Use of diuretics and risk of incident gout: a population-based case-control study

OBJECTIVE Use of diuretics has been associated with an increased risk of gout. Data on different types of diuretics are scarce. We undertook this study to investigate the association between use of loop diuretics, thiazide or thiazide-like diuretics, and potassium-sparing agents and the risk of developing incident gout. METHODS We conducted a retrospective population-based case-control analysis using the General Practice Research Database established in the UK. We identified case patients who were diagnosed as having incident gout between 1990 and 2010. One control patient was matched to each case patient for age, sex, general practice, calendar time, and years of active history in the database. We used conditional logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs), and we adjusted for potential confounders. RESULTS We identified 91,530 incident cases of gout and the same number of matched controls. Compared to past use of diuretics from each respective drug class, adjusted ORs for current use of loop diuretics, thiazide diuretics, thiazide-like diuretics, and potassium-sparing diuretics were 2.64 (95% CI 2.47-2.83), 1.70 (95% CI 1.62-1.79), 2.30 (95% CI 1.95-2.70), and 1.06 (95% CI 0.91-1.23), respectively. Combined use of loop diuretics and thiazide diuretics was associated with the highest relative risk estimates of gout (adjusted OR 4.65 [95% CI 3.51-6.16]). Current use of calcium channel blockers or losartan slightly attenuated the risk of gout in patients who took diuretics. CONCLUSION Use of loop diuretics, thiazide diuretics, and thiazide-like diuretics was associated with an increased risk of incident gout, although use of potassium-sparing agents was not.

Poorly controlled type 2 diabetes mellitus is associated with a decreased risk of incident gout: a population-based case-control study

OBJECTIVE The aim of this study was to explore the risk of incident gout in patients with type 2 diabetes mellitus (T2DM) in association with diabetes duration, diabetes severity and antidiabetic drug treatment. METHODS We conducted a case-control study in patients with T2DM using the UK-based Clinical Practice Research Datalink (CPRD). We identified case patients aged ≥18 years with an incident diagnosis of gout between 1990 and 2012. We matched to each case patient one gout-free control patient. We used conditional logistic regression analysis to calculate adjusted ORs (adj. ORs) with 95% CIs and adjusted our analyses for important potential confounders. RESULTS The study encompassed 7536 T2DM cases with a first-time diagnosis of gout. Compared to a diabetes duration <1 year, prolonged diabetes duration (1-3, 3-6, 7-9 and ≥10 years) was associated with decreased adj. ORs of 0.91 (95% CI 0.79 to 1.04), 0.76 (95% CI 0.67 to 0.86), 0.70 (95% CI 0.61 to 0.86), and 0.58 (95% CI 0.51 to 0.66), respectively. Compared to a reference A1C level of <7%, the risk estimates of increasing A1C levels (7.0-7.9, 8.0-8.9 and ≥9%) steadily decreased with adj. ORs of 0.79 (95% CI 0.72 to 0.86), 0.63 (95% CI 0.55 to 0.72), and 0.46 (95% CI 0.40 to 0.53), respectively. Neither use of insulin, metformin, nor sulfonylureas was associated with an altered risk of incident gout. CONCLUSIONS Increased A1C levels, but not use of antidiabetic drugs, was associated with a decreased risk of incident gout among patients with T2DM.

BitWorker, a Decentralized Distributed Computing System based on BitTorrent

In this paper we present BitWorker, a platform for community distributed computing based on BitTorrent. Any splittable task can be easily specified by a user in a meta-information task file, such that it can be downloaded and performed by other volunteers. Peers find each other using Distributed Hash Tables, download existing results, and compute missing ones. Unlike existing distributed computing schemes relying on centralized coordination point(s), our scheme is totally distributed, therefore, highly robust. We evaluate the performance of BitWorker using mathematical models and real tests, showing processing and robustness gains. BitWorker is available for download and use by the community.

