all countries, except Jamaica (where BAU is most desirable), Montserrat (which performs most poorly under the A2 scenario), and the Netherlands Antilles, which does best under the B2 case. Overall, relative to 2006, the total demand for water in the Caribbean is expected to fall by 2030 by 11.3% to approximately 12,967 million cubic meters. This is due to the expected fall in agricultural water demand by approximately 36% in that period. However, by 2050, total water demand for the Caribbean will again exceed the 2006 level by approximately 4% to 14,896.33 106 m3. By 2100, water demand will increase almost fivefold to approximately 69,233.69 106 m3. Climate change is expected to affect all countries in the Caribbean. In some cases, there will be positive impacts that may continue to increase over time and, in other cases, the impact will be negative and worsen over time. Overall, the agricultural sector is expected to suffer the worst losses over any scenario, whilst growth in the industrial sectors is expected to be significant and contribute the most to increasing water demand over time.

Causes and consequences of low rates of specialisation in science and technology in CDCC member countries

The importance of science and technology (S&T) in Small Island Developing States (SIDS) is clearly articulated in Chapter XI, paragraphs 57, 58, 61 and 62 of the Mauritius Strategy for the Further Implementation of the Programme of Action for Sustainable Development of Small Island Developing States (MSI). At the regional level, the Heads of Government of the Caribbean Community (CARICOM) noted the challenge that CARICOM member States face in competing in this new international economic environment in which the impact of scientific and technological change has created a knowledge-based global economy. Given the importance of S&T to development of Caribbean SIDS, the Economic Commission for Latin America and the Caribbean (ECLAC) Subregional Headquarters for the Caribbean embarked on a study to determine the causes and consequences of low rates of specialisation in S&T with a view to making recommendations for development of strategies for addressing these challenges. Data on postgraduate (Master of Science, Master of Philosophy and Doctor of Philosophy) enrolment and graduation in agriculture, engineering and the sciences from the three campuses of the University of the West Indies (UWI) as well as from the University of Technology in Jamaica and the University of Trinidad and Tobago (UTT) were examined and analysed. Face-to-face interviews were also held with key personnel from these institutions and a questionnaire was also served to individuals in key institutions. Results of the study revealed that although the number of students enrolled in higher degree programmes has increased in absolute terms, they are decreasing in relative terms. However, enrolment in agriculture has indeed declined while enrolment rates in engineering, although increasing, were not significantly high. Market forces have proved to be a main reason for this trend while facilities for the conduct and supervision of cutting-edge research, the disconnect between science and industry and societal labelling of scientists as “misfits” are also contributing to the situation. This has resulted in a reduced desire by students at all levels of the school system and faculty to be involved in S&T; lack of innovation; a better staffed private, as compared with public, sector; and poor remuneration in science-based employment. There also appears to be a gender bias in enrolment with more males than females being enrolled in engineering while the opposite is apparent in agriculture and the sciences. Recommendations for remedying this situation range from increasing investment in S&T, creating linkages between science and industry as well as with the international community, raising awareness of the value of S&T at all levels of the education system to informing policy to stimulate the science – innovation interface so as to promote intellectual property rights.

Perfil antropométrico, aptidão motora e aeróbia de jogadores de futebol profissionais e juniores de Trinidad e Tobago

There is little information on Caribbean soccer players. Thus, the aim this study was to descriptive and to compare the anthropometric, motor and aerobic fitness profile between Trinidad and Tobago team professional and junior soccer players. Twenty six soccer players were evaluated (14 professional and 12 junior): anthropometric (height, body mass, BMI, body fat percent), flexibility (sit and reach), velocity (30 m), explosive strength (horizontal and vertical jump), anaerobic power (maximum, mean and minimum power, index of fatigue) and maximum aerobic power. Student Test-t to independent sample was used in statistical analyzes, considering 5% of significance (p<0,05). Results of professional and junior players were, respectively: height (180,6 ± 8,1; 175,0 ± 6,9 cm), body mass (77,1 ± 7,5; 70,6 ± 8,7 kg); BMI (23,6 ± 1,5 / 23,0 ± 1,6 kgm 2 ); body fat (11,9 ± 1,7; 11,6 ± 1,2 %); sitting and reaching (24,9 ± 10,3; 24,9 ± 7,7 cm); velocity (30 m) (4,61 ± 0,14; 4,66 ± 0,15 s); horizontal jump (263,4 ± 14,9; 239,7 ± 12,1 cm); vertical jump (58,7 ± 4,3; 54,6 ± 6,6 cm); maximum power (7,9 ± 0,9; 6,6 ± 0,8 w∙kg-1 ); mean power (6,5 ± 0,7; 5,4 ± 0,9 w∙kg-1 ); minimum power (5,3 ± 0,7; 4,3 ± 1,1 w∙kg-1 ); index of fatigue (33,0 ± 7,9; 34,8 ± 12,8 %); aerobic power (55,0 ± 3,2; 57,2 ± 4,8 ml∙kg-1 ∙min-1 ). Professional players presented higher horizontal jump and maximum, mean and minimum anaerobic power in comparing to the junior players. The highest values of power tests for the lower limbs may be relationship to the longer time of practice in the modality of professional players, which can also indicate a higher level of specialization, which gives priority to the training of power (force and velocity).

