Incident hypertension among pre-hypertensive adolescents: Evaluation of pre-hypertension as an independent risk factor among secondary school students in the Houston area

Cardiovascular disease has been the leading cause of death in the United States for over fifty years. While multiple risk factors for cardiovascular disease have been identified, hypertension is one of the most commonly recognized and treatable. Recent studies indicate that the prevalence of hypertension among children and adolescents is between 3-5%, much higher than originally estimated and likely rising due to the epidemic of obesity in the U.S. In 2004, the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents published new guidelines for the diagnosis and treatment of hypertension in this population. Included in these recommendations was the creation of a new diagnosis, pre-hypertension, aimed at identifying children at-risk for hypertension to provide early lifestyle interventions in an effort to prevent its ultimate development. In order to determine the risk associated with pre-hypertension for the development of incident HTN, a secondary analysis of a repeated cross-sectional study measuring blood pressure in Houston area adolescents from 2000 to 2007 was performed. Of 1006 students participating in the blood pressure screening on more than one occasion not diagnosed with hypertension at initial encounter, eleven were later found to have hypertension providing an overall incident rate of 0.5% per year. Incidence rates were higher among overweight adolescents–1.9% per year [IRR 8.6 (1.97, 51.63)]; students “at-risk for hypertension” (pre-hypertensive or initial blood pressure in the hypertensive range but falling on subsequent measures)–1.4% per year [IRR 4.77 (1.21, 19.78)]; and those with blood pressure ≥90th percentile on three occasions–6.6% per year [IRR 21.87 (3.40, 112.40)]. Students with pre-hypertension as currently defined by the Task Force did have an increased rate of hypertension (1.1% per year) but it did not reach statistical significance [IRR 2.44 (0.42, 10.18)]. Further research is needed to determine the morbidity and mortality associated with pre-hypertension in this age group as well as the effectiveness of various interventions for preventing the development of hypertensive disease among these at-risk individuals. ^

Effectiveness of dietary intervention in children and adolescents with elevated blood pressure

Hypertension is a known risk factor for cardiovascular disease in adults. Essential hypertension in children and adolescents is increasing in prevalence in the United States, and hypertension in children may track into adulthood. This increasing prevalence is attributed to the trends of increasing overweight and obese children and adolescents. Family history and being of African-American/black descent may predispose youth to elevated blood pressure. Interventions targeted to reduce and treat hypertension in youth include non-pharmaceutical interventions such as weight reduction, increased physical activity, and dietary changes and pharmaceutical treatment when indicated. The effectiveness of non-pharmaceutical interventions is well documented in adults, but there are limited studies with regards to children and adolescents, specifically in the arena of dietary interventions. Lifestyle modifications such as dietary interventions are the mainstay of recommended treatment for those children and adolescents with prehypertension or stage 1 hypertension. Given the association of being overweight and hypertension, efficacy of dietary interventions are of interest because of reduced cost, easy implementation and potential for multiple beneficial outcomes such as reduced weight and reduction of other metabolic or cardiovascular derangements. Barriers to dietary interventions often include socioeconomic status, ethnicity, personal, and external factors. The goal of this systematic review of the literature is to identify interventions targeted to children and adolescents that focus on recommended dietary changes related to blood pressure. Dietary interventions found for this review mostly focused on a particular nutrient or food group with the one notable exception that focused on the DASH pattern of eating. The effects of the interventions on blood pressure varied, but overall dietary modifications can be achieved in youth and can serve a role in producing positive outcomes on blood pressure. Increasing potassium and following a DASH diet seemed to provide the most clinically significant results. Further studies are still needed to evaluate long-term effectiveness and to contribute more supporting evidence for particular modifications in these age cohorts.^

Effectiveness of promoting energy efficiency in Thailand -- the case of air conditioners

This paper aims to identify the magnitude of energy efficiency improvement, which has been promoted through energy efficiency labeling and the Minimum Energy Performance Standard, and to compare this against the increase in the number of products and the average increase in cooling capacity. Air conditioners (ACs) are one of the major contributors to energy consumption in a household. To assess the magnitude of this factor, we developed a formula to decompose total energy consumption from ACs into the number of ACs, their average cooling capacity, and energy efficiency. In the case of ACs in Thailand, energy efficiency improvement has offset the increase in the average AC cooling capacity. However, energy consumption from ACs increases with the number of ACs.