Association of hormone therapy and incident gout: population-based case-control study

OBJECTIVE This study aims to assess the odds of developing incident gout in association with the use of postmenopausal estrogen-progestogen therapy, according to type, timing, duration, and route of administration of estrogen-progestogen therapy. METHODS We conducted a retrospective population-based case-control analysis using the United Kingdom-based Clinical Practice Research Datalink. We identified women (aged 45 y or older) who had a first-time diagnosis of gout recorded between 1990 and 2010. We matched one female control with each case on age, general practice, calendar time, and years of active history in the database. We used multivariate conditional logistic regression to calculate odds ratios (ORs) with 95% CIs (adjusted for confounders). RESULTS The adjusted OR for gout with current use of oral formulations of opposed estrogens (estrogen-progestogen) was 0.69 (95% CI, 0.56-0.86) compared with never use. Current use was associated with a decreased OR for gout in women without renal failure (adjusted OR, 0.71; 95% CI, 0.57-0.87) and hypertension (adjusted OR, 0.62; 95% CI, 0.44-0.87) compared with never use. Tibolone was associated with a decreased OR for gout (adjusted OR, 0.77; 95% CI, 0.63-0.95) compared with never use. Estrogens alone did not alter the OR for gout. CONCLUSIONS Current use of oral opposed estrogens, but not unopposed estrogens, is associated with a decreased OR for incident gout in women without renal failure and is more pronounced in women with hypertension. Use of tibolone is associated with a decreased OR for incident gout. The decreased OR for gout may be related to the progestogen component rather than the estrogen component.

ADAMTS13 gene variants and function in women with preeclampsia: a population- based nested case- control study from the HUNT Study.

INTRODUCTION Known genetic variants with reference to preeclampsia only explain a proportion of the heritable contribution to the development of this condition. The association between preeclampsia and the risk of cardiovascular disease later in life has encouraged the study of genetic variants important in thrombosis and vascular inflammation also in relation to preeclampsia. The von Willebrand factor-cleaving protease, ADAMTS13, plays an important role in micro vascular thrombosis, and partial deficiencies of this enzyme have been observed in association with cardiovascular disease and preeclampsia. However, it remains unknown whether decreased ADAMTS13 levels represent a cause or an effect of the event in placental and cardiovascular disease. METHODS We studied the distribution of three functional genetic variants of ADAMTS13, c.1852C>G (rs28647808), c.4143_4144dupA (rs387906343), and c.3178C>T (rs142572218) in women with preeclampsia and their controls in a nested case-control study from the second Nord-Trøndelag Health Study (HUNT2). We also studied the association between ADAMTS13 activity and preeclampsia, in serum samples procured unrelated in time of the preeclamptic pregnancy. RESULTS No differences were observed in genotype, allele or haplotype frequencies of the different ADAMTS13 variants when comparing cases and controls, and no association to preeclampsia was found with lower levels of ADAMTS13 activity. CONCLUSION Our findings indicate that ADAMTS13 variants and ADAMTS13 activity do not contribute to an increased risk of preeclampsia in the general population.

Dietary patterns and risk of pancreatic cancer in a hospital-based case-control study

Background. It is important to understand the association between diet and risk of pancreatic cancer in order to better understand the etiology of pancreatic cancer.^ Objectives. Describe the dietary patterns of cases of adenocarcinoma of the pancreas and non-cancer controls and evaluate the odds of having a healthy eating pattern among cases and non-cancer controls.^ Design and Methods. An ongoing hospital-based case-control study was conducted in Houston, Texas from 2000-2008 with 678 pancreatic adenocarcinoma cases and 724 controls. Participants completed a food frequency questionnaire and a risk factor questionnaire. Dietary patterns were derived by principal component analysis and associations between dietary patterns and pancreatic cancer risk were assessed using unconditional logistic regression.^ Results. Two dietary patterns were derived: fruit-vegetable and high fat-meat. There were no statistically significant associations between the fruit-vegetable pattern and pancreatic cancer. An inverse association was seen between the high fat-meat pattern and pancreatic cancer risk when comparing those in the upper intake quintile to those scoring in the lowest quintile after adjusting for demographic and risk factor variables (OR=0.67, p=0.03). In sex-stratified analysis adjusted for demographic and risk factor variables, females scoring in the upper intake quintile of the fruit-vegetable pattern had a 49% lower risk of pancreatic cancer compared to females scoring in the lowest quintile (OR=0.51, p=0.03). An inverse relationship was also seen for the high fat-meat pattern when comparing females in the upper intake quintile to females in the lowest quintile (OR=0.50, p=0.03). In males, neither dietary pattern was significantly associated with pancreatic cancer.^ Conclusions. The current findings for the fruit-vegetable pattern are similar to those of previous studies and support the hypothesis that there is an inverse association between a “healthy” diet (comprised of fruits, vegetables, and whole grains) and risk of having pancreatic cancer (in females only). However, the inverse relationship with the high fat-meat pattern and risk of pancreatic cancer is contrary to other results. Further research on dietary patters and pancreatic cancer risk may lead to better understanding of the etiologic cause of pancreatic cancer.^