American Society of Clinical Oncology/American Society of Hematology clinical practice guideline update on the use of epoetin and darbepoetin in adult patients with cancer

Purpose To update American Society of Clinical Oncology/American Society of Hematology recommendations for use of erythropoiesis-stimulating agents (ESAs) in patients with cancer. Methods An Update Committee reviewed data published between January 2007 and January 2010. MEDLINE and the Cochrane Library were searched. Results The literature search yielded one new individual patient data analysis and four literature-based meta-analyses, two systematic reviews, and 13 publications reporting new results from randomized controlled trials not included in prior or new reviews. Recommendations For patients undergoing myelosuppressive chemotherapy who have a hemoglobin (Hb) level less than 10 g/dL, the Update Committee recommends that clinicians discuss potential harms (eg, thromboembolism, shorter survival) and benefits (eg, decreased transfusions) of ESAs and compare these with potential harms (eg, serious infections, immune-mediated adverse reactions) and benefits (eg, rapid Hb improvement) of RBC transfusions. Individual preferences for assumed risk should contribute to shared decisions on managing chemotherapy-induced anemia. The Committee cautions against ESA use under other circumstances. If used, ESAs should be administered at the lowest dose possible and should increase Hb to the lowest concentration possible to avoid transfusions. Available evidence does not identify Hb levels � 10 g/dL either as thresholds for initiating treatment or as targets for ESA therapy. Starting doses and dose modifications after response or nonresponse should follow US Food and Drug Administration–approved labeling. ESAs should be discontinued after 6 to 8 weeks in nonresponders. ESAs should be avoided in patients with cancer not receiving concurrent chemotherapy, except for those with lower risk myelodysplastic syndromes. Caution should be exercised when using ESAs with chemotherapeutic agents in diseases associated with increased risk of thromboembolic complications. Table 1 lists detailed recommendations. This guideline was developed through a collaboration between the American Society of Clinical Oncology and the American Society of Hematology and has been published jointly by invitation and consent in both Journal of Clinical Oncology and Blood.

[New insights into diagnosis and management of gestational diabetes mellitus: recommendations of the Swiss Society for Endocrinology and Diabetes]

Physiology and current knowledge about gestational diabetes which led to the adoption of new diagnostic criterias and blood glucose target levels during pregnancy by the Swiss Society for Endocrinology and Diabetes are reviewed. The 6th International Workshop Conference on Gestational Diabetes mellitus in Pasedena (2008) defined new diagnostic criteria based on the results of the HAPO-Trial. These criteria were during the ADA congress in New Orleans in 2009 presented. According to the new criteria there is no need for screening, but all pregnant women have to be tested with a 75 g oral glucose tolerance test between the 24th and 28th week of pregnancy. The new diagnostic values are very similar to the ones previously adopted by the ADA with the exception that only one out of three values has to be elevated in order to make the diagnosis of gestational diabetes. Due to this important difference it is very likely that gestational diabetes will be diagnosed more frequently in the future. The diagnostic criteria are: Fasting plasma glucose > or = 5.1 mmol/l, 1-hour value > or = 10.0 mmol/l or 2-hour value > or = 8.5 mmol/l. Based on current knowledge and randomized trials it is much more difficult to define glucose target levels during pregnancy. This difficulty has led to many different recommendations issued by diabetes societies. The Swiss Society of Endocrinology and Diabetes follows the arguments of the International Diabetes Federation (IDF) that self-blood glucose monitoring itself lacks precision and that there are very few randomized trials. Therefore, the target levels have to be easy to remember and might be slightly different in mmol/l or mg/dl. The Swiss Society for Endocrinology and Diabetes adopts the tentative target values of the IDF with fasting plasma glucose values < 5.3 mM and 1- and 2-hour postprandial (after the end of the meal) values of < 8.0 and 7.0 mmol/l, respectively. The last part of these recommendations deals with the therapeutic options during pregnancy (nutrition, physical exercise and pharmaceutical treatment). If despite lifestyle changes the target values are not met, approximately 25 % of patients have to be treated pharmaceutically. Insulin therapy is still the preferred treatment option, but metformin (and as an exception glibenclamide) can be used, if there are major hurdles for the initiation of insulin therapy.