Effectiveness for Ddtecting faults within and outside the scope of testing techniques: an independent replication

The verification and validation activity plays a fundamental role in improving software quality. Determining which the most effective techniques for carrying out this activity are has been an aspiration of experimental software engineering researchers for years. This paper reports a controlled experiment evaluating the effectiveness of two unit testing techniques (the functional testing technique known as equivalence partitioning (EP) and the control-flow structural testing technique known as branch testing (BT)). This experiment is a literal replication of Juristo et al. (2013).Both experiments serve the purpose of determining whether the effectiveness of BT and EP varies depending on whether or not the faults are visible for the technique (InScope or OutScope, respectively). We have used the materials, design and procedures of the original experiment, but in order to adapt the experiment to the context we have: (1) reduced the number of studied techniques from 3 to 2; (2) assigned subjects to experimental groups by means of stratified randomization to balance the influence of programming experience; (3) localized the experimental materials and (4) adapted the training duration. We ran the replication at the Escuela Politécnica del Ejército Sede Latacunga (ESPEL) as part of a software verification & validation course. The experimental subjects were 23 master?s degree students. EP is more effective than BT at detecting InScope faults. The session/program andgroup variables are found to have significant effects. BT is more effective than EP at detecting OutScope faults. The session/program and group variables have no effect in this case. The results of the replication and the original experiment are similar with respect to testing techniques. There are some inconsistencies with respect to the group factor. They can be explained by small sample effects. The results for the session/program factor are inconsistent for InScope faults.We believe that these differences are due to a combination of the fatigue effect and a technique x program interaction. Although we were able to reproduce the main effects, the changes to the design of the original experiment make it impossible to identify the causes of the discrepancies for sure. We believe that further replications closely resembling the original experiment should be conducted to improve our understanding of the phenomena under study.

Effectiveness for detecting faults within and outside the scope of testing techniques: an independent replication

The verification and validation activity plays a fundamental role in improving software quality. Determining which the most effective techniques for carrying out this activity are has been an aspiration of experimental software engineering researchers for years. This paper reports a controlled experiment evaluating the effectiveness of two unit testing techniques (the functional testing technique known as equivalence partitioning (EP) and the control-flow structural testing technique known as branch testing (BT)). This experiment is a literal replication of Juristo et al. (2013). Both experiments serve the purpose of determining whether the effectiveness of BT and EP varies depending on whether or not the faults are visible for the technique (InScope or OutScope, respectively). We have used the materials, design and procedures of the original experiment, but in order to adapt the experiment to the context we have: (1) reduced the number of studied techniques from 3 to 2; (2) assigned subjects to experimental groups by means of stratified randomization to balance the influence of programming experience; (3) localized the experimental materials and (4) adapted the training duration. We ran the replication at the Escuela Polite?cnica del Eje?rcito Sede Latacunga (ESPEL) as part of a software verification & validation course. The experimental subjects were 23 master?s degree students. EP is more effective than BT at detecting InScope faults. The session/program and group variables are found to have significant effects. BT is more effective than EP at detecting OutScope faults. The session/program and group variables have no effect in this case. The results of the replication and the original experiment are similar with respect to testing techniques. There are some inconsistencies with respect to the group factor. They can be explained by small sample effects. The results for the session/program factor are inconsistent for InScope faults. We believe that these differences are due to a combination of the fatigue effect and a technique x program interaction. Although we were able to reproduce the main effects, the changes to the design of the original experiment make it impossible to identify the causes of the discrepancies for sure. We believe that further replications closely resembling the original experiment should be conducted to improve our understanding of the phenomena under study.

