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.^

Exploring the use of pharmaceutical patient assistance programs as an option to improve access to and affordability of prescription drugs

Background. Pharmaceutical-sponsored patient assistance programs (PAPs) are charity programs that provide free or reduced-priced medications to eligible patients. PAPs have the potential to improve prescription drug accessibility for patients but currently there is limited information about their use and effectiveness. ^ Objectives and methods. This dissertation described the use of PAPs in the U.S. through the conduct of two studies: (1) a systematic review of primary studies of PAPs from commercially-published and “grey” literature sources; and (2) a retrospective, cross-sectional study of cancer patients' use of PAPs at a tertiary care cancer outpatient center. ^ Results. (1) The systematic review identified 33 studies: 15 evaluated the impact of PAP enrollment assistance programs on patient healthcare outcomes; 7 assessed institutional costs of providing enrollment assistance; 7 surveyed stakeholders; 4 examined other aspects. Standardized mean differences calculated for disease indicator outcomes (most of which were single group, pre-posttest designs) showed significant decreases in glycemic and lipid control, and inconsistent results for blood pressure. Grey literature abstracts reported insufficient statistics for calculations. Study heterogeneity made weighted summary estimates inappropriate. Economic analyses indicated positive financial benefits to institutions providing enrollment assistance (cost) compared to the wholesale value of the medications provided (benefit); analyses did not value health outcomes. Mean quality of reporting scores were higher for observational studies in commercially-published articles versus full text, grey literature reports. (2) The cross-sectional study found that PAP outpatients were significantly more likely to be uninsured, indigent, and < 65 years old than non-PAP patients. Nearly all non-PAP and PAP prescriptions were for non-cancer conditions, either for co-morbidities (e.g., hypertension) or the management of treatment side effects (e.g., pain). Oral chemotherapies from PAPs were significantly more likely to be for breast versus other cancers, and be a newer, targeted versus traditional chemotherapy.^ Conclusions. In outpatient settings, PAP enrollment assistance plus additional medication services (e.g., counseling, reminders, and free samples) is associated with improved disease indicators for patients. Healthcare institutions, including cancer centers, can offset financial losses from uncompensated drug costs and recoup costs invested in enrollment assistance programs by procuring free PAP medications. Cancer patients who are indigent and uninsured may be able to access more outpatient medications for their supportive care needs through PAPs, than for cancer treatment options like oral chemotherapies. Because of the selective availability of drugs through PAPs, there may be more options for newer, oral, targeted chemotherapies for the treatment breast cancer versus other for other cancers.^

Campaign contributions to congressional candidates by the healthcare sector from 1990 to 2008

Stakeholder groups with special interests as donors to finance congressional campaigns have been a controversial issue in the United Sates. While previous studies concentrated on whether a connection existed between the campaign contributions provided by stakeholder groups and the voting behavior of congressional members, there is little evidence to show the trend of allocation of their campaign contributions to their favorite candidates during the elections. This issue has become increasingly important in the health sector since the health care reform bill was passed in early 2010.^ This study examined the long-term trend of campaign contributions offered by various top healthcare stakeholder groups to particular political parties (i.e. Democrat and Republican). The main focus of this paper was to observe and describe the financial donations provided by these healthcare stakeholder groups in the congressional election cycles from 1990 to 2008 in order to obtain an overview of their patterns of campaign contributions. Their contributing behaviors were characterized based on the campaign finance data collected by the Center for Responsive Politics (CRP). Specifically, I answered the questions: (1) to which political party did specific healthcare stakeholder groups give money and (2) what was the pattern of their campaign contributions from 1990 to 2008?^ The findings of my study revealed that the healthcare stakeholder groups had different political party preferences and partisanship orientations regarding the Democratic or Republican Party. These differences were obvious throughout the election cycles from 1990 to 2008 and their distinct patterns of financial contribution were evident across industries in the health sector as well. Among all the healthcare stakeholder groups in this study, physicians were the top contributors in the congressional election. The pharmaceutical industry was the only group where the majority of contribution funds were allocated to Republicans in every election period studied. This study found that no interest group has succeeded in electing the preferred congressional candidate by giving the majority of its financial support to the winning party in every election. Chiropractors, hospitals/nursing homes, and health services/HMOs performed better than other healthcare stakeholder groups by supporting the electoral winner 8 out of 9 election cycles.^