Association of processed red meat and prostate cancer stage in Mexican-Americans: A population based case-control study

Objective: The objective of this study is to investigate the association between processed and unprocessed red meat consumption and prostate cancer (PCa) stage in a homogenous Mexican-American population. Methods: This population-based case-control study had a total of 582 participants (287 cases with histologically confirmed adenocarcinoma of the prostate gland and 295 age and ethnicity-matched controls) that were all residing in the Southeast region of Texas from 1998 to 2006. All questionnaire information was collected using a validated data collection instrument. Statistical Analysis: Descriptive analyses included Student's t-test and Pearson's Chi-square tests. Odds ratios and 95% confidence intervals were calculated to quantify the association between nutritional factors and PCa stage. A multivariable model was used for unconditional logistic regression. Results: After adjusting for relevant covariates, those who consume high amounts of processed red meat have a non-significant increased odds of being diagnosed with localized PCa (OR = 1.60 95% CI: 0.85 - 3.03) and total PCa (OR = 1.43 95% CI: 0.81 - 2.52) but not for advanced PCa (OR = 0.91 95% CI: 1.37 - 2.23). Interestingly, high consumption of carbohydrates shows a significant reduction in the odds of being diagnosed with total PCa and advanced PCa (OR = 0.43 95% CI: 0.24 - 0.77; OR = 0.27 95% CI: 0.10 - 0.71, respectively). However, consuming high amounts of energy from protein and fat was shown to increase the odds of being diagnosed with advanced PCa (OR = 4.62 95% CI: 1.69 - 12.59; OR = 2.61 95% CI: 1.04 - 6.58, respectively). Conclusion: Mexican-Americans who consume high amounts of energy from protein and fat had increased odds of being diagnosed with advanced PCa, while high amounts of carbohydrates reduced the odds of being diagnosed with total and advanced PCa.^

Code and readme of a MATLAB-based graphical user interface program for computing functionals of the geopotential

We present a novel graphical user interface program GrafLab (GRAvity Field LABoratory) for spherical harmonic synthesis (SHS) created in MATLAB®. This program allows to comfortably compute 38 various functionals of the geopotential up to ultra-high degrees and orders of spherical harmonic expansion. For the most difficult part of the SHS, namely the evaluation of the fully normalized associated Legendre functions (fnALFs), we used three different approaches according to required maximum degree: (i) the standard forward column method (up to maximum degree 1800, in some cases up to degree 2190); (ii) the modified forward column method combined with Horner's scheme (up to maximum degree 2700); (iii) the extended-range arithmetic (up to an arbitrary maximum degree). For the maximum degree 2190, the SHS with fnALFs evaluated using the extended-range arithmetic approach takes only approximately 2-3 times longer than its standard arithmetic counterpart, i.e. the standard forward column method. In the GrafLab, the functionals of the geopotential can be evaluated on a regular grid or point-wise, while the input coordinates can either be read from a data file or entered manually. For the computation on a regular grid we decided to apply the lumped coefficients approach due to significant time-efficiency of this method. Furthermore, if a full variance-covariance matrix of spherical harmonic coefficients is available, it is possible to compute the commission errors of the functionals. When computing on a regular grid, the output functionals or their commission errors may be depicted on a map using automatically selected cartographic projection.

Input-Output Based Economic Impact Evaluation System for Small City Development: A Case Study on Saemangeum's Flux City Design

The paper aims to develop a quasi-dynamic interregional input-output model for evaluating the macro-economic impacts of small city development. The features of the model are summarized as follows: (1) the consumption expenditure of households is regarded as an endogenous variable, (2) the technological change is determined by the change of industrial Location Quotient caused by firm's investment activities. (3) a strong feedback function between the city design and the economic analysis is provided. For checking the performance of the model, Saemangeum's Flux City Design Plan is used as the simulation target in our paper.