The European Union and the Arms Trade Treaty: An Analysis of the EU’s Effectiveness in Multilateral Security Governance. Bruges Regional Integration & Global Governance Papers 3/2013

This paper examines the participation of the European Union (EU) in the multilateral negotiations of the UN Arms Trade Treaty (ATT). Given the EU’s declared commitment to effective multilateralism and dedication to act as a global security provider, the paper analyses to what extent the EU can be seen as an effective actor in supporting and promoting the ATT. It is argued that overall the EU was an effective player during the multilateral negotiations on the ATT, but the degree of its effectiveness varied along different dimensions. The EU was relatively successful in the achievement of its goals and in maintaining external cohesion during the negotiations, but it scored relatively low in its efforts to commit other major players to sign up to the ATT. The high level of institutional cooperation and the convergence of EU member states’ interests facilitated the EU’s effectiveness in the ATT negotiations, whereas the international context proved to be the major constraining factor.

EU actorness and effectiveness under political pressure at the Copenhagen climate change negotiations

This paper analyses the extent of European Union (EU) actorness and effectiveness at the fifteenth United Nations Framework Convention on Climate Change (UNFCCC) Conference of the Parties (COP) meeting in Copenhagen in December 2009. For over a decade the European Union has been characterised as a leader in international climate policy-making and as an important actor in international climate change negotiations. The COP15 meeting in Copenhagen has overall brought about disappointing outcomes, especially from the perspective of the European Union. This casts doubts on EU leadership and begs the question of what has happened to EU actorness and effectiveness in this field. In terms of actorness we take Jupille and Caporaso (1998) as a point of departure and then specify a more parsimonious actorness framework that consists of cohesion and autonomy. Effectiveness (i.e. goal attainment) is seen as conceptually separate from actorness. Effectiveness is conceptualised as the result of actorness conditioned by the ‘opportunity structure’, i.e. the external context (of other actors, events and ideas) that enables or constrains EU actions. We hold that the EU’s actorness has been only moderate, especially given somewhat limited preference cohesion. In terms of the opportunity structure in Copenhagen we argue that the high degree of politicisation constrained the EU’s ability to negotiate and thus to attain its goals. Another external factor that had a substantial adverse impact on the EU’s effectiveness at the Copenhagen negotiations was the strong involvement of other actors with rather different positions, namely the United States (US) and the BASIC countries (Brazil, South Africa, India, and China).

Beyond a logic of effectiveness: Horizontal coordination, democratic legitimacy and accountability

Horizontal coordination, where actors join together to accomplish a common task, has been applauded for its output legitimacy. However, such processes often face challenges due to opposition from local actors who raise concerns about democratic legitimacy and accountability. Moving beyond a logic of effectiveness, we aim to show how and why other forms of legitimacy such as input and throughput dimensions also affect horizontal coordination, in addition to output criteria. Beyond the assumed positive relationship between coordination and effectiveness, we additionally expect horizontal coordination to be (a) impeded by local actors' fear of losing democratic legitimacy; and (b) fostered by accountability in terms of the steering capacity of the state. A comparative case study analysis of water supply structures at the regional level in Switzerland shows, in contrast to our expectation, that effectiveness has mixed impacts on horizontal coordination. Rather than being solely a positive factor for horizontal coordination, certain output criteria such as financial redistribution are found to be a key hindrance. We also find that democratic legitimacy may, indeed, impede horizontal coordination whereas increased accountability positively affects such coordination.

A cost-effectiveness analysis of fluvastatin in patients with diabetes after successful percutaneous coronary intervention