On Bayesian seamless phase I-II designs

Early phase clinical trial designs have long been the focus of interest for clinicians and statisticians working in oncology field. There are several standard phse I and phase II designs that have been widely-implemented in medical practice. For phase I design, the most commonly used methods are 3+3 and CRM. A newly-developed Bayesian model-based mTPI design has now been used by an increasing number of hospitals and pharmaceutical companies. The advantages and disadvantages of these three top phase I designs have been discussed in my work here and their performances were compared using simulated data. It was shown that mTPI design exhibited superior performance in most scenarios in comparison with 3+3 and CRM designs. ^ The next major part of my work is proposing an innovative seamless phase I/II design that allows clinicians to conduct phase I and phase II clinical trials simultaneously. Bayesian framework was implemented throughout the whole design. The phase I portion of the design adopts mTPI method, with the addition of futility rule which monitors the efficacy performance of the tested drugs. Dose graduation rules were proposed in this design to allow doses move forward from phase I portion of the study to phase II portion without interrupting the ongoing phase I dose-finding schema. Once a dose graduated to phase II, adaptive randomization was used to randomly allocated patients into different treatment arms, with the intention of more patients being assigned to receive more promising dose(s). Again simulations were performed to compare the performance of this innovative phase I/II design with a recently published phase I/II design, together with the conventional phase I and phase II designs. The simulation results indicated that the seamless phase I/II design outperform the other two competing methods in most scenarios, with superior trial power and the fact that it requires smaller sample size. It also significantly reduces the overall study time. ^ Similar to other early phase clinical trial designs, the proposed seamless phase I/II design requires that the efficacy and safety outcomes being able to be observed in a short time frame. This limitation can be overcome by using validated surrogate marker for the efficacy and safety endpoints.^

Calibration of tracer concentration measurement and results

A reliable assessment of relevant substance flows is very important for environmental risk assessments and efficiency analysis of measures to reduce or avoid emissions of micropollutants like drugs to water systems. Accordingly, a detailed preparation of monitoring campaigns should include an accuracy check for the sampling configuration to prove the reliability of the monitoring results and the subsequent data processing. The accuracy of substance flow analyses is expected to be particularly weak for substances having high short-term variations of concentrations in sewage. This is especially the case linked to the observation of substance flows close to source in waste water systems. The verification of a monitoring configuration in a hospital sewer in Luxembourg is in the centre of interest of the case study presented here. A tracer test in the sewer system under observation is an essential element of the suggested accuracy check and provides valuable information for an uncertainty analysis. The results illustrate the importance of accuracy checks as an essential element of the preparation of monitoring campaigns. Moreover the study shows that continuous flow proportional sampling enables a representative observation of short-term peak loads of the iodinated x-ray contrast media iobitridol close to source.

Exchange Rate Stabilization and IMF High Interest Rate Policy: A Critical Reconsideration Using a Dynamic Model

This paper examines whether the IMF high interest rate policy was suitable for crisis-ridden East Asian economies. Using an "overshoot" model similar to that of Dornbusch's (1976), it shows that this sort of policy might cause an unnecessary deflationary adjusting process and have no effect on containing the real depreciation of exchange rates in the long run. The study also demonstrates that Thai economic data coincides quite well with the model presented here. Finally, it points out that the high interest policy itself might provoke high risk-premium, the existence of which, in turn, justifies the policy. This means that the policy has a self-fulfilling property. In conclusion, a "one-size-fits-all" adaptation of high interest rate policy in a currency crisis is very dangerous in general, and was inappropriate for East Asia. The desirable policy would have been to let currencies depreciate and keep interest rates stable.

Inferring the Effects of Vertical Integration from Entry Games : An Analysis of the Generic Pharmaceutical Industry

This paper introduces a novel method for examining the effects of vertical integration. The basic idea is to estimate the parameters of a vertical entry game. By carefully specifying firms' payoff equations and constructing appropriate tests, it is possible to use estimates on rival profit effects to make inferences about the existence of vertical foreclosure. I estimate the vertical entry model using data from the US generic pharmaceutical industry. The estimates indicate that vertical integration is unlikely to generate anticompetitive foreclosure effects. On the other hand, significant efficiency effects are found to arise from vertical integration. I use the parameter estimates to simulate a policy that bans vertically integrated entry. The simulation results suggest that such a ban is counterproductive; it is likely to reduce entry into smaller markets.

Stark Broadening of Sn III Spectral Lines of Astrophysical Interest: Predictions and Regularities

The determination of the Stark broadening parameters of Sn ions is useful for astrophysicists interested in the determination of the density of electrons in stellar atmospheres. In this paper, we report on the calculated values of the Stark broadening parameters for 171 lines of Sn iii arising from 4d105sns (n= 6–9), 4d105snp (n= 5, 6), 4d105p2, 4d105snd (n= 5–7), 4d105s4f and 4d105s5g. Stark linewidths and line shifts are presented for an electron density of 1023 m−3 and temperatures T= 11 000–75 000 K. These have been calculated using a semi-empirical approach, with a set of wavefunctions obtained from Hartree–Fock relativistic calculations, including core polarization effects. The results obtained have been compared with available experimental data. These can be used to consider the influence of Stark broadening effects in A-type stellar atmospheres

Determination of Dipyrone in pharmaceutical preparations based on the chemiluminescent reaction of the quinolinic hydrazide-H2O2-vanadium (IV) system and flow injection analysis

A rapid, economic and sensitive chemiluminescent method involving flow-injection analysis was developed for the determination of dipyrone in pharmaceutical preparations. The method is based on the chemiluminescent reaction between quinolinic hydrazide and hydrogen peroxide in a strongly alkaline medium, in which vanadium(IV) acts as a catalyst. Principal chemical and physical variables involved in the flow-injection system were optimized using a modified simplex method. The variations in the quantum yield observed when dipyrone was present in the reaction medium were used to determine the concentration of this compound. The proposed method requires no preconcentration steps and reliably quantifies dipyrone over the linear range 1–50 µg/mL. In addition, a sample throughput of 85 samples/h is possible. Copyright © 2011 John Wiley & Sons, Ltd.