Prophylaxis of infectious complications with colony-stimulating factors in adult cancer patients undergoing chemotherapy-evidence-based guidelines from the Infectious Diseases Working Party AGIHO of the German Society for Haematology and Medical Oncology (DGHO).

BACKGROUND Current evidence on myelopoietic growth factors is difficult to overview for the practicing haematologist/oncologist. International guidelines are sometimes conflicting, exclude certain patient groups, or cannot directly be applied to the German health system. This guideline by the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Medical Oncology (DGHO) gives evidence-based recommendations for the use of G-CSF, pegylated G-CSF, and biosimilars to prevent infectious complications in cancer patients undergoing chemotherapy, including those with haematological malignancies. METHODS We systematically searched and evaluated current evidence. An expert panel discussed the results and recommendations. We then compared our recommendations to current international guidelines. RESULTS We summarised the data from eligible studies in evidence tables, developed recommendations for different entities and risk groups. CONCLUSION Comprehensive literature search and expert panel consensus confirmed many key recommendations given by international guidelines. Evidence for growth factors during acute myeloid leukaemia induction chemotherapy and pegfilgrastim use in haematological malignancies was rated lower compared with other guidelines.

Gulf of Mexico and Caribbean Sea Region, ca. 1715 (Raster Image)

This layer is a georeferenced raster image of the historic paper map entitled: A map of the West-Indies or the islands of America in the North Sea : with ye adjacent countries, explaning [sic] what belongs to Spain, England, France, Holland &c. also ye trade winds, and ye several tracts made by ye galeons and flota from place to place : according to ye newest and most exact observations, by Herman Moll, geographer. It was printed for Tho. Bowles in St. Pauls Church Yard and John Bowles at the Black Horse in Cornhill ca. 1715. Scale [ca. 1:4,300,000]. Covers the Gulf of Mexico and Caribbean Sea Region including parts of southern United States, Mexico, Central America, West Indies, and northern South America.The image inside the map neatline is georeferenced to the surface of the earth and fit to the North American Lambert Conformal Conic coordinate system. All map collar and inset information is also available as part of the raster image, including any inset maps, profiles, statistical tables, directories, text, illustrations, index maps, legends, or other information associated with the principal map. This map shows features such as drainage, cities and other human settlements, territorial boundaries, shoreline features, and more. Relief shown pictorially. Includes also historical notes and insets.This layer is part of a selection of digitally scanned and georeferenced historic maps from the Harvard Map Collection. These maps typically portray both natural and manmade features. The selection represents a range of originators, ground condition dates, scales, and map purposes.

Dictionarium scoto-celticum : a dictionary of the Gaelic language; comprising an ample vocabulary of Gaelic words ... with their signification and various meanings in English and Latin ... and vocabularies of Latin and English words with their translation into Gaelic. To which are prefixed, an introduction explaining the nature, objects and sources of the work, and a compendium of Gaelic grammar.

Edited by Macintosh Mackay.

The Impact of Globalization and Corruption on Extraordinary Wealth: An Empirical Analysis

The billionaires of the world attract significant attention from the media and the public. The popular press is full of books selling formulas on how to become rich. Surprisingly, only a limited number of studies have explored empirically the determinants of extraordinary wealth. Using a large data set we explore whether globalization and corruption affect extreme wealth accumulation. We find evidence that an increase in globalization increases super-richness. In addition, we also find that an increase in corruption leads to an increase in the creation of super fortune. This supports the argument that in kleptocracies large sums are transferred into the hands of a small group of individuals.

Shifting interpretations of interiors and buildings: the impact of colour

The ability of a designer – for example, interior designer, architect, landscape architect, etc. – to design for a particular target group (user and/or clients) is potentially enhanced through more targeted studies relating colour in situ. The study outlined in this paper involved participant responses to five achromatic scenes of different built environments prior to viewing the same scenes in colour. Importantly, in this study the participants, who were young designers, came to realise that colour potentially holds the power to impact on the identity of an architectural form, an interior space and/or particular elements such as doorways, furniture settings, etc., as well as influence atmosphere. Prior to discussing the study, a selection of other research, which links colour to meaning and emotions, introduces how people understand and/or feel in relation to colour. For example, yellow is said to be connected to happiness; or red evokes feelings of anger. Secondly, the need for spatial designers to understand colour in context is raised. An overview of the study is then provided. It was found that the impact of colour includes a shift in perception of aspects such as its atmosphere and youthfulness. Through studio/class discussions it was also noted the predicted age of the place, the function, and in association, the potential users when colour was added (or deleted) were often challenged.