Patient-based Literature Retrieval and Integration: A Use Case for Diabetes and arterial Hypertension

Specialized search engines such as PubMed, MedScape or Cochrane have increased dramatically the visibility of biomedical scientific results. These web-based tools allow physicians to access scientific papers instantly. However, this decisive improvement had not a proportional impact in clinical practice due to the lack of advanced search methods. Even queries highly specified for a concrete pathology frequently retrieve too many information, with publications related to patients treated by the physician beyond the scope of the results examined. In this work we present a new method to improve scientific article search using patient information. Two pathologies have been used within the project to retrieve relevant literature to patient data and to be integrated with other sources. Promising results suggest the suitability of the approach, highlighting publications dealing with patient features and facilitating literature search to physicians.

Implementation of safety based incentives in Public Private Partnerships (PPPs): an empirical analysis for the case of Spain

Public Private Partnerships (PPPs) are mostly implemented to circumvent budgetary constraints, and to encourage efficiency and quality in the provision of public infrastructure in order to reach social welfare. One of the ways of reaching the latter objective is by the introduction of performance based standards tied to bonuses and penalties to reward or punish the performance of the contractor. This paper focuses on the implementation of safety based incentives in PPPs in such a way that the better the safety outcome the greater larger will be the economic reward to the contractor. The main aim of this paper is to identify whether the incentives to improve road safety in PPPs are ultimately effective in improving safety ratios in Spain. To that end, Poisson and negative binomial regression models have been applied using information of motorways of the Spanish network of 2006. The findings indicate that even though road safety is highly influenced by variables that are not much controllable by the contractor such as the Average Annual Daily Traffic and the percentage of heavy vehicles, the implementation of safety incentives in PPPs has a positive influence in the reduction of fatalities, injuries and accidents.