Reduced order modeling of some fluid flows of industrial interest

Some basic ideas are presented for the construction of robust, computationally efficient reduced order models amenable to be used in industrial environments, combined with somewhat rough computational fluid dynamics solvers. These ideas result from a critical review of the basic principles of proper orthogonal decomposition-based reduced order modeling of both steady and unsteady fluid flows. In particular, the extent to which some artifacts of the computational fluid dynamics solvers can be ignored is addressed, which opens up the possibility of obtaining quite flexible reduced order models. The methods are illustrated with the steady aerodynamic flow around a horizontal tail plane of a commercial aircraft in transonic conditions, and the unsteady lid-driven cavity problem. In both cases, the approximations are fairly good, thus reducing the computational cost by a significant factor.

Physiological features of Schizosaccharomyces pombe of interest in the making of white wines

This work studies the physiology of Schizosaccharomyces pombe strain 938 in the production of white wine with high malic acid levels as the sole fermentative yeast, as well as in mixed and sequential fermentations with Saccharomyces cerevisiae Cru Blanc. The induction of controlled maloalcoholic fermentation through the use of Schizosaccharomyces spp. is now being viewed with much interest. The acetic, malic and pyruvic acid concentrations, relative density and pH of the musts were measured over the entire fermentation period. In all fermentations in which Schizo. pombe 938 was involved, nearly all the malic acid was consumed and moderate acetic concentrations produced. The urea content and alcohol level of these wines were notably lower than in those made with Sacch. cerevisiae Cru Blanc alone. The pyruvic acid concentration was significantly higher in Schizo. pombe fermentations. The sensorial properties of the different final wines varied widely.

Biofouling of crypts of historical and architectural interest at la Plata Cemetery (Argentina)

Cemeteries are part of the cultural heritage of urban communities, containing funerary crypts and monuments of historical and architectural interest. Efforts aimed at the conservation of these structures must target not only the abiotic stresses that cause their destruction, such as light and humidity, but also biofouling by biotic agents. The purpose of this study was to assess the development of biofouling of several historically and architecturally valuable crypts at La Plata Cemetery (Argentina). Samples obtained from the biofilms, lichens, and fungal colonies that had developed on the marble surfaces and cement mortar of these crypts were analyzed by conventional microbiological techniques and by scanning electron microscopy. The lichens were identified as Caloplaca austrocitrina, Lecanora albescens, Xanthoparmelia farinosa and Xanthoria candelaria, the fungi as Aspergillus sp., Penicillium sp., Fusarium sp., Candida sp. and Rhodotorula sp., and the bacteria as Bacillus sp. and Pseudomonas sp. The mechanisms by which these microorganisms cause the aesthetic and biochemical deterioration of the crypts are discussed.

Open-atmosphere structural depth profiling of multilayer samples of photovoltaic interest using laser-induced plasma spectrometry

The present work aims to assess Laser-Induced Plasma Spectrometry (LIPS) as a tool for the characterization of photovoltaic materials. Despite being a well-established technique with applications to many scientific and industrial fields, so far LIPS is little known to the photovoltaic scientific community. The technique allows the rapid characterization of layered samples without sample preparation, in open atmosphere and in real time. In this paper, we assess LIPS ability for the determination of elements that are difficult to analyze by other broadly used techniques, or for producing analytical information from very low-concentration elements. The results of the LIPS characterization of two different samples are presented: 1) a 90 nm, Al-doped ZnO layer deposited on a Si substrate by RF sputtering and 2) a Te-doped GaInP layer grown on GaAs by Metalorganic Vapor Phase Epitaxy. For both cases, the depth profile of the constituent and dopant elements is reported along with details of the experimental setup and the optimization of key parameters. It is remarkable that the longest time of analysis was ∼10 s, what, in conjunction with the other characteristics mentioned, makes of LIPS an appealing technique for rapid screening or quality control whether at the lab or at the production line.

The experiment CPLM (comportamiento de puentes líquidos en microgravedad) on board Minisat 01

The Universidad Politécnica de Madrid participates in the MINISAT 01 program as the experiment CPLM responsible. This experiment aims at the study of the fluid behaviour in reduced gravity conditions. The interest of this study is and has been widely recognised by the scientific community and has potential applications in the pharmaceutical and microelectronic technologies (crystal growth), among others. The scientific team which has developed the CPLM experiment has a wide experience in this field and had participate in the performance of a large number of experiments on the fluid behaviour in reduced gravity conditions in flight (Spacelab missions, TEXUS sounding rockets, KC-135 and Caravelle aeroplanes, drop towers, as well as on earth labs (neutralbuoyancy and small scale simulations). The experimental equipment used in CPLMis a version of the payload developed for experimentation on drop towers and on board microsatellites as the UPM-Sat 1, adapted to fly on board MINISAT 01.