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Pulse pressure, wide [keywords]
- ANTXR2 is a potential causative gene in the genome-wide association study of the blood pressure locus 4q21. [JOURNAL ARTICLE]
- Hypertens Res 2014 Apr 17.
Hypertension is the most prevalent cardiovascular disease worldwide, but its genetic basis is poorly understood. Recently, genome-wide association studies identified 33 genetic loci that are associated with blood pressure. However, it has been difficult to determine whether these loci are causative owing to the lack of functional analyses. Of these 33 genome-wide association studies (GWAS) loci, the 4q21 locus, known as the fibroblast growth factor 5 (FGF5) locus, has been linked to blood pressure in Asians and Europeans. Using a mouse model, we aimed to identify a causative gene in the 4q21 locus, in which four genes (anthrax toxin receptor 2 (ANTXR2), PR domain-containing 8 (PRDM8), FGF5 and chromosome 4 open reading frame 22 (C4orf22)) were near the lead single-nucleotide polymorphism (rs16998073). Initially, we examined Fgf5 gene by measuring blood pressure in Fgf5-knockout mice. However, blood pressure did not differ between Fgf5 knockout and wild-type mice. Therefore, the other candidate genes were studied by in vivo small interfering RNA (siRNA) silencing in mice. Antxr2 siRNA was pretreated with polyethylenimine and injected into mouse tail veins, causing a significant decrease in Antxr2 mRNA by 22% in the heart. Moreover, blood pressure measured under anesthesia in Antxr2 siRNA-injected mice rose significantly compared with that of the controls. These results suggest that ANTXR2 is a causative gene in the human 4q21 GWAS-blood pressure locus. Additional functional studies of ANTXR2 in blood pressure may identify a novel genetic pathway, thus increasing our understanding of the etiology of essential hypertension.Hypertension Research advance online publication, 17 April 2014; doi:10.1038/hr.2014.84.
- A new fiber-optic non-contact compact laser-ultrasound scanner for fast non-destructive testing and evaluation of aircraft composites. [JOURNAL ARTICLE]
- J Appl Phys 2014 Mar 21; 115(11):113105.
Laser ultrasonic (LU) inspection represents an attractive, non-contact method to evaluate composite materials. Current non-contact systems, however, have relatively low sensitivity compared to contact piezoelectric detection. They are also difficult to adjust, very expensive, and strongly influenced by environmental noise. Here, we demonstrate that most of these drawbacks can be eliminated by combining a new generation of compact, inexpensive fiber lasers with new developments in fiber telecommunication optics and an optimally designed balanced probe scheme. In particular, a new type of a balanced fiber-optic Sagnac interferometer is presented as part of an all-optical LU pump-probe system for non-destructive testing and evaluation of aircraft composites. The performance of the LU system is demonstrated on a composite sample with known defects. Wide-band ultrasound probe signals are generated directly at the sample surface with a pulsed fiber laser delivering nanosecond laser pulses at a repetition rate up to 76 kHz rate with a pulse energy of 0.6 mJ. A balanced fiber-optic Sagnac interferometer is employed to detect pressure signals at the same point on the composite surface. A- and B-scans obtained with the Sagnac interferometer are compared to those made with a contact wide-band polyvinylidene fluoride transducer.
- [Preventing cardiovascular diseases through a screening modelling applicable to wide population groups: results from the first phase of the project]. [English Abstract, Journal Article]
- Epidemiol Prev 2014 Jan-Feb; 38(1):38-45.