Contribution to multiuser videoconferencing systems based on cloud computing

Multi-user videoconferencing systems offer communication between more than two users, who are able to interact through their webcams, microphones and other components. The use of these systems has been increased recently due to, on the one hand, improvements in Internet access, networks of companies, universities and houses, whose available bandwidth has been increased whilst the delay in sending and receiving packets has decreased. On the other hand, the advent of Rich Internet Applications (RIA) means that a large part of web application logic and control has started to be implemented on the web browsers. This has allowed developers to create web applications with a level of complexity comparable to traditional desktop applications, running on top of the Operating Systems. More recently the use of Cloud Computing systems has improved application scalability and involves a reduction in the price of backend systems. This offers the possibility of implementing web services on the Internet with no need to spend a lot of money when deploying infrastructures and resources, both hardware and software. Nevertheless there are not many initiatives that aim to implement videoconferencing systems taking advantage of Cloud systems. This dissertation proposes a set of techniques, interfaces and algorithms for the implementation of videoconferencing systems in public and private Cloud Computing infrastructures. The mechanisms proposed here are based on the implementation of a basic videoconferencing system that runs on the web browser without any previous installation requirements. To this end, the development of this thesis starts from a RIA application with current technologies that allow users to access their webcams and microphones from the browser, and to send captured data through their Internet connections. Furthermore interfaces have been implemented to allow end users to participate in videoconferencing rooms that are managed in different Cloud provider servers. To do so this dissertation starts from the results obtained from the previous techniques and backend resources were implemented in the Cloud. A traditional videoconferencing service which was implemented in the department was modified to meet typical Cloud Computing infrastructure requirements. This allowed us to validate whether Cloud Computing public infrastructures are suitable for the traffic generated by this kind of system. This analysis focused on the network level and processing capacity and stability of the Cloud Computing systems. In order to improve this validation several other general considerations were taken in order to cover more cases, such as multimedia data processing in the Cloud, as research activity has increased in this area in recent years. The last stage of this dissertation is the design of a new methodology to implement these kinds of applications in hybrid clouds reducing the cost of videoconferencing systems. Finally, this dissertation opens up a discussion about the conclusions obtained throughout this study, resulting in useful information from the different stages of the implementation of videoconferencing systems in Cloud Computing systems. RESUMEN Los sistemas de videoconferencia multiusuario permiten la comunicación entre más de dos usuarios que pueden interactuar a través de cámaras de video, micrófonos y otros elementos. En los últimos años el uso de estos sistemas se ha visto incrementado gracias, por un lado, a la mejora de las redes de acceso en las conexiones a Internet en empresas, universidades y viviendas, que han visto un aumento del ancho de banda disponible en dichas conexiones y una disminución en el retardo experimentado por los datos enviados y recibidos. Por otro lado también ayudó la aparación de las Aplicaciones Ricas de Internet (RIA) con las que gran parte de la lógica y del control de las aplicaciones web comenzó a ejecutarse en los mismos navegadores. Esto permitió a los desarrolladores la creación de aplicaciones web cuya complejidad podía compararse con la de las tradicionales aplicaciones de escritorio, ejecutadas directamente por los sistemas operativos. Más recientemente el uso de sistemas de Cloud Computing ha mejorado la escalabilidad y el abaratamiento de los costes para sistemas de backend, ofreciendo la posibilidad de implementar servicios Web en Internet sin la necesidad de grandes desembolsos iniciales en las áreas de infraestructuras y recursos tanto hardware como software. Sin embargo no existen aún muchas iniciativas con el objetivo de realizar sistemas de videoconferencia que aprovechen las ventajas del Cloud. Esta tesis doctoral propone un conjunto de técnicas, interfaces y algoritmos para la implentación de sistemas de videoconferencia en infraestructuras tanto públicas como privadas de Cloud Computing. Las técnicas propuestas en la tesis se basan en la realización de un servicio básico de videoconferencia que se ejecuta directamente en el navegador sin la necesidad de instalar ningún tipo de aplicación de escritorio. Para ello el desarrollo de esta tesis parte de una aplicación RIA con tecnologías que hoy en día permiten acceder a la cámara y al micrófono directamente desde el navegador, y enviar los datos que capturan a través de la conexión de Internet. Además se han implementado interfaces que permiten a usuarios finales la participación en salas de videoconferencia que se ejecutan en servidores de proveedores de Cloud. Para ello se partió de los resultados obtenidos en las técnicas anteriores de ejecución de aplicaciones en el navegador y se implementaron los recursos de backend en la nube. Además se modificó un servicio ya existente implementado en el departamento para adaptarlo a los requisitos típicos de las infraestructuras de Cloud Computing. Alcanzado este punto se procedió a analizar si las infraestructuras propias de los proveedores públicos de Cloud Computing podrían soportar el tráfico generado por los sistemas que se habían adaptado. Este análisis se centró tanto a nivel de red como a nivel de capacidad de procesamiento y estabilidad de los sistemas. Para los pasos de análisis y validación de los sistemas Cloud se tomaron consideraciones más generales para abarcar casos como el procesamiento de datos multimedia en la nube, campo en el que comienza a haber bastante investigación en los últimos años. Como último paso se ideó una metodología de implementación de este tipo de aplicaciones para que fuera posible abaratar los costes de los sistemas de videoconferencia haciendo uso de clouds híbridos. Finalmente en la tesis se abre una discusión sobre las conclusiones obtenidas a lo largo de este amplio estudio, obteniendo resultados útiles en las distintas etapas de implementación de los sistemas de videoconferencia en la nube.

Supporting eradication of maternal child malnutrition in developing countries: a case from Nicaragua scenario.

