To assess whether long-term treatment with candesartan/hydrochlorothiazide, rosuvastatin, or their combination can slow cognitive decline in older people at intermediate cardiovascular risk.
Methods
The Heart Outcomes Prevention Evaluation-3 (HOPE-3) study was a double-blind, randomized, placebo-controlled clinical trial using a 2 × 2 factorial design. Participants without known cardiovascular disease or need for treatment were randomized to candesartan (16 mg) plus hydrochlorothiazide (12.5 mg) or placebo and to rosuvastatin (10 mg) or placebo. Participants who were ≥70 years of age completed the Digit Symbol Substitution Test (DSST), the modified Montreal Cognitive Assessment, and the Trail Making Test Part B at baseline and study end.
Results
Cognitive assessments were completed by 2,361 participants from 228 centers in 21 countries. Compared with placebo, candesartan/hydrochlorothiazide reduced systolic blood pressure by 6.0 mm Hg, and rosuvastatin reduced low-density lipoprotein cholesterol by 24.8 mg/dL. Participants were followed up for 5.7 years (median), and 1,626 completed both baseline and study-end assessments. Mean participant age was 74 years (SD ±3.5 years); 59% were women; 45% had hypertension; and 24% had ≥12 years of education. The mean difference in change in DSST scores was −0.91 (95% confidence interval [CI] −2.25 to 0.42) for candesartan/hydrochlorothiazide compared with placebo, −0.54 (95% CI −1.88 to 0.80) for rosuvastatin compared with placebo, and −1.43 (95% CI −3.37 to 0.50) for combination therapy vs double placebo. No significant differences were found for other measures.
Conclusions
Long-term blood pressure lowering with candesartan plus hydrochlorothiazide, rosuvastatin, or their combination did not significantly affect cognitive decline in older people.
ClinicalTrials.gov identifier
NCT00468923.
Classification of evidence
This study provides Class II evidence that for older people, candesartan plus hydrochlorothiazide, rosuvastatin, or their combination does not significantly affect cognitive decline.
The advantages of creating interactive 3D simulations that allow viewing, exploring, and interacting with land improvements, such as buildings, in digital form are manifold and range from allowing individuals from anywhere in the world to explore those virtual land improvements online, to training military personnel in dealing with war-time environments, and to making those land improvements available in virtual worlds such as Second Life. While we haven't fully explored the true potential of such simulations, we have identified a requirement within our organization to use simulations like those to replace our front-desk personnel and allow visitors to query, naVigate, and communicate virtually with various entities within the building. We implemented the Virtual VMASC 3D simulation of the Virginia Modeling Analysis and Simulation Center (VMASC) office building to not only meet our front-desk requirement but also to evaluate the effort required in designing such a simulation and, thereby, leverage the experience we gained in future projects of this kind. This paper describes the goals we set for our implementation, the software approach taken, the modeling contribution made, and the technologies used such as XNA Game Studio, .NET framework, Autodesk software packages, and, finally, the applicability of our implementation on a variety of architectures including Xbox 360 and PC. This paper also summarizes the result of our evaluation and the lessons learned from our effort.
Abstract There are specific challenges related to forensic dental radiology and difficulties in aligning X‐ray equipment to teeth of interest. Researchers used 3D printing to create a new device, the combined holding and aiming device ( CHAD ), to address the positioning limitations of current dental X‐ray devices. Participants ( N = 24) used the CHAD , soft dental wax, and a modified external aiming device ( MEAD ) to determine device preference, radiographer's efficiency, and technique errors. Each participant exposed six X‐rays per device for a total of 432 X‐rays scored. A significant difference was found at the 0.05 level between the three devices ( p = 0.0015), with the MEAD having the least amount of total errors and soft dental wax taking the least amount of time. Total errors were highest when participants used soft dental wax—both the MEAD and the CHAD performed best overall. Further research in forensic dental radiology and use of holding devices is needed.
The composition and morphology of an atherosclerotic lesion are currently considered more important determinants of acute coronary ischemic syndromes that the degree of stenosis. When a lesion is unstable, it can rupture and cause an acute thrombotic reaction. An unstable plaque can be characterized by a lipid core that is covered by a thin fibrous cap, which has been locally weakened by inflammatory cells. Intravascular Ultrasound Palpography is an intravascular ultrasound based technique that is capable to measure the local strain in coronaries and atherosclerotic plaque. This strain is induced by varying intraluminal pressure. This lecture will show principles of the technology and how this technology is used in clinical trials. Results from a trial with traditional lipid lowering treatment (IBIS1) and from a trial on the efficacy of a new medication (IBIS2) will be presented. Furthermore the potential of Intravascular Ultrasound Modulography will be discussed. This work is financially supported by the Dutch Technology Foundation, The Dutch Heart Foundation and a research grants from Volcano Corporation and Glaxo Smith Kline
With the constant push to do more for less, the use of virtual environments (VE), simulations and serious games has exploded. Human Factors (HF) personnel often use these tools to support a range of activities, including modeling process or the effects of humans in the system; designing, testing and validating new systems and processes; training skills, procedures and techniques; and even for therapeutic activities. This session will describe and demonstrate some of the diverse uses for virtual environments (VEs) in an alternate demonstration format. The session will begin with demonstrators providing a brief description of their VE, and how they’ve used it to answer a critical research question or address a unique need, including a video demonstration of the VE in action. After these introductions, all demonstrations will be set up around the room, and session attendees can move around the room for direct interaction with the demonstrations. This session should provoke ideas among attendees for how VEs, simulations and serious games can help address their research, training, education, evaluation or therapeutic needs.