evaluate, through active call, lifestyles of an asymptomatic population in order to identify hyperglycaemic subjects and/or high-blood pressure sufferers to dispatch to their GP to perform suitable checking, and subjects to invite to a cardiovascular disease prevention programme because of their lifestyles.between January 2009 and July 2012, all healthy residents in the Local Health Authority of Este (ULSS 17 Este) aged 45-59 years were invited to join a cardiovascular disease prevention programme.all participants were evaluated through an administered lifestyle questionnaire. Parameters such as blood pressure (BP), glycaemia, waist circumference and body mass index were collected and recorded. Participants also received counseling, informational materials on lifestyle and were invited to individual or group health promotion initiatives in relation to personal risk factors.among the invited, 55.5% (3,922/7,071) adhered. Women (58.8%) responded significantly better than men (51.9%) (p <0,01). Subjects without risks factors were 16.7%. Subjects with lifestyle risk factors but normal BP and glycaemia were 49.4%, while those adding altered values for BP and glycaemia were 25.2%. The 8.6% of the respondents were not eligible for the study.the preliminary results suggest that a preventive programme based on the citizens active call by the Department of Prevention could be an effective tool to identify asymptomatic individuals with unknown hypertension and/or hyperglycaemia and to offer lifestyle interventions to lower the risk of cardiovascular diseases.
- Evaluation of the Clinical and Cost Effectiveness of Intermediate Care Clinics for Diabetes (ICCD): A Multicentre Cluster Randomised Controlled Trial. [Journal Article]
- PLoS One 2014; 9(4):e93964.
Configuring high quality care for the rapidly increasing number of people with type 2 diabetes (T2D) is a major challenge worldwide for both providers and commissioners. In the UK, about two thirds of people with T2D are managed entirely in primary care, with wide variation in management strategies and achievement of targets. Pay for performance, introduced in 2004, initially resulted in improvements but disparities exist in ethnic minorities and the improvements are levelling off. Community based, intermediate care clinics for diabetes (ICCDs) were considered one solution and are functioning across the UK. However, there is no randomised trial evidence for the effectiveness of such clinics.This is a cluster-randomised trial, involving 3 primary care trusts, with 49 general practices randomised to usual care (n = 25) or intervention (ICCDs; n = 24). All eligible adult patients with T2D were invited; 1997 were recruited and 1280 followed-up after 18-months intervention. Primary outcome: achievement of all three of the NICE targets [(HbA1c≤7.0%/53 mmol/mol; Blood Pressure <140/80 mmHg; cholesterol <154 mg/dl (4 mmol/l)]. Primary outcome was achieved in 14.3% in the intervention arm vs. 9.3% in the control arm (p = 0.059 after adjustment for covariates). The odds ratio (95% CI) for achieving primary outcome in the intervention group was 1.56 (0.98, 2.49). Primary care and community clinic costs were significantly higher in the intervention group, but there were no significant differences in hospital costs or overall healthcare costs. An incremental cost-effectiveness ratio (ICER) of +£7,778 per QALY gained, indicated ICCD was marginally more expensive at producing health gain.Intermediate care clinics can contribute to improving target achievement in patients with diabetes. Further work is needed to investigate the optimal scale and organisational structure of ICCD services and whether, over time, their role may change as skill levels in primary care increase.ClinicalTrials.gov NCT00945204; National Research Register (NRR) M0014178167.
- Religious Attendance and Biological Functioning: A Multiple Specification Approach. [JOURNAL ARTICLE]
- J Aging Health 2014 Apr 14.
This study explores the role of religious attendance across a wide range of biological markers.The data are drawn from the National Social Life, Health, and Aging Project to assess continuous and categorical biomarker specifications.Across specifications, higher levels of attendance are associated with lower levels of pulse rate and overall allostatic load. Depending on the specification, higher levels of attendance are also associated with lower levels of body mass, diastolic blood pressure, C-reactive protein, and Epstein-Barr virus. Attendance is unrelated to dehydroepiandrosterone, systolic blood pressure, and glycosylated hemoglobin across specifications.The study confirms that religious attendance is associated with healthier biological functioning in later life. Additional research is needed to verify these patterns with other data sources and to test viable mediators of the association between religious attendance and biological risk.
- Front matter and contents. [Journal Article]
- Stud Health Technol Inform 2014.:i-xv.