World Health Organization actively stresses the importance of health, nutrition and well-being of the mother to foster children development. This issue is critical in the rural areas of developing countries where monitoring of health status of children is hardly performed since population suffers from a lack of access to health care. The aim of this research is to design, implement and deploy an e-health information and communication system to support health care in 26 rural communities of Cusmapa, Nicaragua. The final solution consists of an hybrid WiMAX/WiFi architecture that provides good quality communications through VoIP taking advantage of low cost WiFi mobile devices. Thus, a WiMAX base station was installed in the health center to provide a radio link with the rural health post "El Carrizo" sited 7,4 km. in line of sight. This service makes possible personal broadband voice and data communication facilities with the health center based on WiFi enabled devices such as laptops and cellular phones without communications cost. A free software PBX was installed at "San José de Cusmapa" health care site to enable communications for physicians, nurses and a technician through mobile telephones with IEEE 802.11 b/g protocol and SIP provided by the project. Additionally, the rural health post staff (midwives, brigade) received two mobile phones with these same features. In a complementary way, the deployed health information system is ready to analyze the distribution of maternal-child population at risk and the distribution of diseases on a geographical baseline. The system works with four information layers: fertile women, children, people with disabilities and diseases. Thus, authorized staff can obtain reports about prenatal monitoring tasks, status of the communities, malnutrition, and immunization control. Data need to be updated by health care staff in order to timely detect the source of problem to implement measures addressed to alleviate and improve health status population permanently. Ongoing research is focused on a mobile platform that collects and automatically updates in the information system, the height and weight of the children locally gathered in the remote communities. This research is being granted by the program Millennium Rural Communities of the Technical University of Madrid.

Soft-computing based visual control for unmanned vehicles

El objetivo principal de esta Tesis es extender la utilización del “Soft- Computing” para el control de vehículos sin piloto utilizando visión. Este trabajo va más allá de los típicos sistemas de control utilizados en entornos altamente controlados, demonstrando la fuerza y versatilidad de la lógica difusa (Fuzzy Logic) para controlar vehículos aéreos y terrestres en un abanico de applicaciones diferentes. Para esta Tesis se ha realizado un gran número de pruebas reales en las cuales los controladores difusos han manejado una plataforma visual “pan-and-tilt”, un helicoptero, un coche comercial y hasta dos tipos de quadrirotores. El uso del método de optimización “Cross-Entropy” ha sido utilizado para mejorar el comportamiento de algunos de los controladores borrosos. Todos los controladores difusos presentados en ésta Tesis han sido implementados utilizando un código desarrollado por el candidato para tal efecto, llamado MOFS (Miguel Olivares’ Fuzzy Software). Diferentes algoritmos visuales han sido utilizados para adquirir la informaci´on visual del entorno, “Cmashift”, descomposición de la homografía y detección de marcas de realidad aumentada, entre otros. Dicha información visual ha sido utilizada como entrada de los controladores difusos para comandar los vehículos en las diferentes applicaciones autonomas. El volante de un vehículo comercial ha sido controlado para realizar pruebas de conducción autónoma en condiciones de tráfico similares a las de una ciudad. El sistema ha llegado a completar con éxito pruebas de más de 6 km sin ninguna interacción humana, mediante el seguimiento de una línea pintada en el suelo. El limitado campo visual del sistema no ha sido impedimento para alcanzar velocidades de hasta 48 km/h y ser guiado autonomamente en curvas de radio reducido. Objetos estáticos y móviles han sido seguidos desde un helicoptero no tripulado, mediante el control de una plataforma visual “pan-and-tilt”. ´Éste mismo helicoptero ha sido controlado completamente para su aterrizaje autonomo, mediante el control del movimiento lateral (roll), horizontal (pitch) y de altitud. El seguimiento de objetos volantes ha sido resulto mediante el control horizontal (pitch) y de orientación (heading) de un quadrirotor. Para tareas de evitación de obstáculos se ha implementado un controlador difuso para el manejo de la orientación (heading) de un quadrirotor. En el campo de la optimización de controladores se ha aportado al estado del arte una extensión del uso del método “Cross-Entropy”. Está Tesis presenta una novedosa implementación de dicho método para la optimización de las ganancias, la posición y medida de los conjuntos de las funciones de pertenecia y el peso de las reglas para mejorar el comportamiento de un controlador difuso. Dichos procesos de optimización se han realizado utilizando “ROS” y “Matlab Simulink” para obtener mejores resultados para la evitación de colisiones con vehículos aéreos no tripulados. Ésta Tesis demuestra que los controladores implementados con lógica difusa son altamente capaces de controlador sistemas sin tener en cuenta el modelo del vehículo a controlador en entornos altamente perturbables con un sensor de bajo coste como es una cámara. El ruido presentes causado por los cambios de iluminación en la adquisición de imágenes y la alta incertidumbre en la detección visual han sido manejados satisfactoriamente por ésta técnica de de “Soft-Computing” para distintas aplicaciones tanto con vehículos aéreos como terrestres.