Background: The Lescol Intervention Prevention Study (LIPS) was a multinational randomized controlled trial that showed a 47% reduction in the relative risk of cardiac death and a 22% reduction in major adverse cardiac events (MACEs) from the routine use of fluvastatin, compared with controls, in patients undergoing percutaneous coronary intervention (PCI, defined as angioplasty with or without stents). In this study, MACEs included cardiac death, nonfatal myocardial infarction, and subsequent PCI and coronary artery bypass graft. Diabetes was the greatest risk factor for MACEs. Objective: This study estimated the cost-effectiveness of fluvastatin when used for secondary prevention of MACEs after PCI in people with diabetes. Methods: A post hoc subgroup analysis of patients with diabetes from the LIPS was used to estimate the effectiveness of fluvastatin in reducing myocardial infarction, revascularization, and cardiac death. A probabilistic Markov model was developed using United Kingdom resource and cost data to estimate the additional costs and quality-adjusted life-years (QALYs) gained over 10 years from the perspective of the British National Health Service. The model contained 6 health states, and the transition probabilities were derived from the LIPS data. Crossover from fluvastatin to other lipid-lowering drugs, withdrawal from fluvastatin, and the use of lipid-lowering drugs in the control group were included. Results: In the subgroup of 202 patients with diabetes in the LIPS trial, 18 (15.0%) of 120 fluvastatin patients and 21 (25.6%) of 82 control participants were insulin dependent (P = NS). Compared with the control group, patients treated with fluvastatin can expect to gain an additional mean (SD) of 0.196 (0.139) QALY per patient over 10 years (P < 0.001) and will cost the health service an additional mean (SD) of 10 (E448) (P = NS) (mean [SD] US $16 [$689]). The additional cost per QALY gained was;(51 (US $78). The key determinants of cost-effectiveness included the probabilities of repeat interventions, cardiac death, the cost of fluvastatin, and the time horizon used for the evaluation. Conclusion: Fluvastatin was an economically efficient treatment to prevent MACEs in these patients with diabetes undergoing PCI.

Discovering user access pattern based on probabilistic latent factor model

There has been an increased demand for characterizing user access patterns using web mining techniques since the informative knowledge extracted from web server log files can not only offer benefits for web site structure improvement but also for better understanding of user navigational behavior. In this paper, we present a web usage mining method, which utilize web user usage and page linkage information to capture user access pattern based on Probabilistic Latent Semantic Analysis (PLSA) model. A specific probabilistic model analysis algorithm, EM algorithm, is applied to the integrated usage data to infer the latent semantic factors as well as generate user session clusters for revealing user access patterns. Experiments have been conducted on real world data set to validate the effectiveness of the proposed approach. The results have shown that the presented method is capable of characterizing the latent semantic factors and generating user profile in terms of weighted page vectors, which may reflect the common access interest exhibited by users among same session cluster.

The effectiveness of an innovative intervention aimed at reducing binge drinking among young people:results from a pilot study

Aims: To assess the effectiveness of a digital-story intervention (short videos made by young people) seeking to reduce the prevalence of young people's binge drinking in Caerphilly. Method: A quasi-experimental design was adopted with three intervention sites and one control site providing the sample (mainly aged 1415 years). Three rounds of self-completion questionnaires, completed prior (T1), immediately after (T2) and 6 months after the intervention (T3). Findings: A total of 1031 questionnaires completed across the three time-points. Two-factor ANOVAs revealed a positive effect on knowledge for the intervention sample. The intervention group results showed stable attitudes towards drinking at the three time-points whilst the control group showed increasing positive attitudes towards drunkenness over the same time period. Intentions towards drunkenness were higher in the control group than the intervention group at T2 (ControlT1 Mean 3.37, T2 Mean 3.90; interventionT1 Mean 3.26, T2 Mean 3.29). Intervention participants got drunk on fewer occasions in the last week (mean occasions last week 1.57) compared to control participants (mean occasions last week 2.00), with the difference approaching statistical significance (F 1.90, p 0.07). Conclusions: Promoting negative attitudes towards drunkenness, alongside a greater sense of control and potential regret about drunkenness are likely to be important factors when considering how to change people's intentions to drink. The study shows the potential to reduce the frequency of drinking behaviour when intentions are changed, and provides recommendations for future interventions of this nature. © 2010 Informa UK Ltd.

Placenta growth factor-1 exerts time-dependent stabilization of adherens junctions following VEGF-induced vascular permeability

Increased vascular permeability is an early event characteristic of tissue ischemia and angiogenesis. Although VEGF family members are potent promoters of endothelial permeability the role of placental growth factor (PlGF) is hotly debated. Here we investigated PlGF isoforms 1 and 2 and present in vitro and in vivo evidence that PlGF-1, but not PlGF-2, can inhibit VEGF-induced permeability but only during a critical window post-VEGF exposure. PlGF-1 promotes VE-cadherin expression via the trans-activating Sp1 and Sp3 interaction with the VE-cadherin promoter and subsequently stabilizes transendothelial junctions, but only after activation of endothelial cells by VEGF. PlGF-1 regulates vascular permeability associated with the rapid localization of VE-cadherin to the plasma membrane and dephosphorylation of tyrosine residues that precedes changes observed in claudin 5 tyrosine phosphorylation and membrane localization. The critical window during which PlGF-1 exerts its effect on VEGF-induced permeability highlights the importance of the translational significance of this work in that PLGF-1 likely serves as an endogenous anti-permeability factor whose effectiveness is limited to a precise time point following vascular injury. Clinical approaches that would pattern nature's approach would thus limit treatments to precise intervals following injury and bring attention to use of agents only during therapeutic windows.