The purpose of this Math Primer is to provide a brief introduction to those parts of mathematics which are, or could be, useful in engineering, especially bioengineering. A wide range of topics is covered and in each area an attempt is made to summarize the ideas involved without going into details. The pace is varied. In the earlier sections there is a relatively leisurely description of simple topics. Later, the tempo increases. Sometimes, the speed is quite hair-raising. Nevertheless, it is hoped that the reader may still catch a glimpse of ideas which may spark interest. It is possible to describe mathematical ideas using few or no formulas and equations, and several well-known books do just this. This is rather like describing a rocket in words - one knows what it does but has no chance of building one. Here formulas and equations have not been avoided. In fact the text is littered with them, but every effort has been made to keep them simple in the hope of persuading the reader that they are not only useful but also accessible to engineers. Mathematics and engineering are inevitably interrelated, and this interaction will steadily increase as the use of mathematical modelling grows. The interaction is not one-sided and there are many examples of cases where engineers have contributed to mathematics. As a young man, the author read, and was impressed by, the notes of the engineer and physicist Oliver Heaviside who did pioneering work in the application of complex numbers in engineering, in the solution of differential equations using symbolic methods, and in vector calculus. His achievements are recalled by the Heaviside function <fnr rid="fn001" /><fn id="fn001">Concepts in bold type are referenced in the Index of Concepts. </fn> in mathematics and the Heaviside layer in the atmosphere. Although mathematicians and engineers often misunderstand one another, their basic approach is quite similar. Consider the problem of designing steam boilers. One of the worst maritime disasters in the history of the USA occurred on April 27, 1865 when a steam boiler exploded on the steamboat Sultana; more than 1500 passengers and crew died. Boiler explosions continued to occur frequently: alone from 1880 to 1890 more than 2000 steam boilers exploded. In response, the ASME (American Society for Mechanical Engineers) drew up its very first standard entitled Code for the Conduct of Trials of Steam Boilers in the year 1884, and in 1914 the ASME issued the first edition of the ASME Boiler Code, Rules for the Construction of Stationary Boilers and for Allowable Working Pressure which set standards for the design of boilers; this code has evolved through the years and is still an industry standard. Every major accident is investigated by the engineering community to determine whether the appropriate industrial codes need to be amended. The stakes are high, as shown by the literature on forensic engineering (see e.g. Peter R. Lewis Safety First? [Lew10]) and the recent disasters in the Gulf of Mexico and Fukushima. In contrast, the mathematical approach is that of fail-safe design. Every possible boiler under every possible condition would be analysed. If successful, this would be formulated as a theorem: Under conditions A, B, … a boiler with this design will be safe. There is of course a slight snag with this approach - the theorem may never be proved in which case boilers may never be built! Another point of similarity between mathematics and engineering is the historical development of each subject. The design of bridges has slowly evolved over the centuries as new ideas and concepts were introduced and new materials became available. In a very similar fashion, the mathematical techniques described below have slowly evolved, starting from the simple concept of a number and expanding step by step. Non-mathematicians often believe that the development of mathematics has more-or-less stopped, whereas in fact the subject continues to develop rapidly. In an attempt to convey this dynamic development, which has accelerated in recent years, the dates when concepts were first introduced are frequently cited. A recurring theme is that of modelling or, in American usage modeling, by which is meant the formulation of a mathematical model for a physical (or biological) system, which can be used to explain and predict the behaviour of the physical system. Examples of modelling are scattered throughout the text and some general remarks will be found in Chapter 16. The Index of Applications contains a list of the applications discussed in the text. In a collaboration between mathematicians and engineers, it is usually easier for the mathematicians to learn the engineering jargon and background, rather than the opposite. In this connection one can not do better than quote John R. Womersley who made a significant contribution to the analysis of arterial blood flow: John R. Womersley An elastic tube theory of pulse transmission and oscillatory flow in mammalian arteries [Wom57, page 4]: It is a particular pleasure to record the friendly collaboration and criticism of Dr. D. A. McDonald, Reader in Physiology at Bart's, who not only first introduced the author to this fascinating problem, but also helped him to acquire some of the experimentalist's "feel" for the physical conditions in many small ways, hard to define, but nonetheless real. This work itself, will, it is hoped, be regarded as a successful result of an experiment in interdisciplinary cooperation. It demonstrates that the successful application of mathematics to biological problems