Interaction of myxomatosis and Rabbit Haemorrhagic Disease in wild rabbit

Increasing resistance of rabbits to myxomatosis in Australia has led to the exploration of Rabbit Haemorrhagic Disease, also called Rabbit Calicivirus Disease (RCD) as a possible control agent. While the initial spread of RCD in Australia resulted in widespread rabbit mortality in affected areas, the possible population dynamic effects of RCD and myxomatosis operating within the same system have not been properly explored. Here we present early mathematical modelling examining the interaction between the two diseases. In this study we use a deterministic compartment model, based on the classical SIR model in infectious disease modelling. We consider, here, only a single strain of myxomatosis and RCD and neglect latent periods. We also include logistic population growth, with the inclusion of seasonal birth rates. We assume there is no cross-immunity due to either disease. The mathematical model allows for the possibility of both diseases to be simultaneously present in an individual, although results are also presented for the case where co infection is not possible, since co-infection is thought to be rare and questions exist as to whether it can occur. The simulation results of this investigation show that it is a crucial issue and should be part of future field studies. A single simultaneous outbreak of RCD and myxomatosis was simulated, while ignoring natural births and deaths, appropriate for a short timescale of 20 days. Simultaneous outbreaks may be more common in Queensland. For the case where co-infection is not possible we find that the simultaneous presence of myxomatosis in the population suppresses the prevalence of RCD, compared to an outbreak of RCD with no outbreak of myxomatosis, and thus leads to a less effective control of the population. The reason for this is that infection with myxomatosis removes potentially susceptible rabbits from the possibility of infection with RCD (like a vaccination effect). We found that the reduction in the maximum prevalence of RCD was approximately 30% for an initial prevalence of 20% of myxomatosis, for the case where there was no simultaneous outbreak of myxomatosis, but the peak prevalence was only 15% when there was a simultaneous outbreak of myxomatosis. However, this maximum reduction will depend on other parameter values chosen. When co-infection is allowed then this suppression effect does occur but to a lesser degree. This is because the rabbits infected with both diseases reduces the prevalence of myxomatosis. We also simulated multiple outbreaks over a longer timescale of 10 years, including natural population growth rates, with seasonal birth rates and density dependent(logistic) death rates. This shows how both diseases interact with each other and with population growth. Here we obtain sustained outbreaks occurring approximately every two years for the case of a simultaneous outbreak of both diseases but without simultaneous co-infection, with the prevalence varying from 0.1 to 0.5. Without myxomatosis present then the simulation predicts RCD dies out quickly without further introduction from elsewhere. With the possibility of simultaneous co-infection of rabbits, sustained outbreaks are possible but then the outbreaks are less severe and more frequent (approximately yearly). While further model development is needed, our work to date suggests that: 1) the diseases are likely to interact via their impacts on rabbit abundance levels, and 2) introduction of RCD can suppress myxomatosis prevalence. We recommend that further modelling in conjunction with field studies be carried out to further investigate how these two diseases interact in the population.

Source apportionment of airborne particulate matter : an overview of Australian and New Zealand studies

Despite the existence of air quality guidelines in Australia and New Zealand, the concentrations of particulate matter have exceeded these guidelines on several occasions. To identify the sources of particulate matter, examine the contributions of the sources to the air quality at specific areas and estimate the most likely locations of the sources, a growing number of source apportionment studies have been conducted. This paper provides an overview of the locations of the studies, salient features of the results obtained and offers some perspectives for the improvement of future receptor modelling of air quality in these countries. The review revealed that because of its advantages over alternative models, Positive Matrix Factorisation (PMF) was the most commonly applied model in the studies. Although there were differences in the sources identified in the studies, some general trends were observed. While biomass burning was a common problem in both countries, the characteristics of this source varied from one location to another. In New Zealand, domestic heating was the highest contributor to particle levels on days when the guidelines were exceeded. On the other hand, forest back-burning was a concern in Brisbane while marine aerosol was a major source in most studies. Secondary sulphate, traffic emissions, industrial emissions and re-suspended soil were also identified as important sources. Some unique species, for example, volatile organic compounds and particle size distribution were incorporated into some of the studies with results that have significant ramifications for the improvement of air quality. Overall, the application of source apportionment models provided useful information that can assist the design of epidemiological studies and refine air pollution reduction strategies in Australia and New Zealand.