Aspects of stadium design for warm climates

The airflow pattern on the spectators' terrace in stadia is affected by numerous architectural factors, such as form, size, permeability, i.e. the morphology of the building. A stadium design not taking into account the prevailing environmental parameters can result in unpleasant thermal and aerodynamic environment in the stadium bowl.     

State-of-the-art principles and practices of medical economics

Genomic DNA from 23 patients with isolated growth hormone (GH) deficiency (12 males and 11 females: heights -4.9 +/- 1.4 SDS) was screened for GH gene deletions by restriction endonuclease analysis of polymerase chain reaction amplification products. Three unrelated patients had typical features of severe GH deficiency and deletions (6.7 kb in two and 7.6 kb in one) of the GH gene. The two patients with 6.7-kb deletions developed growth-attenuating anti-GH antibodies whereas the patient with the 7.6-kb deletion continued to grow with GH replacement therapy. Our finding that 3/23 (approximately 13%) Brazilian subjects had GH gene deletions agrees with previous studies of severe isolated GH deficiency subjects in other populations. Two of three subjects (67%) with deletions developed blocking antibodies despite administration of exogenous GH at low doses. Interestingly, only 1/10 of cases with affected relatives or parental consanguinity had GH-1 gene deletions.     

Endoscopic hemostasis in bleeding gastroduodenal ulcer--a contribution to the cost aspect

Endoscopic injections of fibrin glue for the treatment of gastroduodenal ulcer hemorrhage have been increasingly used instead of sclerosing agents since 1987. Sclerosants have the drawback that they themselves have tissue-destroying or rather ulcerogenic effects. A difficult form of administration and a relatively high price are set against the good biological properties of the fibrin glue. In a randomized study comparing fibrin glue with polidocanol there was a statistically significant lower rebleeding rate in the fibrin group. The data of this study were analysed with regard to economic aspects. They showed an improved cost-benefit and cost-effectiveness ratio of the fibrin glue compared with polidocanol.     

Relationship of cocaine-induced c-Fos expression to behaviors and the role of serotonin 5-HT2A receptors in cocaine-induced c-Fos expression.

Serotonin 5-HT2A receptor antagonists have been shown to attenuate the locomotor stimulant effects of cocaine in rats. The present study used the expression of c-Fos protein as a marker to identify brain areas through which 5-HT2A receptors may modulate cocaine-induced behaviors. Significant correlations were observed between cocaine-induced hyperactivity and c-Fos expression in the nucleus accumbens core (NAcC), caudate-putamen (CPu), and subthalamic nucleus. In a separate experiment, a low, behaviorally relevant dose of cocaine was found to increase c-Fos immunoreactivity in the medial CPu, NAcC, and nucleus accumbens shell (NAcSh). The selective 5-HT2A receptor antagonist M100907 significantly attenuated cocaine-induced c-Fos expression in the medial CPu and in the NAcSh. These data suggest that 5-HT2A receptors in the NAcSh and CPu or in afferents to these regions may contribute to genomic responses to cocaine in the brain as well as to cocaine-induced locomotor activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of radiofrequency ablation on monoplasic action potentials

Reliable MAP (monophasic action potential) measurements were performed during RF delivery with a commercially available ablation system and fractally coated catheters based on an established mechanical design. The obtained results promise an important step forward in online monitoring of the MAP signals during ablation. They may help in the localization of the arrhythmogenic substrate (early and delayed after depolarization) and in the evaluation of RF ablation effect, which have to be investigated in further experimental and clinical studies     

A variable column length strategy to expedite method development

A variable length method development (or VL-MD)strategy, exploiting the potential of an automatic column coupling system, is proposed and has been applied to a number of different pharmaceutical and environmental samples with a varying degree of complexity. The proposed strategy consistently produced separation methods that had at least an equally good critical pair resolution and an equally short run time to those of methods produced using commercially available MD assistance software. In some cases, the VL-MD strategy allowed the MD time to be drastically shortened from >30 h to an overnight run of only 12 h. The developed strategy has the potential to become fully automated provided that reliable chromatogram read-out software becomes available. The advantage of combining different stationary phase types to improve the available selectivity and the integration into the general VL-MD strategy was also demonstrated.     

Pharmacoeconomic evaluation of pravastatin in the secondary prevention of coronary heart disease in patients with average cholesterol levels. An analysis for Germany based on the CARE study

Those people who are to decide about health care systems are increasingly forced to identify unnecessary costs and achieve savings in health care. Especially for diseases with high prevalence like illnesses of the heart and the circulatory system preventive measures are very important. This economic analysis tries to clarify whether the secondary-preventive application of the HMG-CoA reductase-inhibitor pravastatin is, apart from the clinical benefit, economically justified in patients suffering from coronary heart disease with average cholesterol levels. In the case of this study, the underlying type of economic evaluation was an incremental cost-effectiveness analysis. The outcome was defined as costs per life-year saved. This retrospective study is based on the results of the CARE (Cholesterol And Recurrent Events) study which has been published elsewhere [21]. When calculating costs we took into account the perspective of 3rd party payers (public health insurance) in Germany. The calculation of cost-effectiveness was carried out for the whole study population in CARE as well as for all patients aged 60 or more years in the CARE study. This was done because the different groups vary by the numbers of avoided myocardial infarctions, strokes and loss of life years. Netcosts for pravastatin therapy, i.e. drug costs for pravastatin minus costs for avoided events, were about 9.54 Mio DM (referring to 1,000 patients treated for a period of 5 years). Net-costs for patients aged 60 or more years were 8.18 Mio DM. The effectiveness was defined as the number of life years saved and amounted to 216 years of life saved (YOLS) in the overall study group. For patients aged 60 or more years we found that 358 years were saved. The costs per life years saved (i.e. the net-costs of pravastatin therapy divided through the number of life years saved) turned out to be 44,000 DM per person in the study group. For patients over 60 the costs were 23,000 DM. Lipid-lowering with pravastatin in the secondary prevention of coronary heart disease in Germany is cost-effective. In those patients aged 60 or more yeas the use of pravastatin is even more cost-effective than in all patients included in the CARE study.     

Basic principles of cost-benefit analysis in long-term treatment of risk factors

Health care decision makers are increasingly forced to identify and implement the options for potential spendings and savings. Historically, preventive measures for cardiovascular diseases have been scrutinised a great deal. The main reason for this was that substantial financial investments would have to be undertaken long before the clinical benefits were apparent. In the past, most economic evaluations of lipid lowering therapy have been based on models combining logistic regression risk functions from epidemiological cohort studies, such as the Framingham study, with the extent of cholesterol reduction. Recently, however, data from the large controlled outcome studies (4S, CARE, LIPID, WOSCOPS) have been reported which allow a direct estimate of the economic benefits of cholesterol reduction in primary and secondary prevention. The economic evaluation of such therapies can be performed in several ways, from relatively easy cost-consequence analyses to more complex cost-effectiveness analysis. Initial economic analyses of the trials are already available. There are, however, still considerable practical and methodological issues which have to be taken into account in assessing lipid lowering drugs. Available pharmaco-economic data on lipid lowering therapies suggest that statins are a cost-effective option in primary and secondary coronary prevention.