is not to be found in the study or the library. An essential condition for success is that the mathematician must get the "feel" of the problem by personal contact and discussion with the physiologist, and must at the same time have sufficient professional standing to maintain a critical attitude. If the mathematician is merely a junior hired "to do the mathematics" there will be no progress. If he is a Professor in another department to whose Olympian presence problems are brought, some interesting mathematics will be done, but it will lack point and substance from the physiologist's point of view. The history of past attempts at the solution of this very problem is full of such examples. It would seem that progress is likely to depend on the occurrence of happy accidents of the sort that led to the work described here. [Bart's is a London hospital] In such a collaboration, some of the legitimate concerns of the mathematician may become lost. Here, an attempt has been made to show, using simple examples, that questions such as those involving the existence and uniqueness of solutions to problems are often not just pedantic but reflect real practical difficulties. Over the past half century, the mathematical literature has become much more terse, and older famous textbooks by well-known mathematicians now seem very leisurely and imprecise. Much has been gained by the increased rigour, but for the non-specialist and beginner the older literature has advantages and will sometimes be referred to here. As long ago as 1908 the exceptionally creative French mathematician, physicist, and engineer <fnr rid="fn002" /><fn id="fn002">For many years Poincaré (1854-1912) simultaneously held posts as a professor of mathematics and as a senior mining engineer! </fn> Henri Poincaré complained about what he called the advance of the "logicians" and wrote: (Henri Poincaré Science and Method [Poi03, page 129]): The engineer must receive a complete mathematical education, but of what use is it to be to him, except to enable him to see the different aspects of things and to see them quickly? He has no time to split hairs. In the complex physical objects that present themselves to him he must promptly recognize the point where he can apply the mathematical instruments we have put in his hands. In this spirit the author hopes that the reader will become acquainted with some new mathematical instruments which he or she can apply. During the past ten years the author has been fortunate to be able to collaborate with a physiologist, Paul Lunkenheimer, and a biomechanical engineer, Peter Niederer, and this book could not have been written without their encouragement. The author would also like to thank his colleagues in the Institute for Numerical and Applied Mathematics, Westfälische Wilhelms-Universität, Münster, for making it possible for the author to work on this text after his retirement. Thanks are due to Andrew D. McCulloch, Professor of Biomechanics at the University of California San Diego, who generously provided help and access to his computer software "Continuity" during a stimulating visit to San Diego many years ago. Thanks are also due to Dr. Randas Batista, who made it possible for the author to watch the Batista operation many times and thereby gain an appreciation of the real-life complications of heart surgery. A special thank you is due to my colleague Frank Wübbeling who, on numerous occasions, provided advice on coping with the idiosyncrasies of ever-changing computer systems. The staff of IOS Press - in particular Kairi Look and Maureen Twaig - provided helpful advice and patient support. Finally, I thank my wife Gabriele for her help and encouragement during the long gestation period of this book. Colin Walker Cryer firstname.lastname@example.org.
- All This Monitoring…What's Necessary, What's Not? [Journal Article]
- Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2014; 17(1):81-90.
The goal of perioperative monitoring is to aid the clinician in optimizing care to achieve the best possible survival with the lowest possible morbidity. Ideally, we would like to have monitoring that can rapidly and accurately identify perturbations in circulatory well-being that would permit timely intervention and allow for restoration before the patient is damaged. The evidence to support the use of our standard monitoring strategies (continuous electrocardiography, blood pressure, central venous pressure, oxygen saturation and capnography) is based on expert opinion, case series, or at best observational studies. While these monitoring parameters will identify life-threatening events, they provide no direct information concerning the oxygen economy of the patient. Nevertheless, they are mandated by professional societies representing specialists in cardiac disease, critical care, and anesthesiology. Additional non-routine monitoring strategies that provide data concerning the body's oxygen economy, such as venous saturation monitoring and near infrared spectroscopy, have shown promise in prospective observational studies in managing these complex groups of patients. Ideally, high-level evidence would be required before adopting these newer strategies, but in the absence of new funding sources and the challenges of the wide variation in practice patterns between centers, this seems unlikely. The evidence supporting the current standard perioperative monitoring strategies will be reviewed. In addition, evidence supporting non-routine monitoring strategies will be reviewed and their potential for added benefit assessed.