A study into the effectiveness of quality management training:a focus on tools and critical success factors

Purpose – The purpose of this paper is to investigate the effectiveness of quality management training by reviewing commonly used critical success factors and tools rather than the overall methodological approach. Design/methodology/approach – The methodology used a web-based questionnaire. It consisted of 238 questions covering 77 tools and 30 critical success factors selected from leading academic and practitioner sources. The survey had 79 usable responses and the data were analysed using relevant statistical quality management tools. The results were validated in a series of structured workshops with quality management experts. Findings – Findings show that in general most of the critical success factor statements for quality management are agreed with, although not all are implemented well. The findings also show that many quality tools are not known or understood well; and that training has an important role in raising their awareness and making sure they are used correctly. Research limitations/implications – Generalisations are limited by the UK-centric nature of the sample. Practical implications – The practical implications are discussed for organisations implementing quality management initiatives, training organisations revising their quality management syllabi and academic institutions teaching quality management. Originality/value – Most recent surveys have been aimed at methodological levels (i.e. “lean”, “Six Sigma”, “total quality management” etc.); this research proposes that this has limited value as many of the tools and critical success factors are common to most of the methodologies. Therefore, quite uniquely, this research focuses on the tools and critical success factors. Additionally, other recent comparable surveys have been less comprehensive and not focused on training issues.

Development and psychometric evaluation of a new team effectiveness scale for all types of community adult mental health teams:a mixed-methods approach

Defining 'effectiveness' in the context of community mental health teams (CMHTs) has become increasingly difficult under the current pattern of provision required in National Health Service mental health services in England. The aim of this study was to establish the characteristics of multi-professional team working effectiveness in adult CMHTs to develop a new measure of CMHT effectiveness. The study was conducted between May and November 2010 and comprised two stages. Stage 1 used a formative evaluative approach based on the Productivity Measurement and Enhancement System to develop the scale with multiple stakeholder groups over a series of qualitative workshops held in various locations across England. Stage 2 analysed responses from a cross-sectional survey of 1500 members in 135 CMHTs from 11 Mental Health Trusts in England to determine the scale's psychometric properties. Based on an analysis of its structural validity and reliability, the resultant 20-item scale demonstrated good psychometric properties and captured one overall latent factor of CMHT effectiveness comprising seven dimensions: improved service user well-being, creative problem-solving, continuous care, inter-team working, respect between professionals, engagement with carers and therapeutic relationships with service users. The scale will be of significant value to CMHTs and healthcare commissioners both nationally and internationally for monitoring, evaluating and improving team functioning in practice.

The impact of coordination on the effectiveness of last mile relief distribution

Last mile relief distribution is the final stage of humanitarian logistics. It refers to the supply of relief items from local distribution centers to the disaster affected people (Balcik et al., 2008). In the last mile relief distribution literature, researchers have focused on the use of optimisation techniques for determining the exact optimal solution (Liberatore et al., 2014), but there is a need to include behavioural factors with those optimisation techniques in order to obtain better predictive results. This paper will explain how improving the coordination factor increases the effectiveness of the last mile relief distribution process. There are two stages of methodology used to achieve the goal: Interviews: The authors conducted interviews with the Indian Government and with South Asian NGOs to identify the critical factors for final relief distribution. After thematic and content analysis of the interviews and the reports, the authors found some behavioural factors which affect the final relief distribution. Model building: Last mile relief distribution in India follows a specific framework described in the Indian Government disaster management handbook. We modelled this framework using agent based simulation and investigated the impact of coordination on effectiveness. We define effectiveness as the speed and accuracy with which aid is delivered to affected people. We tested through simulation modelling whether coordination improves effectiveness.