- A remote monitoring and telephone nurse coaching intervention to reduce readmissions among patients with heart failure: study protocol for the Better Effectiveness After Transition - Heart Failure (BEAT-HF) randomized controlled trial. [Journal Article]
- Trials 2014; 15(1):124.
Heart failure is a prevalent health problem associated with costly hospital readmissions. Transitional care programs have been shown to reduce readmissions but are costly to implement. Evidence regarding the effectiveness of telemonitoring in managing the care of this chronic condition is mixed. The objective of this randomized controlled comparative effectiveness study is to evaluate the effectiveness of a care transition intervention that includes pre-discharge education about heart failure and post-discharge telephone nurse coaching combined with home telemonitoring of weight, blood pressure, heart rate, and symptoms in reducing all-cause 180-day hospital readmissions for older adults hospitalized with heart failure.A multi-center, randomized controlled trial is being conducted at six academic health systems in California. A total of 1,500 patients aged 50 years and older will be enrolled during a hospitalization for treatment of heart failure. Patients in the intervention group will receive intensive patient education using the 'teach-back' method and receive instruction in using the telemonitoring equipment. Following hospital discharge, they will receive a series of nine scheduled health coaching telephone calls over 6 months from nurses located in a centralized call center. The nurses also will call patients and patients' physicians in response to alerts generated by the telemonitoring system, based on predetermined parameters. The primary outcome is readmission for any cause within 180 days. Secondary outcomes include 30-day readmission, mortality, hospital days, emergency department (ED) visits, hospital cost, and health-related quality of life.BEAT-HF is one of the largest randomized controlled trials of telemonitoring in patients with heart failure, and the first explicitly to adapt the care transition approach and combine it with remote telemonitoring. The study population also includes patients with a wide range of demographic and socioeconomic characteristics. Once completed, the study will be a rich resource of information on how best to use remote technology in the care management of patients with chronic heart failure.ClinicalTrials.gov # NCT01360203.
- Management of atherosclerotic renovascular disease after Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL). [JOURNAL ARTICLE]
- Nephrol Dial Transplant 2014 Apr 9.
Many patients with occlusive atherosclerotic renovascular disease (ARVD) may be managed effectively with medical therapy for several years without endovascular stenting, as demonstrated by randomized, prospective trials including the Cardiovascular Outcomes in Renal Atherosclerotic Lesions (CORAL) trial, the Angioplasty and Stenting for Renal Artery Lesions (ASTRAL) trial and the Stent Placement and Blood Pressure and Lipid-Lowering for the Prevention of Progression of Renal Dysfunction Caused by Atherosclerotic Ostial Stenosis of the Renal Artery (STAR) and ASTRAL. These trials share the limitation of excluding subsets of patients with high-risk clinical presentations, including episodic pulmonary edema and rapidly progressing renal failure and hypertension. Although hemodynamically significant, ARVD can reduce renal blood flow and glomerular filtration rate; adaptive mechanisms preserve both cortical and medullary oxygenation over a wide range of vascular occlusion. Progression of ARVD to severe vascular compromise eventually produces cortical hypoxia, however, associated with active inflammatory cytokine release and cellular infiltration of the renal parenchyma. In such cases ARVD produces a loss of glomerular filtration rate that no longer is reversible simply by restoring vessel patency with technically successful renal revascularization. Each of these trials reported adverse renal functional outcomes ranging between 16 and 22% over periods of 2-5 years of follow-up. Blood pressure control and medication adjustment may become more difficult with declining renal function and may prevent the use of angiotensin receptor blocker and angiotensin-converting enzyme inhibitors. The objective of this review is to evaluate the current management of ARVD for clinical nephrologists in the context of recent randomized clinical trials and experimental research.
- Tai chi for primary prevention of cardiovascular disease. [JOURNAL ARTICLE]
- Cochrane Database Syst Rev 2014 Apr 9.:CD010366.
Stress and a sedentary lifestyle are major determinants of cardiovascular disease (CVD). As tai chi involves exercise and can help in stress reduction, it may be effective in the primary prevention of CVD.To determine the effectiveness of tai chi for the primary prevention of CVD.We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 11, 2013); MEDLINE (Ovid) (1946 to November week 3, 2013); EMBASE Classic + EMBASE (Ovid) (1947 to 6 December 2013); Web of Science (Thomson Reuters) (1970 to 6 December 2013); PsycINFO (Ovid) (1806 to December week 1, 2013); Database of Abstracts of Reviews of Effects (DARE); Health Technology Assessment Database and Health Economics Evaluations Database (Issue 4, 2013). We also searched the Allied and complementary Medicine Database (AMED) and OpenGrey (inception to October 2012) and several Asian databases. We searched trial registers and reference lists of reviews for further studies. We applied no language restrictions.Randomised controlled trials of tai chi lasting at least three months involving healthy adults or adults at high risk of CVD. The comparison group was no intervention or minimal intervention. The outcomes of interest were CVD clinical events and CVD risk factors. We excluded trials involving multifactorial lifestyle interventions or focusing on weight loss to avoid confounding.Two review authors independently selected trials for inclusion, abstracted the data and assessed the risk of bias.We identified 13 small trials (1520 participants randomised) and three ongoing trials. All studies had at least one domain with unclear risk of bias, and some studies were at high risk of bias for allocation concealment (one study) and selective reporting (two studies). Duration and style of tai chi differed between trials. Seven studies recruited 903 healthy participants, the other studies recruited people with borderline hypertension or hypertension, elderly people at high risk of falling, and people with hypertension with liver and kidney yin deficiency syndrome.No studies reported on cardiovascular mortality, all-cause mortality or non-fatal events as most studies were short term (all studies had follow-up of one year or less). There was also considerable heterogeneity between studies, which meant that it was not possible to combine studies statistically for cardiovascular risk (I(2) statistic for systolic blood pressure (SBP) was 96%, for diastolic blood pressure (DBP) 96%, for total cholesterol 96%, low-density lipoprotein-cholesterol (LDL-C) 95%, high-density lipoprotein-cholesterol (HDL-C) 98%, triglycerides 75%). Nine trials measured blood pressure, six individual trials found reductions in SBP (reductions ranged from -22.0 mmHg (95% confidence interval (CI) -26.3 to -17.7) to -11.5 mmHg (95% CI -21.5 to -1.46)), two trials found no clear evidence of a difference (however, CIs were wide and an increase or decrease in SBP cannot be ruled out), and one trial found an increase in SBP with tai chi (increase 5.2 mmHg, 95% CI 3.73 to 6.67). A similar pattern was seen for DBP: three trials found a reduction in DBP (reductions ranged from -12.2 mmHg (95% CI -15.8 to -8.7) to -4.43 mmHg (95% CI -7.14 to -1.72)) and three trials found no clear evidence of a difference, however again with wide CIs. Three trials reported lipid levels and two found reductions in total cholesterol, LDL-C and triglycerides (total cholesterol reductions ranged from -1.30 mmol/L (95% CI -1.57 to -1.03) to -0.50 mmol/L (95% CI -0.74 to -0.26): LDL-C reductions ranged from -0.76 mmol/L (95% CI -0.93 to -0.59) to -0.59 mmol/L (95% CI -0.80 to -0.38): triglyceride reductions ranged from -0.46 mmol/L (95% CI -0.62 to -0.30) to -0.37 mmol/L (95% CI -0.67 to-0.07)) and increased HDL-C with the intervention (HDL-C increases ranged from 0.61 mmol/L (95% CI 0.51 to 0.71) to 0.16 mmol/L (95% CI 0.02 to 0.30)), while the third study found no clear evidence of a difference between groups on lipid levels. Quality of life was measured in one trial: tai chi improved quality of life at three months. None of the included trials reported on adverse events, costs or occurrence of type 2 diabetes.There are currently no long-term trials examining tai chi for the primary prevention of CVD. Due to the limited evidence available currently no conclusions can be drawn as to the effectiveness of tai chi on CVD risk factors. There was some suggestion of beneficial effects of tai chi on CVD risk factors but this was not consistent across all studies. There was considerable heterogeneity between the studies included in this review and studies were small and at some risk of bias. Results of the ongoing trials will add to the evidence base but additional longer-term, high-quality trials are needed.